Welcome. My name is Diana Shenefield. Today’s
topic is Medical Emergencies. And as you’re
thinking about medical emergencies, we’re
always prepared as nurses to intervene for
emergencies, so this should be a
really good review.
So, what do I need to know? What are my learning
outcomes? I need to apply my knowledge of
nursing procedures and psychomotor skills for
emergencies. I need to be running through
algorithms through my mind when there’s
an emergency, one so I’m prepared, two so
that I can intervene at a good time, but also
so that I understand what’s going on in
the process, and then intervene when they
appear to be ready to go into emergency.
A lot of what we do as nurses is we want to
prevent medical emergencies. We want to pick
up on signs and symptoms when a patient is
going into an emergency. We want to know if
they’re going into shock or cardiac arrest
so that we can prevent that from happening.
So a lot of our assessment and reassessment is
prevention, but at times we will find ourselves
in the midst of an emergency that we couldn’t
prevent, and so what do I do as a nurse?
So here’s one of the possible NCLEX questions
you might see. What are the emergency nursing
actions for a patient with a head injury due
to a fall from a third-floor roof? So again,
be thinking about that patient. Picture in
your mind the emergency that has happened.
A, would you assess respirations, assess circulation
and assess level of consciousness?
B, stabilize C-spine, determine responsiveness,
and begin chest compressions?
C, stabilize C-spine, assess airway, and
Or D, assess airway, assess respirations,
and assess circulation?
So again, be thinking through your mind,
what has this patient just gone through?
And if you think about CPR, we think about ABCs,
but there’s something different about this
patient in that they fell off of a roof. So
hopefully you picked C. You want to stabilize
your C-spine first, then do your ABCs, assess
the airway and assess respirations. So again,
read your question and understand whether
there’s a head injury, neck injury, and
what kind of emergency response is required.
So when we talk about emergency care, there's
things that you need to review, and CPR
is at the top of the list. If it has been
a while since you’ve been certified in CPR,
you want to make sure you go back and look
at your CPR. Make sure you know the ratio
of compressions to respirations. Make sure
you understand how to check responsiveness,
where to check for pulses. Make sure you know
the difference between infant, child and adult,
and what your role is in each one of those.
How do you identify somebody that needs CPR?
What kind of other things, risk factors
do you need to look at? Are you looking at
keeping the patient safe, keeping yourself
safe? Then Heimlich maneuver, go back and review.
What do you do when in case of a conscious patient
choking as opposed to an unconscious patient?
What do you if it’s an infant? What do you
do if it’s a child? What do you do if it’s
an adult? What do you do if it’s an obese
adult or a pregnant adult? Again, run those
situations through your mind and make sure
that you remember your CPR procedures.
Respiratory support. How do you put somebody
in respiratory support if they maybe
had a seizure? How do you position them? What
kind of things are you watching for when you’re
dealing with just respiratory? Maybe you have
a near-drowning. Again, run those procedures
through your mind. Make sure you understand
your ABCs and how those fall under each one
of these emergency responses. AEDs. Make
sure you understand how an AED works.
Make sure you know the difference between
a shockable and a non-shockable rhythm.
And if you don’t, make sure you understand why
would somebody get shocked? What rhythm is
it that the AED is looking for? And how do
you keep yourself safe? How do you keep the
patient safe, if you’re in water or if they
have a lot of hair on their chest, what kinds
of things are you watching for? Do you know
the difference between child pads and adult
pads, and making sure that you’re using
the right pads? So again, go back to your
CPR, go back to your CPR books and re-read
that to make sure that that’s fresh in your
mind. How do you care for a wound
that has eviscerated
or dehisced? What are your emergency procedures
if that happens when you’re walking down
the hall or if it happens at the patient’s
bedside? What do you need to do as a nurse
to keep your patient safe? What about
monitoring a patient on a ventilator?
What all kinds of things can go wrong on a
patient on a ventilator? Do you know how to
watch for tube dislodgement? How to watch for
pneumonia? What kind of things am I assessing
for that could be an emergency situation
with a patient that has been intubated, and
making sure that I understand how to
assess and reassess.
So what interventions? Can I assess my patient
at risk for medical emergencies? All the time,
in the back of your mind, every patient, you
should be thinking about what is the worst
case scenario. Once you know what the worst
case scenario is for each individual patient,
then you’ll be more alert to watch for sudden
signs and symptoms. So on NCLEX, when they’re
giving you a patient, be thinking about what’s
the worst case scenario and how would I know
if that worst case scenario is playing through?
Evaluate the treatment provided. If I’m
giving oxygen, is the oxygen working the way
that I intend it to work? Can I assess, can
I evaluate and change my interventions according
to my assessments and evaluations?
Documenting patient response. Making sure
that I’m documenting everything that I’m
assessing and all of my interventions, so
that I can go back and see what is working
and what is not working. And then, notifying
the primary health care provider in patient
change status. This is one of the big reasons
for lawsuits in the United States, is failure
to respond and failure to report. Do I know
when it’s the appropriate time to let the
physician know? Do I know what subtle changes
in the patient’s condition is required for
me to call the physician? Make sure as you’re
reading through your questions on NCLEX that
you’re reading through clearly. One of
the things you want to remember for
NCLEX is most of the time notifying the physician
isn’t going to be the right answer, because
NCLEX wants to know what a nurse would do.
But there are times when they’re looking
at, “Do you know the time when you need
to call the physician because of a change
of status?” So make sure you’re reading
through the questions carefully, and what
is it asking you? Is it asking you what a
nurse would do? Or is it asking you, “Do
you understand and can you assess
a change of status?”
So in closing, most of you already know your
CPR. You understand about medical emergencies,
those are usually at the top of our minds.
But again, go back and review and make sure
you know the details so that you can safely
and effectively take care of your patient
in the emergency, that you can take care of
your patient and hopefully prevent emergencies,
but also be able to assess those when they
happen and keep the patient safe and take
care of the patient so that we don’t
have bad outcomes.
As a reviewing for NCLEX, make sure that you
remember your ABCs, make sure you’re looking
at Maslow, and make sure you’re reporting
any changes to your physician. Good luck on NCLEX.