My Emergency Plan In the case of an emergency, this plan will help you decide when and who to call. Keep it where you can find it. Our agency has nursing staff on call 24 hours a day including nights, weekends, and holidays. Nurse/Therapist Name: __________________________________________________ Phone Number: _________________________ PROBLEM Breathing/Lungs CALL NURSE AT AGENCY CALL 911 Increased () shortness of breath Difficulty breathing A cough that gets worse Severe shortness of breath or wheezing that does not Change in color, thickness, odor, or amount of sputum respond to inhalers or breathing treatments You become restless or agitated Change in the color of your skin to gray or blue OR if you fatigue/weakness become blue around your lips Loss of appetite or weight You develop confusion Fever – oral temperature greater than 100.5 degrees F Heart Failure weight of __ pounds in 1 day OR 3 pounds in ______ Severe shortness of breath shortness of breath, especially when you lie flat Fainting A productive, frothy cough or new coughing at night Sudden or severe chest pain or pressure New congestion, not related to a cold Frothy sputum More swelling in your legs or feet than usual fatigue/weakness Dizziness/lightheadedness when you get up Irregular or rapid heartbeat Chest pain or tightness RELIEVED by rest or medication Chest pain, pressure, or tightness that medication PROBLEM CALL NURSE AT AGENCY Chest Pain CALL 911 (Nitroglycerin) does not help OR Chest pain that goes away and comes back Pain/discomfort in neck, jaw, the back, one or both arms, or stomach Chest discomfort with shortness of breath, sweating, or nausea Blood Pressure Stroke Repeated blood pressure readings above: Sudden numbness or weakness of the face, arm or leg – may _____________________________________________ be on one side of the body Sudden confusion, trouble talking, or understanding Symptoms may include headaches, nose bleeds, blurred vision, Sudden trouble seeing in one or both eyes ringing in ears, lightheadedness, heart palpitations (fluttering) Sudden trouble walking, dizziness, loss of balance or coordination Sudden, severe headache with no known reason Blood Thinner Bleeding Black/dark or blood tinged bowel movements Vomiting blood Bleeding from gums, nose, mouth, or surgical site Unusual bruising Blood in urine Urinary Catheter Urinary Infection Catheter is leaking, blocked, or dislodged (out) Urge to urinate frequently, in small amounts, or unable to urinate Burning when urinating Bloody, cloudy, or change in urine color or foul odor Low back pain May have fever greater than 100.5 degrees or chills Bleeding you can’t control PROBLEM Wound/Skin CALL NURSE AT AGENCY CALL 911 Change in amount, color, or odor of wound drainage Increase in pain at wound site Increase in redness/warmth at wound site Fever greater than 100.5 degrees/chills New skin problem Diabetes High blood sugar symptoms: thirst, frequent urination, hunger, Nausea and vomiting, shortness of breath, fruity breath blurred vision, weakness, dry, itchy skin Repeated blood sugars greater than ___________mg/dl Blood sugar greater than 450 mg/dl Low blood sugar symptoms: Shakiness, sweating, hunger, Unconsciousness headache, fast heartbeat, confusion, changes in vision, irritability Unable to treat low blood sugar at home Repeated blood sugars less than _____________mg/dl Seizures If experiencing above symptoms, test blood sugar first (if possible), Low blood sugar not responding to treatment then treat with some form of sugar such as: 3 glucose tablets, or ½ glass of juice, or 5-6 pieces of hard candy; wait 15 minutes and recheck blood sugar; if your blood sugar is still low and symptoms do not go away, eat a light snack such as ½ peanut butter or meat sandwich and ½ glass of milk. Recheck blood sugar in 15 minutes, if still low, call 911 Fall Other Fall with no serious injury Fall with suspected injury (broken bone or wound) New symptoms Unable to wake patient Healthcare concerns – pain, no BM in 3 day, other Severe or prolonged pain Adapted by Deborah Chisholm, RN, BSN, CPHQ, COS-C from tools developed by Healthcare Partners, Inc., Southfield, MI and Simple Emergency Plan-Carolina Medical Review.