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Medical Urgencies In The Classroom Lori Christopher, RN, MSN, CNP Certified Nurse Practitioner/Nurse...

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Medical Medical Urgencies In The Urgencies In The Classroom Classroom Lori Christopher, RN, MSN, CNP Lori Christopher, RN, MSN, CNP Certified Nurse Practitioner/Nurse Certified Nurse Practitioner/Nurse Manager Manager University Health Services University Health Services *Adapted from the American Academy of Pediatrics 8/03 *Adapted from the American Academy of Pediatrics 8/03
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Medical Medical Urgencies In The Urgencies In The

ClassroomClassroomLori Christopher, RN, MSN, CNPLori Christopher, RN, MSN, CNP

Certified Nurse Practitioner/Nurse Certified Nurse Practitioner/Nurse ManagerManager

University Health ServicesUniversity Health Services*Adapted from the American Academy of Pediatrics 8/03*Adapted from the American Academy of Pediatrics 8/03

University Health ServicesUniversity Health ServicesEastway Dr.Eastway Dr.

We are a large multi-disciplinary facility with We are a large multi-disciplinary facility with over 30, 000 patient encounters per year. over 30, 000 patient encounters per year.

We have 15 clinicians, 4 psychologists, 1 We have 15 clinicians, 4 psychologists, 1 physical therapist, 10 nursing staff members physical therapist, 10 nursing staff members and many ancillary staff members.and many ancillary staff members.

We have a general medical clinic, urgent care We have a general medical clinic, urgent care clinic, women’s clinic, psychology clinic, clinic, women’s clinic, psychology clinic, pharmacy, laboratory, x-ray department, pharmacy, laboratory, x-ray department, immunization department, physical therapy immunization department, physical therapy and a health promotions department. and a health promotions department.

Seizures/ConvulsionsSeizures/Convulsions

Seizures can range from mild to severe – Seizures can range from mild to severe – brief blackouts, involuntary movements, brief blackouts, involuntary movements, sudden falls, periods of confused behavior, sudden falls, periods of confused behavior, and involuntary muscle contractions.and involuntary muscle contractions.

Severe seizures may involve uncontrollable Severe seizures may involve uncontrollable muscle movements (jerking or spasms) and muscle movements (jerking or spasms) and rigidity, loss of consciousness, loss of rigidity, loss of consciousness, loss of bladder and/or bowel control, and in some bladder and/or bowel control, and in some cases, breathing that stops temporarily.cases, breathing that stops temporarily.

Seizures/ConvulsionsSeizures/Convulsions Have another student call 911 while you stay with the Have another student call 911 while you stay with the

student who appears to be having a seizurestudent who appears to be having a seizure Protect the person from injuryProtect the person from injury

Move all furniture or equipment that is nearbyMove all furniture or equipment that is nearby Do not hold or restrain the studentDo not hold or restrain the student Do not put anything in the student’s mouthDo not put anything in the student’s mouth Loosen clothingLoosen clothing Roll the student on his/her side if vomiting occursRoll the student on his/her side if vomiting occurs

After the seizure activity has stoppedAfter the seizure activity has stopped::1.1. Perform rescue breathing if person is blue or not Perform rescue breathing if person is blue or not

breathing (if CPR certified)breathing (if CPR certified)2.2. If breathing, lay person on sideIf breathing, lay person on side

FAINTINGFAINTING

Lay person on back with head to the Lay person on back with head to the side and legs elevatedside and legs elevated

DO NOT give anything by mouthDO NOT give anything by mouth Send the student to the health center Send the student to the health center

with another person, if the student with another person, if the student has recovered and is able to walk has recovered and is able to walk across campus without difficultyacross campus without difficulty

If person doesn’t wake up right away, If person doesn’t wake up right away, call 911call 911

NOSEBLEEDSNOSEBLEEDS

With person sitting, With person sitting, squeeze nostrils squeeze nostrils together between together between thumb and index thumb and index finger for 10 minutesfinger for 10 minutes

If bleeding persists, If bleeding persists, call the student call the student health center or send health center or send the student to the the student to the health center.health center.

CutsCuts

Apply pressure with a clean cloth to Apply pressure with a clean cloth to stop the bleedingstop the bleeding

If the cut is large and deep, call or If the cut is large and deep, call or send the student to the health center send the student to the health center and maintain pressureand maintain pressure

For minor cuts, wash with soap and For minor cuts, wash with soap and water and cover with dressing. water and cover with dressing.

If cut may need sutures, seek medical If cut may need sutures, seek medical care as soon as possiblecare as soon as possible

Puncture WoundsPuncture Wounds DO NOT remove large DO NOT remove large

objects such as knives objects such as knives or sticks, call 911 or sticks, call 911

For minor wounds, For minor wounds, wash with soap and wash with soap and water and call the water and call the student health centerstudent health center

The person may need The person may need a tetanus booster a tetanus booster injectioninjection

StingingStinging InsectsInsects Remove the stinger with the scraping motion of Remove the stinger with the scraping motion of

a fingernaila fingernail DO NOT pull the stinger outDO NOT pull the stinger out Put a cold compress on the bitePut a cold compress on the bite If hives, paleness, weakness, nausea, vomiting, If hives, paleness, weakness, nausea, vomiting,

tightness in chest, breathing difficulty, or tightness in chest, breathing difficulty, or collapse occur, call 911. collapse occur, call 911.

For spider bites, call the student health center For spider bites, call the student health center or Poison Control Centeror Poison Control Center

TEETHTEETH If knocked out, find the tooth and rinse it If knocked out, find the tooth and rinse it

gently without touching the rootgently without touching the root Insert and gently hold the tooth in its Insert and gently hold the tooth in its

socket or transport the tooth in cow’s milksocket or transport the tooth in cow’s milk If broken, save the pieces. Gently clean If broken, save the pieces. Gently clean

the injured area with warm water. Place the injured area with warm water. Place a cold compress to reduce swelling. a cold compress to reduce swelling.

Send the student directly to the dentist or Send the student directly to the dentist or an emergency room. an emergency room. Time is important!Time is important!

ChokingChoking

Partial airway obstruction Partial airway obstruction with good airway exchangewith good airway exchange

Partial airway obstruction Partial airway obstruction with poor airway exchangewith poor airway exchange

Complete airway Complete airway obstructionobstruction

ChokingChoking

Partial airway obstruction with good Partial airway obstruction with good airway exchangeairway exchange Forceful coughForceful cough Wheezing in between breathsWheezing in between breaths

*Stay with the student and encourage *Stay with the student and encourage them to coughthem to cough

ChokingChoking

Partial airway obstruction with poor Partial airway obstruction with poor air exchangeair exchange Weak, ineffective coughWeak, ineffective cough High-pitched noises while breathingHigh-pitched noises while breathing

* This type of obstruction should be * This type of obstruction should be dealt with as if it were a complete dealt with as if it were a complete obstructionobstruction

ChokingChoking

Complete airway obstructionComplete airway obstruction Unable to breathe, speak or coughUnable to breathe, speak or cough Clutching at his/her throat (universal Clutching at his/her throat (universal

distress signal for choking)distress signal for choking)

* If the student is still conscious, * If the student is still conscious, perform Heimlich maneuverperform Heimlich maneuver

* If the student becomes unconscious, * If the student becomes unconscious, call 911 and continue helping if call 911 and continue helping if familiar with Firstfamiliar with First Aid/CPRAid/CPR

Heart AttackHeart Attack

Signs/SymptomsSigns/Symptoms Chest discomfort or pain (it may be Chest discomfort or pain (it may be

described by the student as pressure, described by the student as pressure, squeezing, fullness, tightness, aching, squeezing, fullness, tightness, aching, crushing, constricting or heavy)crushing, constricting or heavy)

Radiation of the pain to the neck, jaw or Radiation of the pain to the neck, jaw or backback

SweatingSweating NauseaNausea Shortness of breathShortness of breath

Heart AttackHeart Attack

A quick response in case of a heart A quick response in case of a heart attack requires that you:attack requires that you:

1.1. Recognize the symptoms of a heart Recognize the symptoms of a heart attack and take action.attack and take action.

2.2. Have the victim stop what he or she is Have the victim stop what he or she is doing and sit or lie down in a doing and sit or lie down in a comfortable position. Loosen comfortable position. Loosen constrictive clothing. Do not let the constrictive clothing. Do not let the victim move around.victim move around.

3.3. Have someone phone 911 for help. Have someone phone 911 for help.

DepressionDepression More Americans suffer from depression than More Americans suffer from depression than

coronary artery disease, cancer and AIDS combinedcoronary artery disease, cancer and AIDS combined

Symptoms of depression include:Symptoms of depression include: Sadness or feeling downSadness or feeling down Loss of interest or pleasure in usual activitiesLoss of interest or pleasure in usual activities Poor appetite or overeatingPoor appetite or overeating Trouble falling or staying asleep or sleeping too muchTrouble falling or staying asleep or sleeping too much Feeling tired or having little energyFeeling tired or having little energy Feelings of worthlessness, self-reproach or guiltFeelings of worthlessness, self-reproach or guilt Trouble concentratingTrouble concentrating Moving or speaking very slowly, or the opposite, being Moving or speaking very slowly, or the opposite, being

fidgety or restlessfidgety or restless Thoughts of being better off dead or of hurting oneself in Thoughts of being better off dead or of hurting oneself in

some waysome way

Depression/SuicideDepression/Suicide Suicide is the second leading cause of Suicide is the second leading cause of

death among all youth 15-24 years old. In death among all youth 15-24 years old. In the US, only accidents and homicides the US, only accidents and homicides claim more young lives.claim more young lives.

Nearly 4,000 people aged 15-24 die by Nearly 4,000 people aged 15-24 die by suicide each year in the US.suicide each year in the US.

A person dies by suicide about every 18 A person dies by suicide about every 18 minutes in the US and an attempt is minutes in the US and an attempt is estimated to be made once every minute.estimated to be made once every minute.

* American Foundation for Suicide Prevention* American Foundation for Suicide Prevention

DepressionDepression

Depression is a major problem for Depression is a major problem for college students, not only because it college students, not only because it can lead to suicide, but also because can lead to suicide, but also because it is associated with poor physical it is associated with poor physical health, substandard academic health, substandard academic performance and irresponsible risk performance and irresponsible risk taking behaviorstaking behaviors

DepressionDepression

Over 90% of youth who die by Over 90% of youth who die by suicide had at least one psychiatric suicide had at least one psychiatric illness at the time of death; in about illness at the time of death; in about half such cases, the psychiatric half such cases, the psychiatric illness was present, although often illness was present, although often unrecognized, for two years or more. unrecognized, for two years or more.

American Foundation for Suicide PreventionAmerican Foundation for Suicide Prevention

Psychological EmergencyPsychological Emergency

If you suspect someone is in If you suspect someone is in psychological crisis and/or suicidal:psychological crisis and/or suicidal: Take it seriouslyTake it seriously Be willing to listenBe willing to listen Voice your concern/Let the person know Voice your concern/Let the person know

you are concerned and understandyou are concerned and understand Encourage the student to get Encourage the student to get

professional help immediatelyprofessional help immediately In the case of suicidal/homicidal In the case of suicidal/homicidal

behavior –Call 911behavior –Call 911

When to dial 911?When to dial 911?

Warning signs of a Medical EmergencyWarning signs of a Medical Emergency Fainting or convulsionsFainting or convulsions Chest or upper abdominal pain or pressureChest or upper abdominal pain or pressure Sudden dizziness, weakness, or change in visionSudden dizziness, weakness, or change in vision Difficulty in breathing, shortness of breathDifficulty in breathing, shortness of breath Severe or persistent vomitingSevere or persistent vomiting Coughing up or vomiting bloodCoughing up or vomiting blood Bleeding that won’t stop after applying 10-15 minutes Bleeding that won’t stop after applying 10-15 minutes

of pressureof pressure Change in mental status (confusion, unusual behavior, Change in mental status (confusion, unusual behavior,

difficulty in staying awake)difficulty in staying awake) Suicidal or homicidal feelingsSuicidal or homicidal feelings

When an Emergency When an Emergency Occurs:Occurs:

Be prepared: Keep the numbers of Be prepared: Keep the numbers of emergency services near your phoneemergency services near your phone

When you call for help, speak calmly and When you call for help, speak calmly and clearlyclearly

Give name, address, phone number, Give name, address, phone number, location of victim and nature of problemlocation of victim and nature of problem

Don’t hang up until the dispatcher tells Don’t hang up until the dispatcher tells you to do so because they may need you to do so because they may need additional informationadditional information

KSU Nurse Help LineKSU Nurse Help Line

After-hours nurse information line After-hours nurse information line Service is provided by the Rainbow Service is provided by the Rainbow

Call Center which is housed in Call Center which is housed in University Hospitals of ClevelandUniversity Hospitals of Cleveland

(330)672-2326(330)672-2326 During regular business hours, line During regular business hours, line

is answered by a nurse working at is answered by a nurse working at UHSUHS

IMPORTANT PHONE IMPORTANT PHONE NUMBERSNUMBERS

Fire, Police or Ambulance……………………..911Fire, Police or Ambulance……………………..911 University Health Services........................672-2322University Health Services........................672-2322 University Nurse Help Line…………………672-2326University Nurse Help Line…………………672-2326 University Psychological Services………….672-2487University Psychological Services………….672-2487 Poison Control Center………………………..1-800-222-Poison Control Center………………………..1-800-222-

12221222 Kent State Police Kent State Police (non-emergent)………………………(non-emergent)………………………672-2212672-2212 Crisis Hotline/Townhall II…………………..678-HELPCrisis Hotline/Townhall II…………………..678-HELP Coleman Professional Services……………… 673-1347Coleman Professional Services……………… 673-1347 Robinson Memorial Hospital………………..297-0811Robinson Memorial Hospital………………..297-0811 Med Center One…………………………………678-4380Med Center One…………………………………678-4380

Sick NotesSick Notes We, at University Health Services, DO NOT give sick We, at University Health Services, DO NOT give sick

notes unless we truly feel the patient should not be notes unless we truly feel the patient should not be going to class. going to class.

We DO NOT give notes for an illness that has resolved We DO NOT give notes for an illness that has resolved or is getting better once the student is actually seen at or is getting better once the student is actually seen at the health center. the health center.

Please do not send students to the health center for a Please do not send students to the health center for a sick note AFTER their illness has resolved. We are no sick note AFTER their illness has resolved. We are no better than you at detecting if someone WAS sick. better than you at detecting if someone WAS sick.

Every student that sees a nurse/nurse Every student that sees a nurse/nurse practitioner/physician/psychologist, has diagnostic practitioner/physician/psychologist, has diagnostic tests performed or buys medication (prescription or tests performed or buys medication (prescription or over-the-counter) is given a walk-out statement when over-the-counter) is given a walk-out statement when they leave the facility. This statement in no way means they leave the facility. This statement in no way means the student was given permission by someone at the the student was given permission by someone at the health center to miss class because of their illness.health center to miss class because of their illness.


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