NSER 7110 Final Exam with Accurate
Solutions
describe unique qualities of emergency nursing practice. - ANSWER-Diverse: patients
of all ages, cultural and social groups seek treatment in emergency departments.
Time-limited: assess patients in crisis
Health Promotion: look to share information in relation to health promotion and injury
prevention
Urgency: related to patient acuity, scare resources, rapid patient turnover, and
unpredictability.
Uncertain and Ambiguous: entry point for many patients, "found down" in back of alley.
Describe the roles of the various members of ED health care teams. - ANSWER-Triage
nurse: triage nurses are the first in health care professionals to meet patients and that
initial interaction often sets the tone for the entire ED visit.
charge nurse: aka Assistant Head Nurse (AHN), the team leader (TL), or patient care
coordinator (PCC) organizes and coordinated the flow of patients through the ED while
providing leadership to the team.
Licensed practical nurse: works in fast track or walking wounded area, and may provide
care for patients who have been admitted to hospital.
emergency physician: Causality officer (CO), is a specialist in resuscitation,
management of major trauma
RT. Forensic nurse examiner: may provide expertise in sexual assaults, child abuse,
geriatric neglect and patient care facilities, interpersonal violence issues/events,
forensic mental health, death investigation, human trafficking, and public health and
safety.
Geriatric emergency nurse (GEN): advanced practice nurse who identifies geriatric
issues, assists elderly patients in navigating the health-care system, and aids in
planning for safe patient discharges. Nurse practioner: NP.
,Analyze the socio-political factors that influence the current state of EDs. - ANSWER--->
Vast cuts to health care services over the past thirty years have resulted in the ED
acting as the gate keeper for a large portion of acute care services.
--> A key role of ED health care professionals is to provide unbiased care to everyone
who presents.
--> These "marginalized" or "at risk" populations are amongst the most vulnerable in our
society for several reasons; they may have chronic diseases, a lack of support systems,
and/or limited financial resources.
1. explain common, emergent conditions that present with the symptom of abdominal
pain. - ANSWER-Tension pain (visceral pain, vague, deep, and poorly localized)
Gastroenteritis (due to irritating foods or infection), constipation (increased forcefulness
of contraction, around obstructing contents), and acute pancreatitis (stretching of an
organ capsule), typically produce the clinical picture of a patient who cannot get
comfortable. The patient shifts position several times during the course of the
examination in an effort to find the most comfortable position.
Inflammatory pain (type C fibers, pain is initially perceived as vague, deep and difficult
to localize).ex: appendicitis. the pain of appendicitis is described by the patient as
midabdominal or periumbilical. As the visceral peritoneum inflames, the symptoms
remain vague and general, much like the tension pain described previously. However,
within several hours, the inflammation extends to involve the parietal peritoneum, and
the patient begins to localize the pain more readily, typically to the right lower quadrant.
Ischemic Pain: Ischemic pain is the third of the visceral pain types, and is the least
common but the most serious. Identifying ischemic pain patterns is important in terms of
avoiding serious and fatal consequences. Fortunately, when symptomatic, ischemic
pain presents as typical ischemic pain does in any other portion of anatomy. It is sudden
in onset, intense, continuous, and progressive. An additional diagnostic clue is that,
unlike other forms of abdominal pain, it is not relieved with analgesia.
outline the concept of "level of urgency" in relation to ED nursing practice. - ANSWER-
Stable patients present with normal clinical findings and a history leading to admission
that is not life or limb threatening.
Unstable patients present with abnormal clinical findings and a history that is considered
life or limb threatening.
A third category of LOU needs to be considered for all stable patients. Potentially
unstable patients may present with normal clinical findings but their history leading to
admission warrants concern and ongoing observation. The patient could deteriorate if
proper intervention is not taken.
, CTAS levels: - ANSWER-Level 1 - Resuscitation
Level 2- Emergent
Level 3 - Urgent
Level 4 - Less Urgent
Level 5 - Non-urgent
Secondary Assessment - ANSWER-1. subjective history (also known as the "history of
presenting illness" or "the story"
2. Objective assessment (also known as the "head-to-toe"
3. Focused system assessments
Primary Assessment - ANSWER-C - identify need for CPR or need to control major
bleeding
A - Airway and C-spine control
B - breathing
C - Circulation
D - Disability, Doctor, Dextrose, Discomfort
E - Expose
F - Full set of vitals signs and family presence
G - Go back and re-assess
H - subjective history, objective assessment (head-to-toe), focused system assessment
J - Journey
C - assessment and intervention - ANSWER-Assessment:
- need for CPR
- uncontrolled bleeding
Interventions:
- CPR- start BLS/ACLS/PALS
- control bleeding
A - Airway and C-spine - ANSWER-Assessment:
- look , listen and feel for air-movement
- clarity of speech
- Patency verses obstructions = stridor, gasping, wheezing, snoring, drooling, gurgling
- AVPU
- C-spine injury in trauma
Interventions:
- clear oropharynx with suctioning
- jaw thrust/chin lift
- oral/nasopharyngeal airway
- consider/prepare for advanced airway
- Spinal Motion Restriction (SMR)
Solutions
describe unique qualities of emergency nursing practice. - ANSWER-Diverse: patients
of all ages, cultural and social groups seek treatment in emergency departments.
Time-limited: assess patients in crisis
Health Promotion: look to share information in relation to health promotion and injury
prevention
Urgency: related to patient acuity, scare resources, rapid patient turnover, and
unpredictability.
Uncertain and Ambiguous: entry point for many patients, "found down" in back of alley.
Describe the roles of the various members of ED health care teams. - ANSWER-Triage
nurse: triage nurses are the first in health care professionals to meet patients and that
initial interaction often sets the tone for the entire ED visit.
charge nurse: aka Assistant Head Nurse (AHN), the team leader (TL), or patient care
coordinator (PCC) organizes and coordinated the flow of patients through the ED while
providing leadership to the team.
Licensed practical nurse: works in fast track or walking wounded area, and may provide
care for patients who have been admitted to hospital.
emergency physician: Causality officer (CO), is a specialist in resuscitation,
management of major trauma
RT. Forensic nurse examiner: may provide expertise in sexual assaults, child abuse,
geriatric neglect and patient care facilities, interpersonal violence issues/events,
forensic mental health, death investigation, human trafficking, and public health and
safety.
Geriatric emergency nurse (GEN): advanced practice nurse who identifies geriatric
issues, assists elderly patients in navigating the health-care system, and aids in
planning for safe patient discharges. Nurse practioner: NP.
,Analyze the socio-political factors that influence the current state of EDs. - ANSWER--->
Vast cuts to health care services over the past thirty years have resulted in the ED
acting as the gate keeper for a large portion of acute care services.
--> A key role of ED health care professionals is to provide unbiased care to everyone
who presents.
--> These "marginalized" or "at risk" populations are amongst the most vulnerable in our
society for several reasons; they may have chronic diseases, a lack of support systems,
and/or limited financial resources.
1. explain common, emergent conditions that present with the symptom of abdominal
pain. - ANSWER-Tension pain (visceral pain, vague, deep, and poorly localized)
Gastroenteritis (due to irritating foods or infection), constipation (increased forcefulness
of contraction, around obstructing contents), and acute pancreatitis (stretching of an
organ capsule), typically produce the clinical picture of a patient who cannot get
comfortable. The patient shifts position several times during the course of the
examination in an effort to find the most comfortable position.
Inflammatory pain (type C fibers, pain is initially perceived as vague, deep and difficult
to localize).ex: appendicitis. the pain of appendicitis is described by the patient as
midabdominal or periumbilical. As the visceral peritoneum inflames, the symptoms
remain vague and general, much like the tension pain described previously. However,
within several hours, the inflammation extends to involve the parietal peritoneum, and
the patient begins to localize the pain more readily, typically to the right lower quadrant.
Ischemic Pain: Ischemic pain is the third of the visceral pain types, and is the least
common but the most serious. Identifying ischemic pain patterns is important in terms of
avoiding serious and fatal consequences. Fortunately, when symptomatic, ischemic
pain presents as typical ischemic pain does in any other portion of anatomy. It is sudden
in onset, intense, continuous, and progressive. An additional diagnostic clue is that,
unlike other forms of abdominal pain, it is not relieved with analgesia.
outline the concept of "level of urgency" in relation to ED nursing practice. - ANSWER-
Stable patients present with normal clinical findings and a history leading to admission
that is not life or limb threatening.
Unstable patients present with abnormal clinical findings and a history that is considered
life or limb threatening.
A third category of LOU needs to be considered for all stable patients. Potentially
unstable patients may present with normal clinical findings but their history leading to
admission warrants concern and ongoing observation. The patient could deteriorate if
proper intervention is not taken.
, CTAS levels: - ANSWER-Level 1 - Resuscitation
Level 2- Emergent
Level 3 - Urgent
Level 4 - Less Urgent
Level 5 - Non-urgent
Secondary Assessment - ANSWER-1. subjective history (also known as the "history of
presenting illness" or "the story"
2. Objective assessment (also known as the "head-to-toe"
3. Focused system assessments
Primary Assessment - ANSWER-C - identify need for CPR or need to control major
bleeding
A - Airway and C-spine control
B - breathing
C - Circulation
D - Disability, Doctor, Dextrose, Discomfort
E - Expose
F - Full set of vitals signs and family presence
G - Go back and re-assess
H - subjective history, objective assessment (head-to-toe), focused system assessment
J - Journey
C - assessment and intervention - ANSWER-Assessment:
- need for CPR
- uncontrolled bleeding
Interventions:
- CPR- start BLS/ACLS/PALS
- control bleeding
A - Airway and C-spine - ANSWER-Assessment:
- look , listen and feel for air-movement
- clarity of speech
- Patency verses obstructions = stridor, gasping, wheezing, snoring, drooling, gurgling
- AVPU
- C-spine injury in trauma
Interventions:
- clear oropharynx with suctioning
- jaw thrust/chin lift
- oral/nasopharyngeal airway
- consider/prepare for advanced airway
- Spinal Motion Restriction (SMR)
