Chapter 7 Nursing Care of Clients Experiencing Disasters

Dr. Marylynn Aguirre

Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke

Copyright 2008 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

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
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke

Copyright 2008 by Pearson Education, Inc.

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
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke Copyright 2008 by Pearson Education, Inc.

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
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke Copyright 2008 by Pearson Education, Inc.

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
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke Copyright 2008 by Pearson Education, Inc.

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
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke Copyright 2008 by Pearson Education, Inc.

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
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke Copyright 2008 by Pearson Education, Inc.

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

Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke

Copyright 2008 by Pearson Education, Inc.

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

Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke

Copyright 2008 by Pearson Education, Inc.

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

Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke

Copyright 2008 by Pearson Education, Inc.

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
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke

Copyright 2008 by Pearson Education, Inc.

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
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke Copyright 2008 by Pearson Education, Inc.

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
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke Copyright 2008 by Pearson Education, Inc.

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
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke Copyright 2008 by Pearson Education, Inc.

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.

Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke

Copyright 2008 by Pearson Education, Inc.

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

Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke

Copyright 2008 by Pearson Education, Inc.

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.
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke Copyright 2008 by Pearson Education, Inc.

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

Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke

Copyright 2008 by Pearson Education, Inc.

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.
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke Copyright 2008 by Pearson Education, Inc.

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.
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke Copyright 2008 by Pearson Education, Inc.

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.

Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke

Copyright 2008 by Pearson Education, Inc.

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.

Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke

Copyright 2008 by Pearson Education, Inc.

Nursing Diagnoses
Anxiety Impaired verbal communication Fear Powerlessness Ineffective coping Risk for Post-Trauma Syndrome Risk for Injury Risk for Trauma
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke Copyright 2008 by Pearson Education, Inc.

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
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke Copyright 2008 by Pearson Education, Inc.

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
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke Copyright 2008 by Pearson Education, Inc.

Special Considerations
Immunocompromised
Assess clients 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
Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke Copyright 2008 by Pearson Education, Inc.

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

Medical-Surgical Nursing, 4/e Priscilla LeMone and Karen Burke

Copyright 2008 by Pearson Education, Inc.