EMERGENCY NURSING Is a specialty area of the nursing profession like no other Provide quality patient care for people

le of all ages, emergency nurses must possess both general and specific knowledge about health care Emergency nurses must be ready to treat wide variety of illness or injury situations, ranging from a sore throat to a heart attack. Historical Development of Emergency Nursing The emergency nurses association Is the specialty nursing association serving the emergency nursing profession through research, publications, professional development, and injury prevention Mission to provide visionary leadership for emergency nursing and emergency care Seeking to define the future of emergency nursing and emergency care Emergency nurses care Non profit organization. mission is to reduce preventable injuries and deaths by educating the public to increase awareness and promote healthy lifestyles TRIAGE French word to sort The process of determining the priority of patients treatments based on the severity of their condition A method of quickly identifying victims who have immediately life threatening injuries and who have the best chance of surviving EMERGENT - divided into two 1. Immediate - unstable and requiring attention within 15 minutes Examples Airway obstruction, compromise Uncontrolled bleeding Shock 2. Urgent - temporarily stable but requiring care within a few hours Examples Threatened loss of limb or eyesight Multiple long bone fractures 3. Non emergency situations - would require intervention, however, could stand significant delay Example Walking wounded Single long bone fracture Closed fracture Soft tissue injuries without significant bleeding Facial fractures without airway compromise ROLES OF EMERGENCY NURSE A. Care provider Emergency nurses care for patients and families in hospital emergency departments, ambulances, helicopters, urgent care centers, cruise ships, sports arenas, industry, government and everywhere someone may have a medical emergency or where medical advances or injury prevention is a concern B. Educator Emergency nurses provide education to the public through programs to promote wellness and prevent illness C. Manager Emergency nurses also work as administrators, managers, and researchers who work to improve emergency health care. D. Advocate Emergency nurses defend or plead a cause or issue on belief of another A nurse advocate has a legal and ethical obligation to safeguard the patient's interests and rights

The Patient's Bill of Rights aka Patient Care Partnership Developed by the American Hospital Association in 1972 Goal is to promote the public's understanding of their rights and responsibilities as consumers of health care QUALIFICATIONS OF ER NURSE Graduated of Bachelor of Science in Nursing A registered nurse Knowledgeable and skillful for technology and equipment used in emergency care setting Must have a basic understanding of triage nursing Must be calm and collected under pressure and must by sympathetic to patients and their families They must be detail oriented, as doctors orders must be carried out instantly and correctly in emergency rooms They must be also be able to emotionally handle the daily sight of physical suffering and the reality that some patients may not be able to be saved, despite everyones best efforts LEGAL ISSUES AFFECTING THE PROVISION OF EMERGENCY NURSING Consent Negligence Confidentiality Autonomy Gather evidence Treatment Malpractice Fidelity Report Decision making MANAGEMENT OF CARE Anthropometric - is the measurement of human individual for the purpose of understanding human physical variation 1. Weight - accurate weight is required Pregnant Infants Children Elderly Prescribed certain medications Scale Should be placed in a spot that the patient is comfortable with Measured in pounds or kilograms TYPES Balance beam scale Digital scale Dial scale 2. Height Can be measured using a Movable SAFETY AND INFECTION CONTROL Disease can be directly transmitted in two ways 1. Vertical disease transmission - passing a disease causing agent vertically from parent to offspring, such as perinatal transmission

2. Horizontal disease transmission - from one individual to another in the same generation, peers in the same group AIRBORNE TRANSMISSION Occurs when bacteria or viruses travel on dust particles or on small respiratory droplets that may become aerosolized when people sneeze, cough, laugh or exhale They hang in the air much like invisible smoke They can travel on air currents over considerable distance Examples Anthrax Smallpox TB Measles Pertussis Chickenpox Influenza AIRBORNE PRECAUTIONS Be in a different room from the person who is ill, with a closed door in between If you need to be in the same room, wearing a mask may help for a brief exposure Covering the mouth or nose when coughing or sneezing decrease risk of infection DROPLETS TRANSMISSION Occurs when bacteria or viruses travel on relatively large respiratory droplets that people sneeze, cough, drip or exhale They travel only short distances before settling, usually less than 3 feet They can be spread directly if people are closed enough to each other The droplets land on hands, toys, tables, mats, or other surfaces, where they sometimes remain infectious for hours Examples Common cold Diptheria Influenza Meningitis Mumps Pertussis Plague Rubella Strep Droplet Precaution 1. Frequent hand washing 2. Cover mouth when coughing, sneezing 3. Using disposable towels and cups 4. Cleaning or disinfecting commonly touched infected surfaces CONTACT TRANSMISSION Requires some form of touch to spread an infection It is divided into two a. direct contact transmission involves immediate contact between two people b. Indirect contact transmission involves fomites, an object that becomes contaminated by touch then spreads the infection by touch Examples Abscesses Diptheria

 Lice Scabies Athletes foot Conjunctivitis Contact Precaution 1. Avoid direct contact with infected person especially whe there is a break in the skin 2. Frequent hand washing 3. Surface disinfecting can interrupt some disease transmission 4. Avoid sharing hairbrushes, combs and hats REVERSE TRANSMISSION The patient is being protected from the nurse and all the people in contact with the patient Examples Immunocompromised patients Cancer patients undergoing chemotherapy PREVENTION AND EARLY DETECTION A. ASSESSMENT GCS - Severe GCS less than or equal to 8 - Moderate GCS 9 - 12 B. PALPATORY the sensory skills developed by trained physicians and used in diagnosis and manipulative techniques C. PULSE PRESSURE Is the difference between the systolic and diastolic pressure It represents the force that your heart generates each time it contracts ! In a person with a systolic blood pressure of 120 mmHg and a diastolic pressure of 80 mmHg, the pulse pressure would 40 mmHg. ! When the pulse pressure is greater than 60 mmHg, there is an increased incidence of adverse cardiovascular events especially in the older population Several studies have identified that high pulse pressure: 1. Causes more artery damage compared to high blood pressure with normal pulse pressure 2. Indicates elevated stress on a part of the heart called the left ventricle 3. Is affected differently by different high blood pressure medicines LEVELS OF CONSCIOUSNESS REFLEX Stretch or deep reflex 4+ - very brisk 3+ - brisker than average 2+ - average normal 1+ - diminished 0 - no response Abnormal findings Clonus Hyperflexia is the exaggerated reflex seen whne the patient has upper motor neuron lesions Hypoflexia is the absence of a reflex A. Biceps reflex C. Brachioradialis reflex D. Quadriceps reflex E. Achilles reflex F. Clonus G. Superficial (Cutaneous) reflex H. Cremasteric reflex

I.

Plantar reflex (Babinski)

OBTAINING SPECIMEN 1. Stool 2. Urine 3. Sputum 4. Complete blood count 5. Capillary blood gas 6. Electrocardiogram V1 - 4th intercostal space, 4 R sternal border V2 - 4th intercostal space, L sternal border V3 - between leads v2 and v4 V4 - 5th L intercostal space in midclavicular line V5 - horizontal even with v4 but in the anterior axillary line V6 - horizontal even with v4 and v5 in the midaxillary line COPING, ADAPTATION, AND PSYCHOLOGICAL ADAPTATION Diet therapy Types Ayurveda diet - works to prevent disease an d rejuvenate the body Macrobiotics diet - Recommend for people suffering from cancer or other chronic diseases because it emphasizes eating low fat, high fiber food Macronutrients - Carbohydrates - Complex carbohydrates - Fiber - Fat RANGE OF MOTION EXERCISES - movement of joint through its full ROM Types 1. Active 2. Passive - no assistance from the client 3. Active assistive - client moves as far as possible and nurse completes the remainder of the movement 4. Active resistive - contraction of muscles against an opposing force BASIC CARE COMFORT Enema - introducing liquids into the rectum and colon via the anus, feeling the urgency and complete evacuation of the lower intestinal tract Types Water Mineral oil Contraindications Appendicitis Intestinal blockage Ulcerative colitis Ileitis Heart disease Rectal bleeding High blood pressure Kidney disease Children not recommended for infants under 6 months of age