Medical Concerns/Emergency Procedures

Lesson 5

Lesson Objectives▪ The student will be able to explain how to promote a safe

environment and comply with safety/prevention measures

▪ The student will be able to identify risk factors related to accidents that can occur in the healthcare facility

▪ The student will be able to explain prevention strategies and demonstrate the appropriate responses needed in each of the following emergency situations:▪ Fall/Fainting Incidents

▪ Airway obstruction▪ Burns▪ Poisoning▪ Heart Attack/Cardiac Arrest▪ Stroke (CVA)

▪ Seizure Activity▪ Bleeding/Hemorrhage

Increased Risk for Accidents▪ Sensory Impairment▪ Poor coordination

and balance▪ Postural hypotension▪ Slow reflexes▪ Brittle bones and

weak muscles

▪ Decreased sensitivity to pain and temperature

▪ Impaired mobility▪ Cognitive impairment▪ Side effects from

medication

Falls - Statistics from CDC▪ Each year, a typical nursing home with 100

beds reports 100 to 200 falls. Many falls go unreported.

▪ Between half and three-quarters of nursing home residents fall each year. That’s twice the rate of falls among older adults living in the community.

▪ Patients often fall more than once. The average is 2.6 falls per person per year.

▪ About 35% of fall injuries occur among residents who cannot walk.

Falls - Statistics from CDC (Continued)▪ Why do falls occur more often in nursing

homes?▪ Falling can be a sign of other health problems.

People in nursing homes are generally frailer than older adults living in the community. They are usually older, have more chronic conditions, and have more difficulty walking. They also tend to have thought or memory problems, to have difficulty with activities of daily living, and to need help getting around or taking care of themselves.8 All of these factors are linked to falling.

Falls – Personal/ Environmental Risk Factors▪Personal Risk Factors

▪Side effects of meds, balance problems, diagnosis of paralysis (etc.), Circulatory problems, cognitive impairment, bowel/bladder problems, Improper fitting shoes or clothing

Falls – Personal/ Environmental Risk Factors▪Environmental Risk Factors

▪Clutter, wet/slippery floors, unsafe arrangement of furniture, uneven surfaces, poor lighting, call light out of reach, side rails not in proper position

Fall Prevention▪ Resident Awareness▪ Toileting program compliance▪ Responding promptly to call lights▪ Use proper footing – shoes/socks with gripping▪ Keep area free of clutter, obstacles, and spills▪ Use alarms when needed on beds/chairs▪ Complete safety check before leaving the room

Fall Interventions

▪See RCP #7 – Falling or Fainting

Choking▪ Partial or complete airway obstruction when

someone is eating, drinking or taking meds

▪ Universal Choking Sign▪ Gasping noise or clutching of his/her throat

▪ Choking Risk Factors▪ History of stroke or swallowing difficulties▪ Unconsciousness or Semi-unconsciousness▪ Cognitive Impairments▪ Foods/Drinks of inappropriate consistencies

Choking Prevention/ Intervention▪ Make sure to check resident assignment

sheets for resident choking history▪ Soft/mechanical diet or pureed diet▪ Liquid Consistency

▪ Nectar thick – thicker than water▪ Honey thick – pours very slowly▪ Pudding thick – semi solid

▪ Intervention – See RCP #8 - Choking

Hemorrhage

▪Defined as: Internal or external excessive blood loss over a short period of time from a cut, tear, rupture, of a large or small blood vessel.

Internal vs. External Hemorrhage▪ Internal Bleeding: bleeding is in the tissues

and body cavities.▪ Pain, vomiting blood, loss of consciousness, shock

or even death may occur.

▪ External Bleeding: can be from an artery or a vein▪ Artery – bright red blood that spurts or gushes

(Serious)▪ Vein – Bluish red blood that trickles or flows

Hemorrhage Risk Factors▪ Age 65 or older

▪ History of:

▪ Stroke▪ Heart Attack▪ GI Bleeding▪ Severe Anemia▪ Diabetes▪ Kidney Disease▪ Taking Anticoagulants▪ Hemophilia

Hemorrhage Prevention

▪ Know risks of resident▪ Safety Awareness▪ Check residents skin daily for changes▪ Use caution when shaving, clipping nails, etc.▪ Resident should not go barefoot or wear tight fitting

clothing/shoes▪ Use care when performing oral care, including using a soft

toothbrush and discourage use of flossing▪ Check daily for bleeding gums.▪ Use lip moisturizer to prevent cracking lips▪ Be sure dentures fit properly▪ Use soft tissues and encourage soft blowing of the nose▪ Promote fluid intake, encourage exercise to prevent

constipation▪ Encourage residents not to strain during BM

Bleeding Intervention

▪ Standard Precautions▪ Apply firm, direct contact to bleeding area

using clean cloth/bandages (preferably sterile)▪ Do not stop pressure until told to stop▪ NEVER USE A TOURNIQUET!▪ Elevate area bleeding if possible▪ Keep resident from moving until nurse arrives

Burns/Scalds – Risk Factors

▪Stroke, paralysis, diabetes diagnosis▪Cognitive, mental status impairment▪Using heating appliances/equipment▪Smoking▪Hot beverages

Burn/Scald - Prevention▪ Know residents with risk▪ Monitor heating equipment▪ Check water temp before giving shower/ bath▪ Supervise smoking if applicable▪ Know where fire extinguishers are▪ Pour hot liquids away from resident▪ Assist resident with hot food▪ Use mugs with lids/adaptive devices

Burn/Scald - Treatment

▪Minor Burns – Run area under cool water or apply a cool compress

Poisoning ▪Risk Factors

▪Residents with cognitive impairment that may wonder into areas with chemicals or poisonous substances are stored

▪Hoarding medications

▪Prevention▪Chemicals and poisons stored in safe areas▪Keep carts and supply areas locked▪Know location of MSDS’s (Material Safety

Data Sheets)

Nausea/Vomiting▪ Nausea/Vomiting are symptoms of an underlying illness, not a

specific disease

▪ Emesis = Vomiting▪ Can cause/aggravate dehydration▪ Causes of Nausea/Vomiting

▪ Gastritis – Inflammation of the lining of the stomach▪ Gastroenteritis – Vomiting and diarrhea ▪ Food Poisoning▪ GERD (Gastro Esophageal Reflux Disease▪ Peptic Ulcer▪ Inner ear disturbances▪ Concussion▪ Migraine▪ Heat▪ Etc.

Nausea/Vomiting

▪Avoid food that are hard to digest▪Remain upright for 30 minutes after a

meal▪Fluid Intake▪Reduce odors▪Remove unpleasant sights

Nausea/Vomiting▪ Interventions

▪ Sit resident in Lateral, Semi-Fowler’s to prevent aspiration

▪ Provide good oral care▪ Provide ice chips, ginger ale, crackers, hot tea etc, if

nurse gives permission▪ Observe for dehydration, aspiration, mental status

changes▪ Report amount, frequency, color, characteristics of

emesis▪ Observe for blood in emesis – blood will vary in

color depending on how long it was in the GI system▪ Delay in vomiting blood –dark red, brown, or black▪ Coffee Ground looking blood – clotted blood

▪ REQUIRES IMMEDIATE REPORTING/MEDICAL ATTENTION!

Medical Emergencies▪ Types of Medical Emergencies

▪ Myocardial Infarction – MI (Heart Attack) (Coronary) – lack of blood supply to the heart resulting in death of the heart muscle

▪ Symptoms – crushing, smothering sensation in chest, traveling down left arm, into the neck, jaw or shoulder blade

▪ Shortness of breath▪ Dizziness▪ Cyanosis▪ Heavy sweating▪ Nausea/vomiting▪ Severe Anxiety▪ If damage is extensive, can lead to Cardiac Arrest or death

Medical Emergencies▪ Types of Medical Emergencies

▪ Cerebral Vascular Accident – CVA (Stroke) – blood clot or ruptured vessel in the brain

▪ Symptoms – headache, dizziness, facial drooping, uneven smile or grips, speech problems, weakness/inability to move extremity/side of body, visual disturbances, memory impairment, change in LOC, behavior or mental status

▪ Report Symptoms immediately and stay with the resident until further instructions are given

Medical Emergencies

▪Types of Medical Emergencies

▪Seizures/Convulsions – sudden, involuntary contractions of muscles caused by electrical discharges in the brain

▪See RCP #9 Seizures

Safety Measures/ Prevention Strategies▪Accident Prevention – Key to Safety▪Observe and remove safety hazards▪Report Items that need repair▪Know resident risk factors for

incidents/accidents▪Place call light on unaffected side▪Maintain clean, safe environment for

residents

▪Know Review Questions for test!