Situation 2.

Two men choose to go ice fishing for the first time of the season. They chose to wear light clothing,
expecting the cabin to be warm, but neglected to take into account the 4 inches of snow on the
ground and the high humidity. They spent the day fishing on the ice without moving much. One man
now presents to the ED for treatment of frostbite of his feet. His friend has been massaging them
en route to the patient insist that this makes his feet feel better. You tell them to cease massage.
Describe the explanation you would give to this patient and evidence base that guides your
response. Tell how you would proceed with managing this patient’s care. Describe the treatment
dilemmas for this type of injury.
Answers:
 Caution the significant others not to rub or massage the affected area because this may
increase damage to the tissue. Although rubbing/massaging produces heat, it can cause
tissue damage due to embedded ice crystal rubbing against fragile cells.
ASSESSMENT AND INTERVENTIONS
 Remove constrictive clothing and jewelry that could impair circulation. Remove wet clothing
as rapidly as possible and put the patient in a warm place.
 Controlled yet rapid rewarming is instituted. Place the patient in a 37®C-40®C circulating
bath for 30-40 minutes spans to restore circulation. Early rewarming decrease amount of
ultimate tissue loss.
 Administer analgesic during rewarming as prescribed, because rewarming process may be
very painful. Body part is not handled or moved to avoid further mechanical injury and
massage is contraindicated since it increases damage to tissue.
 Once rewarmed, affected area is protected from injury and the feet is elevated to help
control in swelling.
 Sterile gauze is placed between toes to prevent maceration and bulky dressing is placed
on extremity. Non hemorrhagic blisters, if present are described to decrease inflammatory
mediators forced in blisters fluid.
 Continued physical assessment is done with rewarming to observe for concomitant injury such
as soft tissue injury, dehydration, alcohol coma and/or fat embolism.
 Assess for hyperkalemia or hypovolemia. If present, correct it.
 Since there is a great risk for infection, strict aseptic technique is used during dressing
changes and tetanus prophylaxis is administered as indicated.
 NSAIDS are administered for its anti-inflammatory effect as to control pain.
 Since the feet are involved, patient should not be allowed to ambulate.
 After rewarming, hourly active motion of any affected digits are/is encouraged patient to
avoid tobacco, alcohol and caffeine because of their vasoconstriction effect which will
further reduce the already deficient blood supply to injured tissue.
Situation 3.
The following four patients present to the triage desk of the ED within minutes of each other. How
would you prioritize and categorize each of these patients? Which ones need immediate attention?
What initial care would you provide at triage? Which patient could wait or be sent to the clinic for
management?
a. A college student with a history of exercise induced asthma and known noncompliance to
prescribed medications present with rapid, shallow respirations and wheezing after jogging
5 miles. His girlfriend is very anxious. He has been this way for about 15 minutes.
b. An attorney who has had a cold for 3 days says she has no primary care physician and
must be seen right now because she cannot breathe. Her respirations are normal, pulse
oxygenation saturation are 100% and she has complaints of sinus drainage and a
headache.
c. A middle-age woman experienced sudden dyspnea and chest tightness while making dinner.
Instead of calling 911, her husband drove her to the ED. She is complaining of left scapular
pain and tingling in her left arm, her skin appears ashen and she is diaphoretic.
d. An elderly woman with a known history of diabetes presents with complaints of vomiting.
Her vital signs are normal, but she is diaphoretic and appears weak.

ANSWER:

 If I was assigned in the ED I would prioritize them as C as category 1, D as category 2, A

as category 3 and B as category 4.
 Patient C needs immediate attention because she exhibiting signs and symptoms of
myocardial infarction. As an initial care, I would administer O2 to client to facilitate
myocardial oxygenation. Next, I would position the client in semi fowler’s position to reduce
cardiac oxygenation needs of the affected area in the myocardium. Administer
nitroglycerin, as ordered. Obtain ECG and other lab exams and monitor vital signs.
 ER nurses treat patients coming through hospital emergency departments for a variety of
reasons – trauma, injury, and acute-onset symptoms. They treat patients of all ages and
background. Most patients are experiencing emergency, life-threatening situations, and ER
nurses must be quick to recognize those acute problems and be able to resolve or stabilize
them immediately upon arrival. They are also in charge in prioritization and categorizing
patients from those needing immediate attention to the least and those that could be sent
to clinics.
 From heart attack to stroke to gunshot wounds, motor vehicle accidents, or just fractured
bones, ER nurses see it all. ER nurses learn to quickly triage patients based on immediate
observation and acute assessment skills, then to treat symptoms in order of life-threatening
priority. They may immediately start CPR to reverse cardiopulmonary arrest or start
slamming blood products for a hemorrhaging patient or work to quickly discover
underlying medical conditions that are less apparent. The job is fast-paced, full of
adrenaline rushes, and completely unpredictable shift-to-shift.
  Patient C, needs immediate attention, patient DAB can wait. And patient B can be sent to
clinics for checkup

Situation 4.
A patient arrives to the triage area of the ED complaining of flulike symptoms. He has
developed a rash that seems to be primarily located on the soles of his feet and palms of his
hands. He cannot remember touching anything that he knows he is allergic to, and he has not
been walking barefoot. He does like to hunt, and only a week ago was in his deer stand for
most of the weekend. What potential disease symptoms are being exhibited by this patient?
What other questions would you ask? What will you focus on when you examine his skin?

ANSWER:
 The exhibiting signs and symptoms of Lyme disease, contact dermatitis and syphilis. Other
questions that I would ask the patients are,
- “Does he touched any unfamiliar plants?” – Poison ivy and other irritants could
trigger an allergic reaction leading to contact dermatitis.
- “Have you walked barefoot during camping?”
- “Where were you sleeping during your camping?” – Lyme disease are contracted
through tick bites.
- “Have you had engaged in multiple sexual partners” – Syphilis is transmitted
through unprotected sexual intercourse.
- ”Are you using or have you used illegal injection drugs?” - Syphilis can be
transmitted through sharing of used needles.

 In inspecting the skin, I would note the characteristic of the rash, its size, color. Also, I would look for
blister formation and other things that could help me to identify the proper disease the patient is
suffering from. I would also get a serum for laboratory test to see the presence of bacteria which
then could help in identifying the disease.
 University of the Philippines Manila
School of Health Sciences
Palo, Leyte

ASSIGNMENT IN NURSING CARE

OF ADULT III

Submitted by:

Karl Jacon M. Ferolino

BSN 37TH Batch

Submitted to:

CARMEN N. FIRMO, RN, MAN, PhD

BSN Department Chair