Emergency Nursing

Emergency Nursing

• In emergency nursing, the first priority when assessing a trauma patient is to ensure a patent airway
• For a patient with uncontrolled external hemorrhage from a lower leg laceration, the initial nursing action should be to apply direct pressure to the bleeding site with a sterile dressing
• Gurgling sounds with respirations in an unresponsive trauma patient should immediately prompt nurse intervention to secure the airway
• When managing a patient with a suspected cervical spine injury in the emergency department, performing a jaw-thrust maneuver to open the airway is most appropriate for maintaining spinal precautions during airway management
• Components of the primary survey in emergency nursing include Disability and Breathing
• During the secondary survey of a trauma patient, the nurse obtains the patient's medication history using the SAMPLE mnemonic, where 'M' stands for Medications
• In a mass casualty incident (MCI), a patient with a minor laceration that is not life-threatening would likely be tagged with green
• Triage is a critical assessment skill used in the emergency department to rapidly determine patient acuity

Cardiac

• For a patient with chronic stable angina reporting chest pain relieved by rest and sublingual nitroglycerin, the ECG during this pain is most likely to show ST segment depression or T wave inversion
• Hypertension has the most direct impact on endothelial injury and left ventricular hypertrophy among modifiable risk factors for coronary artery disease (CAD)
• For a patient diagnosed with an ST-segment elevation myocardial infarction (STEMI) in the emergency department, the priority nursing intervention is to prepare the patient for immediate percutaneous coronary intervention (PCI) within 90 minutes
• Following a percutaneous coronary intervention (PCI) with stent placement, the nurse should instruct the patient about the importance of taking prescribed antiplatelet medications as directed
• ST segment elevation on an ECG is most indicative of myocardial injury
• For a patient with a myocardial infarction (MI) who develops ventricular fibrillation, the priority nursing action is to initiate cardiopulmonary resuscitation (CPR) and prepare for defibrillation
• In a patient with an inferior wall myocardial infarction, central venous pressure (CVP) or preload requires careful monitoring due to potential right ventricular involvement
• A common side effect of sublingual nitroglycerin that the nurse should inform the patient about is headache

Shock and MODS

• Neurogenic shock is characterized by a relative hypovolemia due to massive vasodilation and maldistribution of blood flow
• A patient with a spinal cord injury at the T4 level exhibiting hypotension and bradycardia suggests neurogenic shock
• Early manifestations of cardiogenic shock include tachycardia, hypotension, and narrowed pulse pressure
• The primary treatment strategy for obstructive shock focuses on relieving the underlying physical obstruction to blood flow
• For a patient with hypovolemic shock due to hemorrhage receiving large volumes of crystalloid fluids, the nurse should monitor for hypothermia and coagulopathy
• In the compensatory stage of shock, the body attempts to maintain homeostasis through baroreceptor activation, the renin-angiotensin system, and hormonal responses
• Decreased cardiac output and altered capillary permeability indicates a patient in shock is progressing from the compensatory to the progressive stage
• The refractory stage of shock is characterized by profound hypotension, hypoxemia, and multiple organ dysfunction syndrome
• Aggressive fluid resuscitation is the cornerstone of therapy for septic, hypovolemic, and anaphylactic shock
• For a patient in septic shock who remains hypotensive despite aggressive fluid resuscitation, anticipate the administration of vasopressor drugs
• Systemic vascular resistance (SVR) is expected to decrease in a patient with septic shock
• The primary goal of nutritional therapy for a patient in shock is to decrease morbidity by supporting metabolic needs and enhancing GI perfusion
• Multiple Organ Dysfunction Syndrome (MODS) is characterized by the failure of two or more organ systems where homeostasis cannot be maintained without intervention
• The prognosis for a patient with Multiple Organ Dysfunction Syndrome (MODS) is generally poor, with a high mortality rate

AKI

• Increased serum creatinine is most indicative of acute kidney injury (AKI)
• A patient with AKI who has a urine output of 250 mL in 24 hours is in the oliguric phase
• Prerenal causes of acute kidney injury include hypovolemia, renal artery thrombi, and decreased cardiac output
• Acute tubular necrosis (ATN) is the most common intrarenal cause of acute kidney injury in hospitalized patients
• A patient with postrenal AKI would most likely have hydronephrosis
• During the oliguric phase of AKI, the nurse should monitor for hyperkalemia
• A urine specific gravity of 1.010 would be expected in a patient with intrarenal AKI experiencing oliguria
• During the diuretic phase of AKI, the nurse should monitor the patient closely for hypovolemia and electrolyte imbalances
• A BUN level of 135 mg/dL in a patient with AKI is best described as azotemia
• The RIFLE classification system is used in AKI to define the severity of acute kidney injury
• Aldosterone regulates fluid balance in the kidneys by promoting sodium reabsorption in the distal tubules
• Peaked T waves are the most likely ECG changes to observe in a patient with AKI who develops severe hyperkalemia
• The calculation for daily fluid restriction in a patient with AKI in the oliguric phase typically includes all fluid losses for the previous 24 hours plus 600 mL
• An elevated serum potassium level causing cardiac dysrhythmias would necessitate the initiation of renal replacement therapy (RRT) in AKI

Endocrine

• Increased metabolism and tachycardia are clinical manifestations exhibited by a patient with Graves' disease due to excess thyroid hormones
• Decreased TSH and increased free T4 is a characteristic laboratory finding of primary hyperthyroidism (Graves' disease)
• Radioactive iodine therapy (RAI) is the treatment of choice for most non-pregnant adults with Graves' disease
• Following a thyroidectomy, the nurse should closely monitor the patient for signs of hypocalcemia due to potential damage to the parathyroid glands
• A patient who had a thyroidectomy reporting harsh, vibratory sounds when breathing could indicate laryngeal stridor
• Severe tachycardia and hyperthermia is the most indicative clinical manifestation of a thyroid storm (acute thyrotoxicosis)
• A patient with hypothyroidism prescribed levothyroxine (Synthroid) should be instructed to report any signs of chest pain, nervousness, or tremors
• Increased TSH and decreased free T4 is a characteristic laboratory finding of primary hypothyroidism (Hashimoto's thyroiditis)
• An Addisonian crisis is a life-threatening emergency caused by insufficient levels of adrenal hormones
• A patient with Addison's disease is at risk for hyponatremia and hyperkalemia
• Intravenous administration of corticosteroids and fluid replacement is the primary treatment for an Addisonian crisis
• Moon face and buffalo hump is a clinical manifestation characteristic of Cushing syndrome
• A patient with Cushing syndrome is at increased risk for hypokalemia and hypertension
• The key characteristic of Diabetic Ketoacidosis (DKA) is the presence of moderate to severe ketones
• During the management of DKA, the nurse should monitor for hypokalemia, a potentially dangerous complication related to rapid glucose lowering
• Hyperosmolar Hyperglycemic Syndrome (HHS) is characterized by blood glucose levels typically above 600 mg/dL and absent or mild ketones
• Diabetes Insipidus (DI) is caused by a deficiency of or decreased response to antidiuretic hormone (ADH)
• A patient with Diabetes Insipidus (DI) would have increased serum sodium and decreased urine osmolality
• Syndrome of Inappropriate Antidiuretic Hormone (SIADH) results in excessive water reabsorption and dilutional hyponatremia
• A patient with SIADH is likely to exhibit decreased serum sodium and decreased urine output
• Addison's Disease correlates with Hyperkalemia
• DKA correlates with Variable potassium (initially high, then low)
• Hyperthyroidism correlates with Hypokalemia
• Cushing Syndrome correlates with Hypokalemia