Natural Disaster PDF

Natural disaster- An event occurs that can cause significant damage. Ex: Fire, tornado, floods, earthquakes, tsunami Endemic- A disease that occurs within an area or a community Epidemic- A widespread outbreak that occurs throughout the country Pandemic-A widespread that spread throughout the con...

Natural disaster- An event occurs that can cause significant damage. Ex: Fire, tornado, floods, earthquakes, tsunami Endemic- A disease that occurs within an area or a community Epidemic- A widespread outbreak that occurs throughout the country Pandemic-A widespread that spread throughout the continent Hypovolemic shock- The most common type of shock. External-internal Fluid loss. Decreased Blood volume, Decreased cardiac output, Decreased tissue perfusion. Increased RR Ex: Heat stroke, hemorrhaging, burns, trauma, surgery How to replace it: Isotonic solutions- Normal saline Distributive shock- Displacement of intravascular volume creating a relative hypovolemia and inadequate delivery of oxygen to the cells Septic shock: Caused by a bacterial infection in the bloodstream- Streptococcus (strep) or Staphylococcus (staph) Treatment: Antibiotics, IV norepinephrine (Levophed) Begin rapid administration of IV crystalloid Anaphylactic shock: Caused by a severe allergic reaction or asthma attack- From an allergen- Wide spread Vasodilation causing bronchoconstriction- Bronchospasms (Penicillin-Latex-Peanuts-Shellfish) Decreased LOC, SOB-Dyspnea, Wheezing, Hives Skin: Flushed Management: 02, Epi-vasoconstrictor (check HR- continuous monitor, EKG- arrhythmias), Steroids Neurogenic shock: Imbalance between the parasympathetic and sympathetic. Caused by damage to the nervous system, Ex: Spinal cord injury, Brain injury, Fall, Head injury Manifestations: Hypotension, bradycardia, syncope, fainting, Dry-warm skin Treatment: Stabilize the spinal injury, treat the symptoms - ATROPINE Cardiogenic shock- occurs when the heart’s ability to contract and to pump blood is impaired and the supply of oxygen is inadequate for the heart and the tissues 1. Coronary cardiogenic shock is more common 2. the pain of angina, develop arrhythmias, complain of fatigue, express feelings of doom, and show signs of hemodynamic instability 3. Treatment: 02 nasal cannula at a rate of 2 to 6 L/min IV morphine Dobutamine Nitroglycerin Dopamine Obstructive shock Compensatory stage of shock- 1. NORMAL BP, HR-elevated, RR-Increased 2. Metabolic Acidosis 3. Pt: Feel anxious, or be confused, alert, Decreased LOC, shallow RR-rapid 4. Fluids, hypoperfusion, 02-decrease pt’s anxiety Irreversible stage of shock-ORGAN FAILURE (KIDNEY AND LIVER FAILURE) , 1. BP-decreased. Rapid/shallow RR- 2. Talk to family- Palliative care, End of life care- comfort the patient Dobutamine- Cardiogenic shock Norepinephrine Levophed-Septic Shock Epinephrine- Anaphylactic shock Lactated ringers- Burns Plavix clopidogrel-Atherosclerosis First degree burn- Epidermis- Skin is red, like a sunburn Second degree burn- Epidermis and dermis=Blister Third degree burn- Epidermis, Dermis and Subcutaneous-See fat Fourth degree burn-Deep tissue, muscle and bone-Osteomyelitis- Sepsis shock Treatment: ABC’S. IV  1. Nares are burned First. Airway compromised. Impaired Gas exchange- Assess LOC, Vitals, Pulses, HR/Lung sounds, pulses. Decreased LOC- draw ABG- Metabolic Acidosis-Respiratory Acidosis Fluid shift-Iv fluids- Pain- Infection-decreased the pt’s risk for infection-Dressing (0cculsive dressing) Decrease the risk of contraction-Surgery-potentially have skin grafting-Nutrition-Increase Protein and high fat. Use TPN if necessary Access- TBS, depth of the burn, What burned them, what caused the burn, AGE? Electrolyte to shift- Sodium-Decrease-Chloride-Decreases Potassium level increase-Metabolic Acidosis Emergent resuscitative burn stage- 3rd and 4th degree, 1. Metabolic Acidosis possible Hyperkalemia-Hyponatremia- 2. Rehydrate-LR- suction, NG tube, Foley Catheter- Kidney shut down. Monitor I /O’s. IV meds- Morphine, Fentanyl. Meds for dressing change- Silvadene cream-apply this with Aspeptic gloved hand Cellulitis-a bacterial infection that affects the deeper layers of the skin, including the dermis and subcutaneous fat 1. Leads to Sepsis shock- traveling to the lymphatic system. 2. Red streaks that follow the lymphatic drainage 3. Commonly seen in the lower extremities-Get it from an open wound. From STAPH infection 4. Treatment: Antibiotics Thermal burn-Heat, Most common is- STOVE TOP, hot water Electrical Burns- Can affect the electrical conduction of the heart Mitral valve regurgitation- blood flows from the left ventricle back into the left atrium during systole 1. Nurse will hear a Harsh HOLOSTYLIC MURMUR- blowing sound best heard at the apex. Mitral valve stenosis- Narrowing (reduced) blood flow from the left atrium into the left ventricle. 1. caused by rheumatic endocarditis 2. Medical management- ACE-ARBS-BETA-BLOCKERS- Antibiotics Surgery: valvuloplasty 3. first symptom of mitral stenosis is dyspnea on exertion (DOE) Aortic valve regurgitation- backward flow of blood into the left ventricle from the aorta during diastole 1. A high-pitched, blowing diastolic murmur is heard at the third or fourth intercostal space at the left sternal border Aortic valve stenosis- narrowing of the orifice between the left ventricle and aorta. In adults, stenosis is usually caused by degenerative calcification. Balloon valvuloplasty- Ballon surgery that opens narrowed (STENOSIS) heart valves 1. Nursing diagnosis-Decreased cardiac output- assessment: LOC, vitals, HR/LUNG sounds, pulses 2. Cardiac Monitor-dysthymias 3. Medication- Heparin(hospital) Warfin (2-3 days before discharge-needs to get to therapeutic range (2-3) 4. Access the site for infection-Fever, chills, High temp 5. Beta-blockers (Metoprolol) Calcium channel blocker (amlodipine-nifedipine) ARB-(losartan)-ACE- (lisinopril) Diuretic (thiazide) Cardiomyopathy-Enlarged heart-2 kinds- Dilated and Hydrotropic-Potassium= Main electrolyte 1. Nurses diagnosis- Decreased cardiac output. 2. Improve cardiac output- Rest, positioning(legs down),supplemental O2,medications, low Na diet, avoid dehydration Pericardial effusion- Fluid in the pericardium- turns into cardiac tamponade Cardiac tamponade- Fluid and clots accumulate in the pericardial sac, which compress the heart, preventing blood from filling the ventricles 1. Management: Pericardiocentesis- a procedure that involves removing fluid from the pericardium 2. Monitor: Heart rhythm- Cardiac Monitor Pericarditis-Infection of the pericardium 1. Causative organism: Viral 2. Treat the symptoms- Fluids and Steroids Endocarditis-Infection of the heart's inner lining and valves 1. Causative organism: Bacterial 2. Treatment: Antibiotics and Steroids 3. Mechanical Valve!!!! - Prophylactic antibiotics- Common is DENTAL surgeries Myocarditis- condition where the heart's middle muscle layer, the myocardium, becomes inflamed 1. Causative agent: Viral 2. Treat the symptoms- Fluids and Steroids Left side heart failure- Dyspnea, Crackles (Fluids back into lungs- Pulmonary edema or Pulmonary Congestion) Cough up pink frothy sputum Right side heart failure-JVD, Ascites, Peripheral Edema Atherosclerosis- a buildup of plaque, a sticky fatty deposit, within the inner lining of the arteries 1. Caused by- High Cholesterol (Hyperlipidemia) 2. Fat sticks and hardens forming Plaque 3. Treatment: Statins, Antiplatelet- Plavix clopidogrel Arteriosclerosis- Hardening and Narrowing of the blood vessels caused by Hypertension 1. Correct: Hyperlipidemia 2. Treatment: Beta-blockers (Metoprolol) Calcium channel blocker (amlodipine-nifedipine) ARB- (losartan)-ACE-(lisinopril) Diuretic (thiazide) 3. PVD- affects the Veins (Pain when Walking) Elevate Legs 4. PAD- affects the arteries Legs Dependent for blood to flow Pulmonary embolism- Clot in the lungs 1. Causative agent: DVT 2. PVD as risk 3. Nursing interventions: Compression socking, get up and walk, ROM, Frequent turning 4. Orders: STD’s, antithrombotic- Heparin Deep vein thrombosis- a blood clot that forms in a vein deep in the body, usually in the leg Pulmonary edema- a life-threatening condition that occurs when too much fluid builds up in the lungs, making it difficult to breathe Rheumatoid arthritis- Autoimmune disease that causes inflammation of the joints. Nodules- Hands and feet. Pain in the morning (30mins-1hours) Tell pt to move. Pt will see Rheumatologist-orders methotrexate Osteoarthritis- NON-inflammatory from weight bearing activities. Pain in the morning- less than 30 minutes. Exercise- Active and passive exercises- aerobic exercise Tell them to take NSAIDS Scoliosis- S curvature, Lordosis-Lower, Kyphosis-Upper Osteoporosis- "Too many clast" signifies a cell that breaks down bone (specifically called an osteoclast), and not enough "blast" indicates a cell that builds new bone (called an osteoblast) 1. Highest risk WOMEN- Lack of estrogen- Menopause 2. Increases risk for Fractures 3. Menopause- Lack of Estrogen Septic arthritis-Microorganism has entered the Joint space 1. Manifestants: Fever, Chills, Swelling in the joint, Extreme Joint pain 2. Treatment: Antibiotics, Fluids, Drain the joint space Carpel tunnel- Median nerve is affected, in the wrist 1. After surgery- Patient will have problem with ADL’S. Occupational Therapy Bone reduction-Alignment of the bone 1. BED: Skeletal Traction with Thomas Leg splint 2. Use a Trapeze to help with movement Osteomyelitis-Infection of the bone 1. Fracture- Open fracture- Stage 4 burn- Stage pressure Ulcer 2. Risk: Amputation 3. Treatment: Antibiotics Compartment syndrome- Cast is too tight- No perfusion- Lack of oxygenated blood- Ischemia 5 P’s- Neurovascular Assessment 1. Pain, pallor, pulse, paresthesia, and paralysis 2. Why?- Patient will complain of Pain! Closed fracture- Cast- Worried about compartment syndrome Open fracture- Bone reduction Hip arthroplasty- Hip replacement- Risk: Osteoarthritis