Ch. 13 - Acute and Chronic Illnesses

An illness can be categorized as either acute (with a sudden onset) or chronic (persisting over time). Both acute and chronic illnesses can develop into sudden medical emergencies either rapidly or gradually.

Sometimes, there are no warning signs or symptoms to indicate a medical emergency caused by an acute or a chronic illness. Other times, a patient may only be able to communicate that he or she is feeling ill or that something is wrong. Symptoms may also be atypical; for example, older adults or those with diabetes may have a heart attack without experiencing chest pain.

Transcript

1. Ch 13 – Pg 247
2. Acute and Chronic Illnesses Conditions such as diabetes and epilepsy can cause a variety of signs and symptoms, including sudden, unexplained altered mental status. A patient may complain of feeling light-headed, dizzy, nauseated or may vomit. Respirations, pulse, and skin may change. Ultimately, if a patient looks and feels ill without having experienced trauma, this could indicate a medical emergency. Ch 13 – Pg 247-248
3. Syncope Occurs when the brain is suddenly deprived of its normal blood flow and momentarily shuts down. S&S: • Light-headed or dizzy • Skin may be cool, moist, pale or ashen • Nausea • Numbness or tingling in the fingers and toes • Respirations and pulse may become faster Care: • Maintain open airway • Place in supine position • Have suction ready • Nothing to eat or drink Although the patient usually recovers quickly, the underlying cause may not be clear. Any altered mental status can be an indicator of a serious underlying condition. Always conduct a thorough assessment. Ch 13 – Pg 248
4. Diabetic Emergencies A condition in which the body either fails to produce enough insulin or does not effectively use the insulin it does produce. Insulin is required for the transfer of glucose from the bloodstream to the body’s cells. Ch 13 – Pg 249-250
5. S&S of Diabetic Emergencies • Changes in LOR • Dizziness, drowsiness, and confusion • Rapid breathing • Rapid pulse • Feeling and looking ill Many people with diabetes carry a glucometer to test their blood glucose levels. It is not important for you to differentiate between hyper- and hypoglycemia. The standard treatment for both conditions is the same. Ch 13 – Pg 250
6. Treatment for Diabetic Emergencies Remember… If the patient is known to have diabetes AND exhibits the S&S stated, you should then suspect a diabetic emergency. Treatment 1. If the patient can follow directions and swallow safely: 1. Chew 2-5 glucose tablets, or… 2. Consume oral glucose gel (follow manufacturer’s recommendations) 2. If symptoms persist 5- 10min after the first dose of glucose, Rapid Transport Category, and provide a second dose Ch 13 – Pg 250 NEVER GIVE ANY PATIENT INSULIN!
7. Seizures The result of abnormal electrical activity in the brain. It can cause temporary changes in movement, function, sensation, awareness, or normal behaviour. Types of seizures include generalized seizures, partial seizures, absence seizures, febrile seizures, and status epilepticus. Ch 13 – Pg 251
8. Generalized Seizures Also called tonic-clonic or grand mal seizures. They involve both hemispheres of the brain, and rarely last more than 1-3min. Status Epilepticus is a seizure that lasts longer than 5min or is a series of repeated seizures lasting longer than 5min without a return of normal responsiveness. This is a serious medical emergency and can be fatal. Ch 13 – Pg 251
9. Four Stages of Generalized Seizures 1. Aura phase: may sense something unusual (not all patients will experience an aura) 2. Tonic phase: unresponsive and muscle rigidity 3. Clonic phase: uncontrollable muscular contractions (convulsions) 4. Postictal phase: diminished LOR with gradual recovery and confusion Ch 13 – Pg 251
10. Care for Seizures 1. Prevent injury • Move nearby objects away from patient • DO NOT place anything in the patient’s mouth 2. Manage the airway • Position the patient on their side • NEVER put your fingers into the mouth If the patient is postictal, comfort and reassure. Stay with the patient until they are fully responsive. Ch 13 – Pg 253
11. Transport Decision - RTC • It’s the patient’s first seizure • Status epilepticus (>5min, or repeated seizures, no return of normal LOR) • Takes place in water • Is the result of trauma • Patient is pregnant • Patient is a known diabetic • Patient is a child or infant • Patient fails to regain responsiveness • An older adult who may have suffered a stroke If the patient has a history of seizures that are medically controlled, you may not need to escalate to RTC. Ch 13 – Pg 253