Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 37

1. Medical-Surgical Nursing: An Integrated Approach, 2E Chapter 37 NURSING CARE OF THE CLIENT: RESPONDING TO EMERGENCIES

2. Emergency: Defined as: • A medical or surgical condition requiring immediate or timely intervention to prevent permanent disability or death. • In the U.S., trauma is the number one killer of those under the age of 37 and the fourth leading cause of death overall.

3. Emergency Nursing • The care of clients who require emergency intervention. • The emergency nurse must be capable of rapid assessment and history taking and immediate intervention formulation and implementation using the nursing process. • Clinical knowledge, communication, client teaching, and empathy skills are essential.

4. Approaches to Emergency Care • There are three general approaches to emergency care: • Hospital triage. • Disaster triage. • Emergency medical services.

5. Hospital Triage • Triage refers to classification of clients to determine priority of need and proper place of treatment. • Each hospital with an emergency department (ED) has an established triage system in place.

6. Golden Rules of Emergency Care • Establish the safety of the scene. • Remove the client from danger. • Establish airway, breathing, and circulation. • Manage shock. • Attend to eye injuries. • Treat skin injuries. 7. Call for help.

7. Triage Classifications • Emergent (clients who require immediate care in order to sustain life or limb). • Urgent (clients who require care within 1 to 2 hours to prevent worsening of their condition). • Non-urgent (clients whose care can be delayed without the risk of permanent consequences).

8. Disaster Triage CATEGORY CLIENT NEEDS EXAMPLES

9. Emergency Medical Services • Prior to admission to the ED, the client may have been cared for by an emergency medical technician (EMT) or paramedic. • An EMT is a health care professional trained to provide basic lifesaving measures prior to arrival at the hospital. • A paramedic is a more specialized health care professional trained to provide advanced life support to the client requiring emergency interventions.

10. Shock: Defined as: • A condition of profound hemodynamic and metabolic disturbance characterized by inadequate tissue perfusion and inadequate circulation to the vital organs.

11. Types of Shock

12. Cardiopulmonary Emergencies • Those that jeopardize the function of the hearts and lungs. • Include drowning, foreign body obstruction of the airway, chest trauma, and chest pain.

13. Neurological/Neurosurgical Emergencies • Head injuries are the most common type of neurological trauma. • Spinal cord trauma can also occur as a result of injuries sustained in a head injury. • Head injuries most common in motor vehicle collisions. • Cerebrovascular accidents, or stroke, also require emergency care.

14. Abdominal Emergencies • Abdominal emergencies can be diverse in nature. • Include trauma as well as illnesses that cause abdominal pain (gastroenteritis, gastrointestinal bleeding, etc.).

15. Genitourinary Emergencies • Include rape. • Straddle injuries (those that occur when a client falls while straddling an object, such as a fence or metal bar, thereby injuring the perineum).

16. Ocular Emergencies • Most eye emergencies are urgent to emergent in nature. • Foreign bodies can cause damage to vision very rapidly and thus require immediate attention.

17. Musculoskeletal Emergencies • Can vary from simple strains to major trauma. • Includes sprains, dislocations, fractures.

18. Soft Tissue Emergencies • Most soft-tissue injuries are very common, including minor abrasions, lacerations, puncture wounds, contusions, bites of all varieties, and burn injuries. • Although most do not require emergency care, some are more severe than others and some are potentially fatal.

19. Poisoning and Overdoses • Can be accidental or intentional. • Ingested poisons are most common. • Important to obtain a clear history of the route of entry: inhalation, ingestion, topical, or injection.

20. Environmental/Temperature Emergencies • Exposures to extremes of heat and cold can be potentially life threatening. • Severe cold, or hypothermia, frostbite, extreme heat are examples.

21. Degrees of Frostbite Severity DEGREE SYMPTOMS TREATMENT

22. Comparison of Heat Injuries TYPE SYMPTOMS TREATMENT

23. Multiple System Trauma • Injury sustained in more than one body system. • During the initial care of the emergency client, the mechanism of injury is determined. • Blunt injuries and penetrating trauma are most likely to result in multiple-system involvement.

24. Legal Issues • Nurses must be aware of the legal issues related to emergency care, such as Good Samaritan Laws and mandated reporting.

25. Death in the Emergency Department • Death can occur in the ED at any time due to trauma, sudden illness, or even extended illness. • In the event of sudden death, the family is usually in a state of shock and will need further assistance to cope with the death of their loved one. • Special support groups are available for this assistance and should be contacted for the family.