ER trauma and disaster trauma
anthrax
when exposed to air, infected by inhalation, GI ingestion or skin contact ingest: N/V, fever, ascites, and sepsis hemorrhage: edema, necrosis skin: skin lesions if they survive tx: penicillin for 60 days If they think they are exposed then give prophylactic ciprofloxacin if dead then prefer to cremate bc spores can live for years
You are working in the triage area of an ED, and four patients approach the triage desk at the same time. List the order in which you will assess these patients. 1. An ambulatory, dazed 25-year-old male with a bandaged head wound 2. An irritable infant with a fever, petechiae, and nuchal rigidity 3. A 35-year-old jogger with a twisted ankle, having pedal pulse and no deformity 4. A 50-year-old female with moderate abdominal pain and occasional vomiting
2. An irritable infant with a fever, petechiae, and nuchal rigidity 1. An ambulatory, dazed 25-year-old male with a bandaged head wound 4. A 50-year-old female with moderate abdominal pain and occasional vomiting 3. A 35-year-old jogger with a twisted ankle, having pedal pulse and no deformity
The nurse is triaging pediatric clients as they arrive to the emergency department after a school bus accident. In what order should the nurse triage the victims from highest priority to lowest? All options must be used. 1. Child with a closed head wound and multiple compound fractures of the arms and legs 2. Sobbing child with several minor lacerations on the face, arms, and legs 3. Confused child with bright red blood pulsating from a leg wound 4. Child with a simple fracture of the arm complaining of arm pain
3. Confused child with bright red blood pulsating from a leg wound 1. Child with a closed head wound and multiple compound fractures of the arms and legs 4. Child with a simple fracture of the arm complaining of arm pain 2. Sobbing child with several minor lacerations on the face, arms, and legs
It is the summer season, and patients with signs and symptoms of heat-related illness present in the ED. Which patient needs attention first? 1) An elderly person complains of dizziness and syncope after standing in the sun for several hours to view a parade 2) A marathon runner complains of severe leg cramps and nausea. Tachycardia, diaphoresis, pal¬lor, and weakness are observed. 3) A previously healthy homemaker reports broken air conditioner for days. Tachypnea, hypoten¬sion, fatigue, and profuse diaphoresis are observed. 4) A homeless person, poor historian, presents with altered mental status, poor muscle coordina¬tion, and hot, dry, ashen skin. Duration of exposure is unknown.
4) A homeless person, poor historian, presents with altered mental status, poor muscle coordina¬tion, and hot, dry, ashen skin. Duration of exposure is unknown.
A 56-year-old patient presents in triage with left-sided chest pain, diaphoresis, and dizziness. This patient should be prioritized into which category? 1. High urgent 2. Urgent 3. Non-urgent 4. Emergent
4. Emergent
All people who have household or face-to-face contact with the client diagnosed with smallpox after the fever begins should be vaccinated within what time frame to prevent infection and death? A. 4 days B. 1 week C. 10 days D. 2 weeks
A. 4 days
Which statement below is INCORRECT about the yellow triage tag color in regards to a disaster situation? A. A survivor with this tag color is seen after patients with the green tag color. B. A survivor with this tag color can have treatment delayed for an hour or less. C. A survivor with this tag color has serious injuries that could eventually lead to the compromise of breathing, circulation, or mental status, especially if treatment is delayed more than an hour or so. D. A survivor with this tag color has second priority for treatment of injuries.
A. A survivor with this tag color is seen after patients with the green tag color.
The nurse is the first responder at the scene of a 6-car crash on a highway. Which victim should the nurse attend to first? A. A victim experiencing dyspnea B. A victim experiencing confusion C. A victim experiencing tachycardia D. A victim experiencing intense pain
A. A victim experiencing dyspnea
A homeless client presents to the ED. Upon assessment, the client is experiencing hypothermia. The nurse will plan to complete which priority intervention during the rewarming process? A. Attach a cardiac monitor B. Insert a Foley urinary catheter C. Assist with endotracheal intubation D. Administer inotropic drugs
A. Attach a cardiac monitor Continuous electrocardiograph (ECG) monitoring is performed during the rewarming process because cold-induced myocardial irritability leads to conduction disturbances, especially ventricular fibrillation. A urinary catheter should be inserted to monitor urinary output; however, ECG monitoring is the priority.
The nurse in the hospital emergency department is notified by emergency medical services that several victims who survived a plane crash will be transported to the hospital. Victims are suffering from cold exposure because the plane plummeted and was submerged in a local river. What is the initial action of the nurse? A. Call the nursing supervisor to activate the agency disaster plan. B. Supply the triage rooms with bottles of sterile water and normal saline. C. Call the intensive care unit to request that nurses be sent to the emergency department. D. Call the laundry department and ask the department to send as many warm blankets as possible to the emergency department.
A. Call the nursing supervisor to activate the agency disaster plan.
The wounded victim is able to walk and obey commands. The wounded victim is assigned what tag color? A. Green B. Red C. Yellow D. Black
A. Green
Nursing students are reviewing the categories of intra-abdominal injuries. The students demonstrate understanding of the information when they identify which of the following as examples of penetrating trauma? Select all that apply. A. Gunshot wound B. Knife-stab wound C. Motor-vehicle crash D. Fall from a roof E. Being struck with a baseball bat
A. Gunshot wound B. Knife-stab wound
Which phase of the psychological reaction to rape is characterized by fear and flashbacks? A. Heightened anxiety phase B. Acute disorganization phase C. Denial phase D. Reorganization phase
A. Heightened anxiety phase
A patient arrives at the emergency department after sustaining a gunshot wound to the abdomen. When assessing the patient, the nurse pays particular attention to which of the following? A. Liver B. Stomach C. Large intestine D. Kidneys
A. Liver Penetrating abdominal injuries, such as from a gunshot wound, are serious and result in a high incidence of injury to hollow and solid organs. Although any organs can be injured, the liver is the most frequently injured solid organ. The small bowel is a frequently injured hollow organ. Thus, of the options shown, the nurse would assess the liver area most closely.
A client with suspected inhalation anthrax is admitted to the emergency department. Which action by the nurse takes the highest priority? A. Monitor vital signs and oxygen saturation every 15 to 30 minutes. B. Suction the client as needed to obtain a sputum specimen for culture and sensitivity. C. Assess intake and output and maintain adequate hydration. D. Reassure the client that intubation and mechanical ventilation will be temporary.
A. Monitor vital signs and oxygen saturation every 15 to 30 minutes.
When providing care to a client who has experienced multiple trauma, which of the following would be most important for the nurse to keep in mind? A. The client is assumed to have a spinal cord injury until proven otherwise. B. The most lethal injuries are often the most readily apparent. C. Most multiple trauma victims exhibit evidence of the trauma. D. Injuries have occurred to at least three distinct organ systems.
A. The client is assumed to have a spinal cord injury until proven otherwise.
A client present to the ED following a work-related injury to the left hand. The client has an avulsion of the left ring finger. Which correctly describes an avulsion? A. Tissue tearing away from supporting structures B. Incision of the skin with well-defined edges, usually long rather than deep C. Skin tear with irregular edges and vein bridging D. Denuded skin
A. Tissue tearing away from supporting structures
A nursing instructor is describing the role of a nurse during a disaster. Which of the following would best reflect the nurse's role? A. Variable depending on the needs of the situation B. Client care within the area of expertise C. Provision of comprehensive client-specific care D. Directly specified by the physician in charge
A. Variable depending on the needs of the situation The role of the nurse during a disaster varies and depends on the needs or situation. Nurses may be asked to perform duties outside their areas of expertise and may take on responsibilities normally held by physicians or advanced practice nurses. During a disaster, nursing care focuses on essential care from a perspective of what is best for all clients.
management of hypothermia
ABC, remove wet clothes, rewarm * cold blood returning from extremities has high levels of lactic acid and can cause cardiac dysrhythmias and electrolyte disturbances - pt <32 degrees have Vfib when moved - defibrillator not effective when pt is < 31 degrees active core rewarming: warm fluids, warm humidified oxygen, warm peritoneal lavage passive external rewarming: warm blankets ver the bed heater
Which is the most likely weaponized biological agent available? A. Plague B. Anthrax C. Botulism D. Smallpox
B. Anthrax
A patient is brought to the emergency department and diagnosed with decompression sickness. The nurse interprets this as indicating that the patient most likely has been involved with which of the following? A. Swimming in a lake B. Diving in an ocean C. Running a race in hot humid weather D. Working in a chemical plant
B. Diving in an ocean Decompression sickness occurs when patients have engaged in diving in a lake or ocean or high-altitude flying or flying in a commercial aircraft within 24 hours of diving. Swimming in a lake could lead to a near-drowning episode. Running a race in hot humid weather would increase a person's risk for heat stroke. Working in a chemical plant would increase the risk for chemical burns.
A nurse is completing her annual cardiopulmonary resuscitation training. The class instructor tells her that a client has fallen off a ladder and is lying on his back; he is unconscious and isn't breathing. What maneuver should the nurse use to open his airway? A. Neck tilt-head lift B. Jaw-thrust C. Abdominal thrust D. Seldinger
B. Jaw-thrust If a neck or spine injury is suspected, the jaw-thrust maneuver should be used to open the client's airway. To perform this maneuver, the nurse should position herself at the client's head and rest her thumbs on his lower jaw, near the corners of his mouth. She should then grasp the angles of his lower jaw with her fingers and lift the jaw forward. The head tilt-chin lift maneuver is used to open the airway when a neck or spine injury isn't suspected.
A nurse is providing care to an older adult client who has frostbite of the feet. Which action would be least appropriate? A. Providing an analgesic for pain B. Massaging the feet C. Restricting ambulation D. Placing sterile cotton between the toes after rewarming
B. Massaging the feet Analgesia is given for pain during the rewarming process because it can be very painful. Ambulation would be restricted. Once rewarmed, sterile gauze or cotton is placed between the affected toes to prevent maceration.
During a disaster, the nurse sees a victim with a green triage tag. The nurse knows that the person has which type of injury? A. Life-threatening but survivable with minimal intervention B. Minor; treatment can be delayed hours to days C. Significant; injuries require medical care but can wait hours without threat to life or limb D. Extensive; chances of survival are unlikely even with definitive care
B. Minor; treatment can be delayed hours to days A green triage tag (priority 3, or minimal) indicates injuries that are minor; treatment can be delayed hours to days. A red triage tag (priority 1, or immediate) indicates injuries that are life threatening but survivable with minimal intervention. A yellow triage tag (priority 2, or delayed) indicates injuries that are significant and require medical care but can wait hours without threat to life or limb. A black triage tag (priority 4, or expectant) indicates inju
The wounded victim is unable to walk, has respiratory rate of 12, capillary refill is 8 seconds, and is unresponsive. The wounded victim is assigned what tag color? A. Green B. Red C. Yellow D. Black
B. Red
The wounded victim is unable to walk, has respiratory rate of 40, capillary refill is 6 seconds, and can't follow simple commands. The wounded victim is assigned what tag color? A. Green B. Red C. Yellow D. Black
B. Red
The wounded victim is unable to walk, respiratory rate is absent but when airway is repositioned breathing is noted. The wounded victim is assigned what tag color? A. Green B. Red C. Yellow D. Black
B. Red
The emergency department nurse is caring for clients involved in a chlorine exposure accident at a local chemical plant. The nurse is aware that permanent damage can occur to which body systems? A. Cardiac B. Respiratory C. Renal D. Hepatic
B. Respiratory
The Department of Homeland Security indicates a threat level "Imminent" relative to a situation. What does the nurse know that this indicates? A. Elevated risk of attack B. Severe, credible impending threat, usually with a site specified C. Risk of attack, without a site specified D. Risk of attack, without timing specified
B. Severe, credible impending threat, usually with a site specified
The nurse in charge of a nursing unit is asked to select those hospitalized clients who can be discharged so that hospital beds can be made available for victims of a community disaster. Which clients can be safely discharged? Select all that apply. A. The client with heart failure (HF) who has bilateral rhonchi B. The client who 24 hours earlier gave birth to her second child by caesarean delivery C. The 48-hour postoperative client who has undergone an ileostomy because of ulcerative colitis D. The client with peritonitis caused by a ruptured appendix who is febrile with a temperature of 102º F (38.9º C) E. The 2-day postoperative client who has undergone total knee replacement and is ambulating with a walker F. The 3-day postoperative client who has undergone coronary artery bypass grafting and is ready for rehabilitation
B. The client who 24 hours earlier gave birth to her second child by caesarean delivery C. The 48-hour postoperative client who has undergone an ileostomy because of ulcerative colitis E. The 2-day postoperative client who has undergone total knee replacement and is ambulating with a walker F. The 3-day postoperative client who has undergone coronary artery bypass grafting and is ready for rehabilitation
The nurse is triaging victims after an explosion at an oil refinery. One victim reports tinnitus, dizziness, and otorrhea. For what probable condition should the nurse prepare care? A. Blast lung B. Tympanic rupture C. Head injury D. Abdominal injury
B. Tympanic rupture The nurse should prepare to care for a client with probable tympanic rupture. Signs and symptoms of tympanic rupture include hearing loss, tinnitus, pain, dizziness, and otorrhea. Symptoms of blast lung include dyspnea, hypoxia, tachypnea or apnea, cough, chest pain, and hemodynamic instability. Symptoms of head injury include postconcussive syndrome. Symptoms of abdominal injury include pain, guarding, rebound tenderness, rectal bleeding, nausea, and vomiting.
Child 3rd degree burns on 75% TBSA R 10 P weak M unconscious
BLACK
Head injury Pupils unequal R 20 P present M confusion
BLACK
No visible wounds Supine/ mouth full of vomit R none P absent M unconscious
BLACK
Significant open head injury R 10 P weak M unconscious
BLACK
The nurse is the first responder at the scene of a train accident. Which victim should the nurse attend to first? A. A victim experiencing excruciating pain B. A victim experiencing moderate anxiety C. A victim experiencing airway obstruction D. A victim experiencing altered level of consciousness
C. A victim experiencing airway obstruction
The nurse is the first responder at the scene of a train accident. Which victim should the nurse attend to first? A. A middle-aged man with 1 foot trapped under the wreckage B. A crying teenager who is holding pressure on an arm laceration C. A young woman who appears dazed and confused and is shivering D. A screaming middle-aged woman looking frantically for her husband
C. A young woman who appears dazed and confused and is shivering The young woman is demonstrating classic signs of shock, possibly from a closed head injury. Initial management of a client displaying signs of shock includes management of airway, breathing, and circulation. Initial treatment includes keeping the client warm. Oxygenation and intravenous fluids will be needed immediately to stabilize and maintain tissue perfusion. A first responder would be unlikely to be able to release a foot trapped under wreckage without help. The teenager is already applying pressure to the arm and is more likely to be able to maintain self-care until help arrives.
The nurse from a medical unit is called to assist with care for clients coming into the hospital emergency department during an external disaster. Using principles of triage during a disaster, the nurse should attend to the client with which problem first? A. Fractured tibia B. Penetrating abdominal injury C. Bright red bleeding from a neck wound D. Open massive head injury in deep coma
C. Bright red bleeding from a neck wound The client with arterial bleeding from a neck wound is in immediate need of treatment to save the client's life. This client is classified as such and would wear a color tag of red from the triage process. The client with a penetrating abdominal injury would be tagged yellow and classified as "delayed," requiring intervention within 30 to 60 minutes. A green or "minimal" designation would be given to the client with a fractured tibia, who requires intervention but who can provide self-care if needed. A designation of "expectant" is applied to the client with massive head or other injuries and minimal chance of survival; the corresponding color code is black in the triage process. Such clients receive supportive care and pain management but are given definitive treatment last.
The nurse is caring for a victim of a chemical disaster. Medications given in the treatment of this client include amyl nitrite, sodium nitrite, and sodium thiosulphate. What chemical agent does the nurse know this client has been exposed to? A. Sarin B. Mustard gas C. Cyanide D. Anthrax
C. Cyanide Cyanide poisoning calls for the administration of one or all of the following antidotes: amyl nitrite, sodium nitrite, and sodium thiosulfate. Amyl nitrite promotes the formation of methemoglobin, which combines with cyanide to form nontoxic cyanmethemoglobin. Sarin, mustard gas, and anthrax are not treated in this way.
A catastrophic disaster has occurred 5 miles from the hospital you are working in. The hospital's disaster plan is activated and the wounded are brought to the hospital. You're helping triage the survivors. One of the wounded is able to walk around and has minor lacerations on the arms, hands, chest, and legs. You would place what color tag on this survivor? A. Red B. Yellow C. Green D. Black
C. Green
A nurse is caring for a client who has arrived at the emergency department in shock. The nurse intervenes based on the knowledge that which of the following is the most common cause of shock? A. Anaphylaxis B. Sepsis C. Hypovolemia D. Cardiac dysfunction
C. Hypovolemia
The nurse is caring for a client suffering from carbon monoxide poisoning. The nurse will expect the client to exhibit which manifestation? A. Severe hypertension B. Hyperactivity C. Intoxication D. Cherry red skin coloring
C. Intoxication A client suffering from carbon monoxide poisoning appears intoxicated (from cerebral hypoxia). Other signs and symptoms include headache, muscular weakness, palpitation, dizziness, and mental confusion. The skin coloring in the client with carbon monoxide poisoning can range from pink to cherry red to cyanotic and pale and is not a reliable diagnostic sign.
The NATO triage system uses color-coded tagging to identify severity of injuries. A patient with survivable but life-threatening injuries (i.e., incomplete amputation) would be tagged with which color? A. Black B. Green C. Red D. Yellow
C. Red
You're working as a triage nurse during a disaster situation. Based on the triage color code tags placed on each of the wounded, which tag color represents the wounded who have the highest priority of being treated first? A. Green B. Yellow C. Red D. Black
C. Red
The community health nurse is working with disaster relief after a tornado. The nurse assists in finding safe housing for survivors, providing support to families, organizing counseling, and securing physical care when needed. Which level of prevention does the nurse exercise? A. Primary level of prevention B. Secondary level of prevention C. Tertiary level of prevention D. Quaternary level of prevention
C. Tertiary level of prevention Tertiary prevention involves reduction of the amount and degree of disability, injury, and damage after a crisis. Primary prevention means keeping the crisis from occurring, and secondary prevention focuses on reducing the intensity and duration of a crisis. There is no known quaternary prevention level.
What is a common source of airway obstruction in an unconscious client? A. A foreign object B. Saliva or mucus C. The tongue D. Edema
C. The tongue
The wounded victim is unable to walk, has respiratory rate of 19, capillary refill of one second, and is able to obey your commands. The wounded victim is assigned what tag color? A. Green B. Red C. Yellow D. Black
C. Yellow
The nurse is caring for a client diagnosed with botulism. Which medication classification does the nurse anticipate? A. An antibiotic B. An anti-inflammatory C. Antipyretics D. Antitoxins
D. Antitoxins Botulism is a disease that develops from the neurotoxin produced by Clostridium botulinum. Botulinum antitoxin is the only treatment after exposure to lessen the severity of symptoms. Antibiotics are used for anthrax. Supportive treatments such as antipyretics are used for smallpox. Anti-inflammatory medications are not treatments for botulism.
The wounded victim is unable to walk, respiratory rate is absent and when airway is repositioned breathing is still absent. The wounded victim is assigned what tag color? A. Green B. Red C. Yellow D. Black
D. Black
While triaging the wounded from a disaster, you note that one of the wounded is not breathing, radial pulse is absent, capillary refill >2 seconds, and does not respond to your commands. What color tag is assigned? A. Green B. Red C. Yellow D. Black
D. Black
During a mass disaster, the nurse is caring for a victim whose status has been categorized as yellow during triage. How should the nurse best allocate time and resources to this client's care? A. Forego immediate care because the client is unlikely to survive B. Place a low priority on the client's care because the client will likely recover independently C. Provide high-priority, immediate care to save the client's life D. Delay the client's treatment for a few hours if other clients need immediate care
D. Delay the client's treatment for a few hours if other clients need immediate care For a client categorized as yellow, care can be safely delayed for six to eight hours. Death is not imminent, but spontaneous recovery is unlikely.
A patient who has accidentally ingested toilet bowel cleaner is brought to the emergency department. Which action would NOT be appropriate for the nurse to implement? A. Dilution with water or milk B. Gastric lavage C. Administration of activated charcoal D. Induced vomiting
D. Induced vomiting Vomiting is never induced after ingestion of caustic substances (acid or alkaline) such as toilet bowl cleaner because the substance is corrosive to the tissues.
Which is a true statement regarding severe acute respiratory syndrome (SARS)? A. Constipation usually develops. B. It is spread by fecal contamination. C. Hypothermia will occur. D. It is most contagious during the second week of illness.
D. It is most contagious during the second week of illness. Based on available information, SARS is most likely to be contagious only when symptoms are present, and clients are most contagious during the second week of illness. Diarrhea and hyperthermia may occur with SARS. Respiratory droplets spread the SARS virus when an infected person coughs or sneezes.
A nurse is providing an educational program for a group of occupational health nurses working in chemical facilities. Which of the following would the nurse include as the priority in the case of a chemical burn? A. Applying antimicrobial ointment B. Administering tetanus prophylaxis C. Covering the area with a sterile dressing D. Rinsing the area with copious amounts of water
D. Rinsing the area with copious amounts of water
When preparing for an emergency bioterrorism drill, the nurse instructs the drill volunteers that each biological agent requires specific client management and medications to combat the virus, bacteria, or toxin. Which statement reflects the client management of variola virus (smallpox)? A. Acyclovir is effective against smallpox. B. Smallpox is spread by inhalation of spores. C. A vaccination is effective only if administered within 12 to 24 hours of exposure. D. Smallpox spreads rapidly and requires immediate isolation.
D. Smallpox spreads rapidly and requires immediate isolation. Smallpox is spread by droplet or direct contact. No antiviral agents are effective against smallpox; however, vaccination within 2 to 3 days of exposure is protective. In 4 to 5 days, vaccination may prevent death and should be administered with vaccinia immune globulin. Smallpox spreads rapidly and requires immediate isolation. Even in death, the disease can be transmitted.
A nurse is providing in-service education for staff members about evidence collection after sexual assault. The educational session is successful when staff members focus their initial care on which step? A. Collecting semen B. Performing the pelvic examination C. Obtaining consent for examination D. Supporting the client's emotional status
D. Supporting the client's emotional status The teaching session is successful when staff members focus first on supporting the client's emotional status. Next, staff members should gain consent to perform the pelvic examination, perform the examination, and collect evidence, such as semen if present.
A 15-year-old male client was sent to the emergency unit following a small laceration on the forehead. The client says that he can't move his legs. Upon assessment, respiratory rate of 20, strong pulses, and capillary refill time of less than 2 seconds. Which triage category would this client be assigned to? A. Black. B. Green. C. Red. D. Yellow
D. Yellow
Crying No injury noted R 16 P present M A&O
GREEN
Facial injuries/laceration R 18 P present M A& O
GREEN
Laceration above right eye R 18 P present M A&O
GREEN
Minor laceration on arm R 20 P present M A& O
GREEN
Several patients that have been involved in a bombing are unlikely to survive. What priority are these patients given during triage? Priority 1 Priority 2 Priority 3 Priority 4
Priority 4 Triage category "Expectant" is priority 4 (black) and applies to patients with injuries that are extensive and whose chances of survival are unlikely even with definitive care, such as unresponsive patients with penetrating head wounds, high spinal cord injuries, and wounds involving multiple anatomic sites and organs.
2nd degree burn right left 50% TBSA R 20 P present M A&O
RED
Diabetic - BG 30 Wheezing RR 28 P present M Disoriented
RED
Flail chest R 32 P present M A&0
RED
Open left tib/fib fracture Heavy bleeding R 10 P weak M A&O
RED
Severe breathing difficulty Asymetrical chest movement R 34 P present M A&O
RED
rape and VOV
VOV: treat as best we can in er setting because its important to overall psych well being rape: contact SANE nurse: sexual assault nurse examiner, physical examine, collection of forensic evidence, get basic history and document
Arm swollen, possible closed fracture R 16 P present , cap refill <3 M A&O
YELLOW
Unable to move legs Cap refill <3 R 20 P present M A&O
YELLOW
pt with substance abuse, drugs and alcohol
alcohol poisoning: maintain airway, observes CNS depression, monitor hypotension, monitor withdrawal delirium, and injuries, withdrawal s/s: combative, hallucinations, banana bag: multivitamin, thiamine; withdraws meds: haloperidol and lorazepam cocaine: nasally, inject, smoke; CNS stimulant, s/s: increased HR and BP, overdose: seizures and aggression, nursing: airway, monitor cardiac, seizure control heroin: s/s: pin point pupils, decreased BP, respiratory depression, seizures; look for needle marks, nursing: airway, cardiac, naloxone, EKG monitor bath salts: acts like ecstasy, swallow, snorted, smoked or injected, very violent and aggressive; nursing: airway, cardiac, safety (staff and patient)
radiation injuries
all body systems are affected by acute radiation syndrome (ARS) predicating s/s will indicate survival probable survivors will have no initial s/s or very minimal s/s: N/V last 24-48 hours improbable: acutely ill with N/V/D and shock once s/s show then pt has been exposed to lethal dose and survival time is variable
frostbite at risk s/s warning interventions complications
at risk: older adults, infants, chronic illness, trauma s/s: skin is hard, cool, white, mottled, insensitivity to touch WARNING: as skin is warmed its painful and turns red, do not massage, if feet are involved do not walk, bedrest interventions: controlled, but rapid rewarming, analgesics, circulation bath 30-40 min intervals, monitor all organs complications: hypothermia trumps frostbite
blast lung
bomb wave passes through lung, causes hemorrhage of lung and tearing s/s: SOB, hypoxia, tachycardia, apnea, bleeding from nose
collection of forensic evidence
determine mechanism of injury, time, description of wounds, and collection of any evidence in trauma we assume any everything is evidence do no disturb clothes the have holes, tears, blood stains clothes must be removed and each placed in paper bag plastic will retain moisture do not give anything to family and never leave unattended in patient room
food poisoning
determine what food ABC and supportive care treat fluids and electrolytes control N/V clear liquid diet and progress diet after N/V
triage disaster
expectant/black: dead or close to dec, unresponsive, spinal cord injury, 2-3 degree burns on >60% of body, shock, no BP, weak or no pulse, fixed pupils red/immediate: labeled "1", life threatening injury but can still survive, chest wounds, phenumothroax, airway obstruction, tx shock, 2-3 degree burn on 15-40% of body delayed/yellow: "2", need medical care, but can wait a few hours, stable abdominal wound, wound with out airway issues, open or closed fractures minimal/green: "3", walking wounded, could wait hours/days, minor fractures, burns, sprains, lacerations with out bad bleeding SALT: sorting, assessing, life saving maneuvers, treat
blood agents
likely cyanid, systemic, RR failure, cardiac arrest and death
isolation precautions for biological terrorism agents
practice isolation process - standard at least may need terminal disinfectant most importnat in recognizing: multiple pt with same presentation, protect self, dont touch pt, get help and isolate pt wear most advanced ppe available if pt are intubated and paralyzed then they cant cough or spread agent 3 D's: disrobe all clothing, dry decontamination (blot not shower), don clean gown for wet decontamination
primary wave injury secondary tertiary quaternary
primary: result pressure wave of bomb; pulmonary contusion, blast lung, tympanic rupture, abdominal hemorrhage, sometimes wave can hit twice if in an enclosed space - organs may rupture secondary: debris, shrapnel from bomb, penetrating injuries, DO NOT remove object tertiary: pressure wave, may throw pt, may be further away, head injury or fractures quaternary: result from preexisting conditions, exacerbated from explosion, COPD, asthma, heart conditions, afib may go into vfib
SARS
spreads rapidly intubation period 2-10 days virus so supportive care
radiation decontamination
triage OUTSIDE hospital strict isolation precautions if they have already been in hospital - cover all vents and waster double bagged and labeled radiation staff wear: water resistant gowns, 2 pairs of gloves, caps, googles, masks, and booties decontaminate outside with a shower, be carful of run off obtain biological samples: nasal, throat, blood may need gastric lavage for internal decontamination
pt with multiple trauma
team approach assume cervical spine injury injuries interfering with vital physiologic function have highest priority cant see crush injury or internal bleeding airway, control hemorrhage, prevent shock, assess spinal injury, evaluate other injury, splining fracture, assess neuro
A patient brought to the ED by the rescue squad after getting off a plane at the airport is complaining of severe joint pain, numbness, and an inability to move the arms. The patient was on a diving vacation and went for a last dive this morning before flying home. What is a priority action by the nurse? A. Ensure a patent airway and that the patient is receiving 100% oxygen. B. Send the patient for a chest x-ray. C. Send the patient to the hyperbaric chamber. D. Draw labs for a chemistry panel.
A. Ensure a patent airway and that the patient is receiving 100% oxygen. Decompression sickness, also known as "the bends," occurs in patients who have engaged in diving (lake/ocean diving), high-altitude flying, or flying in commercial aircraft within 24 hours after diving. Signs and symptoms include joint or extremity pain, numbness, hypesthesia, and loss of range of motion. A patent airway and adequate ventilation are established before all other interventions, as described previously, and 100% oxygen is administered throughout treatment and transport.
The nurse in charge of a nursing unit is asked to select the hospitalized clients who can be discharged so that hospital beds can be made available for victims of a community disaster. Select the clients who can be safely discharged. Select all that apply. A. A client with dyspnea B. A client experiencing sinus rhythm C. A client receiving oral anticoagulants D. A client with chronic atrial fibrillation E. A client experiencing third-degree heart block F. A client who has not voided since before surgery
B. A client experiencing sinus rhythm C. A client receiving oral anticoagulants D. A client with chronic atrial fibrillation
The nurse in charge of a nursing unit is asked to select the hospitalized clients who can be discharged so that hospital beds can be made available for victims of a community disaster. Which clients can be safely discharged? Select all that apply. A. A client with chest pain B. A client with a Holter monitor C. A client receiving oral antibiotics D. A client experiencing sinus rhythm E. A client newly diagnosed with atrial fibrillation F. A client experiencing third-degree heart block who requires a pacemaker
B. A client with a Holter monitor C. A client receiving oral antibiotics D. A client experiencing sinus rhythm
The nurse is the first responder after a tornado has destroyed many homes in the community. Which victim should the nurse attend to first? A. A pregnant woman who exclaims, "My baby is not moving." B. A woman who is complaining, "My leg is bleeding so bad, I am afraid it is going to fall off!" C. A young child standing next to an adult family member who is screaming, "I want my mommy!" D. An older victim who is sitting next to her husband sobbing, "My husband is dead. My husband is dead."
B. A woman who is complaining, "My leg is bleeding so bad, I am afraid it is going to fall off!" Priority nursing care in disaster situations needs to be delivered to the living and not the dead. The victim who is bleeding badly is the priority. The bleeding could be from an arterial vessel; if the bleeding is not stopped, the victim is at risk for shock and death. The pregnant client is the next priority, but the absence of fetal movement may or may not be indicative of fetal demise.
The emergency department (ED) nurse receives a telephone call and is informed that a tornado has hit a local residential area and that numerous casualties have occurred. The victims will be brought to the ED. The nurse should take which initial action? A. Prepare the triage rooms. B. Activate the emergency response plan. C. Obtain additional supplies from the central supply department. D. Obtain additional nursing staff to assist in treating the casualties.
B. Activate the emergency response plan.
The nurse received a patient from a motor vehicle accident who is hemorrhaging from a femoral wound. What is the initial nursing action for the control of the hemorrhage? A. Apply a tourniquet. B. Apply firm pressure over the involved area or artery. C. Elevate the injured part. D. Immobilize the area to control blood loss.
B. Apply firm pressure over the involved area or artery. A tourniquet is applied to an extremity only as a last resort when the external hemorrhage cannot be controlled in any other way and immediate surgery is not feasible.
A female patient was sexually assaulted when leaving work. When assisting with the physical examination, what nursing interventions should be provided? (Select all that apply.) A. Have the patient shower or wash the perineal area before the examination. B. Assess and document any bruises and lacerations. C. Record a history of the event, using the patient's own words. D. Label all torn or bloody clothes and place each item in a separate brown bag so that any evidence can be given to the police. E. Ensure that the police are present when the examination is performed.
B. Assess and document any bruises and lacerations. C. Record a history of the event, using the patient's own words. D. Label all torn or bloody clothes and place each item in a separate brown bag so that any evidence can be given to the police. A history is obtained only if the patient has not already talked to a police officer, social worker, or crisis intervention worker. The patient should not be asked to repeat the history. Any history of the event that is obtained should be recorded in the patient's own words. The patient is asked whether he or she has bathed, douched, brushed his or her teeth, changed clothes, urinated, or defecated since the attack, because these actions may alter interpretation of subsequent findings. Each item of clothing is placed in a separate paper bag. The bags are labeled and given to appropriate law enforcement authorities. The patient is examined (from head to toe) for injuries, especially injuries to the head, neck, breasts, thighs, back, and buttocks. The exam focuses on external evidence of trauma (bruises, contusions, lacerations, stab wounds).
nerve agent
hyperstim of nerve endings sarin, soman organophosphates tx: supportive care and atropine bc it blocks acetylcholine decontaminate: copious amounts of soap and water or saline for at least 20 min blot down wipe plastic equipment will absorb sarin gas
carbon monoxide poisoning
inhaled CO2 bind to hemoglobin and does not transfer oxygen pulse ox looks high but its not s/s: CNS s/s predominate skin color and pulse ox not reliable s/s tx: fresh air immediately, CPR, administer O2 100% monitory continuously
vesicants
chemical causes blistering results in burning, bronchitis and death - 24 hours post exposure - stinging and vesicles appear sulfur mustard, nitrogen muistard respiratory issues decontamination: soap and water, do not scrub or use hypochlorite solutions eye exposure requires copious irritation
wounds cleaning primary closure delayed closure
cleaning: most with NS, clip hair dont shave primary closure: suturing subcut fat, brought together and closure of epidermis, skin edges level and possible use of butterfly stitches delayed closure: pt has a significant tissue loss or at high risk for infection, place gauze over wound, make sure its splinted to prevent movement
radiation exposure
decontamination no necessary not a medical emergency radioactive gases, liquids or solide require immediate medical attention to prevent incorporation - uptake of radioactive material into body
pulmonary agents
destroy pulmonary membrane
ER triage
level 1, resuscitation: assess continuously, ex: code/post code, seizure, hemorrhaging; one on one level 2, emergent: assess Q15 min, ex: code stroke, MI postictal level 3, urgent: assess Q30 min, ex: HTN, bleeding wound, fever, funky vs, appendicitis level 4, less urgent: assess Q1 hr, CHF, laceration, ash,a, someone who went to urgent care instead of ER level 5, non urgent: assess Q2 hr, can have PCP manage at later time, ex: ear infection, food poisoning, episodic illness thats easily controlled airway, hemorrhage, hypovolemic shock, wounds, trauma/multiple trauma
personal protective equipment
level A: highest level, self controlled breathing apparatus, vapor tight chemical resistance suit, gloves and boots; highest level hazmat level B: high level respiratory protection, but less skin and eye protectant, and chemical resistant suit; high level hazmat level C: air purified respirator, overall with splash hood, chemical resistant gloves and boots, typically ready in hospital level D: standard precautions
psychiatric emergency
management: maintain safety of all persons and gain control of situation , determine risk of injury, maintain self esteem while caring, determine if there's psych history safety is #1
patients with poisoning
most important: what, when and how s/s of particular poison: call poison control, they will tell you antidote supportive care to maintain all vital organs age and wt for poison control gastric lavage only effective with in 1 hr activated charcoal: most poison besides corrosive, its black thick and messy possibly dieresis or dialysis snake bite antivenom: with in 4 hrs, Favbar and Crofab; type of snake will determine which dose, dry expensive provide warmth, immobilize extremity, no ice measure and assess circumference every 15 min find out the type of snake - certain ones have proteins that affect neuro status, cardiac and RR s/s: localized edema, localized ecchymosis, necrosis of site, N/V, possible metallic taste in mouth lie down and remove clothing
tympanic rupture
most sensitive organ to rupture s/s: hearing loss, tinnitus, dizziness, pain
crush injury complications
rabdo from severe muscle damage hypovolemic shock: movement of blood and plasma into injury once object is removed; ex: pt in a disaster and tree fell on leg, or pinned against wall with chair paralysis of body part, erythema and blistering, damage to body part renal dysfunction: prolong hypotension * dont move object, it will cause more damage
heat stroke s/s interventions complications at risk
s/s: CNS dysfunction, increased temp, hoy dry skin, tachypnea, hypotension, tachycardia, increased O2 demands interventions: cool sheets, cold water, reduce fire temp quickly (over 1 hr), stop at 38 or 104 degree to prevent hypothermia monitor: temp, VS, EKG, LOC, UOP, CVP, IVF ice to groin, neck, chest, axillae, lavage to stomach or colon, bath complications: administer IVF slowly due to high risk of MI or renal issues at risk: older adults, younger, chronic illness, people taking certain meds
intra abdominal injury s/s priorities complications
s/s: abd. bleed: abd, very hard, tympanic blunt injury: difficult to determine exact injury, muscle rigidity, tenderness, swelling of extremities, pain bowel sound hypoactive priority: hold oral fluids, assess other areas accompanying abd. injuries, may need NG tube, prophylactic antibiotic, assess referred pain (spleen, liver, intraperitoneal injury), exploratory surgery, immobilize spine, continuously monitor ct for bleeding labs: ABG, H&H, lactic complications: hemorrhage, gun shot can cause more damage to hollow organs, if viscera (internal organs) are protruding then cover with sterile moist saline dressing
hemorrhage s/s priorities internal vs external
s/s: loss of volume, loss of cardiac output, loss of tissue perfusion numbness, tingling, changes in vision, blood in stool, urine, vomit etc., chest pain, HA, LOC, weakness, seizures s/s shock: cool, clammy, rapid pulse, rapid breathing, N/V priorities: stop bleeding and monitor for s/s of shock fluids: LR then NS, packed RBC, platelets internal: shock VS: tachycardia, hypotension, change in skin, color, pale, weak, fatigue external: tourniquet and pressure, if tourniquet in the filed write time placed bc of perfusion if bleeding is severe then possible rapid transfuser
chemical burns
severity depends on chemical and amount and mechanism tx: immediately flush skin with running water from shower hose or faucet, determine substance, some require prolonged flushing or irrigation white phosphorus should be brushed off not washed off follow up is reexamined at 24 hr, 72 hour and 7 days
smallpox
spread by direct contact, droplet, very contagious s/s: fever, fatigue, HA, rash contagious after rash appears supportive care and antibiotics cremation preferred: virus lives in scabs up to 13 years
