Emergency nursing book pdf free download

With Stuvera where there are no restrictions whatsoever you cam access all the books you want in PDF frmat for free and all this and more is just a fingertip away. Visit Stuvera and find what yo want. Emergency Nursing Made Incredibly Easy! It covers emergency care basics including patient assessment and triage, trauma, disease crises, and patient and family communication, as well as legal issues such as handling evidence and documentation and holistic issues such as pain and end-of-life care.

Nursing Assessment x Monitor for signs of increased ICP—altered LOC, abnormal pupil responses, vomiting, increased pulse pressure, bradycardia, and hyperthermia. Tachycardia with hypotension is indicative of hypovolemia; the patient should be evaluated for additional source of blood loss. Cervical collar and spine precautions should be maintained until spinal fracture has been ruled out.

A significant number of patients are under the influence of alcohol at the time of injury, which may mask the nature and severity of the injury. Administer the treatment for arrhythmias if patient is symptomatic. Evaluate for additional source of blood loss if the patient is tachycardic and hypotensive.

Identify emerging trends in neurological function, and communicate findings to medical staff. Institute nursing measures that have been found to be helpful, such as maintaining normothermia, pre treating before known triggers, applying cool compress to the forehead, and providing relaxing music. If due to Diabetes Insipidus DI, administer pitressin replacement therapy. This is done by careful positioning; to avoid flexing head, reducing hip flexion can reduce venous drainage, causing congestion ; and spreading out care evenly over hour period.

Be alert to triggers suctioning, turning, hyperthermia, infection, auditory stimuli , and treat promptly to control symptoms. Close monitoring of laboratory values is indicated to evaluate trends and maintain normal range. Hypernatremia and hyponatremia should not be reversed quickly, because the rapid change can create rebound cerebral edema and be detrimental to the patient.

Maintaining Respiration: x Monitor respiratory rate, depth, and pattern of respirations; report any abnormal pattern, such as Cheyne-Stokes respirations or periods of apnea. Administer H2-blocking agents to prevent gastric ulceration and hemorrhage from gastric acid hyper secretion. Insulin I. Recognize that any patient with coma is at risk for swallowing difficulties. Assessment of swallowing function decreases risk of aspiration.

Speech therapy is essential for retraining and developing adaptive techniques. Consult your dietitian to institute nutritional support within the first 2 to 3 days after injury to support the recovery process. Weight loss is generally in the form of muscle loss and can be as much as 25 to 30 lb Promoting Cognitive Function Preventing Injury: x Instruct the family regarding the behavioral phases of recovery from brain injury, such as restlessness and combativeness.

Maintain constant vigilance, and avoid restraints if possible. Neurological Disorders 87 x Provide adequate light if patient is hallucinating. Strengthening Family Coping: x Consult with social worker or psychologist to assist the family in adjusting to patient's permanent neurological deficits.

TABLE 3: American Academy of Neurology Guidelines for Sports-Related Concussion Severity Recommendations Grade 1 Transient confusion without loss of x Removal from game and only returned to the game if consciousness and resolution of remains asymptomatic after 15 minutes x If second grade 1 concussion occurs, removal from sports symptoms within 15 minutes activity until asymptomatic for 1 week Grade 2 Transient confusion without loss of x Removal from sporting event and further workup if consciousness and symptoms symptoms do not resolve in 1 week.

If grade 2 occurs after a grade 1 concussion, removal from sporting event and no sporting activities for 2 weeks Grade 3 Loss of consciousness x Removal from sporting event. Return to sporting activities if asymptomatic for 1 week brief loss of consciousness x Return to sporting activities if asymptomatic for 2 weeks prolonged loss of consciousness Unconsciousness with neurological findings should be transported to nearest emergency for full evaluation. The most common sites are the cervical areas C5, C6, and C7, and the junction of the thoracic and lumbar vertebrae, T12 and L1.

Injury to the spinal cord may result in loss of function below the level of cord injury. SCI requires comprehensive and specialized care. Table 4: Incomplete Spinal Cord Clinical Syndromes Syndrome Affected Site Deficit Preservation Central Central cervical More motor deficit in upper Sacral sensory; lower cord spinal cord extremities than lower extremities have better motor extremities caused by medial function than upper extremities damage of corticospinal tract.

Brown- Hemi section of Ipsilateral motor function and Ipsilateral sensory function of Sequard spinal cord fine touch, vibration, and pain and temperature proprioception posterior spinothalamic tract ; contra tract ; contra lateral sensory lateral motor function, fine function pain and temperature touch, vibration, and spinothalamic tract.

Anterior Main anterior Variable motor deficit; Posterior one-third of spinal cord spinal artery of variable sensory deficit of cord posterior spinal artery ; anterior spinal cord pain and temperature sensory function of affecting anterior spinothalamic tract. Cauda Lumbosacral nerve Variable motor deficit; bowel, Lesions proximal to level of equina roots in spinal cord bladder, and lower extremity injury may be reflexic e.

The extent of the deficits may increase due to edema and hemorrhage. Later, increasing neurological deficits and pain may indicate development of syringomyelia.

Nursing Diagnoses x Ineffective breathing pattern related to paralysis of respiratory muscles or diaphragm. Nursing Interventions Attaining an Adequate Breathing Pattern: x For patients with high-level lesions, continuously monitor respirations and maintain a patent airway. Be prepared to intubate if respiratory fatigue or arrest occurs.

Teach effective coughing; if patient is able. Assisted Coughing Many patients with tetraplegia have an impairment of the diaphragmatic and intercostal muscles. The result is a weak or ineffective cough. To increase the mechanical effectiveness of the patient's cough, perform or teach the assisted cough techniques: x Place the patient in supine, low semi-Fowler's position.

Allow your hands to move with the patient. Promoting Mobility: x Place the patient on a firm kinetic turning bed until spinal cord stabilization occurs. After stabilization, turn every two hours on a pressure reduction surface, ensuring good alignment.

Functional electrical stimulation may facilitate independent standing and ambulation. Protecting Skin Integrity. Promoting Urinary Elimination. Promoting Bowel Elimination. SCI patients are more vulnerable to anticholinergic adverse effects and orthostatic hypotension. In addition, numerous potential drug reactions are associated with monoamine oxidase inhibitors and SCI. Reducing Pain: x Assess pain using consistent pain scale.

Report changes from baseline or new location or type of pain. Seizures are thought to result from disturbances in the cells of the brain that cause cells to give off abnormal, recurrent, uncontrolled electrical discharges. Emergency Management of Status Epilepticus Status epilepticus acute, prolonged, repetitive seizure activity is a series of generalized seizures without return to consciousness between attacks.

Status epilepticus is considered a serious neurological emergency. It has high mortality and morbidity permanent brain damage, severe neurological deficits. Factors that precipitate status epilepticus in patients with preexisting seizure disorder include: medication withdrawal, fever, metabolic or environmental stresses, alcohol or drug withdrawal, and sleep deprivation. Nursing Interventions x Establish airway, and maintain blood pressure BP.

Diagnostic Evaluation x Electro encephalogram EEG with or without video monitoring—locates epileptic focus, spread, intensity, and duration; helps classify seizure type.

Management x Pharmacotherapy—AED selected according to seizure type. Complications x Status epilepticus. Nursing Assessment x Obtain seizure history, including prodromal signs and symptoms, seizure behavior, postictal state, and history of status epilepticus. Obtain drug levels before implementing medication changes.

Nursing Diagnoses x Ineffective tissue perfusion cerebral related to seizure activity. Guidelines for the early management of adults with ischemic stroke. Stroke Guide to care of the patient with intracerebral pressure monitoring.

Glenview, Ill. Guide to care of the patient with lumbar drain. Neurological assessment of the older adult: A guide for nurses. Update on the treatment of spinal cord injury. Progress in Brain Research Neuroscience nursing: A spectrum of care 3rd ed. Greenville, Del. Stroke, ischemic. Severe traumatic brain injury: Evolution and current surgical management.

Respiratory management during the first five days after spinal cord injury. Journal of Spinal Cord Medicine Handbook of neurocritical care. Totowa, N. J: Humana Press. EFNS guidelines on management of narcolepsy. European Journal of Neurology Guidelines for the management of severe traumatic brain injury. New York: BTF. Drug therapy for pain in amyotrophic lateral sclerosis or motor neuron disease. Cerebral aneurysms. New England Journal of Medicine 9 Guideline for the management of spontaneuous intracerebral hemorhage in adults.

Glioblastoma multiforme. Available: 5 Neurological Disorders 97 www. Corticosteroids for the long-term treatment in multiple sclerosis. Parkinson's disease. Management of amyotrophic lateral sclerosis. Drugs Combination therapies for multiple sclerosis: Scientific rationale, treatment trials and clinical practice. Current Opinion in Neurology Fever, febrile seizures and epilepsy. Trends in Neurosciences EFNS guidelines on the use of neuroimaging in the management of multiple sclerosis.

The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson's disease.

Neurology Role of screening tests for deep venous thrombosis in asymptomatic adults with acute spinal cord injury: An evidence-based analysis. Spine Optimal treatment for severe neurogenic bowel dysfunction after chronic spinal cord injury: A decision analysis. British Journal of Surgery Gauser, T. International League Against Epilepsy treatment guidelines. Evidence- based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes.

Epilepsie 47 7 Handbook of neurosurgery 6th ed. New York: Thieme. The clinical practice of neurological and neurosurgical nursing 5th ed. Assessment and management of chronic pain. Bloomington, Minn. Herniated lumbar disc. Clinical Evidence Evidence-based approach to the medical management of trigeminal neuralgia.

British Journal of Neurosurgery Treatment and treatment trials in multiple sclerosis. Cerebellar and thalamic stimulation treatment for epilepsy. Acta Neurochirurgica Textbook of neurointensive care. Saunders, Co. Community-acquired bacterial meningitis in adults: Antibiotic timing in disease course and outcome. Infection Fluid therapy for acute bacterial meningitis.

Diagnosis and treatment of myasthenia gravis. The Consult Pharmacist Physical activity and neuroprotection in amyotrophic lateral sclerosis. NeuroMolecular Medicine Amyotrophic lateral sclerosis. Practice parameter: Evaluation and treatment of depression, psychosis, and dementia in Parkinson disease an evidence-based review : Report of the Quality Standards Subcommittee of the American Academy of Neurology.

Spinal cord injury: A guide for living 2nd ed. Responding to primary brain tumor. Nursing 37 1 Acute management of autonomic dysreflexia: Individuals with spinal cord injury presenting to health-care facilities. Washington, D.

Prevention of thromboembolism in spinal cord injury. Neuroscience 4th ed. Sunderland, Mass. Ophthalmic management of facial nerve palsy: A review. Survey of Ophthalmology Management and rehabilitation of neuropathic bladder in patients with spinal cord lesion. Parkinson's disease and dopaminergic therapy—differential effects on movement, reward and cognition. Brain Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack.

Vagus nerve stimulation for intractable epilepsy: Outcome in two series combining 90 patients. Treatment of psychosis in Parkinson's disease. Cochrane Database of Systematic Reviews. Guidelines for the treatment of autoimmune neuromuscular transmission disorders.

Viral encephalitis: A clinician's guide. Practical Neurology Viral encephalitis: A review of diagnostic methods and guidelines for management. Factors related to fatigue in multiple sclerosis. International Journal of MS Care A medical overview of encephalitis. Neuropsychological Rehabilitation Dopamine agonist therapy in early Parkinson's disease. Practice parameter: Diagnosis and prognosis of new onset Parkinson disease an evidence-based review : Report of the Quality Standards Subcommittee of the American Academy of Neurology.

Outcome evaluation of surgical and nonsurgical management of lumbar disc protrusion causing radiculopathy. Therapeutic advances in narcolepsy.

Sleep Medicine The stroke book. Cambridge, Mass. Part I: Spinal-cord neoplasms-intradural neoplasms. Lancet Oncology Metastatic disease to the brain. Available: emedicine. Epilepsia Presentation and management of psychosis in Parkinson's disease and dementia with lewy bodies.

American Journal of Psychiatry Degenerative conditions: Treatment challenges in Parkinson's disease. The Nurse Practitioner, 33 7 , Evidence-Based Cerebral Vasospasm Management. The GI system is responsible for the following essential body functions: x Ingestion and propulsion of food.

Common manifestations include nutritional problems, abdominal pain, indigestion, nausea and vomiting, diarrhea, constipation, change in bowel habits, weight loss, and dysphasia.

Periodically reassess for bowel sounds, bloating, nausea, vomiting, and abdominal distension or tenderness. If a recent weight change, how many pounds? History x Any history of eating disorders? Physical examination x Inspection of the abdomen. Deep palpation in noted areas of tenderness or pain should be performed last. Key Findings x Tenting of the skin when the skin is rolled between thumb and index finger. Tenting may indicate dehydration. Two physical assessment skills that may help to confirm the presence of ascites are testing for shifting dullness and testing for a fluid wave.

Radiology and imaging studies x Barium meal and small-bowel Series. Endoscopic procedures x Capsule endoscopy. Instruments passed through the scope can be used to perform a biopsy or cytological study, remove polyps or foreign bodies, control bleeding, or open strictures. There is a risk of trapping the capsule, delayed passage, or impaired peristalsis.

Pacemakers or implanted defibrillators may alter the quality and quantity of study information. Purposes of Enema Administration x Bowel preparation for diagnostic tests or surgery to empty the bowel of fecal content. Nursing and Patient Care Considerations x If the patient is unconscious, advance the tube between respirations to make sure it does not enter the trachea.

Cyanosis indicates the tube has entered the trachea. After repositioning, always check for placement. Coffee ground-like contents may indicate GI bleeding. Report findings immediately. When possible, medications should be given in liquid form. If the tube is in the trachea, the patient could aspirate. Etiology External Stab or bullet wounds, crush injuries, or blunt trauma. Internal Swallowed foreign objects coins, pins, bones, dental appliances, caustic poisons.

Spontaneous or post emetic rupture Usually in the presence of underlying esophageal disease reflux, hiatus hernia. Mallory-Weiss syndrome. Nonpenetrating mucosal tear at the gastro esophageal junction.

Caused by an increase in transabdominal pressure from lifting, vomiting, or retching. Alcoholism is a predisposing condition.

Nursing Assessment Assess the following to determine status of patient: x Vital signs. Nursing Diagnoses x Deficient fluid volume related to blood loss from injury. Assess respiratory rate, depth, use of accessory muscles, and skin color. Patient Education and Health Maintenance x Instruct the patient on the indications and adverse effects of analgesics. Bleeding is a symptom of an upper or lower GI disorder. It may be obvious in emesis or stool, or it may be occult hidden. Characteristics of Blood.

Intra-arterial vasopressin can be used to slow or stop active bleeding from the diverticulum or vascular ectasia. Advance diet as tolerated. Diet should be high- calorie, high-protein. Frequent, small feedings may be indicated.

Evaluation Expected Outcomes: x Intake and output equal, vital signs stable. The block may occur in the small or large intestine, may be complete or incomplete, may be mechanical or paralytic, and may or may not compromise the vascular supply. Obstruction most frequently occurs in the young and the old.

High small-bowel jejunal or low small-bowel ileal obstruction occurs four times more frequently than colonic obstruction.

Causes include: o Extrinsic—adhesions from surgery, hernia, wound dehiscence, masses, or volvulus twisted loop of intestine. In nonsurgical patients, hernia most often inguinal is the most common cause of mechanical obstruction. Postoperatively after any abdominal surgery.

Peritonitis, pneumonia. Wound dehiscence breakdown. GI tract surgery. Strangulation—obstruction compromises blood supply, leading to gangrene of the intestinal wall. Caused by prolonged mechanical obstruction. May show presence and location of small or large intestinal distention, gas or fluid. Nursing Assessment x Assess the nature and location of the patient's pain, the presence or absence of distention, flatus, defecation, emesis, or obstipation.

ALERT Watch for air-fluid lock syndrome in elderly patients, who typically remain in the recumbent position for extended periods. Nursing Diagnoses x Acute pain related to obstruction, distention, and strangulation. Nursing Interventions x Achieving pain relief. Evaluation: Expected Outcomes x Maintains position of comfort, states pain decreased to 3 or 4 level on 0-to scale.

Nursing Assessment x Obtain history for location and extent of pain. Assess for rebound tenderness in the right lower quadrant, as well as, referred rebound pain when palpating the left lower quadrant. Inflammation of the psoas muscle in acute appendicitis will increase abdominal pain with this maneuver. Hypogastric pain with this maneuver indicates inflammation of the obturator muscle.

Evaluation: Expected Outcomes x Verbalizes decreased pain to 2 or 3 level on 0-to scale with positioning and analgesics. Nursing Assessment x Ascertain bowel function by assessing for abdominal distention and tenderness, guarding, rebound tenderness, hypoactive or absent bowel sounds. Nursing Diagnoses x Acute pain related to peritoneal inflammation. Nursing Interventions x Achieving Pain Relief x Place the patient in semi-Fowler's position before surgery for less painful breathing. Your role in managing Crohn's disease.

The Clinical Advisor Researching the management of constipation in long-term care: Part 1. British Journal of Nursing 16 18 Researching the management of constipation in long-term care: Part 2. British Journal of Nursing 16 19 The risk of retention of the capsule endoscope in patients with known or suspected Crohn's disease.

American Journal of Gastroenterology 10 American College of Gastroenterology Guideline on the management of Helicobacter pylori infection. American Journal of Gastroenterology Increased diagnostic yield of small bowel tumors with capsule endoscopy.

Cancer Ten-year follow-up after laparoscopic Nissen fundoplication for gastroesophageal reflux disease. The American Surgeon 73 8 Managing patients with diverticulitis. The Practitioner , Gastrointestinal Edoscopy 62 5 A comparison of polyethylene glycol laxative and placebo for relief of constipation from constipating medications.

Southern Medical Journal 11 Small bowel adenocarcinoma complicating Crohn's disease: Case series and review of the literature. The American Surgeon 73 11 Gastroenterology The use of aspirin for primary prevention of colorectal cancer: A systematic review prepared for the U. Preventive Services Task Force. Annals of Internal Medicine Preparation of patients for GI endoscopy. Gastrointestinal Endoscopy 57 4 Mastery of surgery. Treatment options for irritable bowel syndrome.

The Nurse Practitioner 32 7 Endoscopic placement of the small-bowel video capsule by using a capsule endoscope delivery device. Gastrointestinal Endoscopy Inherited risk for colorectal cancer: Practical approaches for identification, referral and management. Practical Gastroenterology 31 9 What is the best treatment for chronic constipation in the elderly? The Journal of Family Practice 56 12 CT colonography versus colonoscopy for the detection of advanced neoplasia.

Outcome analysis of patients undergoing colorectal resection for emergent and elective indications. The American Surgeon 73 10 Esophageal cancer: Adjuvant therapy. The Cancer Journal 13 3 Ulcerative colitis: Diagnosis and treatment. American Family Physician 76 9 Functional bowel disorders. Gastroenterology 5 Reflux, dyspepsia, and disorders of the foregut. Southern Medical Journal 3 Adjuvant and neoadjuvant approaches in gastric cancer. Practice parameters for sigmoid diverticulitis.

Diseases of the Colon and Rectum Chronic laryngitis and gastroesophageal reflux disease. Guide to discussing the risks of immunodulator and anti-TNF therapy with inflammatory bowel disease patients. Practical Gastroenterology 31 11 Managing chronic constipation from constipating medicines. Nasogastric intubation. New England Journal of Medicine 17 :e Management of Crohn's Today-The European perspective.

In the clinic: Irritable bowel syndrome. New post-polypectomy surveillance guidelines. Practical Gastroenterology 31 8 Their function is to aid in digestion through the delivery of bile and enzymes to the small intestine. The liver plays additional roles in detoxification of chemicals and synthesis and storage of important nutrients. The pancreas also functions as an endocrine gland. Major liver, biliary, and pancreatic problems can be differentiated by clinical manifestations and thorough history taking and physical examination.

Question the patient about the relationship of the pain to eating or to position. Bilirubin is a product of the breakdown of hemoglobin. Direct conjugated —soluble in water. Total serum Bilirubin 0. Urine Bilirubin Not normally found in urine, but if direct None 0 x Tea-colored urine. Confirm with Ictotest tablet or dipstick. Related to the 1 mg in 2-hour collected over 24 hours amount of Bilirubin excreted into bile. If the patient is receiving antimicrobials, mark the laboratory slip, because the production of Urobilinogen can be falsely reduced.

Albumin—produced by liver cells. Globulin—produced in lymph nodes, 2. It may also be prolonged in malabsorption of fat and fat-soluble vitamins, in which case it will return to normal with vitamin K.

In cholestasis or in obstructive jaundice, obstruction, increased synthesis of the intrahepatic cholestasis, enzyme causes very high levels in blood. Also elevated in osteoblastic diseases, Paget's disease, and hyperparathyroidism. Enzyme Production These enzymes are found in high concentration in the liver as well as some other tissues.

Liver injury results in enzyme release into the blood. In the event of acute respiratory distress, use the scissors to cut across tubing to deflate both balloons and remove tubing. Note: This procedure should be reserved for patients who are known, without a doubt, to be bleeding from esophageal varices and in whom all forms of conservative therapy have failed.

Nursing Diagnoses x Ineffective tissue perfusion related to GI bleeding. Cut tubing and remove esophageal balloon immediately if patient develops acute respiratory distress. Evaluation: Expected Outcomes x BP stable; urine output adequate. It generally occurs after major surgical procedures, severe trauma, or burns. Results from repeated attacks of cholecystitis, calculi, or chronic irritation.

More commonly they remain in the common bile duct and can cause obstruction, resulting in jaundice and pruritus. Nursing Assessment x Obtain history and demographic data that may indicate risk factors for biliary disease.

Read the overview below and download using links given at the end of the post. The most popular pocket reference in emergency nursing now in a new edition. Updated information on topics like poisons, emergency medications, ECG rhythm strips, Common drugs sections, pediatric medications.

It is a well written emergency book. The book is helpful for all medical students, post graduate doctors, physicians as well as for nurses. We hope that you will fined it usefull and download the book in pdf format from the link given.