ACUTE BIOLOGIC CRISIS HEMORRHAGE

Refers to a large amount of blood loss from a vessel. Irreparable brain damage is said to occur in 3 to 5 minutes after the oxygen supply has been interrupted

Classification - General a. Primary occurs at the time of operation b. Intermediary occurs within the first few hours of surgery c. Secondary occurs some time after surgery According to Blood Vessels a. Capillary show general coming from capillaries b. Venous bleeding which is dark in color and bubbles out c. Arterial bleeding with spurts and is bright red in color Signs and Symptoms

apprehensive, restlessness, rapid respirations and pulserate, pallor of mucous membrane, cold and moist skin, thirst and eventual drop in blood pressure

Management

Hemorrhage from internal organs cannot be stopped except through surgical intervention. Role of the nurse is limited to taking measures that will promote the most efficient use of remaining blood.

Bleeding from extremities or periphery can be managed by elevation, application of pressure and application of cold.

EMERGENCY NURSING
A. General information 1. Emergency nursing deals with human responses to any trauma or sudden illness that requires immediate intervention to prevent imminent severe damage or death 2. Care is provided in any setting to persons of all ages with actual or perceived alterations in physical or emotional health.

3. Initially, patients may not have a medical diagnosis. 4. Care is episodic when patients return frequently, primary when it is the initial option for health or preventive care, or acute when patients need immediate and additional interventions. 5. Emergency nursing is a specialty area of the nursing profession like no other. 6. Emergency nurses must be ready to treat a wide variety of illnesses or injury situations, ranging from a sore throat to a heart attack. B. Historical Development of Emergency Nursing 1. Florence Nightingale was the first emergency nurse, providing care to the wounded in the Crimean War in 1854 2. The Emergency Department Nurses Association (EDNA) was organized in 1970 3. A competency-based examination, first administered in 1980, provides Certification in Emergency Nursing; certification is valid for 4 years 4. EDNA developed Standards of Emergency Nursing Practice, published in 1983, to be used as a guideline for excellence and outcome criteria against which performance is measured and evaluated 5. In 1985, the Association name was changed to Emergency Nurses Association (ENA), recognizing the practice of emergency nursing as role-specific rather than site-specific. 6. Originally ENA aimed at teaching and networking, the organization has evolved into an authority, advocate, lobbyist, and voice for emergency nursing. It has 30,000+ members and continues to grow, with members representing over 32 countries around the world. C. Emergency Care Environment

1. Prehospital care by emergency medical services (EMS), emergency medical technicians, and paramedics provides initial stabilizations and transport of patients; personnel communicate with the emergency department during patient transport 2. The national emergency telephone number 911 is the result of an effort to improve access to EMS 3. The concept of the emergency room has expanded to that of the emergency department, which provides various levels of care 4. Specialized electronic technology and techniques are used to monitor patient status continuously; these may pose safety hazards to patients, such as possible exposure to electric shock D. Triage 1. Triage classifies emergency patients for assessment and treatment priorities 2. Triage decisions require gathering objective and subjective data rapidly and effectively to determine the type of priority situation present 3. Emergent situations are potentially life-threatening; they include such conditions as respiratory distress or arrest, cardiac arrest, severe chest pain, seizures, hemorrhage, severe trauma resulting in open chest or abdominal wounds, shock, poisonings, drug overdoses, temperatures over 105F (40.5C), emergency childbirth, or delivery complications 4. Urgent situations are serious but not life-threatening if treatment is delayed briefly; they include such conditions as chest pain without respiratory distress, major fractures, burns, decreased level of consciousness, back injuries, nausea or vomiting, severe abdominal pain, temperature between 102 and 105F (38.9 and 40.5 C), bleeding from any orifice, acute panic, or anxiety

5. Nonemergency situations are not acute and are considered minor to moderately severe; they include such conditions as chronic backache or other symptoms, moderate headache, minor burns, fractures, sprains, upper respiratory or urinary infections, or instances in which a patient is dead on arrival E. Roles of the Emergency Nurse 1. Care provider: provides comprehensive direct care to the patient and family. 2. Educator: provides patient and family with education based on their learning needs and the severity of the situation and allows the patient to assume more responsibility for meeting health care needs 3. Manager: coordinates activities of others in the multidisciplinary team to achieve the specific goal of providing emergency care 4. Advocate: ensures protection of the patients rights F. Functions of the Emergency Nurse 1. Uses triage to determine priorities based on assessment and anticipation of the patients needs 2. Provides direct measures to resuscitate, if necessary 3. Provides preliminary care before the patient is transferred to the primary care area 4. Provides health education to the patient and family 5. Supervises patient care and ancillary personnel 6. Provides support and protection for the patient and family G. Legal issues affecting the provision of emergency nursing 1. Negligence 2. Malpractice

3. Good Samaritan Laws (these statutes may protect private citizens but usually do not apply to emergency personnel on duty or in normal emergency situations) 4. Informed consent 5. Implied consent 6. Duty to report suspected crimes to the police 7. Duty to gather evidence in criminal investigations; be aware of hospital policy and state laws for evidence collection 8. Advanced directives, including durable power of attorney and living wills H. Qualifications of an Emergency Nurse 1. An emergency nurse is a registered nurse with specialized education and experience in caring for emergency patients. 2. Emergency nurses continually update their education to stay informed of the latest trends, issues, and procedures in medicine today. 3. Many take a special examination that proves their level of knowledge. After successful completion of this exam they are certified in emergency nursing. 4. Some emergency nurses also acquire additional certifications in the areas of trauma nursing, pediatric nursing, nurse practitioner, and various areas of injury prevention 5. Many emergency nurses acquire additional certifications in the areas of trauma nursing, pediatric nursing, nurse practitioner, and various areas of injury prevention

CELLULAR ABERRATION
Group of disorders characterized by abnormal cell growth and the ability to metastasize with potential in killing the host.

Cancer refers to a disease whereby cells mutate into abnormal cells that proliferate abnormally. Neoplasia refers to an abnormal cell growth or tumor. A tumor is a mass of new tissue functioning independently and serving no useful purpose

Benign neoplasms are slow-growing, localized, and encapsulated nonmalignant growths with well-defined borders. Malignant neoplasms are aggressive growths that invade and destroy surrounding tissue and which can lead to death unless interventions are taken.

Invasion occurs when cancer cells infiltrate adjacent tissues surrounding the neoplasm Metastasis occurs when malignant cells travel through the blood or lymph system and invade other tissues and organs to form a secondary tumor.