Nursing Quality Improvement and ED Practices

Role of the RN in QI

• Registered Nurses (RNs) play a vital role in quality improvement (QI).

Critical Thinking, Clinical Reasoning, and Systems Thinking

• Critical thinking, clinical reasoning, and systems thinking are important skills for nurses.

Rapid Response Team and ED Nursing

• The role of the rapid response team is crucial in the Emergency Department (ED).
• Vulnerable populations are important to consider in the ED.
• Social determinants of health significantly impact patient care in the ED.
• ED safety protocols are critical for patient well-being.
• Priorities of care in the ED follow a primary survey (airway/c-spine, breathing, circulation, disability [GCS], expose) and triage (levels 1-5).
• Mechanism of injury assessment helps predict injury patterns and severity (e.g., blunt, penetrating).
• Complications of trauma include hemorrhage, airway compromise, sepsis, and hypothermia.

Fluids and Electrolytes

• Ions move by diffusion (high to low) and active transport (low to high).
• Water moves by osmosis (low to high) and filtration (high to low).
• Homeostasis is vital for optimal cellular and organismal function.
• Intake and output measurements are essential for monitoring fluid balance.
• Fluid volume excess (FVE) is characterized by weight gain, hypertension, tachycardia, bounding pulse, crackles, dyspnea, orthopnea, pitting edema, and jugular vein distention.
• Fluid volume deficit (FVD) presents with weight loss, hypotension, tachycardia, tachypnea, poor/tenting turgor, dry mucous membranes, oliguria.
• The renin-angiotensin-aldosterone system (RAAS) responds to decreased blood flow by reducing urine output, constricting arteries, and increasing blood volume/pressure.
• Isotonic fluids have equal osmotic pressure.
• Hypotonic fluids have lower osmotic pressure.
• Hypertonic fluids have higher osmotic pressure.
• Fluid balance in children is critical due to potential for dehydration from diarrhea, vomiting, fever, or medications. Rehydration strategies include oral, IV, and careful attention to potassium replenishment, only after urine output is assured adequate. Replacement of volume deficits with 20 ml/kg fluid boluses may be needed.
• Fluid balance in the elderly requires awareness of reduced body water percentage, decreased thirst, difficulty obtaining fluids, medications increasing fluid loss.

Electrolytes and Imbalances

• Normal ranges, symptoms, causes, and treatments for sodium, potassium, calcium, magnesium imbalances are covered (see table below for a quick summary.)
• The table is not provided.

Acid-Base Balance

• Normal arterial blood gas (ABG) values are pH 7.35-7.45, PaCO2 35-45 mmHg, and HCO3- 22-26 mEq/L.
• Respiratory acidosis results from hypoventilation.
• Respiratory alkalosis results from hyperventilation.
• Metabolic acidosis results from conditions like DKA, diarrhea, or kidney failure.
• Metabolic alkalosis results from conditions such as excessive vomiting

Immune System

• Components include tonsils, adenoids, thymus, lymph nodes, appendix, spleen, bone marrow, Peyer's patches, cells, and tissues.
• The immune system protects the body from infection.
• The immune response involves recognizing and defending against foreign substances.
• The inflammatory response is part of innate immunity.
• Adaptive and innate immune cells arise through complex processes.
• Different types of immunity exist, with long-term protection often from adaptive responses.
• Hypersensitivity reactions (types I-IV) are explained in relation to their causes, symptoms, and management.
• Autoimmune conditions, like Lupus and Lyme disease, are highlighted including their symptoms, prevention, and management.

HIV

• HIV viral load and CD4 count are key indicators.
• Stages of HIV infection are described from acute through AIDS.