Emergency Department Environment

Priority concepts

• Safety

• Teamwork & collaboration

• Communication

Interprofessional Team Collaboration

• Emergency nurse

• Prehospital emergency medical services (EMS)

  • EMTs, paramedics

• Physicians, NPs, PAs

• Hospital technicians

• Professional & ancillary support staff

• Inpatient nurses

Special Nursing Teams: Interprofessional Team Members

• Forensic Nurse Examiners (RN- FNEs)

  • Special training to assess & interview patients who are victims of a crime

  • Collects patient’s Hx & evidence

  • Rape kit

  • Sexual assault nurse

• Psychiatric crisis nurse team

  • Can go all around the hospital

  • Goes to patients having a psychological break

Environment of Care

• Rapid change

• Fast paced

• Challenging stimulating

Core Competencies

• Assessment

• Clinical decision-making

• Multitasking

• Documenting

• Communication

• Cognitive knowledge base

• Flexibility & adaptability

• Priority setting (Triage process)

• Collaborative

Patient & Family Education

• Key role of the emergency nurse

• Health teaching

• Discharge instructions

Staff & Patient Safety Considerations (Staff Safety)

• Injury risks

• Volatile situation

• Security

Staff & Patient Safety Considerations (Patient Safety)

• Patient identification

• Fall risk

• Skin breakdown in vulnerable populations

• High risk for medical errors & adverse events

Demographic Data & Vulnerable Populations

• Care provided across the lifespan

• Vulnerable populations (Wide population)

  • Homeless

  • Poor

  • Mental health issues

  • Substance abuse issues

  • Older adults (People may abandon elderly at ED)

• Patient acuity varies from life-threatening to minor issues

  • Acuity varies

• We CANNOT turn away care for people who can’t pay for it

Common Reasons People Seek ED Care

• Abd. pain

• Chest pain

• Breathing difficulty

• Injuries

  • Especially falls in older adults

• Headache

• Fever

• Pain

  • The most common Sx

Triage

• “Gatekeeper”

• Sorts patients into priority levels based on illness or injury

• Highest acuity receives quickest intervention

• They do NOT sort patients based on time of arrival

  • Based on priority level (acuity)

Emergent, Urgent, & Nonurgent Categories (On The Test!!!)

• Emergent

• Urgent

• Nonurgent

• You can move up the chain of categories, NOT down

Emergent, Urgent, & Nonurgent Categories (Emergent)

• Patient has immediate threat to life or limb, & requires immediate Tx

• Must be treated in under 30 mins

• Stroke, MI, Major burns, Severe resp. distress, Chest pain, Anaphylaxis, Shock, Bleeding out, Major trauma, Limbs that DON’T have a pulse

• Think about ABC’s

Emergent, Urgent, & Nonurgent Categories (Urgent)

• Patient should be treated quickly, but immediate threat to life does NOT exist at this moment

• Tx quickly, but NOT an immediate threat

• Things can turn unstable

• Must be seen within 2 hrs

• Abd. pain, New onset pneumonia, Kidney stone, Complex lacerations that are NOT hemorrhaging, Major fractures or Displaced fractures WITH a pulse

• Temp. > 101 degrees F

Emergent, Urgent, & Nonurgent Categories (Nonurgent)

• Patient can usually wait several hrs for care without risk

• May be stuck in the waiting room for a long time

• Stable

• Sprain, Strain, Simple-closed fracture WITH a pulse, General skin rash

• Discuss w/ them urgent care location or contacting their PCP instead of going to the ER

Trauma Nursing Principles

• Injury mngmnt. is a key component

• Accredited trauma centers

  • Additional opportunities for development of expertise

Primary Survey & Resuscitation Interventions (ON THE TEST!!!)

Primary survey (Things you are going to do first):

• (A) Airway/ Cervical spine

• (B) Breathing

• (C) Circulation

• (D) Disability

  • Assess trauma

  • Neuro assessment

  • GC scale

  • Awake? Moving? Comatose?

• (E) Exposure

  • May have to cut off the patient’s clothes to assess skin (Gunshot, impaling, etc.)

  • Assess every part of the skin

• Exception:

  • In presence of excessive bleeding = CAB

Secondary Survey & Resuscitation Interventions

• Comprehensive head-to-toe assessment

• Identifies other injuries/ issues

• The nurse anticipates

  • Insertion of gastric tube & urinary catheter

  • Preparation for diagnostic studies

  • Other interventions (Foley, NGT, X-ray, Cast, Etc.)