Emergency

When assessing a client who has been admitted to for suspected sepsis, which finding does the nurse identify as the earliest sign? A.Anuria B.Increased heart rate C.Decreased respiratory rate D.Change in systolic and diastolic blood pressure

ANS: B The earliest clinical signs of hypovolemic shock are cardiovascular include increased heart rate and respiratory rate. Changes in systolic blood pressure are not always present in the initial stage of shock because of compensatory mechanisms and should not be used as the main indicator of shock presence or progression

What does the nurse teach a client undergoing chemotherapy about the expected outcome related to hair loss? A.Hair loss may be permanent. B.Viable treatments exist for the prevention of alopecia. C.Hair regrowth usually begins about 1 month after completion of chemotherapy. D.New hair growth is usually identical to previous hair growth in color and texture.

ANS: C Chemotherapy-induced hair loss is usually temporary, and regrowth usually begins 1 month after chemotherapy is finished. New hair growth may differ from the original hair in color, texture, and thickness. No known treatment completely prevents alopecia.

Sepsis and Septic Shock: Assessment

History ØAge and risk factors; drugs taken Physical Assessment: Signs and Symptoms ØCardiovascular ØRespiratory ØSkin ØKidney/urinary Psychosocial assessment ØDecreased patience; restless, fidgety Laboratory tests: ØIncreasing serum lactate level(0.5-1) ØNormal or low total white blood cell (WBC) count ØDecreasing segmented neutrophil level with a rising band neutrophil level ØOther various lab findings Widespread infection due to altered immunity Potential for organ dysfunction due to inappropriate clotting, poor perfusion, poor gas exchange from widespread infection always obtain blood cultures before giving antibiotics O2 Steroids Blood-clotting factor hemodilution can occur I think she said

Trauma Centers levels

Level 1 ØRegional resource facility that provides leadership and total collaborative care from prevention through rehabilitation ØUsually are large teaching hospitals that serve dense populations Level 2 ØUsually community hospitals that can provide care to vast majority of injured patients Level 3 ØUsually smaller, rural hospitals that focus on initial injury stabilization and patient transfer if necessary Level 4 ØUsually located in a rural or remote settings; offers ACLS and transfers patient after stabilization

Bone Marrow Suppression

Protect patient from infection Teach all nursing staff (asst and professional), patient and family how to reduce infection in the home ØReport signs of infection(temp of over 100) ØGood handwashing ØBleeding precautions ØElectric shaver ØMouth care-soft toothbrush, mouthwash with no alcohol or sugar, fatigue is common but it is important to not forget to maintain hygiene ØAvoid contact sports, activities involving bumping, scratching, scraping Also avoid crowds transfusion for below 10,000 less than 50,000-risk for bleeding

Chemotherapy-Induced Peripheral Neuropathy

Loss of sensory perception or motor function of peripheral nerves associated with exposure to certain anti-cancer drugs Teach prevention Coordinate with occupational therapist

Perfusion Concept Exemplar:Hypovolemic Shock

Loss of vascular volume resulting in decreased MAP(aerobic to anaerobic) Shunt blood to the central area increase in lactic acids levels catch it early and stop it

Compensatory Stage

MAP decreases by 10 to 15 mm Hg Kidney and hormonal compensatory mechanisms activated Urine output decreases; blood vessel constriction increases Tissue hypoxia occurs Thirst and anxiety are subjective changes Compare these changes with what was previously identified Pulse pressure will narrow Cool extremities [Exam]

Mechanism of Injury (MOI)

Manner in which traumatic event occurred ØBlunt trauma ØBlast effect ØAcceleration-deceleration ØPenetrating trauma

A 54-year-old male is 3 days postoperative following a colon resection. The nurse has delegated to the assistive personnel (AP) to obtain morning vital signs. At 8:00 AM, the AP reports that the client's oral temperature is 101.8º F. 1. What is the nurse's priority action?

ANS: When the client's elevated temperature is reported by the AP, it is the nurse's responsibility to determine what action should be taken. The nurse should proceed to perform a complete assessment on the client, and then determine if antipyretic medications have been prescribed PRN, or if the health care provider should be contacted.

Side Effects of Radiation Therapy

Acute and long-term Vary according to radiation site***very location specific-will not lose hair if radiation is not there is what she said Radiation dermatitis(mild soap and water; no lotions before radiation therapy; no tight clothing) Altered taste Fatigue Bone marrow suppression *do not expose to sun!! can get chemo with, after or before surgery-kills cancerous and normal cells

Primary survey

Ø(A) Airway/cervical spine Ø(B) Breathing Ø(C) Circulation Ø(D) Disability Ø(E) Exposure Exception: ØIn presence of excessive bleeding, use CAB

Hand-off communication process from ED to next point of care

ØSituation ØPertinent medical history ØAssessment and diagnostic findings (especially critical results) ØTransmission-Based Precautions and safety concerns ØInterventions provided in the ED, and response to interventions

Changes in Cognitive Function

"Chemo brain" - reduced ability to concentrate, memory loss, difficulty learning new information Support the patient, provide resources for cognitive training Discourage use of alcohol, recreational drug use, activities that increase risk for head injury

Sepsis and Septic Shock:Planning and Implementation

1 Hour Bundle Hour-1 Bundle for Management of Sepsis Within 1 hour: 1. Measure lactate level. a 2. Obtain blood cultures before administering antibiotics. 3. Administer broad-spectrum antibiotics. 4. Begin rapid administration of 30 mL/kg crystalloid for hypotension or lactate ≥4 mmol/L. 5. Apply vasopressors if hypotensive during or after fluid resuscitation to maintain a mean arterial pressure ≥65 mm Hg. Ø3 hour bundle Ø6 hour bundle

Modified Early Warning System (MEWS)

A screening and scoring tool for medical-surgical nursing assessment to determine a patient's condition based primarily on the patient's level of consciousness and respiratory rate. Most MEWS tools also include measurements of systolic blood pressure, temperature, heart rate, oxygen saturation, and hourly urinary output (previous 2 hours).

Two hours later, the client reports difficulty swallowing because of sores in her mouth. 3a. What does the nurse anticipate is the problem with the client's mouth? 3b. What nursing interventions will be implemented?

ANS: 3a. The client is most likely experiencing mucositis (sores in mucous membranes). With chemotherapy, mucous membrane cells are killed more rapidly than they are replaced, resulting in the formation of mouth sores. Mouth sores are painful and interfere with eating. 3b. Examine the mouth and between the teeth every 4 hour for fissures, blisters, lesions, or drainage. Document the findings. Provide frequent good mouth care. Encourage the client to avoid mouthwashes that contain alcohol. For mouth care, use a soft-bristled toothbrush or disposable mouth sponges. Do not use dental floss or pressure gum cleaners. Rinse the mouth with ½ peroxide and ½ normal saline every 8 hour (peroxide??). Normally the client should drink at least 2 L of fluids, but due to the client's nausea and vomiting, this is not possible. Continue to monitor IV fluid replacement.

A 44-year-old woman with breast cancer is admitted for severe dehydration from nausea and vomiting associated with chemotherapy 10 days ago. She has had two adjuvant treatments for with doxorubicin and cyclophosphamide. She has a Groshong port that was inserted 2 months ago for chemotherapy administration. The health care provider's orders include Strict I&O every 12 hours May use port for blood draws and IV fluids Call for vomiting or temp of 100º F or greater D5½ NS at 125 mL/hr Ondansetron 8 mg IV every 8 hours Clear liquid diet and progress as tolerated CBC, Ca level, and basic metabolic panel in AM Bed rest with bathroom privileges Knee-high support stockings 1. What does the nurse identify as the rationale for each of the provider's orders?

ANS: •I&O: Because the client was admitted with dehydration, it is very important to monitor intake and output (I&O). •Using port for blood draws/IV fluids: When the client has nausea and vomiting, you often see a decrease in electrolytes from the excessive fluid volume loss. •Call for vomiting or ≥100° F temperature: Any temperature elevation may be a sign of infection and should be reported immediately. •D5½NS: This is to replace fluids. •Ondansetron: This medication is to prevent nausea and vomiting caused by cancer chemotherapy. •Clear liquid diet: This is to replace fluids and to provide some nutrition with decreased risk of nausea and vomiting. •CBC, Ca, BMP: When the client has nausea and vomiting, you often see a decrease in electrolytes from the excessive fluid volume loss. •Bed rest, bathroom privileges: Because the client is weak and dehydrated, these restrictions are for safety. Having bathroom privileges is often less stressful than using a bedpan. •Knee-high stockings: There is a concern for DVT with prolonged bedrest, so support hose is ordered for the client to increase venous return and prevent pooling of the blood.

For which side effect does the nurse assess in a client undergoing radiation for breast cancer? A.Fatigue B.Hair loss C.Mucositis D.Nausea and vomiting

ANS: A Radiation-induced fatigue can be debilitating and may last for weeks to months. Mucositis, alopecia, and nausea and vomiting are side effects associated more frequently with chemotherapy. (the answer is usually always fatigue)

Over the next hour, the client continues to decline with a decreased level of consciousness and a temperature of 103.8º F. BP is 80/40, HR is 134, and RR is 34. The nurse calls the surgeon to report these findings and obtain orders for transfer to the ICU. When preparing for this transfer, the nurse notes that the client's O2saturation is 87% on room air. 4. What is the priority nursing action? A.Draw an arterial blood gas sample. B.Apply oxygen at 2 to 3 L per nasal cannula. C.Administer acetaminophen 650 mg by mouth. D.Place the patient on a cardiac telemetry monitor.

ANS: B The patient is gravely ill. The first priority is the airway. He has a rapid respiratory rate and a low SaO2, so supplemental oxygen should be applied first. His elevated temperature should also be addressed. The nurse may choose to call the Rapid Response Team to help stabilize the patient, even though he is being transferred to the ICU.

While performing a history, a client becomes unconscious. What is the priority nursing action? A.Obtain vital signs. B.Assess the airway. C.Contact the ED physician. D.Evaluate the patient's level of consciousness.

ANS: B The primary survey organizes the approach to the patient so that immediate threats to life are rapidly identified and effectively managed. The primary survey is based on a standard "ABC" mnemonic with a "D" and "E" added for trauma patients: airway/cervical spine (A), breathing (B), circulation (C), disability (D), and exposure (E). The highest priority intervention is to establish a patent airway. All other actions can be completed after the airway is established.

The nurse is caring for a female client who has been seen at the ED multiple times recently for sexually transmitted infections and various physical concerns. When the client's boyfriend goes for coffee, what is the priority nursing action? A.Look for tattooing or 'branding' marks. B.Complete a psychosocial assessment. C.Ask, "Does anyone you know make you feel unsafe?" D.Follow agency policy for contacting local authorities to report the concern

ANS: C After establishing a therapeutic relationship, the nurse should ask the client if she feels unsafe as soon as the boyfriend leaves to get coffee. It is important to obtain information quickly while the client is alone before the boyfriend returns, so that the client can freely express any concerns she has. The nurse can then complete the other portions of the assessment and report, if indicated, to authorities.

Five minutes later, the nurse contacts the surgeon to report the abnormal findings, who prescribes: A.Tylenol 650 mg PO prn q6h for a temperature above 101º F B.Blood cultures × 2, taken 5 minutes apart C.C&S of abdominal wound drainage D.Vancomycin 750 mg IVPB over 1 hour every 24 hour 3. In what order will the nurse implement these interventions?

ANS: C, B, D, A Based on the findings, this client is likely developing sepsis. The wound should be cultured immediately and the nurse should notify the laboratory that blood cultures must be obtained. All cultures must be drawn before administering antibiotics. The first anti-infective should be started within 1 hour after the blood and wound cultures are obtained. The nurse may then give the client Tylenol for the fever.

The ED nurse receives communication about a major and catastrophic explosion that took place in a local city warehouse. How does the nurse classify this event? A.Epidemic B.Pandemic C.Internal disaster D.External disaster

ANS: D An external disaster, like the explosion in this example, is any event outside the health care facility or campus, somewhere in the community, which requires the activation of a facility's emergency management plan. External disasters can be either natural, such as a tornado or hurricane, or technological, such as a biological terror attack. An internal disaster is any event inside a health care facility or campus such as a fire, explosion, or violence that could endanger patients or staff. A pandemic is a general epidemic spread over a wide geographic area.

2. Which provider order will the nurse implement first when caring for this client? A.Feed clear liquid diet B.Apply support stockings C.Obtain laboratory samples D.Administer D5½ NS at 125 mL/hr (this is important she said; Exam)

ANS: D Based on the client's diagnosis, IV fluids should be started first. The client is admitted with dehydration, so the Groshong port should be accessed and IV fluids initiated immediately. The provider has ordered clear liquids, but because the client has been experiencing nausea and vomiting, she may not be able to ingest enough fluids to correct the dehydration. The laboratory values are ordered for the morning, so they should not be obtained until then. The support stockings can be obtained by the AP while IV fluids are started.

Which client will the emergency nurse triage as the priority? A.21-year old with ankle fracture B.33-year old with with vomiting, flank pain, and a history of kidney stones C.49-year-old with profound weakness and 103° F fever D.59-year-old with sweating, jaw pain, and pain in the left arm

ANS: D Based on the information provided, the patient experiencing sweating, jaw pain, and left arm pain should be triaged first. Jaw and left arm pain are signs of referred chest pain which may indicate a myocardial infarction—an emergent condition. The emergent triage category implies that a condition exists that poses an immediate threat to life or limb. The urgent triage category indicates that the patient should be treated quickly but that an immediate threat to life does not exist at the moment. Examples of patients who typically fall into the urgent category are those with kidney stones, complex lacerations not associated with major hemorrhage, displaced fractures or dislocations, and temperature greater than 101° F (38.3° C). {think this pt might be having a heart attack}

Upon assessment, the nurse notes that the client is flushed and slightly diaphoretic. He appears lethargic, but responds to simple questions. His vital signs are now BP 92/42, HR 132, RR 28 and deep, and his temperature has risen to 102.6º F. Lungs are clear throughout. The surgical wound has a dressing that is moist with a moderate amount of purulent drainage. 2. How does the nurse interpret this data?

ANS: The development of infection should be considered based on the client's operative history and vital signs. He has tachycardia and increased respirations, as well as a moderate amount of purulent drainage at the abdominal dressing site. Surgical dressings should not contain purulent drainage.

Following management of a disaster, a patient care technician tells the nurse, "I keep seeing the faces of people that died when I close my eyes." What is the appropriate nursing response? A."The memories will fade eventually; it's just so fresh right now." B."Can you take a few days off to rest and try to feel better?" C."If we just lean on each other, we will get stronger and get through this." D."I will go with you to the occupational nurse who can help you explore your feelings."

ANS: D Critical incident stress *debriefing addresses post-crisis interventions for small to large groups, including communities. After working through the turmoil and the emotional impact of the incident as well as the aftermath, the staff may find it difficult to "get back to normal." Without intervention during and after the emergency, they may develop acute stress disorder (ASD) or post-traumatic stress disorder (PTSD) with multiple characteristic psychological and physical effects, including flashbacks, avoidance, less interest in previously enjoyable events, and detachment, as well as rapid heart rate and insomnia. Ultimately, professional "burnout" can stem from the inability to cope with the stress effectively. Specially-trained individuals can help the health care team deals with a particularly devastating or disturbing incident.

The nurse is performing triage after a mass shooting in a shopping mall. To which client does the nurse assign a black tag? A.21-year-old with confusion B.23-year-old with an open femur fracture C.26-year-old with uncontrollable anxiety D.29-year-old with full-thickness extremity burns

ANS: D Emergent (class I) patients are identified with a red tag; patients who can wait a short time for care (class II) are marked with a yellow tag; nonurgent or "walking wounded" (class III) patients are given a green tag; and patients who are expected to die or are dead are issued a black tag (class IV). Typical examples of black-tagged patients are those with massive head trauma, extensive full-thickness body burns, and high cervical spinal cord injury requiring mechanical ventilation. The rationale for this decision is that limited resources must be dedicated to saving the most lives rather than expending valuable resources to save one life at the possible expense of many others.

A 39-year-old client is admitted with a severely abscessed tooth. The nurse assess vital signs of BP 92/44, HR 134, RR 26, Spo2 90% on room air, temperature 38.9º C. What is the priority nursing intervention? A.Administer prescribed antibiotics. B.Obtain blood cultures and other labs. C.Insert an indwelling urinary catheter. D.Initiate intravenous fluid resuscitation.

ANS: D Initiating IV fluids is the primary intervention, followed by obtaining laboratory values, blood cultures, and providing oxygen. Antibiotics should be started ASAP, however, after blood cultures are obtained. An indwelling urinary catheter is lower in the list of necessary priority interventions.

Which assessment finding in a client in the refractory phase of shock requires immediate nursing intervention? A.Warm, flushed skin B.Urine output of 20 mL/hr C.Increasing respiratory rate D.Bleeding, oozing from IV sites

ANS: D The onset of disseminated intravascular coagulation (DIC) is evidenced by bleeding or oozing from IV sites; this indicates a consumption of clotting factors that occurs in the refractory stage of shock.

When does the nurse determine that a client with Non-Hodgkin's Lymphoma is at greatest risk of developing tumor lysis syndrome? A.After the first cycle of chemotherapy B.During the second cycle of chemotherapy C.Anytime during the client's treatment course D.While undergoing radiation and chemotherapy

ANS: D Tumor lysis syndrome can occur when a large number of tumor cells are rapidly destroyed. This is usually seen in patients with high-grade cancers or those with bulky tumor burden, and occurs after receiving radiation and chemotherapy. At the beginning of the tx because you have the most cells at this point

Chemotherapy Drugs

Antimetabolites Antimitotic antibiotics Antimitotics/Mitosis inhibitors Topoisomerase inhibitors Miscellaneous agents determination is based on high and weight done by the physician Using more than one drug for the treatment Different mechanisms of action work together to impact cell division

Handling Safety with chemo

Avoid direct skin contact with agents Including oral /p.o. chemo Proper disposal

Initial Stage

Baseline MAP decreased by <10 mm Hg Compensation responses include vascular construction and increased heart rate Difficult to detect indicators of shock at this stage ***look for change in HR

If you have a rapidly growing tumor, how would it react to chemo?

Better than slow growing tumors(which is shocking but it is because chemo affects fast growing tumor the most)

Mass Casualty Triage: Black

Black: Expected (and allowed) to die or are dead (class IV)-Black tag means that you are likely to die

Chemotherapy-Induced Nausea & Vomiting

Can occur at any time (acute is most common) Drug therapy(Zofran, antiemetic)

Monoclonal Antibodies

Combines actions from immunotherapy and targeted therapy Asses for infusion reactions, especially in first 30 minutes to 2 hours of initiation ØFever, chills, rigors, rash, headache, hypotension, shortness of breath, bronchospasm, nausea, vomiting, abdominal pain Premedication can decrease incidence

Palliative care for cancer?

Comfort for patient; no tx

Alopecia

Cooling cap may decrease hair loss For those who lose hair, teach to avoid direct sunlight, apply sunscreen, cover head Planning before hair loss can be helpful (e.g., wigs)

Treatment Issues

Dosage Scheduling Administration ØIntrathecal ØIntraperitoneal ØIntravesicular ØTopical ØIntra-arterial Extravasation - monitor blood return at access site during infusion at regular intervals Oral anticancer drugs are just as toxic to patient taking drug, and person handling drug

Emergent vs urgent vs non-urgent

Emergent ØImmediate threat to life or limb Urgent ØRequires quick treatment but immediate threat to life does not exist at the moment Nonurgent ØCan wait several hours for care without significant risk

RBC production

Epogen (epoetin alfa); colony stimulating factor anemia

1:1:1: protocol for bleeding

Give RBCs, platelets, fresh frozen plasma

Mass Casualty Triage: Green

Green: Non-urgent or "walking wounded" (class III)

What is an example of prophylactic tx for cancer?

Getting a mastectomy to reduce risks of developing cancer(possibly based on genetics)

Mucositis

Ice water, ice chips Frequent mouth assessment and oral hygiene

Hypovolemic Shock: Care

Hypovolemic shock is a complication of another condition and is resolved before patients are discharged from the acute care setting. Teach patients and family members early indicators of shock ØIncreased thirst ØDecreased urine output ØLight-headedness elevation: Vascular volume is restored with normal tissue perfusion

Types of Shock

Hypovolemic(low volume) Cardiogenic(pumping is impaired) Distributive(leaky capillaries>neurogenic shock and anaphylactic shock) Obstructive(Pericarditis or cardiac tamponade) look up examples of each

Impact of Cancer on Physical Function

Immunity and clotting(bone marrow) GI function(tumor; pt can have anorexia; wasting syndrome) Peripheral nerve sensory perception Central motor and sensory deficits Respiratory and cardiac function Comfort and quality of life

Stages of Shock

Initial Compensatory Progressive Refractory

Types of Disasters

Internal ØOccurs inside a health care facility or campus ØFire, explosion, loss of critical utilities, violence External ØOccurs outside of a health care facility or campus ØHurricane, earthquakes, tornados, technologic problems, viruses, etc.

Endocrine Therapy

May include use of aromatase inhibitors, gonadotropin-releasing hormone analogues, anti-androgens, and antiestrogens Side effects differ based on specific therapy used

Multi-Casualty vs Mass Casualty Events

Multi-casualty ØCan be managed by a hospital using local resources Mass casualty ØOverwhelms local medical capabilities ØMay require collaboration of numerous agencies and health care facilities to handle crisis

WBC production

Neupogen (filgrastim) febrile neutropenia, blood modifier, colony-stimulating factor (CSF)

Bone marrow suppression means

No sushi or foods that can make you sick. Immune system is compromised.

Are you admitted when you go to the ED?

No, you are just in the ED.

Hypovolemic Shock: Action

Nonsurgical management ØOxygen therapy ØIV therapy(LR) ØDrug therapy (see drug tx word doc)>phenylephrine, dopamine, epi/norepi>vasoconstrictors>she also said something about giving a + inotrope for the heart>nitroglycerin to vasodilator only for cardiac purposes ØMonitoring (hemodynamic in critical care settings) Surgical management

Sepsis and Septic Shock:Health Promotion and Maintenance

Prevention is the best management strategy(wash hands) Evaluate risk Use aseptic technique Remove indwelling urinary catheters and IV access lines as soon as no longer needed Wean from ventilator as soon as possible MEWS (components of qSOFA)\ Early detection

Environment of Care (EOC)

Rapid, fast-paced, challenging/stimulating

Which cells does chemotherapy affect the most?

Rapidly dividing>hair loss, GI, bone marrow, nails(affects integumentary system a lot)

Mass Casualty Triage: RED

Red: Emergent needing immediate attention (class I)- Can't wait

SBIRT stands for

Screening, Brief Intervention, and Referral to Treatment {don't need to know for the exam but used for drug and alcohol abuse}

Oncologic Emergencies

Sepsis and Disseminated Intravascular Coagulation Syndrome of Inappropriate Antidiuretic Hormone (remember OAT) Spinal cord compression(prostate cancer) Hypercalcemia(metastatic bone disease or multiple myeloma>kidney stone could develop, DTRs decrease>biphosphate and hydration for tx) Superior vena cava syndrome(Stridor airway issues, high rate radiation, and chemo>THINK ABOUT AIRWAY, even though circulation is a part of it so first check pulse and blood pressure ) Tumor lysis syndrome(cancerous cells break up and all intracellular components come out>K+ comes out>risk for hyperkalemia>not a solid mass>hydrate patient and allopurinol>check cardiac function because of electrolyte imbalance>remember hyperkalemia)

Debulking (cancer treatment)

Surgical removal of as much of a tumor as possible. Tumor debulking may increase the chance that chemotherapy or radiation therapy will kill all the tumor cells. It may also be done to relieve symptoms or help the patient live longer.

Side Effects of Chemotherapy

Temporary and permanent damage can occur to normal tissues CTCAE - standardized grading scale to evaluate and document common side effects Examples of side effects ØNeutropenia(bleeding-precautions, no IM injects or any kinds of invasive things like electric shavers, rectal suppositories) ØThrombocytopenia ØAlopecia ØMucositis(good mouth care) ØSkin changes ØAnxiety

Within 30 minutes of the client's arrival into the ICU, his condition continues to deteriorate. His SaO2 continues to fall, RR is 36/min, and the ICU nurse notes blood oozing around the IV catheter sites. A Foley catheter is placed, and urine output is minimal. 5. How does the ICU nurse interpret these findings?

The client is going into severe sepsis. The main signs are low oxygen saturation, rapid respiratory rate, decreased to absent urine output, and changes in cognition. He is at risk for septic shock. The blood oozing around the IV catheters may indicate the presence of DIC.

Hypovolemic Shock: Etiology

Too little blood volume causes MAP decrease that prevents total body perfusion and gas exchange; *check urinary output every hour, cardiac, respiratory Recognition of signs Continue assessment and compare to baseline Teach patients about signs and symptoms of shock History ØRisk factors ØIllness, trauma, procedures, chronic health problems ØUrine output Physical Assessment/Signs & Symptoms ØCardiovascular, respiratory, kidney and urinary, skin, CNS, and skeletal muscle changes Psychosocial Assessment ØDetermine if behavior and cognition are the same or different from baseline Laboratory assessment (see lab profile word doc) ØDecreased pH ØDecreased PaO2 ØIncreased PaCO2 ØIncreased lactic acid ØIncreased or decreased hematocrit ØIncreased or decreased hemoglobin ØIncreased potassium Inadequate perfusion due to active fluid volume loss and hypotension ***increase in glucose[exam know this; on word doc] no anxiolytic(will lower bp even more) just stay with pt and give blanket

Refractory Stage

Too little oxygen reaches tissues; cell death and tissue damage result MODS - sequence of cell damage caused by massive release of toxic metabolites and enzymes Rapid loss of consciousness, nonpalpable pulse, cold, dusky extremities; slow, shallow respirations; unmeasurable oxygen saturation

T/F? ED staff members usually prepare the body and room for family viewing.

True

T/F? Family presence may be granted during resuscitation (depending on agency).

True

Survivorship

Unique physical and psychosocial needs Educate patients on importance of routine follow-ups and adherence to the recommended schedule

Colony-Stimulating Factors asSupportive Therapy

Used as supportive therapy during chemotherapy by enhancing recovery of bone marrow function after treatment-induced myelosuppression Most common side effect is bone pain

Radiation Therapy

Uses high-energy radiation to kill cancer cells, with goal of having minimal damaging effects on surrounding normal tissue Usually given in divided doses over a set time Can be used as standalone treatment or combined with other treatments Brachytherapy - internal radiation therapy Provide accurate information Teach about skin care needs Do not remove temporary ink or dye markings *seeds-the pt is radioactive-private room with something on door, shield that protects you as a part of healthcare team, limited visitors (for exam, know about care and precautions for patient with seeds) *unsealed substances taken by mouth is now in body fluids(for exam, know the difference between sealed and unsealed)***

Immunotherapy

Using the body's own defense system to attack foreign cells Immune related adverse events (ir-AE's)

Shock

Widespread abnormal cellular metabolism Occurs when gas exchange with oxygenation and tissue perfusion needs are not sufficiently met to maintain cell function Is a "condition" - not a "disease" All body organs affected A condition in which the circulatory system fails to provide sufficient circulation to enable every body part to perform its function; also called hypoperfusion. S/S: Hypotension, tachypnea, tachycardia Nursing Interventions: bedrest with extremities elevated 20 degrees. knees straight, head slightly elevated (modified Trendelenberg) pg 732(read for exam)**

Do you have to wear gloves when administering chemo drugs PO?

YES, chemo gloves or double gloves (with even pill-formed chemo drugs) are important. Obviously, you have to wear a glove with IV chemo too.

Mass Casualty Triage: Yellow

Yellow: Can wait short time for care (class II)-can wait a little bit

Should both rails on stretchers be up?

Yes because they are high up(think about safety)

Do you have to check the IV site after chemo?

Yes, every hour on getting chemo therapy. Make sure no extravasation happens.

Septic shock

systemic inflammatory response, dysregulated response to infection, cold phase, and warm phase, very leaky capillaries, perfusion is compromised,

She emphasized that chapter 20 will be on

the next Exam ***

MAP formula (mean arterial pressure)

diastolic + diastolic + systolic divided by 3

Progressive Stage

emergency! Sustained decrease in MAP of more than 20 mm Hg from baseline Vital organs develop hypoxia(Low pH) Some tissues die Rapid, low pulse; low BP; pallor; cool, moist skin; anuria, decrease in oxygen saturation Life-threatening emergency Conditions causing shock must be corrected within 1 hour or less of progressive stage onset

What to do for trauma deaths, suspected homicide, and abuse cases?

leave IV lines, indwelling tubes in place