10/4/10 9:53 AM

← EMERGENCY/DISASTER NURSING← Emergency Action PrinciplesUse to get an accident situation under control quickly.

← Survey the sceneCALL 911/ EMERGENCY RESPONSE TEAMDo a primary survey A-- AIR WAYB-- BREATHINGC-- CIRCULATIOND-- DISABILITYE-- EXPOSUREH-- HEMORRHAGE S-- SPINALCORD INJURY←← Airway: Is it open? Minimize neck movements much as possible; apply cervical collar if available.

2 ways in opening the airway **Head Tilt – Chin lift maneuver **Jaw thrust maneuver

Breathing: Is the victim breathing? check ( 3 – 5 sec.) L ---- look, L ---- listen, F ---- feel. ← Circulation

Is there a palpable carotid pulse for adult and brachial pulse for child and infant. Check ( 10 sec. )Disability

Is there injury to the nervous and musculoskeletal systems? Stabilize “C”- spine.Exposure: Remove victim from offending environment. If necessary, place tent over victim. Hemorrhage : look for Severe blood loss, CSF leak.← SPINALCORD INJURY : check for the sensory response, and obvious deformity on the spine.

←← Yellow / Observation **2nd priority**

Their condition is stable for the moment but requires watching.

Green / Wait (walking wounded)**3rd prioity** They will require a doctor's care in several hours or days but

not immediately, may wait for a number of hours or be told to go home and come back the next day.

White / Dismiss (walking wounded)*4rth priority* They have minor injuries; first aid and home care are sufficient, a doctor's care is not required

← Shock← is a critical physical condition due to failure of the circulatory system to maintain adequate blood flow in the body and ceases the delivery of oxygen and nutrients to vital organs.←← BASIC CAUSES OF SHOCK←← Three stages of shock ← THE COMPENSATORY STAGE OF SHOCK ← patient’s blood pressure is within normal limits. shunted from the kidney, skin and GIT to the vital organs- brain, liver.← PROGRESSIVE STAGE OF SHOCK ← regulate blood pressure can no longer compensate and the mean arterial The overworked heart becomes dysfunctional. ← IRREVERSIBLE STAGE OF SHOCK ← there is severe organ damage that patients do not respond anymore to treatment. Survival is almost impossible ←← SIGNS AND SYMPTOMS ←← 1. Early Stage: ← Pallor/cyanosis, cold/clammy skin, shallow and irregular breathing, rapid and weak pulse, nausea and vomiting, thirst, dilated pupil.

←← 2. Late Stage: ← vacant eye, apathetic/unresponsive, mottled appearance, decreased blood pressure, decreased temperature.←←   TYPES OF SHOCK 1.   Cardiogenic – Heart stop to pump due to heart dse. 2.   Anaphylactic --- Severe allergic Reaction3.   Hypovolemic --- Severe fluid loss4.   Psychogenic --- cause by anxiety, fears, altered adaptation in traumatic experience 5.   Neurogenic --- cause by spinal fracture or dislocation 6.   Metabolic --- loss of body fluids7.   Respiratory ---- air way obstruction and hyperventilation8.   Septic --- severe bacterial infection

← Body response to shock← Hyven - Hyper ventilation -> ← Respiratory alkalosis← Flu - Fluid Shifts Intracellular to ← intracellular← V - Vasoconstriction← CT - Tachycardia← IM - Impaired metabolism and organ ← function← Drugs Used To Treat Shock

← C – Corticostiroids – use in septic shock protect cellmembranes and decrease inflammatory response to stress ← A – Antibiotics –infectious process related to septic shock← N - Norephineprine (levophed) improve cardiac contractility and cardiac output potent vasoconstrictor← D – Dopamine (Intropin) perfusion of kidneys & urine output← D - Dobutamine (Dobutrex) increase myocardial contractility, vasodilator.← D - Digitalis preparation improve cardiac performance← I - Isoproterenol (Isuprel)increase myocardial contractility← S - Sodium Nitropusside Vasodilator, increase cardiac output, use in cardiogenic shock, and hypertensive emergency.←← Emergency Nursing Management ← M - Maintain patent airway and adequate Ventilation. ← P - Promote restoration of blood volume;administer

← fluid and blood replacement as ordered ← A - Administer drugs as ordered ← M - Minimize factors contributing to shock.← M - Maintain continuous assessment of the client.← P - Provide psychological support and keep family advised ← P - Provide Nutritional support ← M - Modified trendelenburge – to promote venous return to the heart←

← Wound A bodily injury caused by physical means, with disruption of

the normal continuity of structures.

S/S Pain and tenderness Swelling Discoloration Hematoma Uncontrolled restlessness Thirst Symptoms of shock Vomiting or cough-up blood Passage of blood in the urine or feces Sign of blood along mouth, nose and ear canal

← CLOSED WOUND ← Cause by a damage of a tissue with in the layer of the skins and to the layer of the skin without breaking the continuity of the skin.

← Contusions (more commonly known as a bruise) ← caused by blunt forc trauma that damages tissue under the skin.

Hematoma- (also called a blood tumor)

← caused by damage to a blood vessel that in turn causes blood to collect under the skin.

Crushing Injuries ← caused by a great or extreme amount of force applied over a long period of tissue←← Nursing Management

I – ICE APPLICATION (10 – 15 Min )C -- COMPRESSION ( DIRECT PRESSURE )← E – ELEVATION ( ABOVE THE HEART )

Open Wound IS A BREAK IN THE CONTINUITY OF THE SKIN RESULTINGIN SHEDING OF BLOOD, AND CREATATING A PORTAL OF ENTRY FOR MICRO ORGANISM.

← P – PUNCTURE * Use by sharp and pointed object

A – ABRASION *( grazes) - a superficial wound in which the topmost layer of the skin (the epidermis) is scraped off. S – SUCKING WOUND * a penetrating wound of the chest

through which air is drawn in and out.

A – AVULSION *The forcible tearing away of a body part by trauma.

L – LACERATION *Tissues are torn. An even cut.

I – NCISION * One caused by a cutting instrument. Clean cut.

← EMERGENCY CARE PROCEDURES:← Wash --wash the wound

← Co – Control bleeding← co – Cover the wound← Lo – Look for drop BP and TEMP.← Co – Consult a doctor←← Bruises, strains, sprains, dislocations.← Use rice.←← Amputation ← Control Bleeding← Find the severed part Seek Immediate medical attention.←← Chest Injuries← Check ABC← Stabilize Chest using pillow, coat or blanket.← Seek medical attention← Do not remove impaled object.←← Eye injuries← 1. Protect injured eye← 2. Patch unaffected eye← 3. Do not remove object stuck on the eye← Do not apply hard pressure←← Fracture← EMERGENCY CARE PROCEDURES:← A -- Avoid putting pressure on he affected area← R – Rest ( 20-30 min q 2 – 3 hrs. in 1st 24 – 48 hrs )← I – Ice application ← S – splint ( use to stabilize )←← Head and Spinal Injury ←

← EMERGENCY CARE PROCEDURES:← S - Stabilized the spine

← Co - Control bleeding← As - Asses for bladder distention and pineal erection← Do - Do not irrigate or clean the skull wounds← Do - Do not stop the flow of blood or CSF from the ear or nose← N - NPO← Co - Consult a doctor← ← Burns – Injuries that involve the skin, muscle and even the bones.ClassificationFirst degree: “ Superficial” only involves epithelial layer. Often very painful but resolves with no residual scarring. Skin is red and painful but no blisters.

←← Second degree:* Partial thickness* involves epithelium and part of dermis. Pain and scarring vary according to depth of burn. With blister formation.

← Third degree : *full thickness*. Usually painless. Usually dry and have milky white or tanned leather appearance.←← EMERGENCY CARE PROCEDURES

← So -- Soak in cold water/ apply cold dressing (

w/o open wound or prick blister)

← 1st degree do not cover w/ dressing

← SO -- Soak in cold water/ apply cold dressing

← Cover the wound w/ non sticky dry

sterile dressing /clean cloth

← ( 2nd degree w/ open wound and)

←

← CO -- Cover the wound w/ non sticky dry

sterile dressing /clean cloth

← 3rd degree

←

← A – a blister has formed, do not prick it.← Co -- Consult you Physician.←← Chemical Burns← Wa – wash with water for 15 min.← Kee – Keep eye open, flush with water ← or milk immediately.←

← Heat Emergencies in HumansUnexpected changes in the weather

2 basic environmental emergencies2Eexposure to heat exposure to cold

← Signs and symptoms ** rapid, shallow breathing ** cold, clammy skin, **heavy perspiration **general weakness, ** possible loss of consciousness.

Heat CrampsCAUSE BY ELECTROLYTES IMBALANCE,

← ARTICULARLY EXESIVE LOSS OF SALT.

EMERGENCY CARE PROCEDURES:Move - Move victim to a cool place.Give - Give fluids, preferably ← with electrolytes.Massage - Massage affected muscles (firm ← pressure massage).Apply - Apply moist towels to forehead and ← cramped muscles.Call - Call for transportation to medical care ← if symptoms persist.

← Heat SyncopeResult from intense sweating which lead to dehydration followed by perripheral vasodilation.

← Heat ExhaustionHeat exhaustion is a more serious result of heat exposure.CAUSE BY ELECTROLYTES IMBALANCE,PARTICULARLY EXESIVE LOSS OF SALT.

HEAT STROKE Cause by a extreme body temp. that the body was not able to regulate it and related also to impaired sweating mechanism.

← EMERGENCY CARE PROCEDURES← Activate EMS system (call 911)← Move - Move victim to a cool place.← Rest - Rest victim.← Remove - Remove enough clothing to cool.← Give - Give fluids with electrolytes ← (to conscious victims only).Treat for shock.← Victim - Victim needs high concentration of ← oxygen.← Call - Call for transportation to definitive ← medical care.

← Hypothermia← Get the victim out of the cold← Replace wet cloths with dry warm cloths.← Keep flat and provide other source of heat. ← NO. No. Things← Do not give warm drinks← Do not wrap with blanket unless with out other source of heat.← Do not engage with physical exertion.←← Stroke ← **occurs when a blood vessel in the brain is blocked or bursts. Without blood and the oxygen it carries, part of the brain starts to die. ← S/S← Numbness, weakness, or paralysis of the face, arm, or leg, especially on one side of the body.

← Trouble seeing in one or both eyes. You may have double vision, or things may look dim or blurry. ← Confusion or trouble understanding. ← Slurred or garbled speech. ← Trouble walking. You may feel unsteady, dizzy, or clumsy. ← Severe headache. ←← Causes← ** thrombus/ ischemic/ clot**← Risk factors← Atrial fibrillation← Hypertension← DM← Smoking←← S/S of affected part of the Brain←← 2 types of stroke← a. ischemic stroke develops when a blood clot blocks a blood vessel in the brain.← b. hemorrhagic stroke develops when an artery in the brain leaks or bursts. ← TIA – Acute neurogical deficit lasting for 24 hrs. ← S/S← Pt is irritable← 2. Pt appears in a deist← 3. Disarchia← 4 Temporary blindness ←← EMERGENCY CARE PROCEDURES:← ** Check for ABSDEHS**← ** keep in side lying position**← **Seek immediately medical help.←← SEIZURES ← due to uncontrolled electrical activity in the brain causes involuntary muscle contraction.← EMERGENCY CARE PROCEDURES:

← 1. Do not move/stimulate the victim← 2. Ensure safety “ remove all near by objects”← 3. after seizure ‘’ loosen tight clothing's turn to side’’← 4. Consult a doctor←← DIABETIC EMERGENCY← EMERGENCY CARE PROCEDURES:← ** provide sugar (candy, soda,frit juice)← **Consult a doctor←← ASTHMA ← EMERGENCY CARE PROCEDURES:← 1. RELAXATION TECHNIQUES ‘pursed lip breathing’← 2. SIT Up RIGTH← 3.Assist the victim in his meds.← 4. Consult a doctor←← Cardiac Arrest← -- Occurs when the heart stop pump, or it pumps insufficient blood causing deprivation of o2 to the vital organs.←← THREE CONDITIONS OF CARDIAC ARREST← 1. CA -- CARDIO VASCULAR COLLAPSE← 2. VE -- VENTRICULAR FIBRILLATION← 3. CAR -- CARDIAC STANDSTILL←← EMERGENCY CARE PROCEDURES← L --Limit Stressful activity← S -- Stop the victim from what his doing← O -- Open the airway ← A -- Assist the victim in taking the his prescribe meds← P -- Perform CPR If – P and – B (30:2)←← Priority Nx diagnosis ← Decrease cardiac output← Cause of death in MI← Arrhythmias← Ventricular fibrillation

← Choking← EMERGENCY CARE PROCEDURES← Infant – 5 Back blows and 5 chest Thrust← Adult & Child – Heimlich maneuver, abdominal and chest thrust.←← POISON Any substance that causing illness or death when eaten, drunk, or absorbed even in relatively small quantities. Ingested/ swallowed – by mouthEMERGENCY CARE PROCEDURES:1. Syrup of Ipecac is NOT a routine treatment for poisoning. 2. Activated charcoal is not recommended for home use.3. give milk or water immediately4.. position the victim in left side lying.5. identify the poison and how much and when taken.6. Call poison control center.

← Inhaled – by breathing EMERGENCY CARE PROCEDURES 1. Remove the victim form the toxic environment ← and into fresh air immediately.2. Give 100% of O2 3. Call poison control center.←← Injected poisoning - poison that enters the body through a bite, sting, or syringe.← EMERGENCY CARE PROCEDURES← 1. Remove the stinger ← 2. Wash the wound← 3. cold compress←← Absorbed poisoning← EMERGENCY CARE PROCEDURES← 1. Remove the cloth ( cut the cloth )← 2. Flash it w/ water away from the body part← 3. observe for allergic reaction.

←← VENOMOUS NON VENOMOUS← Movement Cortina, semi-cortina ← or locomotion←← Head Semi-triangular Round←← Skin Rough Smooth←← Manner Non-constrictor Constrictor← of attack←← Pupil Vertical sphere/Oblong←← Body Semi-triangular Oblongated←← Bite mar fang mark Horseshoe shape← visible←← Internal bleeding← Check ABC← Lie on side← Treat shock← Seek medical attention← External bleeding ← Direct wound pressure ← Elevate← Pressure points← Tourniquet ←← Nose Bleeding← EMERGENCY CARE PROCEDURES← Sit upright , head bent slightly forward, pinch the nostrils, breath trough our mouth.←← Water rescue – “Reach, Throw, Row, Go”←←

←←←←←←←←←←←←← Test Taking Techniques← Discern The Exam← Concentrate on fundamentals← Therapeutic Communication← Aseptic Techniques← Safety← Nursing Priority← Basic law touching the practice← lot of Question from Community← Ethical Practice select ans. Respecting human Rights←← 2. Prepare your self← Get enough rest← Eat right← Drink your vit.← Exercise← Avoid negative talk← Release anxiety to your friends← Seek help and verbalize← Relaxation techniques←← 3. Organize your study time.

← There maybe no two individuals who will have the same way of studying. Some prefer studying at night while some, early in the morning or during the day. Some, may have so much work at home, they can only spare a few hours studying. Whatever is your circumstances is, there are the basic rules in organizing study time: ←← Make a checklist of all the things to review.← Make a schedule of this checklist.← Don’t overkill. Do not give so much time on one area while forgetting the others. Don’t just use your favorite area, give equal time even on those that you feel are not coming out of exam.← Organize your study time by reviewing on the basic first, then at the last part of your schedule, make sure you test yourself by answering exam question.← Allow much flexible to accommodate your other important activities.← I always help to remove all distraction like cell phones and television. Boyfriends and girlfriends may schedule later.←← 4. let’s dissects the Monkey.← Read the question carefully from the first word to the last word. Remember not to miss out on key words that would lead you to what the question is really asking for.← look for hints…← -“most, first, best, initial”- indicate you must establish priorities.← -“further teaching is necessary”- answer will contain incorrect information.← -“understand the teaching”- answer will be correct information.←← 3. rephrase the question in your own words so that it can be answered w/a ”yes” or a “no”, or w/ a specific bit of information.← -“what”.”when”, “why”←← Example:← The nurse should teach the patient who was cirrhosis of the liver to avoid w/c of the ff. food in the diet?← a. Baked chicken

← b. Apple pie← c. Macaroni← d. Spinach← Rephrase: what is the metabolic problem of the patient w/ liver cirrhosis?← Answer: he cannot digest fat ← What food is contraindicated for the patients w/ liver cirrhosis← Answer: fatty foods. Thus, among the choices, baked chicken should not be given.←←← HOW TO SCORE POINTS ←← Step1. Read the question. Spend more time on reading the question. learn to rephrase. Underline the key words to increase tour understanding on the important aspect of the problem.←← Step2: after reading the question, stop. Before looking at the options, think of an answer. ←← Step3: selection pass. In selecting the correct answer, read each option carefully and do this.←← Step 3.1 cover all answer choices except one.←← Step3.2 read answer choices ← 1. then repeat the REWORDED QUESTION after reading answer choice. As yourself…

← “does this answer the REWORDED QUESTION.← If it does not – eliminate← Not sure- leave the answer choice for consideration←← Step 3.3 repeat the above process w/ each remaining answer choices.←← Step 3.4 note w/c answer choice remain.←← Step 3.5 reread the question to make sure you have correctly identified the REWORDED QUESTION ←← REWORDED QUESTION. ← STEP 3.6 ask yourself “ w/c answer choices best answer the question?:←← THAT IS YOUR ANSWER!!!← R E M E M B E R ! ! !← 1. eliminate only what you know is wrong. Once choice has been eliminated.. PUT IT OUT OF YOUR MIND!!!← 2. stay focus on the REWORDED QUESTION. Not on the back information!!! Don’t fall for distraction!!!← 3. if your “ideal” answer choice is not there… well don’t sit and moan because it will get you nowhere… read the question again, rephrase, and select the best answer.←← Look for Qualifiers←

← “Never, always, all, none” Most often absolute terms, generalizations. Do not choose these options.←← Look for contrasting options.← Usually contrasting option lead you to correct answer. ← 1 of this is the right answer.←← Example.← Mr. bean is suffering from gastric ulcer. As a nurse, you have to prevent dumping syndrome. Which of the ff. preventive measures should not be taken?← a. allow him to lie down after eating← b. avoid giving fluids after meal.← c. allow him to talk after eating.← d. serve dry meals only.←← Choices a & c are contrasting option, thus one of these may be the correct option, eliminating b& d. the question may be rephrase to” what is the best position after meals to prevent dumping syndrome?” the answer is… a. allow him to lie down after meal, but the question is asking for the measure that should not be advice, thus the answer is… c← 3. PRIORITIES. The board exam is testing your ability to decide your priorities in patient care. The most common bases of prioritization are:← a. ABC’s – airway, breathing & circulation← b. Safety and protection- decide what will cause the least amount of harm. DO NO HARM!!! ← c. Rights of patient- will of the patient is the basis for action. We are safeguards and advocates of the patient well being.← d. Assessment comes before any intervention.← e. The less invasive procedures first before invasive one.← f. Remember MASLOW!!! Physiologic needs comes as a priority

← g. Patient first before equipment.←←←← 4. NORMALS-decide if the assessment data being presented in the question is within normal range. If the answer is yes, you just have to look for the option that will not need further intervention.. ← only continue monitoring or assessment. If the answer is otherwise ,then go ahead and rephrase the question…and follow the steps in answering a question. Familiarize yourself with the values will be much easier than memorizing. Post them on your walls where you see them everyday.←←← 5. Always be therapeutic. ← Therapeutic simply means choosing the options that will solicit information from the patients and make him/her express his feelings. Usually, we eliminate options that will:←← 6. It is your business not others ← Eliminate choices that what doctors midwife or social workers do←← 7. Do every thing by the book.← Every thing is taken from the books, based on ideal settings.←←←←