Disaster in Nursing 2

Medical-Surgical Nursing
Critical Thinking in Patient Care

Fifth Edition
CHAPTER 7
Nursing Care of
Patients Experiencing
Disasters
Medical-Surgical Nursing: Critical Thinking in Patient Care, Fifth Edition Copyright ©2011 by Pearson Education, Inc.
Priscilla LeMone • Karen Burke • Gerene Bauldoff All rights reserved.
Directory
• NCLEX-RN® REVIEW Test Questions

• Lecture Note Presentation
NCLEX-RN® REVIEW
Test Questions
®
NCLEX-RN REVIEW
Test Question 1
1. What is the key difference between
emergencies and disasters?
1. Emergencies are controlled.
2. Disasters result from man-made errors.
3. Emergencies can typically be handled by available
emergency services.
4. Disasters typically involve the local emergency
services and no other agencies.
®
NCLEX-RN REVIEW
Test Question 1 Response
1. What is the key difference between
emergencies and disasters?
1. Emergencies are controlled.
2. Disasters result from man-made errors.
3. Emergencies can typically be handled by
available emergency services.
4. Disasters typically involve the local emergency
services and no other agencies.
®
NCLEX-RN REVIEW
Test Question 1 Rationale
Although emergencies can typically be handled by
available emergency services, disasters involve
multiple services and agencies working together.
®
NCLEX-RN REVIEW
Test Question 2
2. Which of the following is NOT true regarding
nurses’ responsibilities in disaster
preparedness?
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NCLEX-RN REVIEW
Test Question 2 Choices
1. Nurses have a responsibility to the public to be
knowledgeable about disaster preparedness and
response.
2. Nurses must have a personal and family plan as a
part of their disaster preparedness and response
plan.
3. Nurses will be the leaders in the incident command
structure set up at the site of the disaster.
4. Nurses who are prepared for disasters will be better
able to help themselves, their families, and their
communities in a disaster situation.
®
NCLEX-RN REVIEW
1. Nurses have a responsibility to the public to be
knowledgeable about disaster preparedness and
response.
2. Nurses must have a personal and family plan as a
part of their disaster preparedness and response
plan.
3. Nurses will be the leaders in the incident
command structure set up at the site of the
disaster.
4. Nurses who are prepared for disasters will be better
able to help themselves, their families, and their
communities in a disaster situation.
®
NCLEX-RN REVIEW
Nurses are an integral part in assisting with
disasters. However, they do not serve in a
leadership role in the command center. Their role
is in assisting with triage and in meeting the
emergency healthcare needs of those injured or
involved in the disaster.
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NCLEX-RN REVIEW
Test Question 3
3. What is the purpose of reverse triage?
1. Save scarce resources for future use.
2. Test first responders on their triage classification
categories.
3. Save those persons who are in the most critical
condition.
4. Do the greatest good for the greatest number with
limited resources.
®
NCLEX-RN REVIEW
3. What is the purpose of reverse triage?
1. Save scarce resources for future use.
2. Test first responders on their triage classification
categories.
3. Save those persons who are in the most critical
condition.
4. Do the greatest good for the greatest number
with limited resources.
®
NCLEX-RN REVIEW
Reverse triage is necessary when there are limited
resources to care for multiple people injured in a
disaster. This is so the majority of people can be
helped with the resources currently available.
®
NCLEX-RN REVIEW
Test Question 4
4. Why is important for nurses to assess patients’
literacy in their primary language?
1. They are most comfortable speaking in their primary
language.
2. They are most comfortable reading in their primary
language.
3. They may not be able to read and comprehend in
their primary language.
4. They may be too shy to communicate in English if it
is not their primary language.
®
NCLEX-RN REVIEW
4. Why is important for nurses to assess patients’
literacy in their primary language?
1. They are most comfortable speaking in their primary
language.
2. They are most comfortable reading in their primary
language.
3. They may not be able to read and comprehend
in their primary language.
4. They may be too shy to communicate in English if it
is not their primary language.
®
NCLEX-RN REVIEW
It is important to recognize that a patient whose
primary language is not English may not read in
his or her primary language. This can create a
significant problem when providing health
education. It is important to have someone
translate all information to the patient and have the
patient explain what has been taught in order to
ensure proper understanding of the information.
®
NCLEX-RN REVIEW
Test Question 5
5. Which of the following is true about personal
protective equipment (PPE)?
1. PPE protects by creating a barrier against hazards.
2. Eye, face, head, foot, and hand protection are
addressed in PPE programs.
3. PPE should reduce the likelihood of occupational
injury and/or illness.
4. Healthcare workers do not need to wear PPE if they
follow strict hand hygiene protocol and universal
precautions.
®
NCLEX-RN REVIEW
5. Which of the following is true about personal
protective equipment (PPE)?
1. PPE protects by creating a barrier against hazards.
2. Eye, face, head, foot, and hand protection are
addressed in PPE programs.
3. PPE should reduce the likelihood of
occupational injury and/or illness.
4. Healthcare workers do not need to wear PPE if they
follow strict hand hygiene protocol and universal
precautions.
®
NCLEX-RN REVIEW
PPE should lessen the likelihood of occupational
injury and/or illness, but proper precautions also
must be taken to ensure safety. This can be as
simple as proper hand hygiene after removing
gloves, or following isolation guidelines.
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NCLEX-RN REVIEW
Test Question 6
6. Which of the following is NOT true about
decontamination?
1. Decontamination corridors should be set up in an
area downwind from the hospital entrance.
2. Decontamination begins in the hot zone, closest to
the site of the disaster.
3. Decontamination must take place before the patient
enters the hospital.
4. Decontaminating a person should be done by
sweeping strokes away from you and the patient.
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NCLEX-RN REVIEW
6. Which of the following is NOT true about
decontamination?
1. Decontamination corridors should be set up in an
area downwind from the hospital entrance.
2. Decontamination begins in the hot zone, closest
to the site of the disaster.
3. Decontamination must take place before the patient
enters the hospital.
4. Decontaminating a person should be done by
sweeping strokes away from you and the patient.
®
NCLEX-RN REVIEW
Decontamination cannot begin in the hot zone as
this is the area of greatest contamination. It is
important to decontaminate the area outside of the
hot zone to prevent its spread.
®
NCLEX-RN REVIEW
Test Question 7
7. What is another name for a radiological
dispersion bomb?
1. a dirty bomb
2. an ionization radiation bomb
3. a nonfiltered bomb
4. a radio-controlled remote bomb
®
NCLEX-RN REVIEW
7. What is another name for a radiological
dispersion bomb?
1. a dirty bomb
2. an ionization radiation bomb
3. a nonfiltered bomb
4. a radio-controlled remote bomb
®
NCLEX-RN REVIEW
A dirty bomb is a bomb that carries a radiological
signature and can cause contamination and
radiation poisoning.
®
NCLEX-RN REVIEW
Test Question 8
8. One of the results of DNA mutation inside cells
exposed to ionizing radiation that can be
deadly, but is survivable with bone marrow
transplantation, is a description of which of the
following?
1. ionizing sickness
2. radiation sickness
3. TNT sickness
4. compromised immune sickness
®
NCLEX-RN REVIEW
8. One of the results of DNA mutation inside cells
exposed to ionizing radiation that can be
deadly, but is survivable with bone marrow
transplantation, is a description of which of the
following?
1. ionizing sickness
2. radiation sickness
3. TNT sickness
4. compromised immune sickness
®
NCLEX-RN REVIEW
Radiation sickness is the direct result of exposure
to ionizing radiation, which causes cellular
mutation. This condition must be treated rapidly or
death may result as the cells continue to mutate
and die.
®
NCLEX-RN REVIEW
Test Question 9
9. Why should a nurses assess the special needs
of older adults as part of the emergency
preparedness plan?
1. All older adults will need some kind of special
support.
2. Some older adults will take the lead in evacuation
efforts in nursing homes.
3. Not all older adults need the same level of support
in emergencies and disasters.
4. Some older adults will be unable to evacuate even
with multiple support agencies.
®
NCLEX-RN REVIEW
9. Why should a nurses assess the special needs
of older adults as part of the emergency
preparedness plan?
1. All older adults will need some kind of special
support.
2. Some older adults will take the lead in evacuation
efforts in nursing homes.
3. Not all older adults need the same level of
support in emergencies and disasters.
4. Some older adults will be unable to evacuate even
with multiple support agencies.
®
NCLEX-RN REVIEW
Older adults have individual needs. Some may be
more independent than others regarding the
degree of support needed in emergencies,
whereas others may require multiple resources
and support in an evacuation.
®
NCLEX-RN REVIEW
Test Question 10
10. Why would nurses need the assistance of a
mental health worker following a disaster?
1. All nurses need the help of a mental health worker
at one point or another in their nursing careers.
2. Nurses are trained to provide care, regardless of the
situation encountered.
3. Nurses maintain good mental health and rarely
require mental health assistance.
4. The nurse may feel as overwhelmed and
traumatized as the population for whom he or she is
caring.
®
NCLEX-RN REVIEW
10. Why would nurses need the assistance of a
mental health worker following a disaster?
1. All nurses need the help of a mental health worker
at one point or another in their nursing careers.
2. Nurses are trained to provide care, regardless of the
situation encountered.
3. Nurses maintain good mental health and rarely
require mental health assistance.
4. The nurse may feel as overwhelmed and
traumatized as the population for whom he or
she is caring.
®
NCLEX-RN REVIEW
Nurses often are so involved in caring for others
they tend to neglect themselves. In disaster
situations, nurses may also suffer from loss while
caring for others. As a result the nurse may feel
overwhelmed and be as traumatized as those for
whom he or she is caring.
Lecture Note
Presentation
Learning Outcome 1
• Distinguish the difference between an

emergency and a disaster.
Disasters
• Natural or man-made
Natural Disasters
• Acts of nature
– Hurricane
– Earthquake
– Tsunami
• Emerging disease
– Viral contagion
Man-Made Disasters
• Accidental
– Transportation accidents
– Building collapses
• Intentional
– War
– Chemical terrorism
– Biologic terrorism
– Radiologic terrorism
– Nuclear terrorism
Emergencies
• Unforeseen combination of circumstances

• Calls for immediate action
• Range of victims from one to many
Causes of Disaster
• Hazardous materials
– Risk to life, health, and property
• Terrorism
– Conventional weapons
 Bombs
 Guns
– Nonconventional weapons
 Toxin
Learning Outcome 2
• Describe the types of injuries and

manifestations associated with biologic,
chemical, or radiologic terrorism.
Bioterrorism
• Harm/kill a population/food/livestock
• Results not immediately evident
Anthrax
• Anthrax exposure manifestations

– Flu-like symptoms
– Nausea, vomiting
– Pain
Smallpox
• Smallpox manifestations
– High fever
– Headache
– Malaise
– Rash on face and extremities
Biologic Agent
• Indications of a biologic agent release:

– Increased disease incidence in geographic
area
– Disease pattern inconsistent with age
– Symptoms of rare disease
Radiologic Exposure
• Dirty bomb detonation manifestations

– Radiation sickness
– Cancer
Nuclear Detonation
Manifestations
• Thermal burns
• Pressure injuries
• Nausea, fatigue
Learning Outcome 3
• Discuss nursing interventions for the

treatment of injuries related to biologic,
chemical, and radiologic terrorism.
Nursing Intervention:
Bioterrorism
• Recognize, report, treat
• Report changes/trends to infectious
control nurse and public health department
Disaster Preparedness
• Outlines protocol/procedures in case of

bioterrorism attack
• Every health care facility should have
Lab Testing
• Test cultures of unusual disease pattern

• Report unusual clusters of lab results
Risk of Contamination
• Vaccinate when possible

• Monitor closely exposed persons
Care for Blast Injuries
• Focus on abdominal and lung injuries,

penetrating wounds
• Traumatic amputations
• Burns
Nuclear Casualties
• Nursing interventions:
– Triage
– Evacuation/sheltering
– Search and rescue
– Radioactive monitoring
– Decontamination
– Direct patient care
Learning Outcome 4
• Explain the rationale for reverse triage in

disasters versus conventional triage in
emergencies.
Conventional Triage
• Prioritize victims’ needs

• Red: needing most care
• Yellow: less critical
• Green: minor injuries
• Black: deceased
TABLE 7–2 Simple Triage and Rapid Transport (START) System Source: Start.(n.d.) Managing the scene.
Retrieved January 10, 2009, from http://www.citmt.org/start/rpm.htm
Conventional v. Reverse Triage
• Conventional: only a few victims

• Reverse: mass casualty, >100 victims
Reverse Triage
• Treat those with greatest chance of

survival first
• Most seriously injured treated last
Learning Outcome 5
• Discuss situations requiring the need for

patient isolation or patient
decontamination.
Situations Requiring Client
Isolation or Decontamination
• Smallpox, other contagious disease
• Exposed to radioactivity
Protocols
• Private room/ negative-pressure

ventilation
• Cover mouth/nose when
sneezing/coughing
• Personal respiratory protective devices
• Air decontamination: ventilation, UV light
Learning Outcome 6
• Discuss the role of the nurse in disaster

planning, response, and mitigation.
BOX 7–6 Roles of Nurses in Disasters
Role of Nurses: Disasters
• Be flexible, assume expanded roles

• Continue to assimilate new skills
Role of Nurses: Disasters
• The role of a nurse in a disaster depends

on:
– The nature of the disaster
– The number of victims and severity of injuries
– The location of the disaster
– The location of the nurse
– The availability of supplies, personnel, and
resources
Role of Nurses: Mitigation
• Continued education of self and others

• Anticipating needed resources and
policies
Role of Nurses:
Preparedness/Planning
• Nurses participate as representatives on
planning committees
Role of Nurses: Response
• Follow local disaster plan

• Infectious disease–control expertise
• Assess physical and psychosocial needs

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Medical-Surgical Nursing

Critical Thinking in Patient Care

• NCLEX-RN® REVIEW Test Questions

• Distinguish the difference between an

• Unforeseen combination of circumstances

• Describe the types of injuries and

• Anthrax exposure manifestations

• Indications of a biologic agent release:

• Dirty bomb detonation manifestations

• Discuss nursing interventions for the

• Outlines protocol/procedures in case of

• Test cultures of unusual disease pattern

• Vaccinate when possible

• Focus on abdominal and lung injuries,

• Explain the rationale for reverse triage in

• Prioritize victims’ needs

• Conventional: only a few victims

• Treat those with greatest chance of

• Discuss situations requiring the need for

• Private room/ negative-pressure

• Discuss the role of the nurse in disaster

• Be flexible, assume expanded roles

• The role of a nurse in a disaster depends

• Continued education of self and others

• Follow local disaster plan

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