Presented by Julie Ross, MSN, RN Community Health Nursing.

Presented by Julie Ross, MSN, RN Community Health Nursing

Disaster Preparedness and Response (cont.) 2 Preparing disaster supplies Community preparedness Fire safety Earthquake safety Tornado, hurricane, and flood safety Hospital preparedness Triage

Red Cross Volunteers 3

Audience Response Question 1 4 In reviewing disaster preparedness information, the nurse asks community members, If there is a hurricane watch, what would you do? Which response(s) would be correct? (Select all that apply.) 1. Bring inside any outdoor furniture, trash cans, potted plants, toys, etc., that could be picked up by the wind. 2. Fill your cars gas tank. 3. Have cash on hand. 4. Check batteries and stock up on canned food, first-aid supplies, drinking water, and medications. 5. Stay in a mobile home.

Psychological Responses to Disaster 5 Signs and symptoms of emotional shock Stages Impact stage Heroic stage Honeymoon stage Disillusionment stage Reconstruction stage

Disaster Triage System 6 Class I: Emergent (red) Class II: Urgent (yellow) Class III: Nonurgent (green) Class IV: Minor (white) Class V: Dead or expected to die (black)

Triage Tags 7

Triage During Disasters 8 Victims with life-threatening conditions and a good chance of survival are cared for first When there are more victims of a disaster than medical personnel to treat them, those who are likely to survive are treated first; these patients are given green tags The mortally wounded and those who are not expected to survive are attended later, and these patients are issued a black tag

Disasters 9 Nursing responsibilities Nursing roles and management Care of special populations Water and food safety Nursing management in reconstruction stage

Chemical Disaster 10 Indications that a chemical attack has occurred might include Fog-like or low-lying cloud suddenly appearing in the atmosphere Many dead birds, domestic animals, or insects within a particular area Many dead, dying, or sick people in an area or downwind from a suspicious cloud or fog An atypical, unexplained odor for the location

Nuclear Disaster 11 Amount of damage to each person Decontamination Acute radiation sickness syndrome Bone marrow syndrome Gastrointestinal syndrome Cardiovascular/central nervous system syndrome

Decontamination Drill 12

Decontamination Drill (cont.) 13

Nuclear Disaster 14 Treatment of particulate radiation exposure Chelating agents Isotope-specific blocking agents Excretion agents Diluting agents

Biologic Disaster 15 Bioterrorism Nursing role Recognizing a bioterrorism event

Recognizing a Bioterrorism Event 16 Certain signs or events may present a warning that a bioterrorism attack has occurred. Some of the signs include (Peterman, 2010) Rapidly progressing flu-like illness, particularly in the young and among those previously healthy Rapidly progressive respiratory illness, especially in young, previously healthy people

Recognizing a Bioterrorism Event (cont.) 17 Unusual or extensive rashes, especially if preceded by flu-like symptoms Flaccid muscle paralysis Severe bleeding disorders A large group of patients with food-borne illness Sudden death of many animals in the community

Bioterrorism 18 Nursing management Strict adherence to infection control procedures and policies Debriefing

Biologic Agents 19 Category A agents Category B agents Category C agents

Biologic Disaster 20 Anthrax Botulism Plague Smallpox Tularemia Viral hemorrhagic fevers

Face Lesions on a Boy with Smallpox 21

Comparison of Smallpox and Chickenpox Lesions 22

Pandemic (Airborne Respiratory) Infection 23 Teach people to be prepared to stay at home for at least two weeks Reassure people that basic measures for prevention of respiratory infection can be effective Healthy lifestyle to support the immune system Washing hands and covering the mouth during coughing or sneezing, disposing of tissues, and staying away from public places if at all possible

Prevention of Accidents Home safety Highway safety Water safety First aid and Good Samaritan laws Emergency care 24

Recovery Position 25

Emergency Care Clinical decisions, prioritization, and use of protocols are based on Events or incidents that preceded the emergency visit Mechanism of injury Index of suspicion 26

Emergency Care (cont.) Triage: Initial survey Airway and respiration Control of bleeding Neck and spine injuries Cervical spinal immobilization Abdominal trauma Penetrating abdominal trauma Blunt trauma Multiple trauma 27

Emergency Care (cont.) Metabolic emergencies Insulin reaction/severe hypoglycemia Injuries due to extreme heat and cold Heatstroke Hypothermia Frostbite 28

Opening the Airway 29

Spinal Immobilization 30

Accidental Poisoning Prevention Symptoms Treatment Poison Control Center: 1-800-222-1222 31

Poison Prevention Destroy all medicines that are no longer being used In some instances, drugs undergo chemical changes with age, and become toxic compounds Store poisons and inedible products separately from edible foods 32

Poison Prevention (cont.) Do not transfer poisonous substances from their original container to an unmarked one NEVER place a poison in a container that is normally used for edible solids or liquids (such as a soft drink bottle) Never tell children that medicine is candy Always read the labels of chemical products before using them 33

Food Poisoning Prevention Healthy People 2020 food safety standards Symptoms Treatment 34

Inhaled Poisons Carbon monoxide Rescue breathing and CPR 100% oxygen Pulse oximetry and arterial blood gases 35

Bites and Stings Human bites Animal bites Bite wounds should be rinsed immediately with soap and hot running water for 5 to 10 minutes Snakebite Venomous snakebite and nonpoisonous snakebites Insect bites and stings 36

Electric Shock and Burns Severe damage to the entire body, including cessation of breathing, circulatory failure, and serious burns CPR Lightning 37

Separating Victim from Live Electrical Wire 38

Chemical Burns Flush with large amounts of water (with some exceptions) Vomiting Immediate transport to a hospital, inform care provider Offending agent, physical form, and concentration Route and volume of exposure Timing and extent of irrigation Coexisting injuries 39

Emergency Care Choking emergencies Cardiopulmonary resuscitation 2010 American Heart Association Guidelines for cardiopulmonary resuscitation (CPR) CPR is indicated when the person shows signs absence of response to stimuli, absence of respirations, and absence of a carotid pulse 40

Shock Shock is lack of perfusion to tissues Causes Low-circulating volume (hypovolemic shock) Decreased cardiac output (cardiogenic shock) Maldistribution of volume (neurogenic, anaphylactic, or septic shock) Signs and symptoms 41

Clinical Signs of Shock 42

Hypovolemic Shock Stop the fluid loss Volume replacement Crystalloids Colloidspacked red cells, fresh frozen plasma, and other blood products Safety alert: Checking blood products during an emergency situation 43

Hypovolemic Shock (cont.) 44

Blood Loss VOLUME LOST CLINICAL MANIFESTATIONS 10%None 20%At rest, no signs or symptoms; slight postural hypotension when standing; tachycardia with exercise. 30%Blood pressure and pulse normal when supine; postural hypotension and tachycardia with exercise. 40%Below-normal blood pressure, central venous pressure, and cardiac output at rest; rapid, thready pulse and cold, clammy skin. 50%Shock and potential death. 45

Cardiogenic Shock The heart is incapable of pumping enough blood to meet the needs of the body as in myocardial infarction Chemical treatments Mechanical treatments 46

Cardiogenic Shock (cont.) 47

Obstructive Shock Tissue perfusion is impaired by mechanical obstruction to blood flow Pericardial tamponade, tension pneumothorax, aortic dissection, constrictive pericarditis, or massive pulmonary embolus 48

Treatment of Obstructive Shock Pericardial tamponade and tension pneumothorax treated by needle decompression (removal of fluid that is compressing the heart) Aortic dissection and immediate surgery Constrictive pericarditis and medical treatment Massive pulmonary embolus (PE) and heparin and possible thrombolytic therapy 49

Distributive Shock 50

Anaphylactic Shock Acute allergic reactions Treatment Immediate removal of antigen Airway management Epinephrine Antihistamines Steroids Fluid therapy 51

Neurogenic Shock A triad of presenting symptoms includes hypotension, bradycardia, and hypothermia Treatment Crystalloids Dopamine Blankets and environmental temperature control Risk for deep vein thrombosis 52

Sepsis and Septic Shock Documented or suspected infection and two or more signs of systemic inflammatory response syndrome (SIRS) Temperature, > 39 C (102.2 F) or < 36 C (96.8 F) Heart rate > 90/min Respiratory rate > 20/min or Pa CO 2 < 32 mm Hg White cell count > 12,000 cells/mm 3 or 10% bands 53

Sepsis and Septic Shock (cont.) Nursing management Monitoring signs and symptoms and progression to sepsis and shock Prompt notification of physician 54

Sepsis and Septic Shock (cont.) Treatment Fluid resuscitation with crystalloids or colloids to maintain BP, oxygenation Intubation and mechanical ventilation Blood cultures and broad-spectrum antibiotic therapy is started within one hour of diagnosis of septic shock Norepinephrine, dopamine, and dobutamine Steroid therapy 55

Sepsis and Septic Shock (cont.) Systemic inflammatory response syndrome (SIRS) tachycardia, tachypnea, hypotension, oliguria, fever, and signs of poor perfusion Multisystem organ dysfunction syndrome (MODS) Disseminated intravascular coagulation (DIC) and Drotrecogin alfa (activated) (Xigris) 56

Assessment of Shock Ongoing evaluation of the patients level of consciousness, vital signs (including temperature), skin signs, and urine output Watch for changes and trends in physical and laboratory findings Timely reporting to the physician for treatment decisions 57

Treatment Goals and Evaluation Goals Restore circulating volume Treat the underlying cause, if possible Evaluation If interventions are effective, then there should be improvement in tissue perfusion 58

Psychological and Social Emergencies: Combative Patient Signs and symptoms that usually precede an attack Increasing agitation or resistance Aggressive behavior Pacing Frowning Hyperalertness Increasing demands Glaring 59

Strategies for Approaching a Combative Patient Offer help on a one-to-one basis Establish eye contact Use the persons name frequently Explain who you are and what you are trying to do Express genuine concern about the situation Use a soft voice 60

Strategies for Approaching a Combative Patient (cont.) Make sure the patient can hear and understand what is being said Observe for signs of drug or alcohol use 61

Psychological and Social Emergencies Domestic violence and abuse Child abuse Elder abuse 62

Questions to Detect Abuse Have you been hit or hurt in any way in the past year? Who injured you? Has it occurred before? Are you afraid of anyone? Do you feel safe at home? Does your partner use drugs or alcohol? How does his or her behavior change after using them? 63

Audience Response Question 1 A 50-year-old Korean man is admitted for acute alcohol intoxication. Anticipating combative behaviors, the nurse uses which communication skill(s) to help obtain clinical information? (Select all that apply.) 1. Establishing eye contact 2. Using the persons name frequently 3. Expressing genuine concern about the situation 4. Using a loud, commanding voice 5. Involving essential family members 64

Public Health Care Agencies (p. 229 ) Official (Government) Nonprofit Tax supported Disease prevention and wellness Voluntary Nonprofit Voluntary contributions Research and education Copyright 2013 by Elsevier Inc. All rights reserved. Slide 65

Public Health Care Agencies (contd)(p. 229-230 ) Official Government Agencies: Local City or county health department Funded by local tax money and by subsidies from the state and federal levels of government Carry out state laws (mandated) concerning community health Carry out nonmandated programs, such as health promotion programs Copyright 2013 by Elsevier Inc. All rights reserved. Slide 66

Public Health Care Agencies (contd) (p. 230 ) Official Government Agencies: State Each state has a state health department Funded by state tax money Sometimes receive money from the federal government Copyright 2013 by Elsevier Inc. All rights reserved. Slide 67

Public Health Care Agencies (contd) (p. 230 ) Official Government Agencies Federal (national) Department of Health and Human Services (DHHS) Funded by federal taxes Head of the agency appointed by the president of the United States: advises the president in health matters Copyright 2013 by Elsevier Inc. All rights reserved. Slide 68

Public Health Care Agencies (contd) (p. 230 ) Official Government Agencies Federal (national) The DHHS division concerned primarily with health is the U.S. Public Health Service (USPHS) Made up of eight agencies Food and Drug Administration (FDA) Centers for Disease Control and Prevention (CDC) National Institutes of Health (NIH) Health Resources and Services Administration (HSA) Substance Abuse, and Mental Health Administration (SAMHSA) Agency for Healthcare Research and Quality (AHRQ) Agency for Toxic Substance and Disease Registry (ATSDR) Indian Health Services (IHS) Copyright 2013 by Elsevier Inc. All rights reserved. Slide 69

Public Health Care Agencies (contd) (p. 230 ) Official Government Agencies: International World Health Organization (WHO), an agency of the United Nations (UN), located in Geneva Major objective of WHO is highest possible level of health for people all over the world Defines health as a state of complete physical, mental, and social well-being and not merely as the absence of disease or infirmity Funded through fees paid by member nations of the UN Copyright 2013 by Elsevier Inc. All rights reserved. Slide 70

Voluntary Health Care Agencies (p. 230 ) Nonprofit Services provided by volunteers Practical/vocational student nurses and LPN/LVNs can provide valuable service and gain experience by volunteering Copyright 2013 by Elsevier Inc. All rights reserved. Slide 71

Voluntary Health Care Agencies: Visiting Nurse Association (p. 230 ) Provides home nursing care for patients with acute and chronic diseases Care includes health supervision, education, counseling, bedside care, and carrying out physicians orders Visits mothers with newborn infants Engages in health teaching Involves the family in the care of its own members Assists with referrals for patients to other community services Staff is bachelor of science in nursing (BSN) nurses and home health aides Copyright 2013 by Elsevier Inc. All rights reserved. Slide 72

Private Health Care Agencies (p. 231 ) Proprietary (For-Profit) Fee-for-services Curing disease and illness with recent emphasis on disease prevention and wellness Most people get their health care through private providers Copyright 2013 by Elsevier Inc. All rights reserved. Slide 73

Private Health Care Agencies (p. 231 ) Complement and supplement government agencies Corporations that own a chain of health care facilities often own them Occasionally, they are owned by an individual or by doctors who practice in the agency Family practice physicians Private practice nurses Copyright 2013 by Elsevier Inc. All rights reserved. Slide 74

Question 1 Public health care agencies are either official or voluntary. Which of the following is not a description of a public health care agency? 1. Government agencies that are supported by tax money. 2. Direct health care services are sometimes provided. 3. Emphasis is on the delivery of disease prevention and wellness. 4. In general they are proprietary. Copyright 2013 by Elsevier Inc. All rights reserved. Slide 75

Private Health Care (p. 232 ) Family practice physicians deliver primary care and refer to specialists if additional evaluation is needed Private practice nurses are advanced-practice nurses who counsel individuals on health care issues Copyright 2013 by Elsevier Inc. All rights reserved. Slide 77

Proprietary (for Profit) Hospitals (p. 232 ) General Serve full range of medical conditions experienced by patients More than 6000 in the U.S. Specialized Deal with a particular disease or condition Limited to one type of patient More than 1000 in the U.S. Copyright 2013 by Elsevier Inc. All rights reserved. Slide 78

Teaching and Research Hospitals (p. 232 ) Emphasis is on serious or unusual conditions Training sites for health care professionals Conduct research into and development of treatments Almost always affiliated with medical schools Access to highly skilled practitioners Can be private or public Copyright 2013 by Elsevier Inc. All rights reserved. Slide 79

Teaching and Research Hospitals (contd) (p. 232 ) Goals include Treating patients, especially those with serious or unusual conditions Training sites for physicians, nurses, and other health professionals Researching and developing treatments for disease conditions Copyright 2013 by Elsevier Inc. All rights reserved. Slide 80

Public Hospitals (p. 232 ) Public hospitals include Veterans Administration, state, county, and municipally owned and operated nonprofit hospitals Hospitals for people with serious mental illness continue to be funded by federal, state, or county funds Copyright 2013 by Elsevier Inc. All rights reserved. Slide 81

Voluntary Community Hospitals (p. 232 ) Community associations or religious organizations operate voluntary community hospitals These nonprofit hospitals provide short-term inpatient care for people with acute illnesses and injuries Heavily dependent on gifts and donations to supplement sources of revenue The board of trustees appoints a paid administrator to manage the hospital Copyright 2013 by Elsevier Inc. All rights reserved. Slide 82

Ambulatory vs. Acute Care Settings (p. 232 ) Ambulatory Care Outpatient; often less expensive For people who live independently or are cared for at home Provides assessment, treatment, and care coordination Acute Care Inpatient in general and specialized hospitals Patients acutely ill and require more skilled nursing care Copyright 2013 by Elsevier Inc. All rights reserved. Slide 83

Outpatient Clinics (p. 233 ) Provide follow-up care to patients after hospitalization Manage disease on an ambulatory basis for those who do not need to be hospitalized Part of health care facilities or are free-standing (i.e., not attached to a hospital) Function by appointment only Include specialty areas, such as diabetes, neurology, allergy, and oncology Copyright 2013 by Elsevier Inc. All rights reserved. Slide 84

Urgent Care Centers (p. 233 ) Provide services for walk-in patients Make primary health care available People who do not have a family physician use them Names reflect the type of care provided Convenience clinics Express care Quick care Urgent care Copyright 2013 by Elsevier Inc. All rights reserved. Slide 85

One-Day Surgical Care Centers (p. 233 ) Perform surgery at a scheduled date and time Eliminate the need and monetary charge for being hospitalized overnight Outpatient surgery services also provided within an established hospital Copyright 2013 by Elsevier Inc. All rights reserved. Slide 86

Free Clinics (p. 233 ) Alternative means of providing primary health care For people who cannot afford traditional health services or are reluctant to use more traditional services As free from red tape as possible Copyright 2013 by Elsevier Inc. All rights reserved. Slide 87

Rehabilitation Services (p. 233 ) Focus on return of function and prevention of further disability Can take place in Rehabilitation centers Long-term care facilities Outpatient facilities Group residential homes Patients home base Nurses play an important role Copyright 2013 by Elsevier Inc. All rights reserved. Slide 88

Presented by Julie Ross, MSN, RN Community Health Nursing.

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