EXAM 6
If using an all-hazards approach what type of drill should be required in any community?
Active shooter/acts of violence
If a fellow nurse tells you they were vaccinated in 1992 in the military for smallpox and can care for the patient infected with smallpox what would you say?
NO, because those who had vaccinations many years ago are not guaranteed to have lifelong immunity.
Can anthrax be spread from person to person?
NO.
What difference are there between airborne and droplet?
Negative pressure room with HEPA filters in air discharge vents
What does the acronym NBC stand for relating to weapons of mass destruction?
Nuclear, Biologic, Chemical
While caring for a person with Smallpox what symptoms do you expect to see first
Sever myalgia, headache and high fever
What other name is a green tagged patient referred as?
The walking wounded
During a bio terrorism event using small pox does the united states have the resources to vaccinate the general population?
YES
What defines a multi-casualty event
can be managed by a hospital using local resources
Types of internal disasters
fire, explosion, loss of critical utilities (e.g., electricity, water, computer systems, and COMMUNICATION capabilities), and violence.
When is a person with smallpox infectious?
At onset of rash until scabs separate approx 3 weeks
Which of the following is considered a Natural Disaster?A. Bombing B. EarthquakeC. InfluenzaD. Harmful Chemicals
B
How likely is a person to die from cutaneous (skin) anthrax without treatment?A. 10%B. 20%C. 50%D. 80%E. 99%
B. 20%
Examples of a pandemic ( OTHER THAN COVID)
Ebola, H1N1
Anthrax spores can survive in dry places such as soil for how long? A. 8 to 10 daysB. 8 to 10 weeksC. 1 yearD. 3 yearsE. At least 50 years
E. At least 50 years
A community health nurse is providing a community education program about disaster preparedness. Which of the following should the nurse recommend to include in an individual personal readiness supply kit or "go bag"? (SATA)A. Pocket knifeB. WhistleC. AntibioticsD. Bank account informationE. Household bleach
A, B, D, E
What precaution do you take when caring for Smallpox
Airborne
What classifies a disaster as internal
An event occurring inside a health care facility or campus that could endanger the SAFETY of patients or staff is considered to be an internal disaster. The event creates a need for evacuation or relocation. It often requires extra personnel and the activation of the facility's emergency preparedness and response plan
what classifies a disaster as external
An event outside the health care facility or campus, somewhere in the community, which requires the activation of the facility's emergency management plan is considered an external disaste
What precaution is used for anthrax?
Standard
What organization stock piles critical equipment and supplies in case they are needed for a pandemic or large scale vaccine program?
The U.S. government - pg 151
CAN actual disasters count as as a JC required drill?
YES tested through drills or actual participation in a real event at least twice a year.
A nurse is discussing with nursing staff the nurses' responsibility in preplanning for a response to a bioterrorism disaster. Which of the following should be included in the discussion?A. Identify community medical and social services that will be availableB. Evaluate the impact of a disaster on the communityC. Assess survivors of a disaster for levels of psychological stressD. Link victims with support agencies to help with food, clothing, shelter, and counseling needs
a
What defines a pandemic?
an infection or disease that occurs throughout the population of a country or the world
who can be hospital incident commander
his person is usually either a physician in the ED or a hospital administrator who has the authority to activate resources. This role can also be fulfilled by a nursing supervisor functioning as the on-site hospital administrator after usual business hours.
Is patient evacuation necessary for a fire drill?
no
The Centers for Medicare and Medicaid Services (CMS) (2016) requires every health care facility to practice at least how many fire drills or actual fire responses a year?
one fire drill or actual fire response once a year.
Parents who want to have their child immunized against smallpox approach a community health nurse. What is the best response by the nurse to these parents?a. "You should be concerned that your child has their scheduled immunizations."b. "I'll see what I can do to get your child the immunization."c. "Smallpox disease has been eliminated from the world and could only be re-introduced by bioterrorism."d. "You'll have to ask your doctor to order this for you."
"Smallpox disease has been eliminated from the world and could only be re-introduced by bioterrorism."Correct: Smallpox has been completely eradicated from the world, although there is potential for its reintroduction through bioterrorism.
What triage class is a RED tag?
1
Which pathogens are commonly associated with bioterrorism? Select all that apply.1 Variola virus2 Bacillus anthracis3 Yersinia pestis4 coli 0157:H75 Clostridium difficile
1, 2, 3Pathogens commonly associated with bioterrorism include variola virus (smallpox), Bacillus anthracis (anthrax), and Yersinia pestis (plague). E. coli 0157:H7 is associated with food-borne infections. Clostridium difficile is associated with antibiotic therapy use.
What triage class is a black tag?
4
The anthrax skin infection first appears as aA. vesicleB. black escharC. ulcerated lesionD. raised pruritic lesion or papule
D
A patient has skin itching and lesions after exposure to anthrax ( Bacillus anthracis). The nurse identifies that the patient has a high risk of dying. The nurse made this conclusion after learning that antibiotic therapy was not initiated until what had occurred?1The onset of skin itching2The exposure to bacteria3The onset of thoracic edema4The onset of lymphadenopathy
I dont like this answer. 3The patient has anthrax ( Bacillus anthracis) infection, which is first characterized by skin itching and flu-like symptoms. If the infection is not treated immediately, it spreads to the lymph and blood. The patient is more likely to die if he or she does not receive antibiotic treatment until after the onset of cardiopulmonary symptoms such as thoracic edema. The patient will have effective treatment and a lower risk of death if antibiotics are administered at the onset of itching or immediately after exposure. Lymphadenopathy is not a cardiopulmonary symptom and is not associated with anthrax. Therefore, administering antibiotics after the onset of lymphadenopathy will not increase the risk of death in this patient. book states - Cutaneous: 1-7 days after contact; exposed skin itching, progressing to papular and vesicular lesions, eschar, edema, ulceration, and sloughing. If untreated, may spread to lymph nodes and bloodstream. Fatality 5%-20 tell me how they got this answer from the above in chpt 23?
If a patient had a known smallpox exposure 1 week ago will being vaccinated help them?
NO vaccinated should take place within 2-3 days of exposure
A smallpox papular rash turns into what very quickly?
Vesicular rash that is painful and pustular
A patient is exposed to the Ebola virus and asks the nurse when symptoms will begin to show. What would be the nurse's best response? 1 2-21 days 2 12-25 days 3 18-30 days 4 22-35 days
1 Clinical manifestations occur 2-21 days after exposure to the Ebola virus. Therefore 12-25 days, 18-30 days, and 22-35 days are incorrect.
Which disease was labeled as the largest epidemic in history with many West African countries affected?1Ebola2Malaria3Bilharzia4Lassa Fever
1 The 2014 Ebola epidemic was labeled as the largest in history, with many West African countries affected. Therefore, malaria, Bilharzia, and Lassa Fever are incorrect.
Which virus is most commonly spread through exposure to bodily fluids of the infected individual and through needle sticks in which the needle has been contaminated with the virus (CDC, 2014)?1Ebola2Malaria3Bilharzia4Lassa Fever
1 The Ebola virus is most commonly spread by exposure to bodily fluids of the infected individual and through needle sticks in which the needle has been contaminated with the virus (CDC, 2014). Malaria and Lassa fever are highly contagious and widespread. Bilharzia is caused by parasites which live and breed in some freshwater snails.
A patient has a high fever and abdominal pain along with persistent vomiting and diarrhea. The nurse finds unusual bleeding. Which disease does the nurse suspect?1Ebola2Plague3Anthrax4Botulism
1 The symptoms of Ebola include fever of more than 101.5 ° F, vomiting, diarrhea, and abdominal pain along with unexplained hemorrhage. The symptoms of plague include fever and gastrointestinal symptoms, but there is no hemorrhaging. The symptoms of anthrax include itching that causes papular and vesicular lesions, edema, ulcerations, and sloughing. A patient with botulism would have dysphasia, dry mouth, drooping eyelid, and blurred vision along with vomiting and diarrhea or constipation.
What are the manifestations that may be seen in patients with the Ebola virus? Select all that apply.1 Diarrhea2 Muscle pain3 Abdominal pain4 Urinary problems5 Severe stomach ache
1, 2, 3 Usually the manifestations seen in patients with the Ebola virus are diarrhea, muscle pain, abdominal pain, fever, severe headache, weakness, fatigue, and vomiting. Urinary problems and stomach ache are not the manifestations seen in patients with the Ebola virus. But in very rare cases, few of the patients can experience these problems.
A patient asks the nurse how they acquired the Ebola virus. What should the nurse explain to the patient? Select all that apply.1 "Apes transmit the disease."2 "Bats transmit the disease."3 "Cats transmit the disease."4 "Dogs transmit the disease."5 "Primates transmit the disease."
1, 2, 5 The primary source of the Ebola virus is most likely to be contaminated bats or primates (apes and monkeys) in West Africa. Cats and dogs do not transmit the Ebola virus.
The nurse is caring for a patient who was a relief worker in an area of Africa where the Ebola virus was prevalent, and is concerned about being exposed. What symptoms should the nurse instruct the patient to notify his or her primary health care provider of? Select all that apply.1 Severe headaches2 Onset of constipation3 Malaise and weakness4 Unexplained weight loss5 Petechiae and ecchymosis
1, 3, 5 If someone was exposed to the Ebola virus, the nurse should instruct the patient to notify their health care provider of severe headaches, malaise and weakness, and petechiae (pinpoint hemorrhages) and ecchymosis (bruising). Constipation is a side effect of pain medications. Unexplained weight loss happens due to exposure to tuberculosis.
The nurse is taking a continuing education class to learn more about the Ebola virus. Through which body parts is the Ebola virus able to be transmitted? Select all that apply.1 Eyes2 Legs3 Nose4 Hands5 Mouth
1, 3, 5The Ebola virus can enter the body through broken skin or unprotected mucous membranes such as the eyes, nose, and mouth. The Ebola virus is not transmitted through the legs or hands unless there is a break in the skin.
The nurse is the first responder at the scene of a 6-car crash on a highway. Which victim should the nurse attend to first?1.A victim experiencing dyspnea2.A victim experiencing confusion3.A victim experiencing tachycardia4.A victim experiencing intense pain
1.A victim experiencing dyspneaThe client experiencing dyspnea is the priority. Needs related to maintaining a patent airway are always the priority. The victims experiencing confusion, tachycardia, and intense pain would be assessed following stabilization of the client with an airway problem.
The nurse in the hospital emergency department is notified by emergency medical services that several victims who survived a plane crash will be transported to the hospital. Victims are suffering from cold exposure because the plane plummeted and was submerged in a local river. What is the initial action of the nurse?1.Call the nursing supervisor to activate the agency disaster plan.2.Supply the triage rooms with bottles of sterile water and normal saline.3.Call the intensive care unit to request that nurses be sent to the emergency department.4.Call the laundry department, and ask the department to send as many warm blankets as possible to the emergency department.
1.Call the nursing supervisor to activate the agency disaster plan.In an external disaster, many people may be brought to the emergency department for treatment. The initial nursing action must be to activate the disaster plan. Although options 2, 3, and 4 may be additional measures that the nurse would take, the initial action would be to activate the disaster plan.
How long after exposure to Smallpox do symptoms normally start?
10-17
What triage class is a Yellow tag?
2
The nurse is caring for a patient who has Ebola and is experiencing fatigue, fever, severe pain, and hemorrhage. Which statement regarding the Ebola virus disease is correct?1The virus is spread via air, water, or food.2No drug therapy or vaccine for Ebola is yet approved by FDA.3People who traveled to East Africa in the previous 21 days are at a higher risk of contamination.4The causative agent of the disease will be present in the patient's semen for up to six months after recovery.
2 Fatigue, fever, severe headache, muscle pain, abdominal pain, and unexplained hemorrhage are symptoms of Ebola virus disease, caused by Ebola virus. The virus is not spread via air, water, or food. The virus can enter the body through broken skin or unprotected mucous membranes such as the eyes, nose, and mouth. There is no FDA-approved drug therapy or vaccine yet for this disease. People who have traveled to West Africa in last 21 days are at a high risk for having or transmitting the disease. Ebola virus will be present in the patient's semen for up to three, not six, months after recovery.
What supportive care should the nurse provide to a patient with Ebola? Select all that apply.1 Perform decontamination2 Care and comfort measures3 Oxygen and ventilation support4 Wound cleansing and management of lesions5 Intravenous fluid and electrolyte replacement
2, 3, 5When caring for a patient with Ebola, the nurse should care for and make the patient comfortable. The nurse should provide oxygenation and ventilation support as well as intravenous fluid and electrolyte replacement when required. Decontamination of the patient is not required. Wound cleansing and management of lesions are not a part of supportive care.
At a health awareness program, a nurse is educating people about the Ebola virus. What does the nurse teach? Select all that apply.1 "Use masks when going to public places."2 "Avoid contact with an infected patients' body fluids."3 "Stand at least three feet away from an infected patient."4 "Avoid contact with people who have recently been to West Africa."5 "Use condoms for at least three months even after getting treated."
2, 5Ebola viruses spread via direct contact with body fluids. Thus, the nurse should tell people to avoid contact with infected body fluids. Even if a patient has been treated completely, the virus can remain in the semen up to three months; thus, condoms are strongly advocated. Ebola does not spread via air, food, or water so there is no need to wear masks or stay away from patients. The disease cannot spread unless the person has clinical manifestations; a person coming from West Africa does not necessarily need to be avoided if he or she is healthy. BOOK 23-4 Teach patients who recover from Ebola and their partners that the virus is present in semen for up to 3 months. Using a condom may prevent transmission.
The nurse is the first responder after a tornado has destroyed many homes in the community. Which victim should the nurse attend to first?1.A pregnant woman who exclaims, "My baby is not moving."2.A child who is complaining, "My leg is bleeding so bad, I am afraid it is going to fall off!"3.A young child standing next to an adult family member who is screaming, "I want my mommy!"4.An older victim who is sitting next to her husband sobbing, "My husband is dead. My husband is dead."
2.A child who is complaining, "My leg is bleeding so bad, I am afraid it is going to fall off!"Priority nursing care in disaster situations needs to be delivered to the living and not the dead. The child who is bleeding badly is the priority. The bleeding could be from an arterial vessel; if the bleeding is not stopped, the child is at risk for shock and death. The pregnant client is the next priority, but the absence of fetal movement may or may not be indicative of fetal demise. The young child is with a family member and is safe at this time. The older victim will need comfort measures; there is no information indicating she is physically hurt.
In the case of a smallpox outbreak, vaccination priority should be given to all of the following high-risk groups, EXCEPTA. pregnant womenB. Face-to-face close contacts or household contacts to smallpox patients after the onset of the smallpox patient's feverC. Persons involved in the direct medical care, public health evaluation, or transportation of confirmed suspected smallpox patientsD. Persons exposed to the initial release of the virus (if the virus was discovered during the first generation of cases and vaccination may still provide benefit)
A - why does it say?
An internal disaster is classified as an event that occurs within an organization or facility (it poses a threat to disrupt the environment of care). Which of the following are examples of internal disasters? (Select all that apply)A. FireB. TornadoC. HurricaneD. Loss of utilities
A, D
A nurse is providing staff education about smallpox as a bioterrorism threat. Which of the following statements indicates an understanding of this aget (SATA)A. "Smallpox is transmitted person to person."B. "Infection is characterized by severe respiratory distress."C. "Smallpox vaccination ensures lifelong immunity."D. "Naturally occurring smallpox has been eradicated from the world."E. "Smallpox is often confused with varicella."
A, D, E
The START triage tool was developed to be able to triage adult patients within 30 seconds and is the most commonly used tool in the United States. What are the 5 basic parameters to this tool? (select all that apply)A. The ability to walkB. The presence or absence of spontaneous respirationsC. The respiratory rateD. An assessment of perfusionE. The ability to obey commands
A,B,C,D,E
You are working in the hospital as a nurse manager. An earthquake just occurred and your hospital will be receiving multiple patients. It is important to do which of the following? (Select all that apply)A. Call in additional staffB. Designate staff roles the day of the disasterC. Prepare for influx of patientsD. Prepare STAT charts once patients start arriving
A,C
Role of DMAT (Disaster Medical Assistance Team)
A DMAT is a medical relief team made up of civilian medical, paraprofessional, and support personnel that is deployed to a disaster area with enough medical equipment and supplies to sustain operations for 72 hours (U.S. Department of Health & Human Services, 2015). DMATs are part of the National Disaster Medical System (NDMS) in the United States. They provide relief services ranging from primary health care and triage to evacuation and staffing to assist health care facilities that have become overwhelmed with casualties. Because licensed health care providers such as nurses act as federal employees when they are deployed, their professional licenses are recognized and valid in all states. Additional examples of services provided by the NDMS include:• Disaster Mortuary Operational Response Teams (DMORTs) to manage mass fatalities • National Veterinary Response Teams (NVRTs) for emergency animal care; and • International Medical Surgical Response Teams (IMSURTs) to establish fully functional field surgical facilities wherever they are needed in the world
The nurse provides information to a patient who was exposed to anthrax by inhalation. The nurse determines the teaching has been successful if the patient makes which statement?A. "Anthrax can be spread by person-to-person contact."B. "It is not necessary to receive the anthrax vaccine."C. "An antibiotic will be prescribed for 2 months."D. "Antibiotics are only indicated for an active infection."
Answer:C. "An antibiotic will be prescribed for 2 months."Rationale: Postexposure prophylaxis includes a 60-day course of antibiotics. Ciprofloxacin (Cipro) is the treatment of choice. Anthrax is not spread by person-to-person contact; anthrax is spread by direct contact with the bacteria and its spores. The patient may receive the anthrax vaccine (three doses); if vaccinated, the course of antibiotic therapy is reduced to 30 days. Antibiotics are indicated after exposure to inhaled anthrax.
A charge nurse is discussing disaster response with the nursing staff. Which of the following statements indicates staff understanding of the Hospital Incident Command System (HCIS)?A. "HCIS ensures that necessary antibiotics and antidotes are available."B. "HCIS is focused on having multi-disciplinary responders available."C. "HCIS identifies facility responsibilities and channels for reporting."D. "HCIS provides additional responders when needs exceed the ability of local or state agencies."
C
A hospital is participating in a disaster simulation in which a toxic substance is released into a crowded stadium. Which of the following is the lowest priority for a nurse?A.Decon B. proper PPE use C. Educating the client and familyD. Maintaining calm amidst the chaos
C
A worried mother, is talking to a nurse about her son's condition after being exposed to nuclear radiation. The mother begs the nurse to see her son. Select the appropriate response by the Nurse.A. Sure, it is your right as a mother.B. I Cant imagine what you are going through.C. You can see your son when he is stabilized and decontaminated.D. You can see your son after he is bathed, and in new clothes.
C
Included in a disaster plan should be processes forA. drug treatmentB. disease diagnosisC. triage and safety housingD. none of the above
C
A charge nurse in an emergency department is notified by the country's emergency medical services that there has been a multiple-casualty crash involving a truck carrying radioactive waste. Which of the following actions should the nurse take first? A) Designate a decontamination area to accommodate clients who are irradiated. B) Notify the admissions office to clear as many critical care beds as possible. C) Clear the department of all nonurgent clients and move those awaiting admission to a holding area. D) determine the number of casualties the emergency department can accommodate.
C) Clear the department of all nonurgent clients and move those awaiting admission to a holding area. Evidenced-based practice indicates the nurse should first clear the emergency department of nonurgent clients and open up as many treatment areas as possible. Casualties of the crash will be brought to the emergency department, so the nurse must make room to accommodate the high number of clients.
A nurse is teaching a community group about smallpox. When discussing the possible means of transmission, which of the following statements by a member of the group indicates that further teaching is required? A) Smallpox can be transmitted through bodily fluids, such as blood or vomit. B) Smallpox can be transmitted through contaminated objects, such as bedding and clothing.C) Smallpox can be transmitted through bites from insects, such as mosquitoes.D) Smallpox can be transmitted through inhalation of droplets, such as from coughing.
C) Smallpox can be transmitted through bites from insects, such as mosquitoes. Animals and insects have not been shown to be vectors (organisms capable of spreading a contagious disease to humans) for the smallpox virus.
The emergency department (ED) triage nurse is assessing four victims of an automobile accident.Which patient has the highest priority for treatment?a. A patient with absent pedal pulsesb. A patient with an open femur fracturec. A patient with a sucking chest woundd. A patient with bleeding of facial lacerations
CMost immediate deaths from trauma occur because of problems with ventilation, so thepatient with a sucking chest wound should be treated first. Face and head fractures canobstruct the airway, but the patient with facial injuries has lacerations only. The other twopatients also need rapid intervention but do not have airway or breathing problems.
A client is suspected of exposure to inhaled anthrax. The nurse assesses for which initial symptoms?A. Headache, blurred vision, and generalized achesB. Difficulty swallowing, cramping, and diarrheaC. Fever, persistent cough, and dyspneaD. Skin lesions that develop into black scabs
CRationale: Fever, persistent cough, and dyspnea all are initial symptoms of inhaled anthrax.
An emergency room nurse is triaging victims of a multi-casualty event. Which client should receive care first?a. A 30-year-old distraught mother holding her crying childb. A 65-year-old conscious male with a head lacerationc. A 26-year-old male who has pale, cool, clammy skin d. A 48-year-old with a simple fracture of the lower leg
CThe client with pale, cool, clammy skin is in shock and needs immediate medical attention. The mother does not have injuries and so would be the lowest priority. The other two people need medical attention soon, but not at the expense of a person in shock.
Role of a chief when HICs is activated
Chiefs are appointed to manage logistics, planning, finance, and operations as appropriate to the type and scale of the event. In turn, chiefs delegate specific duties to other departmental officers and unit leaders. The idea is to achieve a manageable span of control over the personnel or resources allocated to achieve efficiency. FEMA offers free courses on the NIMS model and HICS structure through its website located at www.training.fema.gov/IS/.
A nurse is educating a family on the proper protocol for their diseast family member who died due to complications of smallpox infection, what would the nurse tell the patient relating to the burial of the patient?
Cremation is preferred for all deaths, because the virus can survive in scabs for up to 13 years
A nurse is assessing a client who is experiencing difficulty sleeping, having nightmares, experiencing feelings of survivor guilt, and having difficulty concentrating one year after the death of a relative during a destructive and devastating natural disaster. Which of the following describe the client's symptoms?A. Generalized anxiety disorderB. Post-traumatic stress syndrome (PTSD)C. Historionic personality disorderD. Dissociative identity syndrome
B
A possible clue to a biowarfare terrorist attack isA. low disease rates among exposed individualsB. more than one epidemic occurring simultaneouslyC. an extended epidemic curve, rising over a long period of timeD. lower morbidity and mortality than normally expected for a disease
B
What is most crucial element in disaster management?A. Tell everyone that everything will be okayB. Plan ahead (do not wait until disaster happens)C. Wait until a disaster happens and then plan according to the disasterD. Utilize the same plan for every possible disaster
B
When planning the response to the potential use of smallpox as an agent of terrorism, the emergency department (ED) nurse-manager will plan to obtain sufficient quantities ofa. blood.b. vaccine.c. atropine.d. antibiotics.
B Smallpox infection can be prevented or ameliorated by the administration of vaccine given rapidly after exposure. The other interventions would be helpful for other agents ofterrorism but not for smallpox.
A community health nurse is preparing a disaster preparedness plan about smallpox. Which of the following groups of people should the nurse include in the plan to inoculate? A) NewbornsB) Mortuary workersC) Immunosuppressed clientsD) Clients who have eczema
B) Mortuary workersSmallpox is an extremely contagious, disfiguring, and deadly disease caused by the variola virus. The nurse should plan to provide prophylaxis through immunization to mortuary workers, who have a high risk of exposure to smallpox. The nurse should plan to only provide immunization to the other client groups following a direct exposure because they have increased risk of complications following immunization.
A nurse is working with community members in order to aid them in preparation for any disaster. She helps the clients compile a personal list of basic supplies needed in case of a disaster. Which of the following should the nurse instruct the clients to include? (SATA)A. Three quarts of water per personB. Clean clothingC. Personal identificationD. MatchesE. Prescription medications
B, C, D, E
Medical Command physician role
medical command physician. He or she focuses on determining the number, acuity, and medical resource needs of victims arriving from the incident scene to the hospital and organizing the emergency health care team response to the injured or ill patients. Responsibilities include identifying the need for and calling in specialty-trained providers In smaller hospitals with limited specialty resources, the medical command physician might also help determine which patients should be transported out of the facility to a higher level of care or to a specialty hospital
Types of external disasters
natural such as a hurricane, earthquake, or tornado, or technologic such as an act of terrorism with explosive devices or a malfunction of a nuclear reactor with radiation exposure.
What defines a mass casualty event
overwhelms local medical capabilities and may require the collaboration of multiple agencies and health care facilities to handle the crisis.
Typical examples of a Black tag patient are?
those with massive head trauma, extensive full-thickness body burns, and high cervical spinal cord injury requiring mechanical ventilation.
who preforms the role of triage officer
triage officer. This person is generally a physician in a large hospital who is assisted by triage nurses. When physician resources are limited, an experienced nurse may assume this role.
What difference is there between droplet and contact?
use of a mask if coming in contact with patient
what type of professionals are invoved in MRC
volunteer medical and public health care professionals, including physicians and nurses.
Does standar decontamination of a room after the patient in the room had smallpox?
yes, . Standard decontamination of the room is effective
how do you care for a patients laundry that has small pox?
Laundry and biologic wastes should be autoclaved before being washed with hot water and bleach
What symptoms of smallpox occurs after 2-3 days after first symptoms?
Papular rash
Hospital incident commander role
Physician or administrator who assumes overall leadership for implementing the emergency plan The hospital incident commander's role is to take a global view of the entire situation and facilitate patient movement through the system, while bringing in personnel and supply resources to meet patient needs. For example, a hospital incident commander might dictate that all patients due to be discharged from an inpatient unit be moved to a lounge area immediately to free up hospital beds for mass casualty victims. He or she could also direct departments such as physical therapy or a surgical clinic to cancel their usual operations to convert the space into a minor treatment area. The incident commander assists in the organization of hospital-wide services to rapidly expand hospital capacity, recruit paid or volunteer staff, and ensure the availability of medical supplies.
What is an all hazards approach
Using this approach, preparedness activities must address all credible threats to the safety of the community that could result in a disaster situation. Disaster drills are ideally planned based on a risk assessment or vulnerability analysis that identifies the events most likely to occur in a particular community
What common disease is confused with Smallpox?
Varicella AKA chicken pox
If using an all-hazards approach what type of drill would be required in Hawaii that would NOT be required in Alabama
Volcano eruption drills
How many disaster drills does joint commission mandate a year
at least twice a year
*A nurse in an emergency department is caring for a victim of a suspected...exposure to cutaneous anthrax. Which of the following is an expected...?A. Immediate onset of respiratory distressB. Flu-like symptoms 48 hr after exposureC. Itching of the skin progressing to ulceration over 1-7D. Immediate onset of vascular lesions of the skin
c
A nurse is assisting with disaster triage following a bomb explosion in a bus station. What color would the nurse assign this patient - An unconscious 6-month-old infant with no respirations; no visible injuries; no pulse a. green b. red c. yellow d. black
d
Why do we as nurses leave black-tagged patients?
doing the greatest good for the greatest number of people. This means that patients who are critically ill or injured and might otherwise receive attempted resuscitation during usual operations may be triaged into an "expectant" or "black-tagged" category and allowed to die or not be treated until others received care.
A nurse is discussing emergency response with a newly licensed nurse. The nurse should identify which of the following is a triage officer during the time of a disaster?A. Members of the Federal Emergency Management Agency (FEMA)B. Responding law enforcement officersC. Representatives from the American Red CrossD. Physician or well trained ED nurse
D
A nurse is triaging clients after a local disaster. Which of the following clients should the nurse recommend to discharge first?A. A client who has a large hematoma over the left eyebrow and is reporting a headacheB. A client who has a contusion to the upper right abdominal quadrant and is reporting painC. A client who has a suspected fracture to the right wrist and is reporting limited movementD. A client who has ecchymosis to the left ankle and is reporting swelling
D
A patient comes in to the ER after a disaster. He is not responsive and is not breathing and no pulses can be found. You are the triage nurse, what color tag should this patient receive?A. RedB. BlueC. GreenD. Black
D
Dispersion of weapons of bioterror can occur byA. aerosolsB. contamination of waterC. contamination of foodsuply D. all of the above
D
Smallpox is primarily a possible threat as a bioweapon becauseA. the virus can mutateB. it is not easily diagnosedC. it can be spread from infected birdsD. the United States no longer vaccinates for smallpox in the general public
D
The nurse is aware that all of the following can contribute to a mentally ill patient in the aftermath of a disaster except?A. Exacerbations of pre-existing chronic mental disorders B. Severe stress C. Most vulnerable peopleD. PTSD
D
What form of identification is bed during a disaster?
Digital photo
What contact precaution is taken with Ebola?
Droplet precaution
The nurse in charge of a nursing unit is asked to select the hospitalized clients who can be discharged so that hospital beds can be made available for victims of a community disaster. Select the clients who can be safely discharged. Select all that apply.1.A client with dyspnea2.A client experiencing sinus rhythm3.A client receiving oral anticoagulants4.A client with chronic atrial fibrillation5.A client experiencing third-degree heart block6.A client who has not voided since before surgery
2.A client experiencing sinus rhythm3.A client receiving oral anticoagulants4.A client with chronic atrial fibrillationClients should be medically stable if discharged and should be able to manage their condition at home independently, with family assistance, or with community services. The client in option 2 is stable because sinus rhythm is a normal finding. Oral anticoagulants can be taken at home as long as the client understands how to take the medication and is provided with education about the medication. The client in option 4 can be discharged because the client's condition is chronic, not acute. The client experiencing dyspnea is not considered stable. The client experiencing third-degree heart block is considered unstable and will most likely need a pacemaker insertion. Clients should not be discharged after surgery until they have voided.
The nurse in charge of a nursing unit is asked to select the hospitalized clients who can be discharged so that hospital beds can be made available for victims of a community disaster. Which clients can be safely discharged? Select all that apply.1.A client with chest pain2.A client with a Holter monitor3.A client receiving oral antibiotics4.A client experiencing sinus rhythm5.A client newly diagnosed with atrial fibrillation6.A client experiencing third-degree heart block who requires a pacemaker
2.A client with a Holter monitor3.A client receiving oral antibiotics4.A client experiencing sinus rhythmClients should be medically stable if discharged and should be able to manage their condition at home. A client experiencing chest pain could be having a myocardial infarction and needs frequent monitoring. A client newly diagnosed with atrial fibrillation requires medication and monitoring to stabilize the condition. A client in third-degree heart block is considered unstable, especially if the client needs a pacemaker.
What triage class is a Green tag?
3
The nurse is the first responder at the scene of a train accident. Which victim should the nurse attend to first?1.A victim experiencing excruciating pain2.A victim experiencing moderate anxiety3.A victim experiencing airway obstruction4.A victim experiencing altered level of consciousness
3.A victim experiencing airway obstructionClient needs related to maintaining a patent airway are always the priority. Therefore, the nurse would attend to the victim experiencing airway obstruction first. Care to the other victims follows.
What is the incubation period for Ebola virus?11 to 3 days22 to 8 days32 to 21 days410 to 17 days
3Clinical symptoms of Ebola virus are seen within 2 to 21 days after the exposure to the microorganism. Symptoms of pneumonic plague appear 1 to 3 days after exposure. Symptoms of lymphatic infection due to plague appear 2 to 8 days after exposure. Symptoms of smallpox appear 10 to 17 days after exposure. table 23-4 - I fact checked
What is the difference between anthrax and small pox?1Papular lesions are present in smallpox but absent in anthrax.2Vesicular lesions are absent in anthrax but present in smallpox.3Fever and headache are present in anthrax but absent in smallpox.4Person-to-person transmission is absent in anthrax but present in smallpox.
4Anthrax infection occurs when the bacterial spores enter the body through ingestion or inhalation. There is no person-to-person transmission. Smallpox can spread by droplet infection or through contact with bleeding lesions. Papular and vesicular lesions are present in both anthrax and smallpox. Both diseases are associated with fever and headache.
Which disease requires droplet precaution?1Anthrax2Botulism3Small pox4Ebola virus disease
4Ebola requires droplet precaution because the virus can be transferred via body fluids. Small pox is a highly contagious airborne disease and needs standard, airborne, and contact precautions. Anthrax spreads by spore inhalation and botulism spreads by toxin ingestion.
Which statement is correct about Ebola?1It has an incubation period of 2 to 8 days.2It spreads by person-to-person contact.3It is often transmitted from healthy people as well as sick people.4It leads to presence of antibodies in the body for 10 years.
4In a patient who has recovered from Ebola infection, the antibodies developed can remain in the body for 10 years. Clinical symptoms can be seen 2 to 21 days after exposure. Ebola is transmitted through bodily secretions, not mere person-to-person contact. It cannot spread from a healthy person.
A client seen in the emergency department reports fever, fatigue, and dry cough but no other upper respiratory symptoms. A chest x-ray reveals mediastinal widening. What action by the nurse is best?a. Collect a sputum sample for culture by deep suctioning.b. Inform the client that antibiotics will be needed for 60 days. c. Place the client on Airborne Precautions immediately.d. Tell the client that directly observed therapy is needed.
ANS: BThis client has manifestations of early inhalation anthrax. For treatment, after IV antibiotics are finished, oral antibiotics are continued for at least 60 days. Sputum cultures are not needed. Anthrax is not transmissible from person to person, so Standard Precautions are adequate. Directly observed therapy is often used for tuberculosis.
A client has been admitted for suspected inhalation anthrax infection. What question by the nurse is most important?a. "Are any family members also ill?"b. "Have you traveled recently?"c. "How long have you been ill?" d. "What is your occupation?"
ANS: DInhalation anthrax is rare and is an occupational hazard among people who work with animal wool, bone meal, hides, and skin, such as taxidermists and veterinarians. Inhalation anthrax seen in someone without an occupational risk is considered a bioterrorism event and must be reported to authorities immediately. The other questions are appropriate for anyone with an infection.
Anthrax is a contagious diseaseTrue or False
False Anthrax is a non-contagious disease; it does not usually spread from one person to another. The person is infected only when exposed to the infectious spores, or infected animals or their products.
Is there a set number of casualties that activates a hospitals emergency disaster plan?
NO, When the number of casualties exceeds the usual resource capabilities, a disaster situation exists. What may be considered a routine day in the ED of a large urban trauma center could be defined as a disaster for a small rural community hospital if the same number of patients arrived. Therefore each facility decides when criteria are met to declare a disaster.
role of triage officer
The triage officer rapidly evaluates each person who presents to the hospital, even those who come in with triage tags in place. Patient acuity is re-evaluated for appropriate disposition to the area within the ED or hospital best suited to meet the patient's needs.
Role of MRC (Medical Reserve Corps)
They offer their services to health care facilities or to the community in a supportive or supplemental capacity during times of need such as a disaster or pandemic disease outbreak. This group may help staff hospitals or community health settings that face personnel shortages and establish first aid stations or special-needs shelters. As a means to alleviate ED and hospital overcrowding, the MRC may also set up an acute care center (ACC) in the community for patients who need acute care (but not intensive care) for days to weeks.
Basic Supplies for personal preparedness
• Backpack • Clean, durable weather-appropriate clothing; sturdy footwear • Potable water—at least 1 gallon per person per day for at least 3 days • Food-nonperishable, no cooking required • Headlamp or flashlight—battery powered; extra batteries and/or chemical light sticks (NOTE: a headlamp is superior because it allows hands-free operation) • Pocket knife or multi-tool • Personal identification (ID) with emergency contacts and phone numbers, allergies, and medical information; lists of credit card numbers and bank accounts (keep in watertight container) • Towel and washcloth; towelettes, soap, hand sanitizer • Paper, pens, and pencils; regional maps • Cell phone and charger • Sunglasses/protective and/or corrective eyewear • Emergency blanket and/or sleeping bag and pillow • Work gloves • Personal first aid kit with over-the-counter (OTC) and prescription medications • Rain gear • Roll of duct tape and plastic sheeting • Radio—battery powered or hand-crank generator • Toiletries (toothbrush and toothpaste, comb, brush, razor, shaving cream, mirror, feminine supplies, deodorant, shampoo, lip balm, sunscreen, insect repellent, toilet paper) • Plastic garbage bags and ties, resealable plastic bags • Matches in a waterproof container • Whistle • Household liquid bleach for disinfection
What are the nursing responsibilities during a fire
• Remove any patient or staff from immediate danger of the fire or smoke. • Discontinue oxygen for all patients who can breathe without it. • For patients on life support, maintain their respiratory status manually until removed from the fire area. • Direct ambulatory patients to walk to a safe location. • If possible, ask ambulatory patients to help push wheelchair patients out of danger. • Move bedridden patients from the fire area in bed, by stretcher, or in a wheelchair; if needed, have one or two staff members move patients on blankets or carry them. • After everyone is out of danger, seek to contain the fire by closing doors and windows and using an ABC extinguisher (can put out any type of fire) if possible. • Do not risk injury to yourself or staff members while moving patients or attempting to extinguish the fire.
What steps can a health care professional take to prevent PTSD
• Use available counseling. • Encourage and support co-workers. • Monitor each other's stress level and performance. • Take breaks when needed. • Talk about feelings with staff and managers. • Drink plenty of water and eat healthy snacks for energy. • Keep in touch with family, friends, and significant others. • Do not work more than 12 hours per day.
What situation would the nurse be able to discharge pt early to free up beds for disaster victims.
• Were admitted for observation and are not bedridden • Are having diagnostic evaluations and are not bedridden • Are soon scheduled to be discharged or could be cared for at home with support from family or home health care services • Have had no critical change in condition for the past 3 days • Could be cared for in another health care facility such as rehabilitation or long-term care
