NUR 113: DISASTER NURSING

STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR

Session # 6

LESSON TITLE: Scope and Practice of Emergency Materials:

Nursing
Book, pen and notebook
LEARNING OUTCOMES:
Upon completion of this lesson, the nursing student can: References:

1. Understand the scope and practice of emergency Veenema, T.G. (2019) Disaster Nursing and
nursing. Emergency Preparedness for Chemical,
2. Identify the issues in emergency nursing care. Biological, and Radiological Terrorism and other
3. Remember the ABCs of emergency nursing care. Hazards 4th Edition
4. Conduct a primary survey during emergency nursing
care.
5. Apply the principles of First Aid, Basic Life Support,
and Cardiopulmonary Resuscitation.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: What are the 3Ps that guides the first aider in responding in an emergency situation?

MAIN LESSON (40 minutes)

SCOPE AND PRACTICE OF EMERGENCY NURSING
• The emergency nurse has had specialized education, training, and experience.
• The emergency nurse establishes priorities, monitors and continuously assesses acutely ill and injured patients,
supports and attends to families, supervises allied health personnel, and teaches patients and families within a
time-limited, high-pressured care environment.
• Nursing interventions are accomplished interdependently, in consultation with or under the direction of a licensed
physician.
• Appropriate nursing and medical interventions are anticipated based on assessment data.
• The emergency health care staff members work as a team in performing the highly technical, hands-on skills
required to care for patients in an emergency situation.
• Patients in the ED have a wide variety of actual or potential problems, and their condition may change constantly.
• Although a patient may have several diagnosis at a given time, the focus is on the most life-threatening ones

ISSUES IN EMERGENCY NURSING CARE

• Emergency nursing is demanding because of the diversity of conditions and situations which are unique in the
ER.
• Issues include legal issues, occupational health and safety risks for ED staff, and the challenge of providing
holistic care in the context of a fast-paced, technology-driven environment in which serious illness and death are
confronted on a daily basis.
• The emergency nurse must expand his or her knowledge base to encompass recognizing and treating patients
and anticipate nursing care in the event of a mass casualty incident.
• Legal Issues Includes:
o Actual Consent
o Implied Consent
o Parental Consent

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“Good Samaritan Law”
- Gives legal protection to the rescuer who act in good faith and are not guilty of gross negligence or willful
misconduct.

Focus of Emergency Care

• Preserve or Prolong Life
• Alleviate Suffering
• Do No Further Harm
• Restore to Optimal Function

Golden Rules of Emergency Care

 Do’s
- Obtain Consent
- Think of the Worst
- Respect Victim’s Modesty & Privacy
 Don’ts
- let the patient see his own injury
- Make any unrealistic promises

Guidelines in Giving Emergency Care

A – Ask for help
I – Intervene
D – Do no Further Harm

Stages of Crisis
1. Anxiety and Denial
• encouraged to recognize and talk about their feelings.
• asking questions is encouraged.
• honest answers given
• prolonged denial is not encouraged or supported
2. Remorse and Guilt
• verbalize their feelings
3. Anger
• way of handling anxiety and fear
• allow the anger to be ventilated
4. Grief
• help family members work through their grief
• letting them know that it is normal and acceptable

Core Competencies in Emergency Nursing

• Assessment
• Priority Setting/Critical Thinking Skills
• Knowledge of Emergency Care
• Technical Skills
• Communication

Assess and Intervene

Check for ABCs of life
A – Airway
B – Breathing
C - Circulation

Team Members
• Rescuer • Incident Commander
• Emergency Medical Technician • Support Staff
• Paramedics • Inpatient Unit Staff
• Emergency Medicine Physicians

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 Emergency Action Principle
I. Survey the Scene - Extent of Injury and First Aid
• Is the Scene Safe? given
• What Happened? - Telephone number from where
• Are there any bystanders who can help? you’re calling
• Identify as a trained first aider! IV. Do Secondary Survey
II. Do a Primary Survey Interview the Patient (SAMPLE)
organization of approach so that immediate threats S – Symptoms
to life are rapidly identified and effectively manage. A – Allergies
M – Medication
Primary Survey P – Previous/Present Illness
A - Airway/Cervical Spine L – Last Meal Taken
- Establish Patent Airway E – Events Prior to Accident
- Maintain Alignment Check Vital Signs
- GCS ≤ 8 = Prepare Intubation
B – Breathing V. Triage
- Assess Breath Sounds  comes from the French word ”trier”, meaning to
- Observe for Chest Wall Trauma sort
- Prepare for chest decompression  process of assessing patients to determine
C – Circulation management priorities
- Monitor VS Categories:
- Maintain Vascular Access 1. Emergent - highest priority, conditions are life
- Direct Pressure threatening and need immediate attention
Estimated Blood Pressure - Airway obstruction, sucking
SITE SBP chest wound, shock, unstable
chest and abdominal wounds,
Radial ≥ 80 open fractures of long bones
2. Urgent – have serious health problems but not
Femoral ≥ 70 immediately life threatening ones. Must be seen
within 1 hour
- Maxillofacial wounds without
Carotid ≥ 60 airway compromise, eye
injuries, stable abdominal
D – Disability
wounds without evidence of
- Evaluate LOC
significant hemorrhage,
- Re-evaluate clients LOC
fractures
- Use AVPU mnemonics
3. Non-urgent – patients have episodic illness
E – Exposure
than can be addressed within 24 hours without
- Remove clothing
increased morbidity
- Maintain Privacy
- Upper extremity fractures, minor
- Prevent Hypothermia
burns, sprains, small lacerations
III. Activate Medical Assistance
without significant bleeding,
Information to be Relayed:
behavioral disorders or
- What Happened?
psychological disturbance.
- Number of Persons Injured

FIRST AID
Role of First Aid
• Bridge the Gap Between the Victim and the Physician
• Immediately start giving interventions in pre-hospital setting
Value of First Aid Training
• Self-help
• Health for Others
• Preparation for Disaster
• Safety Awareness

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BASIC LIFE SUPPORT
Artificial Respiration - a way of breathing air to person’s lungs when breathing ceased or stopped function.
Respiratory Arrest - a condition when the respiration or breathing pattern of an individual stops to function, while the
pulse and circulation may continue.
Causes: Choking, Electrocution, strangulation, drowning and suffocation.
Methods:
• mouth to mouth
• mouth to nose
• mouth to stoma
• mouth to mouth and nose
• mouth to barrier device
To perform rescue breathing perform the following steps:
1. Check the mouth for obstructions, lift the neck and tilt the head back.
2. Pinch the nostrils and seal the mouth, and exhale directly into the victim's mouth.
3. Release the nostrils and the seal around the mouth.
4. Watch for the victim's chest to rise by itself.
5. Feel for a pulse on the victim's neck.
6. If the victim's chest does not start to rise on its own, repeat this process from number 1, until professional
help arrives.

When to Stop AR:

✓ when the patient has spontaneous breathing
✓ when the first aider is too exhausted to continue
✓ when another first aider takes over
✓ when EMS arrives and takes over

Cardiopulmonary Resuscitation (CPR)

Cardiac Arrest - a condition when the persons breathing and circulation/pulse stop at the same time
Causes: Cardiovascular Disease, Heart Attack, MI
Management:
External Chest Compression
- consist of rhythmic application of pressure over the lower portion of the sternum just in between the nipple

Cardiopulmonary Resuscitation = AR + ECC

Goal: Rapid return of pulse, BP and consciousness

Check that the area is safe, then perform the following basic CPR steps:
1. Call 911 or ask someone else to.
2. Lay the person on their back and open their airway.
3. Check for breathing. If they are not breathing, start CPR.
4. Perform 30 chest compressions.
5. Perform two rescue breaths.
6. Repeat until an ambulance or automated external defibrillator (AED) arrives.

When to STOP CPR:

S – SPONTANEOUS BREATH RESTORED
T – TURNED OVER THE MEDICAL SERVICES
O – OPERATOR IS EXHAUSTED TO CONTINUE
P – PHYSICIAN ASSUMES RESPONSIBILITY

COMPLICATIONS OF CPR:
• Rib Fracture
• Sternum Fracture
• Laceration of the liver or spleen
• Pneumothorax, hemothorax

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CHAIN OF SURVIVAL
EARLY ACCESS – early recognition of cardiac arrest, prompt activation of emergency services
EARLY BLS – prevent brain damage, buy time for the arrival of defibrillator
EARLY DEFIBRILLATION - 7-10% decrease per minute without defibrillation
EARLY ACLS – technique that attempts to stabilize patient

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. You are a nurse in the emergency department and it is during the shift that Mr. CT is admitted in the area due to a
fractured skull from a motor accident. You scheduled him for surgery under which classification?
a. Urgent
b. Emergent
c. Required
d. Elective
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. The nurse finds the client unresponsive on the floor of the bathroom. Which action should the nurse implement
first?
a. Check the client for breathing.
b. Assess the carotid artery for a pulse.
c. Shake the client and shout.
d. Call a code via the bathroom call light.
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. The nurse is triaging four clients injured in a train derailment. Which client should receive priority treatment?
a. A 42-year-old with dyspnea and chest asymmetry.
b. A 17-year-oldwith fractured arm.
c. A 4-year-old with facial lacerations.
d. A 30-year-old with blunt abdominal trauma
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. A 56-year-old patient presents in triage with left-sided chest pain, diaphoresis, and dizziness. This patient should
be prioritized into which category?
a. High urgent
b. Urgent
c. Non-urgent
d. Emergent
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. This status is used for any patient who can wait more than 2 hours to be seen without the likelihood of
deterioration in the ED.
a. Emergent
b. Urgent
c. Nonurgent

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 d. Dead
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

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:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

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: CAT: 3-2-1

Instructions:
1. As an exit ticket at the end of the class period
2. After the lesson, have each student record three things he or she learned from the lesson.
3. Next, have them record two things that they found interesting and that they’d like to learn more about.
4. Then, have students record one question they still have about the material.
5. Review the students’ responses. You can use this information to help develop future lessons and
1. determine if some of the material needs to be taught again.

Three things you learned:

1. ______________________________________
2 ______________________________________
3. ______________________________________
Two things that you’d like to learn more about:
1. ______________________________________
2. ______________________________________
One question you still have:
1. ______________________________________

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