COMMUNITY EXAM 4
recovery
- Focuses on stabilization - Returning community to pre-impact status - Rehabilitation - Reconstruction - Epidemiological surveillance as needed
preparedness
1. look for prevention! - Disaster planning o Address needs assessment o Event management o Recovery efforts - Support systems; vital for: o Medical treatment and supplies o Shelter o Food o Water - Prevent mortalities and morbidities - Involves improving community and individual reaction and responses, so that the effects of the disaster are minimized - Plans for communication, evacuation, rescue, victim care, and recovery
The nurse is helping a triage officer evaluate the victims of a large scale disaster. Which client does the nurse anticipate will be given a black tag?
A client with extensive full-thickness body burns
Botulism treatment
Antitoxin Supportive care Maybe mechanical ventilation
Anthrax treatment
Cipro
Which client should be treated first, according to the disaster triage tagging system?
Client with red tag
Anthrax s/s
Cutaneous: sores = blisters = ulcer with black center GI: nausea, anorexia, bloody diarrhea, fever, severe stomach pain Inhaled: cold/flu symptoms
pneumonic plague s/s
Fever Weakness Rapidly developing pneumonia Bloody or watery sputum n/v abdominal pain rapid death if not treated early
Botulism transmission
Food or wound with toxin NOT person to person
The nurse is triaging clients arriving at the hospital after a large-scale disaster. Which condition is most likely to be categorized with a black tag?
Massive head trauma
smallpox treatment
No proven treatment Supportive Antibiotics for secondary infections
For which type of injury would the nurse classify a client with a black tag during a disaster situation?
Older adult with massive head trauma and multiple open fractures
Hemorrhagic fever transmission
Viral reservoirs (rodents, arthropods, animal host) Person to person (contact or bodily fluids)
The nurse is caring for clients who were brought to the hospital following a large-scale disaster. Which client would be suitable for the nurse to triage with a "green" tag?
client who is injured but able to ambulate
Which phase of disaster management involves attempts to limit the disaster's impact on the population?
mitigation
5 phases of emergency and disaster planning
preparedness, prevention, response, recovery and mitigation
response
- Actual implementation of the plan - Activities used to address the event - Focuses on emergency relief - Saving lives - First aid - Minimizing/restoring damaged systems - Care and basic life requirements to victims (food, water, shelter)
Health hazards in the home
- Asbestos - Arsenic - Carbon monoxide - Environmental tobacco smoke - Formaldehyde - Lead - Mold - Pests - Pesticides - Radon - Solvents such as paint thinners, varnishes, and resins (ethers) - Personal care products - Volatile organic compounds (VOCs)
Primary Health care
- Education concerning prevailing health problems and methods of preventing and controlling them - Promotion of food supply and proper nutrition - Adequate supply of safe water and basic sanitation - Maternal and child health, including family planning - Immunization against major infectious diseases - Prevention and control of locally endemic diseases - Appropriate treatment of common diseases and injuries - Provision of essential drugs
National Response Framework
- National Incident Management System o Each key element of NIMS involves an intricate process and directly affects the overall effectiveness of the systems o A guide for comprehensive incident response o Provides direction for all responders
Emerging infections
- Severe acute respiratory syndrome (SARS) - HIV/AIDS - H5N1 - H7N9 (bird flus) - H1N1 (swine flu) influenzas - Middle Eastern respiratory syndrome (MERS) - Variant Creutzfeldt-Jakob disease (mad cow disease)
evaluation/prevention
- What worked? - What didn't? - Problems - Issues - Challenges - Quality assurance - Revisions
Smallpox transmission
Aerosol release Contact with person, bodily fluids, contaminated object Air in enclosed settings
pneumonic plague transmission
Aerosol release Respiratory droplets (person in 6 feet) Untreated bubonic plague sequelae
Which color tag is used for a client who is expected to die after a disaster with mass casualties?
Black
A client is admitted with dysphasia, dry mouth, drooping eyelids, blurred vision, vomiting, and diarrhea, and within 24 hours develops bilateral cranial nerve impairment and descending weakness. Which bioterrorism agent results in these clinical manifestations?
Botulism
Botulism s/s
Double/blurred vision Drooping eyelids Slurred speech Difficulty swallowing Descending muscle weakness
Anthrax transmission
Inhalation of powder or spores from infected animal product (inhaled) Handling infected animal (cutaneous) Undercooked meat from infected animal (digestive) NOT person to person
Which statement by the registered nurse is true regarding the mitigation phase of disaster management?
It is a process of minimizing of the disaster's influence on human health and community.
The disaster management team is evaluating the damage that can happen due to a disaster. They also attempt to limit the influence of the disaster on the health community's function. Which phases of disaster management would the nurse state represents these actions? Select all that apply.
Mitigation and preparedness
Which tag is suitable for a client with high priority during a disaster with mass casualties?
Red
Hemorrhagic fever treatment
Supportive therapy No established cure Ribavirin with Lassa fever
Hemorrhagic fever s/s
Varies depending on virus Fever Exhaustion Muscle aches Loss of strength
complex emergency
a multifaceted "humanitarian crisis in a country, region, or society where there is a total or considerable breakdown of authority resulting from internal or external conflict and which requires a multi-sectorial, international response" (disproportionately impact women and children)
Air Quality Index
a tool to report daily air quality in communities; calculated for four of the six criteria air pollutants (ground-level ozone, particle pollution, carbon monoxide, and sulfur dioxide) with an emphasis on how these affect health
Pneumonic plague treatment
antibiotics
According to the disaster triage tag system, which color tag would the nurse feel is most suitable for a client who died in an earthquake?
black
Epidemiologic surveillance
collect data prevent morbidity and mortality •NNDSS
Era of chronic health
o With decrease in infectious disease, increased life expectancy degenerative disease o Epidemiologic transition: replacement of infectious disease morbidity and mortality with that of chronic disease
precautionary principle
states that in the absence of clear data that indicate the safety of an action, chemical, or material that poses a threat to human health, it should not be used
Which conditions are given a green tag according to triage disaster tag system? Select all that apply.
strains sprains abrasions
scope of disaster
the range of its effect, either geographically or in terms of the number of people impacted (collapse of 500-unit high-rise apartment building has a greater scope than the collapse of a bridge that occurs while only 2 cars are crossing)
CBRNE terrorism
types of weapons that have the ability to create both mass causalities as well as mass disruption of society - Chemical - Biological - Radiological - Nuclear - Explosive
Incident Command System
- A management system that is applicable to small incidents as well as very large, complex incidents/disasters - Consists of procedures for controlling personnel, equipment, and communications during disasters - Designed to begin developing from the time an incident occurs and continues until the incident/disaster does not require management - An Emergency Management System which employs a logical management structures, defined responsibilities, clear reporting channels, and a common nomenclature to help unify hospitals with other emergency responders
3 C's of disaster response
- Communication - Coordination - Collaboration
Limitations of CBRNE
- Effective dissemination difficult o Many attempts have been made, very few successfully o Chemical agents must be used in relatively large quantities, especially if released in an open area. For chemicals, this requires quantities measured in pounds and gallons for a massive effect. This requirement creates manufacturing problems and increases the risk of detection. - Potentially hazardous to the terrorist o Suicide bombers o Infected disease carriers - Development and use require skill
Major issues nurses face today
- Emerging infectious diseases - Human trafficking - Maternal-newborn health - Health inequities - Maldistribution of health workers
Global health objectives
- Eradicating extreme poverty and hunger - Achieving universal primary education (health literacy) - Empowering women - Reducing child mortality rates - Improving maternal health - Combating HIV, malaria, and other diseases - Ensuring environmental sustainability - Global partnerships *bolded are Millennium Development Goals
IPREPARE
- I: INVESTIGATE potential exposures (when in contact with something, when at home or work) - P: PRESENT WORK (what exposed to, MSDS location, PPE, coworkers with health problems) - R: RESIDENCE (age, location, heating type, stored chemicals, drinking water source) - E: ENVIRONMENTAL concerns (concerns about air, water, soil in neighborhood; industries/farms/landfill/waste-site nearby) - P: PAST WORK (experience, longest work period, military, farm, seasonal or volunteer work) - A: ACTIVITIES (hobbies, burn/solder/melt, garden/fish/hunt, eat what grown or hunted, alternative healing) - R: REFERRALS & RESOURCES - E: EDUCATE (materials available to client, plan for follow-up)
2 key measures of global health
- Life expectancy - Infant mortality
mitigation
- Measures taken to reduce harmful effects - Preventions - Occurs before incident - Adjust the plan as needed
Global burden of disease
- Questions related to value of a life - Disparities, verified with quantifiable data, in the burden of disease worldwide among the developing countries, especially among children - As more people around the world are living longer, the number of years lived with disability (YLD) increases (back pain and depression are the mostly commonly cited causes of disability in countries worldwide) - Disability-adjusted life year: to compare across conditions and risk factors; the combination of years of life lost because of premature mortality and years of life lived with disability adjusted for the severity of disability
Category A Bio terrorism Agents
- Smallpox - Inhalation Tularemia - Viral Hemorrhagic Fever - Anthrax - Pneumonic Plague - Botulism
Build environment
- refers to all aspects of our human environment that are not naturally occurring and includes not only the physical structures (e.g., dams, roadways, buildings) but also the features that contribute to social cohesiveness or disruption - Environmental justice: the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies
smallpox s/s
High fever Head/body aches Vomiting Progressive rash
The registered nurse is teaching a student nurse about the disaster triage tag system. Which statement made by the student nurse indicates ineffective learning?
I will use a yellow tag for a client in shock
life cycle of disaster
Pre-incident Trans-incident Post-incident
correct order for emergency preparedness
Preparedness Response .Recovery Mitigation Evaluation
Which tag color according to the disaster triage tag system is assigned to a client who has an immediate threat to life?
Red
Tularemia s/s
Skin ulcers Swollen/painful lymph glands Sore throat Mouth sores Diarrhea Pneumonia Inhaled: abrupt onset fever, chills, headache, muscle aches, joint pain, dry cough, progressive weakness
Tularemia transmission
Tick, deerfly Sick/dead infected animal Contaminated food/water Inhalation NOT person to person
Tularemia treatment
antibiotics
Which would the nurse describe as an example of an internal disaster?
fire or explosion
Which color tag should be given to "walking wounded" clients according to the disaster triage tag system?
green
Which client conditions require the nurse to tag with red according to the disaster triage tag system? Select all that apply.
hemorrhage airway obstructuion
Which phase in the disaster management continuum does the nurse understand as including the attempt to limit a disaster's impact on human health and community function?
mitigation
`Era of Infectious diseases
o Communicable diseases - 5 of 10 leading causes of death, major preventive measure of immunization o Interventions such as integrated management of childhood illness (IMCI), polio endgame, and oral rehydration therapy o Eradication, elimination, and control of communicable diseases
Natural disasters
o Earthquake o Tornado o Floods o Hurricanes o Blizzards o Wildfires o Tsunamis o Nuclear
The geographic location of a community makes it vulnerable to storms. The community health nurse teaches the community about safety measures to be taken during a storm. Which phase of disaster management is this action?
preparedness
intensity of disaster
the level of destruction and devastation it causes (an earthquake centered in a large metro area and one centered in a desert have same Richter scale rating yet have very different intensities in terms of the destruction they cause
Tertiary prevention emergency preparedness
• Decrease complications and disabilities due to infectious disease through treatment and rehab • Monitory treatment compliance • Identify and link clients to needed community resources
Secondary preventions emergency preparedness
• Increase early detection through screening and case findings • Refer suspected cases of communicable disease for reporting and confirmation • Provide postexposure prophylaxis • Quarantine clients when necessary
Primary prevention emergency preparedness
• Prevent the occurrence of infectious disease • Educate the public regarding the need for immunizations, and vaccination programs • Counsel clients travelling to other countries about protection from infectious diseases. Refer client to health department about mandatory immunizations • Educate the public regarding prevention of disease and ways to eliminate risk factors for exposure
HP2020`
o Outdoor air quality o Surface and groundwater quality o Toxic substances and hazardous wastes o Homes and communities o Infrastructure and surveillance o Global environmental health
