MODULE D LESSON 10: PHYSIOLOGICAL ADAPTATION

TOPIC: EMERGENCY NURSING

MODULE D: PHYSIOLOGICAL INTEGRITY
LESSON 10: PHYSIOLOGICAL ADAPTATION
TOPIC: EMERGENCY CARE
I. Cardiac Arrest
A. CPR
B. Ear! De"i#riati$%
II. S&$c'
III. Tra()a Care
P$i%ts t$ Re)e)#er
Ter)s t$ *%$+
CORE CONTENT
I.Cardiac Arrest
A.CPR
1.Deter)i%e (%res,$%si-e%ess
a.S&a'e a%d s&$(t .Are !$( $'a!/.
#.Ca "$r &e,
0.P$siti$% t&e cie%t1 i" %$ e-ide%ce $" tra()a 2I" tra()a1 see
II. #e$+3
4.O,e% t&e air+a!
a.Head5tit c&i% i"t
#.6a+ t&r(st 2i" s,i%e )a! #e i%7(red3
8.Assess "$r #reat&i%9: $$'1 iste% a%d "ee
:.Gi-e resc(e #reat&s
a.Assess i" #reat&s 9$ i%t$ (%9s #! c&est )$-e)e%t
#.I" air d$es %$t 9$ i%1 re,$siti$% air+a! 2see ;4 a#$-e3
c.I" air sti d$es %$t 9$ i%1 c&ec' "$r "$rei9% #$d!
1.Hei)ic& )a%e(-er
0.D$ %$t ,r$ceed (%ti air+a! a%d resc(e #reat&i%9
esta#is&ed
d.<&e% air+a! is cear1 c&ec' "$r ac' $" ,(se
e.Be9i% c&est c$),ressi$%s
1.Be s(re cie%t is $% a "ir) s(r"ace
0.Ha%d ,$siti$% is critica
a.0 "i%9er5+idt&s a#$-e =i,&$id 2S+$rd5s&a,ed.3
xi!"id r"cess # A thin, elongated process
extending caudally from the
body of the sternum.
#.L$+er $%e5&a" $" ster%()
ster$%& 5 The narrow, flat bone in the median
line of the thorax in front.
4.>$r ad(t1 1.: t$ 0 i%c& c$),ressi$% de,t&
8.T+$ resc(ers1 ?0 t$ 100 ,er )i%(te
:.O%e resc(er1 ?0 ti)es ,er )i%(te
".Ater%ate c$),ressi$%s a%d #reat&s
1.T+$ resc(ers1 : t$ 1
0.O%e resc(er1 1: t$ 0
9.Reassess
B.Ear! De"i#riati$%
1.I% ad(ts1 t&e arr&!t&)ia )$st c$rrecta#e is -e%tric(ar
"i#riati$% i" treated ,r$),t!
'e$tric%(ar )i*ri((ati"$ 5 The primary mechanism and
arrhythmia seen in
sudden cardiac arrest.
0.Be"$re starti%9 CPR "$r -e%tric(ar "i#riati$%1 ca "$r &e,
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MODULE D LESSON 10: PHYSIOLOGICAL ADAPTATION
TOPIC: EMERGENCY NURSING

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MODULE D LESSON 10: PHYSIOLOGICAL ADAPTATION
TOPIC: EMERGENCY NURSING

II.S!"c+ 5 see t&e disc(ssi$% $" s&$c' $% ,a9e 8@ i% t&e Cardiac
secti$% $" t&is s(#cate9$r!
III.Tra%&a Care
Tra()a Care: A T&r$(9& I
Air+a!
Breat&i%9
Circ(ati$%
Disa#iit! 5 %e(r$ e=a)
E=,$se
>a&re%&eit
Get -itas
Hist$r!1 Head5t$5t$e
I%s,ect #ac'
A.Air+a! +it& Si)(ta%e$(s Cer-ica S,i%e I))$#iiAati$%
1.M(st (se 7a+ t&r(st
0.D$ %$t (se &ead5tit c&i%5i"t: it c$(d i%7(re %ec'
B.Breat&i%9
1.L$$'1 iste% a%d "ee "$r res,irati$%s
0.>$$+ CPR ,r$ced(re
C.Circ(ati$%
1.Assess ,(ses
a.Car$tid ,(se : BP at east B0
#.>e)$ra ,(se: BP at east @0
c.Radia ,(se: BP at east ?0
0.St$, a%! acti-e1 -isi#e #eedi%9
4.A"ter i%itia assess)e%t1 start ar9e5#$re ICS
D.Disa#iit!: Brie" Ne(r$$9ica E=a)
1.Le-e $" c$%sci$(s%ess
0.P(,i res,$%se t$ i9&t
4.A#iit! t$ )$-e e=tre)ities
8.A#iit! t$ )$-e a9ai%st resista%ce
E.E=,$se
1.U%dress cie%t
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MODULE D LESSON 10: PHYSIOLOGICAL ADAPTATION
TOPIC: EMERGENCY NURSING
0.I%s,ect "$r i%7(ries $r de"$r)ities
>.>a&re%&eit
1.Ta'e te),erat(re
0.Mai%tai% +ar)t&
a.<ar) #a%'ets
#.<ar)i%9 i9&ts
G.Get Citas
1.P(se
0.Res,irat$r! rate
4.B$$d ,ress(re
H.Hist$r! a%d Head5t$5t$e >( Assess)e%t
1.H$+ did i%7(r! $cc(r 5 )ec&a%is) $" i%7(r!
0.Cie%tDs )edica &ist$r!
4.>( #$d! s!ste) assess)e%t
I.I%s,ect t&e Bac'
1.R$ t&e cie%t $-er 5 $9 r$ +it& &e,
0.I%s,ect "$r de"$r)ities

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MODULE D LESSON 10: PHYSIOLOGICAL ADAPTATION
TOPIC: EMERGENCY NURSING
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MODULE D LESSON 10: PHYSIOLOGICAL ADAPTATION
TOPIC: EMERGENCY NURSING


POINTS TO REMEM,ER
CPR 5 Ear! de"i#riati$% is t&e 'e! t$ s(ccess"( res(scitati$% "$r
)a%! ad(ts. C$%ti%(a! reassess d(ri%9 CPR t$ see i" t&e cie%t
re9ai%s a ,(se $r #e9i%s #reat&i%9. Reassess t$ see t&at t&e c&est
)$-es a%d ,(ses are ,a,a#e d(ri%9 CPR.
SHOC- 5I% s&$c'1 t&e "irst &$(r $" treat)e%t is )$st critica. Ear!
detecti$% is 'e!. T&ere are di""ere%t +a!s t$ cate9$riAe s&$c'.
Basica!1 s&$c' ,rese%ts t&ree ,$te%tia ,r$#e)s:
1.N$t e%$(9& "(id i% t&e #$d! OR
0.>(id &as )$-ed $(tside t&e -esses1 s$ ca%%$t #e ,(),ed t$
t&e $r9a%s OR
4.Heart ca%%$t ,(), "(id t&at is ,rese%t
S!"c+ a$d Te&erat%re 5 I% se,tic s&$c'1 t&e s'i% a%d #$d!
te),erat(re )a! i%crease. I% $t&er
s&$c' states1 #$d! a%d s'i% te),erat(re +i decrease.
S!"c+ a$d Resirati"$ # As #$$d "$+ t$ (%9s decreases1 ess 9as
e=c&a%9e +i $cc(r. <&e% tiss(es recei-e ess $=!9e%1 t&e! ,r$d(ce
)$re actate a%d )eta#$ic acid$sis sets i%. Meta#$ic acid$sis
i%creases ris' $" cardiac arr&!t&)ias. >$r a cie%t i% s&$c'1 #$d! ces
recei-e ess $=!9e% a%d %(trie%ts. T&(s treat)e%t ai)s at i%creasi%9
#$t& a-aia#e $=!9e% a%d -$()e $" #$$d i% -esses 2(%ess t&e &eart
&as "aied3. Medicati$%s ca% i),r$-e t$%e $" #$$d -esses 2i%$tr$,es3
$r treat t&e ca(se $" s&$c' 2c$rtic$ster$ids1 a%ti#i$tics3. <&e% treati%9
a tra()a cie%t1 !$( )(st E(ic'! assess ABCs. A"ter !$( '%$+ t&e
cie%t is #reat&i%9 a%d &as a ,(se1 -ita si9%s ca% +ait +&ie !$( st$,
a%! #eedi%9 a%d start $t&er i%ter-e%ti$%s 2s(c& as starti%9 ICS3. D$%Dt
re! $%! $% t&e -ita si9% %()#ers.
Head a$d Si$e I$.%r/ # I" cie%t &as &ead i%7(r!1 t&e )$st i),$rta%t
assess)e%t is e-e $" c$%sci$(s%essF %e=t is ,(,i res,$%se t$ i9&t.
C&a%9es i% -itas are -er! ate si9%. <it& tra()a cie%ts1 ass()e s,i%e
is i%7(red (%ti ,r$-e% $t&er+ise. <&ie !$( $,e% t&e air+a!1 !$(
)(st 'ee, cer-ica s,i%e i))$#ie.
TERMS TO -NO0
,(a$c! test # A circulation test performed by applying and then
quickly releasing pressure to a fingernail or toenail.
Cardi"1e$ic s!"c+ 5Shock resulting from failure to maintain the
blood supply to the circulatory system and tissues because of
inadequate cardiac output.
Cardi"&/"at!/ # Disease of the myocardium, esp. that caused by
primary disease of the heart muscle.
C"(("id - A gluelike substance such as a protein or starch whose
particles (molecules or aggregates of molecules, when
dispersed as much as possible in a sol!ent, remain uniformly
distributed and do not form a true solution.
Cr/sta(("id 5 "ike a crystal.
C/a$"sis G Slightly bluish, grayish, slatelike, or dark purple
discoloration of the skin caused by the resence of abnormal
amounts of reduced hemoglobin in the blood.
Dia*etic +et"acid"sis # #luid !olume deficit $regulatory failure%
may be related to hyperosmolar urinary losses, gastric losses,
and inadequate intake, possibly e!idenced by increased
urinary output&dilute urine, reports of weakness, thirst, sudden
weight loss, hypotension, tachycardia, delayed capillary refill,
dry mucous membranes, poor skin turgor.
Dia!"resis # 'rofuse sweating.
Distri*%ti'e s!"c+ # Shock in which there is a marked decrease in
peripheral !ascular resistance and consequent hypotension.
G(/c"1e$ # A polysaccharide, (()*+,-. x, commonly called
animal starch, a whitish powder that can be prepared from
mammalian li!er and muscle and other animal tissues.
H/"'"(e&ia # Diminished blood !olume.
H/"xe&ia # Decreased oxygen tension (concentration in the
blood, measured by arterial oxygen partial pressure ('a-/
!alues.
I$"tr"ic # 0nfluencing the force of muscular contractility.
M"ti(it/ # The power to mo!e spontaneously.
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MODULE D LESSON 10: PHYSIOLOGICAL ADAPTATION
TOPIC: EMERGENCY NURSING
M/"cardia( i$)arcti"$ # An infarction in the cardiac muscle,
usually resulting from formation of a thrombus in the
coronary arterial system.
Sesis # The spread of an infection from its initial site to the
bloodstream, initiating a systemic response that ad!ersely
affects bloodflow to !ital organs.
Seci)ic 1ra'it/ # The weight of a substance compared with an equal
!olume of water.
Tria1e # The screening and classification of sick, wounded, or
in1ured persons during war or other disasters to determine
priority needs for the efficient use of medical and nursing
personnel, equipment, and facilities.
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