emergency nursing
TRANSCRIPT
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Emergency Nursing
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Objectives
Discuss the unique challenges of nursing practice in an emergency care setting
List the most common type of trauma and interventions to prevent trauma.
Identify the components of an initial trauma assessment
Describe the collaborative management of trauma patient
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Historical Perspectives
Emergency nursing was officially recognized as a specialty in 1970
According to ENA, the definition of Emergency Nursing includes
The assessment , diagnosis and treatment of perceived actual or potential , sudden or urgent, physical or psychosocial problems that are primarily episodic or acute.
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These may require minimal care or life support measures, education of patient and significant others, appropriate referral and knowledge of legal implications
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Characteristics of Emergency Nursing Practice
Assessment , analysis , nursing diagnosis, planning, implementation and evaluation of human responses of individuals in all age groups
Care that is complicated by limited access to medical history and the episodic nature of the health care
Triage and prioritization
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Emergency operations preparedness Stabilization and resuscitation Crisis intervention for unique patient
populations such as sexual assault survivors. Provision of care in uncontrolled or un
predictable environments Consistency as much as possible across the
continuum of care.
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Principles of Emergency Care
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Triage
Means to sort out or sift out
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Emergency Nurses Association ( guidelines for triage ) Level I – resuscitation
Level II – Emergent
Level III- Urgent
Level IV- less urgent
Level V - Nonurgent
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Four Color – Coded Disaster Triage System Black – Dead
Red- Critical or Life threatening
Yellow- Serious
Green - Minimal policies on disposition and managent
of DEM patients.doc
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Triage Category Systems
RED- Critical...... Likely to survive with immediate simple care
BLUE - Catastrophic Survives with extensive care or poor prognosis...
YELLOW - Urgent..... Survives with care given in few hours
GREEN - Minor ..... Survives with care delayed hours to days
BLACK - Dead
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As a triage nurse in a busy emergency department, it is your responsibility to prioritize patients who present for care
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Based on your understanding of the triage process, assign each of the following patients according to the four color coded disaster triage system
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Mr. P. Pascual is a 28 year old who fell off a roof while working.
He has a wrist fracture, several small lacerations, and a swollen ankle.
He is awake , alert and complaining of pain
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Answer
SERIOUS
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S. Milby is a three year old who bit through her lip when she fell off her bicycle
She is frightened and crying
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Answer
MINIMAL
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Mr. M is a 62 year old who suffered a heart attack.
Paramedics were called to Mr. M’s house where defibrillation for ventricular fibrillation was necessary.
He has just arrived at the emergency department .
His blood pressure is 100/60 He is diaphoretic and pale
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ANSWER
CRITICAL
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Assess and Intervene
ABCD method
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Primary Survey
Airway
Breathing
Circulation Disability Exposure
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Secondary Survey
Complete health history and head to toe assessment
Diagnostic and laboratory testing Insertion or application of monitoring devices Splinting of suspected fractures Cleansing , closure and dressing or wounds.
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Issues in Emergency nursing care Documentation of consent and Privacy Violence in the Emergency Department Restraints Mandatory Reporting Evidence . Collection and Preservation Providing Holistic Care
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Ethical Issues in the Emergency Department
Unexpected Death
Organ and Tissue Donation
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Airway obstruction
Hemorrhage
Hypovolemic shock
Wounds Trauma
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Environmental Emergencies Poisoning Substance Abuse Violence, Abuse and Neglect Psychiatric Emergencies
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Airway Obstruction
ADVANCED CARDIAC LIFE SUPPORT.pptCardiopulmonary-Cerebral Resuscitation.ppt..\articlesadult_choking_small.wmvadult_cpr_small.wmv
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Airway Obstruction
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Hemorrhage
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Hemorrhage
Results in the reduction of circulating blood volume
Minor bleeding Signs and Symptoms
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Control of External Hemorrhage
Control of Internal Bleeding
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Hypovolemic Shock
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Shock
Is a condition in which there is loss of circulating blood volume
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Management
Airway Patent AIRWAY
Breathing Maintaining Breathing
Circulation Restoration of circulating blood volume
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Wounds
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Wounds
Involving injury to soft tissue from minor tears to severe crushing injuries
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Management
Wound Cleansing Primary Closure Delayed Primary Closure Tetanus prophylaxis
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Trauma
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Trauma
an unintentional or intentional wound or injury inflicted on the body from a mechanism which the body cannot protect itself.
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Forensic Evidence Injury Prevention Multiple Trauma
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Assessment and Diagnostic Findings Gross evidence of trauma may be slight or
absent
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Management
To determine the extent of injuries and to establish priorities.
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Intraabdominal Injuries
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Penetrating
Blunt trauma
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Assessment and Diagnostic Findings Adominal Assessment Peritoneal irritation Hypotension and symptoms of shock
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Internal Bleeding Intraperitoneal Injury Genitourinary Injury
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Management
Airway
Breathing
Circulation
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Crush Injuries
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Assessment and Diagnostic Findings Hypovolemic shock Paralysis of the body part Erythema and blistering of skin Damaged body part Renal dysfunction
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Fractures
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Management
Assessment of Airway, Breathing and Circulation
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Environmental Emergencies
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Heat Stroke
Is acute medical emergency caused by failure of the heat regulating mechanisms of the body
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Frostbite
Is trauma from exposure to freezing temperature and actual freezing of the intracellular fluid and fluids in the intercellular spacess
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Hypothermia
Is a condition in which the core ( internal ) temperature is 35 degree centigrade or less as a result of exposure to cold.
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Near Drowning
Is defined as survival for at least 24 hours after submersion that caused a respiratory arrest
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Decompression Sickness
Occurs in patients who have engaged in diving , high altitude flying, or flying in commercial aircraft within 24 hours after diving.
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Anaphylactic Reaction
Is acute systemic hypersensitivity reaction that occurs within seconds or minutes after exposure to certain foreign substances
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Poisoning
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Is any substance that, when ingested, inhaled, absorbed applied to the skin, or produced within the body in relatively small amounts, injures the body by its chemical action.
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Emergency Treatment
To remove or inactivate the poison before it is absorbed.
To provide supportive care in maintaining vital organ systems
To administer a specific antidote to neutralize a specific poison
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Ingested ( Swallowed ) Poisons Carbon Monoxide Poisoning Skin contamination Poisoning Food poisoning
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Substance Abuse
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Is the misuse or specific substances to alter mood or behavior
Drug and Alcohol Abuse
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Acute Alcohol Intoxication Alcohol Withdrawal Syndrome/ Delirium
Tremens
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Violence, Abuse and Neglect
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Assessing for Abuse, Maltreatment and Neglect I noticed that you have
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Sexual Assault
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Psychiatric Emergencies
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Overactive Patients Violent behavior Posttraumatic Stress Disorder Underactive or Depressed Patients Suicidal Patients
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EMERGENCY NURSING
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The Specialty of Emergency Nursing
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Specific body system
Specific disease process/problem
Specific age group
Specific population, such as women’s health care or mental health
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CORE
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The scope of emergency practice involves the* ASSESSMENT* ANALYSIS* NURSING DIAGNOSIS * OUTCOME IDENTIFICATION* PLANNING* IMPLEMENTATION OF * INTERVENTIONS*EVALAUTION
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Independent and Collaborative
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DIMENSIONS
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Responsibilities Functions Roles Skills
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BOUNDARIES
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Internal and External
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INTERSECTIONS
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Professional and Governmental groups
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Major Trauma
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Mechanisms of injury
Knowledge of the object producing the injury ( motor vehicle,handgun )
Type of energy released ( kinetic, thermal, chemical Force of energy ( velocity of vehicle or missile ) Use of protective devices ( seat belts, air bags ,
helmets )
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Type of injury
Blunt injury Penetrating injuries
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Oxygen delivery and consumption
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Neuroendocrine stress response
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Systemic Inflammatory Response syndrome
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Multiple Organ Dysfucntion Syndrome
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Coagulopathy
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Hypothermia
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Psychologic Response
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Assessment
History and Risk factors Mechanism of injury Intoxicants Preexisting medical conditions Last meal Initial subjective presentation Initial objective presentation
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Diagnostic Tests
Complete Blood Count Blood chemistries Arterial blood gas ( ABG ) analysis Oximetry Type and cross-match Blood alcohol, toxicology screen Urinalysis X-ray Computed tomography
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Collaborative Management
Airway management Oxygen Fluid management- Crystalloids- ColloidsColloids Packed red blood cells Gastric intubation Urinary drainage
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Pharmacotheraphy- Antibiotics- Analgesics and Anxiolytics
Nutrition theraphy
Surgery
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Nursing Diagnoses
Fluid volume deficit related to active loss secondary to physical injury
Altered protection related to clotting factor alterations ; decreased hemoglobin level.
Risk for infection related to inadequate primary defenses secondary to physical trauma or surgery
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Impaired tissue integrity related to mechanical factors
Hypothermia related to exposure at the scene of injury
Altered nutrition ;less than body requirements , related to increased need secondary to hypermetabolic posttrauma site
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Fear related to potentially threatening situation
Risk for injury Posttrauma syndrome
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TRAUMATIC BRAIN INJURY
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PRIMARY BRAIN INJURIES
Contusion Diffuse axonal injuries Concussion
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Secondary brain injuries
Intrinsic
Extrinsic
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Diagnostic tests
Skull X-ray Cervical spine X-ray Computed tomography ( CT ) MRI Cerebral angiography EEG Serum laboratory studies
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Collaborative Mangement
Surgical intervention Management of intracranial pressure of dynamics Reduction of ICP by CSF drainage Hyperventilation Monitoring jugular venous oxygen saturation Diuresis theraphy
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Maintenance of blood pressure to maintain cerebral perfusion pressure
Reduction of metabolic demand Modifying nursing care activites that raise
ICP Nutrition Rehabilitation
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Nursing Diagnoses
Impaired gas exchange Risk for infection Decreased adaptivecapacity Ineffective thermoregulation Risk for disuse syndrome
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CHEST TRAUMA
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Collaborative Management
Oxygen theraphy Intubation Mechanical ventilation Blood replacement Chest tubes
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Analgesia Pleural decompression Stabilization and fixation of flail chest Thoracotomy
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Nursing Diagnoses
Risk for fluid volume deficit
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Near Drowning
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Is a survival of more than 24 hr following drowning
Near drowning with aspiration ( wet ) Near drowning without aspiration ( dry )
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Collaborative Management
Oxygen therapy Endotracheal intubation Positive end-expiratory pressure ( PEEP ) Bronchoscopy Extracorporeal membrane oxygenation Rewarming for hypothermia Pharmacotheraphy
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Fluid and electrolyte management Neurologic support Management of event that precipitated the
near drowning
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Impaired gas exchange Hypothermia Risk for infection
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Cardiac Trauma
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Diagnostic Tests
Chest X-ray Troponin Cardiac Enzymes ECG MUGA
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Echocardiography TEE
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Collaborative Management
Treatment of dysrhythnias Relief of acute pain Immediate corrective surgical repair Treatment of shcok Treatment of myocardial failure
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Nursing Diagnoses
Altered Tissue perfusion
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Acute Cardiac Tamponade
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Is a sudden accumulation of blood , fluid, clots, pus , and /or gas in the pericardial space, which copresses the heart and interferes with both ventricular filling ( diastole ) and ejection ( systole ).
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Etiology
Trauma Iatrogenic Infection Carcinoma Nontraumatichemorrhage Left ventricular hemorrhage
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Assessment
Beck’s triad – distended neckveins,hypotension, muffled heart tones
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Collaborative
Pericardicentesis Surgical Procedure Fluid Resuscitation Inotropic agents Oxygen,intubation,mechanical ventilation
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Nursing Diagnoses
Decreased Cardiac Output
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Renal and Lower Urinary Tract Trauma
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Pelvic Fracture
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Acute Spinal Cord Injury
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Abdominal Trauma