concepts of emergency room nursing

The ER nurse: 

Nursing 477 The ER nurse

Emergency Department Environment: 

Emergency Department Environment Characterized by: Rapid change Multispecialty care Crowded, noisy conditions Crucial communications with ambulance staff, helicopter personnel Complex age and demographic range of patients

Special Nursing Teams: 

Special Nursing Teams Forensic nurse examiners are trained to obtain patient histories, collect forensic evidence, and offer counseling and follow-up care for victims of rape, child abuse, and domestic violence. Psychiatric crisis nurse team interacts with patients and families in crisis.

Interdisciplinary Team Members: 

Interdisciplinary Team Members Prehospital care providers Emergency medical technicians (EMTs) Paramedics Emergency medicine physician Support staff Inpatient unit staff

Staff and Patient Safety Considerations : 

Staff and Patient Safety Considerations

Considerations for Older Adults: 

Considerations for Older Adults Safety

Emergency Nursing Special Considerations : 

Emergency Nursing Special Considerations Patient identification Patient safe from falls and skin breakdown Risk for errors and adverse events Precautions to protect the personal safety of emergency department staff

Training and Certification: 

Training and Certification

The triage process: 

The triage process The process of sorting or classifying patients into priority levels depending on illness or injury severity Triage nurse = “gatekeeper” of the ER Typical = emergent, urgent, nonurgent Emergent – immediate threat to life or limb Urgent – should be treated quickly Nonurgent – can generally tolerate waiting several hours Other Multi-tiered options Emergency Severity Index (ESI)

Triage (Cont’d) : 

Triage (Cont ’ d)

Triage (Cont’d): 

Triage (Cont ’ d) Triage nurse in the emergency care system performs rapid assessment to determine triage priority by category: Emergent triage Urgent triage Nonurgent triage Emergency Severity Index (ESI) categorizes both patient acuity and resource utilization.

Care of the Emergency Department Patient: 

Care of the Emergency Department Patient Patients with a variety of heath care needs are seen in the emergency department Cultural considerations Care of patients with mental illness Disposition Case management Patient and family teaching

Death in the Emergency Department: 

Death in the Emergency Department “ Expected ” death “ Sudden/Unexpected ” death Family presence during resuscitation Dealing with family members in crisis ED personnel dealing with death

Trauma Nursing Principles: 

Trauma Nursing Principles Trauma nursing Trauma centers (Level I to Level IV) Trauma systems

Mechanism of Injury: 

Mechanism of Injury MOI—manner in which the patient ’ s traumatic even occurred: Blunt trauma Blast effect Acceleration-deceleration forces Penetrating trauma

Primary Survey and Resuscitation Interventions: 

Primary Survey and Resuscitation Interventions The primary survey organizes the order of approach to the patient by mnemonic device: (A) Airway/cervical spine (B) Breathing (C) Circulation (D) Disability (E) Exposure

Disposition : 

Disposition Depending on the nature of the injury and the facility ’ s resource capability: Patient may be transported immediately to the operating room or interventional radiology suite. Patient may be admitted to the trauma critical care unit, step-down unit, or surgical floor for continued care. Patient may be transferred to a facility with a higher level of care.

A=Airway: 

A=Airway Cervical spine immobilization Jaw-thrust maneuver Rapid sequence intubation

Verify Tube Placement: 

Verify Tube Placement Ausculate breath sounds Secure tube Post intubation chest film

B = Breathing: 

B = Breathing Administer Oxygen Administer medications to open airway

C = Circulation: 

C = Circulation Check central pulse Skin assessment Insert IV’s Pneumatic antishock garments

D = Disability: 

D = Disability Brief Neurologic exam GCS Pupils AVPU A = alert V = responsive to voice P = responsive to pain U = unresponsive

E = Exposure/Environmental Control: 

E = Exposure/Environmental Control Remove all clothing Limit heat loss Prevent hypothermia

Secondary Survey: 

Secondary Survey Identification of ALL injuries - completed after primary survey completed and any life-saving interventions initiated