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C228 Review_Chapter 6
Communicable Diseases, Disasters, and Bioterrorism
46
Health Care
Undergraduate 4
07/17/2016

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Term
Communicable diseases worldwide -- most deaths are from
Definition
* pneumonia
* diarrheal diseases
* TB
* malaria
* measles
* HIV/AIDS
Term
Populations at risk for communicable disease
Definition
* young children
* older adults
* immunosuppressed clients
* IV drug users
* health care workers
Term
CDC recommendations for immunizations -- age groups
Definition
* 0 to 6
* 7 to 18
* 19 and up
Term
Modes of transmission
Definition
* airborne
* foodborne
* waterborne
* vector-borne
* direct contact
Term
Airborne diseases (inhaled by a susceptible host)
Definition
* measles
* chickenpox
* streptococcal infection
* TB
* pneumonia
* influenza
Term
Foodborne diseases (bacterial, viral, parasitic infection of food)
Definition
* salmonellosis
* hepatitis A
* trichinosis
* escherichia coli
Term
Waterborn diseases (fecal contamination of water)
Definition
* cholera
* typhoid fever
* giardia lamblia
Term
Vector-borne diseases (via carrier such as mosquito or tick)
Definition
* Lyme disease
* Rocky Mountain spotted fever
* Malaria
Term
Direct contact diseases (skin-to-skin contact with mucous membrane discharges)
Definition
* STD
* HIV
* gonorrhea
* syphillis
* genital herpes
* hep B, C, D
* infectious mononucleosis
* impetigo, lice, scabies
Term
Portals of entry
Definition
* respiratory system
* GI tract
* skin
* mucous membranes
Term
Portals of exit
Definition
* respiratory system
* feces
* blood
* semen / vaginal secretions
* saliva
* skin
Term
Defense mechanisms
Definition
* Natural immunity
* Artificial (acquired) immunity
Term
Natural immunity
Definition
from body's antigen antibody response -- exposed to actual disease; create own antibodies
Term
Artificial immunity
Definition
* through vaccination
* active immunity -- vaccination with live, killed, toxoid
* passive immunity -- from antitoxin or antibodies
Term
CDC
Definition
4-level biosafety system to guide in care of those with communicable disease
Term
Reportable diseases (not all inclusive) -- National Notifiable Diseases Surveillance System)
Definition
* AIDS
* anthrax
* botulism
* cholera
* diptheria
* encephalitis
* giardiasis
* gonorrhea
* hepatitis A-D
* influenza activity
* Legionellosis / Legionnaires' disease
* leprosy
* Lyme disease
* malaria
* meningococcal infections
* mumps
* pertussis
* poliomyelitis
* rabies
* Rocky Mountain spotted fever
* rubella
* rubeola (measles)
* salmonellosis
* shigellosis
* severe acute respiratory syndrome-associated Coronavirus disease (SARS-CoV)
* syphillis
* smallpox
* tetanus
* toxic shock syndrome
* trichinosis
* TB
* typhoid fever
* vancomycin-resistant staphylococcus aureus (VRSA)
* varicella (chickenpox)
Term
Health care goals r/t communicable disease control
Definition
Reduce
* vaccine-preventable disease among lower-income populations
* pneumococcal and meningococcal infections for high-risk clients such as older adults or college students
* TB for high risk groups such as homeless or older adults
* Group B streptococcal disease in newborns
* antibiotics for ear infections in children to prevent resistance
Increases in
* TB pts who complete therapy
* travelers who receive recommended vaccines
* vaccination coverage
* safety levels for food production
* use of condoms for the prevention of STD
Term
Community Health nurse
Definition
* tracks immunization schedules of at-risk populations
* educates community about importance of immunization
* must stay up to date on current immunization schedule recommendations and appropriate precautions when administering immunizations
Term
Primary prevention in communicable disease
Definition
* prevent occurrence of infectious disease
* educate public re need for immunizations, federal and state vaccination programs, and immunization laws (e.g., "no-shots, no school")
* counsel travelers re mandatory immunizations (refer to health dept)
* educate public re eliminating risk factors for exposure; e.g., hand hygiene, univeral precautions, proper food handling / storage, condom use
Term
Secondary prevention in communicable disease
Definition
* increase early detection thru screening and case finding
* refer suspected cases for diagnostic confirmation and epidemiologic reporting
* treat postexposure infections (hep A, rabies)
* quarantine clients when necessary
Term
Tertiary prevention in communicable disease
Definition
* decrease complications and disabilities due to infectious diseases thru treatment and rehab
* monitor treatment compliance, including directly observed therapy
* prevent reinfecition; identify community resources
Term
3 leavels of disaster management
Definition
* Disaster preparedness
* Disaster response
* Disaster recovery
Term
Disaster preparedness
Definition
* Federal Response Plan
* FEMA
* US Public Health Service
* CDC
-- guides coordination of efforts in response to disaster
* ID and assess populations at risk
* fewer resources or less ability to survive
* disabled, isolated
* plan for possibility of worldwide pandemics
* individual plan for communication, evacuation route, disaster kit
* set up communication protocol
* provide for access to emergency agencies
* range from in-house, local, state-wide, or national, depending on size of disaster
* conduct mass casualty drills / mock disaster response
Term
Disaster response
Definition
* various agencies responsible for different levels of disaster reponse
* FEMA, OEM, Red Cross
* local hospitals, ER, public health dept, rescue personnel
* initial assessment of span of disaster
* how many affected?
* how many injured or dead?
* how much fresh water / food is available?
* what are areas of risk or sanitation problems?
Term
Nursing roles in disaster response
Definition
* triage victims with serious versus minior injuries
* prioritize care of victims
* transfer those needing immediate attention to medical facilities
* administer tetanus shots, first aid, medical attention
* shelter nursing may extend into recovery phase
Term
Disaster recovery
Definition
* time it takes to restore economic and civil life of community
* PTSD and delayed stress reactions (DSR) are common -- affect caregivers and victims
Term
Phases of emotional reaction in disaster
Definition
* Heroic -- occurs at time of disaster; intense excitement and concern for survival of self and others
* Honeymoon -- (2 weeks to 2 months); feel support from government relief
* Disillusionment - (several months to a year or more) unexpected delays in receiving aid
* Reconstruction -- lasts several years and is attempt to rebuild
Term
Nursing roles in recovery
Definition
* stress counseling
* home health care
* reassessment of health care needs
Term
CH Nurse roles in Disaster Mgt -- Participation in risk assessment
Definition
* what are pop at risk?
* what are previous disasters
* what size is likely to be affected in worst-case scenario
* what is community disaster plan?
* what kind of warning system is in place?
* what types of disaster response teams are in place?
* what kinds of resource facilities are available?
* what type of environmental dangers may be involved?
* what type of evac measures will be needed
Term
CH Nurse roles in Disaster Mgt --
Participation in community disaster planning
Definition
* dev disaster response plan based on most probably disaster threats
* ID warn system / communication center; learn how to access
* ID first responders
* make list of agencies available for varying levels of disaster mgt, locally and nationally
* define nursing roles in 1st priority, 2nd priority, 3rd priority triage
* ID roles of personnel and chain of command
* locate all equipment / supplies needed for disaster mgt (hazmat suits, infectious control items, medical supplies, food, potable water); ensure replenishment
* check equipment (including evac vehicles) regularly
* eval efficiency, response time, and safety of disaster drills, mass casualty drills, and disaster plans
Term
CH Nurse roles in Disaster Mgt --
Participation in community disaster response
Definition
* participating in community disaster plans
* activating disaster mgt plan
* performing triage, directing diaster victimes, evacuation, quarantine, mgt of shelters
* assess disaster victimes and caretakers for PTSD, DSR, provide psyc treatment
Term
CH Nurse roles in Disaster Mgt -- Participation in evaluation of community disaster response
Definition
* eval area, effect, and level of disaster
* create ongoing assessment / surveillance reports
* eval efficiency of disaster response teams
* estimate length of time for recovery of community services (electricity, potable water)
Term
Category A agents of bioterrorism
Definition
* highest priority agents
* pose risk to nat'l security d/t easily transmitted and have high mortality rates
* smallpox (variola), botulism, anthrax, tularemia, hemorrhagic viral fevers, plague
Term
Category B agents of bioterrorism
Definition
* 2nd highest priroity
* moderately easy to disseminate
* moderate morbidity rates
* low mortality rates
* examples -- typhus and cholera
Term
Category C agents of bioterrorism
Definition
* 3rd highest priority
* emerging pathogens that can be engineered for mass dissemination
* easy to produce
* potential for high morbidity and high mortality
* example -- hantavirus
Term
Inhalational anthrax
Definition
Sx
* sore throat
* fever
* muscle aches
* severe dyspnea
* meningitis
* shock
Rx -- IV ciprofloxacin
Term
Botulism
Definition
Sx
* difficulty swallowing
* progressive weakness
* NV, abd cramps
* difficulty breathing
Rx
* airway mgt
* antitoxin
* elimination of toxin
Term
Smallpox
Definition
Sx
* high fever
* fatigue
* severe HA
* rash (begins on face / tongue; quickly spreads to arms / legs; then hands / feet with 24 hr) turns to pus-filled lesions
* vomiting
* delirium
* excessive bleeding
Rx
* no cure
Supportive care
* hydration
* pain med
* antipyretics
Prevention -- vaccine provides 10-year immunity
Term
Ebola
Definition
Sx
* sore threat
* HA
* high temp
* NVD
* internal and external bleeding
* shock
Rx
* no cure
Supportive care
* minimization of invasive procedures
Prevention -- avoidance of contaminated items
Vaccine -- in testing phase; none currently available
Term
Delivery mech for biological agents
Definition
* direct contact (subcutaneous anthrax)
* simple dispersal device (airborne, nuclear)
* water and food contamination
* droplet or blood contact
Term
Role of CH nurse in bio terrorism event
Definition
* participate in planning and preparation for immediate response
* ID potential agents for bioterrorism
* survey for and report bioterrorism activity (usualy to local health department)
* promptly particpate in measures to contain and control spread of infections resulting from bioterrorist activity
Term
Assessment of bioterrorism threat
Definition
* is pop at risk for sudden high disease rates?
* is vector that normally carries a specific disease available in the geograhical area affected?
* is there a potential delivery system within the community?
Term
Recognition of a bioterrorism event
Definition
* is there a rapidly increase disease incidence in a normally healthly pop?
* is a disease occurring that is unusual for the area?
* is an endemic occurring at an unusua time (ex. flu in summer)
* are there large #s of people dying rapidly with similar presenting symptoms?
* are there individuals presenting with unusual symptoms
* are there unusual numbers of dead / dying animals; unusual liquids / vapors / odors?
Term
Primary prevention in bioterrorism
Definition
* prep with drills, vaccines, and ABX for exposure prophylax
* bioterrorism planning
* design response plan
* assess local facilities with Level I, II, III, and IV biosafety gear
* ID chain of command for reporting
* define nsg roles
* set up protocols for different levels of infection control and containment
Term
Secondary prevention in bioterrorism
Definition
* early recognition
* activation of response plan
* immediate implementation of infection control and containment including decontamination, disinfection, PPE, comm ed / notification, quarantines
* screening for exposure, assessing rates of infection, admin vaccines
* assist / ed pop regarding sx ID and mgt
* monitor mortality and morbidity
Term
Tertiary prevention in bioterrorism
Definition
* rehab of survivors
* monitoring med regimens and referrals
* eval effectiveness and timeliness of bioterrorism plan
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