Disaster Planning

Nina is a new graduate nurse that started orientation six weeks ago in the emergency department. After receiving disaster training, which statement indicates that Nina needs additional disaster orientation?

Any situation that creates an environment that endangers healthcare workers. Correct

The S.T.A.R.T. adult triage is a system that contains four triage categories that are color-coded. The nurse explains that all clients are assessed, identified, and tagged according to 1 of 4 colors, each color representing the severity of injury. When instructed to select the appropriate order from least to worst categories, which sequence indicates the nurses understand the triage process?

Green, yellow, red, black.

While burns can cause rapid swelling of the airway, chemical burns cause mucosal irritation that exacerbates edema in the airway. It is important for the nurse to be familiar with and able to quickly gather intubation supplies and equipment to assist the person performing the procedure. Which information is helpful for the nurse to know when assisting the HCP with airway intubation? (Select all that apply.)

Know how to connect the laryngoscope blade to the handle. Correct Be familiar with where the intubation equipment is kept. Correct Understand correct positioning of the client for the procedure. Correct

Venous access is very important for critically ill clients and can be difficult in injured or burned clients. Due to David's extensive burns, Nina has difficulty quickly obtaining an IV site. Which action by the nurse would expedite rapid infusion of fluid, blood products, and medication for this trauma victim?

Locate the client's proximal tibia and prepare for access insertion. Correct

Nina is notified that other ambulances are in route to the hospital. She is instructed to prepare for the arrival of victims and don PPE to assist with the decontamination of the incoming clients. Which of the nurse's actions illustrate safe removal of PPE?

Remove the gown by rolling downward from head to toe without touching outside of gown. Correct

Walking through the double doors of the hospital, Nina heads to her car. She noticed someone leaning up against the wall sobbing with face in hands. It is the charge nurse who startles as Nina approaches. Nina places her hand on the tearful charge nurse's shoulder in an effort to provide comfort. Which therapeutic approach should Nina implement that would most likely initiate a conversation with the charge nurse?

Offer the charge nurse silence and non-verbal communication while allowing the charge nurse to cry. Correct

While the manager is on the phone, the charge nurse gathers the disaster preparedness manual and hands it to the manager. Realizing the severity of having both internal and external disasters occurring simultaneously the manager assigns roles to the staff in the ED as outlined in the disaster preparedness policies and procedures.

-Ensure that all tasks assigned are performed according to policy. -Ensure that all tasks are completed as assigned.

Meanwhile, the charge nurse delegates to the environmental services (EVS) supervisor and the hospital's maintenance department employees a list of additional supplies needed immediately in the triage area. Which are the most important for the EVS supervisor to gather and take to the triage area? (Select all that apply.)

-Gowns and suits for clients to don post decontamination, Self Decon "trash bag" kits, tarps. Correct -Mild soap, sponges, sterile gauze, long handled soft bristle brushes, towels, and blankets. Correct -Containers, hoses with gentle flow, controlled nozzles with hot and cold water, ropes. Correct -Shower single with flex head and/or multiple heads, plastic pallets to prevent slippage, and barrier tape. Correct -Water containment collection system such as wading pools, barrels, pumps, and modesty screens. Correct

After explaining the triage system, the nurse clarifies the clinical parameters that are used to evaluate each client before deciding what color of tag to use. Assessments and observations are categorized in four words; observe, palpate, listen, and smell. Based on the S.T.A.R.T. adult triage system, which assessments demonstrate the appropriate triage assignment? (Select all that apply.)

-Presence of spontaneous breathing and respiratory rate less than 30 breaths per minute with an open fracture = Yellow. -Extensive body injuries or burns that impact the client's ability to survive = Black. Those who are able to ambulate by themselves and who have superficial lacerations = Green. -Shock, airway obstruction, third-degree burns over 75% of body = Red.

The charge nurse is aware that the hospital has a disaster preparedness plan for such incidents. Which key components should the nurse expect to be included in the plan? (Select all that apply.)

-Security, documentation, and resource allocation. -Client care, communication, and safety. -Effective triage strategy for clients.

When setting up decontamination tents, it is imperative to set up a flow that includes which areas? (Select all the apply.)

-Set up an initial triage, a decontamination area, second triage, and treatment area. -Set up a fast track area for clients with life threatening injuries that would allow delivering basic life-saving treatment during decontamination.

The charge nurse explains to the hospital staff that they may be required decontaminate clients because it is the first step when responding to any chemical incident. Which statements accurately reflect the staff members' understanding of client decontamination? (Select all that apply.)

-There are two types of client decontamination always performed by first responders to not affect the way the hospitals set up the triage. Correct -Client decontamination is a process that leads to removal of something on a client that will affect the client or healthcare providers. Correct

If many clients who sustained minor injuries arrive at once, there may be a delay with decontamination procedures. The volunteers should give the green clients washing instructions. Which explanation indicates to the nurse that the triage client understands the decontamination instructions? (Select all that apply.)

-They explain that they must rinse off chemically exposed areas and remove all clothing which should then be placed in a labeled polyethylene bag. -They explain that they must flush skin with plain water for 2 to 3 minutes, then flush skin with a solution of ¼ peroxide and ¾ water, rinsing twice between flushes, being careful not to cut the skin.

The volunteers have arrived to assist the nurse in assembling supplies According to Maslow's needs, which supplies should the nurse ask the volunteers to assemble first? (Select all that apply.)

Allergy bands and name labels Blankets Water and snacks.

Mr. Mazoch returns from decontamination and Nina has administered a tetanus injection per the healthcare provider's prescription. Nina notices erythema and raised wheals on Mr. Mazoch's chest and upper and lower bilateral extremities. Nina anticipates and prepares to take action with which intervention?

Anticipate administering diphenhydramine 50 mg intravenously stat.

Most of the HAZMAT team is aware of the principles of decontamination: decontaminate as soon as possible, decontaminate by priority, and decontaminate only what is necessary and as far forward as possible.

Avoid direct contact with chemicals if possible. Correct Use appropriate PPE to reduce exposures to chemicals as much as possible. Correct Follow established methods for decontaminating clients. Correct

In situations where explosions occur in chemical plants, the high concentration of chemical exposure can cause adverse effects. The severity of the effects will depend on the length of exposure. During a chemical spill, which type of injuries can a nurse triaging clients expect? (Select all that apply.)

Chemicals are toxic when inhaled, so exposure can cause respiratory problems. Correct Clients exposed to mustard gas will present with gritty, itchy eyes.

After the need to collect physical evidence, which forensic nurse ability plays a key role in the investigation of a disaster?

Discovery, identification, and collection of physical and non-physical evidence, and documentation. Correct

When a nurse is advanced triaging clients during a disaster, which principle is the most important to remember?

Do the greatest good for the greatest number of clients. Correct

Once the evidence is collected and the client is taken to the autopsy room for holding. The charge nurse tells Nina that the disaster has been contained and that she was just notified the incoming staff had arrived and she was going to be able to go home. Working well beyond her scheduled shift, Nina gives report to the incoming nurse and prepares to leave the hospital. Which implication poses the greatest risk to client safety and to Nina as the shift ends and she drives home?

Exhaustion

Fluid resuscitation is a critical intervention for burn management and the Parkland formula is one of the most widely used burn resuscitative fluid formulas. The charge nurse is instructing Nina about the application of the formula. Which intervention is accurate in describing fluid replacement based on the Parkland formula?

Half the fluid is given over the first 8 hours after injury and the remaining half given over the next 16 hours. Correct

The pharmacist is responsible for ensuring enough medications and supplies are available throughout the duration of the disaster event. The nurse confirms with the pharmacist that enough medication is available for chemical and explosive types of injuries.

Have him immediately removed from the unit to the decontamination tent for removal of any potential chemical residue.