Please Help me!

zmansc, ASN, RN · Nov 23, 2014

Start with the basics of cell biology, signalling, positive and negative ions, and build from there, it's all based on that.

guest474423 · Nov 25, 2014

Cell biology? That's not very nice.

Here you go: 1) benign belly pain 2) chronic belly pain 3) subacute belly pain 4) acute belly pain 5) dental pain 6) benign joint pain and 7) "dilaudid is the only thing that helps" pain.

But seriously, in terms of what the CEN test deems as need-to-know material for the ER nurse: cardiac and respiratory pathologies and management of their emergencies; abdominal pathologies; psychiatric crisis; traumatic injury (aka: blood loss, shock, ABCs, etc.)

hrodriguez088 · Nov 26, 2014

Thank you very much Proudblood :)

**NickiLaughs, ADN, BSN, RN** · Nov 26, 2014

LOL @ Proudblood.

In regards to the actual question, it varies from ER, it's hard to say there's just 7 you should know. Different ERs have different problems, although most now have a pain problem as demonstrated by Proudblood’s post.

Neuro- Hemorrhagic and embolitic stroke. Know tPA when it’s appropriate to give and when not to as well as stroke scales. A lot of things can mimic stroke – hypoglycemia, hyponatremia, bells palsy.

Cardiac –

STEMI, non STEMI. Know meds such as heparin, Plavix, etc and take a 12 lead EKG class and arrhythmia. I’ve never heard anyone say, “man I shouldn’t have taken that class, it’s such useless knowledge.” I’ve most recently started an ER job that required an EKG /rhythm test in order to get the job. It was harder than the ones I’d had as a Cardiac ICU nurse, it’s useful information.

CHF- there’s left sided/right sided, Labs BNP, Meds- Lasix.

Other less common but miscellaneous to knows are aortic dissections, cardiac tamponade,

Respiratory

COPD Exacerbations

Asthma Exacerbations

GI/GU

Pyelo

Kidney Stones

Trauma – take TNCC, it’s important and all information you should know and be familiar with

Hemo/Pneumothorax – understand the concept that the lung is shrunk down because of air in the pleural space, purpose of a chest tube. The spontaneous pneumos are cool, the patient usually just looking uncomfortable and you think it’s just a random constachondritis and watching the doc read the xray and everyones surprised.

Liver/Spleen Lacs- might buy a trip to IR

Multi

Sepsis- you just need to know it, backwards/forwards. You will see it. A LOT

There are also other problems that you will see more frequently, such as generalized back pain, toe pain, dental abscesses, but the pathophys of those just isn’t as significant as the other ones.

hrodriguez088 · Nov 29, 2014

THank you very much NIckylaughs. I still have a few months before graduating. With the info that you gave me, I'll be much more prepared. Happy Holidays :)

friendlylark · Nov 29, 2014

I would definitely get a good baseline understanding of the pathophysiology of CHF. CHF is one of the most common reasons for hospital admissions in older adults. Here is an excellent list of common admissions:

Most Common Causes of Hospital Admissions for Older Adults - Diabetes,... - AARP

My favorite population is the elderly/geriatric. Yesterday I worked in the ER as an ICU float nurse. I had a homeless man who was DKA. I enjoy taking a DKA patient from an astronomical blood glucose level to under 250. I enjoy the protocol! I also enjoy giving blood (it makes my patients feel so much better!), and I like using the heparin protocols for ACS and PE.

Focus on neuro problems such as stroke as well. That is a huge competency in the ER!

Best of luck!

Anne Marie

friendlylark · Nov 29, 2014

YES! Low back pain is a huge one that we see in the ER. I agree with NickiLaughs, it is definitely not as interesting of a pathophysiology, but I have had 2 patients recently with cauda equina syndrome - something to be very aware of and to watch for in your LBP patients!