Introduction to Medical-Surgical Nursing, 6th ed.
16
Lesson Plans for
First Aid, Emergency Care, and Disaster
Management
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 16.1:
2. List the steps of the initial assessment and interventions for the person requiring emergency care.
4. Outline the steps of the nursing process for emergency or first aid treatment of victims of cardiopul-
Lesson 16.2:
4. Outline the steps of the nursing process for emergency or first aid treatment of victims of cardiopul-
5. Discuss the roles of nurses and nursing students in relation to bioterrorism and natural disasters.
CHAPTER TEACHING FOCUS
• In this chapter, the student will be introduced to topics related to first aid and emergency care, including
specific emergencies such as cardiopulmonary arrest, choking or airway obstruction, hemorrhage,
traumatic injury, burns, heat and cold exposure, poisoning, and bites and stings.
• Assessment and interventions for these emergencies are included in this chapter.
• The student will also be introduced to the legal aspects of emergency care.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
THEME: Homeostasis and Regulation
• Concept: Thermoregulation
• Exemplar: Hyperthermia, p. 243
• Table 16-4: Emergency Interventions for Heat and Cold Exposure, p. 245
2 Chapter 16 First Aid, Emergency Care, and Disaster Management __________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) During the initial assessment of a patient in an emergency situation, the nurse should __________.
a) assess the patient’s airway, breathing, and circulation
b) look for uncontrolled bleeding
c) look for a medical alert tag
d) assess for the presence of fractures
2) The immediate treatment for external bleeding is to apply pressure __________.
a) below the site of bleeding
b) directly at the site of bleeding
c) slightly above the site of bleeding
d) at the jugular vein
3) A nurse is called to take a look at an individual who is lying on the grass and not moving. No one saw
him fall. The nurse notes that he is breathing and has a pulse. Next, the nurse should __________.
a) attempt to stand him up
b) roll him over on his stomach to assess for possible wounds on his back
c) avoid moving his limbs
d) not move the victim until the emergency medical technicians (EMTs) arrive
4) A nurse is asked to help a victim of a motorcycle crash. She sees a metal rod sticking out of the
victim’s leg. The nurse should __________.
a) pull the rod out
b) leave the rod where it is
c) attempt to bend the rod
d) attempt to push the rod through
5) A nurse arrives at an accident scene. The victim is not breathing, but the jugular pulse is present.
The nurse can anticipate that __________.
a) soon the pulse will stop as well
b) the victim will soon start breathing on his or her own
c) the victim will continue to have a pulse but not respirations
d) rescue breathing is not necessary
6) A nurse arrives at an accident scene. The victim is breathing and has a weak, thready pulse of 30
beats per minute. The nurse should __________.
a) start rescue breathing
b) start cardiac compressions, but no rescue breathing
c) start both cardiac compressions and rescue breathing
d) wait for the pulse to become stronger and faster
7) A good place to perform effective CPR is on __________.
a) a couch
b) the floor
c) a water bed
d) a chair
8) A person with an airway obstruction is unable to breathe and __________.
a) talk
b) gesture
c) swallow
d) stand
Introduction to Medical-Surgical Nursing, 6th ed.
9) A nurse is having dinner with her family. Suddenly, an adult member of the family starts coughing
after taking a bite of food. The nurse should __________.
a) perform the Heimlich maneuver immediately
b) start CPR
c) take no immediate action
d) call 911
10) Hypovolemic shock is likely to occur in a healthy middle–aged adult if the amount of blood loss is
__________.
a) 200 mL
b) 1 L
c) 500 mL
d) 50 mL
4 Chapter 16 First Aid, Emergency Care, and Disaster Management __________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: An individual is found lying on the ground in his backyard and is resuscitated by his neighbor
who happens to know cardiopulmonary resuscitation (CPR). The paramedics, who arrive on the scene
minutes later, notice that the victim’s abdomen is very distended and his bowel sounds are distant. What
can be a possible cause of this finding?
Answer: Abdominal distention and consequent distant, hard-to-hear bowel sounds usually occur when
Question: The EMTs rescue an accident victim who is in cardiac arrest. The EMTs perform CPR and
defibrillation. The patient is now recovering in the intensive care unit (ICU). What nursing diagnoses are
indicated for this patient?
__________________________________ Chapter 16 First Aid, Emergency Care, and Disaster Management 5
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.1
Instructor Preparation
Textbook Objectives Covered
1. List the principles of emergency and first aid care.
3. Describe the components of the nursing assessment of the person requiring emergency care.
4. Outline the steps of the nursing process for emergency or first aid treatment of victims of
cardiopulmonary arrest, choking, shock, hemorrhage, traumatic injury, burns, heat or cold
exposure, poisoning, bites, and stings.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speaker: EMT
• Student performance evaluation of all entry-level skills required for student comprehension and
application of first aid and emergency care, including:
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• avulsion (p. 240)
• cardiac tamponade (p. 241)
• cardiopulmonary arrest
• poison (p. 244)
• respiratory arrest (p. 236)
• shock (p. 237)
6 Chapter 16 First Aid, Emergency Care, and Disaster Management __________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.1
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 234-235)
ANSWER – Study Guide
• Part IB: 2 (p. 88)
2
READ – Textbook (pp. 235-236)
REVIEW
• Box 16-1: Assessment of the Patient Who Requires First Aid or Emergency Care (p. 236)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1, 3 (p. 253)
ANSWER – Study Guide
• Part IB: 1 (p. 88)
• Part IIIH: 18 (p. 93)
3
READ – Textbook (pp. 236-247)
4
READ – Textbook (pp. 236-247)
ANSWER – Text
• Review Questions for the NCLEX Examination: 2, 4 (p. 253)
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 16
First Aid, Emergency Care, and Disaster Management
1
&
2
Slide 2
General Principles of Emergency Care
• Cardinal rule: Remain calm!
• Priority is to preserve life and minimize effects of injuries
• Manner in which you conduct yourself also can soothe and reassure the victim
• Assessment and intervention must be done quickly and efficiently to identify and treat
priority needs immediately
TALKING POINTS:
• The nursing process is used in emergencies just as it is in other nursing situations.
__________________________________ Chapter 16 First Aid, Emergency Care, and Disaster Management 7
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.1
Slide 3
General Principles of Emergency Care (cont.)
• The primary survey looks for life-threatening injuries and intervenes immediately in the
following sequence
• Assess ABCs
• Initiate CPR or rescue breathing as needed
TALKING POINTS:
• What should the rescuer do after the primary survey?
Slide 4
General Principles of Emergency Care (cont.)
• Protect the airway
• Splint injured parts in the position they are found
• Prevent chilling, but do not add excessive heat
• Stay with the injured person until medical care or transportation arrives
2
&
Slide 5
Nursing Assessment in Emergencies
• Chief complaint
• Determine problem, signs and symptoms, and how the injury or illness occurred
Slide 6
Nursing Assessment in Emergencies (cont.)
• Medical history
• Determine known health problems
• Check for a medical alert tag; may provide essential information if the patient cannot
TALKING POINTS:
• Ask why it is important to determine know health conditions. What is the significance?
3
Slide 7
Physical Examination
• The first priority: CABs
• Circulation, airway, breathing
• Watch chest for rhythmic breathing; listen near mouth and nose for air movement
TALKING POINTS:
• Begin collecting objective data as soon as the victim is seen, and quickly determine
whether the patient is responsive.
8 Chapter 16 First Aid, Emergency Care, and Disaster Management __________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.1
Systematic Head-to-Toe Assessment
• CABs are followed by D and E
Slide 9
Systematic Head-to-Toe Assessment (cont.)
• Evaluate comprehension
• Ask patient to follow simple commands, such as opening and closing the eyes
• Inspect eyes to assess pupil size, equality, and reaction to light
• Ask about neck pain or stiffness and the ability to swallow
• Inspect for chest wall movement symmetry
Systematic Head-to-Toe Assessment (cont.)
• Assess breathing, dyspnea, and abnormal sounds associated with respirations
4
Slide 11
Cardiopulmonary Arrest
• Absence of a heartbeat and respirations
• Causes
• Myocardial infarction, heart failure, electrocution, drowning, drug overdose,
TALKING POINTS:
• The cardiac and respiratory systems are so dependent on each other that when one fails,
the other quickly fails as well.
• How long can the brain go without oxygen before brain cells begin to die?
Cardiopulmonary Arrest (cont.)
• Nursing assessment
TALKING POINTS:
• American Heart Association guidelines for CPR are revised at intervals.
• What changes were made in the 2005 guidelines?
__________________________________ Chapter 16 First Aid, Emergency Care, and Disaster Management 9
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.1
Slide 13
Choking or Airway Obstruction
• Assessment
• The initial response when a person appears to be choking depends on the severity of
the airway obstruction
• Mild airway obstruction
• If the victim has good air exchange, is responsive, and can cough forcefully,
do not interfere
TALKING POINTS:
• Fear of suffocation is terrifying.
• What facial expressions may the victim display?
• Is there universal sign for choking? What is it?
• What is the most important question to ask a person you think may be choking?
Slide 14
Choking or Airway Obstruction (cont.)
• Interventions
• Victim is conscious
• Ask whether the victim is choking. If he or she nods and cannot speak, activate
the emergency response system
• If the victim is standing or sitting
• Stand or kneel behind the individual
• Wrap your arms around the victim’s waist
TALKING POINTS:
• The Heimlich maneuver is a “bear hug” procedure named for the physician who first
described it.
• Stand behind the victim and reach around the victim slightly above the umbilicus and
below the xiphoid process.
10 Chapter 16 First Aid, Emergency Care, and Disaster Management __________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.1
Slide 15
Choking or Airway Obstruction (cont.)
• Interventions (continued)
• Victim is responsive and is lying down
• Perform abdominal thrusts with the victim lying down
• Responsive choking victim is pregnant or obese
TALKING POINTS:
• Use a student to demonstrate proper administration of the Heimlich maneuver.
Choking or Airway Obstruction (cont.)
• Victim unconscious/loses consciousness
• Activate the emergency response system
TALKING POINTS:
• How could most choking deaths be prevented?
Choking or Airway Obstruction (cont.)
• Prevention
• Cut food into small pieces, eat slowly, and chew food thoroughly before swallowing
Slide 18
Shock
• Results from acute circulatory failure caused by inadequate blood volume, heart failure,
overwhelming infection, severe allergic reactions, or extreme pain or fright
Hemorrhage
• The loss of a large amount of blood
TALKING POINTS:
• Assess for signs and symptoms of hemorrhage, which may include obvious bleeding;
cool, sweaty, pale skin; thready pulse; rapid respirations; and decreasing alertness.
• What are the symptoms of internal bleeding?
__________________________________ Chapter 16 First Aid, Emergency Care, and Disaster Management 11
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.1
Slide 20
Hemorrhage (cont.)
• Assessment
• Assess for signs and symptoms of hemorrhage
• Obvious bleeding
• Cool, sweaty, pale skin
• Thready pulse
Slide 21
Hemorrhage (cont.)
• Interventions
• Immediate treatment for external bleeding is direct, continuous pressure
• Elevate and immobilize the injured part (unless fracture is suspected)
TALKING POINTS:
• Ideally, a sterile dressing is placed over the wound.
• When should a tourniquet be used?
Slide 22
Hemorrhage (cont.)
• Epistaxis
• Blood from anterior or posterior portion of the nose
• Most anterior nosebleeds respond to pressure
Slide 23
Question 1
• Which of the following general guidelines for first aid treatment of emergency patients is
incorrect?
A. Protect the airway.
B. Splint injured parts in the position they are found.
C. Prevent chilling, but do not add excessive heat.
D. Remove penetrating objects.
TALKING POINTS:
• Correct answer: D
• Rationale: Do NOT remove penetrating objects.
12 Chapter 16 First Aid, Emergency Care, and Disaster Management __________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the sequence of the initial
assessment and immediate intervention in
the event of an emergency.
• Discuss the guidelines for first aid treatment.
• Have students make a study guide for CPR
providers, outlining the steps of CPR. Have
pairs of students role-play by taking turns
teaching each other CPR principles.
• Divide the class into small groups. Have
students discuss and outline the necessary
nursing actions in the following scenarios:
• The patient is breathing and has a weak
pulse of 20 beats per minute.
• The patient is not breathing and has a
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
2
DISCUSS
• Invite an EMT to speak about the situations
and responsibilities in his or her workplace.
Ask the speaker to describe his or her
training, interaction with patients and
families, and legal issues in the work
environment.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Discuss the
ways in which a nursing assessment in an
emergency situation outside of the hospital
differs from one in an institutional health
care setting. Why is assessment an
__________________________________ Chapter 16 First Aid, Emergency Care, and Disaster Management 13
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.1
3
DISCUSS
• Discuss the components of a health history
for a patient who requires emergency care.
• Divide the class into small groups. Have
them describe the best way to obtain a
health history, including the history of
medications, in the following situations:
• A 74-year-old woman with an open wrist
(compound) fracture is found on the
floor at the mall. She cannot remember
the current date or her address.
• An intoxicated victim of a motorcycle
accident is bleeding from his scalp.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Assign
students to a group. Assign each group one
of the following situations and ask them to
describe nursing actions and provide
rationales.
• A nurse finds an elderly nursing home
patient on the floor in her bathroom; she
is wincing and trying to hold her right
leg.
• A nurse finds a woman who lives in an
assisted living environment trying to put
4
DISCUSS
• Discuss the assessment and interventions
for a person in cardiopulmonary arrest.
• Divide the class into small groups. Have
each group discuss and outline the nursing
actions needed in the following situations:
• A pregnant woman who is choking
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe the
treatment of a person with external bleeding.
Why is the use of a tourniquet controversial?
What are the alternatives?
14 Chapter 16 First Aid, Emergency Care, and Disaster Management __________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.1
Critical Thinking Question
A nurse is driving on the highway on her way to work. She approaches an accident scene
and sees that one of the cars sustained significant damage. There is no ambulance at the
scene, and she sees two people next to the car frantically waving their arms at the passing
cars. She suspects that someone is injured. What should she do?
Discussion Guidelines: When a nurse happens to be near an accident scene, she is usually not
obligated by law to stop and provide help. Very few states (e.g., Vermont) mandate a health care
Instructor Notes/Student Feedback
__________________________________ Chapter 16 First Aid, Emergency Care, and Disaster Management 15
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.2
Instructor Preparation
Textbook Objectives Covered
4. Outline the steps of the nursing process for emergency or first aid treatment of victims of
6. Explain the legal implications of administering first aid in emergency situations.
7. Explain the implications of the Good Samaritan laws.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speaker: local health department staff member
• Student performance evaluation of all entry-level skills required for student comprehension and
application of first aid and emergency care, including:
• Assemble materials and supplies needed for each lesson as indicated below.
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• avulsion (p. 240)
• cardiac tamponade (p. 241)
• poison (p. 244)
• respiratory arrest (p. 236)