Natural Disaster in a Small Community

HESI 02 – CAPSTONE Natural Disaster in a Small Community Case Study – Capstone Section 1 Planning Jennifer Allen is an RN and nurse manager for the Montcalm County Health Department. One of her primary responsibilities includes the continuous development of the county’s emergency preparedness plan, which follows the principles of disaster management: prevent occurrence of disaster when possible minimize casualties prevent further casualties rescue victims provide first aid evacuate the injured provide definitive medical care promote reconstruction of lives Question 1 of 27 Which action by Jennifer, the Health Department RN, is an example of primary prevention in disaster management for Montcalm County? Perform triage of disaster victims. This is an example of secondary prevention in disaster management occurring after the disaster. Provide follow-up care for recovery victims. This is an example of tertiary prevention in disaster management. Train potential rescue workers in basic first aid. This example demonstrates planning before the disaster has happened; therefore, it is classified as primary prevention. Supervise shelter activities after a disaster. This is an example of tertiary prevention in disaster management occurring after the disaster. Section 2 Jennifer Allen, RN holds quarterly education sessions with the county’s volunteer first responders to teach basic first aid and triage. Jennifer continues to update the emergency preparedness plan, which includes four phases of disaster management. Question 2 of 27 Plans that prevent the occurrence of a disaster or reduce the effects of the disaster fall within which phase? Mitigation. Includes plans that prevent the occurrence of a disaster or reduce the effects of the disaster. Preparedness. Plans for rescue, evacuation, and caring of victims are part of the preparedness portion of the plan. Response. Response includes putÝng the disaster planning services into action. Recovery. Recovery includes actions taken to return the community to a normal state after the disaster. Question 3 of 27 Jennifer preparing an educational session for the volunteer first responders on common reactions disaster victims display. Identify common physiological reactions that may be displayed after a disaster. Select all that apply Hypoventilation. Hyperventilation, not hypoventilation, is a common reaction to a disaster. Palpitations. Palpitations are a common reaction to a disaster. Rapid heartbeat. Rapid heartbeat is a common reaction to a disaster. Apathy. Apathy is not a common reaction to a disaster. Chest pain. Chest pain is a common reaction to a disaster. Question 4 of 27 Included in her education session with the volunteer first responders, Jennifer will discuss commonly delayed reactions that may be displayed after a disaster. Which commonly delayed reactions may be exhibited by victims after a disaster? Select all that apply Skin rashes. Skin rashes are a commonly delayed reaction to a disaster. Decreased startled reflex. Victims of a disaster often display a heightened startle reflex. Hypoactivity. Victims of a disaster often display hyperactivity. Teeth grinding. Victims of a disaster may display teeth grinding. Excessive sleeping. Victims of a disaster often experience insomnia. Section 3 Jennifer shares the Montcalm County Emergency Preparedness Plan with the area schools. A Montcalm County school nurse, Jodie Stone, RN, prepares to teach an education class on family disaster planning to the Parent Teacher Organization (PTO). Question 5 of 27 The school nurse should include which preparedness procedure for the PTO presentation? Select all that apply Keep in storage, a 3-day supply of water, which equals 1 gallon per day per family. One gallon per day per individual should be stored instead of per family. Replace emergency food and water supply every 2 years. Food and water supply should be replaced every 3 to 6 months. Place a spare electrically operated radio in a safe place for emergencies. Battery operated equipment should be stored in case of loss of electrical services. Plan a meeting place for family members for each type of likely disaster. Planning a meeting place inside or outside of the home for specific disasters decreases confusion and promotes safety when a disaster occurs. Keep medical information (allergies, blood type, prescription medication, health history, etc) on file in the emergency kit for each family member. This will assist in ensuring that clients receive appropriate medical care if health or pharmaceutical records are not immediately retrievable. Jodie conducts the PTO education meeting, and several parents have questions about the availability of prescription medications for their children in the event of an emergency. The mother of a child with asthma asks the school nurse if she should stock up on her child’s albuterol inhalers in case of emergency. Question 6 of 27 How should the school nurse respond to the mother’s question? Keep a 1 to 2 week supply of medication in an easily accessible safe place. The American Red Cross and the Department of Homeland Security recommend keeping a 7- to 14-day supply of medications in an emergency kit in case of disaster. The expiration date must be checked frequently. Have the pediatrician’s phone number, so he or she will be able to call in extra prescriptions to the pharmacy. In the event of a mass disaster, medical records may be destroyed and communication may be disrupted; therefore, the parent should always keep a record of the exact medication and dose in a safe place. Retain a 6-month supply to ensure the child has enough medication if a disaster occurs. It would be very costly and unrealistic to keep a 6-month supply available because the medication may expire and be ineffective when needed. Local pharmacies will dispense medications without a prescription during a disaster. National databases are being developed to electronically store prescription information that can be accessed even in evacuations, but this is not available at the present. Pharmacies cannot generally dispense medications without a prescription. During the meeting, Jodie explains that a disaster drill will be conducted with the students as part of the emergency preparedness plan. Question 7 of 27 What should the school nurse include in a disaster drill for elementary students? Announce a disaster has occurred and do not let students know it is a drill. This could cause psychological distress and fear for some students. Rehearse evacuation routes with the students, faculty, and staff. Rehearsing evacuation routes will increase familiarity with the route during an actual disaster. Practice disaster drills for all types of disasters on a routine basis. The Federal Emergency Management Agency (FEMA) recommends identifying and practicing disaster preparedness for disasters most likely to happen in each specific school or region. Identify a place within the school where students should assemble for all disasters. Students may not assemble within the school for all disasters. They may need to exit. Section 4 The school nurse successfully implements disaster drills with the students, and they practice safe evacuation routes from the building as one part of the drill. Section 5 Question 8 of 27 To prepare the ED for possible victims of the earthquake, which action should Kacie take first? Reassess the clients who are currently in the ED to determine if further injuries have occurred. The clients currently in the nurse’s care should be the first priority. They should also be triaged to determine if they can be released or moved to make room for the injured. Call the central supply department to place an order for rooms to be stocked with supplies. Rooms need to be stocked with supplies that are needed for injuries sustained by earthquake victims, but another action takes priority. Set up a triage station in the waiting room to prioritize treatment of arriving disaster clients. A triage station will need to be set up so that arriving ED clients can be assessed quickly, but another action takes priority. Assign a person to communicate with families trying to locate missing or injured individuals. Someone will need to be assigned this duty, but another action takes priority. Prioritization Kacie Moore, RN is the charge nurse in the Emergency Department (ED) of the Montcalm County Hospital. While working the 7 am to 7 pm shift, she suddenly feels a sharp jolt from the ground, followed by a few stronger, sharp shakes that pass quickly. Kacie has lived on the west coast for 35 years, and she recognizes the event as a small earthquake. The nursing supervisor directs the staff to implement the emergency response plan. Section 6 Question 9 of 27 According to this tool, a client brought to the ED coded with which color should be assessed first? Green Green indicates only minor injuries. Yellow Yellow indicates delayed needs. Red Red indicates an immediate need. Black Clients coded with black are already deceased or have sustained injuries so severe that they cannot survive. Kacie and the other nurses assess the clients in the ED and find no new injuries. Discharge is expedited for those who qualify, and Kacie sets up a triage center in the waiting room. The house supervisor quickly calls in extra stafÏng for the hospital. First responders in Montcalm County use the most common triage tool, the Simple Triage and Rapid Treatment (START) tool. An announcement is made via radio broadcast that an old apartment building in downtown Montcalm County has partially collapsed. Kacie prepares the ED for potential casualties. Section 7 First Responders Bryan White is an RN and a volunteer fire fighter who is trained as a first responder. He arrives at the collapsed building and finds a pregnant woman limping out of the building holding her right leg, which appears to be fractured. Her pedal pulse is present, and her respirations are 24 breaths/min. She cannot walk on her own, but she answers questions coherently and she points to where others are in need of help. Question 10 of 27 This woman should be coded with which color using the START tool? Green. Clients who cannot walk on their own are not eligible for the green group. Yellow. Respiratory status, perfusion, and mental status are intact; therefore, she falls within this group. Red. Clients with a respiratory rate greater than 30 breaths per minute, a capillary refill greater than 2 seconds, and a pulse that is not palpable; or clients who cannot follow simple commands are classified as immediate or red. Black. Clients with no respiratory rate are classified as black. Section 8 Bryan is the first responder to arrive at the scene because he lives in the downtown area. After helping the pregnant woman find a safe place to sit, Bryan carefully enters the collapsed area of the building. He sees an elderly woman inside the rubble; she is nonresponsive and has no respirations. Question 11 of 27 Which action should Bryan take first? Code the client with a black tag. The first responder should take further action prior to coding. Attempt to locate the victim’s family members. Locating family members is not the first priority in an emergency. Move on to the next client, who appears to need immediate assistance. It will be important to move on, but only after other measures are taken. Reposition her head to attempt to open the airway. The client may have a blocked airway due to positioning. Repositioning the airway may stimulate respirations and save the client. Section 9 Bryan attempts to open the woman’s airway, but he is unsuccessful. He codes her as black and moves on to the next victim. Bryan assesses a young boy who is surrounded by debris and lying face down, unconscious, with a large beam across his upper back. He is pale and cool to touch with respirations of 8 breaths per minute and a pulse of 42 beats per minute. Question 12 of 27 Which action should Bryan take first? Cover the child with a blanket. Although hypothermia can happen quickly with neurogenic shock, this is not the initial action. Clear the debris in and around the boy's mouth and nose. Clearing the airway should be the initial action. The child is exhibiting symptoms of neurogenic shock. All interventions should be implemented only after the airway is cleared. Attempt to remove the beam from the boy's back. This is not the initial action. Bryan may need to wait for additional assistance to avoid injuring the child further when removing the beam. Obtain equipment to begin fluid resuscitation. Fluid resuscitation is a priority with clients in neurogenic shock, but it is not the best initial action in this case. Other responders quickly arrive at the scene of the collapsed apartment building and begin to help Bryan with triage, rescue, and recovery. Section 10 Community Resources During a disaster, a team of multidisciplinary members, many of whom are in the healthcare profession, respond to the crisis situation. Representatives from the American Red Cross (ARC) arrive at the scene of the collapsed apartment building. Question 13 of 27 Which statements describes the role of the American Red Cross (ARC)? Select all that apply All staff members are licensed healthcare professionals who volunteer their services. Although many people are licensed and volunteer services, there are also paid employees and unlicensed staff and volunteers who offer a variety of services. Each state has one central ofÏce that provides relief to communities most in need of services. Most states have multiple ARC ofÏces that provide services at the local level. The federal government gives the organization the authority to provide disaster relief. This is a true statement regarding the ARC. A small fee is charged for disaster relief services provided to individuals or communities. Relief provided by the ARC during a disaster is free. ARC assists in care to the masses by providing shelter and food to the affected communities. ARC does provide shelter and food to communities affected by disasters. Kayla Jones is an RN who works for the American Red Cross and who is in charge of setÝng up a temporary shelter for residents who lost their homes in the apartment collapse. With volunteer assistance, Kayla sets up a temporary shelter in a local gymnasium. Question 14 of 27 The nurse recognizes that which action takes priority according to Maslow’s hierarchy of needs? Determine what prescription medications clients need. Physiological safety is on the second level of the hierarchy. Provide counseling to residents who are fearful. Psychological safety is on the second level of the hierarchy. Encourage an atmosphere of belonging within the shelter. Belonging and love are on the third tier of the hierarchy of needs. Obtain food and water for shelter residents. Food, water, and air are the first priority according to Maslow’s hierarchy of needs. Section 11 Kayla coordinates the food and water supply and mobilizes the volunteer shelter for nurses to assess current health needs for shelter residents. Section 12 Medication Administration The ARC shelter is providing residence for 24 clients. Residents arriving at the shelter have not been injured, but many were not able to gather their prescription medications prior to leaving the apartment building. Question 15 of 27 One of the nurses volunteering in the shelter assesses the medication needs of four clients. The nurse should first address the needs of the client with which condition and medication need? A 62-year-old woman taking sulfamethoxazole (Bactrim) for a urinary tract infection. A missed dose of an antibiotic will not cause a life-threatening complication. A 35-year-old man injecting regular insulin for type I diabetes mellitus. Missed insulin injections could rapidly lead to acute complications of diabetes mellitus, including diabetic ketoacidosis. This is the problem that needs to be addressed first. A 72-year-old woman taking levothyroxine (Synthroid) for hypothyroidism. A client with hypothyroidism would need to miss several doses before acute symptoms occur. A 39-year-old woman using ketoconazole (Nizoral) for a yeast infection. The woman may experience discomfort without the medication but no life-threatening symptoms. The shelter nurse contacts the primary HCPs for the clients and obtains prescriptions that are filled for each client. The shelter nurse also obtains a glucometer, and the client with type I diabetes mellitus checks his blood glucose before lunch. The blood glucose is 239 mg/dL, and the client has a prescription to inject regular insulin 6 units subcutaneously. Question 16 of 27 Which action should the nurse implement? Immediately recheck the client’s blood glucose using another glucometer. There is nothing to indicate that the blood glucose needs to be rechecked. The nurse should expect an increase because the client has been under an incredible amount of stress. Provide the client with an 8-ounce glass of water before the client takes insulin. Although water helps to rehydrate the client with increased blood glucose, this is not essential. Provide the client with a meal within 30 minutes of insulin injection. The onset of regular insulin is 30 minutes to 1 hour. If the client does not eat, he may become hypoglycemic. Return the insulin to the pharmacy if it is appears clear. Regular insulin is clear in color. This is the expected finding. Section 13 The client receives his insulin and a meal. His blood glucose decreases to 130 mg/dL that evening. Question 17 of 27 Fill in the blank The shelter resident taking levothyroxine (Synthroid) regularly takes 75 mcg per day. The bottle delivered from a different pharmacy contains levothyroxine (Synthroid) 0.150 mg per tablet. The nurse advises the client to take how many tablets? (Enter numeric value only. If rounding is required, round to the tenth.) 0.5 Section 14 Question 18 of 27 The shelter nurses clean the mattresses to prevent the spread of bacteria to the clients. According to the epidemiology triangle, what does the mattress represent? Host. The client represents the host. Agent. The potential bacteria are an example of the agent. Environment. The shelter or the mattress is the environment. Virulence. Virulence refers to the strength of the agent or bacteria in this case. Epidemiology The ARC nurses are trained in epidemiology, and they understand that contagious diseases can quickly spread in a shelter. The shelter nurses understand intrinsic factors influence the epidemiological triangle and the spread of disease. Question 19 of 27 Which are examples of a host’s intrinsic factors? Select all that apply Age. This is an example of an intrinsic factor. It influences exposure, susceptibility, or response to the agent. Gender. This is an example of an intrinsic factor. It influences exposure, susceptibility, or response to the agent. Physical environment. This is an example of an extrinsic factor. It influences the existence of the agent, exposure, or susceptibility of the agent. Socioeconomic status. This is an example of an extrinsic factor. It influences the existence of the agent, exposure, or susceptibility of the agent. Ethnic origin. This is an example of an intrinsic factor. It influences exposure, susceptibility, or response to the agent. The ARC nurses know stress reduction can slow down the epidemiological process and reduce the spread of disease from host to host. Question 20 of 27 Which technique should the nurse employ to reduce stress? Encourage victims to make their decisions independently. When experiencing mental anxiety, victims often need help making even simple decisions. Listen to victims tell and retell their feelings related to their current situation and the disaster. Victims often need to tell their story more than once to reduce the mental shock and relieve stress. Discourage victims from sharing their feelings with other residents. Victims should be encouraged to share feelings with others. They have shared a common experience. Institute a “lights out” policy from midnight to 5 am to encourage rest. Lights out should start prior to midnight. Five hours of sleep is not enough sleep to reduce stress. The ARC nurses continue to work diligently to prioritize and care for the physiological and psychological needs of the shelter residents until more permanent housing can be found. Section 15 Home Health Vanessa McBrayer, RN is a home healthcare nurse in Montcalm County. Her primary objective is to allow individuals to stay at home while receiving a variety of healthcare services that would otherwise require hospitalization. Vanessa is in the home health ofÏce preparing for her daily visits when the initial impact of the earthquake is felt. Vanessa and the other home care nurses prepare to institute the home care emergency response plan. Question 21 of 27 Which method for contacting clients should the home healthcare nurse attempt first? Provide local law enforcement with a list of home health clients so they can mobilize units to the homes. Law enforcement will be busy responding to emergency calls from the disaster and should only be contacted after all other methods are attempted. Divide the client list between nurses and unlicensed assistive personnel (UAP), and then visit each home. This should be the third method attempted. It is not as efÏcient as other methods listed. Attempt to contact all clients by telephone to find out if they are safe. If the telephones are in working order, this is the first and most efÏcient method of contacting each client. Place an inquiry phone call to the emergency contact person listed for each client. This should be the second method attempted if the client cannot be reached. Section 16 Vanessa is assigned a group of clients to contact. Fortunately, the telephone is working in most areas of the county. She is able to reach all but four of the clients or their emergency contacts to ensure they are safe. Question 22 of 27 Vanessa prepares to make a home care visit to the four clients she has been unable to reach. Which client should the home healthcare nurse visit first? A 64-year-old man in the beginning stages of dementia who lives alone. This client should be assessed first. He is at highest risk because he could be confused and he lives alone. A 75-year-old woman who lives alone and who is receiving dressing changes to an arm wound. Although this client lives alone, she does not have as many risk factors as another client. An 82-year-old man who lives with his wife and who is receiving IV piggyback antibiotics for an infection. This client does not live alone; therefore, he is not at the highest risk. An 88-year-old woman who lives with her daughter and who is being taught how to manage a colostomy. This client does not live alone; therefore, she is not at the highest risk. The home health nurse makes a visit to each of the four clients, and she finds that no one was injured during the earthquake. Section 17 Delegation and Assignment Douglas, an RN, is the charge nurse for the telemetry unit at Montcalm County Hospital. He was at home enjoying his first day off in 5 days when the impact of the earthquake struck. Douglas makes sure his family is safe, then he drives to the hospital, where he is needed. According to the emergency response plan, one of Douglas' duties is to utilize available personnel to their full capacity. Question 23 of 27 Which duty should Douglas delegate to a student nurse? Monitor a client’s blood pressure and adjust the nitroprusside (nipride) drip accordingly. This duty should not be done independently by the student nurse. Complete an admission assessment on a client arriving from the ED. The RN is required to complete the comprehensive assessment. Transport a discharged client via wheelchair to the pick-up area. A student nurse can independently complete this client care task. Deliver supplies from central supply to the nursing unit. This task should be assigned to a volunteer who is not trained in nursing care. Section 18 The student nurse assists with a client’s discharge, and the charge nurse calls housekeeping to prepare the room for another client being admitted to the telemetry unit from the ED. The client admitted to the telemetry unit reported an onset of chest pain during the earthquake. The client has been scheduled for a cardiac catheterization, but the catheterization lab is currently full. Question 24 of 27 Which task should the nurse delegate to the unlicensed assistive personnel (UAP)? Complete a pain assessment. The UAP may report data about pain to the nurse, but the pain assessment should be completed by the nurse. Take initial vital signs. UAPs are trained and competent in taking vital signs. Assess the intravenous site. Assessment of the IV site should be done by the nurse. Obtain the medical history. This is part of the admission assessment, which should be completed by the RN. That evening, Douglas prepares stafÏng for the next shift. Two RNs and one licensed practical nurse (PN) will be stafÏng the unit. Question 25 of 27 Which client should be assigned to the PN? A client with a deep vein thrombosis who is on a heparin drip. This client has a high acuity requiring drip management and should be assigned to the RN. A postoperative appendectomy client on a patient controlled analgesic (PCA) pump. The IV PCA pump should be managed by the RN. A client in third degree heart block awaiting surgery for a permanent pacemaker. This client has a life-threatening condition requiring frequent monitoring by the RN. A client who had a stroke 2 years ago who requires gastrostomy feedings every 4 hours. This client does not have a life-threatening condition or need frequent assessment, so the client should be assigned to the PN. Grastrostomy feeding is within the scope of practice for the PN. Douglas prepares to end his shift, but he is worried because nursing stafÏng is still critically low in the hospital. Section 19 Self-Care Douglas feels stress from the hectic atmosphere and the trauma of the day. At times he feels like he wants to cry. Question 26 of 27 What coping strategy should be utilized by the nurse to reduce stress? Call home frequently to explain the stressful atmosphere to his spouse. Although calling home may help relieve some stress, discussing the hospital atmosphere with a spouse is not a good strategy and could create more tension. Discuss stressful feelings with the psychological counselor visiting clients on the unit. If a psychological counselor is available, this person would be most experienced in helping Douglas deal with his feelings. Talk to the clients on the telemetry unit about the stressful atmosphere on the unit. Communicating with clients is important, but clients are under stress about their own hospitalization and hearing the nurse’s concerns about stress will not help them. Try not to focus on the stressful feelings until after the shift is over. It is important for Douglas not to keep his feelings bottled up. This could lead to increased stress. Section 20 Douglas briefly discusses his feelings with the counselor and is surprised to find he feels better. Question 27 of 27 According to the ARC and Pan American Health Organization, which strategies should the nurses use to avoid stress while working a disaster? Select all that apply Get enough sleep. Sleep is an essential part of psychosocial well-being. Use humor to break the tension. Appropriate humor can provide relief and decrease stress during a disaster. Eat 2 large meals per day. It is recommended to eat several small meals throughout the day. Take breaks away from the disaster when possible. Taking even a small break from the disaster site or recovery area will provide relief and decrease stress. Use positive self-talk. Keeping a positive atÝtude during a time of disaster will decrease stress. Section 21 Case Outcome The nurses and other healthcare professionals in Montcalm County continue their recovery efforts. They know that it may take months for community members to heal physically and psychologically. Damaged physical structures will need to be rebuilt, and the community will need to work together to continue revising the emergency preparedness plan based on the evaluation of the response to this disaster.