BACHELOR OF SCIENCE IN NURSING:

NCMB418: CARE OF THE CLIENTS WITH LIFE-

THREATENING CONDITIONS, ACUTELY-ILL / MULTI-
ORGAN PROBLEMS, HIGH ACUITY AND EMERGENCY
SITUATION (ACUTE AND CHRONIC)
COURSE MODULE COURSE LAB WEEK
3 3 17

First Aid: Bandaging, CPR, Triage

✓ Comprehend the course and laboratory unit objectives.

✓ Peruse through the study guide prior to class attendance.
✓ Analyze the required learning resources; refer to course unit
terminologies for jargons.
✓ Proactively participate in classroom discussions.
✓ Participate in weekly discussion board (Canvas).
✓ Answer and submit course unit tasks on time.

At the end of this unit, the students are expected to:

1. Identify patients needing immediate resuscitation and assign them to a predesignated patient
care area.
2. Prioritizing emergency nursing care based on the type of injury or illness, its severity,
symptoms, and vital signs.
3. Institute appropriate corrective actions to prevent or minimize harm arising from adverse
effects.
4. Apply safe and quality interventions (e.g. first aid bandaging, CPR) to address the client’s
immediate needs as appropriate.
AHA (2020). Highlights of the 2020 American Heart Association (AHA) Guidelines for
Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC). Retrieved
from https://cpr.heart.org/-/media/cpr-files/cpr-guidelines-files/highlights/hghlghts_2020_ecc
_guidelines_english.pdf

American CPR Training Team (2015 November). Bandaging a wound. Retrieved from
https://americancpr.com/blog/116/bandages-and-first-aid/bandaging-a-wound.html

Emergency Nurses Association. (2019). Sheehy’s Manual of Emergency Care, 7th ed. St. Louis:
Elsevier Mosby

St. Luke’s (n.d.). First aid: Bandaging. Retrieved from https://www.saintlukeskc.org/health-

library/first-aid-bandaging

Computer device or smartphone with internet access (at least 54 kbps; average data subscription
will suffice)

In first aid treatment the nurse needs to remember that the goal is to improve the situation
and avoid further harm.

Bandaging
✓ Covering a break in the skin to help control bleeding and protect client against infection
✓ Dressings are pads of gauze or cloth that can be placed directly against the wound to absorb
blood and other fluids. Cloth bandages, on the other hand, cover dressings and hold them in
place.
✓ Purposes – apply pressure to wounds, cover wounds and burns, and providing support and
immobilization of broken bones, sprains, and/or strains
✓ Bandages – gauze, triangular, elastic, and tubular (refer to Fig. 1)

Figure 1. Bandages

A B C D

Legend: A-elastic, B-triangular, C-gauze, D-tubular

SKILLS PROCEDURE: Bandaging

IMPORTANT! Ensure all your equipment and materials are at hand before going to the client.
Perform proper hand hygiene.

❖ FIRST: Introduce self and identify the client by asking for at least 2 identifiers (e.g. name,
birthday, age, etc.)
Assessment:
1. Assess ABCs, wounds and cuts, and disability (body parts with broken bones, sprain, and/or
strain).
2. Assess severity and level of consciousness.
3. Establish the cause and time of the injury.
4. Assess for associated injuries (Associated injuries may be sustained while the victim attempts to
move and result in internal injuries or fractures).
5. Identify pre-existing illnesses.

Planning:
1. Identify expected outcomes
2. Assemble and prepare the bandage needed.

Implementation
❖ Provide privacy at all times.
1. Explain the procedure and purpose to the client, sensations the client would feel.
2. Prepare the materials: clean gloves, wound dressing, antiseptic, topical antibiotics (if ordered or
needed) appropriate bandage. (Any square clean cloth can be used as a triangular bandage).

Figure 2. Making a Traingular Bandage and a Cravat

3. Dress the wound

For minor wounds: Cleanse the wound by washing with warm soap and water or wiping with an
antiseptic, carefully picking out debris and light scrubbing in the case of severe abrasions
For major wounds: STOP the bleeding
 a. Put on gloves or use other protection to avoid contact with the victim's blood.
b. Clean the wound with mild soap and water.
c. Apply a small layer of topical antibiotic if ordered or if necessary.
d. Place a clean dressing over the entire wound (Gauze dressings let in air for faster healing;
nonstick dressings have a special surface that won't cling to the wound).
e. If blood soaks through the dressing, place another dressing over the first one.
4. Support the injury. (The client may be instructed to support the are if possible).
5. Cover with bandage (Using a triangle bandage)
For head injuries
a. Fold the base at least 2-3inches and place the folded base aligned with the client’s eyebrows.
b. Pull both ends in front and secure with a square knot at the center of the folded base. Tuck
the ends.
c. Pull down apex and tuck sides neatly.
d. Tuck the apex neatly at cross-over area.
Figure 3. Head and Hand Bandaging

For head injuries with eye involvement (Cravat Bandage)

❖ Cravat bandage – made by bringing the point of a triangular bandage to the middle of the
base and then folding lengthwise to the desired width
a. Lay the center of the first cravat over the top of the head with the front end falling over the
injured eye.
b. Bring the 2nd cravat around the head, over the eyes, and over loose ends of the 1st cravat.
Tie in front.
c. Bring ends of the 1st cravat back over the top of the head, tying and pulling the 2nd cravat
up and away from the injured eye.

Figure 4. Cravat Bandage for the Eye

For chest injuries (Chest Bandage)
a. Place the apex of the bandage at the shoulder of the injured side.
b. Pull back the folded base and secure with square knot at the center indention of the back.
c. Knot/tie the longer end with the apex.

For hand and/or wrist injuries (Hand Bandage)

a. Place the affected hand in the middle of the triangular bandage with wrist at the base.
b. Place the apex over the fingers and tuck any excess material into the pleats on each side of
the hand.
c. Cross the ends on top of the hand, take them around the wrist and tie with a square knot.

For arm injuries (Arm and Underarm Sling)

a. Place folded base vertically over one arm (with the pointed side directly under the elbow of
the injured arm)
b. Lower ends of the base at the side of the neck using a square knot.
c. Make several twists with the apex and tie a knot.
d. Hide the knot
e. Underarm sling: Same procedure as arm sling but the lower end of the base is tucked under
the injured arm. End of the base and apex are secured with a square knot at the center
indention of the back.

Figure 5. Underarm Sling Bandage

For elbow injuries

a. Bend arm at elbow and place the center of the cravat at point of elbow
b. Bring ends up and across each other in overlapping spiral turns
c. Continue with one end up the arm and the other end down to the forearm
d. Bring ends to front of the elbow and tie.
Figure 6. Cravat Bandaging for Joint Injuries

c c c c
 For knee injuries
a. Start on top of the knee.
b. Cross over and twist 2-3 time under the knee.
c. Cross over on top and pull ends towards opposite sides.
d. Secure with a square knot.

For injuries on the arm, and leg (non-joint areas)

a. Place the center of the cravat over the wound dressing.
b. Begin ascending turns with the upper end and descending turns with the lower end; each turn
covering 2/3 of preceding turn until dressing is covered.
c. Terminate by tying both ends in a square knot.
Figure 7. Cravat Bandaging for Joint Injuries

c c c
c
6. Ensure that the bandage is secures. (Replace sterile dressing, if ordered or as necessary, using
sterile technique).
7. Check circulation in the area below the bandage every 15-30minutes (Pale, bluish, and/or cold
skin, and complains of numbness / tingling sensation are indicators of poor circulation). Loosen
bandage immediately, if signs of poor circulation are evident.
8. Help client to preferred comfortable position.
9. Dispose all soiled material and equipment appropriately and perform hand hygiene.

Evaluation
1. Inspect the body part or wound condition for evidence of effectiveness of therapy and sensitivity
to touch.
2. Obtain vital signs and compare with baseline.
3. Identify any unexpected outcome.

Recording and Reporting: Record, document, and report all pertinent information of the
procedure performed.

SKILLS PROCEDURE: Cardiopulmonary Resuscitation (CPR)

✓ An emergency lifesaving procedure performed when the heart stops beating. Immediate CPR
can double or triple chances of survival after cardiac arrest (AHA, 2020)

IMPORTANT! Ensure all your equipment and materials are at hand before going to the client.
Perform proper hand hygiene.

Assessment:
1. Scene safety – check the environment and ensure it is safe and secure
2. Assesses patient responsiveness (“Hey! Hey! Are you ok?” is commonly verbalized by the
rescuer while tapping both of the client’s shoulders at the same time)
3. Check for presence of pulse (carotid pulse).
4. Check / observe for breaths and breathing (checks for no longer than 10 seconds)

Planning:
1. Identify expected outcomes
2. Assemble and prepare the equipment, materials, and other resources needed.

Implementation: (Adapted from AHA, 2020)

❖ Provide privacy at all times.
I. Adult (Single Rescuer)
1. Secure the scene.
2. Check for client’s responsiveness and call for help if the client is unresponsive.
3. Check for presence of pulse and breathing.
4. If client is unresponsive, no pulse and no breathing, perform CPR.
a. Use your fingers to locate the end of the client's sternum. Place two fingers at the tip.
b. Place the heel of the other hand right above your fingers (on the side closest to the
person's face).
c. Start chest compressions. Use both hands to give chest compression at a rate of 100-
120/min and depth of approximately 2 inches.
d. Allow complete chest recoil between compressions.
e. Opening the client’s airway using the head tilt/chin lift or jaw thrust maneuver.
f. Give effective breaths by observable / visible chest rise.
5. Perform a second round of CPR until help with an AED has arrived
6. Place the AED, without interrupting CPR. (AED analyzes rhythm)
7. Client is cleared for rhythm check and shock. (Shock delivered)
8. Immediately return to CPR after shock delivered.

Signals to stop the CPR process:

✓ If the client is revived and starts breathing on his own.
✓ If medical help such as ambulance paramedics arrive to take over.
✓ The person performing the CPR is forced to stop from physical exhaustion.

II. Adult (2-Rescuer)

1. Secure the scene.
2. Check for client’s responsiveness and call for help if the client is unresponsive.
3. Check for presence of pulse and breathing.
4. If client is unresponsive, no pulse and no breathing, begin Two-Rescuer CPR. Rescuers
take turns in performing CPR.
a. Use your fingers to locate the end of the client's sternum. Place two fingers at the tip.
b. Place the heel of the other hand right above your fingers (on the side closest to the
person's face).
c. Start chest compressions. Use both hands to give chest compression at a rate of 100-
120/min and depth of approximately 2 inches.
d. Allow complete chest recoil between compressions.
5. After two minutes of two-rescuer CPR, both rescuers will pause to check for a pulse. If no
pulse is present, attach the AED.
6. Place the AED, without interrupting CPR. (AED analyzes rhythm)
 7. Client is cleared for rhythm check and shock. (Shock is delivered)
8. First rescuer takes the position of providing rescue breaths and begins another round of CPR.

SKILLS PROCEDURE: Triage Process

✓ A process for sorting injured people into groups based
on their need for or likely benefit from immediate
medical treatment; an ongoing process done many
times
− Used in hospital emergency rooms, on battlefields, and
at disaster sites when limited medical resources must
be allocated
− Focus: To do as little as possible for the greatest
number in the shortest period of time (Famorca, 2013);
75-85% of fatalities occur within first 20 minutes

IMPORTANT! Before performing a triage

✓ Evaluate every situation before acting; perform quick
incident scene survey
✓ Determine scene hazards
✓ Use appropriate PPE
✓ Remain in appropriate zone

Figure 8. START Algorithm in Triage

I. Activity: Bandaging
From the given 1st aid bandaging techniques, chose 3 and make an individual video using the
available materials at home in demonstrating the procedures. The video must contain the 3
chosen techniques in 1 file, unedited (spontaneous demonstrations) and must be less than or
equal to 10 minutes in length. Use the chosen bandaging techniques as the video title for
submission.

II. Activity: Triage

On August 24, 2020, at 11:54 am, a motorcycle bomb placed next to a military truck detonated
outside the Paradise Food Plaza in downtown Jolo, Sulu. The police and military responded to
the scene. An hour later, at 12:57 pm, a female suicide bomber approached the cordoned-off
area and attempted to enter. Upon being stopped by a soldier, she detonated the bomb she
carried, killing herself and the soldier who stopped her, it occurred approximately 100 meters
away from the first blast,

Using the START and/or JumpSTART algorithm, identify the correct color tag for each given
patient condition and justify your decision.
1. Ms. Minchin is a 91-year-old female who can only speak the local dialect. She is brought to
the hospital in her son’s car after the incident. Her son tells you she is “very sick” and she
also fell 3 days earlier and bruised her right hip. You noted that she can transfer to a
wheelchair with minimal assistance as she was able to walk, limping, though she’s wincing at
 every step. You are unable to ascertain her pain level, though she tells you she’s alright.
Initial vital signs: BP = 150/90mmHg, HR = 88bpm, RR = 20cpm.
2. A father presents to the hospital at 5pm with his 3 ½ -year-old daughter, Sarah, stating she
cannot breathe as the incident made it worse. She had a sore throat 2 days prior. She has
no cough nor stridor, but with shortness of breath, pink and warm skin.
3. Cedie, a 38-year-old male, was brought into the hospital by a workmate. He has a deep
laceration of about 10cm to the inner aspect of his left arm. The wound is bleeding “quite a
bit” half hour ago as stated by Cedie, but the blood loss has been controlled with a firm
bandaging; now seen as fully soaked with blood. Cedie tells you the wound is “not that
painful” but he looks pale and is sweating profusely. His HR is 84bpm, RR = 32cpm.
4. Lottie, a 17-year old female, presents to the hospital via an ambulance with her husband in
an altered conscious state. She is 30 weeks pregnant (G3P1). The EMS personnel reports
fluctuating conscious state. At the scene she tolerated an oropharyngeal airway but spat it
out on route. She is a lateral position on the ambulance trolley with supplemental oxygen via
face mask. Her vital signs are as follows: T = 36.3°C, RR = 10, SaO2 = 93%, HR = 130, BP
= 190/110mmHg, GCS = 10.
5. A mother arrived at the hospital with her 6-month-old baby, Gertrude, who says she will not
wake up. Gertrude is breathing, but with stridor, cannot be roused and has pinpoint pupils.

Date Completed:
Date Submitted:

AHA (2020). Highlights of the 2020 American Heart

Association (AHA) Guidelines for Cardiopulmonary
Resuscitation (CPR) and Emergency Cardiovascular Care
(ECC). Retrieved from https://cpr.heart.org/-/media/cpr-
files/cpr-guidelines-files/highlights/hghlghts_2020_ecc
_guidelines_english.pdf

American CPR Training Team (2015 November). Bandaging

a wound. Retrieved from
https://americancpr.com/blog/116/bandages-and-first-aid/bandaging-a-wound.html

Centers for Disease Control and Prevention (CDC) (n.d.). https://www.cdc.gov/

Emergency Nurses Association. (2019). Sheehy’s Manual of Emergency Care, 7th ed. St. Louis:
Elsevier Mosby

Famorca, Z, Nies, M., McEwen, M. (2013). Nursing Care of the Community: A comprehensive text
on community and public health nursing in the Philippines. Singapore: Elsevier Pte Ltd

St. Luke’s (n.d.). First aid: Bandaging. Retrieved from https://www.saintlukeskc.org/health-

library/first-aid-bandaging

YouTube.com