Lesson 47: Medical Emergencies
A nurse and an assistive personnel (AP) found an adult client on the bathroom floor who has a pulse but is unresponsive and not breathing. The nurse determines the AP is delivering an adequate number of rescue breaths if the AP delivers how many breaths per minute? 6 10 16 20
10 RATIONALE: During cardiopulmonary resuscitation (CPR), the rescuer delivers 8 to 10 breaths per minute to the adult victim. Each rescue breath is delivered over 1 second at a rate of 1 breath every 6 to 8 seconds. Six, 16, and 20 breaths per minute are incorrect.
An adult client who recently underwent surgery suddenly experiences sharp chest pain and dyspnea and lapses into unconsciousness. The client is not breathing and does not have a pulse. The nurse calls a code and begins CPR. How many chest compressions per minute does the nurse deliver? 40 50 70 100
100 RATIONALE: The proper number of chest compressions per minute should be delivered to ensure adequate cardiac output. In an adult client, the correct number of chest compressions is at least 100 per minute. Forty, 50, and 70 are all incorrect.
After demonstrating the correct procedure for CPR in an infant during a CPR recertification course, the nurse asks a student to perform the procedure on a mannequin. Which ratio of chest compressions to ventilations performed by the student indicates to the nurse that the student is performing the procedure correctly? 5:1 15:1 15:2 30:2
30:2 RATIONALE: CPR in an infant or child is performed at a ratio of 30 chest compressions to two ventilations. Therefore the other options are incorrect.
BASIC LIFE SUPPORT Foreign Body Airway Obstruction
A variety of foreign bodies may become lodged in a person's airway, but the type most frequently encountered is food.
BASIC LIFE SUPPORT Cardiopulmonary Resuscitation: Variations Child
A child is defined as a person between 1 and 8 years of age. The procedure is basically the same as that done for an adult; variations are listed below.
BASIC LIFE SUPPORT Cardiopulmonary Resuscitation Breathing Nursing Considerations
A victim who is breathing is log-rolled onto his or her side as a unit (without twisting) with the lower arm in front of the body (recovery position) to help maintain an open airway; if a spinal cord injury is suspected, however, the victim should not be moved. Occasional gasps from a victim may not result in adequate ventilation and this victim should be treated as if he or she is not breathing. A nonbreathing victim requires the following procedure: *Give two ventilations (breaths) of 1 second per breath (mouth-to-mouth, mouth-to-barrier device, or bag mask if available, ensuring an adequate air seal); allow the victim to exhale between breaths (avoid excessive ventilation). *Each rescue breath is delivered over 1 second; ventilations are delivered at a rate of 1 breath every 6 to 8 seconds (8 to 10 ventilations per minute). *If giving breaths is unsuccessful, reposition the victim's head and try again (improper chin and head position is a common cause of difficulty in ventilating a victim). *While giving ventilations, be alert to gastric distention, which indicates that the airway has not been properly opened and air from ventilations is entering the stomach rather than the lungs; this can result in regurgitation and aspiration. *A sufficient tidal volume is needed when delivering breaths to produce a visible chest rise. *A compression to ventilation ratio of 30:2 is recommended until an advanced airway is placed. In special situations, an alternative breathing method may be used.
BASIC LIFE SUPPORT Cardiopulmonary Resuscitation: Adults
Adult CPR consists of life-support measures that include early recognition of cardiac arrest and activation of the emergency response system, early CPR using C-A-B procedures, rapid defibrillation if necessary, advanced life support, and post-cardiac arrest care.
BASIC LIFE SUPPORT Cardiopulmonary Resuscitation Airway Nursing Considerations
After delivering 30 compressions, the rescuer opens the victim's airway (after donning gloves and a face shield, if they are available). The head tilt-chin lift is the preferred method of opening the airway (refer image, left). To perform the head tilt-chin lift, one hand is placed on the client's forehead, and firm pressure is applied to tilt the head backwards; using the first and second fingers of the other hand, pressure is applied under the bony part of the jaw, taking care not to block the airway and ensuring that the tongue is not obstructing the airway. If the victim has sustained a head, neck, or spinal cord injury, the jaw-thrust maneuver (refer image, right) is used to open the airway. The jaw-thrust maneuver is performed by placing the first and second fingers of both hands on the corner-point of the mandible and both thumbs on the chin, then pushing the mandible upwards; this prevents obstruction of the airway by the tongue.
BASIC LIFE SUPPORT Cardiopulmonary Resuscitation: Variations Infant
An infant is defined as a person who is less than one year of age.
BASIC LIFE SUPPORT Foreign Body Airway Obstruction Nursing Considerations
Ask the victim, "Are you choking?" (The victim will not be able to speak or cough if he or she is choking and may display what is commonly referred to as the universal sign for choking [refer image].) If the victim's airway is partially obstructed, a crowing sound is heard; encourage the victim to cough. If the victim is having difficulty breathing, activate the EMS system. If the victim is having difficulty breathing, activate the emergency response system. Relieve the obstruction with the use of the abdominal thrust maneuver. Perform the abdominal thrust maneuver in rapid sequence until the object is dislodged or victim becomes unconscious. If the victim becomes unresponsive, place in a supine position, and begin CPR for 2 minutes and then activate emergency response system; if a second rescuer is present, that person should immediately activate emergency response system. Each time the airway is opened during CPR, the rescuer should look in the victim's mouth for an object and if found, remove it.
Jean determines that John is unconscious. John's wife cries, "I want to help! What can I do? Just tell me what to do and I'll do it!" What is the appropriate response? Asking her to perform chest compressions on John Quickly teaching her how to perform mouth-to-mouth resuscitation Asking her to call 911 to get help and an automatic external defibrillator (AED) Tell her that there is nothing that she can do unless she knows how to perform CPR
Asking her to call 911 to get help and an automatic external defibrillator (AED) RATIONALE: Once it has been determined that a victim is unconscious, emergency medical services (EMS) should be activated. Jean would most appropriately ask John's wife to go to the nearest telephone, if she does not have a cell phone with her, and call 911 to get help. Bringing an AED, if one is available, is also important, because early defibrillation improves the victim's chance of survival. Jean would not ask John's wife to perform chest compressions unless she first determined that his wife was certified in CPR. Quickly teaching John's wife to perform mouth-to-mouth resuscitation would delay lifesaving measures. Telling the woman that there is nothing she can do unless she knows how to perform CPR is incorrect.
A nurse is having dinner with a friend at a restaurant when a woman at a nearby table suddenly clutches her neck with both hands. Suspecting that the woman is choking, the nurse quickly approaches her. What action should the nurse take first? Asking the woman whether she can speak Helping the woman into a supine position Striking the woman's back forcefully with a fist Opening the woman's airway and attempting to perform ventilation
Asking the woman whether she can speak RATIONALE: One sign of airway obstruction is the universal signal for choking (the victim clutches the neck with one or both hands). When someone appears to be choking, the first action is to ask the victim, "Are you choking?" or "Can you speak?" If the victim can cough forcefully or speak, the rescuer need not intervene and should monitor the victim. The victim will not be able to speak or cough if he or she is choking. If an obstruction is present, the rescuer administers the abdominal thrust maneuver and notifies the emergency response system. Opening the woman's airway and attempting to perform ventilation and placing the woman in a supine position are both steps of the abdominal thrust maneuver for an unconscious victim. Striking the woman on the back forcefully with a fist is an incorrect action, can be harmful, and is not a component of the abdominal thrust maneuver.
ONCOLOGICAL EMERGENCIES Superior Vena Cava Syndrome Nursing Considerations
Assess the client for early signs and symptoms of SVC syndrome. Prepare the client for high-dose radiation therapy to the mediastinal area and, possibly, for surgery to insert a metal stent into the vena cava.
BASIC LIFE SUPPORT Foreign Body Airway Obstruction: Variations Nursing Considerations Infant
Assess the victim for obstruction and note breathing problems. Place the infant over an arm or on the lap, position the head lower than the trunk, and support the head firmly, holding the jaw (refer image, left). Deliver five back blows with the heel of the hand between the shoulder blades. Turn the infant over, positioning the head lower than the trunk. Deliver five chest thrusts at same location used for chest compressions (refer image, right). Check for a foreign object and remove it, only if one is seen. Repeat the sequence until the object has been removed.
BASIC LIFE SUPPORT Automated External Defibrillator Nursing Considerations
Attach the AED leads to the victim per AED instructions. Turn on the AED and follow the AED prompts. Ensure that no one is touching the victim when the shock is delivered. Shockable rhythm: resume CPR immediately for 2 minutes after the shock so as to minimize interruptions. Non-shockable rhythm: resume CPR immediately for 2 minutes and check rhythm every 2 minutes.
While holding his airway open, Jean assesses John for spontaneous respiration and notes that it is absent. Which action should Jean take next? Turning John on his side Calling emergency medical services Maintaining an open airway until EMS arrives Blowing two slow, full breaths into John's mouth, ensuring that his chest rises with each breath
Blowing two slow, full breaths into John's mouth, ensuring that his chest rises with each breath RATIONALE: If John is not breathing, Jean must maintain an open airway and administer mouth-to-mouth respirations by blowing two slow, full breaths into John's mouth, ensuring that his chest rises with each breath. EMS should have been activated as soon as it was determined that the client was unconscious. Turning John onto his side is incorrect, because Jean would not be able to administer CPR with him in this position. Maintaining an open airway until EMS arrives delays lifesaving measures.
BASIC LIFE SUPPORT Cardiopulmonary Resuscitation Airway
Before effective rescue breathing can be administered, a patent airway must be confirmed or, if it is not present, opened manually.
BASIC LIFE SUPPORT Cardiopulmonary Resuscitation
Cardiopulmonary resuscitation, known by most as CPR, is the process of providing oxygen to the brain, heart, and other vital organs in a victim who cannot do so for him- or herself.
BASIC LIFE SUPPORT Cardiopulmonary Resuscitation Chest Compressions
Chest compressions are used to keep blood moving through the victim's body, delivering oxygen to crucial areas, such as the brain.
Foreign Body Airway Obstruction: Variations Nursing Considerations Pregnant or Obese Victim
Chest thrusts are used for obese victims or a victim in the late stage of pregnancy. The rescuer places his or her arms under the axillae and across the chest. The thumb side of a clenched fist is placed against the middle of the sternum, and the other hand is placed over the fist. Backward chest thrusts are performed until the foreign body is expelled or the victim loses consciousness. If a pregnant victim loses consciousness, the rescuer places her on her back, then inserts a wedge (e.g., a pillow or rolled blanket) under the woman's right flank and hip to displace the uterus off of the aorta. The rescuer then attempts ventilations; if ventilation is unsuccessful, the rescuer positions the hands as for chest compressions and delivers firm chest thrusts to remove the obstruction. If defibrillation is needed in a pregnant victim, the paddles are placed one rib interspace higher than usual because the heart is displaced slightly by the enlarged uterus.
BASIC LIFE SUPPORT Foreign Body Airway Obstruction: Variations Nursing Considerations Child
Choking is suspected in an infant or child experiencing acute respiratory distress associated with coughing, gagging, or stridor (high-pitched, noisy breathing). Allow the victim to continue coughing if the cough is forceful. If the cough is ineffective or the victim demonstrates increased respiratory difficulty accompanied by a high-pitched noise while inhaling, help is needed. In a conscious child, the abdominal thrust maneuver should be performed until the obstruction is dislodged.
ONCOLOGICAL EMERGENCIES Spinal Cord Compression
Compression occurs when a tumor directly enters the spinal cord or when the vertebral column collapses as a result of tumor entry; clients with multiple myeloma or those with metastasis to bone have an increased risk of developing this complication. The affected individual experiences back pain, usually before neurological deficits occur. Neurological deficits, which are related to the level of the spine being subjected to compression, include numbness; tingling; loss of urethral, vaginal, and rectal sensation; and muscle weakness.
A client hospitalized with prostate cancer is undergoing chemotherapy. While the nurse is helping the client with hygiene care, the client suddenly complains of severe back pain and numbness of the lower extremities. The nurse should take which immediate action? Contact the health care provider Administer pain medication Take the client's blood pressure Allow the client to rest and complete the bath later
Contact the health care provider RATIONALE: Spinal cord compression and damage occur when a tumor enters the spinal cord or when the vertebral column collapses as a result of tumor entry. A tumor may begin in the spinal cord or spread from another area of the body, such as the prostate gland, lung, breast, or colon. Spinal cord compression causes back pain, usually before neurological deficits occur. Such deficits include tingling; numbness; loss of urethral, vaginal, and rectal sensation; and muscle weakness. If paralysis occurs, it is usually permanent. The nurse would contact the health care provider to report the occurrence. Although pain medication may be needed, it is most appropriate to contact the health care provider so that a thorough evaluation of the client's pain may be conducted. Allowing the client to rest and completing the bath at a later time may be necessary, but this action delays necessary intervention. The nurse would expect the client's blood pressure to be increased if the client is in pain, and although the blood pressure would be measured, the most appropriate action is to contact the health care provider about the sudden occurrence of severe pain.
EMS has arrived. Which actions should Jean take at this time? Select all that apply. Helping the emergency medical technicians (EMTs) with the AED Continuing CPR until she is asked to stop Talking to John's wife while the EMTs work on John Going for a run to relieve the stress of the situation Preparing to go with John and his wife to the hospital Telling the EMTs what has happened since she has been there
Continuing CPR until she is asked to stop Talking to John's wife while the EMTs work on John Telling the EMTs what has happened since she has been there RATIONALE: Jean will continue CPR until the EMTs are ready to take over. She will also give them report about the situation and answer their questions about what has happened while she has been with John. When the EMTs no longer need Jean's or John's wife's attention, Jean will be able to talk to John's wife to help her understand what the EMTs are doing and calm her as needed. Jean would not help the EMTs with the AED; the EMTs are trained to perform this procedure. She would not go to the hospital with John and his wife unless they asked her to go and she wanted to do so; this is not an expected nursing action. She might go for a run to relieve her stress, but she would not do it at this time.
BASIC LIFE SUPPORT Cardiopulmonary Resuscitation: Variations Infant Nursing Considerations
Determine unresponsiveness; stroke the infant and watch for a response, such as movement, but don't shake the infant. If there is no response, follow the C-A-B procedures. If the rescuer is alone, 5 cycles of compressions and breaths (which will take about 2 minutes) are done before activating emergency response system and obtaining an AED. If a second rescuer is present, that person activates emergency response system while the first attends to the infant. Compression-breath ratio is 30:2. Use the brachial pulse to assess circulation. The breastbone is compressed 1.5 inches at a rate of 100 times per minute with the use of two or three fingers. In an infant, provide mouth-to-nose ventilation when delivering breaths.
PRIORITY POINTS TO REMEMBER!
Disseminated intravascular coagulation is an exaggerated clotting process, and clients with sepsis, trauma, malignancy, organ destruction, hepatic failure, or toxic reactions may be predisposed to this condition. Oncologic emergencies (e.g., syndrome of inappropriate antidiuretic hormone, spinal cord compression, hypercalcemia, superior vena cava syndrome, and tumor lysis syndrome) are life-threatening situations that may occur as a result of cancer or cancer treatment. Assessing a victim for responsiveness is always the first step in lifesaving efforts. If a head, neck, or spinal cord injury is suspected, the jaw-thrust maneuver is used to open the airway. If the victim is younger than 1 year, use the brachial pulse to assess circulation. The location for hand placement for chest compressions on a child is the same as that for an adult; in a child, use the heel of one hand. In an infant, the breastbone is compressed 1.5 inches at a rate of 100 times/min. Minimize interruptions when performing cardiopulmonary resuscitation (CPR). In an infant, an airway obstruction is relieved with the use of five back blows and five chest thrusts.
ONCOLOGICAL EMERGENCIES Spinal Cord Compression Nursing Considerations
Early recognition is crucial: Assess the client for back pain and neurological deficits. Administer high-dose corticosteroids as prescribed to reduce swelling around the spinal cord and relieve symptoms. Prepare the client for immediate radiation, chemotherapy, or both to reduce the size of the tumor and relieve compression. Surgery may be required to remove the tumor and relieve pressure on the spinal cord. Instruct the client in the use of neck or back braces if they are prescribed.
ONCOLOGICAL EMERGENCIES Tumor Lysis Syndrome Nursing Considerations
Encourage oral hydration; IV hydration may be prescribed for the client experiencing nausea. Stress the importance of fluid intake during chemotherapy. Administer diuretics as prescribed to increase urine flow through the kidneys. Administer medications as prescribed to increase the excretion of purines (e.g., allopurinol). Prepare to administer an IV infusion of glucose and insulin to treat hyperkalemia. Prepare the client for dialysis if hyperkalemia and hyperuricemia persist despite treatment.
BASIC LIFE SUPPORT Cardiopulmonary Resuscitation: Variations Child Nursing Considerations
If the rescuer is alone, 5 cycles of compressions and breaths (which will take about 2 minutes) are done before activating the emergency response system and obtaining an AED. One hand is used for chest compressions and ventilations are delivered more gently than in an adult. Adjust chest compressions to the child's age and size; compression-breath ratio is 30:2. If the child is breathing, ensure that the airway stays open. If the child is not breathing, take the appropriate measures (mouth-to-mouth ventilation). After 5 cycles of CPR, if there is no response and an AED is available, apply it and follow the AED prompts; use pediatric pads if available, if pediatric pads are not available, use adult pads. Continue CPR until the child moves or help arrives.
Disseminated Intravascular Coagulation (DIC)
In this condition, known to many as DIC, an exaggerated clotting process leads to the formation of clots in the microcirculation. This thromboembolus formation may result in bleeding and vascular occlusion of the organs.
ONCOLOGICAL EMERGENCIES Syndrome of Inappropriate Antidiuretic Hormone Nursing Considerations
Initiate fluid restriction and increased sodium intake. As prescribed, administer an antagonist to ADH. Monitor the client's serum sodium level.
A nurse is grocery shopping when a woman screams, "Help me! He's choking on a piece of candy!" On rushing to the scene, the nurse sees that the woman's 4-year-old son is having respiratory difficulty and hears high-pitched inspiratory noises from the child. Which action should the nurse immediately take? Calling 911 on a cell phone Laying the child on the floor Placing the child across her lap and delivering five back blows Standing behind the child and administering abdominal thrusts
Standing behind the child and administering abdominal thrusts RATIONALE: The abdominal thrust maneuver is recommended for use in adults and children 1 year of age and older. If the victim is coughing but the cough is ineffective or if the victim exhibits respiratory difficulty accompanied by a high-pitched noise while inhaling, help is needed. The nurse must immediately stand behind the child and administer abdominal thrusts. Although the emergency response system should be activated, this is not the nurse's immediate action. The nurse must stay with the child and administer care and ask the child's mother to call 911. Back blows and chest thrusts are administered to an infant who is choking. An unconscious child would be placed in a supine position.
ONCOLOGICAL EMERGENCIES Hypercalcemia Nursing Considerations
Monitor the serum calcium level. Administer oral or parenteral fluids (normal saline solution) as prescribed. Administer medications to lower the calcium level as prescribed. Encourage low-impact exercises in order to increase renal excretion of calcium. Prepare the client for dialysis if the condition becomes life threatening or is accompanied by renal impairment.
Alternative Breathing Methods
Mouth-to-nose breathing may be used when it is impossible to ventilate a victim through the mouth (e.g., the mouth cannot be opened, the mouth is seriously injured, or a tight mouth-to-mouth seal is difficult to achieve). Mouth-to-stoma breathing is used for the victim who has undergone a tracheal stoma; a round pediatric face mask is used to create an adequate seal.
ONCOLOGICAL EMERGENCIES Superior Vena Cava Syndrome
Occurs when the superior vena cava (SVC) is compressed or obstructed (refer image) by tumor growth, commonly as a result of lung cancer or lymphoma (A cancer that originates from lymphoid tissue). Signs and symptoms result from blockage of blood flow in the venous system of the head, neck, and upper trunk. Early signs and symptoms, which generally occur in the morning, include edema of the face, especially around the eyes, and tightness of shirt collars (Stokes sign). As the condition worsens, the client experiences edema of the arms and hands, dyspnea, erythema of the upper body, and epistaxis. Life-threatening signs and symptoms include airway obstruction, hemorrhage, cyanosis, mental status changes, decreased cardiac output, and hypotension.
BASIC LIFE SUPPORT Cardiopulmonary Resuscitation Breathing
Once the airway has been secured, the rescuer delivers breaths to keep oxygen moving through the victim's body.
ONCOLOGICAL EMERGENCIES Sepsis Interventions
Prevent sepsis through early identification of clients at high risk, such as clients who are immunosuppressed. Maintain strict aseptic technique with the immunosuppressed client and monitor closely for infection. Administer antibiotics intravenously (IV) as prescribed.
Disseminated Intravascular Coagulation (DIC) Nursing Considerations
Prevent the complication through early identification of clients at high risk for DIC. Remove the underlying cause. Monitor vital signs; assess for bleeding and signs of shock. Prepare for oxygen therapy, volume replacement, blood component therapy, and possibly heparin therapy. Administer anticoagulants as prescribed during the early phase of DIC. Administer cryoprecipitated clotting factors, as prescribed, when DIC progresses and hemorrhage is the primary problem. Monitor for complications associated with fluid and blood replacement and heparin therapy. Monitor urine output and maintain at 30 mL/hr (renal failure is a complication of DIC).
Despite her attempts to ventilate John, Jean is unable to deliver the breaths. As Jean repositions John's head, his wife asks, "Could this have happened because of his cancer?" Which of the following oncologic emergencies could precipitate this situation? Hypercalcemia Tumor lysis syndrome (TLS) Superior vena cava (SVC) syndrome Syndrome of inappropriate antidiuretic hormone (SIADH)
Superior vena cava (SVC) syndrome RATIONALE: Superior vena cava (SVC) syndrome related to lung cancer or lymphoma is the most likely contributor to this situation because of its potential for respiratory compromise. Hypercalcemia and TLS may lead to electrocardiographic changes but would not contribute to respiratory obstruction. SIADH would not likely contribute to cardiac or respiratory arrest.
BASIC LIFE SUPPORT Cardiopulmonary Resuscitation Nursing Considerations
Rescuers should follow the C-A-B formula: *C: compression *A: airway *B: breathing The procedures involved in these steps are described later in the lesson, as is the full sequence of actions for CPR in adult clients, with modifications for pediatric and pregnant clients; use of the automated external defibrillator (AED); and treatment of the choking victim. Basic steps include immediate recognition of the sudden cardiac arrest (unresponsiveness and absence of normal breathing) and activation of the emergency response system, early CPR, and rapid defibrillation with an AED.
BASIC LIFE SUPPORT Cardiopulmonary Resuscitation Chest Compressions Nursing Considerations
Stand or kneel beside the victim's chest; ensure that the victim is lying supine on a firm surface (if possible); air-filled mattresses should be deflated before performing CPR. Place the heel of one hand on the lower half of the sternum, which is the center or middle part of the victim's chest, with the heel of the other hand on top of the first so that the hands are overlapped and parallel. The adult chest is compressed to a depth of at least 2 inches and compressions should be hard and fast at a rate of at least 100 per minute. Allow complete recoil of the chest after each compression to allow the heart to fill completely before the next compression. A compression to ventilation ratio of 30:2 is recommended. If 2 rescuers are present, to prevent rescuer fatigue, rescuers may switch positions (compressor and ventilator) after approximately 2 minutes (or after 5 cycles of compression and ventilation at a ratio of 30:2). Interruptions in chest compressions need to be minimized. Chest compressions and ventilations are continued until spontaneous circulation returns or resuscitative efforts are terminated.
Abdominal Thrust Maneuver
Stand the behind victim. Place your arms around the victim's waist. Make a fist. Place the thumb side of the fist just above the victim's umbilicus, well below the xiphoid process. Perform quick in-and-up thrusts between the umbilicus and xiphoid process.
Jean Teenem, a registered nurse, is employed on a medical unit at a large medical center. Today, on her day off, she decides to take a walk along the beach. On the beach she is approached by a frantic woman who screams, "John—my husband—has collapsed, and I need help! Please come help us!" Jean runs to John, who is lying supine on the sand, and kneels at his side. Number the following actions that Jean will take in the order of priority, with number 1 as the first action and number 4 as the last. Opening John's airway with a jaw-thrust maneuver and delivering 2 breaths for every 30 compressions Delivering compressions and at a rate of 100 compressions per minute Checking John's carotid pulse Tapping or gently shaking John and shouting, "Are you OK?"
Tapping or gently shaking John and shouting, "Are you OK?" Checking John's carotid pulse Delivering compressions and at a rate of 100 compressions per minute Opening John's airway with a jaw-thrust maneuver and delivering 2 breaths for every 30 compressions RATIONALE: A person who appears to be unconscious may actually be asleep, deaf, or even intoxicated. Therefore Jean must first determine whether John is unconscious by gently shaking, tapping, or moving his shoulders and shouting, "Are you OK?" Next Jean should assess circulation by palpating the carotid pulse (for no longer than 10 seconds) and begin chest compressions, if this is necessary. Finally the nurse would open John's airway with the use of the jaw-thrust maneuver and deliver rescue breaths, if they are necessary.
ONCOLOGICAL EMERGENCIES Sepsis
The client with cancer is at increased risk for infection, particularly with Gram-negative organisms, in the bloodstream (i.e., sepsis or septicemia) and, as a result, DIC, which is often associated with sepsis.
A nurse arrives at the home of a neighbor, who called for help when her husband fell off a ladder during a seizure. The neighbor tells the nurse that she called 911 and that an ambulance is on the way. The nurse assesses the man and determines that he is unconscious without a pulse. After performing 30 chest compressions, the nurse prepares to deliver rescue breaths and uses which method to open the man's airway? The jaw-thrust maneuver The head tilt-chin left method Lifting the chin and using the fingers to open the mouth Placing the fingers in the victim's mouth, using a hooking action
The jaw-thrust maneuver RATIONALE: When injury to the head, neck, or spinal cord is suspected, the jaw-thrust maneuver is used to open the airway. This maneuver maintains proper head and neck alignment, thereby reducing the risk of further damage. The head tilt-chin lift method is the preferred method of opening the victim's airway and is used if no head, neck, or spinal cord injury is suspected. Lifting the chin and using the fingers to open the mouth and placing the fingers in the victim's mouth with the use of a hooking action are incorrect methods that would not effectively open the airway. Additionally, the nurse would not place fingers in the mouth of a client who has had a seizure.
BASIC LIFE SUPPORT Cardiopulmonary Resuscitation: Adults Nursing Considerations
The rescuer should ensure that the scene is safe before approaching the victim. The health care provider should first determine if the victim is unresponsive with no breathing or normal breathing (by tapping the victim at the shoulder and shouting "Are you OK?"), activate the emergency response system, obtain the AED if alone and if one is easily accessible, attach and use the AED, and then begins CPR (using C-A-B procedures). If two rescuers are present then one can obtain the AED while the other begins CPR. Checking for a pulse: if a pulse is not felt within 10 seconds, the rescuer should begin chest compressions. If a pulse is definitely felt, the rescuer should give 1 breath every 5 to 6 seconds if the victim is not breathing and recheck the pulse every 2 minutes. If no pulse is felt or its presence cannot be determined, CPR is started at a ratio of 30:2 (compressions to ventilations).
BASIC LIFE SUPPORT Automated External Defibrillator
This device, known by many as an AED, is used to convert ventricular fibrillation into a perfusing rhythm. The AED differentiates nonventricular fibrillation rhythms and permits early defibrillation by laypersons and first responders.
ONCOLOGICAL EMERGENCIES Hypercalcemia
This late manifestation of extensive malignancy is most common in clients with bone metastasis. Decreased physical mobility contributes to or worsens hypercalcemia; decreased renal excretion of calcium occurs with immobility. Early signs include fatigue, anorexia, nausea and vomiting, constipation, and polyuria. More serious signs and symptoms include severe muscle weakness, diminished deep tendon reflexes, paralytic ileus, dehydration, and electrocardiographic changes.
ONCOLOGICAL EMERGENCIES Tumor Lysis Syndrome
Tumor lysis syndrome (TLS) occurs when large quantities of tumor cells are destroyed rapidly and released into the bloodstream faster than body's homeostatic mechanisms can handle them. Hyperkalemia and hyperuricemia occur; hyperuricemia can lead to acute renal failure. TLS is a sign that cancer treatment is effective; however, if left untreated, it can cause severe tissue damage and death.
ONCOLOGICAL EMERGENCIES Syndrome of Inappropriate Antidiuretic Hormone
Tumors may produce or secrete antidiuretic hormone (ADH) or stimulate the brain to synthesize ADH. In this syndrome, commonly referred to as SIADH, mild symptoms include weakness, muscle cramps, loss of appetite, and fatigue; the serum sodium level ranges from 115 to 120 mEq/L (115 to 120 mmol/L). More serious signs and symptoms, related to water intoxication, include weight gain, personality changes, confusion, and extreme muscle weakness. As the serum sodium level approaches 110 mEq/L (110 mmol/L), seizures, coma, and death occur unless the condition is treated quickly and aggressively.
