Digestive Tract: Let’s Get to the Bottom of it By: Diana Blum RN MSN Metropolitan Community College.
Emergency By Diana Blum MSN Metropolitan Community College.
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Transcript of Emergency By Diana Blum MSN Metropolitan Community College.
EmergencyEmergency
By Diana Blum MSNMetropolitan Community College
Environment of Care
Rapid changeNoisyUnpredictable
DemographicMultiple specialtiesIncreasing visits to 107.5 million in 2001Avg age of patient is 35.7 yrs old75 + years old highest visit rateCommon reasons for healthcare seeking:
Chest painAbd painHeadachefever
Team Members
ER nurseEMTsParamedicsPhysciansAncillary members: admissions, radiology, etc.Special teams: forensic nurse, psychiatric team
Client SafetyAll patients have ID number and if unconscious they are named John or Jane Doe
If unconscious the nurse plays detective
Prevent falls and breakdownGet med list if available Always ask allergies if ableLook for medic alert bracelets, necklacesStandard precaution alwaysRecognize volatile situations (plan escape route)
Priority Emergency Measures for All Patients
• Make safety the first priority• Preplan to ensure security and a safe environment• Closely observe patient and family members in the event that
they respond to stress with physical violence• Assess the patient and family for psychological function
• Patient and family-focused interventions– Relieve anxiety and provide a sense of security– Allow family to stay with patient, if possible, to alleviate
anxiety– Provide explanations and information– Provide additional interventions depending upon the stage
of crisis
ER Nursing
6 months to 1 year acute care/ICU trainingSome ERs will hire new grads using intern program
Technical SkillsMultitaskingAssist with:
Wound closureForeign body removalCentral line insertionTransvenous pacemaker insertionLumbar puncturePelvic examChest tube insertionLavageFracture management
http://www.youtube.com/watch?v=n5Zw4ZARvNg
Core Competencies
Knowledge of ER Care
Broad basedMulti disease process/insects/snakes/animalsMandatory reporting for sexual assault, abuseBLS, ACLS, PALS
Assessment
Rapid recognition of abnormal findingsMust be aware of comorbiditesAct Quickly
Communication
Complex barriersUse professional languageProtect HIPPA related information
Principles
TriageMeans: to sort: ED triage differs from disaster triage in that patients who are the most critically ill receive the most resources, regardless of potential outcome
1. Across-the-room assessmentstarts with visual contact, general appearance, work of breathing, skin color
2. Determine chief complaint3. Focused assessment
(Subjective data) demographics, onset of symptoms, past medical history, LMP, current meds, allergies(Objective data) inspection, palpation, auscultation, obtain vital signs
Basic Elements
Assign acuity levelEmergent: immediate threat to life or limb
CODE, Respiratory Failure, Chest pain, hemorrhage
Urgent: treat quickly but life no immediate threat present at this time
Pneumonia, abd pain, fractures
Non-Urgent: can wait for several hours if needed
Strains, sprains, toothaches, cold, some rashes
5 Level Triage
Level 1- immediate life saving interventions, many resourcesLevel 2- high risk, many resourcesLevel 3- urgent, two or more resources, wait 30 minLevel 4- non-urgent one resource, wait up to 1 hourLevel 5-no resources, wait up to 2 hours
Resources
Labs IV fluidsXRAY ConsultsEKG Simple procedureCT/MRI Complex procedureIV/IM medications
Examples
Level 1- CPR, intubation requiredLevel 2- chest pain, dyspnea, suicidal with plan or attempt, stroke, pregnant with active bleedingLevel 3-abdominal pain, closed fractures, dislocationsLevel 4- sore throat, strains, sprains, URI, Level 5- suture removal, medication refill, certain rashes
Primary SurveyA: Airway
patency, watch for tripod, stridor, inability to speak, rise and fall of chest
B: Breathing rate and depth, breath sounds, chest expansion, skin color, spontaneous breathing
C: Circulationheart rate, pulses, blood pressure, skin, cap refill
D: DisabilityAlertness, Responsive to Voice, Responsive to pain, UnresponsivenessE: Exposure
Remove clothing, keep pt warm
2nd ary Survey
Identifies other injuries or medical issues that needs to be managed
Secondary Survey
• Before beginning Secondary survey– Attach EKG leads, Pulse ox, C02 device to ETT,
foley cath if not contraindicated, NG, radiographs-Full set of vital signs/Focused interventions
FAST scan-focused assessment-Give comfort measures-History/Head to toe assessment
Pre-hospital info AMPLE
Priorities of Care for the Patient With Multiple Trauma
• Use a team approach
• Determine the extent of injuries and establish priorities of treatment
• Assume cervical spine injury
• Assign highest priority to injuries interfering with vital physiologic function
Care of Client
Place client in hospital gownEnsure privacyMed administration as ordered Assist with proceduresReprioritize and reassess as needed
Disposition
Admitted or discharged is the questionWhat is the nurses role?
Case Management
Nurse case managers intervene when necessary to assist in making follow up and referral arrangements especially with elderly and homeless, and abused clients
Teaching
review D/C instructionsReinforce safety (sealtbelt wearing)Discuss home safety (detectors, fall prevention) teach new procedures that will continue at home
Priority Setting
Triaging client careCritical thinker
Go to Prioritization PPT