NSG128 Emergency Nursing Lecture 2024 PDF

N NSG128 EMERGENCY NURSING LECTURE Nursing Care of Clients with Life-Threatening Conditions/Acutely Ill/ Multi- Organ Problems/ High Acuity and Emergency Situations, Acute and Chronic Credit : 2 units / 2 hours per week: By: As...

N NSG128 EMERGENCY NURSING LECTURE Nursing Care of Clients with Life-Threatening Conditions/Acutely Ill/ Multi- Organ Problems/ High Acuity and Emergency Situations, Acute and Chronic Credit : 2 units / 2 hours per week: By: Asst. Prof. IV – Ulysses T. Abellana MN, RN  AMBULANCE AMBULANCE  At the end of the ER lecture discussion, the students will be able 1. Define and explain emergency care nursing. 2. Identify the different functional requirements of an ER department. 3. States the legal aspects involved in various emergency situation. 4. Explain the principles of ER care. 5. Discuss the process of assessment in various emergency situations. 6. Utilize the nursing process in the care of patients in emergency situation. 7. Formulate appropriate nursing diagnosis as to priority. 8. Evaluate outcome of the nursing care goals for each situation. 9. Define disaster. 10. Describe examples of natural and manmade disasters attack. 11. Describe the different phases of a disaster. 12. Describe the nurse’s role in managing the disaster victims. 13. Compare the reactions of children and the elderly as disaster victims. 14. Discuss the role of the nurse in primary, secondary and tertiary care. 15. Define and explain triage system. 16. Apply principles of triage to select situations. 17. Define biological warfare. 18. Identify biological agents. 19. Discuss the different causes of disaster. 20. Describe the principles of disaster management. 21. Discuss the nursing management of victims with Post Traumatic Stress Disorder. EMERGENCY NURSING is a nursing specialty in which nurses care for patients in the emergency or critical phase of their illness or injury. While this is common to many nursing specialties, the key difference is that an emergency nurse is skilled at dealing with people in the phase when a diagnosis has not been made and the cause of the problem is not known. EMERGENCY MANAGEMENT refers to care to patients with urgent and critical needs. EMERGENCY DEPARTMENT often the first place where people go to seek for help. An emergency is a situation that poses an immediate risk to health, life, property or environment. Most emergencies require urgent intervention to prevent a worsening of the situation, although in some situations, mitigation may not be possible and agencies may only be able to offer palliative care for the aftermath. The precise definition of an emergency, the agencies involved and the procedures used, vary by jurisdiction, and this is usually set by the government, whose agencies (emergency services) are responsible for emergency planning and management. In order to be defined as an emergency, the incident should be one of the following: Immediately threatening to life, health, property or environment. Have already caused loss of life, health detriments, property damage or environmental damage Have a high probability of escalating to cause immediate danger to life, health, property or environment QUALITIES of an Emergency nurse:  has had specialized education, training, and experience to gain expertise in assessing and identifying patient’s health care problems in crisis situations.  Establishes priorities  monitors and continuously assesses acutely ill and injured patients  supports and attends to families  supervises allied health personnel  Teaches patients and families within a time-limited high-pressured care environment. Documentation of consent ❑ Consent to examine and treat the patient is part of the ER record ❑ Patient must consent to invasive procedure unless he/she is unconscious or in critical condition and unable to make decisions ❑ If brought unconscious without family or friends must be documented. Limiting exposure to health risks ❑ All health care providers should adhere strictly to standard precautions for minimizing exposure.  The routine use of appropriate barrier precautions to prevent skin and mucous membrane exposure when contact with blood or other body fluids of any individual may occur or is anticipated.  Universal Precautions apply to blood and to all other body fluids with potential for spreading any infections. Dangers to life  Many emergencies cause an immediate danger to the life of people involved. This can range from emergencies affecting a single person, such as the entire range of medical emergencies including heart attacks, strokes, and trauma to incidents that affect large numbers of people such as natural disasters including tornadoes, hurricanes, floods, and mudslides.  Most agencies consider these to be the highest priority of emergency, which follows the general school of thought that nothing is more important than human life.  Cardiovascular  Neurologic  Respiratory  Traumatic  Soft Tissues Injuries MYOCARDIAL INFARCTION (Heart Attack) Also known as Myocardial infarction; MI; Acute MI; ST-elevation myocardial infarction; Non- ST-elevation myocardial infarction A heart attack occurs when blood flow to a part of your heart is blocked for a long enough time that part of the heart muscle is damaged or dies. Most heart attacks are caused by a blood clot that blocks one of the coronary arteries. The coronary arteries bring blood and oxygen to the heart. If the blood flow is blocked, the heart is starved of oxygen and heart cells die. The blockage might be complete or partial: A complete blockage of a coronary artery means you suffered a “STEMI” heart attack or ST-elevation myocardial infarction. A partial blockage is an “NSTEMI” heart attack or a non-ST-elevation myocardial infarction Treatments differ for a STEMI versus NSTEMI heart attack, although there can be some overlap.  A hard substance called plaque can build up in the walls of your coronary arteries. This plaque is made up of cholesterol and other cells. A heart attack can occur as a result of plaque build-up.  The cause of heart attacks is not always known. Heart attacks may occur:  When you are resting or asleep  After a sudden increase in physical activity  When you are active outside in cold weather  After sudden, severe emotional or physical stress, including an illness  A heart attack is a medical emergency. If you have symptoms of a heart attack, call 911 or your local emergency number right away.  DO NOT try to drive yourself to the hospital.  DO NOT DELAY. You are at greatest risk of sudden death in the early hours of a heart attack.  Chest pain is the most common symptom of a heart attack. You may feel the pain in only one part of your body, or it may move from your chest to your arms, shoulder, neck, teeth, jaw, belly area, or back.  The pain can be severe or mild. It can feel like:  A tight band around the chest  Bad indigestion  Something heavy sitting on your chest  Squeezing or heavy pressure  The pain usually lasts longer than 20 minutes. Rest and a medicine called nitroglycerin may not completely relieve the pain of a heart attack. Symptoms may also go away and come back. Treatment  You will most likely first be treated in the emergency room.  You will be hooked up to a heart monitor, so the health care team can look at how your heart is beating.  The health care team will give you oxygen so that your heart doesn't have to work as hard.  An intravenous line (IV) will be placed into one of your veins. Medicines and fluids pass through this IV.  You may get nitroglycerin and morphine to help reduce chest pain.  The following drugs are given to most people after they have a heart attack. These drugs can help prevent another heart attack. Ask your doctor or nurse about these drugs:  Antiplatelet drugs (blood thinners) such as aspirin, clopidogrel (Plavix), or warfarin (Coumadin), to help keep your blood from clotting  Beta-blockers and ACE inhibitor medicines to help protect your heart  Statins or other drugs to improve your cholesterol levels  You may need to take some of these medicines for the rest of your life. Always talk to your health care provider before stopping or changing how you take any medicines. Any changes may be life threatening.  After a heart attack, you may feel sad.  You may feel anxious and worry about being careful in everything you do. All of these feelings are normal. They go away for most people after 2 or 3 weeks.  You may also feel tired when you leave the hospital to go home.  Most people who have had a heart attack take part in a cardiac rehab program. While under the care of a doctor and nurses, you will:  Slowly increase your exercise level  Learn how to follow a healthy lifestyle  Also known as Cerebrovascular disease; CVA; Cerebral infarction; Cerebral hemorrhage; Ischemic stroke; Stroke - ischemic; Cerebrovascular accident; Stroke – hemorrhagic  A stroke happens when blood flow to a part of the brain stops. A stroke is sometimes called a "brain attack."  f blood flow is stopped for longer than a few seconds, the brain cannot get blood and oxygen. Brain cells can die, causing permanent damage.  There are two major types of stroke: ischemic stroke and hemorrhagic stroke.  Ischemic strokes may be caused by clogged arteries. Fat, cholesterol, and other substances collect on the artery walls, forming a sticky substance called plaque.  A hemorrhagic stroke occurs when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain. Some people have defects in the blood vessels of the brain that make this more like.  High blood pressure is the number one risk factor for strokes. The other major risk factors are:  Atrial fibrillation  Diabetes  Family history of stroke  High cholesterol  Increasing age, especially after age 55  Race (black people are more likely to die of a stroke)  People who have heart disease or poor blood flow in their legs caused by narrowed arteries are also more likely to have a stroke.  The chance of stroke is higher in people who live an unhealthy lifestyle by:  Being overweight or obese  Drinking heavily  Eating too much fat or salt  Smoking  Taking cocaine and other illegal drugs  Birth control pills can increase the chances of having blood clots. The risk is highest in woman who smoke and are older than 35.  A headache may occur, especially if the stroke is caused by bleeding in the brain. The headache:  Starts suddenly and may be severe  Occurs when you are lying flat  Wakes you up from sleep  Gets worse when you change positions or when you bend, strain, or cough  Other symptoms depend on how severe the stroke is and what part of the brain is affected. Symptoms may include:  Change in alertness (including sleepiness, unconsciousness, and coma); Changes in hearing; Changes in taste; Changes that affect touch and the ability to feel pain, pressure, or different temperatures; Clumsiness  Confusion or loss of memory; Difficulty swallowing; Difficulty writing or reading; Dizziness or abnormal feeling of movement (vertigo); act of control over the bladder or bowels  Loss of balance; Loss of coordination; Muscle weakness in the face, arm, or leg (usually just on one side)  Numbness or tingling on one side of the body  Personality, mood, or emotional changes  Problems with eyesight, including decreased vision, double vision, or total loss of vision  Trouble speaking or understanding others who are speaking  Trouble walking  A stroke is a medical emergency. Immediate treatment can save lives and reduce disability. Call 911 or your local emergency number or seek urgent medical care at the first signs of a stroke.  It is very important for people who are having stroke symptoms to get to a hospital as quickly as possible. If the stroke is caused by a blood clot, a clot-busting drug may be given to dissolve the clot.  Most of the time, patients must reach a hospital within 3 hours after symptoms begin. Some people may be able to receive these drugs for up to 4 - 5 hours after symptoms begin.  Treatment depends on how severe the stroke was and what caused it. Most people who have a stroke need to stay in a hospital.  The goal of treatment after a stroke is to help the patient recover as much function as possible and prevent future strokes.  The recovery time and need for long-term treatment is different for each person. Problems moving, thinking, and talking often improve in the weeks to months after a stroke. A number of people who have had a stroke will keep improving in the months or years after the stroke. The outlook depends on:  The type of stroke; How much brain tissue is damaged  What body functions have been affected; How quickly you get treated Complications  Breathing food into the airway (aspiration); Dementia; Falls  Loss of mobility; Loss of movement or feeling in one or more parts of the body; Muscle spasticity; Poor nutrition; Pressure sores; Problems speaking and understanding; Problems thinking or focusing  Stroke is a medical emergency that needs to be treated right away. Call your local emergency number (such as 911) if someone has symptoms of a stroke.  Angina (an-JI-nuh or AN-juh-nuh) is chest pain or discomfort that occurs if an area of your heart muscle doesn't get enough oxygen-rich blood.  Angina may feel like pressure or squeezing in your chest. The pain also can occur in your shoulders, arms, neck, jaw, or back. Angina pain may even feel like indigestion.  Angina isn't a disease; it's a symptom of an underlying heart problem. Angina usually is a symptom of coronary heart disease (CHD).  CHD is the most common type of heart disease in adults. It occurs if a waxy substance called plaque (plak) builds up on the inner walls of your coronary arteries. These arteries carry oxygen-rich blood to your heart.  Angina also can be a symptom of coronary microvascular disease (MVD). This is heart disease that affects the heart’s smallest coronary arteries. In coronary MVD, plaque doesn't create blockages in the arteries like it does in CHD.  Types of Angina  The major types of angina are stable, unstable, variant (Prinzmetal's), and microvascular. Knowing how the types differ is important. This is because they have different symptoms and require different treatments. Stable Angina  Stable angina is the most common type of angina. It occurs when the heart is working harder than usual. Stable angina has a regular pattern. (“Pattern” refers to how often the angina occurs, how severe it is, and what factors trigger it.)  If you have stable angina, you can learn its pattern and predict when the pain will occur. The pain usually goes away a few minutes after you rest or take your angina medicine.  Stable angina isn't a heart attack, but it suggests that a heart attack is more likely to happen in the future. Unstable Angina  Unstable angina doesn't follow a pattern. It may occur more often and be more severe than stable angina. Unstable angina also can occur with or without physical exertion, and rest or medicine may not relieve the pain.  Unstable angina is very dangerous and requires emergency treatment. This type of angina is a sign that a heart attack may happen soon. Variant (Prinzmetal's) Angina  Variant angina is rare. A spasm in a coronary artery causes this type of angina. Variant angina usually occurs while you're at rest, and the pain can be severe. It usually happens between midnight and early morning. Medicine can relieve this type of angina. Microvascular Angina  Microvascular angina can be more severe and last longer than other types of angina. Medicine may not relieve this type of angina.  Age (≥ 55 years for men, ≥ 65 for women)  Cigarette smoking  Diabetes mellitus (DM)  Dyslipidemia  Family History of premature Cardiovascular Disease (men