EMERGENCY SITUATION FOR NURSES

Updated 5/25

A nurse who works in the ER can appreciate,
there are countless ways that an emergency
may occur. A patient who has a car accident
may be admitted for a pneumothorax, or a
patient may be admitted for a  heart attack,
stroke and more.

The clinical scenario above demonstrates
the situation of a new nurse.
She is assigned to the ER and is really
scared. She does not know how to get organized.

** A word of caution. Nursing is a wonderful 
profession. Taking care of the sick and helping
 them to get well, is a great accomplishment.
Perfecting good clinical judgement and
performance, cannot be  accomplished
 by high scores only. 

Scenario: A teenager in the ICU has been
declared brain dead after a gunshot wound. 
An angry family stands outside.

How should a nurse deal with this situation?

A nurse should use good communication skills 
to decrease the anxiety the family is feeling.
A compassionate nurse uses good communication
and tact to win them over.

EMERGENCY FOR NURSES

Updated 7/24

Dear nurses,

This has been a very sad week for many who had to be evacuated and lost their homes, due to fires in Southern California, USA. My prayers go out to all who were involved in one way or another.
Have you ever been in an emergency situation? Have you ever been unable to get home and take care of your daily responsibilities? 

Whether the answer is yes or no, here are some helpful pointers:-
- try to keep an extra change of clothes and toiletries in your car, for emergency use.
- have a contact number to reach someone who can pick up your kids etc. if you are unable to do so.
- keep some non-perishable foods in your car , so you can have something to eat in an emergency.
- if there is a co-worker who has had a tragic lost, try to share your love and maybe pick up a collection to help out. Have a great week!
For more clinical information, click on the link:
Emergency Room 

CRANIAL NERVE ASSESSMENT

CRANIAL NERVE -3, THE OCULOMOTOR NERVE is responsible for constriction of the pupils.

Damage to this nerve may occur after trauma or surgical intervention.

For more helpful information on this topic, just click on the link:
STROKE SERIES -ASSESSMENT IN THE CLINICAL SETTING.

CRANIAL NERVE ASSESSMENT

 Updated 3/24

 

Dear nurses,

New information is  available regarding cranial nerves and stroke assessment.
Please click on the links below:

Cranial nerves
Stroke assessment

The information below is no longer available.

Last week, CRANIAL NERVE ASSESSMENT in the Clinical Setting was begun. This week two more Cranial Nerves will be discussed. Cranial Nerve 2 -is the OPTIC NERVE which is responsible for vision. Damage to the Optic nerve may result in blindness.

Diplopia is discussed in this scenario, but is not entirely caused by damage to this nerve. Injury to the TROCHLEAR- Cranial Nerve 4, may result in diplopia ( double vision).

FOR MORE HELPFUL INFORMATION ON THIS TOPIC, JUST CLICK ON THE LINK:

STROKE SERIES ASSESSMENT IN THE CLINICAL SETTING.

UNDERSTANDING THE CRANIAL NERVES

Updated 6/24

Dear nurses,

There are twelve pairs of cranial nerves. Patients who have

brain injuries or surgical intervention , may need to have the

cranial nerves checked.To learn more, simply click on the
link : Cranial nerves

and enjoy learning.

SIMPLIFYING THE CRANIAL NERVES

Updated 8/24

Dear nurses,

Dearnurses.com is no longer available. 

It is important to recognize that, following 
a stroke or traumatic brain injury, a patient
may have damage to the cranial nerves.

.

                                       THE CRANIAL NERVES

CRANIAL NERVE ASSESSMENT

Dear nurses,

Updated 4/24

Updated information can be accessed 
by clicking on the links below.

Many nurses at one time or another will be faced with the challenge of taking care of a patient who has had brain surgery or brain injury due to trauma or tumors etc. The goal is to simplify the functions of the CRANIAL NERVES so ASSESSMENT CAN BE MADE EASY. So, follow along and make assessment in the clinical setting easy!

Updated 6/23

Click on the link for updated info:

The human brain and quiz

Cranial nerves

HYDROCHLORIC ACID IN DIGESTION

Every nurse at some time or another is put in the position of taking care of a patient with an order for NPO or NG tube insertion. When ordered by the doctor, the stomach is kept empty

for example before surgical procedures or after trauma.

If a Nasogastic tube is inserted, instructions are usually given by the MD to put NG to suction to remove excess gastric contents. There are cases when suction is not ordered. Hydrochloric acid is present in gastric contents. Above is an overview.

Enjoy reading more about the Clinical Setting.

and watch  SESSIONS 14   - ENTERAL AND PARENTERAL FEEDING

BROWN SEQUARD SYNDROME

Brown Sequard Syndrome is a rare condition, fortunately. It may be caused by a penetrating wound or a tumor which obstructs blood flow. Its course is outlined above.

DERMATOMES IN SPINAL INJURY

Hi guys,

Hope you had a good week . I have tried to simplify the meaning of Dermatomes in spinal cord injury. If you work in an area where Spinal Injuies are treated, you may well have to take on the challenge of checking and recording the patient's sensation post injury. Some units have a chart for this purpose.
Even if you do not have a chart, you can document your findings in your nurse's
notes. Remember to follow your institution's policies.
Enjoy learning more about Spinal Injuries.

Have a great week!

Updated  1/24

Please click on the link for more updated version:
Defining dermatomes

THE NURSE'S ROLE IN TH CLINICAL SETTING

The Clinical Setting step by step is no longer available.

Updated 8/23

Dear nurses,

Have you ever considered the s role the nurse plays in the clinical setting?
Do you have the knowledge base to handle challenging situations? 

Just click on the links:

Cardiogenic shock

Clinical videos

Enjoy learning!

THE NURSE'S ROLE IN THE CLINICAL SETTING

Dear nurses,

Have you ever considered the important role a nurse has to play in the Clinical Setting? Many hours are spent at the bedside. Having a good knowledge base in order to do an effective job, is of paramount importance. If you wish to improve your knowledge base, just click on to the link: 
The Clinical Setting

This is an ongoing series of clinical scenarios to improve your CLINICAL SKILLS.

RECOGNIZING ANASARCA IN THE CLINICAL SETTING

Dear nurses,

Updated 3/24

The Clinical Setting Step by Step is no longer 
available. 

Anasarca (generalised edema)may have numerous causes. 
Low albumin (hypoalbuminemia), burns, heart problems, 

kidney and liver failure are some of the causes. 

Serous fluid seeps into the tissues and accumulates. 

There is usually an increase in the patient's weight.
The edema may be pitting or non-pitting. In pitting edema,
 if the finger is pressed into the skin, a depression is left. 

The stretching of the skin, results in skin breakdown.

Learn more about Hepatic encephalopathy

ANASARCA CAUSES AND TREATMENT

Anasarca and its causes

Anasarca, which is also known as generalised edema, may
be caused by a number of conditions. These include:

- Heart, renal or liver failure

- Low albumin (hypoalbuminemia), burns

- Corticosteroids and more

This topic, including quiz questions, continues here:

Anasarca 

Learn more about : Organ failure and transplantation

Updated 3/25

ANASARCA CAUSES AND TREATMENT

Anasarca and its causes

Anasarca, which is also known as generalised edema, may
be caused by a number of conditions. These include:

- Heart, renal or liver failure

- Low albumin (hypoalbuminemia), burns

- Corticosteroids and more

This topic, including quiz questions, continues here:

Anasarca 

Learn more about : Organ failure and transplantation
and Hepatic encephalopathy

Updated 3/25

INTRAVENOUS INFILTRATION

IV therapy is commonly used in the clinical setting. It is very important to assess and document the condition of the IV site. If your patient complains of pain or sensitivity at the IV site, immediate steps should be taken to carefully examine the site. There are drugs such as, Dilantin Dopamine and Potassium  that may damage the soft tissue around the IV site, if there is an

infiltration.

Updated 5/23
For more updated information on IV assessment, click on the links:

IV assessment and quiz

and The New nurse - blood transfusion

 

ATRIAL FIBRILLATION ( CASE STUDY )

Dear nurses,

Are you having trouble understanding what happens in Atrial Fibrillation( page 24)?

A case study (page 21)has been done just for you. At the end of this case study, you should be able to :

- identify Atrial Fibrillation on the EKG.

- relate the treatment with medication and Cardioversion (Chapter 14)

- describe the effects and side effects of Heparin Therapy(Anticoagulation Therapy,Chapter 9)
New nurses visit Easy EKG Reading

Enjoy learning!

ASSESSMENT OF CHEST PAIN FOR NURSES

Dear nurses,

Updated 3/24

Chest Pain Series is no longer available. Please click on the link:
Chest pain assessment

for more updated information.

Are you having difficulty with your CLINICAL SKILLS? Do you know how to assess and document chest pain? Simply, click on to the link: " CHEST PAIN SERIES"and

your questions will be answered. You will learn how to :

- assess and intervene when there is chest pain.

- document findings and call for help.

You may also enjoy watching the video :

http://www.dearnurses.com/clinical_nursing_videos_called_sessions ( Sessions 12)

STROKE RELATED TO ATRIAL FIBRILLATION

Dear nurses,

How limited is your knowledge of the complications of Atrial Fibrillation ? To understand, please click on to the link: http://www.dearnurses.net/the_clinical_setting_step_by_step
( Chapter 11, Part 2).
Your patient will also benefit by understanding the correlation between Stroke and Atrial Fibrillation. Just click on the link for patient education of the layperson:
http://www.dearnurses.com/stroke_for_the_layperson_-_learning_the_visual_way

MALIGNANT HYPERTHERMIA

 Updated 3/24

 Dear nurses,

The Clinical Setting Step by Step is no longer available. Please 
click on the links below for updated information:
The purpose of anesthesia

Hope you had a good week. This week I have tried to simplify Malignant hyperthermia.

This is a rare, but life-threatening form of hyperthermia.

Certain inhaled anesthetic gases like Halothane, Desflurane and Sevoflurane may trigger
 this condition. Muscle relaxants like Succinylcholine(Anectine)may also be responsible.

MALIGNANT HYPERTHERMIA

Malignant Hyperthermia

Malignant Hyperthermia  is characterized by a rapid rise in temperature, tachycardia, 
hypertension and increased muscle contractions.

This condition, though rare,requires quick action in order to terminate the inhaled gas.
Cooling measures with ice, will help minimize damage to the body. Dantrolene IV is
known as the only effective drug.

Updated 10/24

The Clinical Setting Step by Step is no longer available.
Please click on the links :

PACU

The purpose of anesthesia

and enjoy learning.

IDENTIFYING HYPERTHERMIA

Hyperthermia is caused by a rise in body temperature above what is considered normal
( 98.6*F or 37 C).  When temperatures rise to > 99*F, heat exhaustion or heat stroke may
result if left untreated.

Signs and symptoms of hyperthermia may include:

- severe headache, dizziness and mental confusion
- tachycardia, tachypnea and vasodilation
- seizures may occur in small children- red, flushed skin

Regardless of the cause, if hyperthermia is left untreated , the consequences can be fatal. 
Quick action to correct the problem should always be a priority. 

ADDRESSING HYPERTHERMIA AND ITS CAUSES

  Updated 4/25

Some causes of hyperthermia

In the image above, hyperthermia causes are demonstrated. 
1. Someone who has been trapped in a burning building.

2. Someone who experienced heat exposure from excessive
swimming in extreme heat.

3. Someone who has been sunbathing in extremely hot weather
and becomes very dehydrated, leading to heat stroke.

Addressing hyperthermia 

Hyperthermia is recognized as a temperature which is above
normal. A severe form of this condition may be recognized
as heat stroke. ( temperature above 104 degrees). Heat stroke

if left untreated, may lead to further problems.

The hypothalamus is the temperature regulating center of the brain.

Injury to this part of the brain like trauma,  may also result in

hyperthermia. Antipyretics are used to decrease the temperature

and prevent hyperthermia.

Cooling measures like a cooling blanket, may also be used.

Learn more : Electrolytes and dehydration

and new topics at : Bydesign

TREATMENT OF HYPERTHERMIA

PREVENTION OF HYPERTHERMIA IS BETTER THAN HAVING TO CURE IT! Avoid hyperthermia by taking simple steps to understand what happens when the rise in body temperature is not compatible with life. If you have outdoor plans like a picnic , swimming on a very hot day etc., be sure to have enough fluids and wear light-colored clothing. Avoid alcoholic beverages! For information on Hypothermia, please click on the link below:
Hypothermia

Enjoy learning!
Updated 4/23