Fourth Year - First Semester: Our Lady of Fatima University - QC

(5) EVALUATION
DISASTER ★ MOST NEGLECTED PART → after
DISASTER: A disturbance in normal occurrence → response, we often forget to evaluate if our
alterations = not normal! actions were sufficient and effective.
- Disasters are serious disruptions to the functioning - This is essential to know if the plan is
of a community that exceed its capacity to cope effective.
using its own resources.
PSYCHOLOGICAL EFFECTS
TYPES OF DISASTER
(1) HEROIC “Buhay tayo! T^T”
(1) NATURAL - Survival (reaction)
- Environment - Survivors usually show altruistic behavior
- Any calamitous occurrence generated by in the form of rescuing, sheltering, feeding,
the effects of natural, rather than and supporting fellow human beings.
human-driven, phenomena that produces - This phase often passess quickly.
great loss of human life or destruction of (2) HONEYMOON
the natural environment, private property, - Acceptance → dramatic shift in emotion.
or public infrastructure. A natural disaster - Disaster assistance is readily available.
may be caused by weather and climate - Community bonding occurs and optimism
events or by earthquakes, landslides, and exists that everything will return to normal
other occurrences that originate at Earth’s quickly.
surface or within the planet itself. - This phase may last a few weeks.
(2) MAN-MADE: Technological, Complex, (3) DISILLUSION “Buhay tayo pero gutom! >_<”
Synergistic - Anger!
- Element of human intent, negligence, or - Community realizes the limits of disaster
error involving a failure in a man-made assistance.
system. - Optimism (from honeymoon phase) →
discouragement & stress = negative
MAN-MADE DISASTERS reactions.
- This phase can last months and even years
Technological Complex Synergistic = extended by trigger events such as the
anniversary of the disaster.
Industrial War and Conflict Two or more
(4) RECONSTRUCTION
Pollution Human Suffering agents together
- Overall feeling of recovery.
Nuclear Death that produce
- Community begins to assume responsibility
Radiation harm or damage
for rebuilding lives and people adjust to a
Toxic Wastes ex: People Power → natural +
new normal while continuing to grieve
Dam Failures = LOW man-made
losses.
Transportation ECONOMY
- This phase begins around the anniversary of
Accidents ex: Volcanic
the disaster and may continue beyond.
Factory Eruption + No
Explosion Electricity TRIAGE/TIER
Chemical Spills
Fires

FIVE (5) PHASES OF DISASTER

(1) PREPAREDNESS: Risk Assessment, Forecasting
- NO disaster
- Most important plan
★ CREATE A PLAN (best) = disaster plan
PREPAREDNESS

Risk Assessment Forecasting

A process used to identify Providing timely and

potential hazards. accurate alerts about
impending disasters.
ex: Bicol = typhoon → ● Classify according to prioritization.
near pacific ocean ● GOAL: TO SAVE LOTS OF PATIENTS.
(2) MITIGATION ● Classified INSIDE the hospital.
- NO disaster → paparating pa lang. ★ EMERGENT
- To lessen the risk/effects. - ASAP, immediate!
- Acceptance that the event will occur and - ABC: airway, breathing,
seek to reduce the inevitable impact. circulation
(3) RESPONSE - LIFE-THREATENING.
- PRESENCE of disaster - ex: Ruptured Appendicitis
- ACTION phase and IMPLEMENTATION ○ URGENT
of the plan. - 30 minutes to 2 hours
(4) RECOVERY - ex: Appendicitis
- Repair - Mabilis mamatay!
- Reconstruction ○ NON-URGENT

⋅˚₊‧ ୨ believe you can & you’re halfway there. ୧ ‧₊˚ ⋅ #RN2024
 COMPETENCY APPRAISAL 2 - First Aid Emergency Nursing
- 2 hours or MORE
POISONING
○ EXPECTANT
(Injection, Inhalation, Ingestion)
- Death & Last Resort
- Expected na mamamatay na yung (1) INJECTION
pasyente kaya hindi na mas’yadong a. Bee Sting
kelangan i-prioritize. ★ Can you use tweezers? NO!
● Classified OUTSIDE the hospital. → FIELD/ Lalabas yung katas → it may
COLOR/ MILITARY squeeze the venom sac and increase
○ Priority: AMBULATORY = para mas the amount of venom released into
marami ang ma-save na pasyente. the wound (may also cause
★ YELLOW = outside tetanus).
RED GREEN ★YELLOW BLACK
★ SCRAPE WITH BLUNT ITEM
(ATM card) - scrape then wash!
immediate delayed minimal expectant b. Jellyfish
- NEMATOCYST = stinging cells,
emergent urgent non-urgent death it contains poisonous substance
(venom) that helps jellyfish to
ASAP 30 mins. 2h UP - protect themselves.
- Secretes ALKALINE.
CARDIOPULMONARY RESUSCITATION (CPR) ★ Give ACID = vinegar
c. Snake Bite
● Cardio = HR
● Pulmonary = RR
● Resuscitation = Revive → do BLS (basic life
support)
● CPR = FOR ALL; ACLS = FOR NURSES ONLY
○ Advanced Cardiac Life Support - refers to
a set of clinical guidelines for the urgent
and emergent treatment of life-threatening
cardiovascular conditions that will cause or
have caused cardiac arrest, using advanced
medical procedures, medications, and
techniques.
● ACLS is a more sophisticated and advanced
certification course that builds on the fundamentals
of BLS. Basic life support (BLS) is performed in ** Ex: Cats - = calm ; = ready to attack
the beginning stages of the emergency while ACLS - Put on a tourniquet - DO NOT SUCK!
is the supportive medical care that healthcare - LOWER the affected area = NEVER ELEVATE
professionals use to continue treatment in the → para hindi agad pumunta sa brain ang venom.
hospital.
Bee Sting

AGE

Adult Child Infant

8 y/o ↑ 1- 7 y/o ↑ 1 y/o ↓

** 2020 - CMD → covid, prone position (CPR) due to

aerosol transmission; intubate → press → secretion OUT.

● STOP CPR if;

○ Healthcare FATIGUE (exhaustion)
○ EMT - Emergency Medical Technician
(new)
○ Pronounced Death
○ PT already alive - survived
● COMPRESSION:
○ Thirty (30) compressions and two (2) SYMPTOMS
rescue breaths. ● Instant, sharp burning pain at the sting
C B H/F Landmark Depth site
● A red welt at the sting site
A 30 2 2h Nipple Line 1.5-2 in. ● Slight swelling around the sting site
● Itching
C 30 2 1h Slightly below NL 1-1.5 in.
Typically, the swelling and pain go away
I 30 2 2f Below the NL 1/3-1/2 in. within a few hours, but may last 1-2 days.

** Big boobs = paghiwalayin ang boobs tapos i-CPR.

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 COMPETENCY APPRAISAL 2 - First Aid Emergency Nursing
TREATMENT
1. If present, gently remove the stinger by
scraping it out with a fingernail, the
edge of a credit card, or the dull side of
a knife. Never squeeze the stinger or
use tweezers for removal as this will
push more venom into the skin.
2. Wash the sting area with soap and
water or an antiseptic wipe.
3. Apply a cold compress and
antihistamine cream or paste of baking
soda and water to relieve itching,
swelling, and pain.
4. Treat severe itching with an oral
antihistamine (i.e., Benadryl®).
5. Take an over-the-counter pain reliever
for pain as needed.
6. Seek immediate medical attention if a
sting causes swelling in the face, eyes,
lips, tongue, or throat.
7. Avoid scratching the sting site and seek
medical care for signs of infection.
8. Anyone stung is at increased risk of
contracting tetanus. If you have never
received a tetanus vaccine or have not
had a tetanus booster in the last five
years, seek evaluation by a medical
professional.
Jellyfish
SYMPTOMS
● Burning, prickling, stinging pain
● Welts or tracks on the skin — a "print"
of the tentacles' contact with the skin
● Itchiness (pruritus)
● Swelling
● Throbbing pain that radiates up a leg or
an arm
TREATMENT
First-Aid:
1. Carefully pluck visible tentacles with
fine tweezers.
2. Soak the skin in hot water. Use water
that's 110 to 113 F (43 to 45 C). It
should feel hot, not scalding. Keep the
affected skin immersed or in a hot
shower until the pain eases, which
might be 20 to 45 minutes.
3. Apply 0.5% to 1% hydrocortisone
cream or ointment twice a day to the
affected skin.
Avoid:
1. Scraping out stingers
2. Rinsing with human urine
3. Rinsing with cold, fresh water
4. Applying meat tenderizer
5. Applying alcohol, ethanol or ammonia
6. Rubbing with a towel
7. Applying pressure bandages
Medical Treatment:
1. Emergency care. Someone having a
✩°｡ RN 2024 ₊˚⊹♡
severe reaction to a jellyfish sting may
need cardiopulmonary resuscitation
(CPR), life support or, if the sting is
from a box jellyfish, antivenom
medication.
2. Oral medicine. A delayed rash or
other skin reaction may be treated with
oral antihistamines or corticosteroids.
You may also be given oral pain
medicine.
3. Eye flushing. A jellyfish sting on or
near the eye generally requires
immediate medical care to control pain
and flush the eye.
Snake Bite
SYMPTOMS
● Puncture marks at the wound
● Redness, swelling, bruising, bleeding,
or blistering around the bite
● Severe pain and tenderness at the site
of the bite
● Nausea, vomiting, or diarrhea
● Labored breathing (in extreme cases,
breathing may stop altogether)
● Rapid heart rate, weak pulse, low blood
pressure
● Disturbed vision
● Metallic, mint, or rubber taste in the
mouth
● Increased salivation and sweating
● Numbness or tingling around face
and/or limbs
● Muscle twitching
TREATMENT
1. Seek medical attention as soon as
possible (dial 911 or call local
Emergency Medical Services [EMS]).
○ Antivenom is the treatment for serious
snake envenomation. The sooner
antivenom can be started, the sooner
irreversible damage from venom can
be stopped.
○ Driving oneself to the hospital is not
advised because people with snake
bites can become dizzy or pass out.
2. Take a photograph of the snake from a
safe distance if possible. Identifying
the snake can help with treatment of
the snakebite.
3. Keep calm.
4. Inform your supervisor.
5. Apply first aid while waiting for EMS
staff to get you to the hospital.
6. Lay or sit down with the bite in a
neutral position of comfort.
○ Remove rings and watches before
swelling starts.
○ Wash the bite with soap and water.
○ Cover the bite with a clean, dry
dressing.
○ Mark the leading edge of
tenderness/swelling on the skin and
write the time alongside it.
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 COMPETENCY APPRAISAL 2 - First Aid Emergency Nursing
Do NOT do any of the following:
1. Do not pick up the snake or try to trap
it. NEVER handle a venomous snake,
not even a dead one or its decapitated
head.
2. Do not wait for symptoms to appear if
bitten, get medical help right away.
3. Do not apply a tourniquet.
4. Do not slash the wound with a knife or
cut it in any way.
5. Do not try to suck out the venom.
6. Do not apply ice or immerse the wound
in water.
7. Do not drink alcohol as a painkiller.
8. Do not take pain relievers (such as
aspirin, ibuprofen, naproxen).
9. Do not apply electric shock or folk
therapies.
(2) INHALATION
a. Carbon Monoxide (CO) - one carbon
atoms
b. Carbon Dioxide (CO2) - two carbon atoms
= heavier!
c. Oxygen (O2)
■ Blurred vision
■ Drowsiness
■ Loss of muscle control
■ Loss of consciousness
■ Symptoms related to the nervous
system and brain can come on after
recovery from carbon monoxide
poisoning. The risk of these is
higher in people who lost
consciousness from the carbon
monoxide and older people.
Symptoms might include:
- Memory loss
- Personality changes
- Movement problems
○ Carbon monoxide poisoning can be
especially dangerous for people who are
asleep, drugged or drunk. Carbon monoxide
can cause brain damage or death before
anyone realizes there's a problem.
(3) INGESTION
a. Corrosive
b. Non-corrosive
CORROSIVE NON-CORROSIVE

Muriatic Acid Over Medications

● CARBON MONOXIDE POISONING
○ DEATH DUE TO NO OXYGEN! DO NOT INDUCE INDUCE VOMITING
■ 02 + Hgb = oxyhemoglobin VOMITING - it will cause
■ C02 + Hgb = Carboxyhemoglobin burns to the throat and
■ Mas magaan ang Carbon Dioxide mouth severely (double
kaya s’ya ang kinukuha ni poisoning & burns)
Hemoglobin.
■ C02 is faster (200x) → 0XYGEN is NO IPECAC (-) IPECAC (+) - to induce
NOT taken by the hemoglobin = vomiting
carbon monoxide builds up in the
bloodstream and the body replaces (+) AC (+) AC
the oxygen in RBC with CO=
serious tissue damage. (+) water = neutralization (+) water = replenishment
■ CO2 poisoning = lungs cannot take
in enough oxygen. Activated Charcoal = absorbent
■ GIVE OXYGEN to the patient.
○ Carbon monoxide poisoning occurs when BURNS
carbon monoxide builds up in the blood.
When too much carbon monoxide is in the (1) Radiation - it is caused by UV-rays, X-rays, or
air, the body replaces the oxygen in the red radiation therapy that treats cancer.
blood cells with carbon monoxide. This can B.I.T.E
lead to serious tissue damage, or even
death. B - Brachytherapy T - Teletherapy
○ Carbon monoxide is gas that has no odor, I - Internal E - External
taste or color. Burning fuels, including gas,
wood, propane or charcoal, make carbon (2) Thermal Burns - skin injuries caused by excessive
monoxide. Appliances and engines that heat from contacts with hot surfaces, hot liquids,
aren't well vented can cause the gas to build steam, or flames.
up to dangerous levels. A tightly enclosed (3) Electrical Burns - skin burn that happens when
space makes the buildup worse. electricity comes in contact with your body. It can
○ Anyone exposed to carbon monoxide needs damage tissues and organs.
to get into fresh air and seek medical care (4) Chemical Burns - tissue damage caused by strong
right away. Call emergency medical acids, drain cleaners, paint thinners, gasoline, and
services (EMS) or dial 911 right away for other substances.
someone who's in a coma or can't respond. - Acid
○ Carbon monoxide poisoning affects the - Alkaline
brain and heart the most. Exposure over - Ex: Zonrox - nangangati ang kamay
time might lead to symptoms that can be
mistaken for the flu without the fever. LAYERS OF THE SKIN:
Clearer symptoms of carbon monoxide - Epidermis
poisoning can include: - Dermis
■ Headache - Subcutaneous
■ Weakness - Muscle
■ Dizziness - Bone
■ Nausea or vomiting
■ Shortness of breath ** Fascia separates the
■ Confusion muscle and bones.

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 COMPETENCY APPRAISAL 2 - First Aid Emergency Nursing
- saturated burns → dikit-dikit
- this method divides the body's surface area
into percentage

a. Depth (lalim)
1 2 3 4

Layers Epidermis Epidermis Epidermis Epidermis

Dermis Dermis Dermis
Subq Subq
Bones

Color Red Mottling White Black

balat

Pain Mild Pain Very Painless Painless

Painful
up to nerve
endings

Healing 3-5 d 14-21 d Grafting Grafting

c. Response (Local & Systemic)

Local Systemic

↓ 25% TBA damage ↑ 25% TBA damage

(skin affected)

➢ Integumentary System: HYPOTHERMIA

○ at risk for infection (no skin = no
protection)
➢ GIT: STRESS ULCERS
○ Cushing - brain, no blood in GIT =
ACIDIC GIT
○ Curling - burns, ACIDIC
b. Extent (lawak) ➢ Respiratory System: CO POISONING
PALM METHOD (Pt’s hand/palm) ○ hoarseness of voice
➢ Cardio: HYPOTENSION
- patient = 1% ○ fluid = plasma
- unsaturated burns → hindi dikit-dikit ○ hemoconcentration (malapot na
- small or patchy burns can be approximated by dugo) = ↑ BLOOD VISCOSITY =
using the surface area of the patient's palm. risk for blood clot formation =
- total = number of palms affected obstruction
➢ Kidneys: RENAL FAILURE
○ Ex: Severe Muscle Injury →
myoglobin (protein) is released into
the blood after burn injury →
blockage → necrosis = ACUTE
TUBULAR NECROSIS → renal
failure
■ Dialysis is needed due to
RULE OF NINE kidney failure (kaya
nagddialysis yung mga burn

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 COMPETENCY APPRAISAL 2 - First Aid Emergency Nursing
patient after healing)
d. According to Zones
1. Coagulation - most affected part
2. Stasis - blood flow
3. Hyperemia - less affected part (↑blood)
e. Management (Emergent, Acute, Resuscitative)
EMERGENT - first 24 hrs
- First 24 hours
a) safe place
b) oxygen due to CO poisoning
c) stop, drop, roll
● Airway, Breathing, Circulation
● Stop, Drop, Roll
● Fluid Resuscitation (Parkland Formula)
PARKLAND FORMULA: used to calculate initial
fluid requirements in burn patients. FLUID GIVEN
AT FIRST 48 HOURS to avoid hypovolemic shock.
** 3 = undermedication to increased HR
ACUTE - 24 to 48 hrs
- 24 to 48 hours
- 3rd &4th degree has NO PAIN but give them
MORPHINE SULFATE (pain during
debridement)
● Pain Medication
● Hydrotherapy [15-30 mins]
○ cold bath tub (stainless)
○ natural debridement → painful due to
contraction
● Debridement
○ Natural - wounds voluntarily fall off
○ Mechanical - ex. tweezer
● Antibiotic = SILVER SULFADIAZINE
○ This medication is used with other
treatments to help prevent and treat
wound infections in patients with
serious burns. Silver sulfadiazine
works by stopping the growth of
bacteria that may infect an open
wound. This helps to decrease the risk
of the bacteria spreading to
surrounding skin, or to the blood
✩°｡ RN 2024 ₊˚⊹♡
where it can cause a serious blood
infection (sepsis). Silver sulfadiazine
belongs to a class of drugs known as
sulfa antibiotics.Silver sulfadiazine
must not be used on premature babies
or on newborns during the first 2
months of life because of the risk of
serious side effects.
○ After matanggal ng wounds, lagyan
agad ng silver sulfadiazine.
● Dressing - para dumikit ang antibiotic.
○ Provide a barrier to bacteria, prevent
progression of the burn injury, absorb
exudate, prevent wound desiccation,
and promote healing.
● Nutrition
○ Protein = body-building food
○ Calories (2400 to 2600) = energy
RESUSCITATIVE/REHABILITATIVE
● Counseling
● Occupational Therapy
SHOCK
- Decreased tissue perfusion.
- ↓ Blood Supply = ↓ Oxygen = SHOCK
STAGES (CO.P.I)
COmpensatory ↑ BP ↓ UO - oliguria
↑ HR
NORMAL UO: 30 Cold & Clammy
cc/hr Conscious
Respiratory Alkalosis
Progressive Confusion
Rapid respiration
Fatigue in myocardial tissue
Metabolic Acidosis
Irreversible Mechanical Ventilator
Comatose
Anuria - absence of urine = 10c/h↓
Severe Metabolic Acidosis (profound)
TYPES OF SHOCK
Cardiogenic Due to a weak heart
Hypovolemic Due to severe fluid loss
Distributive - ● Septic - severe infection
due to massive ● Anaphylactic - allergic reaction
vasodilation ● Neurogenic - severe damage to
neurologic system (ex. spinal
injury)
CARDIOGENIC SHOCK
● Cardio = heart → myocardium = muscle
● There is a problem with contraction.
○ It is a life-threatening condition in which
the heart suddenly cannot pump enough
blood to meet the body’s needs.
○ ↓ blood = ↓ oxygen
● Causes:
○ Myocardial Infarction “heart attack” -
due to decreased or complete cessation of
blood flow to a portion of the myocardium.
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 COMPETENCY APPRAISAL 2 - First Aid Emergency Nursing
○ Congestive Heart Failure - backflow; the ○ Trauma
heart does not pump blood as efficiently as ○ Major Surgery
it should. ○ Menstruation
○ Valvular Heart Disease - valves are loose
SIGNS & SYMPTOMS
thread → occurs when one or more of the
hypo-tachy-tachy
heart valves do not open or close properly.
(1) Hypotension
Total Myocardial Infarction (MI)
(2) Tachycardia
Partial Angina (3) Tachypnea

Total + Backflow Congestive Heart Failure (CHF) MANAGEMENT

a. Position: MODIFIED TRENDELENBURG
Total + ↓CO + ↓O2 Cardiogenic Shock
** Cardiac Output - product of HR and SV (HRxSV) →
amount of blood pumped by the heart per minute.
** Cardiogenic Shock = mababa ang oxygen at mababa
ang dugo na nagpa-pump galing sa heart.
b. Blood Transfusion
SIGNS & SYMPTOMS DISTRIBUTIVE SHOCK
(1) Chest Pain ● “Vasodilatory Shock”
➢ Kapag mababa ang oxygen na pumupunta ○ Massive vasodilation causes decreased
sa heart, expected na may chest pain. blood flow and low oxygen supply to the
➢ PAIN MANAGEMENT - give oxygen to vital organs.
relieve pain.
(2) Anxiety Septic - Infection = PSEUDOMONAS
(3) Diaphoresis Signs & Symptoms:
➢ Kapag nagkakaroon ng shock, expected na - High fever
stimulated din ang sympathetic nervous - Chills
system kase eto yung “fight-or-flight - ☆ Decreased UO = notify
response” ng katawan natin. Sympathetic physician because it might be a
responses include sweating. sign of multiple organ failure.
(4) Cold and clammy skin Management:
➢ Bumababa ang blood pressure sa CS dahil - Symptomatic approach
nagco-compensate yung katawan. Nili-limit
ang blood flow sa extremities. Anaphylactic - Exposure to antigen → meds,
foods, dye (iodine)
MANAGEMENT - normal: Antibody
- BV: dilate = redness
a. Give oxygen. - Lungs: constrict = DOB
b. Position: HIGH-FOWLERS Signs & Symptoms:
- Redness
c. Vital Signs - Itchiness
- focused on RR - medulla oblongata - DOB
d. Medications Management:
i. MORPHINE SULFATE - Antihistamine
- Antidote: Naloxone/Narcan
ii. Sublingual → burning sensation upon Neurogenic - Dysregulation of the autonomic
administration nervous system.
a. NITROGLYCERIN - Trauma → SCI
- vasodilator → SE: headache Inflammation
(laging tandaan na nagkakaroon
Vasodilation
ng headache dahil nagdi-dilate ang
Signs & Symptoms:
veins).
- Upper: cold to touch
- 3 doses, 5 mins. interval
- Lower: warm to touch → nasa
- dark colored = photosensitive
baba ang dugo
- shelf life: 3 months
- Below: paralysis
- expiration starts upon opening the
Management:
bottle
- Immobilize the patient
iii. Oral
- Upper: ACTIVE ROM
iv. IV
- Down: PASSIVE ROM
v. Topical
- skin (patch type): must be hairless,
trimmed, clipped.
- automatically removed by the body
once it detected absence of pain =
SENSOR TYPE.
- kapag attached pa rin, ibig sabihin,
may chest pain pa rin.

HYPOVOLEMIC SHOCK
● Severe blood or other fluid loss makes the heart
unable to pump enough blood to the body.
● DECREASED BLOOD VOLUME.
● Causes:
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