Disaster Nursing Student Activity Sheet PDF

NUR 113: DISASTER NURSING STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR Session # 17...

NUR 113: DISASTER NURSING STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR Session # 17 Materials: LESSON TITLE: Disaster Caused by Biological Agents Book, pen and notebook LEARNING OUTCOMES: Upon completion of this lesson, the nursing student can: References: 1. Identify causes biological disasters. Veenema, T.G. (2019) Disaster Nursing and 2. Identify the factors associated with biological disasters Emergency Preparedness for Chemical, 3. Determine the emergency nursing interventions for Biological, and Radiological Terrorism and other patients who were exposed to biological agents. Hazards 4th Edition 4. Describe the managements for person who were exposed to biological agents LESSON PREVIEW/REVIEW (5 minutes) Instruction: What are the three common pathogens used in bioterrorism? MAIN LESSON (40 minutes) CDC Classification of Biological Agents Category A: most deadly microbes known to man; high mortality rates; induce public panic and social disruption; high infectivity Category B: moderate morbidity and lower mortality; lower infectivity Category C: emerging agents, potential future infective threats Category A - Anthrax (Bacillus anthracis) - Botulinum toxin (Clostridium botulinum) - Plague (Yersinia pestis) - Smallpox (Variola major) - Tularemia (Francisella tularensis) - Hemorrhagic fever viruses Category B - Brucellosis - Epsilon toxin of Clostridium perfringens - Melioidosis - Psittacosis - Q fever - Ricin toxin - Staphylococcal enterotoxin B - Typhus fever - Viral encephalitis Category C - Nipah fever - Hantavirus This document and the information thereon is the property of PHINMA Education (Department of Nursing) 1 of 6 ANTHRAX A zoonotic disease, generally found in herbivores (sheep, goats, and cattle) Bacillus anthracis: spore-forming bacterium Contact with infected animals or animal products Wool sorter’s disease Extremely resilient and can remain viable for decades Inhalation anthrax Last reported case of naturally occurring inhalation anthrax in the US was in 1978 Anthrax as bioterrorism: late 2001 to early 2002 with 23 identified cases High level of resistance to high temperatures and disinfectants Secretes powerful exotoxin (anthrax toxin) Confirmatory: clinically compatible case of either cutaneous, gastrointestinal, inhalation diseases, confirmed by isolation of B. anthracis from an affected tissue or site Inhalation Anthrax Inhalation of spores Incubation period: 1-6 days, then producing bacteremia Signs and symptoms: Nonspecific: Viral URTI Severe edema and hemorrhagic mediastinitis Respiratory failure Septic shock Hemorrhagic meningitis Death Cutaneous Anthrax Spores enter skin through cuts or abrasions Macule or papule, which ulcerates ( 1 - 7 days) Black, painless eschar Severe local edema Painful regional lymphadenopathy Gastrointestinal Anthrax Ingested spores in the upper or lower GI, that leads to sepsis. Upper GI form Oral or esophageal ulcers Edema; Lymphadenopathy Vomiting Lower GI form Vomiting Bloody diarrhea Acute abdomen Ascites Isolation, Vaccination, and Postexposure Prophylaxis Universal precaution: contact with suspected patients Contact isolation: patients with inhalation or cutaneous anthrax Vaccine: AVA (Anthrax Vaccine Adsorbed) Post-exposure prophylaxis: - For those exposed to airspace contaminated with aerosolized B. anthracis - Ciprofloxacin or doxycycline for 60 days - 100 days prophylaxis for inhalation exposure that is significant Treatment: Cutaneous anthrax: ciprofloxacin or doxycycline, 60 day oral course This document and the information thereon is the property of PHINMA Education (Department of Nursing) 2 of 6  Inhalation anthrax: - ciprofloxacin or doxycycline, 60 -day IV course, plus one or two microbials - Aminoglycoside - Clindamycin Multidrug antibiotic regimens Chest tube drainage: hemorrhagic pleural effusion BOTULISM Caused by Clostridium botulinum (anaerobic bacterium), which produces botulinum toxin; soil contaminant Neuroparalytic Foodborne illness that can kill rapidly Four major types: 1. Foodborne botulism: home processed foods 2. Infantile botulism: food contamination through ingestion 3. Wound botulism 4. Intestinal botulism Pathogenesis C. botulinum is widespread in soil, surfaces of foods, and dust Killed by boiling at 100 degrees Celsius Blocks acetylcholine release from peripheral cholinergic nerve terminals The neurotransmitter blockade is irreversible, requiring the growth of new nerve endings for nerve conduction to resume Clinical Manifestation Cranial nerve palsies; ophthalmoplegia Progressive, descending, symmetric weakness or paralysis Respiratory failure leading to death Foodborne botulism: - Nausea and vomiting - Diarrhea leading to constipation in advanced stage Infantile botulism: - Constipation - Flaccidity (floppy baby) - Poor suck reflex and feeding - Poor head control Isolation, Vaccination, and Postexposure Prophylaxis - Universal precautions - Droplet precautions; isolation is not necessary - C. botulinum antitoxin for laboratory personnel - Postexposure prophylaxis is not recommended for asymptomatic patients Treatment Ventilatory support: average of 6-8 weeks, but can last to 7 months Administration of botulinum antitoxin Acts only in unbound toxin and therefore, its efficacy is greatest early in the patient’s clinical course. Cathartics and enemas For infantile botulism: human derived Botulism Immune Globulin (BIG) PLAGUE Most feared infectious disease in the history of humankind; more than 200 million died during the Black Death of the Middle Ages Yersinia pestis (gram-negative bacteria) Plague-infected fleas moved from their natural hosts (rodents) to humans Transmission: This document and the information thereon is the property of PHINMA Education (Department of Nursing) 3 of 6  bite of an infected flea droplet spread from patients with pneumonic plague Types of Plague 1. Bubonic Plague - Bite of an infected flea - Bacteria migrate to local lymph nodes and multiply - Signs and symptoms: Large, swollen, extremely tender lymph nodes: bubo Bacteremia Fever, chills, myalgia Nausea and vomiting Sepsis to shock DIC Coma and death 2. Septicemic Plague - Bite of an infected flea - Signs and symptoms: Sepsis DIC Grangrene Necrosis of fingers and toes 3. Pneumonic Plague - Deadliest form; spread by droplet dispersal from infected patients, or by hematogenous spread - Infects the lungs; cardinal sign: severe pulmonary involvement - Signs and symptoms: Severe hemorrhagic, necrotizing bronchopneumonia Dyspnea and chest pain Cough and hemoptysis Isolation, Vaccination, Postexposure Prophylaxis Strict isolation Gloves, gowns, masks and eye protection should be worn for at least 48 hours of treatment Antibiotic prophylaxis: recommended for contacts of patients infected with plague: o Doxycycline o Ciprofloxacin o Tetracycline o Sulfonamides o Chloramphenicol Treatment Treatment of choice: Streptomycin Gentamicin Doxycycline Ciprofloxacin Chloramphenicol CHECK FOR UNDERSTANDING (10 minutes) You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You are given 10 minutes for this activity: This document and the information thereon is the property of PHINMA Education (Department of Nursing) 4 of 6 Multiple Choice 1. What is the most common naturally occurring form of anthrax? a. inhalation b. cutaneous c. gastrointestinal d. neurologic ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 2. Which form of plague can be spread from person to person? a. Pneumonic b. Bubonic c. septicemic d. foodborne ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 3. Which of the following forms of anthrax infection causes most fatalities? a. Cutaneous b. inhalation c. gastrointestinal d. neurologic ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 4. The deadliest form/ type of plague. a. Bubonic plague b. Septicemic plague c. Pneumonic plague d. All of the above ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ 5. Which of the following would be a symptom of botulism? a. Disfigured nodules on the skin b. lockjaw c. flaccid paralysis d. sepsis ANSWER: ________ RATIO:____________________________________________________________________________________ __________________________________________________________________________________________ __________________________________________________________________________________________ RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION) The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves. Write the correct answer and correct/additional ratio in the space provided. 1. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 5 of 6 2. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 3. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 4. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ 5. ANSWER: ________ RATIO:_______________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________ LESSON WRAP-UP (5 minutes) You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track how much work you have accomplished and how much work there is left to do. You are done with the session! Let’s track your progress. AL Activity: CAT: 3-2-1 Instructions: 1. As an exit ticket at the end of the class period 2. After the lesson, have each student record three things he or she learned from the lesson. 3. Next, have them record two things that they found interesting and that they’d like to learn more about. 4. Then, have students record one question they still have about the material. 5. Review the students’ responses. You can use this information to help develop future lessons and 1. determine if some of the material needs to be taught again. Three things you learned: 1. ______________________________________ 2 ______________________________________ 3. ______________________________________ Two things that you’d like to learn more about: 1. ______________________________________ 2. ______________________________________ One question you still have: 1. ______________________________________ This document and the information thereon is the property of PHINMA Education (Department of Nursing) 6 of 6