Nursing Knowledge for Bioterrorism Agents
A CHN is educating other community health nurses on identifying smallpox to identify where the rash will appear first.
What is the face.
Rationale: 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.
You are the triage nurse reporting to a roof collapse at a nursing home. The first resident you come across is an 84-year-old resident who is lying under pieces of ceiling on the floor. The resident complains of pain with an obvious fracture of the right lower extremity with swelling. Vitals: BP- 116/70, HR- 110, RR- 28, Temp- 98.0, O2 sat- 94% RA, Cap refill- 2 seconds. Patient is alert and oriented X3 and able to follow simple commands.
You retrieve a wheel chair to move the patient to a safe place and place this tag around their neck.
What is a Yellow tag.
Rationale:
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 right lower extremity fracture.
This would not allow them to walk. Tag Yellow
A CHN is participating in a community planning committee for disaster preparedness in a local community that is at risk for hurricanes. The nurse understands that during Disaster prevention, the identification and assessment of populations at risk is important because of this reason.
What is populations at risk have fewer resources and tend to be physically isolated.
Rationale: Populations at risk are those that have fewer resources or less of an ability to withstand and survive a disaster without physical harm. These populations tend to be physically isolated, disabled, or unable to access disaster services.
Examples of this include the influenza and rabies virus.
What is Category C Biological Agents.
•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 and muscle weakness.
Name that bioterrorism agent.
What is Botulism.
Rationale: Botulism manifestations include double or blurred vision, slurred speech, difficulty swallowing, progressive muscle weakness, and difficulty breathing. This mimics a stroke, however, a stroke is usually one sided and botulism affects both sides of the body.
A CHN understands that when developing a plan of care for a patient with Botulism, you would include this.
What is an antitoxin.
Rationale: Administration of an antitoxin is the treatment for botulism along with airway management and possible mechanical ventilation.
You are the triage nurse reporting to a roof collapse at a nursing home. 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.
Vital signs: BP- 130/88, HR- 122, RR- 28, Temp- 97.9, O2 sat- 92% RA, Cap refill- less than 2 seconds. Patient is Alert and oriented X3 and able to follow simple commands.
You would hang this color of tag around the patient's neck.
What is a green tag.
Rationale:
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.
The CHN is practicing disaster drills with the local hospital to replicate possible scenarios that area may experience in the future.
This is which part of the disaster management cycle?
What is the Disaster preparedness.
Rationale: Disaster drill replicate possible scenarios in the local area and enhance Preparedness of community members, government agencies, health care facilities, and businesses.
Examples of this include Smallpox, Anthrax, and Botulism.
What is Category A Biological Agents.
•56 year old patient present, C/O swollen neck glands, fever, chills, headache, dry cough, and muscle and joint aches.
•Onset- 6 hours ago
Name that Bioterrorism Agent.
What is Tularemia.
Rationale: Tularemia manifestations include sudden fever, chills, headache, diarrhea, muscle aches, joint pain, dry cough, and progressive weakness.
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 this type of precaution is needed to treat patients with Ebola.
What are droplet and contact isolation precautions.
Rationale: Impermeable gowns or coveralls; two pairs of disposable gloves, boot/shoe covers, apron, and an N95 mask are needed when treating patients with Ebola.
You are the triage nurse reporting to a roof collapse at a nursing home. 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.
Vital signs: BP- unable to obtain, HR- 5, RR- 0 after two chin tilt attempts, Temp- 95.3, O2 sat- 15% RA, Cap refill- none
You would hang this colored tag around this patient's neck.
What is a black tag.
Rationale:
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 CHN understands that this phase of the disaster management cycle begins when the danger no longer exists and can take years to complete.
What is the disaster recovery phase.
Rationale: Recovery begins when danger no longer exists and needed representatives and agencies are available to assist with rebuilding. Recovery lasts until the economic and civil life of the community are restored, which can last days, weeks, or even years.
Examples of this includes Typhus fever, E. coli, and West Nile virus.
What is Category B Biological Agents.
•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.
Name that Bioterrorism Agent.
What is Pneumonic Plague.
Rationale: Pneumonic plague manifestations include fever, headache, weakness, pneumonia with shortness of breath, chest pain, cough, and bloody or watery sputum.
The CHN understands that the following prevention strategies are used with patients suffering from the Plague.
What is Droplet precautions until 72 hours after antibiotics for pneumonic plague.
Rationale: Droplet precautions until 72 hours after antibiotics for pneumonic plague. Other precautions are not correct because symptoms of pneumonic plague include cough and blood or watery sputum.
You are the triage nurse reporting to a roof collapse at a nursing home. 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.
Vital signs: BP- 140/76, HR- 139, RR- 32, Temp 98.0, O2 sat- 86% RA, Cap refill 3 seconds, the patient is alert and oriented X3 and is able to follow simple commands.
You would hang this colored tag around the patient's neck.
What is a red tag.
Rationale:
Step 1- Breathing. The patient’s respiratory rate is greater than 30.
Tag Red.
The CHN continually assessed the number of people affected, the number of people injured or deceased, how much fresh water and food is available, medication needs, and sanitation problems during this phase of the disaster management cycle.
What is the disaster response phase.
Rationale: Disaster response includes an initial assessment of the span of the disaster and the continued monitoring of the disaster.
This is the category that includes emerging pathogens that can be engineered quickly and have a potential for high morbidity and mortality rates.
What is Category C Biological Agents.
Rationale: Category C is the third-highest priority, comprising emerging pathogens that can be engineered for mass dissemination because they are easy to produce, and/or have a potential for high morbidity and mortality rates.
•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.
Onset 3 days ago with rash appearing today.
Name that Bioterrorism Agent.
What is Smallpox.
Rationale: Smallpox manifestations include high fever, fatigue, head and body aches, 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.
The CHN expects this medicine to be ordered for Tularemia during a mass casualty?
What is doxycycline or ciprofloxacin.
Rationale: Streptomycin or gentamicin is correct for just a few cases of Tularemia and are the antibiotics of choice. However, during a mass casualty, doxycycline or ciprofloxacin are used because they are more readily available and more easily distributed for the increased number of patients requiring them during a mass casualty.
You are the triage nurse reporting to a roof collapse at a nursing home. 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.
Vital signs: BP- 50/20, HR- 40 (weak), RR- 2 (agonal) no improvement after two chin tilts, Temp 96.0, O2 sat- 20% RA, Cap refill- greater than 5 seconds, and unresponsive.
You would hang this colored tag around the patient's neck.
What is a black tag.
Rationale:
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.
While working in a displacement shelter, a CHN assesses two community members who have become friends due to the fact that their homes were destroyed during a disaster. She constantly hears them talking about the events of that day and reliving each detail. The CHN understands that this is which phase of emotional reaction during a disaster?
What is the Honeymoon phase.
Rationale: The honeymoon phase is where affected individuals begin to bond and relive their experiences.
This is the category that poses a risk to national security because of the high mortality rates.
What is Category A Biological Agents.
Rationale: Category A has the highest priority agents, posing a risk to national security because they are easily transmitted and have high mortality rates.
•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.
Name that Bioterrorism Agent.
What is Ebola.
Rationale: Ebola manifestations include fever, severe headache, sore throat, loss of appetite, joint and muscle aches, fatigue and weakness, hemorrhage, vomiting and diarrhea, and shock.