exam 3: ATI CHPT.8 Flashcards
disaster
event that causes human suffering and demands more resources than are available in the community.
-can be naturally occurring, man-made, or both (natural disaster causing technological failure)
disaster preparedness
includes planning for all types od hazards and establishing protocols for managing the surge of clients in the health care system
disaster prevention (mitigation)
-includes activities to prevent natural and man-made disasters (increasing surveillance, improving inspections and airport security, and immunization/quarantine)
-strengthing barriers to prevent flooding
-teaching methods of preventing communicable diseases
-include identification and assessment of populations at risk
populations at risk for disasters
-fewer resources
-less of an ability to withstand a disaster w/o physical harm
-tend to be physically isolated, disabled, or unable to access disaster services
strategic emergency planning
strategy to prevent loss of lives in susceptible populations
disaster preparedness
-occurs at the national, state, and local levels.
-Personal and family preparedness are crucial components
-professional preparedness for individuals employed in civil service and health care.
disaster preparedness stems from
threats and vulnerabilities identified at the prevention level and should coordinate community efforts as well as outline the specific roles of local agencies.
individual and family disaster preparedness includes
-creating an action plan
-determining alternative methods of communication
-highlighting possible evacuation routes
-identifying local and distant meeting places
-creating a disaster kit
communication plan
-important
-should provide for access to emergency agencies (Red cross, state, and federal government agencies)
disaster drills
replicate possible scenarios in the local area and enhance the preparedness of community members, government agencies, healthcare facilities, and businesses
disaster response
Disaster management response includes an initial assessment of the span of the disaster.
-How many people are affected?
-How many are injured or dead?
-How much fresh water and food is available?
-What are the areas of risk or sanitation problems?
National Incident Management System (NIMS)
provides structure for managing any type of disaster, incorporating various public and private agencies
the goal of NIMS
effective communication and a clear chain of command to manage disasters
agencies involved with disaster response
Federal Emergency Management Agency (FEMA), the CDC, U.S. Department of Homeland Security (DHS), American Red Cross (ARC), Office of Emergency Management (OEM), and the public health system.
if federal emergency is declared
the national response framework (NRF) is activated and provides direction for an organized, effective national response
disaster recovery
begins when danger no longer exists and needed representative and agencies are available to assist with rebuilding
how long does recovery last in a community disaster
until the economic and civil life of the community are restored, which can be days, weeks, or even years
how long does recovery last in an individual disaster
it is the time it takes an individual to become functional within a community after a disaster.
important aspects of disaster recovery
communicable disease and sanitation controls
what is common during the aftermath of disasters
-Post-traumatic stress disorder (PTSD) and delayed stress reactions (DSR)
-affects both caregivers and victims
phases of emotional reaction during a disaster
heroic, honeymoon, disillusionment, and reconstruction
heroic phase
-Intense excitement and concern for survival.
-Often a rush of assistance from outside the area is present.
honeymoon phase
Affected individuals begin to bond and relive their experiences.
disillusionment phase
-Responders can experience depression and exhaustion.
-Phase contains unexpected delays in receiving aid.
reconstruction phase
-Involves adjusting to a new reality and continued rebuilding of the area.
-Counseling is sometimes needed.
-Those affected begin looking ahead.
Risk assessment questions
-populations at risk
-previous disasters
-size of area affected in worst case scenario
-community disaster plan
-warning systems
-disaster response teams
-resource facilities
-evacuation measures
-environmental dangers
disaster planning
-Develop a disaster response plan based on the most probable disaster threats.
-identify warning system
-identify first responders’ plan
-list of agencies for disaster management levels
-define nursing roles in triage
-identify specific role of personnel involved in disaster response and the chain of command
-locate all equipment/supplies
-check equipment
-evaluate efficiency, and response time during drills
-Assist community members with personal preparedness by having a plan for evacuation and making a disaster kit.
-Talk with medical facilities and governing agencies about crisis standards of care to determine how care standards might be altered to manage a large surge of clients.
disaster kits should include
at least 3 days’ supply of food, water, medication, clothing, and hygiene items per person, copies of personal documents, and first aid supplies.
disaster response
-Activate the disaster management plan.
-Perform triage
-Collaborate with response partners to develop plans for triage algorithms.
-Identify and place public health nurses and other support personnel to provide care according to the developed algorithms.
triage involves
identifying those who have serious versus minor injuries, prioritizing care of victims, and transferring those requiring immediate attention to medical facilities.
Red triage
injury to:
-airway/breathing
-uncontrolled/severe bleeding
-severe burns
-signs of shock
-open chest/abdominal wounds
yellow triage
-burns with no airway problems
-major/multiple bone or joint injuries
-back injuries with or w/o spinal cord injuries
green triage
-minor fractures
-minor soft tissue injuries
black triage
-obvious death
-obvious non-survivable injury
-respiratory or cardiac arrest
Reverse Triage
1: “if you can walk, come to sound of my voice”; if they walk= green
2: start triage; assess breathing, then circulation, then mental status
Step 1: breathing in reverse triage
> 30 RR/min= shock= red/immediate
<30 RR/min= assess circulation
no RR after 2 chin tilt attempts= black/death
what to do after you tag someone with black
turn patient to left side (position of comfort) and move on to the next patient
Step 2: circulation in reverse triage
> 2 sec cap refill= red/immediate
<2 sec cap refill= assess mental status
if bleeding, control w/pressure bandages
Step 3: Mental status in reverse triage
“squeeze my hand”
-no response= shock= immediate/red
-follows command, but unable to walk= delayed/yellow
disaster recovery
-Make home visits and reassess the health care needs of the affected population.
-Provide and coordinate care in shelters.
-Provide stress counseling and assessing for PTSD or delayed stress reactions and making referrals for psychological treatment.
-Monitor the physical and psychosocial environment.
evaluation of disaster response
-Evaluate the area, effect, and level of the disaster.
-Create ongoing assessment and surveillance reports.
-Evaluate the efficiency of the disaster response teams.
-Estimate the length of time for recovery of community services, such as electricity and running potable water.
Category A Biological Agents
The highest priority agents, posing a risk to national security
-easily transmitted
-have high mortality rates.
Cat A bio agents ex
smallpox, botulism, anthrax, tularemia, viral hemorrhagic fevers (Ebola), and plague.
category B biological agents
The second-highest priority -moderately easy to disseminate
-have high morbidity rates and low mortality rates
Cat B BA Ex
typhus fever, ricin toxin, diarrheagenic E. coli, and West Nile virus.
category C BA
The third-highest priority, comprising emerging pathogens that can be engineered for mass dissemination
-are easy to produce,
-have a potential for high morbidity and mortality rates.
Cat C BA ex
hantavirus, influenza virus, tuberculosis, and rabies virus.
bioterrorism: anthrax
bacillius anthracis; is found in agricultural regions of central/south america
-inhaled and cutaneous
prevention of anthrax
immunization; developed in 1888 by Louis Pasteur
symptoms of anthrax poisoning
inhaled: pneumonia sx, internal hemmorhaging, and then septicemia
cutaneous: enter a break in the skin and become infected with blistered areas on the skin and then enter the bloodstream
FATAL IF NOT CAUGHT EARLY
treatment of anthrax
-cutaneous: penicillin if diagnosed quickly
-inhaled: antitoxin vaccine and iv antibiotics (ciprofloxacin or doxycycline)
botulism symptoms
-double/blurred vision
-slurred speech
-difficulty swallowing
-progressive muscle weakness
-difficulty breathing
botulism prevention
no approved vaccine
botulism treatment
-airway management
-antitoxin
elimination of toxins in botulism
-induce vomitting
-enemas
-surgical excision of wound tissue
supportive care of botulism
-nutrition
-fluids
-prevention of complications
smallpox symptoms
-High fever
-Fatigue
-Head and body aches
-Vomiting
-Rash that begins on the
face and tongue; quickly spreads to the trunk, arms, and legs, then hands and feet; then turns to pus-filled lesions
smallpox prevention
Vaccination (can also
vaccinate within 3 days of exposure)
smallpox spread
-contact
-airborne
treatment of smallpox
only 2 antivirals approved:
-tecovirimat
-brincidofovir
supportive care of smallpox
-Hydration
-Pain medication
-Antipyretics
Antibiotics for any secondary infections
ebola day 7-9 sx
-headache
-fatigue
-fever
-muscle soreness
ebola day 10 symptoms
-sudden high fever
-vomiting blood
-passive behavior
ebola day 11 sx
-brusing
-brain damage
-bleeding from nose, mouth, eyes, anus
ebola day 12 sx
final stages of disease
-loss of conciousness
-seizures
-massive internal bleeding
-death
transmission of ebola
body fluids
ebola prevention
-ebola vaccine
-PPE/droplet isolation
-prevent contact with semen of someone who was previously infected
-avoid contact with used needles and medical equipment
treatment of ebola
-supportive care
-IVF’s
-dialysis
-airway management
-psychological counseling
-minimize invasive procedures (bleeding risk)
-pharm
pharm treatments of ebola
2 form of treatments approved in 2020
Mixture of 3 antibodies
-atoltivimab,
-Maftivimab
-odesivimab-ebgn
single antibody
-ansuvimab-zykl
bubonic plague
-attacks lymphatic system
-most commonly seen form of the black death
-mortality rate= 30-75%
-symptoms took 1-7 days to appear
bubonic plague symptoms
-fever
-headache
-malaise
-swollen (buboes; outside of body), pus exudation, or bleeding in lymph nodes
-n/v
-pain/aches in joints
septicemic plague
-affect circulatory system
-most rare form
-mortality close to 100%
-victims usually died the same day sx appeared
septicemic plague sx
-high fever
-skin turning deep shade of purple (caused by disseminated intravascular coagulation)
-gangrene of nose and digits
pneumonic plague sx
attacks lungs
-fever
-headache
-weakness
-pneumonia w/ SOB
-chest pain
-cough
-bloody/watery sputum
prevention of plague
-no vaccine
-contact precautions
-droplet precautions until 72 hours after antibiotics
treatment of plague
-gentamicin
-fluroquinolones
tularemia transmission
-between rodents, rabbits, and to humans by ticks
-contact w/infected animals
-eating undercooked rabbit meat
-inhaling contaminated dust
-drinking contaminated water
tularemia prevention
-vaccine is under review
-insect repellant
-wear gloves when handling sick or dead animals
tularemia symptoms
-sudden fever
-chills
-headache
-diarrhea
-muscle aches
-joint pain
-dry cough
-progressive weakness
-enlarged lymph nodes
airborne tularemia sx
-life threatening
-pneumonia and systemic infections
treatment of tularemia
-streptomycin or gentamicin
-mass casualty: doxycycline or ciprofloxacin
primary prevention of bioterrorism
planning
-drills, vaccines, and availability for antibiotics
-bioterrorism response plan using most probable biological agent in local area
-identify chain of command for reporting bioterrorism attacks
-define nursing roles in attack
-protocols for different levels of infection control and containment
secondary prevention for bioterrorism
early recognition
-activate plan
-immediately implement infection control and containment measures
-screen population for exposure, assessing rates of infection, and administering vaccines as availble
-assist with education to population regarding sx
-monitor mortality and morbidity
tertiary prevention of bioterrorism
rehabilitation of survivors
-monitor medication regimens and referrals
-evaluate the effectiveness and timeliness of the bioterrorism plan
