Selected Pt Emergencies

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  1. Orthostatic Hypotension
    • Susceptible Persons: Pt who have been on bedrest elderly those with neurological or cardiac conditions
    • Prevention: ace wrap from feet to groin use of abdominal binder, elastic hose, ROM exercise in supine allow pt to acclimate to upright gradually
    • S&S: drop in BP, dizziness, sweating, pallor, possible nausea
    • Response: place the person in supine, apply a cold compress to their forehead, have Pt rest, avoid exertion, stay calm
    • After symptoms pass amy attempt to upright position or may decide to wait until next session
  2. Autonomic Dysfreflexia
    • A massive SNS response to noxious stimulus severe vasoconstricion
    • Susceptible persons: Pt with SCI abouve T6 level. PTs with Guilliane Barre
    • Causes: bladder distention, Fecal impation. open pressure ulcers, Tight straps, localized pressure exercise otheres
    • S&S: Severe hypertension, bradycardia, profuse diaphoreses above the level of lesion, Pounding HA, General Feeling of discomfort, red skin blotches, goose bumps. Can progress to seizures or loss of consciousness
    • Response: Place Pt in sitting postion to decrease hypertension, If noxious timuli can be identified it should be removed or relieved, Monitor Pt vital signs frequently
    • Call for medical assistance
  3. Hypoglycemia
    • Low Blood Sugar
    • Causes: too much insulin, too little food excessvie exercise in relation to metablic state
    • S&S: sudden onset of pale, moist tongue, hunger possibel mental confusion
    • Response: If Pt is conscious provide some form of sugar, If Pt is unconscious IV glucose may be needed. PT should rest and avoid activity.
  4. Hyperglycemia
    • elevated Blood Sugar
    • Causes: Too little insulin, intake or too much or improper food, insufficient physical activity related to metabolic state
    • S&S: gradual onset of flushed, dry skin drowsiness, fruity breathh, deep labored breathing, vomiting, dry tongue, thirst
    • Can lead to diabetic coma and death
    • Response: Seek medical assistance, do not give Pt sugar, Usually Pt needs an injection of insulin
  5. Heat Exhaustion
    • Cause: hot, humid environment< vigorous physical activity, dehydration, depleted body electrolytes
    • S&S: muscle cramps in legs and abdomen, profuse diaphorisis, nausea, HA, Shallow rapid breathing, weak rapid pulse, pale exhaustion or collapse
    • Response: Cool the person & counteract dehydration move Pt to shady area supported postion, Removeout clothing, monitor vital signs, cool compresses to forehead & neck, increase fluid intake, water or electrolytes
    • If no relief of symptoms os symptos worsen seek medical help
  6. Heat Stroke
    • Medical Emergency
    • Cause: hot, humid environment, vigorous physical activity, dehydration, depleted electroytes
    • S&S: no diaphoreis, nauses, HA, labored breathing, strong rapid pulse, pulse skin or changes to gray, elevated temp, exhaustion, collapse, seizures
    • Progresses to loss of consciousness
    • Response: obtain medical assistance
    • Place person in semi-relining position in a shady well ventilated area, remove outer clothing, monitor vital signs, cool the person quickly, apply cold wet compresses, towels or sheets to body, apply ice bags to wrists, ankles, groin, axilla, lateral neck to cool large blood vessles,
    • Life theratening, needs prompt emergency care
  7. Mechanical Ventilation
    • For Pts requiring support for ventilation and or oxygenation
    • Diagnosis may include COPD respiratory failure SCI and respiratory ms paralysis
    • Continuous vs. intermittent
    • Endotracheal tube vs Tracheostomy
  8. Tracheostomy
    • Purpose:
    • A surgical intervention for those who need long term ventilation.
    • Precautions:Be careful when moving the patient, the movement of the tube may cause coughing and it can become detached. Communicate with RN about suctioning if needed.
  9. Catheter
    • Purpose: Insertion of a tube through the urethra into the bladder in order to collect urine into a collection bag for the patient who is not able to control urination.
    • Precaustions: Keep the collection bag below the insertion site, do not pull or tug on the tube as it can be pulled out.
  10. Chest tube
    • Purpose: Inserted into pleural cavity in order to empty air or fluid out of the pleural space.
    • Precautions: Do not pull on the tube; prior to moving patient will need to ask RN if suction can be turned off. Keep 3 chamber collection system upright, do not tip over.
  11. Intravenous therapy
    • Purpose: To prevent fluid or electrolyte imbalance; to administer medications.
    • Precautions: Avoid tension on the IV lines; if it crosses a joint, don’t go to extreme of ROM. Apply pressure if pulled out.
  12. Nasogastric tube
    • Purpose: Inserted into the nose and esophagus into the stomach. To administer feedings for the patient who is not able to swallow, or tolerate adequate nutritional intake by mouth.
    • Precaustions:
    • Head of bed needs to be up at least 30 degrees when the feeding is operational. Do not pull or tug on the lines.
    • PEG tube: do not put gait belt on over the stomach tube.
  13. Patient Controlled Analgesia
    • Purpose: IV line that allows the patient to deliver small amounts of medication without risk of overdose.
    • Precautions: Do not pull or tug on the line.
  14. Sequential Compression Pumps
    • Purpose: Drives superficial blood into deep veins where it can be evacuated by venous valves.
    • Precautions: Need to disconnect if moving patient. Remember to reconnect after session.
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Selected Pt Emergencies
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