CNA Chapter 7 Emergency Care and Disaster Preparation

Remember:

When speaking to an emergency services dispatcher it is important not to hang up until the dispatcher hangs up or says to hang up.

When a resident is falling, the NA should do the following:

Widen his stance and bring the resident's body close to the NA's body. NA should have knees bent and support the resident as he lowers her to the floor. NA should not try to stop or reverse a fall. NA should notify the nurse immediately.

Epilepsy

a brain disorder that results from a disruption in normal electrical impulses in the brain, which causes repeated seizures.

Insulin reaction

a complication of diabetes that can result from either too much insulin or too little food; also known as hypoglycemia.

Diabetic Ketoacidosis (DKA)

a complication of diabetes that is caused by having too little insulin in the body.

Obstructed airway

a condition in which something is blocking the tube through which air enters the lungs.

Shock

a condition that occurs when organs and tissues in the body do not receive an adequate blood supply.

Myocardial infarction (MI)

a condition that occurs when the heart muscle does not receive enough oxygen because blood flow to the heart is blocked; also called heart attack.

Abdominal thrusts:

a method of attempting to remove an object from the airway of someone who is choking.

Epistaxis

a nosebleed.

Orthostatic hypotension

a sudden drop in blood pressure that occurs when a person sits or stands up.

Transient ischemic attack (TIA)

a warning sign of a CVA/stroke resulting from a temporary lack of oxygen in the brain; symptoms may last up to 24 hours.

Care of the burn:

depends on its depth, size, and location.

Dyspnea

difficulty breathing.

First aid:

emergency care given immediately to an injured person by the first people to respond to an emergency.

Syncope

loss of consciousness; also called fainting.

Cardiopulmonary resuscitation (CPR)

medical procedures used when a person's heart or lungs have stopped working.

Emesis

the act of vomiting, or ejecting stomach contents through the mouth and/or nose.

Conscious

the state of being mentally alert and having awareness of surroundings, sensations, and thoughts.

The following is a brief review for people who have had CPR training:

1. After making sure that the scene is safe, check whether the person is responsive. Tap the person on the shoulder and shout, "Are you all right?" 2. If there is no response, call 911 immediately or send someone to call 911. Stay calm. 3. After calling 911, get an automated external defibrillator (AED) (if available and if trained in its use). Return to the person to provide CPR. More information on the AED is in step 10. 4. The person should be on his back on a hard surface (if he has no spinal injuries) before CPR is started. 5. Open the airway. Tilt the head back slightly. Lift the chin with one hand while pushing down on the forehead with the other hand (head tilt-chin lift method). This method is used if a neck injury is not suspected. 6. Look, listen, and feel for signs of life for no longer than 10 seconds: Look for the chest to rise and fall. Listen for sounds of breathing. Put your ear near the person's nose and mouth. Feel for the person's breath on your cheek.

The following are steps to take in case of a hurricane:

Know what category the hurricane is and track the expected path. Know which residents or clients must go to shelters, hospitals, or other facilities, and which need assistance. Be aware of people with special needs. High-risk people include the elderly and those unable to evacuate on their own. High-risk areas include mobile homes or trailers. Call your employer for instructions. Fill the bathtub with fresh water. Board up windows. Evacuate if advised to do so. Check the fuel level in automobiles. Have a portable battery-operated radio, flashlight, and cooking equipment available.

The following are signs and symptoms of fainting:

Dizziness Lightheadedness Nausea Perspiration Pale skin Weak pulse Shallow respirations Blackness in visual field

The following are steps to take in case of an earthquake: If indoors, follow these guidelines:

Drop to the ground. If possible, get under a sturdy piece of furniture, such as a heavy table, and hold on until the shaking stops. If no table or desk is available, stay crouched down in the inside corner of a building, and cover your face and head with your arms. Stay away from windows, outside walls, and anything that might fall over or fall down. Do not exit a building during the shaking. Do not use elevators.

The acronym F.A.S.T. can be used as a way to help respond effectively to a stroke.

Face - Is one side of the face drooping or is the person's smile uneven? Arms - Is one arm numb or weak? Speech - Is the person's speech slurred? Can the person repeat a simple sentence? Time - Time is of the utmost importance when responding to a stroke. Report to the nurse immediately if the person shows any of these signs.

The following are signs that a TIA or CVA (stroke) is occurring

Facial numbness, weakness, or drooping, especially on one side Paralysis on one side (hemiplegia) Arm numbness or weakness, especially on one side (hemiparesis) Slurred speech or inability to speak Inability to understand spoken or written words Use of inappropriate words Severe headache Blurred vision Ringing in ears Redness in face Noisy breathing Elevated blood pressure Slow pulse rate Nausea or vomiting Loss of bowel and bladder control Seizures Dizziness Loss of consciousness

Remember:

Facilities often use codes to inform staff of emergencies without causing panic and stress among residents and visitors. It is important for NAs to know the codes in their facilities and to respond calmly and professionally.

The following are steps to take in case of a flood:

Fill the bathtub with fresh water. Evacuate if advised to do so. Check the fuel level in automobiles. Make sure there is enough fuel to last through an evacuation if one becomes necessary. Have a portable battery-operated radio, flashlight, and cooking equipment available. Do not drink water or eat food that has been contaminated with floodwater. Do not handle electrical equipment. Do not turn off the gas yourself. Ask the gas company to turn off the gas.

The following are steps to take in case of a blackout:

Get a flashlight. Take prompt action to keep calm and provide light. Use a backup pack for electrical medical equipment, such as an IV pump. Backup packs do not last more than 24 hours, so contact emergency services when instructed.

Remember:

Gloves must be worn when helping a resident with a nosebleed.

Seizures may happen in these situations:

High fever (especially young children) Serious illness Head injury Seizure disorder such as epilepsy

The following are signs and symptoms of insulin reaction:

Hunger Headache Weakness Rapid pulse Low blood pressure Perspiration Cold, clammy skin Confusion Trembling Nervousness Blurred vision Numbness of lips and tongue Unconsciousness

The following are signs and symptoms of diabetic ketoacidosis:

Increased hunger or thirst Increased urination Abdominal pain Deep or labored breathing Breath that smells fruity or sweet Headache Weakness Rapid, weak pulse Low blood pressure Dry skin Flushed cheeks Drowsiness Nausea and vomiting Shortness of breath or air hunger Unconsciousness

Remember:

It is important to do no harm to severe burns. Ice, ointment, salve, and grease should NEVER be applied to a burn. Pulling away clothing or rubbing the burned area can also damage the skin or contribute to infection later on.

Remember:

It is very important for NAs to report all falls to the nurse and to complete an incident report.

Steps to take in case of an earthquake If outdoors, follow these guidelines:

Move away from buildings, electric poles and wires, and streetlights. Falling or flying debris is a greater danger than ground movement. If driving, stop as quickly as is safely possible and stay in the vehicle. Avoid stopping under overpasses or near buildings or wires if possible. If trapped under debris after an earthquake, do not light a match or ignite a lighter, and avoid kicking up dust. Breathe through a handkerchief or clothing and make tapping noises or use a whistle, if available, to get rescuers' attention. Do not shout. Shouting could cause you to inhale dangerous amounts of dust.

Remember:

Nobody should try to force anything into the mouth of a person who is having a seizure. The goal of a caregiver is to keep the resident safe.

Remember:

Not all facilities permit NAs to start CPR - even those trained to do so. It is important to know the facility's policy. Anyone who is not trained should never attempt to perform CPR.

It is important to note that women may also experience the following associated with TIA/CVA:

Pain in the face, arms, and legs Hiccups Weakness Chest pain Shortness of breath Palpitations

The following are signs of shock:

Pale or cyanotic skin Staring Increased pulse and respiration Low blood pressure Extreme thirst

NAs should be prepared to give the following information to emergency services when reporting an emergency:

Phone number and address, including directions, landmarks, and location in building Victim's condition, including any known medical background NA's name and position First aid given

In any disaster, it is important to follow these general guidelines:

Remain calm. Know where exits and stairways are. Know where alarms and extinguishers are. Know appropriate action to take. Stay informed via Internet, radio, or TV.

The following are steps to take in case of a tornado:

Seek shelter inside, ideally in a steel-framed or concrete building. Stay away from windows. Stand in the hallway or in a basement, or take cover under heavy furniture. Do not stay in a mobile home or trailer. Lie as flat as possible.

NAs responding to an emergency need to recognize the following symptoms of injury:

Severe bleeding Changes in consciousness Irregular breathing Unusual color or feel to the skin Swollen places on the body Medical alert tags Pain

Remember:

Severe bleeding must be controlled immediately, but NAs must take the time to put on gloves before trying to control bleeding

Signs of seizures include the following:

Severe shaking Thrusting arms and legs uncontrollably Jaw clenching Drooling Inability to swallow

The following are steps to take in case of lightning If indoors, follow these guidelines:

Stay inside and away from open doors and windows. Avoid the use of electrical equipment, such as hair dryers and televisions.

The following are symptoms of a heart attack:

Sudden, severe pain in the chest, usually on the left side or in the center behind the breastbone Pain or discomfort in other areas of the body, such as the arms, back, neck, jaw, or stomach Indigestion or heartburn Nausea and vomiting Dyspnea Dizziness Pale or cyanotic skin color Perspiration Cold and clammy skin Weak and irregular pulse rate Low blood pressure Anxiety and a sense of doom Denial of a heart problem Women can have MI without chest pressure. They are most likely to have shortness of breath, nausea, lightheadedness, stomach pain, sweating, fatigue, and back, neck or jaw pain. Some women's symptoms are more flu-like, and women are more likely to deny that they are having MI.

First-degree burn:

Superficial burn.

Remember:

The NA should notify the nurse immediately if she suspects poisoning.

Symptoms of poisoning can vary widely, but may include:

Vomiting Heavy, difficult breathing Acting drowsy or confused Burns or red areas around the mouth

Responding to a seizure:

1. Note the time. Put on gloves. 2. Lower the person to the floor. Cradle the head to protect it. If a pillow is nearby, place it under the person's head. Loosen clothing to help with breathing. Try to turn the person to one side to help lower the risk of choking. This may not be possible during a violent seizure. 3. Have someone call the nurse immediately or use the call light. Do not leave a person during a seizure unless you must do so to get medical help. 4. Move furniture away to prevent injury. 5. Do not try to restrain the person or stop the seizure. 6. Do not force anything between the person's teeth. Do not place your hands in the person's mouth for any reason. You could be bitten. 7. Do not give the person liquids or food. 8. When the seizure is over, note the time. Gently turn the person to his left side if you do not suspect a head, neck, back, spinal, or abdominal injuries. Turning the person reduces the risk of choking on vomit or saliva. If the person begins to choke, get help immediately. Check for adequate breathing and pulse. Begin CPR if breathing and pulse are absent and if you are allowed and trained to do so. Do not begin CPR during a seizure. 9. Remove and discard gloves. Wash your hands. 10. Report and document the incident properly, including how long the seizure lasted.

Responding to a nosebleed

1. Notify the nurse immediately. 2. Elevate the head of the bed, or tell the person to remain in a sitting position, leaning forward slightly. Offer tissues or a clean cloth to catch the blood. Do not touch blood or bloody clothes, tissues, or cloths without gloves. 3. Put on gloves. Apply firm pressure on both sides of the nose, on the soft part, up near the bridge. Squeeze the sides with your thumb and forefinger. Have the resident do this until you are able to put on gloves. 4. Apply the pressure until the bleeding stops. 5. Use a cool cloth or ice wrapped in a cloth on the bridge of the nose to slow the flow of blood. Never apply ice directly to skin. 6. Remove and discard gloves. Wash your hands. 7. Report and document the incident properly.

Responding to fainting:

1. Notify the nurse immediately. 2. Have the person lie down or sit down before fainting occurs. 3. If the person is in a sitting position, have him bend forward. He can place his head between his knees if he is able. If the person is lying flat on his back, elevate his legs about 12 inches. 4. Loosen any tight clothing. 5. Have the person stay in position for at least five minutes after symptoms disappear. 6. Help the person get up slowly. Continue to observe him for symptoms of fainting. Stay with him until he feels better. If you need help but cannot leave him, use the call light. 7. If a person does faint, lower him to the floor or other flat surface. Position him on his back. If he has no head, neck, back, spinal, or abdominal injuries, elevate his legs eight to 12 inches. If unsure about injuries, leave him flat on his back. Loosen any tight clothing. Check to make sure the person is breathing. He should recover quickly, but keep him lying down for several minutes. Report the incident to the nurse immediately. Fainting may be a sign of a more serious medical condition. 8. Report and document the incident properly.

Responding to vomiting:

1. Notify the nurse immediately. 2. Put on gloves. 3. Make sure the head is up or turned to one side. Place an emesis basin under the chin. Remove it when vomiting has stopped. 4. Remove soiled linens or clothes and set aside. Replace with fresh linens or clothes. If resident's intake and output (I&O) is being monitored (Chapter 15), measure and note the amount of vomitus. 6. Flush vomit down the toilet unless vomit is red, has blood in it, or looks like wet coffee grounds. If these symptoms are observed, show this to the nurse before discarding the vomit. After disposing of vomit, wash and store basin. 7. Remove and discard gloves. 8. Wash your hands. 9. Put on clean gloves. 10. Provide comfort to resident. Wipe face and mouth, position comfortably, and offer a drink of water or oral care (Chapter 13). Oral care helps get rid of the taste of vomit in the mouth. 11. Put soiled linen in proper containers. 12. Remove and discard gloves. 13. Wash your hands again. 14. Document time, amount, color, odor, and consistency of vomitus.

Control Bleeding

1. Notify the nurse immediately. 2. Put on gloves. Take time to do this. If the resident is able, he can hold his bare hand over the wound until you can put on gloves. 3. Hold a thick sterile pad, clean cloth, or clean towel against the wound. Press down hard directly on the bleeding wound until help arrives. Do not decrease pressure. Put additional pads over the first pad if blood seeps through. Do not remove the first pad. 5. If you can, raise the wound above the level of the heart to slow down the bleeding. Prop up the limb if the wound is on an arm, leg, hand, or foot and there are no broken bones. Use towels or other absorbent material. 6. When bleeding is under control, secure the dressing to keep it in place. Check for symptoms of shock (pale skin, staring, increased pulse and respiration rates, low blood pressure, and extreme thirst). Stay with the person until help arrives. 7. Remove and discard gloves and wash hands thoroughly when finished. 8. Report and document the incident properly.

To treat a minor burn:

1. Notify the nurse immediately. Put on gloves. 2. Use cool, clean water to decrease the skin temperature and prevent further injury. Do not use ice or ice water, as ice may cause further skin damage. Dampen a clean cloth with cool water, and place it over the burn. 3. Once the pain has eased, you may cover the area with a dry, clean dressing or nonadhesive sterile bandage. 4. Remove and discard gloves. Wash your hands. 5. Never use any kind of ointment, salve, or grease on a burn.

Responding to shock:

1. Notify the nurse immediately. Victims of shock should always receive medical care as soon as possible. 2. If controlling bleeding, put on gloves first. This procedure is described later in the chapter. Have the person lie down on her back. If the person is bleeding from the mouth or vomiting, place her on her side. Elevate the legs about eight to 12 inches unless the person has a head, neck, back, spinal, or abdominal injury; breathing difficulties; or fractures. (cont'd) Elevating the legs allows blood to flow back to the brain (and other vital areas). Never elevate a body part if the person has a broken bone or if it causes pain. Check pulse and respirations if possible (see Chapter 14). Begin CPR if breathing and pulse are absent and if you are trained to do so. 5. Keep the person as calm and comfortable as possible. Maintain normal body temperature. If the weather is cold, place a blanket around the person. If the weather is hot, provide shade. Do not give the person liquids or food. Report and document the incident properly.

How to treat more serious burns:

1. Remove the person from the source of the burn. If clothing has caught fire, have the person stop, drop, and roll, or smother the fire with a blanket or towel to put out flames. Protect yourself from the source of the burn. 2. Notify the nurse immediately. Put on gloves. 3. Check for breathing, pulse, and severe bleeding. If the person is not breathing and has no pulse, begin CPR if trained and allowed to do so. 4. Do not use any type of ointment, water, salve, or grease on the burn. 5. Do not try to pull away any clothing from burned areas. Cover the burn with sterile gauze or a clean sheet. Apply the gauze or sheet lightly. 6. Take care not to rub the burned area. 7. Monitor vital signs and wait for emergency medical help. 8. Remove and discard gloves. Wash your hands. 9. Report and document the incident properly.

Third-degree burn:

A full-thickness burn.

Second-degree burn:

A partial-thickness burn.

NAs should memorize these steps in responding to an emergency:

Assess the situation. Make sure you are not in danger and note the time. Assess the victim. Check the victim's level of consciousness. Call for help or send someone to get help. Remain calm and confident. After the emergency is over, complete an incident report.

The following are steps to take in case of lightning If outdoors, follow these guidelines:

Avoid the largest objects, such as trees, and avoid open spaces. Stay out of the water. Seek shelter in buildings. Stay away from metal fences, doors, or other objects. Avoid holding metal objects, such as golf clubs, in your hands. Stay in automobiles. It is safe to perform CPR on lightning victims; they carry no electricity.