1
Q
What are the responsibilities of an Emergency RN?
A
Special training and certification
- Prioritizes, monitors & assesses patients
- Supports & attends to family
- Supervises & delegates to allied healthcare personnel
- Educates patient & family
Emergency RNs play a crucial role in patient care and family support.
2
Q
What does EMTALA stand for?
A
Emergency Medical Treatment and Active Labor Act
It mandates medical screening exams for patients with ER complaints.
3
Q
When an EMTALA patient is transferred, what must be completed?
A
- Consent to transfer (if unable, document why)
- Must have an accepting provider and receiving facility
- Must have an appropriate transfer method (e.g. helicopter or ambulance)
- Documentation of ALL assessments and interventions must be sent with the pt.
4
Q
When is a medical screening exam mandated through EMTALA?
A
- When their acute s/sx could result in serious injury or death if left untreated
- Or, pt. is in active labor
5
Q
What is the first priority in Emergency Nursing?
A
Safety
6
Q
What are some safety measures taken in emergency nursing to prevent violence?
A
- Hand or ankle restraints are never released for DOC, guard is always present
- Mask can be placed to prevent spitting or biting
- Physical restraints on any violent patient
- Distance maintained from patient
- No jewelry
- No stethoscopes around neck
- Maintain escape route
- Objects not left in patients reach
7
Q
What is the most common type of violence faced by ED staff?
A
Verbal Abuse
8
Q
What are some patient and family focused interventions to promote safety?
A
- Actions to relieve anxiety and provide a sense of security
- Allow family to stay with patient, if possible, to alleviate anxiety
- Provide explanations and information in terms that are easily understandable
- Appoint a family liason
- Human contact and reassurance
- Referral for a Family Facilitator
9
Q
What are the three categories of the Basic Triage System?
A
- Emergent: Highest priority (ABCs)
- Urgent: Serious health problems, but not life threatening
- Nonurgent: Episodic illness
10
Q
What is the Emergency Severity Index (ESI)?
A
Triage system with levels 1-5
Level 1 = most urgent
Level 5 = least urgent
11
Q
What is the Triage Bypass System?
A
- Decreases wait times
- Moves the pt. directly to an open bed in the ED
- Receiving RN does initial assessment and Vitals
12
Q
What is the Team Triage System?
A
- Triage RN and HCP work together to triage
- Move patients to diagnostics and possible discharge without full ED admission
- Also called PIT = Provider in Triage
13
Q
What is included in the Primary Survey in emergency nursing?
A
A: Airway: Establish airway
B: Breathing: Provide adequate ventilation
C: Circulation: Evaluate and restore cardiac output; control hemorrhage; prevent and treat shock
D: Disability: Determine neurologic status; AVPU
E: Exposure: Undress to assess wounds or areas of injury
14
Q
What is included in the Secondary Survey in emergency nursing?
A
- Health history
- Head to toe assessement
- Reassess airway, breathing, vital signs
- Diagnostic and lab testing
- Monitoring devices: ECG, arterial lines, urinary catheters
- Splinting of fractures
- Wound care
- Other interventions based on condition
15
Q
What are some signs of a compromised airway?
A
- Inability to speak, cough, or breathe
- Refusing to lie flat
- Inspiratory and expiratory stridor
- Labored breathing, use of accessory muscles
- Weak, ineffective cough
- Breathing but unconscious
- Burns on face, singed nose hairs, swelling lips
- Cyanosis and loss of consciousness are LATE signs
16
Q
What must be assessed after an artificial airway is inserted?
A
- Breath sounds - equal and bilateral
- ABGs
- SpO2
- Capnography
17
Q
What needs to be done in regards to collecting forensic evidence with a trauma or death?
A
- Pts. can not be left alone in suspicious trauma or death
- Meticulous documentation of every wound with pictures
- Clothing collected in paper bag
- Valuables to family or security and documented
- Wet clothes hung to dry
- Fingernail clippings for tissues
- Document exact words in quotes
- All tubes and lines stay in place with a suspicious death
18
Q
What happens to the lungs when they are unable to expand due to salt water?
A
Change in osmotic pressure ⇒ pulmonary edema
Increased risk for ARDS with associated hypoxia, hypercarbia, respiratory/metabolic acidosis.
19
Q
What are the priorities for a patient with multiple trauma?
A
Single catastrophic event that causes life-threatening injuries to at least two distinct organs or organ systems
- Requires a team approach
- ABCs
- Life saving interventions first
- Expose pt. and quickly assess next
- Always assume a spinal cord injury until ruled out
20
Q
What does the AVPU mnemonic stand for in assessing disability?
A
- Alert: Is the patient alert and responsive?
- Verbal: Does the patient respond to verbal stimuli?
- Pain: Does the patient respond to painful stimuli?
- Unresponsive: Is the patient unresponsive to all stimuli?
This mnemonic helps determine neurologic status.
21
Q
What are the focused assessments for an internal hemorrhage?
A
Inspect front of the body, flanks, and back
- Bluish discoloration?
- Asymmetry?
- Abrasions?
- Contusions?
Abdominal US - FAST
- Rapidly assess patients who are hemodynamically unstable through ultrasound
22
Q
What are the focused assessments for an Intraperitoneal injury?
A
- Assess for tenderness, rebound tenderness, guarding, rigidity, spasm, increasing distention, and pain
- Diagnostic peritoneal lavage
- Abdominal US
- Abdominal CT
23
Q
What is the overall management for intra-abdominal injuries?
A
- ABCs - First priority!
- Spinal precautions: Backboard, C-Collar, Log rolling
- Wounds: locate, measure, document
- Protuding viscera? Cover with sterile saline dressing
- NPO
- NGT/OGT for decompression
- Infection prevention: TDaP and Broad Spectrum ABx
- Constant monitoring
- Prepare for possible surgery
24
Q
What is the overall management for Crush Injuries?
A
- ABCs - FIRST priority!
- Assess for Rhabdomyolysis
- Monitor CK and lactic acid
- Any major soft tissue injuries? Splint to control bleeding and pain
- Extremity injury? Elevate to control swelling and pain
- Assess for compartment syndrome - restore neurovascular function with fasciotomy
- Medicate for pain and anxiety
- Prepare for possible surgery
- Hyperbaric Oxygen chamber
25
What is the **classic triad of Rhabdomyolysis**?
* Myalgias
* Generalized muscle weakness
* Darkened urine
## Footnote
Recognizing these symptoms is crucial for timely intervention.
26
Who is most at risk of **heat stroke**?
* Individuals not acclimated to heat
* Older or very young people
* Ill or debilitated people
* Individuals taking medications
27
What are the **manifestations of heat stroke**?
* CNS dysfunction
* Elevated temperature (≥40.6°C, 105°F)
* Hot dry skin
* Anhidrosis
* Tachypnea
* Hypotension
* Tachycardia
## Footnote
***These symptoms indicate a failure of heat-regulating mechanisms.***
28
What is the first priority in managing a patient with **heat stroke**?
**ABCs (Airway, Breathing, Circulation)**
## Footnote
***Immediate cooling is also critical to prevent further complications.***
29
What is the overall **management** of **heat stroke**?
* **ABCs**
* Reduce temperature to 39.2°C as quickly as possible
* Cool using: cool sheets, towels, sponges with cool water; ice to neck, groin, chest, and axillae; cooling blankets; immersion in cold water bath
* Monitor temp, VS, ECG, CVP, LOC, I&Os
* IVF Replacement
* Medications: Anticonvulsants, potassium, sodium bicarbonate, benzodiazepines
30
What is the goal of **frostbite management**?
**Restore normal body temperature**
## Footnote
***This includes removing constrictive clothing and wet clothing.***
31
What are some **clinical manifestations** of **frostbite**?
* Hard, cold, insensitive to touch
* White or mottled
* Poor judgment, apathy, ataxia, dysarthria, drowsiness
* Pulmonary edema
* Acid base imbalances
* Coagulopathy
* Shivering may be suppressed
* Absent peripheral pulses
* Cardiac arrhythmias
* Hypoxia
32
What is **Passive external rewarming**?
**Over the bed heaters to the extremities**
*This increases blood flow to the acidotic, anaerobic extremities.*
## Footnote
***Used for mild hypothermia***
33
What is **Active External Rewarming**?
**Forced-air warming blankets**
*Be sure to prevent extremity burn from these devices due to decreased sensation*
## Footnote
***Used for mild hypothermia***
34
What is **Active internal rewarming**?
* Cardiopulmonary bypass
* Warm fluid administration
* Warmed humidified oxygen by ventilator
* Warmed peritoneal lavage
## Footnote
***Used for moderate to severe hypothermia***
35
What are the **risk factors** for drowning?
* Age (< 5 years & > 85 years)
* Alcohol use
* Inability to swim
* Diving injuries
* Hypothermia
* Exhaustion
36
What are the **priorities** in drowning management?
* Maintain cerebral perfusion
* Manage hypoxia
* Address acidosis
* Treat hypothermia
## Footnote
***These priorities are essential to prevent end organ damage.***
37
What is the purpose of **Critical Incident Stress Management (CISM)**?
* **Defusing** *(Immediately after event)*
* **Debriefing** *(1-10 days after event)*
* **Follow Up** *(if needed, extra support)*
## Footnote
***These steps help ED staff cope with stress after critical incidents.***
38
What happens to the lungs when **salt water** is aspirated?
Change in osmotic pressure ⇒ pulmonary edema
## Footnote
***Increased risk for ARDS with associated hypoxia, hypercapnia, respiratory/metabolic acidosis.***
39
What happens to the lungs when **fresh water** is aspirated?
Loss of surfactant ➡️ unable to expand lungs
40
What specific interventions should be done in **cold water drowning** cases?
* Core temperature monitoring
* Rewarming started during resucscitation
41
What is the overall **management** of drownings?
* **CPR!**
* Serial CXR, ABG, and electrolytes
* If unconscious - ETT and vent support
* Breathing and airway protected? Oxygen via mask
* Fluid resuscitation
* Inotropic IV agents
* Telemetry monitoring
* Strict UOP monitoring
* NGT
* ICP measurement
42
What are **drowning** patients at an increased risk for?
* AKI
* Hypoxic or ischemic cerebral injury
* ARDS
* Cardiac arrest
* Aspiration
* Acid-base imbalances
43
What age group is at the **highest risk** for snake bites?
1-9 years old
## Footnote
***Most bites occur during the day or early evening in the summer months.***
44
What percentage of snake bites result in **envenomation**?
75%-80%
## Footnote
***The remainder are classified as 'dry bites'.***
45
What are the **classic manifestations** of a snake bite?
* Ecchymosis
* Edema
* Hemorrhagic bullae leading to necrosis
* Lymph node tenderness
* Nausea/Vomiting
* Numbness
* Metallic taste in the mouth
## Footnote
***Without treatment, symptoms can progress to fasciculations, hypotension, paresthesias, seizures, and coma.***
46
What is the **indication for antivenin administration**?
* Coagulopathy
* Systemic reaction
47
When should **antivenin** be given to be the most effective?
Antivenin is most effective when given within 4 hours of the bite and no later than 12 hours.
48
What should be done if an antidote is available for ingested poisoning?
Give ASAP
## Footnote
Ineffective methods include removing or diluting the ingested substance.
49
What is the **nursing management** when giving **antivenin**?
* Measure the circumference of the extremity before administration and Q15min *(after 1st dose - change to Q30-60min for 48 hrs)*
* Pre-medicate with histamine blocker
* IV antivenin is preferred - but can do IM
* Dilute antivenin with 500-1000 mL NS
* Rate - start slow, increase after 10 minutes if no reaction
* Total amount should be infused within 4-6 hours after bite
50
What is the **management** for **Ingested poisons**?
* **ABCs!**
* Monitor VS, EKG, LOC, UOP
* Labs - determine concentration of drug/poison
* Details on what, when, how much was ingested
* Health history
* Remove toxin or decrease absorption *(activated charcoal, dialysis, or hemoperfusion)*
* Give antidote ASAP if available
* Give milk or water to dilute corrosive substance
* Gastric lavage - only within 1 hour of ingestion *(not used as much anymore)*
* seizure precautions *(2/2 CNS stimulation or oxygen deprivation)*
51
What are the interventions if an **allergic reaction** develops to **antivenin**?
* **STOP** infusion
* Diphenhydramine IV
* Vasopressors for shock
*(Resuscitation equipment nearby during administration)*
52
What is the **management goal** for **carbon monoxide** poisoning?
* Reverse cerebral & myocardial hypoxia
* Hasten elimination of carbon monoxide
53
What are the **manifestations** of **carbon monoxide** poisoning?
* Headache
* Muscular weakness
* Palpitations
* Dizziness
* Confusion
* Coma
## Footnote
***Skin color may appear pink or cherry-red to cyanotic and pale. Not a good indicator***
54
What is the **management** of **carbon monoxide** poisoning?
* **ABCs!**
* Move patient to fresh air if possible
* Open all doors and windows
* Loosen all tight clothing
* Prevent chilling, wrap in warm blankets
* Keep patient as quiet as possible
* Do not give alcohol or allow patient to smoke
* Monitor carboxyhemoglobin levels
* 100% oxygen given at atmospheric or hyperbaric pressures
* Monitor VS
55
What is the **treatment** for **chemical burns**?
* Remove wet chemicals with copious amounts of water
* Gently brush off dry substances before the area is flushed
* Determine identity and characteristics of the agent
* Abx
* Debridement
* Tetanus prophylaxis
* Antidote administration
* Plastic surgery for wound management
* Reexamine at 24H, 72H, and 7 days
## Footnote
***Severity determined by mechanism of action, penetrating strength, concentration, and duration of exposure.***
56
What is the **management** of **Alcohol withdrawal** in the **ER**?
* Substance Hx
* Monitor vitals *(Q30min)*
* Benzodiazepines
* Delirium Tremens? Haloperidol, esmolol, midazolam
* Calm, nonstressful environment
* Lights on
* Bathroom and closet doors closed
* IV and PO fluid replacement
* Referral to rehab/treatment facilities
57
What are the **symptoms** of **Delirium Tremens**?
**48 - 96 hours after last ETOH**
* Visual, tactile, olfactory, auditory hallucinations
* Agitation
* Tachycardia
* Hypertension
* Dilated pupils
* Hyperthermia
* Profuse perspiration
## Footnote
***Most severe form of alcohol withdrawal syndrome.***
58
What are the **three stages** of **Rape Trauma Syndrome**?
**Acute phase** *(days to weeks after)*
* Expressed, controlled, or shocked disbelief
**Outward adjustment phase**
* 5 coping techniques: minimization, dramatization, suppression, explanation, fight
**Resolution phase**
59
What is the **nursing managment** for a **survivor of sexual assault**?
* Treat any identified injuries
* Gather hx of event
* Provide emotional support
* Gather complete physical exam, explaining need for each part of exam
* Urine sample and toxicology within 96 hours
* Offer prophylaxis: ceftriaxone IM, metronidazole PO, Azithromycin PO or Doxycyline PO
* Pregnancy prevention (PO contraceptive - most effective 12-24 hrs after)
* Antiemetic
* Offer cleansing douche, mouthwash, fresh clothing
* Counseling for pt and family
* Referral to National Sexual Assault hotline
* STI/HIV testing
* Accompanied out of ED with family or friend
60
What are **common behaviors** of victims of **human trafficking**?
* Cowering
* Frightened
* Agitated
* Deferring to the person accompanying them
61
What are the **nursing interventions** for victims of **human trafficking**?
* Offer opportunity for patient to speak alone
* Use targeted appropriate questions
* Resource: The National Human Trafficking Hotline
62
What are the typical **Trauma Care** interventions?
**Decrease risk for hypothermia:**
* Remove wet clothing
* Cover with warm blanketss
* Infuse warm IVF
**Decrease risk for hypovolemia:**
* Large amount of fluid resuscitation - use LR *(with caution)*
* Blood administration
**Monitoring:**
* Hemodynamic status
* Body temperature *(internal urinary catheter probe is most accurate)*
63
What are **signs** of **hypovolemic shock**?
* Cool, moist skin
* Hypotension
* Tachycardia
* Delayed capillary refill
* Decreased UOP
64
What is the **nursing management** for **Fluid replacement** due to **hemorrhage**?
* 2 Large Bore PIVs needed - in large veins *(ACs)*
* Type and screen collected
* Administer Isotonic Fluids: LR, NS, colloids, PRBCs
* Blood products should be warmed
* Manage rapid infuser *(Belmont)*
65
What is the **management** for an **internal hemorrhage**?
* Rapid infusion of PRBCs, platelets, plasma
* Surgery
* Pharmacologic therapy
* ABGs
* Supine position
* Close monitoring
66
What is the **management** for an **external hemorrhage**?
* Rapid assessment of wounds/source of bleeding
* Direct and firm pressure
* Pressure dressing
* Elevation of injury
* Immobilize injured/bleeding extremity
* Tourniquet *(possibly)*
67
What is the **goal** of **psychiatric** emergency management?
Maintain safety of all persons and gain control of the situation
## Footnote
***Determine if the patient is at risk for injuring themselves or others.***
NRS 202 Exam #1
flashcards
Decks in class (10)
# Cards
