Emergency & Mass Casualty Nursing

  1. in a disaster, if medical services are not availble/not on the scene, what is your 1st nursing intervention?
    • assess situation & determine priority of action.
    • a primary survey (rapid assessment) of life threatening conditions, completed systematically, is made 1st & should take no longer than 60 sec to perform.
  2. you found an unconscious pt. what would be your 1st priority?
    • A = airway/cervical spine
    • B = breathing
    • C = circulation
    • D = disability
    • E = exposure
  3. setting priorities: which pt. would you see 1st?
    6 y.o. who has facial lacerations
    40 y.o. who has a dislocated shoulder
    20 y.o. who has a fx femur
    12 y.o. w/ bruising to his sternum
    12 y.o. w/ bruising to his sternum (b/c it can comspromise the airway).
  4. an elderly pt. was brought in w/ a productive cough, who is progressively fogetful, doesn't remember things, & has trouble communicating. what is your greatest concern?
    productive cough b/c it can be a sign of pneumonia.
  5. there is traffic accident infront of you, a car hits a light pole, & there are loose wires hanging over car. the pt. is bleeding but you can't tell if they are breathing, what is your 1st action?
    safety--don't touch the car b/c there are loose wires hanging (use something non-mental like wood to move the wires), then remove victim from the car (don't move if you suspect a neck injury).
  6. setting priorities: which pt. would you see 1st?
    pt. c/o chest pain
    pt. c/o fx femur
    pt. who has a penetrating abd wound
    pt. c/o chest pain.
  7. pt. who has been in bed is c/o nausea & vomiting then suddenly vomits, how do you protect their airway?
    place pt. in a left-lateral/side-lying position.
  8. you're on the way home when an accident occurs right infront & you decide to stop & render aid. what is the standard of care you must practice?
    • w/in your knowledge & scope of practice.
    • standard of care--what a reasonable, prudent, competent person would do in a similar situation.
  9. when could you be held liable under the good samaritan law?
    when you are negligent (the failure of a health care professional to meet his/her responsibilities to a pt. w/ resultant injury).
  10. do we take care of severe injuries 1st/minor injuries in a disaster?
    minor injuries 1st so they can help tx others.
  11. when working in an emergency department & a disaster event occurs, what plan do you follow?
    follow facility procedures.
  12. pt. w/ heat exhaustion (a syndrome resulting primarily from dehydration caused by heavy perspiration, as well as inadequate fluid & electrolyte intake during heat exposure over hrs to days) is getting a fluid challenge (250-500 mL of NS through IV), when assessing the pt. you hear crackles in the lung fields, what do you do?
    slow down IV rate to about 30 mL/hr (TKO/KVO rate).
  13. pt. has a temp. of 104 F from heat stroke, what interventions would you implement?
    • 1st aid tx:
    • strip away clothing.
    • place ice packs on neck, axillae, chest, & groin.
    • immerse in cold water.
    • wet body w/ tepid water & fan rapidly.
    • keep NPO (neurological symptoms).
  14. what are the 2 major types of heat stroke?
    • exertional heat stroke: suddent onset & is often the result of strenous activity in hot, humid conditions; not being used to hot weather & wearing clothing too heavy for the environment are common contributing factors.
    • classic heat stroke: occurs over a period of tome as a result of chronic exposure to hot, humind environment; generally affects ill & older adults.
  15. pt. has hypothermia, what are your priorities of action?
    • 1st aid tx:
    • shelter from the cold.
    • remove we clothing.
    • passive re-warming (warm clothing/blankets).
    • active re-warming (heating blankets, warm packs, air heaters).
  16. hypothermia may me mild, moderate or severe. what is the diff. between the 3?
    • mild: shivering, dysarthria, muscular incoordination, mental slowness, & "cold diuresis" (peripheral vasoconstriction) --> increased blood in the core --> increased blood flor to kidneys.
    • moderate to severe: motor impairment & weakness; confusion, apathy, incoherence, stupor, unconsciousness; shivering stops; VS depressed (bradycardia & hypotension typical); dysrhythmias; clotting abnormalities.
  17. what s/s can a pt. w/ hypothermia have?
    **weather is the most common cause of hypothermia**
    • moderate to severe:
    • motor impairment & weakness.
    • confusion.
    • apathy.
    • incoherence.
    • stupor--a state of altered mental status (decreased responsiveness to 1's environment) in which a person is arousable only w/ vigorous/unpleasant stimulation.
    • unconsciousness.
    • shivering stops.
    • VS depressed (bradycardia & hypotension typical).
    • dysrhythmias.
    • clotting abnormalities.
  18. what is the main goal of continuous re-warming for hypothermic pts.?
    to decrease tissue damage.
  19. pt. came into the ER w/ a rattle snake bite incident that occurred a couple of hrs ago. what would be your priority of action?
    • 1st aid tx:
    • apply constricting band (not tourniquet b/c it doesn't allow for arterial flow) if hospital transport is delayed.
    • hospital care:
    • pit viper bites--check VS Q15 min.
  20. pt. who has bit by a (black widow) spider now has facial edema & dyspnea. what would the 1st aid tx?
    • 1st aid tx:
    • monitor for systemic toxicity & support ABCs (until MD arrives).
  21. the same pt. w/ a (black widow) spider bite is allergic to that venom, what can anaphylaxis result in?
    • compromised airway patency.
    • poor circulation.
    • hypotension.
  22. what do you do for mountain sickness (altitude related illness--as altitude increases, atmospheric pressure decreases; oxygen makes up 21% of the pressure, so as pressure decreases, O2 in the air decreases resulting in hypoxia)?
    • 1st aid tx:
    • most important intervention is descent to a lower altitude.
    • rest & acclimation.
    • oxygen if available.
    • hospital care:
    • administration of acetazolamide (Diamox) to prevent & tx AMS (acute mountain sickness) [causes HCO3 diuresis correcting alkolosis, rids excess fluid in brain/lungs; steroids to decrease cerebral edema].
  23. near drowning victims: which pt. would be suffering from hypovolemia?**has to do w/ fluid shifts**
    a person who was pulled out of a (fresh water) lake.
    a child who was pulled out of a bath tub.
    a diver from the ocean.
    a person who was pulled out of a backyard pool.
    a diver from the ocean b/c fluid goes out due to salt water & causes hypovolemia.
  24. pt. was brought in for nearly drowning in the ocean (high salt content so there is fluid loss). what potential danger should the nurse assess the client?
    salt water aspiration (hypertonic fluid) --> increased osmotic gradient (increased sodium) that draws fluid from the vascular space into the alveoli --> pulmonary edema & hypovolemia.
  25. what do you do to decrease (external) bleeding?
    • 1st aid tx:
    • apply direct, firm pressure.
    • apply indirect pressure to an artery between the wound & the heart if direct pressure does not control bleeding.
    • apply a tourniquet as a last resort if bleeding does not stop; tourniquet cuts off the blood flow in the artery completely.
  26. what is shock position?
    • flat w/ legs up.
    • **prob. w/ trendelenburg position is its hard to expand the lung**
  27. a pt. who is involved in a motor vehicle accident has facial lacerations, fx tibia, no abd pain/distention. why would an MD order a foley catheter?
    • s/s of hypovolemic shock:
    • decreased BP.
    • weak.
    • thready pulse.
    • cool.
    • clammy skin.
    • tachycardia.
    • tachypnea.
    • hyperpnea (deep gasping breath).
    • restlessness.
    • anxiety.
    • decreased urinary output.
  28. before putting a pt. into a shock position, assess what?
    head/neck injury.
  29. best assessment that indicates fluid replacement therapy is effective?
  30. you are walking a pt. to the bathroom & suddenly her knees buckle, what do you do?
    sit them down, assess, then call for help to help put pt. back in wheelchair/bed.
  31. a young teenager who just broke up w/ her bf is distraught & took a bottle of tylenol, what is the antidote for tylenol?
    acetylcysteine (Mucomyst).
  32. what type of household poising can occur in homes built before the 1970s?
    lead poisoning (plumbism).
  33. lead poisoning (plumbism) affects what system in the body more than anything else?
    • CNS (central nervous system).
    • **poisoning is irrevirsible & stays in the brain**
  34. a mother calls the ER & says her little one has just taken a swig of liquid furniture polish (petroleum distillate), what would you advise her?
    call the poison control center.
  35. an 18 mo. old toddler is dx w/ botulism (severe food poisoning). what can cause botulism?
    • Clostridium botulinum found in improperly sterilized home canned foods & honey; can cause progressive weakness, paralysis, death.
    • **may be caused by eating poisonous fruits, berries, or vegetables**
  36. a pt. splashed bleach in their eyes & calls the ER. what advice would you give?
    caustic substances, such as chemicals, must be flushed out immediately.
  37. a child has a foreign object lodged in their eye, what do you do?
    cover both eyes if object is imbedded to decrease eye movement b/c anything that lodges n the cornea irritates it & can scrath or cause permanent damage.
  38. why is not ideal to perform a blind finger sweep on an infant?
    the blind sweep can push the object further back.
  39. instead of performing a bling finger sweep on an infant, what should you do?
    4 back blows & 4 abd thrusts.
  40. normal white count level: x,xxx-xx,xxx
    normal specific gravity level: x.xxx-x.xxx
    normal potassium level: x.x-x
    normal creatinine level:x.x-x.x
    normal BUN level: _ _ _ _ xx
    • -8,000-10,000
    • **above 10,000 is too high = sign of infection**
    • -1.003-1.030
    • -3.1-5
    • -0.6-1.2
    • -up to 20
  41. for a liquid chemical burn, what do you do?
    flush w/ water.
  42. what do you do for a powder chemical burn?
    brush it off 1st then flush w/ water.
  43. a pt. comes in after an explosion w/ burns on their arms & has stridor. what should you be concerned about 1st?
    • 1. airway.
    • 2. burns--take off his clothes then flush/cool to get rid of chemicals.
  44. if someone was trapped in a building & laying on their back, breathing ok, but has an inability to move his legs. what is your next priority?
    call for help.
  45. pt. comes into the ER c/o a fx ankle & there is an abnormally large amt of ecchymosis around the ankle. what question might you ask concerning the ecchymosis?
    are you on blood thinners/do you take aspirin?
  46. pt. has a herniated disk, what acitivities can increase their pain?
    coughing, sneezing, lifting, laughing.
  47. what kind of isolation is done for a pt. suffering from c-deficile?
    contact isolation.
  48. pt. has an NG tube & salem sump, what kind of losses from the NG tube should we be concerned about?
    fluids, electrolytes & acid.
  49. pt. is admitted after several days of vomiting, breathing is slow & shallow, what acid-base balance would you suspect?
    metabolic alkolosis to try & compensate for respiratory acidosis (when you hang on to CO2).
  50. a pt. is c/o pain, what would you ask regarding the pain?
    • C = characteristic.
    • O = onset.
    • L = location.
    • D = duration.
    • S = severity.
    • P = pattern.
    • A = association.
Card Set
Emergency & Mass Casualty Nursing
Term 2 Exam 1 Review