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Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Textbook For Nursing Assistants
Chapter 12 - Basic First Aid and Emergency Care
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
What is an Emergency?
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
What is an Emergency? A condition that requires immediate medical or surgical evaluation or treatment in order to prevent the person from dying or having a permanent disability
What Leads to an Emergency? Conditions that affect breathing, circulation, or both
Emergency
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Respiratory arrest: breathing has stopped
Cardiac arrest: the heart has stopped beating
Emergency – Related Terms
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Clinical deathThe person has no pulse or is not breathing
Reversible
Biological deathOccurs if clinical death is not promptly reversed
Not reversible
Emergency – Related Terms
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
There are several ways that breathing and circulation can be hindered, leading to an emergency situation. For example:
When a person chokes
When a person loses large amounts of blood in a short period of time
When a person suffers a “heart attack”
Emergency - Factors Leading to an Emergency
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Responding to an Emergency
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Training allows you to be better prepared for emergency situations
Training programs that cover the principles of first aid and basic life support (BLS) are provided by the:
American Red Cross (ARC)
National Safety Counsel (NSC)
American Heart Association (AHA)
Training Programs
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Familiarity with patients or residents makes you more likely to notice signs and symptoms of an imminent emergency
By reporting signs that seem unusual or give you cause for alarm to the nurse, you may prevent an emergency situation from developing
Nursing Assistants - Role
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Responsibilities of a nursing assistant in case of an emergency include:
Recognizing that an emergency exists
Deciding to act
Checking for consciousness
Activating the emergency medical services (EMS) system
Providing appropriate care until the EMS personnel arrive
Nursing Assistants - Responsibilities
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Basic Life Support Measures (BLS)
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
The goal of BLS is to prevent respiratory arrest, cardiac arrest, or both
By using certain BLS measures, such as rescue breathing and CPR, you are essentially performing breathing and circulation for someone who is unable to perform these functions on her own
BLS - Basic Life Support Measures
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
The steps of BLS are: “A” – Check “airway”
“B” – Check for “breathing”
“C” – Check for “circulation”
Check for bleeding
BLS - Procedure
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Emergency Situations
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Heart attacks and strokes
Fainting (syncope)
Seizures
Hemorrhage
Shock
Airway obstruction
Emergency Situations
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
When a person has a myocardial infarction (MI), blood flow to the muscular wall of the heart is blocked, and part of the heart muscle diesThe crippled heart muscle is unable to pump blood effectively throughout the body, creating an emergency situationIf the damaged area of the heart is large enough, cardiac arrest can occur Prompt medical intervention can help to minimize damage to the heart muscle
Emergency Situations - Heart Attack
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
The signs and symptoms of a heart attack can vary greatly from one person to the next. The most typical symptoms include
Pain or tightness in the chest
A pale or grayish color of skin
Excessive sweating
Breathing trouble
Nausea or heartburn-like pain
Heart Attack - Signs and Symptoms
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
If you observe that a person is having signs or symptoms of a heart attack, have the person lie down
Raise the person’s head to help make breathing easier, and call the nurse or activate the EMS system immediately
If the person goes into respiratory or cardiac arrest, you will need to begin BLS
Heart Attack - First Aid
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Strokes, also known as “brain attacks” or cerebrovascular accidents (CVAs), are caused by blocked blood flow to a body partIn the case of a stroke, the affected body part is the brainIf you think that a person is having or has had a stroke, report your observations to the nurse and activate the EMS system
Emergency Situations - Strokes
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
A stroke might cause only mild physical changes in some people. In others, it might cause loss of consciousness or a coma
Signs of a stroke include:Change in a person’s level of orientation or consciousness
Slurred speech
Muscle weakness or paralysis
Drooping of the eyelid or a corner of the mouth
Severe headache
Strokes - Signs and Symptoms
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Keep the person lying down and watch for signs of respiratory arrest until advance care arrives
New advances in the treatment of stroke have resulted in improved outcomes for some patients, when treatment is started early
Strokes - First Aid
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Fainting occurs when the blood supply to the brain suddenly decreases, resulting in a loss of consciousnessAlthough fainting may be an early sign of a serious medical condition, such as a heart problem, it can also be the result of hunger (“low blood sugar”), pain, extreme emotion, fatigue, medication side effects, a “stuffy” room (poor ventilation), excessive heat, or standing for a long time Fainting is not life-threatening in and of itself, but a person who faints is at risk for injury from falling
Emergency Situations - Fainting
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
If you believe that a person is about to faint:Have the person lie down in the supine position and elevate his legs 12 inches, or ask him to sit down and bend forward, placing his head between his knees
Loosen any restraints or tight clothing (such as a belt or necktie), and have the person remain in the supine or sitting position (with his head between his knees) for at least 5 minutes
Fainting - First Aid
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
If a person you are assisting does faint:Lower him to the floor or other flat surface, remembering to use good body mechanics Position the person on his back with his head turned to the side, in case he vomitsIf you are sure that the person does not have any injuries to the head, neck, or spinal cord, raise his legs 12 inches, and loosen any tight clothing or restraintsMake sure the person is breathing, and call for help
Even if the person recovers from the episode quickly, have him continue to lie down until the nurse arrives.
Fainting - First Aid
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Seizures, also known as convulsions, occur when brain activity is interruptedSeizures can result from head injuries (either recent or past), strokes, infections, high fevers, poisonings, brain tumors, and epilepsyTypes of seizures include
Grand mal seizurePetit mal seizure
Emergency Situations - Seizures
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Grand mal seizures are characterized by generalized and violent contraction and relaxation of the body’s muscles
During a petit mal (absence) seizure, the person may stare into space or stop speaking in mid-sentence, only to “come back” a few moments later
Seizures - Signs and Symptoms
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
First aid for a person having a grand mal seizure involves:
Protecting the person until the seizure is over
Keeping the airway open during the period of unconsciousness
Seizures - First Aid
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
If a person is having a grand mal seizure, you would:Help the person to the floor and move furniture or other objects that might cause injury out of the wayProtect the person’s head by placing a pillow or folded towel underneath it and call for help while allowing the seizure to run its courseNever place anything in the person’s mouth or between the teethThe gag reflex may be temporarily lost, saliva may pool in the mouthAfter the seizure is over, turn the person to her side (place her in the recovery position) and allow any secretions to drain from her mouth to prevent chokingProvide warmth and a quiet environment
Seizures - First Aid
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Hemorrhage (severe, uncontrolled bleeding) can be caused by trauma to a blood vessel or by certain illnesses, such as gastric ulcers
Ordinarily, when a blood vessel wall is injured, a blood clot forms to prevent the escape of blood
If the trauma to the blood vessel wall is substantial, or if the person lacks the clotting factors needed to form blood clots, the bleeding will not stop
Emergency Situations - Hemorrhage
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Hemorrhage can be either External (visible), or Internal (within the body)
Hemorrhage can be either venous or arterial, depending on the type of blood vessel that is injured
Venous hemorrhage flows steadily Arterial hemorrhage spurts or pulses with the heartbeat
Emergency Situations - Hemorrhage
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
In the event of an emergency situation where a person is hemorrhaging, call for help and make sure the person is lying downTake standard precautions to protect yourself from exposure to bloodborne pathogensApply firm, steady pressure directly to the wound using a sterile dressing, a clean towel, or whatever else is clean and available for use as a compressIf the direct pressure does not stop or slow the flow of blood, raise the affected body part (if it is an arm or leg) and apply pressure to a pulse point above the wound
Hemorrhage - First Aid
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Shock results when the organs and tissues of the body do not receive enough oxygen-rich blood
To treat shock, the underlying cause of the shock must be addressed
Emergency Situations - Shock
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Emergency Situations - ShockTypes Causes
Cardiogenic Occurs when heart is unable to pump enough blood throughout the body
Hemorrhagic Results from massive blood loss
Septic Caused by severe bacterial infections
Anaphylactic Caused by severe allergic reactions
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Shock - Signs and SymptomsA person entering a state of shock will:
Have a low blood pressure
Have a pulse that is rapid and weak
Have cool, clammy, and pale skin
Be confused or disoriented
Breathe rapidly, and if he is conscious, he may complain of thirst
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Shock – First AidKeep the person warm and calm
The treatment for anaphylactic shock is the immediate administration of a medication called epinephrine
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Emergency Situations - Airway Obstruction
Types Symptoms
Partial airway obstruction with good air exchange
Person coughs strongly and has good skin color
Partial airway obstruction with poor air exchange
Person’s coughing is a weak, ineffective effort with high-pitched, “crowing” sounds as he tries to breathe; bluish skin color
Complete airway obstruction
Person cannot cough, speak, or breathe and might lose consciousness quickly
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
First aid to be administered in case of choking:
Clearing the airway in adults and children older than 1 year Heimlich maneuver (abdominal thrusts) Modified Heimlich maneuver (chest thrusts; used
on very heavy people or pregnant women)
Emergency Situations - Airway Obstruction
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Clearing the airway in infantsIn children younger than 1 year, the Heimlich
maneuver is not used because of the risk for damaging the baby’s internal organs
Instead, a combination of back blows and chest thrusts is used
Emergency Situations - Airway Obstruction
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
The Chain of Survival
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
Recognize that an emergency situation exists, and activate EMSProvide first responder care (basic first aid, including BLS if applicable)Medical intervention, such as that provided by an EMT, a paramedic, a nurse, or a doctor, must be providedAfter the immediate crisis passes, hospital care may be needed to help the person surviveRehabilitation, the final step in the chain of survival, focuses on improving the general health of a person
Chain of Survival - Steps
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
As a nursing assistant, you: Play a vital role in helping to see a person through the immediate crisis (points 1 and 2)
Might find yourself caring for someone who is in the recovery phase (points 4 and 5)
Chain of Survival
Copyright © 2005. Lippincott Williams & Wilkins. Instructor's Manual to Accompany Lippincott's Textbook for Nursing Assistants.
End of Presentation