community health exam 3- ch. 8

Patient #3• 19 year old patient presents, C/O coughing up blood, fever, chest pain, severe dyspnea, and muscle weakness.•Onset 2-3 days ago•Pt states, they thought it was just a cold, but noticed the blood this morning and got scared.

Pneumonic Plague

The forth resident you come across is a 88-year-old resident who is lying on the floor, pinned underneath an overturned wheelchair. Water is rising in the room and is up to the resident's ears. a. BP 140/76 b. P 139 c. RR 32 d. Temp 98.0 e. O2 86% RA f. Cap refill- 3 seconds

Step 1- Breathing. The patient's respiratory rate is greater than 30. Tag Red.

•A CHN is educating other community health nurses on identifying smallpox. Which of the following would the CHN state that a rash will appear first? A) Face B) Posterior shoulders C) Abdomen D) Lower extremities

A: face is the correct answer.• The rash first appears on the face and tongue, quickly spreads to the trunk, arms, and legs, then hands and feet; then turns to pus-filled lesions.•

A faith based nurse is going to travel to Sierra Leone for a mission trip. In preparation for the possibility of coming into contact with an Ebola patient, the nurse knows which of the following?• A. I will get an immunization for Ebola before travelling.• B. Standard precautions are needed to treat patients with possible exposure to Ebola.• C. Supportive care for patients with Ebola include IV fluids, dialysis, and airway management.• D. We will be able to do as many invasive procedures as necessary on patients with Ebola.

Correct Answer- C• A. There is no approved vaccine available.• B. Impermeable gowns or coveralls; two pairs of disposable gloves, boot/shoe covers, apron, and an N95 mask are needed when treating patients with Ebola.• C. Supportive care includes IV fluids, dialysis, airway management, and psychological counselling.• D. Minimize invasive procedures because of the increased bleeding.

List the phases of emotional reaction during a disaster in order .•A: Heroic, Honeymoon, Disillusionment, Reconstruction •B: Disillusionment, Heroic, Honeymoon, Reconstruction •C: Heroic, Disillusionment, Honeymoon, Reconstruction •D: Disillusionment, Honeymoon, Heroic, Reconstruction

Correct Answer: A •A: The correct sequence is:•Heroic, Honeymoon, Disillusionment, and then Reconstruction

•A nurse in an emergency department is triaging clients following an explosion at a local factory. Which of the following client(s) should the nurse identify as Delayed (Yellow)? (SATA) A) A client who has superficial burns to 10% of the abdomen. B) A client who has tracheal deviation, shortness of breath, and RR- 34. C) A client who has agonal respirations without improvement with chin tilts and an open head injury. D) A client who has a fracture of the humerus, a bleeding foot laceration, cap refill of 2, and is able to follow commands.

Correct Answer: A & D• A: The client with burns to 10% of the body would be labeled delayed care. • B: The client with the tracheal deviation and shortness of breath is the most important to assess- this patient is awake and responsive because they are short of breath would be labeled immediate. Tracheal deviation could be a collapsed lung from the blast of the explosion. •C: The client with agonal breathing- not improved with chin tilts and an open head injury would be labeled black. •D: The client with the fractured arm and a laceration to the foot would be delayed care with cap refill of 2 and the ability to follow commands.

Disaster- Mass Casualty• A nurse on the scene following a mass casualty explosion is triaging a client with a large wound to the head. After fully assessing the patient, the CHN decides to tag the patient black. What is the next step? A) Turn the client to left semi-Fowler's position and begin assessing the next client. B) Place a firm pressure dressing to the occiput and open the airway. C) Apply a cervical spine collar and perform a focused neurological exam. D) Request that the client be assessed immediately by the next available provider.

Correct Answer: A• A: Turn the patient in a position of comfort and move on. This patient is labeled black during reverse triage.•Any time spent on this patient past assessment is not productive in saving the lives of the other patients. During reverse triage (START triage), you help the majority of the patients, the most good for the most amount of people. Anyone who requires multiple people and resources to keep them alive is taking those valuable resources away from the other patients that can be saved.

During a bioterrorism event, the CHN monitors for mortality and morbidity of the community. What prevention strategy is this? •A: Primary •B: Secondary •C: Tertiary

Correct Answer: B B- Monitoring or assessing the mortality and morbidity of a community is a secondary prevention strategy.

The CHN is setting up a communication protocol to provide access to emergency agencies like the American Red Cross. What part of the disaster management cycle is this? •A: Mitigation• B: Preparedness •C: Recovery •D: Response

Correct Answer: B •A: Setting up the communication protocol does not help to prevent disasters. •B: Setting up a communication protocol is an important part of community disaster planning. The communication plan should provide for access to emergency agencies, such as the Red Cross and state and federal government agencies. •C & D: Setting up the communication protocol is not beneficial to try to do during a disaster or after the disaster has acutely stopped.

A CHN is participating in a community planning committee for disaster preparedness for a local community that is at risk for hurricanes. Which of the following information should the nurse contribute to the plan? A) A list of residents who have experienced a hurricane in the past and will not need evacuation. B) A list of areas within the community where residents speak English as a second language. C) How to activate the local medical facility's emergency-management plan. D) The name of the individual who is necessary to implement the plan.

Correct Answer: B •A: These residents are located in an area within the community that has withstood a hurricane before. People who need help evacuating would be discussed before those who do not .•B: Identifying populations within the community who are at a greater risk to be effected by the hurricane are of great importance. Getting information out to everyone in the community that they can read and understand is important. •C: The CHN would identify the community's disaster warning system and communication center- not the local medical facility's warning system. •D: The CHN would identify all the stakeholders, first responders, and disaster management agencies at the local, state, and national level. Not just one person.

A CHN is developing a plan of care for a patient with Botulism. Which of the following is correct? •A. Antibiotics are given for botulism.• B. Vaccines are given to infants to prevent botulism.• C. Symptoms such as fatigue, body aches, and rashes are common. D. An antitoxin can be given to treat botulism.

Correct Answer: D• A: Antibiotics are not given for botulism.• B: There is no approved vaccine for botulism.• C: Symptoms of botulism include double or blurred vision, slurred speech, difficulty swallowing, progressive muscle weakness, and difficulty breathing.• D: Administration of an antitoxin is the treatment for botulism along with airway management and possible mechanical ventilation.

During a mass casualty where Tularemia becomes an issue, which treatment would be chosen? •A: Gentamycin• B: Fluoroquinolones •C: Streptomycin •D: Ciprofloxacin

Correct Answer: D•A & C: Gentamycin and Streptomycin are the antibiotics of choice, however, during a mass casualty- doxycycline and ciprofloxacin are used because of the availability of these antibiotics and the cheaper cost of using these on a much larger population all at once.•B: Fluoroquinolones is used on the Plague.

Which of the following Bioterrorism agents have a vaccine available today? (SATA) •A: Anthrax •B: Botulism• C: Smallpox• D: Plague• E: Tularemia• F: Ebola

Correct Answers: A & C• A: Anthrax has a vaccine that can be used for those at high-risk for exposure to anthrax. •B: Botulism does not have an approved vaccine today. •C: Smallpox has a vaccine for those at high risk or can be given within 3 days of exposure to smallpox .•D: Plague has a vaccine that is no longer available in the U.S.•E: Tularemia has a vaccine that is under review by the FDA .•F: Ebola does not have an approved vaccine today.

What incidences or occurrences would the community health nurse notice that might lead the nurse to decide that the community has a suspected bioterrorism event? (SATA) •Decreasing reports of a disease process that would not occur naturally .•An unusual disease occurring in an area. •Abnormal timing of a common disease within a community .•Increasing numbers of people dying with the same onset of symptoms .•Increasing numbers of dead or dying animals.

Correct Answers: B, C, D, & E •A: it would be "Increasing" reports of a disease process that would not occur naturally. •B, C, D, & E: Would be unusual and lead the CHN to suspect that something is occurring within the community.

Patient #1• The first resident you come across is an 84-year-old resident who is lying under pieces of ceiling on the floor. The resident c/o pain with an obvious fracture of the right wrist with a lot of swelling.• a. BP 116/70• b. P 110• c. RR 28• d. Temp- 98.0• e. O2- 94% RA• f. Cap refill- 2 seconds

Patient #1 Step 1- Breathing- the patient's respirations are less than 30 so we move to step 2. Step 2- Circulation- the patient's cap refill is 2 seconds, so we move to step 3 Step 3- Mental Status- the patient's only issue is the rib/fib fracture.This would not allow them to walk. Tag Yellow

The last resident you come across is an 91-year-old resident who is sitting against the wall, in moderate pain with a forearm deformity and swelling. a. BP- 150/90 b. P- 140 c. RR- 28 d. Temp- 97.9 e. O2-97% RA f. Cap refill- >2 seconds

Step 1- Breathing- The patient's respiratory rate is less than 30, so we move to step 2.Step 2- Circulation- The patient's cap refill is greater than 2 seconds. Tag Red.

The fifth resident you come across is a 72-year-old resident who is lying on the floor with a piece of roof on top of his chest. a. BP 50/20 b. P 40 (weak) c. RR 0After two chin tilts- RR-0 d. Temp- 96.0 e. O2- 20% RA f. Cap refill- 5 seconds

Step 1- Breathing- The patient's respiratory rate is zero. After two chin tilts, the patient's respiratory rate is still zero. Tag Black and place the patient in a position of comfort. Move on to the next patient.

The third resident you come across is an 82-year-old resident who is lying on the floor with a large chunk of roofing on top of his chest. The patient is not responsive to verbal commands or painful stimuli. a. BP- unable to obtain b. P- 5 c. RR- 0After two tilt chin attempts- RR-0 d. Temp- 95.3 e. O2%- 15% RA f. Cap refill- none

Step 1- Breathing- The patient's respiratory rate is zero. After two chin tilts- the patient's respiratory rate is still zero.Tag Black and place the patient in a position of comfort. Move on to the next patient.

The second resident you come across is a 79-year-old resident who is sitting in the corner shivering from the cold, crying, has minor abrasion to both lower extremities and no abnormal findings. This resident is able to walk. a. BP 130/88 b. P 122 c. RR 28 d. Temp 97.9 e. O2- 92% RA f. Cap refill- 2 seconds

Step 1- Breathing- the patient's respirations are less than 30 so we move to step 2.Step 2- Circulation- the patient's cap refill is 2 seconds, so we move on to step 3.Step 3- Mental Status- the patient's only issue is the abrasions to both arms. This would not stop the patient's ability to walk. Tag Green.

Disaster- Mass Casualty Scenario: •At midnight, during winter time, a "flash flood warning" is initiated. Before you have been able to respond to the weather warning, the flooding strikes a one-story nursing home where you and 5 other nurses are working. •The nursing home houses 20 residents per wing, and there are 4 wings. You and your team of nurses are responding to the last of the West wing quarters where 6 elderly, residents live.•Part of the flat roof has collapsed from the weight of the accumulated water, causing multiple injuries to the residents. Water is entering the west wing, making the patients cold. •The building structure appears intact at this time, except for the hole where the roof collapsed. The generator is providing emergency lighting. Cell phone service is not working and you have no access to TV. The emergency radio is broadcasting more rain so you must get these residents to safety.

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Patient #1 •25 year old patient presents, C/O muscle weakness. States they have fallen down a few times and has a hard time typing on the computer without the words getting blurry. •Onset- 2 days ago •While talking to the patient you as the nurse notice that the patient has slurred speech.•Patient states

•Botulism

Patient #4• 23 year old patient presents, C/O severe headache, muscle aches, weakness, vomiting and diarrhea.•Onset 10 days ago.•First started with just fatigue, headache, and muscle soreness.•Came in today because of the bleeding gums, vomiting blood, and high temperature.•States he thought it was just jetlag from traveling.

•Ebola

Patient 5• Patient presents with high fever, fatigue, body aches, and a rash that started on his face and tongue and quickly spread to his chest and back.

•Smallpox

Patient #2• 56 year old patient present, C/O swollen neck glands, fever, chills, dry cough, and muscle aches.•Onset- 2 days ago

•Tularemia