Chapter 10
Care of Patients with
Common Environmental Emergencies
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Concepts
The priority concept in this chapter is
TISSUE INTEGRITY
The interrelated concept in this chapter is
COMFORT
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Heat-Related Illnesses
High environmental temperature
High humidity
At-risk populations
Older adults
Those with mental health conditions
Those who work outside
Homeless individuals
Users of illicit drugs
Outdoor athletes
Military in hot climates
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Heat Exhaustion
Dehydration from heavy perspiration
and inadequate fluid and electrolyte
intake during heat exposure over hours
to days
Flu-like symptoms
Treatment
Stop physical activity, transfer to a cool
place
Cooling measures
Rehydration therapy
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Heat Stroke
True medical emergency
Body temp may exceed 104° F (40° C)
High mortality rate without treatment
Exertional—sudden onset; from
strenuous physical activity in hot,
humid conditions
Non-exertional (classic)—occurs over
period of time from chronic exposure to
hot, humid environment
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Heat Stroke (cont.)
Symptoms include mental status
changes, tachycardia, tachypnea
Can be fatal if untreated
Treatment
Oxygen therapy
IV lines
Urinary catheter
Continuous cooling
Benzodiazepine if shivering occurs
Monitor for multi-system organ dysfunction
syndrome, electrolyte imbalances
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Snakebites, andArthropod Bites
and Stings
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Snakebite Hospital Care
Supplemental oxygen
IV lines for NSS or RL
Continuous cardiac, BP monitoring
Opioids
Tetanus prophylaxis
Wound care
Broad-spectrum antibiotics
Baseline laboratory values with CBC,
CK, crossmatch
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Types of Venomous Snakes in
North America
Pit vipers
Rattlesnakes, copperheads, cottonmouths
Coral snakes
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Arthropods
Spiders
Scorpions
Bees
Wasps
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Table 9-2
See Table 9-2 for detailed information
about organisms, characteristics,
pathophysiology, and associated care
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Lightning Injuries
Usually highly preventable
Cardiopulmonary and central nervous
systems profoundly affected
Treatment
Immediate CPR in the field (no danger to
rescuer because victim is not charged)
Provide for advanced life support
management
ECG, CT of head, CK, tetanus prophylaxis
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Cold-Related Injury: Hypothermia
Occurs at core body temperature <95° F
(35° C)
Mild: 90 to 97° F (32 to 36° C)
Moderate: 82 to 90° F (28 to 32° C)
Severe: Below 82° F (<28° C)
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Hypothermia (Cont.)
Treatment
Shelter from the cold
Remove wet clothing
Engage in rewarming
Monitor hospitalized patients for cardiovascular
instability, ARDS, acute renal failure,
pneumonia
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Cold-Related Injury: Frostbite
Occurs when body tissue freezes and
causes tissue integrity damage
Categorized between first-degree and
fourth-degree
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Frostbite (Cont.)
Rapid rewarming
Pain control
Management of compartment syndrome
Debridement or amputation may be
needed
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Altitude-Related Illness
High altitude illness, or disease (HAD)
—“altitude sickness”
Acute mountain sickness (AMS)
High altitude cerebral edema (HACE)
High altitude pulmonary edema (HAPE)
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Acute Mountain Sickness
Assessment: Noticing
Throbbing headache
Anorexia, nausea, and vomiting
May feel like “alcohol-inducted hangover”
HACE
Apathy, ataxia, mental status changes
HAPE
Persistent dry cough
Lip and nail bed cyanosis
Pink, frothy sputum
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Acute Mountain Sickness Planning
and Implementation: Responding
Descent to lower altitude
Oxygen
Acetazolamine
Admission with possible critical care
management
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Drowning
Prevention is key
Safe rescue of victim and removal from
water
Spine stabilization
Oxygen, ET intubation, CPR,
defibrillation may be necessary
Gastric decompression
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Chapter 9
Audience Response System Questions
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Question 1
A patient brought to the ED after becoming ill
while hiking reports weakness, nausea, and
vomiting, and severe right lower leg pain.
Blood pressure is 90/60, and the right lower
leg has localized swelling and redness. What
condition does the nurse anticipate?
A.
A. Snakebite
B. Heat exhaustion
C. Altitude sickness
D. Brown recluse spider bite
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Question 2
A 24-year-old patient comes to the ED with
respiratory distress, reporting being stung by a bee
while gardening. The patient’s history includes one
prior bee sting. What is the appropriate nursing
intervention?
A.
A. Prepare to administer epinephrine IM, oral
diphenhydramine, and oxygen.
B. Remove the stinger, apply ice to the sting site,
administer oral diphenhydramine.
C. Obtain vital signs, administer oxygen, prepare to
administer epinephrine IV.
D. Establish an IV infusion with normal saline, apply
heat to the sting site, administer
acetaminophen. Copyright © 2018 Elsevier Inc. All rights reserved.
Question 3
A patient who was hiking and caught in a
blizzard is brought to the ED by friends who
report applying dry chemical warmers to the
feet. The patient is vigorously rubbing both
feet. After the ED physician diagnoses
frostbite, the nurse teaches the patient of
which further outcome?
A.
A. Reduced area of injury
B. Possible further tissue injury
C. Reduced swelling of the injured area
D. Less pain during the rewarming session
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