1Emergency Nursing_student notes

1Emergency Nursing_student notes - Emergency Nursing AMY L...

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Emergency Nursing AMY L. HUFF, MSN, RN MARTIN METHODIST COLLEGE SPRING 2015
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Emergency Nursing Emergency Department (ED) Environment Fast-paced Urgent/emergent Crowded, chaotic Conditions treated in the ED Varying acuity Special populations in the ED Homeless Poor Elderly Cultural differences
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Emergency Priorities & Goals Priorities - * Stabilize * Provide critical treatments * Prompt transfer to appropriate setting Goals - * Preserve life * Prevent deterioration * Restore to useful living
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Emergency Nursing Requires… Education/experience Assessment skills Critical thinking/priority setting Emergency care knowledge Technical skills Communication Certifications
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Emergency Team Members Emergency Nurses Forensic nurse examiners SANE (sexual assault nurse examiners) Psychiatric crisis nurse team Pre-hospital Care Providers: EMTs, Paramedics Emergency Physicians, NPs, PAs Support Staff Respiratory, laboratory, radiology, nursing techs, social workers, clergy
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Safety Staff Disease transmission Physical threats Patient Disease transmission Injury prevention Patient identification Ignatavicius & Workman, Chart 10-1: Maintaining Patient and Staff Safety in the Emergency Department
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Emergency Triage Highest acuity = fastest evaluation and treatment Sample triage system Emergent – immediate threat to life or limb Urgent – requires quick treatment, but no immediate threat Nonurgent – may wait without significant risk
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Triage Chief complaint Timeline Related factors (i.e. unconscious) How has problem changed Allergies Medical/Surgical history Current meds Vital signs Last meal Regular MD Immunizations
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Primary Survey Priorities addressed in initial assessment A - Airway (determine/establish ______ ______) B - Breathing (adequate ___________ ) C - Circulation (adequate cardiac output _________ ) D - Disability (neuro status; AVPU, GCS) E - Exposure (clothing removed; prevent ___________ ) Ignatavicius & Workman, Table 10-4, pg. 134
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Secondary Survey More comprehensive, head-to-toe assessment Identify other injuries/issues that need to be addressed
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Airway Highest priority; most life threatening Suspected or actual trauma – * control cervical spine * never hyperextend or hyperflex the neck * maintain neutral position Nonresponsive patient – most common reason for obstruction is the tongue
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Emergency Airway Open airway Chin lift or jaw thrust To insert oral airway - measure from corner of lips to angle of jaw or bottom of earlobe Advanced airway management Airway obstruction Partial or complete Foreign body, anaphylaxis, trauma, burns, infection s/sx: choking, stridor, labored breathing, flared nostrils, anxiety Treatment: BLS, suction, advanced airways
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Breathing After determining patency of airway, determine effectiveness of breathing If inadequate: Provide O2 per mask or cannula High Fowler’s position Treat underlying cause BVM Advanced airway/ventilation
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Circulation Must have adequate: Pump (heart function) Vasculature Blood volume (too much or too little?)
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