Chpt 9 Care of Pt's w Environmental Emergencies Flashcards Preview

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Flashcards in Chpt 9 Care of Pt's w Environmental Emergencies Deck (23):

Heat Related Illnesses causes by what 2 factors?

Environmental temp Above 95 F (35 c)
Humidity above 80%


Who's at risk for Heat stroke/ Exhaustion?

o Older adults
o Those with mental health conditions
o People who work outside, such as construction & agricultural workers (more men than women)
o Homeless people
Strenuous exercise, seizures, Burns
o Illicit drug users (especially cocaine users)
o Outdoor athletes (recreational and professional)
o Members of the military who are stationed in countries with hot climates (e.g., Iraq and Afghanistan)
Comorbidities- obesity, Heart Dx, Fever 101 (older adults 99-96)
Meds S/E: Lithium, Antipsychotics, Beta Blockers, Anticholinergistic, ACE inhibitors, Diuretics ; increase risk for heat-related illnesses n increase K+ loss, digoxin


Health Promotion and Maintenance Preventions

1. Avoid ETOH & caffeine
2. Use sunscreen SPF 30
3. Rest freq in hot environments
4. Wear light weight/colored clothes/ loose fitting
5. Modify activities outdoors w/in physical limitations
6. Take cool baths
7. Stay indoors/air-conditioned rooms
8. Ask neighbors/family/friends to check on elderly 2wice daily during heat waves.


What is Heat Exhaustion? Path

is a syndrome primarily caused by dehydration,
heavy sweating (loose sodium)
inadequate fluids and electrolyte intake (hypoNatremia).


S/S of Heat Exhaustion?
Clinical Manifestations?

flu-like symptoms with headache, weakness, nausea, and/or vomiting.
If untreated: STROKE!!!


Difference btw Heat Exhaustion and Heat Stroke?

Body temp NOT elevated with Heat Exhaustion, patients may still perspire despite dehydration.


Nursing Safety Priority (QSEN) for Heat Exhaustion?
Assess patient for?

Assess the patient for orthostatic hypotension and tachycardia, especially the older adult who is predisposed to rapid dehydration. Older adults who are already dehydrated often experience acute confusion and are at risk for falls.


Patient-centered Collaborative Care for Heat Exhsaustion?

Treat the patient by
1. immediately stopping physical activity
2. moving him or her to a cooler place,
3. cooling measures (Place Ice packs on neck, chest, abdomen & groin)
4. Soak Pt w/ cool water & fan while spraying
5. Remove constrictive clothing
6. Oral ReHydration ( sports drink/ oral hydration therapy solution. PLAIN H2O= worsen Na deficit.
7. DONT give salt tabs ( irritate stomach, N/V)
8. if s/s permit transport to Hospital via 911


What does RN Do to treat Heat Exhaustion IMMEDIATELY?
In Clinical setting?

1. Monitor VS
2. Rehydrate with IV 0.9% saline (Isotonic) if N/V persist
3. Draw Bloods for Serum electrolytes analysis.


Monitor Treatment of Rehydration by?

1. Monitor fluid therapy q2hrs
2. monitor weight q8hrs
3. Monitor pulse pressure/quality/ urine output
4. Assess IV site hourly


Monitor fluid overload by:

1. bounding pulse
2. difficulty breathing
3. Neck vein distention in upright position
4. Check for edema


Physical assessment of dehydration incl?

1. Cardiovascular changes ( increase Heart rate)
2. Peripheral pulses weak ( less Bld volume)
3. BP decreases ( norm 120/80)
4. RR q2hrs ( increased) try to keep O2 b/c decreased perfusion
5. Skin ( turgor is poor, dry skin, mucous dry & sticky, tougne old have deep furrows)
6. Neuro Changs ( Confusion, bizzarre behavior, low grade fever)
7. Fever of 102 and longer for 6 hrs ( every degree over the body looses minimum of 500 mL of fluid) pg 157
8. Kidney changes ( Specific gravity greater than 1.030)
9. Urine output less than 500 mL/day( 30mL/hr) is cause for concern
10. Weight loss of 1/2 lb per day is fluid loss


Laboratory Assessment findings w/ Dehydration?

1. Elevated Hbg
2. Elevated Hct
3. Elevated Serum osmolarity ( norm 270-300 mOsm)
4. Glucose
5. Protien
6. BUN


Rehydration treatment effective if?

Pulse pressure changes from 22 mm Hg to 32 mm Hg (pg 158)


Also ASSESS With Dehydration, Hypo/Hyper- Kalemia?

K- (N = 3.5 - 5) if infusing 5-10 never exceed 20 mEq/hr,
hypokalemia- if below 2.9

s/s : absent of peristalsis ( paralytic ileus), shallow RR, muscle weakness, weak pulse, short term irritability, acute confusion, Abd distention, S-T depression, flat/ inverted T waves, increased U wave. ask client if on diuretic or laxative ( pg 165) NCLEX CHALLENGE

Hyperkalemia- if over 5.0 ,

s/s HR less than 60bpm ( notify Rapid Response team!!! w/P wave absent, T waves tall) , QRS widen, deep tendon reflex hyperactive, bowel sound hyper, numbness/tingling hand/feet & around mouth, anxious,


Normal Electrolyte Values

Na+ 135-145 mEq/L
K+ 3.5-5.0 mEq/L
Ca+ 9-10.5 mg/dL
Cl- 98- 106 mmol/L
Mg+ 1.3- 2.1 mEq/L
P 3- 4.5 mg/dL


Heat Stroke

Body temperature may exceed 104° is a true medical emergency


Exertional heat stroke

sudden onset and is often the result of strenuous physical activity in hot, humid conditions.


Classic heat stroke

occurs over a period of time as a result of chronic exposure to a hot, humid environment.


Patient Collaborative Care
Assessment for Heat Stroke?

1. Mental status changes occur as a result of thermal injury to the brain. Manifestations can include confusion, bizarre behavior, seizures, or even coma.

2. VS Abnormalities- Hypotension, Tachycardia, Tachypnea

3. Cardiac Troponin I levels freq elevated w/ classic heat stroke ( non-exertional)
NOTE: Severe incr greater than 1.5 ng = severe myocardial damage + decreases pt chance of survival after 1 yr.


What are complications of Classic Heat Stroke? That can lead to death

Multiple Organ Dysfunction Syndrome (MODS)
Renal Impairment
Electrolyte and acid imbalances
Coagulopathy (Abnormal clotting)
Pulmonary Edema
Cerebral Edema


What are Heat Stroke interventions at Hospital?

1. Give O2 by mask/cannula, endotracheal Intubation

2. Start Lrg bore IV, 0.9% NaCl solution

3. DONT GIVE ASPIRIN or antipyretics.

4. Assess rectal temp q15 mins

5. Insert urinary catheter, I/O & specific gravity

6. Monitor VS, Obtain labs, cardiac enzymes, electrolytes, liver enzymes, CBC. aterial bld gases
7. PT shivering, admin benzodiazepine ( muscle relaxant)

8. STOP cooling measures when 102 f (39 c)reached.


What is internal cooling methods?

Iced gastric and bladder lavage