copyright © 2005. lippincott williams & wilkins. instructor's manual to accompany...

Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.

Textbook For Nursing Assistants

Chapter 12 - Basic First Aid and Emergency Care


What is an Emergency?


What is an Emergency? A condition that requires immediate medical or surgical evaluation or treatment in order to prevent the person from dying or having a permanent disability

What Leads to an Emergency? Conditions that affect breathing, circulation, or both

Emergency


Respiratory arrest: breathing has stopped

Cardiac arrest: the heart has stopped beating

Emergency – Related Terms


Clinical deathThe person has no pulse or is not breathing

Reversible

Biological deathOccurs if clinical death is not promptly reversed

Not reversible

Emergency – Related Terms


There are several ways that breathing and circulation can be hindered, leading to an emergency situation. For example:

When a person chokes

When a person loses large amounts of blood in a short period of time

When a person suffers a “heart attack”

Emergency - Factors Leading to an Emergency


Responding to an Emergency


Training allows you to be better prepared for emergency situations

Training programs that cover the principles of first aid and basic life support (BLS) are provided by the:

American Red Cross (ARC)

National Safety Counsel (NSC)

American Heart Association (AHA)

Training Programs


Familiarity with patients or residents makes you more likely to notice signs and symptoms of an imminent emergency

By reporting signs that seem unusual or give you cause for alarm to the nurse, you may prevent an emergency situation from developing

Nursing Assistants - Role


Responsibilities of a nursing assistant in case of an emergency include:

Recognizing that an emergency exists

Deciding to act

Checking for consciousness

Activating the emergency medical services (EMS) system

Providing appropriate care until the EMS personnel arrive

Nursing Assistants - Responsibilities


Basic Life Support Measures (BLS)


The goal of BLS is to prevent respiratory arrest, cardiac arrest, or both

By using certain BLS measures, such as rescue breathing and CPR, you are essentially performing breathing and circulation for someone who is unable to perform these functions on her own

BLS - Basic Life Support Measures


The steps of BLS are: “A” – Check “airway”

“B” – Check for “breathing”

“C” – Check for “circulation”

Check for bleeding

BLS - Procedure


Emergency Situations


Heart attacks and strokes

Fainting (syncope)

Seizures

Hemorrhage

Shock

Airway obstruction

Emergency Situations


When a person has a myocardial infarction (MI), blood flow to the muscular wall of the heart is blocked, and part of the heart muscle diesThe crippled heart muscle is unable to pump blood effectively throughout the body, creating an emergency situationIf the damaged area of the heart is large enough, cardiac arrest can occur Prompt medical intervention can help to minimize damage to the heart muscle

Emergency Situations - Heart Attack


The signs and symptoms of a heart attack can vary greatly from one person to the next. The most typical symptoms include

Pain or tightness in the chest

A pale or grayish color of skin

Excessive sweating

Breathing trouble

Nausea or heartburn-like pain

Heart Attack - Signs and Symptoms


If you observe that a person is having signs or symptoms of a heart attack, have the person lie down

Raise the person’s head to help make breathing easier, and call the nurse or activate the EMS system immediately

If the person goes into respiratory or cardiac arrest, you will need to begin BLS

Heart Attack - First Aid


Strokes, also known as “brain attacks” or cerebrovascular accidents (CVAs), are caused by blocked blood flow to a body partIn the case of a stroke, the affected body part is the brainIf you think that a person is having or has had a stroke, report your observations to the nurse and activate the EMS system

Emergency Situations - Strokes


A stroke might cause only mild physical changes in some people. In others, it might cause loss of consciousness or a coma

Signs of a stroke include:Change in a person’s level of orientation or consciousness

Slurred speech

Muscle weakness or paralysis

Drooping of the eyelid or a corner of the mouth

Severe headache

Strokes - Signs and Symptoms


Keep the person lying down and watch for signs of respiratory arrest until advance care arrives

New advances in the treatment of stroke have resulted in improved outcomes for some patients, when treatment is started early

Strokes - First Aid


Fainting occurs when the blood supply to the brain suddenly decreases, resulting in a loss of consciousnessAlthough fainting may be an early sign of a serious medical condition, such as a heart problem, it can also be the result of hunger (“low blood sugar”), pain, extreme emotion, fatigue, medication side effects, a “stuffy” room (poor ventilation), excessive heat, or standing for a long time Fainting is not life-threatening in and of itself, but a person who faints is at risk for injury from falling

Emergency Situations - Fainting


If you believe that a person is about to faint:Have the person lie down in the supine position and elevate his legs 12 inches, or ask him to sit down and bend forward, placing his head between his knees

Loosen any restraints or tight clothing (such as a belt or necktie), and have the person remain in the supine or sitting position (with his head between his knees) for at least 5 minutes

Fainting - First Aid


If a person you are assisting does faint:Lower him to the floor or other flat surface, remembering to use good body mechanics Position the person on his back with his head turned to the side, in case he vomitsIf you are sure that the person does not have any injuries to the head, neck, or spinal cord, raise his legs 12 inches, and loosen any tight clothing or restraintsMake sure the person is breathing, and call for help

Even if the person recovers from the episode quickly, have him continue to lie down until the nurse arrives.

Fainting - First Aid


Seizures, also known as convulsions, occur when brain activity is interruptedSeizures can result from head injuries (either recent or past), strokes, infections, high fevers, poisonings, brain tumors, and epilepsyTypes of seizures include

Grand mal seizurePetit mal seizure

Emergency Situations - Seizures


Grand mal seizures are characterized by generalized and violent contraction and relaxation of the body’s muscles

During a petit mal (absence) seizure, the person may stare into space or stop speaking in mid-sentence, only to “come back” a few moments later

Seizures - Signs and Symptoms


First aid for a person having a grand mal seizure involves:

Protecting the person until the seizure is over

Keeping the airway open during the period of unconsciousness

Seizures - First Aid


If a person is having a grand mal seizure, you would:Help the person to the floor and move furniture or other objects that might cause injury out of the wayProtect the person’s head by placing a pillow or folded towel underneath it and call for help while allowing the seizure to run its courseNever place anything in the person’s mouth or between the teethThe gag reflex may be temporarily lost, saliva may pool in the mouthAfter the seizure is over, turn the person to her side (place her in the recovery position) and allow any secretions to drain from her mouth to prevent chokingProvide warmth and a quiet environment

Seizures - First Aid


Hemorrhage (severe, uncontrolled bleeding) can be caused by trauma to a blood vessel or by certain illnesses, such as gastric ulcers

Ordinarily, when a blood vessel wall is injured, a blood clot forms to prevent the escape of blood

If the trauma to the blood vessel wall is substantial, or if the person lacks the clotting factors needed to form blood clots, the bleeding will not stop

Emergency Situations - Hemorrhage


Hemorrhage can be either External (visible), or Internal (within the body)

Hemorrhage can be either venous or arterial, depending on the type of blood vessel that is injured

Venous hemorrhage flows steadily Arterial hemorrhage spurts or pulses with the heartbeat

Emergency Situations - Hemorrhage


In the event of an emergency situation where a person is hemorrhaging, call for help and make sure the person is lying downTake standard precautions to protect yourself from exposure to bloodborne pathogensApply firm, steady pressure directly to the wound using a sterile dressing, a clean towel, or whatever else is clean and available for use as a compressIf the direct pressure does not stop or slow the flow of blood, raise the affected body part (if it is an arm or leg) and apply pressure to a pulse point above the wound

Hemorrhage - First Aid


Shock results when the organs and tissues of the body do not receive enough oxygen-rich blood

To treat shock, the underlying cause of the shock must be addressed

Emergency Situations - Shock


Emergency Situations - ShockTypes Causes

Cardiogenic Occurs when heart is unable to pump enough blood throughout the body

Hemorrhagic Results from massive blood loss

Septic Caused by severe bacterial infections

Anaphylactic Caused by severe allergic reactions


Shock - Signs and SymptomsA person entering a state of shock will:

Have a low blood pressure

Have a pulse that is rapid and weak

Have cool, clammy, and pale skin

Be confused or disoriented

Breathe rapidly, and if he is conscious, he may complain of thirst


Shock – First AidKeep the person warm and calm

The treatment for anaphylactic shock is the immediate administration of a medication called epinephrine


Emergency Situations - Airway Obstruction

Types Symptoms

Partial airway obstruction with good air exchange

Person coughs strongly and has good skin color

Partial airway obstruction with poor air exchange

Person’s coughing is a weak, ineffective effort with high-pitched, “crowing” sounds as he tries to breathe; bluish skin color

Complete airway obstruction

Person cannot cough, speak, or breathe and might lose consciousness quickly


First aid to be administered in case of choking:

Clearing the airway in adults and children older than 1 year Heimlich maneuver (abdominal thrusts) Modified Heimlich maneuver (chest thrusts; used

on very heavy people or pregnant women)



Clearing the airway in infantsIn children younger than 1 year, the Heimlich

maneuver is not used because of the risk for damaging the baby’s internal organs

Instead, a combination of back blows and chest thrusts is used



The Chain of Survival


Recognize that an emergency situation exists, and activate EMSProvide first responder care (basic first aid, including BLS if applicable)Medical intervention, such as that provided by an EMT, a paramedic, a nurse, or a doctor, must be providedAfter the immediate crisis passes, hospital care may be needed to help the person surviveRehabilitation, the final step in the chain of survival, focuses on improving the general health of a person

Chain of Survival - Steps


As a nursing assistant, you: Play a vital role in helping to see a person through the immediate crisis (points 1 and 2)

Might find yourself caring for someone who is in the recovery phase (points 4 and 5)

Chain of Survival


End of Presentation

copyright © 2005. lippincott williams & wilkins. instructor's manual to accompany...

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