1
Q
Heat-Induced Illnesses
A
- Range from Mild and self limiting to life threatening emergencies.
- Heat Stroke is most serious
- Inability to maintain cardiac output
- Most common cause is non-exertional, prolonged exposure to an environmental temp. greater than 39.2°C (102.5°F),
- Clinical manifestations resemble flu
— HA, Weakness, N/V - Treatment – Reduce Temp, Stop physical activity, transfer to a cool place
2
Q
Heat-Related Illness: Heat Stroke
A
- True medical emergency
- Body temp may exceed 104 º F (40º C)
- High mortality rate without treatment
- Exertional – Sudden onset; from strenuous physical activity in hot, humid conditions
- Non-exertional (Classic) – Occurs over period of time from chronic exposure to hot, humid environment
3
Q
Heat Stroke Complications
A
- Multiple organ dysfunction syndrome
- CNS dysfunction
- Cerebral edema
- Pulmonary edema
- Renal impairment
- Electrolyte and acid-base disturbances
- Coagulopathy
- See Chart 72-6 Preventing Heat Induced Illnesses
4
Q
Heat Stroke Treatment
A
- Stabilize CAB’s
- IV Access
- Remove Clothing
- Rapid Reduction of temp
- Cool Sheets
- Ice
- Cooling Blankets
- Immersion in cold water
- Fan
- Monitor
5
Q
An older client with heat exhaustion is being cooled with cool water spray and fanning. What assessment indicates to the nurse that the client needs hospitalization?
A
- A. The client is alert and oriented.
- B. The client’s mucous membranes are dry and sticky.
- C. The client reports weakness and nausea.
- D. The client continues to sweat while being cooled.
D?
6
Q
Which client is at greatest risk for heat exhaustion?
A
- a. A 34 year old police officer
- b. A 78 year old gardener
- c. A 42 year old swimming instructor
- d. A 24 year old construction worker
B?
7
Q
Cold-Related Injury: Hypothermia
A
- Occurs at core body temp <95º F (35º C)
- Categories by severity: Treatment depends on severity
- Mild: 90-97º F (32-36º C) - shivering, dysarthria (slurred speech), muscular incoordination, impaired cognitive abilities, and cold diuresis.
- Moderate: 82-90º F (28-32º C) - obvious motor impairment and weakness
- Severe: Below 82º F (<28º C) coagulopathy (abnormal clotting) or cardiac failure can occur.
8
Q
Cold-Related Injury: Hypothermia
A
- Cold water immersion
- Acute illness (e.g., sepsis)
- Shock states
- Immobilization
- Cold weather (especially for the homeless and people working outdoors)
- Advanced age
- Selected medications (e.g., phenothiazines, barbiturates)
- Alcohol intoxication and substance abuse
- Malnutrition
- Hypothyroidism
- Inadequate clothing or shelter (e.g., the homeless population)
- Traumatic injury
9
Q
Cold-Related Injury: Hypothermia
Teach:
A
- Proper clothing/layers
- -Prepare for cold weather
- Wear synthetic not cotton
- Wear a hat to decrease heat loss
- Face Protection including sunscreen
- Protect eyes
10
Q
Hypothermia: Pre Hospital and Hospital Treatment
Pre Hospital for Mild
A
- Sheltered from cold
- remove wet clothing
- Warm clothing or blankets (Passive)
- Drink warm fluids no caffeine or alcohol
11
Q
Hospital Care for Moderate and Severe hypothermia
A
- Prevent ventricular fibrillation – avoid external heating devices which can cause vasodilation.
- Horizontal position (supine to reduce orthostatic changes
- Maintenance of ABCs
- After-drop – cont. decrease in core body temp-return of cold blood
- Extracorporeal rewarming methods
12
Q
Cold-Related Injury: Frostbite
A
- Accompanied by initial pain, numbness, pallor of affected area
- Deep frostbite requires aggressive management in a medical facility
- First degree – least severe type hyperemia of involved area and edema formation
- Second-degree - development of large fluid-filled blisters with partial-thickness skin necrosis.
- Third-degree - small blisters containing dark fluid and affected body part cool, numb, blue, or red and does not blanch.
- Fourth-degree most severe no blisters or edema. body part numb, cold, and bloodless. gangrene develops, which may necessitate amputation of the affected part.
13
Q
Do not apply dry heat or massage the frostbitten areas as part of the warming process. These actions can produce further tissue injury.
A
14
Q
Rewarming Methods
A
- Active internal (Core) rewarming
- Passive or Active external rewarming
15
Q
An occupational health nurse is teaching a safety class to city employees who work outdoors year round. What does the nurse teach are risk factors for developing frostbite? Select all that apply.
A
- A. Excessive fatigue
- B. Prior episodes of frostbite
- C. Diabetes or other peripheral vascular disease
- D. Dehydration
- E. Smoking
- F. Wearing polyester socks
B, C, D, E?
16
Q
Non Fatal Drowning
A
- Prevention is key
- Safe rescue of victim
- Airway and cardiopulmonary support interventions
- CPR greatest influence on survivial.
- Gastric decompression
- Support of body systems
- Don’t swim alone, watch others who are not good swimmers, test depth of water before diving, avoid alcohol, use water rescue equipment.
17
Q
Non-Fatal Drowning
A
- Aspiration causes surfactant to wash out of lungs
- Pulmonary Edema
- Water Quality – contaminants
- Duration and severity of hypoxia determine outcomes
- Hypothermia might be better
- Immediate emergency care focuses on a safe rescue of the victim
- Do not attempt to get the water out of the victim’s lungs; deliver abdominal or chest thrusts only if airway obstruction is suspected.
18
Q
Therapeutic Goals
A
- Maintain perfusion
- Maintain Breathing
- Maintain Temperature
19
Q
A 2-year-old child falls into the community swimming pool and does not resurface. A lifeguard dives in to save the child. What does the lifeguard do first after the rescue?
A
- a. Rapidly rewarms the child
- b. Stabilizes the child’s spine
- c. Removes water from the child’s lungs
- d. Initiates rescue breathing on the child
D?
20
Q
Decompression sickness
A
- AKA The BENDS
- Occurs in diving, high altitude flying or flying commercial within 24 hours after diving.
- Results from formation of nitrogen bubbles that occur with rapid changes in atmospheric pressure.
- S/S – Joint or extremity pain, numbness, hypesthesia, decrease ROM
21
Q
The nurse is providing reminders to a Red Cross class about safety procedures to prevent drowning or submersion. In which situation does this present the greatest risk?
A
- a. College students going to a frat party at a boat hours
- b. Families going to the quarry to swim
- c. Children swimming at the community pool
- d. A Couple going swimming together at a local lake
A?
22
Q
Animal Bites
A
- Common reason for ED Visit
- Dogs most common
- Cats are high risk for infection
- Must be reported to public health
23
Q
Human Bites
A
- Freq. assoc. with rape and sexual assaults or battery
- Lots of bacteria in the human mouth
- Need pictures for evidence
- Cleanse with soap and water followed by antibiotics
24
Q
Snakebites Pit Vipers vs. Coral Snakes
Snakebite manifestations
A
- Severe pain, swelling/redness or ecchymosis (bruising) around bite
- Later vesicles or hemorrhagic bullae may form.
- Assess for systemic responses vs. Anxiety and panic
- Minty, rubbery, or metallic taste
- tingling or paresthesias of the scalp, face, and lips
- Muscle fasciculations (twitching) and weakness
- Nausea, vomiting, hypotension, seizures,
- Coagulopathy (clotting abnormalities) or DIC
25
Snakebite Hospital Care
- Supplemental oxygen
- IV lines for NSS or RL
- Continuous cardiac, BP monitoring
- Opioids
- Tetanus prophylaxis
- Wound care
- Broad-spectrum antibiotics
- Baseline laboratory values with CBC, CK, crossmatch
- Measure site every 15-30 mins
26
Do’s and Don’t of Snakebites
Do:
- Immobilizing affected extremity in a position of function with a splint may help limit the spread of the venom.
- Maintain extremity at level of heart.
- Keep the person warm
- Provide calm reassurance
- Give Antivemon for pit viper (CroFab Crotalidae Polyvalent Immune Fab )
Do NOT:
- Offer Alcohol
- Incise the wound
- Suck the wound
- Apply ice
- Use a tourniquet
27
Coral Snake
- Venom causes neurotoxic effects.
- Weakness, cranial nerve deficits
- Decreased LOC
- Respiratory Paralysis
- Spread via lymphatic system
- Intervention Pre hospital
— Pressure Immobilization
- Hospital
— Cardiac Monitoring, VS, ICU
— Prepare of possible intubation
— Antivenom is no longer manufactured in U.S.
— Contact Poison Control
28
The camp nurse is providing snakebite prevention tips. Which statement by a camper indicates a need for additional education?
- a. A dead snake is a safe snake
- b. Venomous snakes are not good pets
- c. Snakes are most active on warm nights
- d. Snakes should be transported in sealed containers
A?
29
Before administering Crotalidae Polyvalent Immune Fab [Ovine] (CroFab) to a client who sustained a pit viper bite, which client allergy concerns the nurse?
- A.Mangos
- B.Pineapples
- C.Sulfa Drugs
- D.Chicken
B?
30
Arthropod Bites and Stings
- Brown recluse spider bites result in ulcerative lesions
- Necrotic wound (necrotic arachnidism)
- Systemic effects (loxoscelism)
31
Brown Recluse Spider Bite: Pre- Hospital and Hospital Care
Pre
- Intermittent Cold Compresses NO HEAT
- Elevate Extremity, local wound Care and Rest
Post
- Topical antiseptic and sterile dressing
- Possible antibiotics
- Possible reconstructive surgery
- Supportive care for loxoscelism (management of renal failure, leukopenia, seizures, hemolytic anemia, coma)
32
Systemic Complications (Loxoscelism)
Manifestations include:
- Fever and chills
- Nausea/vomiting
- Kidney failure
- Hemolytic anemia
- Thrombocytopenia
- Disseminated intravascular coagulation (DIC)
- Death
33
Black Widow Spider Bite: Hospital Care
- Latrodectism
- Monitor vital signs
- Opioid pain medication
- Muscle relaxants
- Tetanus prophylaxis
- Antihypertensive agents
- Treatment of pulmonary edema, uncontrollable hypertension, shock
34
The nurse is coordinating care for a client who was bitten by a black widow spider. Which nursing action is assigned to the LPN/LVN?
- A. Monitoring for respiratory compromise in the client
- B. Providing discharge instructions to client when the family arrives
- C. Administering tetanus toxoid vaccine intramuscularly
- D. Assessing the client for neurologic changes
C?
35
Scorpions
- Most species’ venom effects are typically self-limiting; best treated by analgesics, supportive management, basic wound care
- Bark scorpion sting inflicts severe, potentially fatal systemic response
36
Scorpion Sting Interventions
- Priority to assess vital signs/continuous monitoring for symptom progression
- Use ice pack on site to control pain
- Analgesic and sedative agents
- Treat fever
- Tetanus prophylaxis
- Basic wound care
37
A 12-year-old boy comes to the emergency department (ED) after being bitten by a scorpion. Which action does the nurse perform first?
- a. Administer a tetanus shot
- b. Assess the clients vital signs
- c. Apply an ice pack to the sting site
- d. Call the poison control center
B?
38
Bees & Wasps
- Potential for anaphylactic reaction
- Emergency care to remove stinger and apply ice pack
- Advanced emergency hospital care to ensure airway, breathing, circulation
- “EpiPen” administration especially valuable for allergic patients
39
Anaphylaxis
- Life-threatening, allergic response
- TRUE medical emergency
- Symptoms:
— Respiratory distress with bronchospasm
— Laryngeal edema
— Hypotension
— Decline in mental status
— Cardiac dysrhythmias
- Allergic reaction vs. toxic venom reaction
— May be indistinguishable; both can cause same early signs/symptoms
40
Tick Bites
- Common in US
- Grassy or wooded areas
- Pathogen can cause serious disease including:
— Rocky Mountain Spotted Fever,
— Tularemia
— West Nile virus
— Lyme Disease
41
While on the school playground, a child is stung by a bee, resulting in redness and swelling. The school nurse is nearby when it happens. What does the nurse do first?
- a.Inject the child with an epinephrine pen (EpiPen auto-injector).
- b.Remove the bee and save it for evidence of the sting
- c. Apply an ice pack to the stinger
- d.Gently scrape out the stinger with a credit cared.
D?
42
Poisoning
- Substance that, when ingested, inhaled, absorbed, applied to the skin, or produced within the body in relatively small amounts, injures the body by its chemical action.
- Types:
— Swallowed
— Inhaled
— Skin Contamination (Chemical Burns)
— Food
43
The local poison control center should be called if an unknown toxic agent has been taken or if it is necessary to identify an antidote for a known toxic agent
44
Carbon Monoxide
S/S:
- Possible industrial or household incident
- Suicide
- Binds to Oxygen
- Signs and Symptoms
— Headache
— Muscular weakness
— Palpitation
— Dizziness
— Confusion
— Skin Changes
45
Carbon Monoxide Treatment
- Goal to reverse cerebral and myocardial hypoxia
- Eliminate Carbon Monoxide
- Move patient to fresh air
- Loosen all tight clothing
- CPR
- Prevent Chilling
46
Substance Abuse
Management of the Patient With Substance Abuse
- Acute alcohol intoxication: a multisystem toxin
- Alcohol poisoning may result in death
- Maintain airway and observe for CNS depression and hypotension
- Rule out other potential causes of the behaviors before it is assumed the patient is intoxicated
- Use a nonjudgmental, calm manner
- May need sedation if noisy or belligerent
- Examine for withdrawal delirium, injuries, and evidence of other disorders
47
Violence Abuse and Neglect
Management of the Patient with Sexual Assault
- Management goals:
— Provide support
— Reduce emotional trauma
— Gather available evidence for possible legal proceedings
- Nurses may be SANE certified
- Physical exam
- Specimen collection
- Treating consequences: STIs, pregnancy
- Encourage follow-up care
48
Human Trafficking
- Most rapid growing area of criminal activity in the world
- Defined as: “use of force, fraud, or coercion for the purpose of subjection into involuntary servitude” (Solheim, 2016)
- Data shows 20 million people are trafficked, with at least 17,000 in the United States
- These people have limited access to healthcare
49
Victims of Human Trafficking
- May present to ED with injury, accompanied by boyfriend or travel partner
- Hx of chronic runaway, homelessness, self-mutilation
- Common behaviors: cowering, frightened, agitated, deferring to the person accompanying them
- Common complaints: injuries, poor healing, abd pain, dizziness, headaches, rashes or sores
- May demonstrate behaviors: addiction, panic attacks, impulse control, hostility, suicide ideations
50
Nursing Role and Interventions for Victims of Human Trafficking
- Offer opportunity for patient to speak alone, without companion
- Use targeted, appropriate questions:
— Are you in control of your own money?
— Are you able to come and go as you please?
— Who is the person(s) accompanying you?
- May decline assistance
- Resource: The National Human
— Trafficking Hotline
51
Suicidal Patients
- Males more successful
- Unusual loss can be a trigger
- 1st manage consequence of attempt
- 2nd focus on prevention
- Signs and Symptoms
- Communication
- History
- Family History
- Loss of a parent at an early age
- Plan
- Means to carry out plan
52
Emergency Care: Overactive Patients
- Overactive patients, violent behavior, underactive, or depressed patients and suicidal patients
- Management
— Maintain the safety of all persons and gain control of the situation
— Determine if the patient is at risk for injuring him- or herself or others
— Maintain the person’s self-esteem while providing care
— Determine if the person has a psychiatric history or is currently under care to contact that therapist
- Crisis intervention
- Interventions specific to each of the conditions
53
A patient is brought into the ED after becoming ill while working on a construction site. During the assessment he reports weakness, nausea, and vomiting. His blood pressure is abnormally low, and he reports severe left lower leg pain. What is this patient most likely suffering from?
A. Snakebite
B. Heat exhaustion
C. Myocardial infarction
D. Brown recluse spider bite
D?
54
A 21-year-old woman comes to the ED displaying signs of respiratory distress. She is anxious and believes she was stung by a wasp while gardening in her yard. She states she has not been stung since she was a child, at which time she had a severe reaction that required hospitalization for a day. What is the appropriate nursing intervention?
A. Prepare to administer epinephrine IM, oral diphenhydramine, and oxygen.
B. Remove the stinger, apply ice to the area, and administer oral diphenhydramine.
C. Obtain vital signs, administering oxygen, and prepare to administer epinephrine intravenously.
D. Prepare to administer oral diphenhydramine, followed by epinephrine IM, and establish an IV infusion with normal saline.
D?
55
A woman is brought to the ED by her boyfriend. They were hiking when they were caught in a snowstorm, and now she has severe frostbite on her feet. The boyfriend had applied dry chemical warmers and was rubbing her feet before she was admitted. The nurse expects these actions to result in which outcome?
- A. Reduced area of injury
- B. Possible further tissue injury
- C. Reduced swelling of the injured area
- D. Less pain during the rewarming session
B?
56
Clients who have been admitted to the emergency department (ED) are assessed by the ED triage nurse for an oncoming shift. Which client is most appropriately assigned to an LPN/LVN?
- a. A 59-year-old who was hiking and is now confused, and has crackles throughout all lung fields
- b. A 72-year-old stung by an unknown insect who reports shortness of breath
- c. A 24-year-old with heat exhaustion, receiving an IV of normal saline, with normal chemistry laboratory results and a temperature of 37° C
- d. A 48-year-old reporting right forearm swelling secondary to a “bug bite” with capillary refill in the right hand of greater than 3 seconds
C?
