BAY AREA COLLEGE OF NURSING

Module 12: Emergency Procedure

I. Terminology A. ABCs B. Airway C. Agitation D. Aspirate E. Breathing F. Cardiac Arrest G. Circulation H. Cyanosis I. J. Diaphoresis Code Situation

K. CPR L. Dyspnea M. Heimlich Manuever N. Hemorrhage O. Insulin Shock P. Pallor Q. Respiratory Arrest R. Respiratory Distress S. STAT

T. Unconscious U. DNR II. Common signs and symptoms of conditions associated with resident distress and the CNAs role and responsibility in preventing and/or responding.

A.

Heart attack myocardial infraction, a disruption of the flow of blood to an area of the muscle of the heart with subsequent death of the tissue at that area. 1. Signs and symptoms a. Chest pain b. SOB c. Diaphoresis 2. CNA Role a. Call for help loudly and pull the emergency light if available. b. Remain calm. c. Stay with the resident. d. Place resident in comfortable position (some heart attack victims can breathe easier in a sitting rather than lying position) e. Reassure the resident. f. Intervene at level of competence as directed by RN. g. Assess condition and vital signs while awaiting assistance from RN. h. Keep the resident warm as needed.

B. Stroke cerebrovascular accident; a disturbance or obstruction of the flow of blood to a particular area of the brain with subsequent death of tissue. 1. Signs and symptoms a. Hemiplegia or weakness of one side of the body b. Difficulty in speaking or understanding speech. c. Headache 2. CNA role a. Call for help loudly and pull emergency call light if available. b. Remain calm. c. Stay with the resident. d. Place resident in a position of comfort. e. Reassure resident. f. Intervene at level of competence as directed by the RN. g. Assess residents condition and take vital signs while awaiting assistance from the RN. h. Keep resident warm as needed.

C. Fainting episode syncope; a feeling of dizziness with possible temporary loss of consciousness 1. Signs and symptoms a. Pallor or paleness of the skin b. Cool, moist skin c. Eyes may roll back d. Unsteadiness or loss of upright position (resident may fall) 2. CNA Role a. Assist to floor if resident begins to fall, protecting resident from injury. b. If sitting, place residents head down between his knees. c. Remain calm, call for help loudly, and pull emergency call light. d. Raise residents legs approximately 8 inches. e. Loosen tight or binding clothing. f. Observe for any changes in condition and monitor vital signs while waiting for help to arrive. D. Seizure convulsions or epilepsy; an interference with the normal electrical activity of the brain with subsequent changes in mental status. 1. Signs and symptoms a. A mild blackout; looks as though daydreaming b. Uncontrolled muscular contractions (can be minimal to major with possible violent head jerking) 2. CNA Role a. Assist resident to ground safely. b. Remain calm, call for help loudly and pull emergency call light. c. Stay with resident and observe, gently turning head to one side. d. Pad any items that may be dangerous to the resident or move items away from resident (i.e. furniture) e. Do NOT attempt to restrain or put anything into residents mouth.

E. Insulin shock hypoglycemia; condition resulting from an overdose of

insulin resulting in reduction of the blood sugar level below normal. 1. Signs and symptoms a. Pale, moist skin b. Rapid bounding pulse. c. Headache, confusion, weakness d. Unconscious 2. CNA Role a. Stay with resident. b. Remain calm, call for help loudly and pull emergency call light. c. Administer orange juice, milk or snack if instructed by charge nurse.

F. Hemorrhaging bleeding; an extreme or unexpected loss of blood

1. Signs and symptoms. a. External bleeding

1) Bleeding in spurts (arterial) 2) Steady flow of blood (venous) 3) Slow oozing of blood (capillary) b. Internal bleeding 1) Coughing up bright red blood. 2) Vomit that has the appearance of coffee grounds. 3) Blood in urine or stool (stool may be black and tarry in appearance) 2. CNA Role 1) Remain calm, call for assistance loudly and pull emergency call light. 2) Stay with resident. 3) Apply direct pressure, with gauze pad, over area that is bleeding. 4) Elevate affected limb. 5) Do not offer food or drink. 6) Cover resident to keep him warm.

G. Shock failure of the cardiovascular system to provide sufficient blood

circulation to every part of the body. 1. Signs and symptoms a. Skin pale, cold and clammy or moist b. Pulse rapid (over 100) and weak c. Respiration shallow, irregular or labored d. Eyes dull and lackluster. e. Nausea, anxiety or thirst f. May collapse (faint) or vomit 2. CNA Role a. Remain calm, call for help loudly and pull emergency call light. b. Stay with resident. c. Maintain an open airway (head tilt-chin lift or modified chin lift). d. Do not give food or drink. e. Cover resident to keep him warm.

H. Respiratory Distress 1. Signs and symptoms a. Shortness of breath (S.O.B.) b. Cyanosis c. Dyspnea d. Tachypnea e. Anxiety confusion 2. CNA Role a. Stay with resident. b. Elevate HOB, or allow resident to assume position of comfort. c. Remain calm, call for help and pull emergency call light. d. Reassure/calm resident. e. Assess vital signs while awaiting assistance from RN. f. Be prepared to gather equipment as instructed by nurse; i.e. oxygen tank and tubing

III.

The immediate intervention in a medical emergency A. Know residences code status 1. Full code 2. DNR Immediate interventions: 1. Check to see if resident is conscious. 2. Airway open if resident is unconscious 3. Breathing: a. Check for circulation by feel for a pulse. b. Give two breaths. 4. Circulation: a. Check for circulation for feel for a pulse. b. Give compressions. 5. Mask a mask must be used by the CNA to do rescue breathing

B.

C.

General rules for emergency situation with a resident: 1. Stay calm. 2. Call for help gain assistant of RN. 3. Remain with resident. 4. Intervene at level of competence as directed by RN. 5. Reassure/calm resident.

IV.

Causes and signs of choking and discuss the use of the Heimlich maneuver A. Airway obstruction or choking can lead to cardiac arrest. It can caused by: 1. Foreign body such as poorly chewed pieces of meat. 2. Tongue in the unconscious resident the tongue can fall backward in the throat and block the airway. 3. Small object. 4. Vomitus aspiration of vomit 5. Dentures B. Signs of choking: 1. Respiratory difficulty victim can not breathe 2. High pitched sounds 3. Inability to speak or cough. 4. Universal choking sign victim clutches throat C. Heimlich maneuver is used to relieve obstructed airway. Refer to manual skills procedure Heimlich Maneuver for Conscious and Unconscious Victim (pp. 12.10 12.11)

V.

Common emergency codes used in long-term care facilities