8 Emergency Care, First Aid, and Disasters 1. Define important words in this chapter abdominal thrusts a method of attempting to remove an object from.

8Emergency Care, First Aid, and Disasters

1. Define important words in this chapter

abdominal thrusts a method of attempting to remove an object from the airway of someone who is choking.

cardiac arrest the medical term for the stopping of the heartbeat.

code team group of people chosen for a particular shift to respond to resident emergencies.

conscious the state of being mentally alert and having awareness of surroundings, sensations, and thoughts.



CPR (cardiopulmonary resuscitation) refers to medical procedures used when a person’s heart and lungs have stopped working.

diabetic ketoacidosis a life-threatening complication of diabetes that can result from undiagnosed diabetes, not enough insulin, eating too much, not getting enough exercise, and stress; also known as ketoacidosis or hyperglycemia.

dyspnea difficulty breathing.

emesisthe act of vomiting, or ejecting stomach contents through the mouth and/or nose.



epistaxis a nosebleed.

expressive aphasia inability to express oneself to others through speech or written words.

fainting loss of consciousness; also called syncope.

first aid care given by the first people to respond to an emergency.


1. Define important words in this chapterhemiparesis weakness on one side of the body.

hemiplegia paralysis of one side of the body.

hyperglycemia a life-threatening complication of diabetes that can result from undiagnosed diabetes, not enough insulin, eating too much, not getting enough exercise, and stress; also known as diabetic ketoacidosis (DKA) or ketoacidosis.

hypoglycemia a life-threatening complication of diabetes that can result from either too much insulin or too little food; also known as insulin reaction and insulin shock.



insulin reactiona life-threatening complication of diabetes that can result from either too much insulin or too little food; also known as hypoglycemia or insulin shock.

myocardial infarction (MI) a condition in which blood flow to the heart is blocked and muscle cells die; also called a heart attack.

obstructed airway a condition in which the tube through which air enters the lungs is blocked.

receptive aphasia inability to understand what others are communicating through speech or written words.



respiratory arrestthe medical term for the stopping of breathing.

shock a condition in which there is decreased blood flow to organs and tissues.

syncope loss of consciousness; also called fainting.


2. Demonstrate how to respond to medical emergencies

Define the following term:conscious the state of being mentally alert and having awareness of surroundings, sensations, and thoughts.



The most serious medical emergencies involve these situations:

• The person is unconscious • The person is not breathing • The person has no pulse • The person is bleeding severely



REMEMBER: When an emergency happens, try to remain calm. Act quickly and communicate clearly. Take two pairs of gloves and a barrier face mask with you. Look around to make sure the area is safe. Make sure you are safe before providing care.



Remember these steps to take in an emergency situation:

• Make sure the area is safe. Put on gloves. • Assess the situation. Notice the time. Try to find out what happened.

• Assess the victim. Ask the injured or ill person what happened. Determine if the person is conscious.

• Call for help or send someone to call for help right away.

• If the person is conscious, listen to him and reassure him that he is being taken care of.



Know the things to look for when checking for injury:• Severe bleeding• Changes in consciousness• Irregular breathing• Unusual color or feel to skin• Swollen places on the body• Medical alert tags• Any complaints of pain



REMEMBER:Document an emergency as soon as it is over.



Think about this question:Why is it important to remember as many details as you can and to report only facts when documenting an emergency?



The acronym PPE SCC is used to help you remember how to prepare to perform first aid:

• PPE: Grab and apply personal protective equipment.

• Safety first! Are you safe?• Call for help or point to a person and say: “You, get help now!”

• Care for victims.


3. Demonstrate knowledge of first aid procedures

Define the following terms:respiratory arrest the medical term for the stopping of breathing.

cardiac arrest the medical term for the stopping of the heartbeat.

CPR (cardiopulmonary resuscitation) refers to medical procedures used when a person’s heart and lungs have stopped working.

first aidcare given by the first people to respond to an emergency.



REMEMBER:The first few minutes of any emergency can determine the victim’s ability to survive.



• Emergency situations can happen to anyone at any time.

• When a person is involved in a serious accident, such as drowning or choking, respiratory arrest can occur, meaning that breathing stops. If the person is not helped quickly, cardiac arrest may soon follow, meaning that the heart stops.

• When respiratory arrest and cardiac arrest occur, cardiopulmonary resuscitation (CPR) is necessary.



REMEMBER:Only properly trained people should perform CPR. In an emergency situation, never do anything that is beyond your ability or training. Give basic first aid until the emergency medical team arrives.



Define the following terms:obstructed airway a condition in which the tube through which air enters the lungs is blocked.

abdominal thrusts a method of attempting to remove an object from the airway of someone who is choking.



Residents who have difficulty chewing or swallowing, are confused, or have poor vision may be at risk of choking. When something is blocking the tube through which air enters the lungs, the person has an obstructed airway.



REMEMBER:Abdominal thrusts should not be performed unless the person shows signs (poor air exchange, trouble breathing, silent coughing, cyanosis, inability to breathe or speak) of a severely obstructed airway.

Performing abdominal thrusts for the conscious person

1. Stand behind the person. Bring your arms under her arms. Wrap your arms around the person’s waist.

2. Make a fist with one hand. Place the flat, thumb side of the fist against the person’s abdomen, above the navel but below the breastbone.

3. Grasp the fist with your other hand. Pull both hands toward you and up (inward and upward), quickly and forcefully.

4. Repeat until the object is pushed out.



Define the following term:shocka condition in which there is decreased blood flow to organs and tissues.



Shock occurs when organs and tissues in the body do not receive an adequate blood supply. Bleeding, heart attack, severe infection, and falling blood pressure can lead to shock.



REMEMBER:Shock is a life-threatening situation that may be worsened by fear or pain.



Know the symptoms of shock:• Pale or cyanotic skin• Staring• Increased pulse and respiration rates• Decreased blood pressure• Extreme thirst

Responding to shock

1. Notify the nurse immediately. Victims of shock should always receive medical care as soon as possible.

2. If controlling bleeding, put on gloves first. The next procedure will explain how to do this.

3. Have the person lie down on her back. If the person is bleeding from the mouth or vomiting, place her on her side (unless you suspect that the neck, back, or spinal cord is injured).

Responding to shock

4. Check pulse and respirations if possible (Chapter 13). Begin CPR if breathing and pulse are absent.

5. Keep the person as calm and comfortable as possible. Loosen clothing or ties around the neck and any belts or waist strings.

6. Maintain normal body temperature. If the weather is cold, place a blanket around the person. If the weather is hot, provide shade.

Responding to shock

7. Elevate the feet unless the person has a head, neck, back, spinal or abdominal injury, breathing difficulties, or fractures. Never elevate a body part if a broken bone exists or if it causes pain.

8. Do not give the person anything to eat or drink.



REMEMBER:Severe bleeding can cause death quickly and must be controlled.

Controlling bleeding

1. Notify the nurse immediately.

2. Put on gloves. Always take time to do this. If the person is able, he can hold his bare hand over the wound until you can put on gloves.

3. Hold a thick sterile pad, clean cloth, handkerchief, or towel against the wound.

4. Press down hard directly on the bleeding wound until help arrives. Do not decrease pressure. Put additional pads over the first pad if blood seeps through. Do not remove the first pad.


5. If you can, raise the wound above the level of the heart to slow down the bleeding. If the wound is on an arm, leg, hand, or foot, and there are no head, neck, back, spinal, or abdominal injuries or fractures, prop up the limb. Use towels or other absorbent material.


6. When bleeding is under control, secure the dressing to keep it in place. Check the person for symptoms of shock (pale skin, staring, increased pulse and respiration rates, decreased blood pressure, and extreme thirst). Stay with the person until help arrives.

7. Remove gloves and wash hands thoroughly when finished.



REMEMBER:If a resident is burned, call or have someone call for the nurse immediately.



Care of a burn depends on its depth, size, and location.

There are three types of burns: • First-degree (superficial) • Second-degree (partial-thickness)• Third-degree (full thickness)

Treating burns

To treat a minor burn:

1. Notify the nurse immediately. Put on gloves.

2. Use cool, clean water to decrease the skin temperature and prevent further injury. Do not use ice or ice water, as ice may cause further skin damage. Dampen a clean towel with cool water, and place it over the burn.

Treating burns

3. Once the pain has eased, you may cover the area with a dry, clean dressing or non-adhesive sterile bandage.

4. Never use any kind of ointment, water, salve, or grease on a burn.

Treating burns

For more serious burns:

1. If clothing has caught fire, have the person stop, drop, and roll, or smother the fire with a blanket or towel. Use water to help put out the fire, if possible. Protect yourself from the source of the burn.

2. Notify the nurse immediately. Put on gloves.

Treating burns

3. Check for breathing, pulse, and severe bleeding. If the person is not breathing, begin rescue breathing. If the person is not breathing and has no pulse, begin CPR. Do not put pillows under the head, as this may obstruct the airway.

4. Do not use any type of ointment, water, salve, or grease on the burn.

Treating burns

5. Do not try to pull away any clothing from burned areas. Cover the burn with a clean cloth, a dry, non-adhesive sterile bandage, or a clean sheet. Apply the cloth, bandage, or sheet lightly. Take care not to rub the burned area.

6. Take steps to prevent shock.

7. Do not give the person food or fluids.

8. Monitor vital signs and wait for emergency medical help.

9. Remove gloves and wash hands.



Define the following terms:fainting loss of consciousness; also called syncope.

syncope loss of consciousness; also called fainting.



Fainting, or syncope, occurs as a result of decreased blood flow to the brain, causing a loss of consciousness. Know the possible causes of fainting:

• Hunger• Fear• Pain• Fatigue• Standing for a long time• Poor ventilation• Pregnancy• Overheating



Remember these signs and symptoms of fainting:• Dizziness• Nausea• Perspiration • Pale skin• Weak pulse• Shallow respirations • Blackness in the visual field



Know the steps to take if a person faints:• Lower person to floor or other flat surface.• Position person on back.• Elevate legs, except in case of injury.• Make sure person is breathing.• Keep person lying down for several minutes.• Report incident to the nurse immediately.

Responding to fainting


2. Have the person lie down or sit down before fainting occurs.

3. If the person is in a sitting position, have her bend forward and place her head between her knees. If the person is lying flat on her back, elevate the legs.

Responding to fainting

4. Loosen any tight clothing.

5. Have the person stay in this position for at least five minutes after symptoms disappear.

6. Help the person get up slowly. Continue to observe her for symptoms of fainting. Assist her to sit down if needed. Stay with her until she feels better. If you need help but cannot leave the person, use the call light.



Know the signs and symptoms of poisoning:• Sudden collapse• Vomiting• Heavy, difficult breathing

Responding to poisoning


2. Put on gloves. Look for a container that will help you determine what the person has taken or eaten. With your gloves on, carefully open mouth and look inside to check the mouth for chemical burns. Do not place your fingers inside the mouth. Note breath odor.

3. The nurse may have you call a poison control center. Follow these instructions.

4. Remove gloves and wash your hands.



Define the following term:epistaxis a nosebleed.



Remember these possible causes of a nosebleed:• Dry air• Injury• Medication

Responding to a nosebleed


2. Elevate the head of the bed, or tell the person to remain in a sitting position, leaning forward slightly. Offer tissues or a clean cloth to catch the blood. Do not touch blood or bloody clothes, tissues, or cloths without gloves.


3. Put on gloves. Apply firm pressure over the bridge of the nose. Squeeze the bridge of the nose with your thumb and forefinger. You can have the person do this until you are able to put on gloves.

4. Apply pressure until the bleeding stops.

5. Use a cool cloth or ice wrapped in a cloth on the back of the neck, the forehead, or the upper lip to slow the flow of blood. Never apply ice directly to skin.


6. Keep person still and calm until help arrives.




Define the following term:emesis the act of vomiting, or ejecting stomach contents through the mouth and/or nose.



Think about this question:Why should you both soothe the resident and report to the nurse when vomiting occurs?

Responding to vomiting


2. Put on gloves.

3. Place an emesis basin under the chin. If an emesis basin is not nearby, use the wash basin. Remove it when vomiting has stopped.

4. Remove soiled linens or clothes and set aside. Replace with fresh linens or clothes.


5. Note amount, color, and consistency of vomitus. Look for blood in vomitus, blood-tinged vomitus, or medication (pills) in vomitus. Find out if a specimen should be sent to the laboratory. Show the nurse the vomitus before discarding or if blood or pills are noted.

6. Flush vomitus down the toilet and wash and store the basin.

7. Remove and discard gloves.


8. Wash your hands.

9. Put on fresh gloves.

10. Provide comfort to the person. Wipe his face and mouth. Position him comfortably, and offer a drink of water or a sip to swish in the mouth and spit. Provide oral care (see Chapter 12). It helps get rid of the vomit taste in the mouth.


11. Put the soiled linen in proper containers.

12. Remove and discard gloves.

13. Wash your hands again.

14. Document time, amount, color, odor and consistency of vomitus.



Define the following terms:myocardial infarction (MI)a condition in which blood flow to the heart is blocked and muscle cells die; also called a heart attack.

dyspneadifficulty breathing.



Know the signs and symptoms of a heart attack:• Sudden, severe pain in the chest• Pain or discomfort in other areas of the body• Indigestion or heartburn• Nausea and vomiting• Difficulty breathing• Dizziness



Signs and symptoms of a heart attack (cont’d.):• Pale, gray, or cyanotic skin color or mucous membranes

• Perspiration• Cold and clammy skin• Weak and irregular pulse rate• Low blood pressure• Anxiety and a sense of doom• Denial of a heart problem



Women may experience different symptoms than men, and are somewhat more likely to experience the following:

• Shortness of breath• Nausea and vomiting• Back, shoulder or jaw pain• Flu-like symptoms

Responding to a myocardial infarction

1. Call or have someone call the nurse.

2. Place the person in a comfortable position. Encourage him to rest. Reassure him that you will not leave him alone.

3. Loosen clothing around the person’s neck.


Responding to a myocardial infarction

5. Monitor the person’s breathing and pulse. If the person stops breathing, perform rescue breathing. If the person has no pulse, begin CPR if trained and allowed to do so.

6. Stay with the person until help has arrived.



Define the following terms:insulin reaction a life-threatening complication of diabetes that can result from either too much insulin or too little food; also known as hypoglycemia or insulin shock.

hypoglycemia a life-threatening complication of diabetes that can result from either too much insulin or too little food; also known as insulin reaction and insulin shock.



Define the following terms:diabetic ketoacidosis a life-threatening complication of diabetes that can result from undiagnosed diabetes, not enough insulin, eating too much, not getting enough exercise, and stress; also known as ketoacidosis or hyperglycemia.

hyperglycemia a life-threatening complication of diabetes that can result from undiagnosed diabetes, not enough insulin, eating too much, not getting enough exercise, and stress; also known as diabetic ketoacidosis (DKA) or ketoacidosis.



Know the causes of insulin reaction:• Too much insulin• Too little food• Additional activity that causes the body to rapidly absorb food

• Vomiting • Diarrhea



Remember these signs and symptoms of insulin reaction:• Feeling weak or different• Nervousness • Dizziness• Perspiration• Hunger• Rapid pulse• Headache



Signs and symptoms of insulin reaction (cont’d.):• Low blood pressure• Cold, clammy skin• Confusion• Trembling• Blurred vision• Numbness of the lips and tongue• Unconsciousness



REMEMBER:These signs and symptoms mean that the resident needs food; a diabetic resident should always have a quick source of sugar handy.



Know the causes of diabetic ketoacidosis (DKA):• Undiagnosed diabetes• Not enough insulin• Eating too much• Not getting enough exercise• Physical and emotional stress



Remember these signs and symptoms of DKA:• Increased thirst or urination• Abdominal pain• Deep or difficult breathing• Breath that smells sweet or fruity• Nausea and vomiting• Loss of appetite• Headache• Blurred vision• Rapid, weak pulse



Signs and symptoms of DKA (cont’d.):• Low blood pressure• Dry skin, dry mouth• Flushed cheeks• Drowsiness• Confusion• Weakness• Unconsciousness



REMEMBER:DKA can lead to diabetic coma and death, if left untreated.



Seizures are involuntary, often violent, contractions of muscles. They can involve a small area or the entire body.

Know the causes of seizures:• Abnormality in the brain• High fever• Serious illness• Head injury



REMEMBER:Your main goal during a seizure is to make sure the resident is safe.



Remember these signs of seizure:• Severe shaking• Uncontrolled thrusting of arms and legs• Clenching jaw• Drooling• Inability to swallow



Types of seizures:• Absence or Petit Mal• Myoclonic• Atonic• Tonic• Clonic• Tonic-clonic

Responding to seizures

1. Note the time. Put on gloves.

2. Lower the person to the floor. Cradle and protect his head. Loosen clothing to help with breathing. Attempt to turn his head to one side to lower the risk of choking. This may not be possible during a violent seizure.

3. Have someone call the nurse immediately or use the call light. Do not leave the person unless you must do so to get medical help.


4. Move furniture away to prevent injury. If a pillow is nearby, place it under his head.

5. Do not try to stop the seizure or restrain the person.

6. Do not force anything between the person’s teeth. Do not place your hands in his mouth for any reason. You could be bitten.



8. When the seizure is over, note the time. Gently turn the person to his left side if you do not suspect a head, neck, or spinal injury. This reduces the risk of choking on vomit or saliva. If the person begins to choke, get help immediately. Check for adequate breathing and pulse. If the person stops breathing, perform rescue breathing. If the person has no pulse, begin CPR if trained and allowed to do so. Do not begin CPR during a seizure.


9. Report the length of the seizure and your observations to the nurse.




Define the following terms:hemiplegia paralysis of one side of the body.

hemiparesis weakness on one side of the body.

expressive aphasia inability to express oneself to others through speech or written words.

receptive aphasia inability to understand what others are communicating through speech or written words.



Know the symptoms of a transient ischemic attack (TIA):

• Tingling • Weakness• Some loss of movement in an arm or leg



REMEMBER:TIA is a warning sign of a CVA. Symptoms should be reported to the nurse immediately.



A cerebrovascular accident (CVA) or stroke occurs when the blood supply to a portion of the brain is cut off.

Know the signs that a stroke is occurring:• Dizziness• Confusion• Loss of consciousness• Seizures• Shaking or trembling• Redness in the face• Facial droop



Signs that a stroke is occurring (cont’d.):• Drooping of one eyelid or eye• Loss of sight in one eye• One pupil is larger• Blurred vision• Ringing in the ears• Headache• Nausea and vomiting• Loss of bowel and bladder control• Numbness or tingling on one side of the body



Signs that a stroke is occurring (cont’d.):• Hemiplegia• Hemiparesis• Expressive aphasia• Receptive aphasia• Use of strange words• Noisy breathing• Elevated blood pressure• Slow pulse rate


4. Explain the nursing assistant’s role on a code team

Define the following term:code team group of people chosen for a particular shift to respond to resident emergencies.


4. Explain the nursing assistant’s role on a code team

Understand your role as a member of the code team:• May be asked to get special equipment.• May do chest compressions during CPR.• Note whether or not you are on code team at start of shift.

• Respond to codes from wherever you are in the facility.

• Do not panic.• Get another staff member to take over any care you are performing.


5. Describe guidelines for responding to disasters

A disaster can occur during your shift at a facility. Disasters can include fire, flood, earthquake, hurricane, tornado, or severe weather. Acts of terrorism are also considered disasters.

As a nursing assistant, you are expected to respond calmly and skillfully to disasters. You need to be responsible and efficient.



Understand your role in the event of a disaster:• Know where disaster plan is located.• Listen carefully and follow instructions.• Know location of all exits and stairwells.• Know where fire alarms and fire extinguishers are located.

• Pay close attention to classes on disasters and disaster drills.



Think about these questions:• Have you had any experiences with disasters? • If yes, what actions did you (or those around you) take that were helpful?

• What actions did you (or others) take that were not helpful?


ExamMultiple Choice. Choose the correct answer.1. Which of the following conditions may mean you need emergency medical help?(A) Person is behaving rudely.(B) Person has a scratch.(C) Person does not want help.(D) Person is unconscious.

2. The first two steps in approaching an emergency are:(A) Perform first aid and assess the situation(B) Call the victim’s family and then call 911(C) Assess the situation and the victim(D) Get assistance and perform CPR


Exam (cont’d.)3. After an emergency, the nursing assistant will need to:(A) Document the incident in her notes(B) Give an opinion about what is wrong with the resident(C) Tell the resident she is very worried about his condition(D) Prescribe medication for the resident

4. When a person’s breathing stops, this is called:(A) Cardiac arrest(B) Respiratory arrest(C) CPR(D) Choking


Exam (cont’d.)5. If a person’s breathing and heartbeat stop, brain damage can occur within ______ minutes.(A) 4-6(B) 8-10(C) 10-15(D) 15-20

6. If a nursing assistant is in an emergency situation but has not been trained to perform CPR, she should:(A) Perform CPR anyway(B) Ask someone at the scene to tell her how to do it(C) Give basic first aid until the emergency medical team arrives(D) Do nothing


Exam (cont’d.)7. In which of the following situations should a nursing assistant give abdominal thrusts to someone?(A) The person is coughing.(B) The person cannot speak, cough, or breathe.(C) The person is breathing very rapidly.(D) The person tells the nursing assistant that she feels short of breath. 8. One sign that a person is in shock is:(A) Flushed or reddish skin(B) Decreased pulse and respiration rates(C) Increased blood pressure(D) Extreme thirst


Exam (cont’d.)9. To control bleeding, a nursing assistant should:(A) Use her bare hands to stop it(B) Lower the wound below the heart(C) Hold a thick pad or clean cloth against the wound and press down hard(D) Apply light pressure with a Band-Aid®

10. If a resident has a minor burn, a nursing assistant should use _____ to decrease the temperature of the skin.(A) Ice or ice water(B) Cool water(C) Ointment (D) Grease


Exam (cont’d.)11. If a resident feels faint, a nursing assistant should:(A) Try to have the resident stand up before fainting occurs(B) Have the resident lean forward and place her head between her knees(C) Tighten clothing(D) Leave the resident alone as soon as symptoms disappear

12. Which of the following can a nursing assistant do if he suspects poisoning?(A) Suggest the resident put his finger down his throat to induce vomiting.(B) Feed the resident crackers or bread to soak up the poison.(C) Give the resident medication and then call poison control.(D) Look for a container that will help him find out what the resident took or ate.


Exam (cont’d.)13. Which of the following is a correct response to a nosebleed?(A) Lower the head of the bed(B) Ask the person to lie down(C) Apply ice directly to the skin to stop the bleeding faster(D) Apply pressure over the bridge of the nose

14. Another word for “vomiting” is:(A) Emesis(B) Epistaxis(C) Dyspnea(D) Infarction


Exam (cont’d.)15. When a resident is suspected of having a heart attack, a nursing assistant should:(A) Not give the person food or fluids(B) Cover the resident with a heavy blanket(C) Make sure the resident is standing up to promote circulation(D) Leave the resident to call his family 16. Which of the following symptoms is more often experienced by women during a heart attack?(A) Shortness of breath(B) Extreme fatigue(C) Anxiety and a sense of doom(D) Low blood pressure


Exam (cont’d.)17. Insulin reaction is also called: (A) Myocardial infarction(B) Diabetic coma(C) Hypoglycemia(D) Epistaxis

18. Hyperglycemia may be caused by:(A) Having too much insulin in the body(B) Having too little insulin in the body(C) Eating too little food(D) Too much exercise


Exam (cont’d.)19. Which of the following is true of assisting a resident who is having a seizure?(A) Give the resident a glass of water to drink.(B) Hold the resident down if he or she is shaking severely.(C) Move furniture away to prevent injury to the resident.(D) Open the resident’s mouth to move the tongue to the side.

20. A transient ischemic attack is a warning sign of:(A) Cerebrovascular accident(B) Myocardial infarction(C) Hypoglycemia(D) Epistaxis


Exam (cont’d.)21. A sign that a stroke is occurring is:(A) Abdominal pain(B) Gasping for air(C) Low blood pressure(D) Facial droop

22. In a healthcare facility, codes are used to:(A) Keep track of residents(B) Inform staff of emergencies without alarming residents and visitors(C) Teach procedures to new nursing assistants(D) Welcome new residents to the facility


Exam (cont’d.)23. During code team procedures, a nursing assistant might be asked to:(A) Give a resident oxygen(B) Call the resident’s family(C) Work with the suction machine(D) Give chest compressions during CPR

8 Emergency Care, First Aid, and Disasters 1. Define important words in this chapter abdominal thrusts a method of attempting to remove an object from.

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