NUR 113: DISASTER NURSING

STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR

Session #5

Materials:
Book, pen and notebook
LESSON TITLE: Principles of Emergency Care
LEARNING OUTCOMES: References:
Upon completion of this lesson, the nursing student can: Veenema, T.G. (2019) Disaster Nursing and
Emergency Preparedness for Chemical,
1. Familiarize the common terms used in emergency care Biological, and Radiological Terrorism and other
2. Understand the basic principles in emergency care Hazards 4th Edition
3. Identify the aims of emergency care
4. Be able to intervene in an emergency situation https://www.makrosafe.co.za/blog/principles-
of-emergency-care

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: Differentiate quarantine, isolation and civil commitment.

MAIN LESSON (40 minutes)

Common Terms Used in Emergency Care
• Trauma :Intentional or unintentional wounds/injuries on the human body from particular mechanical mechanism
that exceeds the body’s ability to protect itself from injury
• Emergency Management: traditionally refers to care given to patients with urgent and critical needs
• Triage: process of assessing patients to determine management priorities.
• First Aid: an immediate or emergency treatment given to a person who has been injured before complete
medical and surgical treatment can be secured.
• BLS: level of medical care which is used for patient with illness or injury until full medical care can be given.
• ACLS: Set of clinical interventions for the urgent treatment of cardiac arrest and often life threatening medical
emergencies as well as the knowledge and skills to deploy those interventions.
• Defibrillation: Restoration of normal rhythm to the heart in ventricular or atrial fibrillation
• Disaster: Any catastrophic situation in which the normal patterns of life (or ecosystems) have been disrupted and
extraordinary, emergency interventions are required to save and preserve human lives and/or the environment
• Mass Casualty Incident: situation in which the number of casualties exceeds the number of resources
• Post Traumatic Stress Syndrome: characteristic of symptoms after a psychologically stressful event was out of
range of an normal human experience

Principles of Emergency Care

First aid is the initial emergency care given immediately upon arrival at the scene to an ill or injured person. The first aider
and people who are assisting should continue with assistance until the professional medical assistance takes over the
care of the casualty. Medical professionals may include paramedics, doctors, or ambulance officers. First aiders should
always make notes or fill out a casualty report for any event attended, no matter how minor. Proper records will help you
to recall the incident if you are ever asked about it at a later stage.

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Records may be used in a court, so ensure your reports or notes are legible, accurate, factual, contain all relevant
information and are based on observations rather than opinions.

Treatment

The last step is to actually provide care to the limits of the first aider's training, but never beyond. In some jurisdictions,
you open yourself to liability if you attempt treatment beyond your level of training. Treatment should always be guided by
the 3Ps:

• Preserve life
• Prevent further injury
• Promote recovery

Treatment will obviously depend on the specific situation, but some situations will always require treatment (such as
shock). The level of injury determines the level of treatment required. The principles first, do no harm and life over limb is
essential parts of the practice of first aid. Do nothing that causes unnecessary pain or further injury unless to do otherwise
would result in death.

Aims

Although the 3Ps are outlined above, we will also include two more areas that needs attention when conducting primary
emergency care:

• Protection against further injury.

• Preservation of life.
• Promotion of recovery.
• Prevention of injuries for people at any age.
• Promotion of healthy lifestyles.

Protection against further injury

No injured person should be moved if his or her life is not in danger. If a person is not breathing and has no pulse, his or
her life is in danger. Life threatening situations exist where there is significant risk of loss of life.

Preservation of Life

In order to stay alive, all persons need to have an open airway—a clear passage where air can move in through the
mouth or nose through the pharynx (part of the throat) and down in to the lungs, without obstruction.

Conscious people will maintain their own airway automatically, but those who are unconscious may be unable to maintain
a patent airway, as the part of the brain which automatically controls breathing in normal situations may not be
functioning.

Once the airway has been opened, the first aider would assess to see if the patient is breathing. If there is no breathing, or
the patient is not breathing normally, such as agonal breathing (abnormal pattern of breathing), the first aider would
undertake what is probably the most recognized first aid procedure, called cardiopulmonary resuscitation or CPR, which
involves breathing for the patient, and manually massaging the heart to promote blood flow around the body.

Promoting Recovery

The first aider is also likely to be trained in dealing with injuries such as cuts, grazes or bone fracture. They may be able to
deal with the situation in its entirety (a small adhesive bandage on a paper cut), or may be required to maintain the
condition of something like a broken bone, until the next stage of definitive care (usually an ambulance) arrives.

Prevention of Injuries for people at any Age

The first aider must prevent injuries for all age groups. Age groups are categorised as follow:

1. Infant: For purposes of first aid, an infant is defined as being younger than 1 year of age.
2. Child: A child is categorised as being above 1 year of age
3. Adult: For purposes of first aid, adults are defined as people about age 12 (adolescents) or older.

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You need parental permission to give care to a child or an infant, even if it is an emergency. The only reasons for which
you could give care without permission are if the parent is not present or is injured and unable to respond.

Promoting of Healthy Lifestyles

The upside to living healthy is that there are many different ways to go about doing it. So many ways that there is no
reason why you can't find a plan which suits you well. But no matter which way you decide works best for you, here are
some general guidelines you are probably going to want to adhere to:

• Be a role model.
• Encourage healthy eating
• Encourage physical activity.

TRIAGE

The word triage comes from the French word trier, meaning “to sort.” In the daily routine of the ED, triage is used to sort
patients into groups based on the severity of their health problems and the immediacy with which these problems must be
treated.

• What were the circumstances, precipitating events, location, and time of the injury or illness?
• When did the symptoms appear?
• Was the patient unconscious after the injury or onset of illness?
• How did the patient get to the hospital?
• What was the health status of the patient before the injury or illness?
• Is there a medical or surgical history? A history of admissions to the hospital?
• Is the patient currently taking any medications, especially hormones, insulin, digitalis, anticoagulants?
• Does the patient have any allergies? If so, what are they?
• Does the patient have any bleeding tendencies?
• When was the last meal eaten? (This is important if general anesthesia is to be given or if the patient is
unconscious.)
• Is the patient under a physician’s care? What are the name and location of the physician?
• What was the date of the patient’s most recent tetanus immunization?

ASSESS AND INTERVENE

For the patient with an emergent or urgent health problem, stabilization, provision of critical treatments, and prompt
transfer to the appropriate setting (intensive care unit, operating room, general care unit) are the priorities of emergency
care. Although treatment is initiated in the ED, ongoing definitive treatment of the underlying problem is provided in other
settings, and the sooner the patient is stabilized and moved to that area, the better.

The primary survey focuses on stabilizing life-threatening conditions. The ED staff work collaboratively and follow the
ABCD (airway, breathing, circulation, disability) method:

• Establish a patent airway.

• Provide adequate ventilation, employing resuscitation measures when necessary. (Trauma patients must have
the cervical spine protected and chest injuries assessed first.)
• Evaluate and restore cardiac output by controlling hemorrhage, preventing and treating shock, and maintaining or
restoring effective circulation.
• Determine neurologic disability by assessing neurologic function using the Glasgow Coma Scale.
• After these priorities have been addressed, the ED team proceeds with the secondary survey. This includes
• A complete health history and head-to-toe assessment
• Diagnostic and laboratory testing
• Insertion or application of monitoring devices such as electrocardiogram (ECG) electrodes, arterial lines, or
urinary catheters
• Splinting of suspected fractures
• Cleaning and dressing of wounds
• Performance of other necessary interventions based on the individual patient’s condition

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Once the patient has been assessed, stabilized, and tested, appropriate medical and nursing diagnoses are formulated,
initial important treatment is started, and plans for the proper disposition of the patient are made.

CHECK FOR UNDERSTANDING (10 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice

1. During the nursing assessment, which data represent information concerning health beliefs?
a. Family role and relationship patterns
b. Educational level and financial status
c. Promotive, preventive, and restorative health practices
d. Use of prescribed and over-the-counter medications
ANSWER: ________
RATIO:____________________________________________________________________________________
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2. Which assessment data should the nurse include when obtaining a review of body systems
a. Brief statement about what brought the client to the health care provider
b. Client complaints of chest pain, dyspnea, or abdominal pain
c. Information about the client’s sexual performance and preference
d. The client’s name, address, age, and phone number
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
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3. A male client is admitted to the hospital with blunt chest trauma after a motor vehicle accident. The first nursing
priority for this client would be to:
a. Assess the client’ s airway
b. Provide pain relief
c. Encourage deep breathing and coughing
d. Splint the chest wall with a pillow
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. Nurse Kelly is acquiring information from a client in the emergency department. Which is an example of
biographic information that may be obtained during a health history?
a. The chief complaint
b. Past health status
c. History immunizations
d. Location of an advance
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
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5. An anxious 24-year-old college student complains of tingling sensations, palpitations, and chest tightness. Deep,
rapid breathing and carpal spasms are noted. What priority nursing action should you take?
a. Notify the physician immediately.
b. Administer supplemental oxygen.
c. Have the student breathe into a paper bag.
d. Obtain an order for an anxiolytic medication.
ANSWER: ________

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 RATIO:____________________________________________________________________________________
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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
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2. ANSWER: ________
RATIO:_______________________________________________________________________________________
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3. ANSWER: ________
RATIO:_______________________________________________________________________________________
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4. ANSWER: ________
RATIO:_______________________________________________________________________________________
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5. ANSWER: ________
RATIO:_______________________________________________________________________________________
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LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: Minute Paper

1) What was the most useful or the most meaningful thing you have learned this session?
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2) What question(s) do you have as we end this session?
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