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nr203 test 4 Disaster Nursing


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Four Steps to Safety
1. Find Out What Could Happen to You
Contact your local Red Cross chapter or emergency management office before a disaster occurs--be prepared to take notes.
Ask what types of disasters are most likely to happen. Request information on how to prepare for each.
Learn about your community's warning signals: what they sound like and what you should do when you hear them.
Ask about animal care after a disaster. Animals are not allowed inside emergency shelters because of health regulations.
Find out how to help elderly or disabled persons, if needed.
Find out about the disaster plans at your workplace, your children's school or day care center, and other places where your family spends time.
Four Steps to Safety
2. Create a Disaster Plan
2. Create a Disaster Plan

Meet with your family and discuss why you need to prepare for disaster. Explain the dangers of fire, severe weather, and earthquakes to children. Plan to share responsibilities and work together as a team.
Discuss the types of disasters that are most likely to happen. Explain what to do in each case.
Pick two places to meet:
Right outside your home in case of a sudden emergency, like a fire.
Outside your neighborhood in case you can't return home. Everyone must know the address and phone number.
Ask an out-of-state friend to be your "family contact." After a disaster, it's often easier to call long distance. Other family members should call this person and tell them where they are. Everyone must know your contact's phone number.
Discuss what to do in an evacuation. Plan how to take care of your pets.
Four Steps to Safety
3. Complete This Checklist
Post emergency telephone numbers by phones (fire, police, ambulance, etc.).
Teach children how and when to call 9-1-1 or your local Emergency Medical Services number for emergency help.
Show each family member how and when to turn off the utilities (water, gas, and electricity) at the main switches.
Check if you have adequate insurance coverage.
Get training from the fire department for each family member on how to use the fire extinguisher (ABC type), and show them where it's kept.
Install smoke detectors on each level of your home, especially near bedrooms.
Conduct a home hazard hunthome hazard hunt.
Stock emergency supplies and assemble a Disaster Supplies Kit.
Take a Red Cross first aid and CPR class.
Determine the best escape routes from your home. Find two ways out of each room.
Find the safe places in your home for each type of disaster.
Four Steps to Safety
4. Practice and Maintain Your Plan
4. Practice and Maintain Your Plan

Quiz your kids every six months or so.
Conduct fire and emergency evacuations.
Replace stored water and stored food every six months.
Test and recharge your fire extinguisher(s) according to manufacturer's instructions.
Test your smoke detectors monthly and change the batteries at least once a year
What needs to be secured/repaired/cleaned in a disaster scenario?
In a disaster, ordinary items in the home can cause injury and damage. Anything that can move, fall, break, or cause a fire is a potential hazard.
Repair defective electrical wiring and leaky gas connections.
Fasten shelves securely.
Place large, heavy objects on lower shelves.
Hang pictures and mirrors away from beds.
Brace overhead light fixtures.
Secure water heater. Strap to wall studs.
Repair cracks in ceilings or foundations.
Store weed killers, pesticides, and flammable products away from heat sources.
Place oily polishing rags or waste in covered metal cans.
Clean and repair chimneys, flue pipes, vent connectors, and gas vents.
Neighbors Helping Neighbors
Neighbors Helping Neighbors
Working with neighbors can save lives and property. Meet with your neighbors to plan how the neighborhood could work together after a disaster until help arrives. If you're a member of a neighborhood organization, such as a home association or crime watch group, introduce disaster preparedness as a new activity. Know your neighbors' special skills (e.g., medical, technical) and consider how you could help neighbors who have special needs, such as disabled and elderly persons. Make plans for child care in case parents can't get home.
Check for Damage in Your Home...
Check for Damage in Your Home...

Use flashlights. Do not light matches or turn on electrical switches, if you suspect damage.
Sniff for gas leaks, starting at the water heater. If you smell gas or suspect a leak, turn off the main gas valve, open windows, and get everyone outside quickly.
Shut off any other damaged utilities. (You will need a professional to turn gas back on.)
Clean up spilled medicines, bleaches, gasoline, and other flammable liquids immediately
Remember to...
Remember to...

Confine or secure your pets.
Call your family contact--do not use the telephone again unless it is a life-threatening emergency.
Check on your neighbors, especially elderly or disabled persons.
Make sure you have an adequate water supply in case service is cut off.
Stay away from downed power lines.
Examples of disaster caused illnesses and injuries
Earthquakes: Crush injuries, lacerations, fractures, internal injuries.
Hurricanes: Drownings (storm surge), clean up injuries-lacerations, GI illness, anima and insect bites
Tornadoes: severe soft tissue injuries such as contusions, complex lacerations, multiple fractures
Floods: Drownings, clean up injuries.
Bioterrorism: Anthrax
Most likely to be used
Encapsulated, inactive form of bacteria
Spores survive for years
Usually found in wildlife and livestock
Can be acquired through the skin, inhaled in the lungs, or ingested through the GI tract
Three Forms of Anthrax
Cutaneous-On skin-papule-vesicle-clear fluid with black area. Not as critical but can become septic. Most recover. Treatable. Cut-Spores of anthrax get in-
Incubation-60 days-will spread
Gastrointestinal- Eat-Contaminated food (in nature) Flu-like symptoms. SOA, dyspnea, stridor, cyanosis, septic shock, meningitis, lymph node enlargement. Hemorrhaging-die in 24-46 hours. Lymphoedema in the lungs.
Diagnosis/treatment of Anthrax
Foolproof screening test doesn’t exist.
Treatment: Cipro (Ciprofloxacin) IV Q 12 hours
Prophylactic treatment: Oral Cipro or Doxycycline.---Up to 60 days.
Anthrax vaccine-for military and lab people at increased risk.
7 different toxins A-G
Usually from contaminated food
S/S include: Nausea/Vomiting, malaise, dizziness
Later: Diplopia, dysarthria, dysophonia, dysphagia
Home canned tomatoes
Damage to neurons in CNS
Classic triad-symptoms of botulism
Symmetric descending flaccid paralysis which progresses to respiratory muscle weakness ( difficulty breathing)
Absence of fever
Alertness and orientation without sensory deficits
Diagnosis and treatment
Rule out other neuron disorders such as Guillain-Barrre, Myasthenia Gravis, and Polio.
Antitoxin available for toxin types A, B, and E (screen for horse allergies/allergies to horse serum)
Supportive treatment (ICU, Ventilator)
“Black Death”
Bubonic plague
Rodent Flea Man
Inhalation of droplets-Pneumonic Plague
Handling tissues of infected animals
Bioterrorists may aerosolize the bacteria
Plague Symptoms
Severe Malaise, myalgia, high fever, cough, hemoptysis (cough up blood), ecchymosis, H/A followed by septicemia and fulminant pneumonia
Rapid progression, death from respiratory failure and circulatory collapse
Treatment of Plague
No vaccine
Streptomycin IM BID for 10 days or
Doxycycline IV BID for 10-14 days or
Chloramphenicol IV for 10-14 days
Must start antibiotics with 24 hours of S/S, rapidly fatal if not
Pneumonic plague highly contagious
Standard and Droplet Precautions
Carried by rabbits, deer and other wildlife
Human infection by contact with infected animals
2 types, Jellison type A and Jellison Type B
Type A can be fatal, type B mild
Inhalation is the likely route in a bioterrorism act
No isolation needed, standard precautions if skin lesions present.
Tularemia signs and symptoms
Several types:
Ulceroglandular: painless ulcer at the infection site and swelling of regional lympth nodes
Glandular: lymphadenopathy, no ulcer
Typhoidal: inhalation of the organism causes pleuropulmonary disease and fulminating sepsis.
Tularemia treatment
Streptomycin IM BID for 10 days or
Gentamycin IV for 10-14 days

Prophylactic treatment:
Doxycycline po BID for 14 days or
Tetracycline po QID for 14 days

May have developed antibiotic resistant strains, fatalities could be high
Without treatment 30-60% fatality rate
Most feared biologic agent
Easily transmitted from human to human
No treatment exists
Considered 20-40% fatal
Can leave disfiguring scars on survivors
Spreads by direct contact or inhalation of respiratory droplets
Would likely be spread as an aerosol in a terrorist attack
S/S: rash, high fever, malaise, backache, abdominal pain, vomiting
Rash progresses from macules to papules, to vesicles, to pustules, and then crusted scabs.
Differences between Chicken Pox and Smallpox
Fever: Smallpox-2-4 days before the rash. Chicken Pox: at time of rash
Rash appears: Smallpox: Pocks in same stage. Chicken Pox: Pocks in several stages.
Smallpox: More pocks on arms and legs. Chicken Pox: more pocks on body.
On palms and soles: small pox: present usually. Chicken pox: absent usually.
Death: Smallpox: Usually 1 in 10 die. Chicken pox: very uncommon.
Development: smallpox: slow. Chicken Pox: rapid.
Smallpox-Describe progression of smallpox
How is smallpox diagnosed?
Rash starts on face and extremities and moves to the trunk
Lesions are all at same level of development
Diagnosis can be confirmed by analysis of vesicular scraping
Smallpox vaccine
Smallpox vaccine could contain an outbreak if given within 3-4 days of exposure
Vaccine immune globulin within 3 days of exposure may also help
Hydration, supportive treatment
Strict exposure precautions: Isolation, airborne, contact, and standard precautions
Proper disposal of laundry, trash
Patients who die must be cremated
When to be suspicious
Increase in disease incidence
Large numbers of pts with similar but unexplained illness
Diseases occurring outside normally endemic areas
Increased symptom severity
Deaths from usually benign diseases
An increase in drug-resistant organisms
Strategic national stockpile
Deployment of essential medical materials to a community if large-scale chemical or biological attack occurs.
Med-Surg. Supplies (bandages, airway and IV supplies)
2 components of strategic national stockpile
Push Package: Preassembled supplies and pharmaceuticals
Vendor-Managed Inventory-more specific supplies.
Toxic Chemicals
Nerve agents
Convulsions, loss of consciousness in seconds
Respiratory failure in minutes
Over stimulation of the nerurotransmitter
Acetylcholine causes most symptoms (salivation, > sweating, muscle twitching, incontinence, confusion, convulsions, death).
Antidote for Nerve agents
Atropine-anticholinergic which blocks the attachment of acetylcholine to receptor sites and prevents over-stimulation caused by the nerve agent
Prevent overstimulation
Ionizing Radiation
Nuclear Bombs
Attacks on nuclear power plants
Release of radioactive materials into public areas
Potassium iodide (KI) only therapy for radiation exposure protects the thyroid from developing cancer.

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