Chapter 43 - Care of Patients During Disasters, Bioterrorism Attacks, and Pandemic Infections - SG

Emergency Preparedness Plan

Will identify who will be in charge and the chain of command for the facility.

Botulism (what, s&s, treatment)

- Caused by botulinum toxins produced by Clostridium botulinum. - S&S: double vision, drooping eyelids, and difficulty swallowing - Treatment: antitoxin given immediately, mechanical ventilation, penicillin

Diluting Agents

Reduce the concentration of the radioactive material. - Water is the best example of a diluting agent - Special precautions need to be used because the fluids produced could be radiologically contaminated.

Disillusionment Stage

- Reality of loss occurs - Ongoing physical and emotional fatigue can result in substance abuse and discouragement. - Feeling of abandonment and ignored by the larger community because of the gap between resources and need.

Influenza

- Seasonal - There are always fatalities associate with influenza

Honeymoon Stage

- Survivors are grateful that they are still alive. - Strong sense of brotherhood and community spirit

Impact Stage

- Survivors are stunned, apathetic, and disorganized. - Difficulty following directions - Need strong support and firm guidance

What are the triad of symptoms for Botulism?

- Symmetrical descending flaccid paralysis progressing to respiratory weakness - Absence of fever - Alertness and orientation without sensory deficits

Patient teaching of the flu:

- Be prepared to stay at home for at least 2 weeks. - Healthy lifestyle to support the immune system is encouraged. - Hand hygiene - Covering the mouth and nose during coughing and sneezing. - Disposing of tissues - Staying away from public places if possible.

While admitting a young, previously healthy patient with a severe respiratory illness, a nurse becomes suspicious of a bioterrorism event. Which question could confirm the suspicion?

"Has the illness progressed rapidly?"

A nurse is participating in a disaster drill. A mock victim with a green tag asks, "What does this tag mean?". What is the nurse's best response?

"You will have to wait for care because your injuries are not life-threatening."

Class V: Dead or suspected to die

(Black Tag) Dead, or imminently dying with little chance of survival. Treatment: None

Class III: Nonurgent

(Green Tag) "Walking Wounded" (closed fractures, sprains, strains, contusions) Treatment: More than 2 hrs.

Class I: Emergent

(Red Tag) Immediate threat to life, such as airway compromise or hemorrhagic shock. Treatment: Immediate

Class IV: Minor

(White Tag) Minor injuries not requiring provider care (abrasion, bruises) Treatment: Dismiss

Class II: Urgent

(Yellow Tag) Major injuries, open fractures, large wounds. Treatment: Within 30 min. - 2 hrs.

Nurse's Role in Preparedness and Response

- A nurse's duty to care is high, because risk of harm to self is low. - Education and hands on training are highly recommended to increase nurse preparedness. - Recognize cluster of cases suggestive of a biologic event - Work closely with law enforcement and public health departments.

Some radiation produce particles which?

- Adhere to airborne dust particles; may be inhaled. - Will settle on clothes, crops, water supplies, and other surfaces.

Category C Agents

- Agents that have yet to be weaponized, but have the potential for high morbidity and mortality. - Plentiful, easy to produce and disseminate. - Examples: Hantavirus, tick-borne encephalitis, yellow fever.

Plague (what, s&s, treatment)

- Caused by gram-negative bacillus, Yersinia pestis. Starts as a skin infection and spreads to the lymph nodes. S&S: Hemoptysis, cough, high fever, chills, myalgia, headache, respiratory failure, lymph node swelling. Treatment: Gentamicin - IV drug of choice, Streptomycin - IM for first-line treatment, Ciprifloxacin and doxycyline are used to treat pneumonic plague for 7-10 days.

Tularemia (what, s&s, treatment)

- Caused by gram-negative coccobacillus, Francisella tularensis. Vector-borne illness, transmitted by an infected tick, mosquito, or deer fly bite, by direct exposure to contaminated animal tissues and fluids. - S&S: abrupt onset of fever, chills, headache, muscle aches, nonproductive cough, sore throat. - Treatment: Streptomycin and gentamicin are the first drugs of choice. Doxycycline and ciprofloxacin may also be used. Usually 10-14 days.

Anthrax (what, s&s, treatment)

- Caused by gram-positive bacteria Bacillus anthracis, forms spores. Disease of sheep and cows. - S&S: rapid downhill. Respiratory failure, shock, possible death within 2-5 days. dyspnea, diaphoresis, fever, cough, chest pain - Treatment: Ciprofloxacin or Doxycycline (antibiotics for 14 days) Treatment continues for 60 days if infection is present.

Smallpox (what, s&s, treatment)

- Caused by variola virus. Communicable, no known effective treatment and high mortality rate. - S&S: fever for 1-4 days and rash occurs. headache, backache, malaise, vomiting, and delirium. - Treatment: There is no treatment, but patients should be under strict Airborne Infection Isolation and Contact Precautions. Receiving the smallpox vaccine within 4 days of exposure can reduce the severity of the disease.

In the event of a tornado, hurricane, or flood:

- Choose ahead of time when evacuation is necessary. - Listen to local radio or television stations for instructions - Keep road maps handy

What do you need to do when there is a chemical disaster in your neighborhood?

- Close all windows and doors to house - Turn off all heaters, fans, and AC systems - Wet towels and jam under doors - Go to an above ground room with fewest windows and doors - Stay inside until all clear

What are the three different forms tularemia occurs in?

- Cutaneous - Pneumonic - Typhoidal

What are the three forms of anthrax?

- Cutaneous (95% of all cases) - Gastrointestinal (less than 1%) - Inhalation (5%)

Category B Agents

- Delivered through food and water sources. - Produce moderate amounts of illness and low death rates. - Examples: Q fever, brucellosis, glanders, ricin toxin, Staph B.

Governmental agencies for disaster planning are:

- Department of Homeland Security - Office of Domestic Preparedness - Federal Emergency Management Agency (FEMA) - U.S. Public Health Service - The American Red Cross (Voluntary service)

Category A Agents:

- Easily disseminated - Readily available - May be transmitted from person to person as well

Six forms of botulism:

- Food-borne - Wound - Injection-related - Inhalation - Adult intestinal - Infant botulism

Viral hemorrhagic fevers (what, s&s, treatment)

- Group of illnesses caused by 4 families of viruses: arenaviruses, filoviruses, flaviviruses, and bunyaviruses. Occur in different geographic parts of the world. Usually occurs by being bitten by an infected arthropod, infected animal carcasses, inhaling aerosolized rodent excreta. S&S: incubation period: 2-42 days. fever, fatigue, dizziness, muscle aches, loss of strength, abdominal pain, diarrhea, exhaustion. Treatment: No specific treatment, but supportive treatment. Precautions are double gloves, impermeable gowns, leg & shoe coverings, face shields, eye protection, & N95 mask.

Nursing management in the reconstruction stage:

- Individual self-help and work therapy is encouraged. - Existing community facilities & resources must be used as much as possible for continued care. - Promote the effectiveness of the health service agency by knowing and helping implement the agency's disaster plan. - Restore community health by controlling environmental health hazards is extremely important.

Heroic Stage

- Individuals want to be helpful, may minimize or ignore their own injuries and demonstrate rescue behavior that is risky to self.

Signs a bioterrorism attack has occurred:

- Large numbers of patients with similar symptoms of disease - Higher than expected illness & death incidence with common disease - Unusual disease presentation - Large number of patients with unexplained symptoms, disease, or deaths - Disease typical to the area with a sudden unexplained increase in incidence - Atypical incidence of disease in patients not usually affected - Sudden death of many animals in the community

In the event of a fire:

- Leave quickly, if told to evacuate - If fire or smoke is evident, drop to the floor and crawl. Cover your mouth and nose with a moistened cloth.

In the community, who is responsible for coordinating efforts to assist people when a disaster happens?

- Local law enforcement agency - City or county emergency management department - State public health department - American Red Cross

Nuclear Disaster

- May be the result of an accident at a nuclear power plant, a disruption of a nuclear power plant by terrorists, or a nuclear "dirty bomb".

Reconstruction Stage

- May continue for years as people rebuild their lives. - Begin to see the crisis as a growth and opportunity period

Bring the following with you if you need to evacuate:

- Prescription medications and medical supplies, glasses, hearing aids, and other assistive devices - Bedding and clothing - Bottled water, radio, extra batteries, first aid kit, and flashlight - Documents (ID, insurance policies, wills, social security card, and tax records)

Patient teaching of removal and disposal of contaminated clothing:

- Quickly take off clothing - Wash away any chemicals from skin with large amount of soap. - If eyes are burning, rinse with plain water for 10-15 minutes - If contact lenses are worn, remove them - Place all contaminated items into a plastic bag and seal it. Place into another bag and seal it. - Dress in clothing that hasn't been contaminated. - The health department or emergency personnel will handle the bags and arrange for disposal.

Active Shooters in the hospital

- The Joint Commission and OSHA require hospitals to address an active shooter scenario in their workplace violence plan. - "Code Silver" is designated. - Be aware of potential violence based on behaviors, actions, and speech. - Security or community law should be called ASAP. - Potential violence may come from patients, staff, or visitors. - RUN, HIDE, FIGHT.

The amount of damage that a nuclear disaster does to a person depends on?

- The type of radiation - The dose received - The length of time of exposure - The route of exposure

Community members should have a 3 days' supply kit that includes:

- Water in plastic containers - Nonperishable food items - Can opener, flashlights, radio, extra batteries, first aid kit, and medications - Clothing, emergency blankets, emergency contact information, extra cash, and cellphones & chargers.

What are the signs and symptoms of emotional shock?

- headaches, nausea, chest pain - preexisting medical conditions may worsen due to stress

How many drops of bleach to a gallon of water?

16 drops

Perishable foods should not be kept warmer than 40 F for more than?

2 hours

A freezer that is half full will keep food safe for up to?

24 hours

How long should you boil water to purify it before drinking?

3-5 minutes

A freezer that is full will keep food safe for up to?

48 hours

What is a dirty bomb?

A nuclear weapon containing radioactive substances.

Pandemic

AN infection that is an international outbreak of disease.

Examples of Category A Agents

Anthrax, plague, smallpox, botulism, viral hemorrhagic fevers, and tularemia

Hospital Incident Commander

Assumes the responsibility for launching the emergency preparedness plan. (provider or administrator)

Which behavior by the nurse indicates that there is a need for additional counseling beyond the counseling offered through a critical incident stress debriefing?

Avoids coworkers and friends for a prolonged time.

Chelating Agents

Bind with radioactive materials and allow it to be excreted without being absorbed into tissues.

Preparedness by health care professionals involves:

Both personal and employment-related responsibilities. Disaster supplies, with all the recommended items, should be prepared by every household.

A large number of patients are arriving in the hospital from a scene of a chemical disaster. What is the nurse's priority action?

Decontaminate all patients outside the hospital by showering.

Decontamination

Done with showering and scrubbing the skin to remove particles.

Disaster

Exists when the number of casualties exceeds the resource capabilities of the area.

Bioterrorism

Involves the deliberate release of microorganisms or toxins derived from living organisms that cause disease or death to humans, plants, or animals.

Mass Casualty

Many-victims incident

Surge Capacity

Maximum services that a facility can offer when every resource is mobilized.

What populations are considered special populations?

Older adults, disabled, immunocompromised, infants

Debriefing

Questioning of personnel involved and obtaining knowledge about event and problems that occurred during a disaster.

A patient is tentatively diagnosed with chickenpox. During a skin assessment, what is the nurse likely to find that confirms diagnosis?

Skin lesions occur in various stages.

Triage

Sorting out of casualties by priority of need for treatment.

Which patient needs to be put immediately in isolation?

Suspected smallpox, but probable chickenpox.

The greatest chance of inhaling spores of anthrax after aerosolization is during?

The first day after the event

When the radiation exposure is in the form of particulates that have entered the body, treatment depends on?

The type of radiologic substances

What are the keys to the quantity of radiation an individual will receive?

Time, distance, and shielding

At a disaster scene, a nurse notices that a person has been triaged with a black tag. What should the nurse do?

Try to locate family members so that they can be present when the person dies.

Excretion Agents

Used when radioactive material has been ingested, these reduce the time the material is in the GI tract.

Isotope-Specific Blocking Agents

Uses potassium iodide to prevent the thyroid cancer this type of radiation causes.

When is the flu considered a pandemic?

When the death rate is significantly elevated with international epidemiology.