MED/SURG2: Chapter 68

The nurse on duty receives a call requiring an emergency first responder team to deploy to the incident location. Which statement by the caller confirms an emergency situation in an extraordinary event?

"I need to report a multivehicle crash on the highway." The term emergency is used to refer to an event that would require a rapid and skilled response and that can be managed within the community's existing resources. A multivehicle crash on a highway is an emergency situation that endangers the lives of the people involved. A large earthquake is a natural disaster and cannot be handled with the existing resources of a community. Communities such as the American Red Cross and Federal Emergency Management Agency may be called for support of casualties caused by a natural disaster. A finger injury can be treated with administration of first-aid at home. Stroke patients need to be rushed to the hospital for immediate attention, but stroke is not an extraordinary event. p. 1645

A school bus crash leaves many children injured. Which children will be given a yellow tag?

-A child with a broken leg -A child with a bruised and swollen arm The children with urgent non-life-threatening injuries are given yellow tags; these include the child with a broken leg and the child with a bruised and swollen arm. The children in respiratory distress, with abdominal pains, and with a head wound and drowsiness need red tags and should be transported to the hospital first. The child with minor scrape will be given a green tag, indicating minor injuries, and will be transported last. p. 1646

A patient was classified as emergency severity index (ESI)-2. Which parameters were most likely assessed to make this determination?

-Breathing -Circulation Breathing is an essential parameter and is included in the primary survey. If the patient has difficulty breathing then oxygen supplements should be given or ventilation with a bag mask with 100% oxygen should be provided. In cases of severe respiratory distress or arrest, intubation should be performed. Circulation is also a parameter to be evaluated in the primary survey. Circulation is assessed by checking the carotid and femoral pulses. If there is no pulse, then cardiopulmonary resuscitation and advanced life-support measures should be taken. A full set of vital signs is assessed in the secondary survey. Vital signs include temperature, heart rate, respiratory rate, oxygen saturation, and bilateral blood pressure. Focused adjuncts such as the need for additional procedures are assessed in the secondary survey. A full head-to-toe assessment and the history of the patient are completed during the secondary assessment. p. 1629

A patient suffered cardiac arrest while manually shoveling snow after a blizzard. The patient's temperature is 96.8˚F (36˚C) on arrival to the emergency department. Which methods are used to provide therapeutic hypothermia?

-Cold saline infusions -Cooled ventilator circuit A cooled ventilator circuit and cold saline infusions are used to provide therapeutic hypothermia for a patient after return of spontaneous circulation after cardiac arrest. A cooling blanket (as opposed to a warming blanket) or internal cooling catheter device can be used to provide continuous consistent hypothermia. Socks applied bilaterally will not contribute to therapeutic hypothermia. With use of ice, it is difficult to maintain a consistent temperature so this is not an appropriate intervention. Transcutaneous devices provide a cooling pad for the head to help with management of the temperature; a stocking hat would not assist in providing hypothermia. p. 1634

The nurse identifies that a patient is at an increased risk for frostbite if the patient has what condition?

-Diabetes mellitus -Peripheral vascular disease Increased blood glucose levels and decreased blood supply to the peripheral tissue impair tissue integrity and increase the risk of frostbite. Therefore a person with diabetes mellitus and peripheral vascular disease has a higher risk of frostbite. Abdominal pain, an increase in thyroid hormone levels, or decreased urine outflow do not impair tissue integrity, so these conditions do not increase the risk of frostbite. p. 1637

During the primary survey the nurse observes a patient exhibit paradoxical movement of the chest wall during respiration. What actions does the nurse take?

-Give supplemental oxygen therapy -Ventilate with bag-valve-mask with 100% oxygen When a patient exhibits paradoxical movement of the chest wall during respiration, supplemental oxygen should be given through an appropriate delivery system. If the respiration is inadequate or absent, the patient should be ventilated using a bag-valve mask with 100 percent oxygen. When airway patency is absent, the airway should be opened. An endotracheal tube is inserted when there is no airway patency. Intubation is performed if there is respiratory distress and the patient cannot breathe. The jaw-thrust maneuver is performed to prevent obstructing the airway. p. 1630

The patient is brought to the emergency department feeling weak, and presenting with dehydration, a body temperature of 102° F (38.8ºC), and pale skin. What are the appropriate nursing interventions in this situation?

-Placing patient in a cool environment -Providing high-flow oxygen in a nonrebreather mask -Managing and maintaining airway, breathing, and circulation Heat exhaustion usually occurs in individuals engaged in strenuous activity in hot, humid weather. It is characterized by fatigue, dehydration, and a mild to severe temperature elevation between 99.6° to 104° F. Initial intervention starts with the assessment of the airway, breathing, and circulation. The patient is placed in a cool area where rapid cooling measures are initiated. The nurse removes the patient's clothes, places a wet sheet over the patient, and places the patient in front of a fan. The patient is provided with high-flow oxygen in a nonrebreather mask. Salt tablets should not be used because of potential gastric irritation and hypernatremia. Moist sheets, rather than warm sheets, should be placed over the patient to decrease core temperature through evaporative heat loss. p. 1637

The nurse is caring for a patient with superficial frostbite on the nose, fingers, and toes. What interventions should the nurse perform?

-Use warm soaks for the face. -Apply a sterile dressing following debridement. -Immerse toes and fingers in a water bath at 98.6° to 104° F The nurse should use warm soaks for the face. Blisters that form within a few hours should be debrided and covered with a sterile dressing. The affected toes and fingers should be immersed in a water bath at 98.6° to 104° F. The frostbitten area should be handled carefully; massaging causes damage to the tissues. The nurse should avoid using heavy blankets for the patient because they could cause friction and sloughing of damaged tissue. p. 1638

The patient has a prescription for 0.9% normal saline intravenous (IV) at a rate of 75 mL/hour. The IV tubing has a drop factor of 10 gtts/mL. At how many drops per minute should the nurse regulate the flow of the IV solution?

13 gtt/minute Use the following formula to calculate the rate of IV solutions: Volume multiplied by drop factor divided by time (in minutes). Multiply 75 by 10 to yield 750 and divide this by 60 to yield 12.5, or 13 gtt/minute (because the nurse cannot count a fraction of a drop). p. 1631

Which core body temperature readings confirm hyperthermia?

99.6° to 105.8° F (37.5 ºC to 41ºC) Hyperthermia indicates an elevated core body temperature. Heat exhaustion causes hyperthermia and is indicated when the core body temperature is at 99.6° F to 105.8° F. Hypothermia in a patient indicates low core body temperature. Mild hypothermia is reported at 93.2° F to 96.8° F, moderate hypothermia at 86° F to 93.2°F, and severe hypothermia is less than or equal to 86° F. p. 1637

Many people lost power for a long period during a snow storm, and a large group of people developed frostbite while trying to walk to a shelter. Which patient requires the nurse's priority attention?

A patient who is insensitive to touch on a mottled leg The leg that is mottled and insensitive to touch has deep frostbite. If circulation is not restored, the patient may lose the leg, so this patient requires the nurse's immediate attention. The child with a red face should be treated for pain next. The patient with pale yellow skin that feels frozen has superficial frostbite and should be treated next. The patient with edema and blisters has likely had the injury for 24 hours or more and should be treated as soon as the others have been treated. p. 1638

An explosion at a large industrial plant has left many injured. Which victim should receive a black tag?

A patient with a gaping head wound and no pulse The patient with a gaping head wound and no pulse is dead and should receive a black tag. The patient having chest pains after a crushing injury, the patient with a bleeding leg after a stabbing injury, and the patient with blood pressure of 60/60 mmHg and a heart rate of 40 beats/minute should receive red tags, as all of these conditions are life-threatening.

What is the appropriate nursing action in the initial treatment for animal and human bites?

Administer tetanus prophylaxis Initially, the nurse administers tetanus prophylaxis to counter any risk associated with tetanus infection from the bite. Punctured wounds should be left open. All cuts and lacerations should be loosely sutured. A facial wound requires an initial closure. Analgesics are administered to provide relief from pain. p. 1642

A parent brings a child to the emergency department with a bee sting. The child has nausea, feels faint, and is having difficulty breathing. Which of the following health care provider's prescriptions should the nurse implement first?

Administering 0.4 mg epinephrine subcutaneously Removing the stinger with tweezers may have caused additional venom to be released into the body. This would increase the severity of the reaction, as seen with the nausea, syncope, and breathing difficulties. Therefore the priority intervention would be to administer epinephrine to treat the reaction. Cool compresses, administering diphenhydramine, and elevating the arm are all appropriate treatments if the reaction is mild, that is, stinging, swelling, headache, and so forth. p. 1640

A patient has been admitted to the emergency department after ingesting an entire bottle of chewable multivitamins in a suicide attempt. The nurse should anticipate which intervention?

Administration of activated charcoal Among the most common treatments for poisoning is the administration of activated charcoal. Induced vomiting typically is not indicated, and there is no need for plasma administration. Whole bowel irrigation may be used as an adjunct therapy later in treatment, but the use of activated charcoal is central to the treatment of poisonings. p. 1643

A flu outbreak in a small town has infected 50 people, with many requiring medical attention. The local emergency department is overwhelmed. Which organization is best able to help?

American Red Cross The Red Cross can help manage patients who do not need the most immediate medical attention so that trained medical personnel can care for those that do. The police department can help with crowd control situations. The hazardous materials team is not called in for flu epidemics. The CDC may be called in to identify the source of the outbreak, but its role is to contain the outbreak, not provide care. p. 1645

The nurse is caring for a patient who has consumed a poisonous substance. Assessment findings include an almond odor on the patient's breath, hypertension, and bradycardia. The treatment strategy that would be most beneficial for the patient would be to administer what?

Amyl nitrate nasally Presence of an almond odor to the breath, hypertension, and bradycardia indicate that the patient has cyanide poisoning. Amyl nitrate is an inhalant that acts as a cyanide antagonist and reverses the effects of cyanide. Therefore the nurse expects that administering amyl nitrate nasally will be beneficial for the patient. Activated charcoal does not absorb cyanide, so it does not reduce the effects of cyanide poisoning. Corticosteroids help to treat alkaline burns. Deferoxamine is a chelating agent that decreases the effects of iron poisoning. Therefore administering activated charcoal, corticosteroids, or deferoxamine will not be beneficial for the patient. p. 1643

The nurse is providing support for the family of a patient who died immediately after arrival in the emergency department. Which intervention by the nurse would be most supportive of the family's spiritual needs?

Ask the family whether they would like to visit with the hospital chaplain, who is standing by When a family suffers a loss in the emergency department, the nurse can support spiritual needs by asking whether they would like to see the hospital chaplain, who is often readily available. Religious affiliation may or may not be available in the electronic health record; religion reflects formal practices, whereas spirituality reflects the meaning one attaches to life. Offering to contact the mortuary will not help to meet the family's spiritual needs. While encouraging the family to be with the loved one may help them to accept the loss, it will not specifically address their spiritual needs. p. 1682

A professional swimmer experiences a seizure under water and is brought to the emergency department with a submersion injury. Which nursing action is part of the primary survey?

Assessing airway, breathing, and circulation Treatment of submersion injuries focuses on correcting the basic physiologic functions. Initial evaluation involves assessment of airway, cervical spine, breathing, and circulation. During the secondary survey, the nurse assesses the patient for any other injuries caused. At this time, the body temperature is taken to begin the process of rewarming if required. A gastric tube is orally inserted for any freshwater or saltwater aspiration. p. 1631

A patient is admitted to the emergency department after falling from a roof. To which assessment finding should the nurse assign the highest priority?

Asymmetrical chest movement Prioritization of care for this patient follows an initial assessment of airway, breathing, circulation, and neurologic status. In a traumatic injury, ribs may be fractured and detached from the chest wall, resulting in asymmetric chest movement. This may compromise respiratory status and indicate a pneumothorax or other internal injuries. After identification of asymmetric chest movement, pain on inspiration would be evaluated as part of the respiratory assessment. After the breathing and respiratory issues are assessed, pale, moist skin and lower extremity lacerations may be evaluated as part of the circulatory assessment. p. 1630

What finding indicates mild hypothermia?

Body temperature of 93.2º to 98.6º F, (34º to 35ºC) Assessment findings in hypothermia are variable and depend on the core body temperature of the patient. In mild hypothermia, the patient experiences shivers and reports a body temperature between 93.2 and 96.8 oF. In moderate hypothermia, the shivering diminishes or disappears and the body temperature is maintained between 86 and 93.2 oF. Severe hypothermia is a life-threatening situation when the body temperature is at or below 86 o. At 86 o F, the patient appears dead. p. 1638

The nurse creates a plan of care for a patient with frostbite of the hands. What is the most desirable outcome for the patient?

Brisk capillary refill The major dysfunction with frostbite is impaired circulation. Therefore measures to promote and maintain adequate circulation are the highest priority. This includes assessment of the nail beds for capillary refill. A good appetite, a balanced fluid intake and output, and normal blood pressure are not direct indicators in the treatment of frostbite. p. 1637

A patient has his or her eyes closed at the scene of a disaster. What method will the nurse use first to assess level of consciousness?

Call the patient by name The appropriate first method to assess level of consciousness in a patient with his or her eyes closed is to call the patient by name. If the patient does not respond, one should repeat the patient's name. If the patient still does not respond, one may touch the patient to get his or her attention. Talking with the patient's family will not assist in determining the patient's level of consciousness. Yelling is not appropriate at any time. p. 1630

What differentiates heatstroke from heat exhaustion?

Core body temperature In heat exhaustion, the core temperature of a patient is 99.6° to 104° F, and that of a patient with heat stroke is greater than 104° F. Extended exposure to heat leads to heat stress characterized by fatigue and weakness, which occurs during heatstroke and heat exhaustion. Heatstroke patients sweat profusely; however, increased sweating in heat exhaustion eventually causes the sweat glands to stop working, leading to absence of perspiration. The mental status of the patient is affected in heatstroke as well as in heat exhaustion as a result of thermal injury to the brain. p. 1637

A terrorist's dirty bomb scattered radioactive material in the city. What initial measure does the nurse take to limit radioactive contamination?

Cover patients' noses and mouths In a "dirty bomb" blast, radioactive material is scattered into the surrounding environment, resulting in radioactive contamination. The radioactive dust and smoke can spread and cause illness if inhaled. Hence the nurse should initiate measures like covering patient's noses and mouths to limit contamination. Victims who have sustained blast injuries can be treated, but this does not limit radioactive contamination. The nurse assesses vital signs in emergency care during a primary survey when patients are presented in triage. Administration of antibiotics is relevant when patients are suffering from a disease that can be effectively treated with medicines, not to prevent radioactive contamination. p. 1645

Which is the most significant problem related to dog bites of children?

Destruction of skin Animal bites pose a greater risk to children. Facial bites are common in children and are often caused by the dog owned by the victim. The most significant problem that arises is destruction of skin, which may lead to tearing of multiple layers of tissue under the skin. The bite may cause a simple wound or may be a serious puncture wound; hence there is no occurrence of a rash on the affected area. Paralysis is caused by reaction to tick-borne disease. Heart disease is a result of pulmonary complications in an event of respiratory distress. p. 1642

The nurse is examining the abdomen of the patient in the emergency unit of the hospital. What finding indicates excessive fluid in the abdomen?

Dullness on percussion Dullness on percussion of the abdomen indicates excessive fluid in the abdomen. Tympany on percussion indicates excessive air in the abdomen. Decreased bowel sounds may indicate a temporary paralytic ileus. Bowel sounds in the chest may indicate a diaphragmatic rupture. p. 1633

In the triage area, a patient complains of pain in the right foot. The nurse assesses an injury sustained during a natural disaster. What should the nurse do while the patient waits for a full assessment?

Elevate the right leg and place ice on the injury Pain management strategies should start with nonpharmacologic methods such as splinting, elevation, ice, and distraction. Pain relief measures should be instituted before the patient and family are moved to the waiting room. The patient should not consume anything until the doctor has evaluated the patient. It is not appropriate to tell the patient the doctor has been busy all day, as this may cause more distress for the patient and does not address the patient's problems. p. 1634

A terrorist attack involving a nuclear bomb occurred in a nearby city, and the closest hospital is expected to receive a large volume of victims. The hospital has activated its emergency response plan and patients are beginning to arrive. To utilize resources effectively and efficiently, there are colored tags available for triaging patients in order to determine the seriousness of injury and the likelihood of survival. A nurse is triaging a patient who is able to walk, has no obvious deformities, is in no distress, and is complaining of wrist pain. What tag should the nurse give this patient?

Green tag Triaging for a mass casualty incident (MCI), such as a nuclear bombing, requires the use of colored tags to determine the seriousness of the injury and likelihood of survival. The nurse should apply a green tag, because it is used for minor injuries. Red tags designate life-threatening injuries that need immediate intervention. Blue tags designate those who are expected to die. Black tags are for those victims who are dead. p. 1646

A patient has suffered a severe blow to the head during a tornado. Which observation during the nursing assessment places this patient at the greatest risk and must therefore be addressed first?

Hematoma to the left neck A hematoma to the left neck means the patient's airway is at risk for collapse due to compression; this is the greatest risk for this patient. Vomiting blood and deep facial lacerations may cause a circulatory problem if the bleeding is excessive, but this is a secondary concern to airway obstruction. Complaints of a headache are secondary to the ABCs: airway, breathing, and circulation. p. 1630

A teenager who attempted suicide is brought into the emergency department by the mother. The mother suspects that the teenager consumed the liquid bleach kept in the bathroom. Which clinical manifestation in the child's body confirms poisoning?

Irritation of lips, mouth, and eyes When poisoning is by bleach, the initial clinical findings include irritation of the lips, mouth, and eyes. Jaundice is associated with acetaminophen poisoning 72 to 96 hours of consumption. Cyanide poisoning causes the breath to take on an almond odor. High doses of carbon monoxide in the bloodstream can cause respiratory depression. p. 1643

Which nursing intervention would be included in the exposure and environmental control assessment component of the primary survey in the emergency department?

Keeping the patient warm with blankets In the Exposure or Environmental Control step, the patient's clothes are removed for a thorough physical assessment. Once the patient is exposed, warming blankets, overhead warmers, and warmed IV fluids are used to limit heat loss, prevent hypothermia, and maintain privacy. A brief pain assessment is conducted under the disability step during primary survey to periodically reassess pain using standardized pain scale. The patient's forehead is secured to the backboard to achieve cervical spine stabilization and/or immobilization. A neurologic examination is a measure of the degree of disability, done to assess the patient's level of consciousness. p. 1632

Chemical agents were used to cause harm to a group of patients. What parts of the body are most affected by chemical agents?

Lungs and skin Chemical agents used in terrorism affect lungs by inhalation and the skin by contact. The heart, adrenal glands, bladder, and rectum are not as commonly directly affected by contact or inhalation of chemical agents. p. 1645

While examining the chest of a patient after a motor vehicle accident, which finding during the assessment will prompt the nurse to take immediate action?

Muffled and low-pitched heart sounds Muffled heart tones may indicate trauma to the heart, and the patient should be immediately evaluated for a blunt chest injury, which represents the most immediate threat to the patient's life. A bruise is blood already coagulated; this may not cause further problems with circulation, but it should be observed closely. Lacerations on the limbs are dangerous if they are hemorrhaging, but this is secondary to heart trauma. Complaints of topical pain are secondary to the potential of a chest trauma. p. 1633

Which guideline for the assessment of intimate partner violence (IPV) should the emergency nurse follow?

Patients should be screened routinely for family and IPV In the emergency department, the nurse needs to screen for family and IPV. Routine screening for this risk factor is required. Such assessment should not be limited to female, high-risk, or young patients, and evidence need not be present to screen for the problem. p. 1644

Which is an initial manifestation of Rocky Mountain spotted fever?

Pink Rash Rocky Mountain spotted fever is a tick-borne disease caused by the organism Rickettsia rickettsii. Pink macular rash develops in 2 to 10 days following the tick bite. It appears on the palms, wrists, soles, feet, and ankles. Tick paralysis is caused by exposure to neurotoxin in a dog infected with ticks. The early signs of Lyme disease include flulike symptoms, such as stiff neck. Bull's-eye rash also develops in patients who have been bitten by a tick infected with Lyme disease. p. 1641

A patient comes into the emergency department complaining of extreme thirst and vomiting on a very hot day. The nurse assesses that the patient has profuse diaphoresis and is ashen in color. Vital signs are blood pressure 90/50, pulse 98, and temperature is 101 o Fahrenheit. Which of the following is the immediate priority for the nurse?

Place the patient in a cool area and remove any restrictive clothing The patient is experiencing heat exhaustion, and the initial treatment step is to place the patient in a cool area and remove any restrictive clothing. The nurse would not administer salt tablets, because this could lead to complications such as gastric irritation or hypernatremia. The nurse would not administer oral fluid and electrolyte replacement for a patient experiencing nausea or vomiting. An intravenous bolus may be started, but it would consist of 0.9% normal saline, not lactated Ringers. p. 1637

The nurse recalls that phosgene gas causes a patient to develop what condition?

Pulmonary edema Phosgene gas causes pulmonary edema and impairs pulmonary functioning, resulting in death. Mustard gas causes skin burns. Explosives such as TNT and dynamite may cause middle ear disorders. If a patient is exposed to ionizing radiation, then it results in acute radiation syndrome. p. 1645

A patient has sought care three days after experiencing a series of tick bites. Which manifestation would indicate that a patient is experiencing tick paralysis?

Respiratory distress A classic manifestation of tick paralysis is flaccid ascending paralysis, which develops over one to two days. Without tick removal, the patient dies, because respiratory muscles become paralyzed. Aggression, decreased level of consciousness, fever, and necrosis at the bite sites are not characteristic of the problem. p. 1641

An elderly patient is brought to the hospital with puncture wounds caused by a cat bite. Which complication can arise?

Septic arthritis Older adults are at a higher risk of infection from animal bites. The puncture wounds from cat bites can cause infections from causative organisms found in the mouth of even the healthiest of cats. This infection leads to septic arthritis. Meningitis may occur in a patient with Lyme disease, within days or weeks after initial symptoms. Heart disease is manifested in the later stage of Lyme disease. Human bites can cause puncture wounds that are infected by hepatitis virus. p. 1642

A patient seeks treatment following a cat bite. The nurse recognizes that the bite may result in which condition?

Tenosynovitis Cat bites cause deep puncture wounds that can damage tendons and joint capsules, resulting in tenosynovitis. Dog ticks or wood ticks may cause tick paralysis. Lyme disease is a tick-borne disease that is caused by a tick infected with Borrelia burgdorferi. Immersion syndrome is caused when an individual immerses in cold water for a long time. p. 1642

A nurse is directed to travel with a patient during transport to another hospital. About which condition does the nurse immediately call the doctor during the transport?

The patient has 200 mL of fresh blood from the chest tube The patient is at risk for hemorrhage when there is 200 mL of fresh blood in the chest tube, and the nurse should immediately notify the sending doctor. A GLASCO score of 10 and difficulty to arouse may be expected on a versed drip. The blood pressure may be lowered by titrating the dopamine drip to a lesser dose; the nurse can do this without calling the physician. The Foley catheter may have caused some trauma resulting in blood-tinged urine; however, it is not critical to inform the doctor of this during the transport. p. 1634

A group of people have suffered hypothermia after an ice storm on a highway. Which patient is exhibiting moderate hypothermia?

The patient whose heart rate is 50 beats/minute and whose blood pressure is hard to obtain The patient with a heart rate of 50 beats/minute and whose blood pressure is difficult to obtain is exhibiting moderate hypothermia. The patient who is shivering and confused is exhibiting mild hypothermia. The patient with absent reflexes and pupils that are fixed and dilated is suffering from severe hypothermia. The patient who is acting irrationally and has slight heart rate changes has mild hypothermia. p. 1638

A nurse is conducting a primary survey in an emergency department. What is the purpose of the survey?

To evaluate the status of airway, breathing, circulation, disability and exposure and environmental control The primary survey in an emergency assessment focuses on airway, breathing, circulation (ABC), disability, and exposure or environmental control. It aims to identify life-threatening conditions so that appropriate interventions can be started. The initial focused assessment prior to a primary survey determines the presence of actual or potential threats to life. Determining the priority for treatment is triaging. Patients are evaluated to decide whether they meet the criteria for ESI (Emergency Severity Index), thereby determining the number of resources required for the treatment. p. 1630

A patient is admitted to the emergency department with a traumatic head injury. What is an appropriate nursing action during the primary survey?

Using the Glasgow Coma Scale During the primary survey, the Glasgow Coma Scale is used to assess the degree of disability. It determines the patient's response to verbal and/or painful stimuli to assess the level of consciousness. In the secondary survey, the nurse uses a portable x-ray to check for any displacement of endotracheal or gastric tubes if any are inserted into the patient. The patient's clothing is later removed for a thorough physical assessment. An electrocardiogram (ECG) monitors the heart rate and rhythm as part of the secondary survey when the patient requires life-saving interventions. p. 1632

A bomb explosion is most appropriately categorized as which type of disaster?

Violence Violence is defined as the acting out of fear and/or anger to cause harm to someone or something; a bombing is an example of this. Natural disasters and weather may harm people through extremes of wind, temperature, or water. Accidents may involve equipment or trauma to the body, but they are not intentional as in the case of a bomb. While a bomb may emit poisonous substances, it can also be harmful only via explosion. p. 1645

After a bomb has exploded in a public place, the nurse assesses a patient who has an open fracture to the left leg, a blood pressure of 160/90 mmHg, heart rate of 90 beats/minute, and respiratory rate of 24 breaths/minute. The patient is also anxious and crying in pain. Which color tag should the patient receive?

Yellow This patient has urgent but non-life-threatening injuries and should receive a yellow tag. Green tags are for minor injuries. Red tags are for life-threatening injuries. Blue tags are for patients expected to die. p. 1646