Nursing Quality Improvement and ED Care

Preparatory Module

• Role of the RN in Quality Improvement (QI): Focuses on improving systems, clinical judgment, critical thinking, prioritizing cues, and reporting.
• Clinical reasoning and systems thinking are crucial in QI.
• Rapid Response Team (RRT) vs. Code Team: RRT used for sudden changes in patient condition, Code Team used for cardiopulmonary arrest.
• Safe delegation involves specific guidelines; assessment/evaluation and education cannot be delegated. Tasks that can be delegated should follow the 5 rights of delegation.
• Scope of practice and policies should be followed.
• Failure to recognize changes in patient condition and failure to respond appropriately are critical concerns.

ED Nursing

• Vulnerable populations and social determinants of health are key considerations.
• Prioritizing care involves a primary survey (ABCDE). Assessing for bleeding, airway, breathing, circulation, disability (GCS), and exposing/protecting the patient are critical first steps.
• Triage categorizes patients needing immediate care, 5-minute wait, hours for a full evaluation, hours of minimal care, or days for no immediate care.

Fluid, Electrolytes, and Homeostasis

• Fluids are water with dissolved substances (glucose, proteins, ions, and cells).
• Electrolytes are mineral salts that dissolve in water and separate into ions (charged particles).
• Homeostasis is maintained through several processes: diffusion (high to low), osmosis (low to high), filtration (high to low), and active transport (low to high).
• Fluid distribution occurs between different spaces in the body (kidneys, vascular, interstitial).

Fluid Volume Assessment

• Fluid volume assessment (FVO) includes intake and output measurement, physical examination, lab work, and daily weights.
• Sensible losses (measurable losses) include urine, diarrhea, and emesis.
• Insensible losses include respiratory and skin losses.
• Weight gain, hypertension, tachycardia, tachypnea, bounding pulse, crackles, dyspnea, and orthopnea are signs to note.
• Pitting edema, jugular vein distention, and periorbital edema reflect fluid overload.

Fluid Volume Deficits (FVD)

• Fluid volume deficit (FVD) symptoms include weight loss, hypotension, tachycardia, poor/tenting turgor, and dry mucus membranes.
• Oliguria (decreased urine output) also signifies FVD.
• Treatment involves oral solutions (water and salts), or intravenous (IV) solutions, to replenish fluids.
• Ensure the output doesn't exceed intake.

Electrolyte Imbalances

• Common electrolyte imbalances (sodium and potassium) are defined, along with their symptoms and causes.
• Treatment and nursing strategies for each electrolyte imbalance are described.

Acid-Base Balance

• Normal blood gas parameters are defined (pH, CO2, HCO3-).
• Respiratory and metabolic acidosis and alkalosis are categorized, along with possible causes and conditions.

Immune System

• Components of the immune system are named (tonsils, adenoids, thymus, lymph nodes, spleen, bone marrow, Peyer's patches, and specific cells).
• Immune system functions to protect the body.

Hypersensitivity Reactions

• Different types of hypersensitivity reactions are described along with their causes, symptoms, and treatments.
• Epinephrine use in anaphylaxis and acute allergic reactions is outlined.

Other Topics

• Additional topics covered include specific conditions (e.g., SLE, contact dermatitis, Lyme disease).
• Information on preventative measures for these conditions, treatment, and nursing interventions is provided.
• HIV transmission, stages, and management are discussed.
• Different types of hematological conditions and their specific considerations are covered (e.g., anemia, blood transfusions).