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04/10/2010 01:53:00

EMERGENCY/DISASTER NURSING
Emergency Action Principles
Use to get an accident situation under control quickly.

Survey the scene


CALL 911/ EMERGENCY RESPONSE TEAM
Do a primary survey
A-- AIR WAY
B-- BREATHING
C-- CIRCULATION
D-- DISABILITY
E-- EXPOSURE
H-- HEMORRHAGE
S-- SPINALCORD INJURY

Airway:
Is it open? Minimize neck movements much as possible; apply
cervical collar if available.
2 ways in opening the airway
**Head Tilt Chin lift maneuver
**Jaw thrust maneuver
Breathing:
Is the victim breathing? check ( 3 5 sec.)
L ---- look, L ---- listen,
F ---- feel.

Circulation
Is there a palpable carotid pulse for adult and brachial pulse for
child and infant.
Check ( 10 sec. )
Disability
Is there injury to the nervous and musculoskeletal systems?
Stabilize C- spine.
Exposure:
Remove victim from offending environment. If necessary, place tent over
victim.
Hemorrhage :
look for Severe blood loss, CSF leak.

SPINALCORD INJURY :
check for the sensory response, and obvious deformity on the spine.

Yellow / Observation **2nd priority**


Their condition is stable for the moment but requires
watching.
Green / Wait (walking wounded)**3rd prioity**
They will require a doctor's care in several hours or days but
not immediately, may wait for a number of hours or be told to go
home and come back the next day.
White / Dismiss (walking wounded)*4rth priority*
They have minor injuries; first aid and home care are sufficient, a
doctor's care is not required

Shock
is a critical physical condition due to failure of the circulatory
system to maintain adequate blood flow in the body and ceases the
delivery of oxygen and nutrients to vital organs.

BASIC CAUSES OF SHOCK

Three stages of shock

THE COMPENSATORY STAGE OF SHOCK

patients blood pressure is within normal limits. shunted from the


kidney, skin and GIT to the vital organs- brain, liver.

PROGRESSIVE STAGE OF SHOCK

regulate blood pressure can no longer compensate and the mean


arterial The overworked heart becomes dysfunctional.

IRREVERSIBLE STAGE OF SHOCK

there is severe organ damage that patients do not respond


anymore to treatment. Survival is almost impossible

SIGNS AND SYMPTOMS

1. Early Stage:

Pallor/cyanosis, cold/clammy skin, shallow and irregular


breathing, rapid and weak pulse,
pupil.

nausea and vomiting, thirst, dilated

2. Late Stage:
vacant eye, apathetic/unresponsive, mottled
appearance, decreased blood pressure, decreased temperature.

TYPES OF SHOCK
1. Cardiogenic Heart stop to pump due to heart dse.
2. Anaphylactic --- Severe allergic Reaction
3. Hypovolemic --- Severe fluid loss
4. Psychogenic --- cause by anxiety, fears, altered adaptation in
traumatic experience
5. Neurogenic --- cause by spinal fracture or dislocation
6. Metabolic --- loss of body fluids
7. Respiratory ---- air way obstruction and hyperventilation
8. Septic --- severe bacterial infection

Body response to shock

Hyven - Hyper ventilation ->

Respiratory alkalosis

Flu - Fluid Shifts Intracellular to

intracellular

V-

Vasoconstriction

CT -

Tachycardia

IM - Impaired metabolism and organ

function
Drugs Used To Treat Shock

C Corticostiroids use in septic shock

protect cellmembranes and decrease


inflammatory response to stress

A Antibiotics infectious process related to

septic shock

N - Norephineprine (levophed) improve

cardiac contractility and cardiac output potent


vasoconstrictor

D Dopamine (Intropin) perfusion of kidneys

& urine output

D - Dobutamine (Dobutrex) increase

myocardial contractility, vasodilator.

D - Digitalis preparation improve cardiac

performance

I - Isoproterenol (Isuprel)increase myocardial

contractility

S - Sodium Nitropusside Vasodilator, increase cardiac

output, use in cardiogenic shock, and hypertensive emergency.

Emergency Nursing Management


M - Maintain patent airway and adequate

Ventilation.

P - Promote restoration of blood volume;administer


fluid and blood replacement as ordered
A - Administer drugs as ordered
M - Minimize factors contributing to shock.
M - Maintain continuous assessment of the client.
P - Provide psychological support and keep family advised
P - Provide Nutritional support
M - Modified trendelenburge to promote venous return to the

heart

Wound
A bodily injury caused by physical means, with disruption of
the normal continuity of structures.
S/S
Pain and tenderness
Swelling
Discoloration
Hematoma
Uncontrolled restlessness
Thirst
Symptoms of shock
Vomiting or cough-up blood
Passage of blood in the urine or feces
Sign of blood along mouth, nose and ear canal

CLOSED WOUND
Cause by a damage of a tissue with in the layer of the
skins and to the layer of the skin without breaking the continuity
of the skin.

Contusions (more commonly known as a bruise)


caused by blunt forc trauma that damages tissue under the

skin.
Hematoma- (also called a blood tumor)

caused by damage to a blood vessel that in turn causes


blood to collect under the skin.
Crushing Injuries

caused by a great or extreme amount of force applied over a


long period of tissue

Nursing Management
I ICE APPLICATION (10 15 Min )
C -- COMPRESSION ( DIRECT PRESSURE )

E ELEVATION ( ABOVE THE HEART )


Open Wound
IS A BREAK IN THE CONTINUITY OF THE SKIN
RESULTING
IN SHEDING OF BLOOD, AND CREATATING A PORTAL OF ENTRY
FOR
MICRO ORGANISM.

P PUNCTURE * Use by sharp and pointed object

A ABRASION *( grazes) - a superficial wound in which the


topmost
layer of the skin (the epidermis) is scraped off.
S SUCKING WOUND * a penetrating wound of the chest
through which air is drawn in and out.
A AVULSION *The forcible tearing away of a body part by
trauma.
L LACERATION *Tissues are torn. An even cut.
I NCISION * One caused by a cutting instrument. Clean cut.

EMERGENCY CARE PROCEDURES:


Wash --wash the wound

Co Control bleeding
co Cover the wound
Lo Look for drop BP and TEMP.
Co Consult a doctor
Bruises, strains, sprains, dislocations.
Use rice.
Amputation
Control Bleeding
Find the severed part Seek Immediate medical attention.
Chest Injuries
Check ABC
Stabilize Chest using pillow, coat or blanket.
Seek medical attention
Do not remove impaled object.
Eye injuries
1. Protect injured eye
2. Patch unaffected eye
3. Do not remove object stuck on the eye
Do not apply hard pressure
Fracture
EMERGENCY CARE PROCEDURES:
A -- Avoid putting pressure on he affected area
R Rest ( 20-30 min q 2 3 hrs. in 1st 24 48 hrs )
I Ice application
S splint ( use to stabilize )
Head and Spinal Injury

EMERGENCY CARE PROCEDURES:


S - Stabilized the spine

Co - Control bleeding
As - Asses for bladder distention
and pineal erection
Do - Do not irrigate or clean the
skull wounds
Do - Do not stop the flow of blood or
CSF from the ear or nose
N - NPO
Co - Consult a doctor

Burns Injuries that involve the skin, muscle and even


the bones.
Classification
First degree: Superficial only involves epithelial layer. Often very
painful but resolves with no
residual scarring. Skin is red and painful but no blisters.

Second degree:* Partial thickness* involves epithelium and


part of dermis. Pain and scarring
vary according to depth of burn. With
blister formation.

Third degree : *full thickness*. Usually painless. Usually dry


and have milky white or tanned leather
appearance.

EMERGENCY CARE PROCEDURES

So -- Soak in cold water/ apply cold dressing

( w/o open wound or prick blister)


1st degree do not cover w/ dressing

SO -- Soak in cold water/ apply cold

dressing

Cover the wound w/ non sticky dry

sterile dressing /clean cloth

( 2nd degree w/ open wound and)

CO -- Cover the wound w/ non sticky dry

sterile dressing /clean cloth

3rd degree

A a blister has formed, do not prick it.


Co -- Consult you Physician.
Chemical Burns
Wa wash with water for 15 min.
Kee Keep eye open, flush with water
or milk immediately.

Heat Emergencies in Humans


Unexpected changes in the weather
2 basic environmental emergencies
2E
exposure to heat
exposure to cold

Signs and symptoms


** rapid, shallow breathing
** cold, clammy skin,
**heavy perspiration
**general weakness,
** possible loss of consciousness.
Heat Cramps
CAUSE BY ELECTROLYTES IMBALANCE,

ARTICULARLY EXESIVE LOSS OF SALT.


EMERGENCY CARE PROCEDURES:
Move - Move victim to a cool place.
Give - Give fluids, preferably

with electrolytes.
Massage - Massage affected muscles (firm

pressure massage).
Apply - Apply moist towels to forehead and

cramped muscles.
Call - Call for transportation to medical care

if symptoms persist.

Heat Syncope
Result from intense sweating which lead to dehydration followed
by perripheral vasodilation.

Heat Exhaustion
Heat exhaustion is a more serious result of heat exposure.
CAUSE BY ELECTROLYTES IMBALANCE,PARTICULARLY
EXESIVE LOSS OF SALT.

HEAT STROKE
Cause by a extreme body temp. that the body was not able to
regulate it and related also to impaired sweating mechanism.

EMERGENCY CARE PROCEDURES


Activate EMS system (call 911)
Move - Move victim to a cool place.
Rest - Rest victim.
Remove - Remove enough clothing to cool.
Give - Give fluids with electrolytes
(to conscious victims only).Treat for shock.
Victim - Victim needs high concentration of
oxygen.
Call - Call for transportation to definitive
medical care.
Hypothermia
Get the victim out of the cold
Replace wet cloths with dry warm cloths.
Keep flat and provide other source of heat.
NO. No. Things
Do not give warm drinks
Do not wrap with blanket unless with out other source of heat.
Do not engage with physical exertion.

Stroke
**occurs when a blood vessel in the brain is blocked or bursts.
Without blood and the oxygen it carries, part of the brain starts to die.

S/S

Numbness, weakness, or paralysis of the face, arm, or leg,


especially on one side of the body.

Trouble seeing in one or both eyes. You may have double vision, or
things may look dim or blurry.

Confusion or trouble understanding.

Slurred or garbled speech.

Trouble walking. You may feel unsteady, dizzy, or clumsy.

Severe headache.

Causes

** thrombus/ ischemic/ clot**

Risk factors

Atrial fibrillation

Hypertension

DM

Smoking

S/S of affected part of the Brain

2 types of stroke
a. ischemic stroke develops when a blood clot blocks a blood vessel
in the brain.

b. hemorrhagic stroke develops when an artery in the brain leaks or


bursts.

TIA Acute neurogical deficit lasting for 24 hrs.

S/S

Pt is irritable

2. Pt appears in a deist

3. Disarchia

4 Temporary blindness

EMERGENCY CARE PROCEDURES:

** Check for ABSDEHS**

** keep in side lying position**

**Seek immediately medical help.

SEIZURES

due to uncontrolled electrical activity in the brain causes


involuntary muscle contraction.

EMERGENCY CARE PROCEDURES:

1.
2.
3.
4.

Do not move/stimulate the victim


Ensure safety remove all near by objects
after seizure loosen tight clothing's turn to side
Consult a doctor

DIABETIC EMERGENCY
EMERGENCY CARE PROCEDURES:
** provide sugar (candy, soda,frit juice)
**Consult a doctor
ASTHMA
EMERGENCY CARE PROCEDURES:
1. RELAXATION TECHNIQUES pursed lip breathing
2. SIT Up RIGTH
3.Assist the victim in his meds.
4. Consult a doctor

Cardiac Arrest
-- Occurs when the heart stop pump, or it pumps
insufficient blood causing deprivation of o2 to the vital organs.

THREE CONDITIONS OF CARDIAC ARREST

1. CA -- CARDIO VASCULAR COLLAPSE

2. VE -- VENTRICULAR FIBRILLATION

3. CAR -- CARDIAC STANDSTILL

EMERGENCY CARE PROCEDURES

L --Limit Stressful activity

S -- Stop the victim from what his doing

O -- Open the airway

A -- Assist the victim in taking the his prescribe meds

P -- Perform CPR If P and B (30:2)

Priority Nx diagnosis

Decrease cardiac output

Cause of death in MI

Arrhythmias

Ventricular fibrillation

Choking

EMERGENCY CARE PROCEDURES

Infant 5 Back blows and 5 chest Thrust

Adult & Child Heimlich maneuver, abdominal and

chest thrust.

POISON
Any substance that causing illness or death when eaten, drunk, or
absorbed even in relatively small quantities.
Ingested/ swallowed by mouth
EMERGENCY CARE PROCEDURES:
1. Syrup of Ipecac is NOT a routine treatment for poisoning.
2. Activated charcoal is not recommended for home
use.
3. give milk or water immediately
4.. position the victim in left side lying.
5. identify the poison and how much and when taken.
6. Call poison control center.

Inhaled by breathing
EMERGENCY CARE PROCEDURES
1. Remove the victim form the toxic environment

and into fresh air immediately.


2. Give 100% of O2
3. Call poison control center.

Injected poisoning - poison that enters the body through a


bite, sting, or syringe.

EMERGENCY CARE PROCEDURES

1. Remove the stinger

2. Wash the wound

3. cold compress

Absorbed poisoning

EMERGENCY CARE PROCEDURES


1. Remove the cloth ( cut the cloth )
2. Flash it w/ water away from the body part
3. observe for allergic reaction.

VENOMOUS

Movement
or locomotion

Head
Skin
Manner
of attack
Pupil
Body
Bite mar
visible

NON

VENOMOUS

Cortina, semi-cortina

Semi-triangular
Rough

Smooth

Non-constrictor

Vertical

Constrictor

sphere/Oblong

Semi-triangular
fang mark

Round

Oblongated

Horseshoe shape

Internal bleeding
Check ABC
Lie on side
Treat shock
Seek medical attention
External bleeding
Direct wound pressure
Elevate
Pressure points
Tourniquet

Nose Bleeding
EMERGENCY CARE PROCEDURES
Sit upright , head bent slightly forward, pinch the nostrils,
breath trough our mouth.

Water rescue Reach, Throw, Row, Go

Test Taking Techniques


Discern The Exam
Concentrate on fundamentals
Therapeutic Communication
Aseptic Techniques
Safety
Nursing Priority
Basic law touching the practice
lot of Question from Community
Ethical Practice select ans. Respecting human Rights
2. Prepare your self
Get enough rest
Eat right
Drink your vit.
Exercise
Avoid negative talk
Release anxiety to your friends
Seek help and verbalize
Relaxation techniques
3. Organize your study time.

There maybe no two individuals who will have the same way of
studying. Some prefer studying at night while some, early in the morning
or during the day. Some, may have so much work at home, they can only
spare a few hours studying. Whatever is your circumstances is, there are
the basic rules in organizing study time:

Make a checklist of all the things to review.

Make a schedule of this checklist.

Dont overkill. Do not give so much time on one area while


forgetting the others. Dont just use your favorite area, give equal time
even on those that you feel are not coming out of exam.

Organize your study time by reviewing on the basic first, then at the
last part of your schedule, make sure you test yourself by answering
exam question.

Allow much flexible to accommodate your other important activities.

I always help to remove all distraction like cell phones and


television. Boyfriends and girlfriends may schedule later.

4. lets dissects the Monkey.

Read the question carefully from the first word to the last
word. Remember not to miss out on key words that would lead
you to what the question is really asking for.

look for hints

-most, first, best, initial- indicate you must establish


priorities.

-further teaching is necessary- answer will contain


incorrect information.

-understand the teaching- answer will be correct


information.

3. rephrase the question in your own words so that it can be


answered w/a yes or a no, or w/ a specific bit of information.

-what.when, why

Example:

The nurse should teach the patient who was cirrhosis of


the liver to avoid w/c of the ff. food in the diet?

a. Baked chicken

b. Apple pie
c. Macaroni
d. Spinach
Rephrase: what is the metabolic problem of the patient w/
liver cirrhosis?

Answer: he cannot digest fat

What food is contraindicated for the patients w/ liver


cirrhosis

Answer: fatty foods. Thus, among the choices,


baked chicken should not be given.

HOW TO SCORE POINTS

Step1. Read the question. Spend more time on reading the


question. learn to rephrase. Underline the key words to increase
tour understanding on the important aspect of the problem.

Step2: after reading the question, stop. Before looking at


the options, think of an answer.

Step3: selection pass. In selecting the correct answer, read


each option carefully and do this.

Step 3.1 cover all answer choices except one.

Step3.2 read answer choices

1. then repeat the REWORDED QUESTION after reading


answer choice. As yourself

does this answer the REWORDED QUESTION.


If it does not eliminate
Not sure- leave the answer choice for consideration

Step 3.3 repeat the above process w/ each remaining


answer choices.

Step 3.4 note w/c answer choice remain.

Step 3.5 reread the question to make sure you have


correctly identified the REWORDED QUESTION

REWORDED QUESTION.

STEP 3.6 ask yourself w/c answer choices best answer


the question?:

THAT IS YOUR ANSWER!!!

R E M E M B E R ! ! !

1. eliminate only what you know is wrong. Once choice has


been eliminated.. PUT IT OUT OF YOUR MIND!!!

2. stay focus on the REWORDED QUESTION. Not on the back


information!!! Dont fall for distraction!!!

3. if your ideal answer choice is not there well dont sit


and moan because it will get you nowhere read the question
again, rephrase, and select the best answer.

Look for Qualifiers

Never, always, all, none Most often absolute terms,


generalizations. Do not choose these options.

Look for contrasting options.

Usually contrasting option lead you to correct answer.

1 of this is the right answer.

Example.

Mr. bean is suffering from gastric ulcer. As a nurse, you have


to prevent dumping syndrome. Which of the ff. preventive
measures should not be taken?

a. allow him to lie down after eating

b. avoid giving fluids after meal.

c. allow him to talk after eating.

d. serve dry meals only.

Choices a & c are contrasting option, thus one of these may


be the correct option, eliminating b& d. the question may be
rephrase to what is the best position after meals to prevent
dumping syndrome? the answer is a. allow him to lie down
after meal, but the question is asking for the measure that should
not be advice, thus the answer is c

3. PRIORITIES. The board exam is testing your ability to


decide your priorities in patient care. The most common bases of
prioritization are:

a. ABCs airway, breathing & circulation

b. Safety and protection- decide what will cause the least


amount of harm. DO NO HARM!!!

c. Rights of patient- will of the patient is the basis for action.


We are safeguards and advocates of the patient well being.

d. Assessment comes before any intervention.

e. The less invasive procedures first before invasive one.

f. Remember MASLOW!!! Physiologic needs comes as a


priority

g. Patient first before equipment.

4. NORMALS-decide if the assessment data being presented


in the question is within normal range. If the answer is yes, you
just have to look for the option that will not need further
intervention..

only continue monitoring or assessment. If the answer is


otherwise ,then go ahead and rephrase the questionand follow the steps
in answering a question. Familiarize yourself with the values will be much
easier than memorizing. Post them on your walls where you see them
everyday.

5. Always be therapeutic.
Therapeutic simply means choosing the options that will
solicit information from the patients and make him/her express
his feelings. Usually, we eliminate options that will:

6. It is your business not others

Eliminate choices that what doctors midwife or social


workers do

7. Do every thing by the book.

Every thing is taken from the books, based on ideal settings.