emergency exam evolve

What specific procedures can the unit implement to decrease medication errors?

Decrease interruptions while obtaining and dispensing medications, ensure using two methods of identification before giving medications, always ask about allergies before giving any medication, and use standard policy for identifying unconscious people or those who do not have identification.

An older client with heat exhaustion is being cooled with cool water spray and fanning. What assessment indicates to the nurse that the client needs hospitalization? A. The client is alert and oriented. B. The client's mucous membranes are dry and sticky. C. The client reports weakness and nausea. D. The client continues to sweat while being cooled.

Answer: B Rationale: Heat exhaustion is usually treatable with a cool water spray and fanning. However, if the client does not respond to these interventions, heat stroke can occur with severe dehydration. Dry and sticky membranes are present in clients with severe dehydration.

A client on a climbing expedition reports a headache and nausea. The client rests 1 day at the current altitude and then climbs further the following day. The third day, other members of the climbing team note that the client has developed gross motor coordination difficulties. What action by the team nurse takes priority? A. Administering acetazolamide (Diamox) B. Providing 100% oxygen by facemask C. Having the client descend to a lower altitude D. Ensuring that the client stays warm at all times

Answer: C Rationale: The client needs to be at a lower altitude first before other interventions are used. Treating the client at a high altitude will not resolve the clinical manifestations of altitude illness.

What challenges does this nurse face in terms of his or her own safety and health?

First, the nurse must maintain personal safety. As tempting as it may be, unless the nurse has had special training, he or she should not enter unstable buildings or try to extract persons who are trapped. The nurse needs to maintain vigilance and a high degree of situational awareness. Illness is common after disasters, and the nurse should follow protocols for taking prophylactic medications, keep vaccinations up to date (including vaccinations for emergent travel), and maintain basic standard precautions.

What populations are at highest risk of safety compromise while in the ED?

Highest risk populations include older adults, confused patients, patients who were given pain medication or sedation, patients impaired by drug or alcohol use, those who are unconscious, and those with no identification. In addition any condition that can cause dizziness and fainting or lying in the same position can cause a safety risk. Invasive procedures can increase the patient's risk for infection.

How can the staff reduce hazard risks for patients who are confused (either as a chronic condition or as the result of medication side effects) or who have delirium?

Reorient the patient as needed, provide a calm, quiet environment and have family or familiar person sit at the bedside; if no family is available, provide a sitter. Use the smallest dose of medication needed to control symptoms, reassure the patient that he or she is safe, allow the patient to sit in a chair as tolerated, provide food and fluids if allowed, keep the patient warm, and meet other needs that might lead to patient trying to get up. Keep the siderails up and the call light in reach.

What risk factors did these people have for lightning injury?

The campers were participating in outdoor activities and had little shelter from the impending storm. Some may have been wet from water activities or in or around water, which would increase the flashover effect lightning had on that person.

Which person should the nurse assess first, and what is the priority of care of this patient?

The nurse should assess the unconscious patient first. The most lethal effect of lightning is on the cardiopulmonary system and can manifest as cardiopulmonary arrest. If needed, the nurse needs to provide cardiopulmonary resuscitation to this individual.

What actions can be delegated to unlicensed personnel in the following areas: medication administration, skin protection, and fall risk?

a. Medication administration: none b. Skin protection: Institute turning schedule, keep linens dry and wrinkle free, keep incontinent patients clean and dry, offer trips to the bathroom frequently for those who can walk, and ensure that the patient is not lying on supplies or other items. c. Fall risk: Sit with the patient, reorient the patient, ensure that the call light is within reach, ensure that side rails are up, and ask about personal needs (e.g., bathroom, water as allowed).

Some local residents are so distraught that they are unable to function and are not eating or sleeping. What assistance can the nurse provide?

First the nurse should recognize the extreme stress the local residents are under. They may be overwhelmed by the catastrophic nature of the event, feel guilty for having survived when so many others have died, and feel vulnerable and afraid if they have lost their homes and belongings. The nurse can convey caring, acceptance, and safety either verbally or nonverbally. The nurse might be able to assist with establishing temporary shelters. If there are interpreters available, some basic education on response to stress and healthy ways of managing it may be useful. The nurse might also be able to assess residents with the Impact of Event Scale—Revised if there is no language barrier and the population is literate. If mental health capacity is available, the nurse should refer anyone scoring highly on the entire test or on any subscale to a qualified counselor or mental health provider.

What direction should the nurse give the large crowd of campers and camp staff?

Unless someone is actively helping in the rescue effort, the nurse should direct the crowd indoors to prevent further injuries. Someone should call 911 for prompt evacuation of all injured people to a hospital for further assessment and care. If available, dry sterile dressings can be applied to any obvious burns.

What potential complication does the nurse plan to address in the immediate rescue period?

A potential complication the nurse must consider is the possibility of spinal cord injury, especially if one of the victims was thrown by the strike. The individuals reporting lower extremity weakness are also at risk for this complication.

After returning from the mission trip, the nurse feels apathetic and disengaged with regular employment and is often short tempered with coworkers and staff. What resources exist for the nurse?

After an extreme incident, the services of the Critical Incident Stress Foundation are useful to provide services that range from debriefing to ongoing education on stress management and coping skills. Optimally, members of the mission team have ready access to team members who have been trained in Critical Incident Stress Management techniques. Without appropriate processing of critical incidents, responders are vulnerable to posttraumatic stress disorder.

The emergency department nurse is assigned to five clients waiting for orders to be implemented. Which client does the nurse assess first? A. 60-year-old waiting for transport to the operating room for an emergency appendectomy B. 25-year-old with a closed femur fracture who received pain medication 10 minutes ago C. 30-year-old with nausea and vomiting who has IV fluids infusing and is now sleeping D. 28-year-old construction worker with a laceration to the arm that is waiting to be sutured

Answer: A Rationale: The 60-year old client is scheduled for an emergent surgery and needs to be assessed to be transported. The other clients are stable at this time or have less life-threatening health problems.

An occupational health nurse is teaching a safety class to city employees who work outdoors year round. What does the nurse teach are risk factors for developing frostbite? Select all that apply. A. Excessive fatigue B. Prior episodes of frostbite C. Diabetes or other peripheral vascular disease D. Dehydration E. Smoking F. Wearing polyester socks

Answer: A, B, C, D, E Rationale: All of these factors predispose a person to frostbite except for wearing polyester socks.

The ED charge nurse is assigning duties to nurses who have been floated to the ED or who have volunteered to help staff the ED during a mass casualty situation. Which assignments are most appropriate? Select all that apply. A. GI laboratory nurse assigned to orthopedic clients having sedation procedures B. Critical care nurse assigned to client, not related to the mass casualty, having chest pain C. Medical-surgical nurse assigned to accompany clients to radiology D. Nursing manager from an inpatient unit assigned to monitor clients in the waiting room E. Liaison nurse from the operating room assigned to work with families

Answer: A, B, E Rationale: The most useful nurses in a mass casualty situation are those who can assist with the type of patients that would be seen in this type of event. Nurses would be needed to communicate with families and to assist with direct care and triage.

A trauma client has been brought to the emergency department after a motor vehicle crash. The client has severe injuries. What action does the nurse perform first? A. Start 2 large-bore IVs and run normal saline. B. Apply oxygen and an oximeter probe to the client. C. Stabilize the cervical spine and assess the airway. D. Place pressure on a large bleeding wound to the forehead.

Answer: C Rationale: Establishing an airway is always the priority in a client with major trauma. The other interventions are done after the airway is established and patent.

The nurse is triaging clients arriving at the hospital after a large scale disaster. Which of these clients is correctly classified? A. Young adult with closed fractures of her right leg and arm: Yellow tag B. Older adult with severe abdominal pain who is dazed and confused: Black tag C. Middle-aged adult with third-degree burns over 90% of his body: Red tag D. Young adult with bruises and superficial lacerations: Green tag

Answer: D Rationale: The young adult with bruises can walk and get away from the disaster; this is characteristic of green tag clients. The young adult with fractures should be classified as green, the older adult with severe abdominal pain should be classified as yellow, and the middle-aged adult should be black-tagged as there is no chance for survival with that injury.

How can the nurse manage basic hygiene and meet basic needs?

Water safety is crucial; unless the medical mission team brought a large supply of bottled water, the nurse will be drinking local water, which will need to be decontaminated using commercial devices, boiling the water, or adding 10 to 20 drops of chlorine bleach to each gallon of water. Food, especially meat, should be cooked thoroughly. Sanitation can be maintained by lining buckets with plastic bags that are then buried after bleach has been added. Toilet "pits" can be dug into the ground. The nurse should ensure that he or she follows good handwashing procedures.