Chapter 13 Nursing Care of Patients with Emergent Conditions and Disaster

Answers CHAPTER 13 NURSING CARE OF PATIENTS WITH EMERGENT CONDITIONS AND DISASTER/ BIOTERRORISM RESPONSE AUDIO CASE STUDY Tabitha and the Emergency Department 1. To immobilize the spine until injury can be ruled out to prevent further damage that could result in paralysis. 2. Hypotension, tachycardia, and jugular vein distention, because the heart was being compressed and couldn’t fill properly due to the pericardial sac fluid. 3. The patient’s chest likely hit the steering wheel. He may have injuries to his heart or lungs and could develop cardiac tamponade. 4. Not wearing a seat belt. VOCABULARY 1. (3) 2. (2) 3. (1) 4. (5) 5. (4) 6. (7) 7. (6) 8. (10) 9. (8) 10. (9) SIGNS AND SYMPTOMS OF INCREASED INTRACRANIAL PRESSURE 1. (2) 2. (1) 3. (1) 4. (2) 5. (1) 6. (2) 7. (2) 8. (1) 9. (1) 10. (1) 11. (2) 12. (2) ASSESSMENT OF MOTOR FUNCTION If the patient is unable to: Extend and flex arms Extend and flex legs Flex foot, extend toes Tighten anus The lesion is above the level of: C5 to C7 L2 to L4 L4 to L5 S3 to S5 ENVIRONMENTAL HYPERTHERMIA 1. (2) 2. (1) 3. (2) 4. (2) 5. (1) 6. (1) 7. (1) 8. (2) 9. (1) 10. (2) PRINCIPLES FOR TREATING SHOCK 1. True 2. True 3. False. Direct pressure. 4. False. Apply blanket to warm patient. 5. True 6. False. Take frequent vital signs as indicated by condition. 7. False. Do not give the patient oral fluids. 8. True PRINCIPLES FOR DISASTER OR BIOTERRORISM RESPONSE 1. overwhelms 2. disaster 3. notified, discharged 4. triage, stabilization 5. seriously, full 6. drills 1 2 Chapter 13 Answers 7. familiar, role 8. internal 9. external 10. community-wide CRITICAL THINKING 1. Call for emergency medical services; keep the patient calm to slow down the absorption and spread of venom, if present; immobilize the affected body part below the level of the heart; obtain information about the color and shape of the snake, and take a photo if it can be done from a safe distance, to identify the snake. 2. Initial symptoms of a poisonous snakebite include a pair of puncture marks at the wound, discoloration and swelling around the bite, and pain at the site of the bite. Systemic effects may occur. 3. Conduct primary and secondary surveys. Consult an experienced toxicologist to guide treatment with antivenin. Provide supportive care per symptoms. 4. Acute Pain, Anxiety, Deficient Knowledge. 5. Keep the patient calm, keep affected body part below the heart level, gently wash the bite marks with mild soap and water, and cover with a loose clean dressing. Do not irrigate or flush the wound. Ice should not be applied to the wound. Teach wound care and signs of infection to report. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (3, 5, 6) are correct. Wheezing and stridor may be experienced because of fluid in the airways and constricted bronchi. Hypotension results from vasodilation. (1, 2, 4) are not common with anaphylactic shock. 2. (1) is correct. Arterial blood flow is evaluated with capillary refill. (2, 3, 4) are not evaluated with capillary refill. 3. (3) is correct. A rapid, thready pulse indicates compensation (rapid) and loss of blood volume (thready). (1, 2, 4) are incorrect. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 4. (1) is correct. Morbidity and mortality are usually from pulmonary aspiration secondary to loss of the gag reflex. (2, 3, 4) are neurological signs that would occur later with complications. The nurse’s priority is monitoring the patient to prevent complications from occurring. 5. (2) is correct. Activated charcoal might be given in this severe case, as the patient is unconscious, to help absorb the medication. (1, 3, 4) would not be appropriate for an unconscious patient. 6. (2) is correct. (1, 3, 4) are incorrect. Core body temperature should be within normal range. Skin should be warm and dry. 7. (3) is correct. (1, 2, 4) are incorrect. 1 mL 5 mg 3 mg = 0.6 mL 8. (1) is correct. A rapid, thready pulse indicates compensation (rapid) and loss of blood volume (thready) requiring intervention by the nurse. (2, 3) are incorrect; 60 and 84 are normal pulse findings, and tachycardia would be expected with large amounts of blood loss. (4) is incorrect. A bounding pulse is not a concern and would not be noted with hemorrhage. 9. (3, 2, 1, 4, 5) is the correct order. Airway is the first priority, then breathing, circulation, disability, and exposure. 10. (2) is correct. The brachial artery is the proximal artery to the radial artery. (1, 3, 4) are not the most proximal arteries to the radial artery. 11. (2, 3) are required per standard precautions when caring for a patient with anthrax. (1, 4, 5, 6) are not required. 12. (2, 3, 5) indicate an awake and alert patient from the naloxone’s (Narcan) reversal of the narcotic. (1, 4, 6) do not indicate that the narcotic’s effects were reversed. 13. (1, 5, 6) are normal findings. (2, 3, 4) are abnormal findings. 14. The nurse will apply pressure-point control to the left femoral artery to stop the bleeding of a left leg laceration.