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Chapter 7 Nursing Care of Clients Experiencing Disasters Dr. Marylynn Aguirre

Disasters and Emergencies : 

Disasters and Emergencies Types of Disasters Natural: caused by acts of nature or emerging diseases Man-made: may be accidental or intentional Types of Emergencies Multiple casualty incidents-complex emergencies Mass casualty: more than 100 casualties

Natural Disaster Injuries : 

Natural Disaster Injuries Hurricane – drowning, bone, joint & muscle injuries, disease Tsunami – Tsunami lung Earthquake – GI & resp problems, burns Snowstorm – MI Thunderstorm – Electrical burns Tornado – Debris related injuries

Cholera : 

Cholera Acute bacterial infection (vibrio cholerae) of the small intestine Severe diarrhea, vomiting, muscular cramps, dehydration Oral/fecal route in water or food 50% mortality untreated Antibiotics, IV fluids, clean water, cholera vaccine

Typhoid Fever : 

Typhoid Fever Bacterial infection (salmonella typhi) transmitted by contaminated milk, water or food Headache, delirium, cough, watery diarrhea, intestinal hemorrhage or perforation Antibiotics, annual typhoid vaccine, proper disposal of human waste

Terrorism : 

Terrorism Conventional weapons – bombs, guns Nonconventional weapons – contact infection control, lab, CDC Chemical: toxin into food, water, air, medications Biologic: use of disease (bioterrorism) detected by surveillance system in public health Nuclear: radiologic dispersion bomb

Anthrax : 

Anthrax Bacillus anthracis – gram pos bacteria Inhalation: flu-like symptoms to hemodynamic collapse in 3-5 days Cutaneous: itching papule to vesicle with black, necrotic center GI: n/v, bloody diarrhea Treat with ciprofoxacin or doxycycline for 60 days

Ricin : 

Ricin Potent toxin from castor beans (Ricinus communis) Produces agglutination of RBCs, inflammation, and hemorrhage of the resp and GI mucosa

Smallpox : 

Smallpox Highly contagious viral disease Fever, prostration, vesicular, pustular rash Humans are the only reservoir Smallpox vaccine made from dried smallpox virus only for lab workers exposed to pox virus

Ebola Virus : 

Ebola Virus Lethal disease (90% in one week) characterized by hemorrhage and fever Initial symptoms fever, HA, chills, malaise Later severe abd pain, vomiting,diarrhea Incubation period 2 -21 days: natural reservoir unknown, blood/body secreations, airborne particles

Radiation Exposure : 

Radiation Exposure A measure of the ionization produced in air by x-rays or gamma rays Unit of exposure is the roentgen Exposure of whole body to 10,000 rad is fatal in 24 hours Dose between 500 to 1200 rad is fatal in 2-3 days Death may occur weeks after exposure of 200 to 500 rad, but 600 rad considered fatal

Radiation Sickness : 

Radiation Sickness Radiation breaks DNA chains, cells die or mutate Severity determined by volume of radiation, length of time, and area of body Moderate exposure: HA, n/v, anorexia, diarrhea Long term: leukemia, other cancers, survivable with bone marrow tranplant

Thermal Nuclear Blast : 

Thermal Nuclear Blast Thermal burns are caused as thermal energy travels through the air until absorbed on contact Burns may involve only epidermis and upper layers of dermis and treated as any burn Flash blindness is temporary Radiation suppresses the immune system

Situations Requiring Isolation or Decontamination : 

Situations Requiring Isolation or Decontamination Biological Agents Exposure: containment is essential; accomplished by isolation of the victim Radioactive Exposure: will spread to other persons if the patient is not isolated Chemical Exposure: person must be decontaminated according to protocol prior to treatment

Terrorism Associated Symptoms or Injuries : 

Terrorism Associated Symptoms or Injuries Healthcare providers must be alert to the recognition, reporting, and treatment of high-priority biologic agents. A disaster preparedness plan should be established in every healthcare facility During a disaster, nurses may be expected to perform triage.

Simple Triage : 

Simple Triage A very basic triage system is to categorize or label victims. Immediate (Red) = victims needing the most support and emergency care Delayed (Yellow) = victims less critical but still in need of transport to emergency centers for care Ambulatory (Green) = victims who have minor injuries and do not warrant transport to an emergency center Expectant (Black) = victims who are least likely to survive or are already deceased

Reverse Triage : 

Reverse Triage When there is a mass casualty event with greater than 100 victims, reverse triage may be instituted. Reverse triage works on the principle of the greatest good for the greatest number. Persons who are the most ambulatory and least injured would be transported or instructed to move quickly to the warm zone, away from the immediate accident site to get processed first.

Terrorism Associated Symptoms or Injuries : 

Terrorism Associated Symptoms or Injuries Reverse Triage Used for mass casualties Least injured would be transported away from a scene first Minor injuries would be treated next Critical injuries treated after the minor injuries Most critical and severely injured would be treated last

Casualty Management : 

Casualty Management Triage is a continuous process in which priorities are reassigned as needed. Must balance lives with the realities of the situation, such as supplies and personnel. Crowd control is the responsibility of security and police. Psychiatric services takes an active role to prevent PTSD by assessing individual needs, offering immediate counseling and referral for follow-up.

The Role of the Nurse : 

The Role of the Nurse It is imperative that nurses first know how to take care of themselves in order to assist others. By educating oneself and being proactive in regular drills and practice of skills, nurses take an active role in helping others to save lives and fulfill an important obligation to society. Applying basic first aid skills can be very helpful in immediate disaster relief efforts until emergency help can be obtained.

The Role of the Nurse : 

The Role of the Nurse - Prepare selves, families, friends, and communities for disasters in conjunction with the local disaster preparedness plan. Continue educating self on various types of disasters and appropriate response. Provide emergency services with consideration of victims’ abilities, deficits, culture, language, or special needs. Assist in the mobilization of healthcare personnel, food, water, shelter, medication, clothing, and other assistive devices.

The Role of the Nurse : 

The Role of the Nurse Collaborate with agencies in authority including local, state, and federal representatives to deploy resources based on the greatest good for the greatest number. Consider needs of victims including shelter both temporary and permanent, as well as psychologic, economic, legal, and spiritual factors. Become involved with local, state, and national disaster planning agencies to schedule regular meetings to continually review and modify disaster plans.

Nursing Diagnoses : 

Nursing Diagnoses Anxiety Impaired verbal communication Fear Powerlessness Ineffective coping Risk for Post-Trauma Syndrome Risk for Injury Risk for Trauma

Predisaster Preparation : 

Predisaster Preparation Mitigation - disaster prevention programs Preparedness – comprehensive disaster plan in place Response – happens in the emergency stage including surge capacity Recovery – reconstruction, the final stage is mitigation to prevent or reduce the harmful effects of a disaster

Special Considerations : 

Special Considerations Older Adults Do not generalize their needs Need to determine the “appropriateness” of staying in their own home during a disaster List of medications, names of family members, attorney, and who to notify in case of emergency Need list of allergies, special dietary information, name of healthcare provider, and any special equipment needed for ADL

Special Considerations : 

Special Considerations Immunocompromised Assess client’s knowledge level concerning drinking and dietary restrictions Sensory Deficit, Speech, or Language Impaired Assess the most effective means of communication Mobility Deficit (13% US pop) Asses the support services needed

Special Considerations : 

Special Considerations Non-English Speaking Assess the literacy of the client in their own language through the use of an interpreter or use visual aids Spiritual Considerations Religion is a source of comfort Be sensitive to religious beliefs when concerning the human body and tissues

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