16 Chapter 16 First Aid, Emergency Care, and Disaster Management __________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.2
Assignments 2 hours
4
READ – Textbook (pp. 236-247)
REVIEW
• Figure 16-1: The universal choking sign (p. 237)
• Figure 16-2: The Heimlich maneuver for the conscious choking victim (p. 237)
• Figure 16-3: Major arterial pressure points (p. 238)
• Figure 16-4: Epistaxis may be controlled by having the patient sit up and lean forward slightly
(p. 239)
• Figure 16-5: Eversion of the upper eyelid for inspection (p. 240)
• Figure 16-6: Paradoxical motion caused by loss of chest wall support (p. 241)
ANSWER – Text
• Review Questions for the NCLEX Examination: 6, 7, 8, 9, 10 (pp. 253–254)
ANSWER – Study Guide
• Part IA: 1-17 (pp. 87-88)
• Part IC: 1 (p. 88)
• Part ID: 1-4 (p. 88)
5
READ – Textbook (pp. 247-251)
REVIEW
• Table 16-7: Biologic Agents Most Likely to Be Used as Bioterrorism Weapons (p. 250)
6
READ – Textbook (pp. 251-252)
7
READ – Textbook (pp. 251-252)
__________________________________ Chapter 16 First Aid, Emergency Care, and Disaster Management 17
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.2
50-Minute Lesson Plan
Lecture Outline 20 minutes
4
Slide 24
Fracture
• A break in a bone
• Simple (closed) fracture
• Does not break the skin
• Compound (open) fracture
TALKING POINTS:
• What may cause a traumatic injury?
Slide 25
Fracture (cont.)
• Assessment
• Primary symptom is pain
• Numbness/tingling from nerve injury and blood vessels
• Signs: deformity, swelling, discoloration, decreased function, and bone fragments
protruding through the skin
Nursing Diagnoses, Goals, and Outcome Criteria
• Risk for trauma related to movement of unstable fractures
TALKING POINTS:
• What is the key to emergency management of fractures?
Slide 27
Fractures
• Interventions
• Immobilize the injured part, including the joints above and below the injury, to avoid
further trauma to the bone and surrounding soft tissue
• Do not attempt to straighten a broken bone
• Splint the bone in the position in which it was found, with as little movement as
possible
• Severe bleeding
18 Chapter 16 First Aid, Emergency Care, and Disaster Management __________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.2
Slide 28
Strains and Sprains
• Strains
• Injuries to muscles or tendons, or both
• Sprains
• Injuries to ligaments
TALKING POINTS:
• Ask students to explain the RICE protocol for a sprain for strain (rest, ice, compression,
elevation)
Slide 29
Head Injury
• Suspected with any type of blow to the head or any unexplained loss of consciousness
• Level of consciousness (LOC) is the most sensitive and reliable indicator of neurologic
function
• Assessment
• Inspection and palpation of the head
TALKING POINTS:
• What is a critical complication of a head injury?
• Older adults are at special risk for head injuries because they are more likely to have
Slide 30
Head Injury (cont.)
• Interventions
• Must be assessed by a physician as soon as possible
• Immobilize neck and keep victim flat with proper alignment of the neck and head
• Backboard used for transporting victim
TALKING POINTS:
Neck and Spinal Injuries
• Assessment
• Assess breathing and circulation and then begin resuscitation if needed
TALKING POINTS:
• Suspect neck and spinal injuries along with head injuries, especially if the victim has had
__________________________________ Chapter 16 First Aid, Emergency Care, and Disaster Management 19
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.2
Slide 32
Nursing Diagnosis, Goal, and Outcome Criteria
• Risk for trauma related to improper movement of the fractured spine
• Outcome criteria include continuous immobilization of the spine and transport for
medical care
Slide 33
Neck and Spinal Injuries (cont.)
• Interventions
• Immediately summon expert emergency team
• In remote or life-threatening settings, the victim may have to be moved
• A rolled towel or article of clothing can be used as a collar to support the neck
TALKING POINTS:
• How is a victim “log–rolled”?
Slide 34
Eye Injury
• Assessment
• Inspect eyelid for trauma and the eye for redness, foreign bodies, or penetrating
objects
• To inspect for foreign bodies, evert the eyelids
Slide 35
Nursing Diagnosis, Goal, and Outcome Criteria
• Risk for injury related to foreign body, direct trauma, or exposure to harmful substances
• Goal is to minimize injury to the eye
• Outcome criteria may be removal of a foreign body or chemical or protection of the
eye from further damage while medical attention is obtained
TALKING POINTS:
Slide 36
Ear Trauma
• Assessment
• Assess extent of injury; note if any tissue is fully separated and severity of bleeding
• Apply direct pressure to injury to control bleeding
Slide 37
Nursing Diagnosis, Goal, and Outcome Criteria
• Impaired tissue integrity related to trauma
Slide 38
Ear Trauma (cont.)
• If injured part is actually separated, reattachment may be possible
• Retrieve the tissue, wrap it in plastic, keep it cool, and transport it with the victim
20 Chapter 16 First Aid, Emergency Care, and Disaster Management __________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.2
Slide 39
Chest Injury
• Critical injuries: open pneumothorax, flail chest, massive hemothorax, and cardiac
tamponade
• Assessment
• Note rate and character of respirations, skin color, pulse rate and rhythm, symmetry of
the chest wall movement, and the presence of any apparent injuries to the chest
TALKING POINTS:
• Injuries to the chest can result in serious impairment of respiratory function.
• What is the difference between an open and a closed chest injury?
Slide 40
Nursing Diagnosis, Goal, and Outcome Criteria
• Impaired gas exchange related to altered anatomic structure
• Goal is adequate oxygenation; outcome criteria are absence of dyspnea, normal
pulse and respiratory rates, and normal skin color
Slide 41
Abdominal Injury
• Assessment
• Assess abdomen for evidence of injury
• Protrusion of internal organs through a wound is called evisceration
Slide 42
Abdominal Injury (cont.)
• Interventions
• Require medical evaluation
• Give nothing by mouth in preparing for transport
• Do not attempt to replace eviscerated organs in the abdomen; this may cause
additional harm
• Cover organs with material, such as plastic wrap or foil, to conserve moisture and
warmth
Slide 43
Traumatic Amputation
• If partially/completely detached, reattachment is possible
• Clean the wound surfaces with sterile water or saline and place the tissue in its normal
position
• A body part that is completely detached should ideally be wrapped in sterile gauze
moistened with sterile saline, placed in a watertight container such as a resealable plastic
__________________________________ Chapter 16 First Aid, Emergency Care, and Disaster Management 21
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.2
Slide 44
Burns
• Assessment
• Determine the type of burn
• If patient has a flame burn or was in a closed, smoke-filled area, assess respirations
first
• Determine the extent and depth of the burns
• Inspect skin for color, blisters, tissue destruction
• Superficial burns: typically pink or red and painful
TALKING POINTS:
• When a burn accident occurs, the immediate concern is to stop the burning process.
• How can the burning process be stopped?
Slide 45
Burns (cont.)
• Interventions
• Ensure a patent airway and respirations
• Caused by flames, fumes, or chemicals, the victim may have inhaled substances that
cause respiratory impairment
TALKING POINTS:
• If the burns have been caused by flames, fumes, or chemicals, the victim may have
inhaled substances that cause respiratory impairment.
Hyperthermia
• Body temperature >37.2° C (99° F)
• Heat edema and heat cramps are mild degrees of hyperthermia
TALKING POINTS:
• Should victims of heat hyperthermia take salt tablets?
Slide 47
Hypothermia
• Decrease in body core temperature to <36° C (95° F)
• Caused by prolonged exposure to cold, extremely cold temperatures, or immersion in
cold water
22 Chapter 16 First Aid, Emergency Care, and Disaster Management __________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.2
Slide 48
• Why are older adults susceptible to hypothermia?
Hypothermia (cont.)
• Mild stage
• Patient shivers in an effort to generate body heat
• Blood vessels in the extremities are constricted, and performing complex motor tasks
is impaired
• Moderate hypothermia
• Appears dazed, poor motor coordination, slurred speech, and violent shivering
• May behave irrationally
TALKING POINTS:
Slide 49
Carbon Monoxide Poisoning
• Assessment
• Early signs and symptoms: headache and shortness of breath with mild exertion
• Then dizziness, nausea, vomiting, and mental changes
TALKING POINTS:
• Carbon monoxide is an odorless, invisible gas emitted by automobile engines, gas stoves
and furnaces, and burning charcoal and other combustible materials.
• What happens when carbon monoxide is inhaled?
Slide 50
Nursing Diagnosis, Goal, and Outcome Criteria
• Impaired gas exchange related to carbon monoxide poisoning
• The goal of nursing care for the emergency treatment of the victim of carbon
monoxide poisoning is normal oxygenation
TALKING POINTS:
• What are the criteria for evaluating the effects of nursing interventions?
Slide 51
Carbon Monoxide Poisoning (cont.)
• Interventions
• Immediately move the victim to fresh air
• If person not breathing, start rescue breathing
TALKING POINTS:
• A hyperbaric chamber uses pressure to force oxygen into the blood and tissues.
__________________________________ Chapter 16 First Aid, Emergency Care, and Disaster Management 23
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.2
Slide 52
Drug or Chemical Poisoning
• Assessment
• History: data about relevant signs and symptoms
• Name of drug or chemical. If the victim cannot provide the information, look for
clues and save the container
• Amount consumed
• Length of time since substance was taken
Slide 53
Nursing Diagnosis, Goal, and Outcome Criteria
• Risk for injury related to poison
TALKING POINTS:
• What is the criterion for evaluating successful intervention for drug or chemical poisoning?
Slide 54
Drug or Chemical Poisoning (cont.)
• Interventions
• Immediately call your poison center
TALKING POINTS:
• It is helpful to have the product container with you because specific interventions depend
on knowing exactly what poison was consumed.
• When should syrup of ipecac be used?
Slide 55
Food Poisoning
• Assessment
• Symptoms: nausea, vomiting, abdominal cramps, and diarrhea
• Botulism caused by Clostridium botulinum has neurotoxic effects: difficulty breathing,
seeing, and swallowing
• Clue that food poisoning is causing victim’s symptoms is that all who consumed a
TALKING POINTS:
• Victims of food poisoning often recognize the relationship between their symptoms and
the ingestion of food.
• What are the most common symptoms of food poisoning?
Nursing Diagnosis, Goal, and Outcome Criteria
• Risk for injury related to food poisoning
• Type of injury depends on the action of the contaminant
24 Chapter 16 First Aid, Emergency Care, and Disaster Management __________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.2
Food Poisoning (cont.)
• Interventions
• Medical care necessary if symptoms are severe or persistent
• How can food poisonings be prevented?
Slide 58
Bites and Stings
• Assessment
• Try to determine the type of bite
• Inspect bite to identify characteristics of bite site and any changes in surrounding
tissue
TALKING POINTS:
• Snakes, ticks, bees, wasps, household pets, and even humans are capable of causing
serious harm by their bites or stings.
• What are the most serious effects of bites?
5
Slide 59
• Health care facilities should have readily available information on resources, including the
local health department and the Centers for Disease Control and Prevention (CDC).
Acts of Bioterrorism
• Deliberate release of pathogens to kill people
• Most common biologic agents in terrorist attack: anthrax, botulism, plague, smallpox,
tularemia
TALKING POINTS:
• A major problem in the United States is the lack of experience in recognizing and treating
these infections.
__________________________________ Chapter 16 First Aid, Emergency Care, and Disaster Management 25
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.2
Slide 60
Disaster Planning
• A challenge for the health care system is to be ready for natural disasters that often occur
with short warning
• American Red Cross and the Salvation Army are experienced in handling these situations
TALKING POINTS:
• The Red Cross offers courses in disaster training for nurses and nursing students.
• What are the competencies for nurses in relation to emergency and disaster
preparedness?
6
&
7
Slide 61
Legal Aspects of Emergency Care
• Emergency doctrine
• In emergencies, person may be unable to consent to care
• Treatment can be provided under the assumption that the patient would have
consented if able
• Good Samaritan laws
misconduct
TALKING POINTS:
• In the first aid treatment of emergencies outside the hospital, the nurse is expected to
demonstrate the same skill, knowledge, and care that would be provided by other nurses
26 Chapter 16 First Aid, Emergency Care, and Disaster Management __________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.2
Activities
Online
4
DISCUSS
• Discuss the appropriate emergency
interventions for a patient with a fracture.
• Divide the class into small groups. Ask them
to determine the order in which these
patients should be seen in an emergency
department.
• A child with hot water burns to 50% of
his body
• A 74-year-old woman with a fractured
right hip
• A 25-year-old man who nearly drowned
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Assign
students to a group. Have each group
describe patient teaching for one of the
following conditions:
• Carbon monoxide poisoning
• Insect bite allergy
• Lyme disease
5
DISCUSS
• Discuss the unique role of the student nurse
in the event of an act of bioterrorism.
• Contact the local health department. Invite a
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Describe the
legal versus moral obligations of health care
__________________________________ Chapter 16 First Aid, Emergency Care, and Disaster Management 27
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.2
6
DISCUSS
• Discuss the legal aspects of emergency
care.
• Divide the class into small groups. Have
them describe how the Health Insurance
Portability and Accountability Act (HIPAA)
and privacy laws are applied or violated in
the following situations:
• A famous college basketball player is
hospitalized in the orthopedic unit of a
hospital. A nurse from the unit tells her
family, and they ask her to get them an
autograph.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. How does the
nurse’s involvement at the scene of an
emergency outside of the health care
system differ from that in an institutional
setting?
7
DISCUSS
• How is a nurse covered by Good Samaritan
laws if he or she helps a victim in the
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Research
Critical Thinking Question
A nurse is shopping in the grocery store and comes across a group of people surrounding a
person on the floor. The person is not breathing. The nurse chooses to stop and assist the
victim. As part of providing first aid, she performs CPR on the victim until the paramedics
arrive and take over. The victim is taken to the hospital, where it is later discovered that the
victim has several broken ribs. This is found to be a consequence of CPR. Can the nurse be
sued for this?
Discussion Guidelines: The nurse was performing under the scope of the Good Samaritan law
that offers protection in the cases like the one mentioned above. Good Samaritan laws were
28 Chapter 16 First Aid, Emergency Care, and Disaster Management __________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 16.2
Instructor Notes/Student Feedback
__________________________________ Chapter 16 First Aid, Emergency Care, and Disaster Management 29
Introduction to Medical-Surgical Nursing, 6th ed.
16
Assessments for
First Aid, Emergency Care, and Disaster
Management
CHAPTER 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-
monary arrest, choking, shock, hemorrhage, traumatic injury, burns, heat or cold exposure, poisoning,
bites, and stings.
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.
7. Explain the implications of the Good Samaritan laws.
Assessments by Lesson & Objective
1
Study Guide
• Part IB: 2 (p. 88)
• Part IIG: 2 (p. 89)
• Part IIIH: 18 (p. 93)
Evolve Instructor Resources
• Test Bank: 16, 23
Evolve Student Resources
3
Evolve Instructor Resources
• Test Bank: 1, 3, 4, 6
Evolve Student Resources
• NCLEX Review: 5
30 Chapter 16 First Aid, Emergency Care, and Disaster Management __________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
Assessments by Lesson & Objective
4
Study Guide
• Part IA: 1-17 (pp. 87-88)
• Part IC: 1 (p. 88)
• Part ID: 1-4 (p. 88)
• Part IE: 1-8 (p. 88)
Evolve Instructor Resources
• Test Bank: 2, 3, 5, 7, 11-15, 17-30
Evolve Student Resources
• NCLEX Review: 3, 4, 6-9
• Prioritization: 1-5
6
Evolve Instructor Resources
• Test Bank: 9
7
Evolve Instructor Resources
• Test Bank: 10
Instructor’s Notes/Student Feedback