lOMoARcPSD|26582732
1
Synthesis exam 2
Care of the client in emergency care situations ch. 72
– 14 questions
Introduction
• Emergency management or care o defined as care given to patients with urgent or critical needs
• Many people don’t have access to health care (either geographically or financially) and utilize the
Emergency department for non-emergency problems
o federal mandated law:
Emtla: emergency medical and treatment and labor act (anti-dumping act)
Protects pt from not getting care if it is a true emergency
Prevents one hospital from dumping the pt onto another hospital due to the pt not having
financial ability
Prevents pts from being transferred from one facility to another unless they are stabilized
when you are able to transfer:
• When the pt is chronically stable and if the service is not available that they need, then they can transfer
the pt
• The pt comes in to the hospital and the hospital does have the services, but the family member requests
that the pt be transferred to another hospital à document the family's request
• Levels of trauma hospitals o level 1 = highest
Provides comprehensive trauma care
Has the ability to handle all types of trauma – have the services and resources and
specialists available
Generally, participates in education and research
Ex. Augusta university o level 2 =
Provides comprehensive trauma care
Not required to participate in education and research ex. University hosp.
O level 3 =
Provides prompt, immediate emergency care and stabilization of pt, then generally can
transfer to a higher level hospital
Treats a community that does not have the ability to get to a higher level trauma center o
level 4 =
Provides advance trauma life support before transfer
Goal – resuscitate that pt and stabilize and then immediately transfer
Role of the emergency nurse
• Have specialized training in emergency nursing
• Have expertise in assessing patients in crisis situations o usually when they come into er they are
doing a rapid assessment; usually have a triage nurse out front to make a decision if pt is in
immediate danger
• Have the ability to establish priorities o what and who do i need to see first
• Have the ability to treat patients within a high-pressured environment (high pressure)
• Knows the nursing process fluently (provides a logical framework for problem-solving) o of trying
to analyze and problem solve about what is going on with the pt who comes in with several health dx
and problems and some can be life-threatening issues in emergency nursing care legal issues
o Some pt’s can request no phone calls or visitors
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o If consent form needed and pt is unconscious, life threatening and cannot contact any family
then you do it and document everything!
o If pt needs to be arrested, they have to be stabilized first because if arrested first and something
happens then state takes on the cost of the pt care
o If criminal comes into er—remember hippa
most not identified by their name and usually have security with them
• Occupational health issues and safety o always use standard precautions – b/c we might not know
what the pt is coming in with
Airborne = coughing and then the pt might be dx with tb
Bloodborne = invasive procedures – hiv or hepatitis or coming in with trauma and open
wounds o violence
Altercations, stabbings
Usually there is a security officer is on staff and the door to the er is locked and all
requires badge access or security guard to let you back in
Some places might have metal detectors
Prisoners – can come in with handcuffs
• The challenge of providing holistic care in a fast-paced, high-tech, high-stressed environment and
confront serious illnesses and death daily o if pt unconscious, treat them as if they were conscious-
explain everything you are doing o good therapeutic relationship with pt and family
o Go ahead and do it – implied consent b/c it is a life threatening emergency and needs to be done
o human touch is very important and comforting o document, document, document!!!
• Disasters from terrorism or natural disasters which may cause mass casualties o make sure there is
safety and confidentiality (privacy)
o Usually they give a special number or name so that the pt is hard to identify = and might need 24
hour security
o Most hospitals will have a special code when a lot of pts are about to come in and they usually
have protocols – calling nurses that are off to come in and help, getting equipment ready nursing
care:
o Provide holistic care o update the pts family
o Encourage questions – b/c there is a lot of anxiety and stress of the pt and family emergency
nursing and the continuum of care
• Patients can be transferred from the emergency department to inpatient rooms, discharged home, or
sent back to long-term care facilitiesà no matter where they are being sent you need good
communication o able to send the pt’s:
Home
Admit to the floor
Morgue
Other hospital/psychiatric facility
Rehab or long term care facility
• If d/cd home make sure discharge instructions are written (in layman’s terms) in addition to verbal
and legible (written copy as well)
• Make arrangement for any referrals to community services (ex. Home health, social work, etc) as
needed
• If patients were from a long-term care facility or assisted living, make sure there is proper
communication regarding the patient’s condition and any changes in health care o need good
instructions and very good communications when sending the pt out of the er
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3
Written paperwork should go with the pt
Instructions to home or rehab – in laymen terms
Spoken phone report and written report
The elderly and emergency care
• Patients over 65 years of age account for more than 99 million visits emergency departments
• They typically present with more than one medical problem
• They also may present with atypical presentations which makes management more difficult
• Example: o elderly with uti:
May not come in the er with urgency, frequency, burning or fever
May come in with decreased loc, confusion, decreased appetite
Principles of emergency care—know this for test and prioritizing care
she will give a scenario on test-is the pt minor or urgent?
• You can change the patients level based off their condition assessment
• Triage: to sort based on the severity of patient’s health problems and the potential for
loss of life o emergent (true emergency) -> urgent -> non-urgent -> “fast track”
review triage scenarios on pg. 2149 #3 under “critical thinking exercises”
• 5 level triage system o resuscitation (highest priority)
Means the pt is in cardiac arrest and chest compressions are being done when they are
coming in
Examples: pt needs immediate tx to prevent death
o Emergent
Pts condition is life-threatening and may deteriorate rapidly and requires time sensitive tx
Example: pt comes in with an acute stroke
o Urgent
Pt may have a serious health problem but it is not immediately life threatening
Have something serious but can be seen within an hour
Pt will require at least 2 or more resources (list on handout from class)
Example: laceration and it is covered b/c it can cause infection and blood loss, bleeding a
lot but you can control it, appendicitis o nonurgent
Not life-threatening
Can wait more than an hour, only requires 1 resource
Example: pt comes in with a spill of hot water that results in a 1st or 2nd degree burn and
not threatening their airway
o Minor (fast track/express care)
Pts can be seen in a physicians office
Does not require resources (resources are not needed)
Example: pt has a low grade fever and coughing
• 4 level triage system o emergent (highest priority)
Pts condition may deteriorate rapidly and requires time sensitive tx
Condition is life threatening and needs to be seen immediately
Example: pt comes in with an acute stroke/mi/tension pneumothorax/bleeding out
o Urgent
Same as above
o Nonurgent
Same as above o fast track
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1
Synthesis exam 2
Care of the client in emergency care situations ch. 72
– 14 questions
Introduction
• Emergency management or care o defined as care given to patients with urgent or critical needs
• Many people don’t have access to health care (either geographically or financially) and utilize the
Emergency department for non-emergency problems
o federal mandated law:
Emtla: emergency medical and treatment and labor act (anti-dumping act)
Protects pt from not getting care if it is a true emergency
Prevents one hospital from dumping the pt onto another hospital due to the pt not having
financial ability
Prevents pts from being transferred from one facility to another unless they are stabilized
when you are able to transfer:
• When the pt is chronically stable and if the service is not available that they need, then they can transfer
the pt
• The pt comes in to the hospital and the hospital does have the services, but the family member requests
that the pt be transferred to another hospital à document the family's request
• Levels of trauma hospitals o level 1 = highest
Provides comprehensive trauma care
Has the ability to handle all types of trauma – have the services and resources and
specialists available
Generally, participates in education and research
Ex. Augusta university o level 2 =
Provides comprehensive trauma care
Not required to participate in education and research ex. University hosp.
O level 3 =
Provides prompt, immediate emergency care and stabilization of pt, then generally can
transfer to a higher level hospital
Treats a community that does not have the ability to get to a higher level trauma center o
level 4 =
Provides advance trauma life support before transfer
Goal – resuscitate that pt and stabilize and then immediately transfer
Role of the emergency nurse
• Have specialized training in emergency nursing
• Have expertise in assessing patients in crisis situations o usually when they come into er they are
doing a rapid assessment; usually have a triage nurse out front to make a decision if pt is in
immediate danger
• Have the ability to establish priorities o what and who do i need to see first
• Have the ability to treat patients within a high-pressured environment (high pressure)
• Knows the nursing process fluently (provides a logical framework for problem-solving) o of trying
to analyze and problem solve about what is going on with the pt who comes in with several health dx
and problems and some can be life-threatening issues in emergency nursing care legal issues
o Some pt’s can request no phone calls or visitors
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
2
o If consent form needed and pt is unconscious, life threatening and cannot contact any family
then you do it and document everything!
o If pt needs to be arrested, they have to be stabilized first because if arrested first and something
happens then state takes on the cost of the pt care
o If criminal comes into er—remember hippa
most not identified by their name and usually have security with them
• Occupational health issues and safety o always use standard precautions – b/c we might not know
what the pt is coming in with
Airborne = coughing and then the pt might be dx with tb
Bloodborne = invasive procedures – hiv or hepatitis or coming in with trauma and open
wounds o violence
Altercations, stabbings
Usually there is a security officer is on staff and the door to the er is locked and all
requires badge access or security guard to let you back in
Some places might have metal detectors
Prisoners – can come in with handcuffs
• The challenge of providing holistic care in a fast-paced, high-tech, high-stressed environment and
confront serious illnesses and death daily o if pt unconscious, treat them as if they were conscious-
explain everything you are doing o good therapeutic relationship with pt and family
o Go ahead and do it – implied consent b/c it is a life threatening emergency and needs to be done
o human touch is very important and comforting o document, document, document!!!
• Disasters from terrorism or natural disasters which may cause mass casualties o make sure there is
safety and confidentiality (privacy)
o Usually they give a special number or name so that the pt is hard to identify = and might need 24
hour security
o Most hospitals will have a special code when a lot of pts are about to come in and they usually
have protocols – calling nurses that are off to come in and help, getting equipment ready nursing
care:
o Provide holistic care o update the pts family
o Encourage questions – b/c there is a lot of anxiety and stress of the pt and family emergency
nursing and the continuum of care
• Patients can be transferred from the emergency department to inpatient rooms, discharged home, or
sent back to long-term care facilitiesà no matter where they are being sent you need good
communication o able to send the pt’s:
Home
Admit to the floor
Morgue
Other hospital/psychiatric facility
Rehab or long term care facility
• If d/cd home make sure discharge instructions are written (in layman’s terms) in addition to verbal
and legible (written copy as well)
• Make arrangement for any referrals to community services (ex. Home health, social work, etc) as
needed
• If patients were from a long-term care facility or assisted living, make sure there is proper
communication regarding the patient’s condition and any changes in health care o need good
instructions and very good communications when sending the pt out of the er
Downloaded by NELSON KIIRU ()
, lOMoARcPSD|26582732
3
Written paperwork should go with the pt
Instructions to home or rehab – in laymen terms
Spoken phone report and written report
The elderly and emergency care
• Patients over 65 years of age account for more than 99 million visits emergency departments
• They typically present with more than one medical problem
• They also may present with atypical presentations which makes management more difficult
• Example: o elderly with uti:
May not come in the er with urgency, frequency, burning or fever
May come in with decreased loc, confusion, decreased appetite
Principles of emergency care—know this for test and prioritizing care
she will give a scenario on test-is the pt minor or urgent?
• You can change the patients level based off their condition assessment
• Triage: to sort based on the severity of patient’s health problems and the potential for
loss of life o emergent (true emergency) -> urgent -> non-urgent -> “fast track”
review triage scenarios on pg. 2149 #3 under “critical thinking exercises”
• 5 level triage system o resuscitation (highest priority)
Means the pt is in cardiac arrest and chest compressions are being done when they are
coming in
Examples: pt needs immediate tx to prevent death
o Emergent
Pts condition is life-threatening and may deteriorate rapidly and requires time sensitive tx
Example: pt comes in with an acute stroke
o Urgent
Pt may have a serious health problem but it is not immediately life threatening
Have something serious but can be seen within an hour
Pt will require at least 2 or more resources (list on handout from class)
Example: laceration and it is covered b/c it can cause infection and blood loss, bleeding a
lot but you can control it, appendicitis o nonurgent
Not life-threatening
Can wait more than an hour, only requires 1 resource
Example: pt comes in with a spill of hot water that results in a 1st or 2nd degree burn and
not threatening their airway
o Minor (fast track/express care)
Pts can be seen in a physicians office
Does not require resources (resources are not needed)
Example: pt has a low grade fever and coughing
• 4 level triage system o emergent (highest priority)
Pts condition may deteriorate rapidly and requires time sensitive tx
Condition is life threatening and needs to be seen immediately
Example: pt comes in with an acute stroke/mi/tension pneumothorax/bleeding out
o Urgent
Same as above
o Nonurgent
Same as above o fast track
Downloaded by NELSON KIIRU ()
