Health Promotion - Disaster Preparedness

Question 1

Vulnerable populations that visit the ED

Answer 1

homeless, poor, and older adults

Question 2

Forensic nurse examiners (RN-FNEs)

Answer 2

obtain pt histories, collect forensic evidence, offer counseling and follow-up care for victims of rape, child abuse, and domestic violence

Question 3

Sexual assault nurse examiners (SANEs)

Answer 3

forensic nurses who specialize in helping victims of sexual assault

Question 4

Interventions performed by forensic nurses

Answer 4

providing information about developing a safety plan or how to escape a violent relationship; document injuries and collect physical and photographic evidence; provide testimony in court

Question 5

Psychiatric crisis nurse team

Answer 5

evaluates pts with emotional behaviors or mental illness and facilitates the follow-up treatment plan; interact with the pts and families when sudden illness, serious injury, or death may have caused a crisis

Question 6

Emergency medical technicians (EMTs)

Answer 6

provide basic life support interventions such as oxygen, basic wound care, splinting, spinal immobilization, and monitoring of vital signs; communicate information to other staff members for continuity of care

Question 7

Paramedics

Answer 7

advanced life support (ALS) providers that can perform advanced techniques, such as cardiac monitoring, advanced airway management and intubation, establishing IV access, and administering drugs en route to the ED; communicate information to other staff members for continuity of care

Question 8

Emergency medicine physician

Answer 8

has received specialized education ad training in emergency pt management; directs the overall care in the ED

Question 9

ED support staff

Answer 9

radiology and ultrasound technicians, respiratory therapists, lab technicians, social workers, nursing assistants, clerical staff

Question 10

ED nurse

Answer 10

accountable for communicating pertinent staff considerations, pt needs, and restrictions to support staff; ensures that ongoing pt and staff safety issues are addressed

Question 11

ED nurse hand-off communication

Answer 11

situation, brief medical history, assessment and diagnostic findings, transmission-based precautions needed, interventions, and response to those interventions

Question 12

SBAR

Answer 12

Situation, Background, Assessment, Response

Question 13

Staff safety

Answer 13

standard precautions; anticipate hostile, violent pt, family, and/or visitor behavior; plan options if violence occurs (support from security dept, panic button, remote door access controls)

Question 14

Patient identification

Answer 14

provide ID bracelet for each pt; use two unique identifiers; if pt identity is unknown, use special ID system

Question 15

Patient injury prevention

Answer 15

keep rails up on stretcher and in lowest position; remind pt to use call light for assistance; reorient confused pt frequently; if pt is confused, as family to stay with him/her; implement skin prevention measures for pt at risk for skin breakdown

Question 16

Risk for errors and adverse events in the ED

Answer 16

obtain thorough pt and family history; check pt for med alert bracelet; search pts belongings for weapons or other harmful devices with he or she has altered mental status

Question 17

Core competency - Assessment

Answer 17

ED nurse must be able to rapidly and accurately interpret assessment findings according to acuity and age

Question 18

Core competency - Priority settings

Answer 18

depends on accurate assessment, good critical thinking and clinical decision-making skills; often initiates interdisciplinary protocols for lifesaving interventions such as cardiac monitoring, oxygen therapy, insertion of IV catheters, and infusion of appropriate parenteral solutions; knowledgeable with critical care equipment; able to assist the physician with procedures

Question 19

Common ED procedures

Answer 19

wound closure, foreign body removal, central line insertion, ET intubation and initiation of mechanical ventilation, transvenous pacemaker insertion, lumbar puncture, pelvic exam, chest tube insertion, peritoneal lavage, paracentesis, fracture management

Question 20

Core competency - Communication

Answer 20

common barrier is pts cultural beliefs and practices; assess each pt as individual; do not stereotype

Question 21

Basic Life Support (BLS)

Answer 21

noninvasive assessment and management skills for airway maintenance and cardiopulmonary resuscitation

Question 22

Advanced Cardiac Life Support (ACLS)

Answer 22

invasive airway management skills, pharmacology, and electrical therapies, special resuscitation

Question 23

Pediatric Advanced Life Support (PALS)

Answer 23

neonatal and pediatric resuscitation

Question 24

Certified Emergency Nurse (CEN)

Answer 24

validates core emergency nursing knowledge base

Question 25

Triage

Answer 25

an organized system for sorting or classifying pts into priority levels depending on illness or injury severity

Question 26

Triage nurse

Answer 26

gatekeeper; RN; performs rapid assessment; may seek the input of emergency physician, or physician assistant to determine acuity level if the pts presentation is highly unusual

Question 27

Emergent triage category

Answer 27

a condition exists that poses an immediate threat to life or limb; respiratory distress, chest pain with diaphoresis, active hemorrhage, unstable VS

Question 28

Urgent triage category

Answer 28

pt should be treated quickly but immediate threat to life is not present; severe abdominal pain, renal colic, displaced or multiple fractures, complex or multiple soft tissue injuries, new onset respiratory infection (esp pneumonia)

Question 29

Nonurgent triage category

Answer 29

can tolerate waiting several hours for health care services without a significant risk for clinical deterioration; skin rash, strains and sprains, "colds", simple fracture

Question 30

Disposition

Answer 30

should the pt be admitted to the hospital, transferred to a specialty care center, or discharged to home?

Question 31

Case management interventions

Answer 31

facilitates referrals to primary care providers or subsidized community-based health clinics; arranges referrals into disease management programs in the community; directs pt to educational resources; works with staff to plan disposition for homeless people; locate a safe environment for victims of domestic violence or elder abuse; provide information on resources for low-cost or free prescriptions

Question 32

Death in ED

Answer 32

may require forensic investigation (will not remove IV lines and indewelling tubes or clean the pts skin if possibility of damaging evidence; use simple concrete terms; demonstrate caring, compassion, and empathy; coordinate with crisis staff; off clergy or calling someone of family choosing for support

Question 33

Trauma

Answer 33

bodily injury; trauma nursing encompasses injury prevention and prehospital services, to acute care, rehabilitation, and community reintegration

Question 34

Trauma center

Answer 34

specialty care facility that provides competent and timely trauma services to pts depending on its designated level of capability

Question 35

Level I trauma center

Answer 35

usually located in large teaching hospital systems in densely populated areas; provides full continuum of trauma care for all pts

Question 36

Level II trauma center

Answer 36

located in community hospital; provides care to most injured pts; transports pts to higher trauma center level if pt needs exceed resource capability

Question 37

Level III trauma center

Answer 37

located in community hospital; stabilizes pts with major injuries; transports pts to higher trauma center level if pt needs exceed resource capability

Question 38

Level IV trauma center

Answer 38

located in rural and remote areas; provides advanced life support; transports to higher trauma center levels when able

Question 39

Trauma system

Answer 39

organized and integrated approach to trauma care designed to ensure that all critical elements of trauma care delivery are aligned to meet the injured pts needs

Question 40

Trauma system elements

Answer 40

access to care through communication technology, timely availability of prehospital emergency medical care, rapid transport to a qualified trauma center, early provision of rehabilitation services, system-wide injury prevention, research, and education initiatives

Question 41

Mechanism of injury (MOI)

Answer 41

describes how the pts traumatic event occurred; provides insight into the energy forces involved; may help providers predict injury types and pt outcomes

Question 42

Blunt trauma

Answer 42

results from impact forces like those sustained a motor vehicle crash, a fall, and an assault with fists, kicks, or a baseball bat; blast effect is also included

Question 43

Penetrating trauma

Answer 43

caused by injury from sharp objects and projectiles

Question 44

Primary survey

Answer 44

initial assessment of the trauma pt; ABCDE

Question 45

Airway/Cervical Spine

Answer 45

Establish a patent airway by positioning, suctioning, and oxygen as needed; Protect the cervical spine by maintaining alignment; use a jaw thrust maneuver if there is a risk for spinal injury; If the GCS score is 8 r less or the pt is at risk for airway compromise, prepare for endotracheal intubation and mechanical ventilation

Question 46

Breathing

Answer 46

Assess breath sounds and resp effort; Observe for chest wall trauma or other physical abnormality; Prepare for chest decompression if needed; Prepare to assist ventilations if needed

Question 47

Circulation

Answer 47

Monitor VS, esp BP and pulse; Maintain vascular access using a large-bore catheter; Use direct pressure for external bleeding

Question 48

Disability

Answer 48

Evaluate the pts LOC using the AVPU system and the GCS; Re-evaluate the pts LOC frequently

Question 49

Exposure

Answer 49

Remove all clothing for complete physical assessment; Prevent hypothermia

Question 50

AVPU method of LOC eval

Answer 50

A: Alert; V: responsive to Voice; P: responsive to Pain; U: Unresponsive

Question 51

GCS

Answer 51

scores eye opening, verbal response, and motor response; lowest score is 3 (unresponsive); highest score is 15 (normal)

Question 52

Secondary survey

Answer 52

more comprehensive head to toe assessment; used to identify other injuries or medical issues than need to managed or that might affect the course of treatment

Question 53

Internal disaster

Answer 53

any event inside a health care facility or campus that could endanger pts or staff; creates need for evacuation or relocation; often requires additional personnel and activation of emergency preparedness and response plan

Question 54

External disaster

Answer 54

an event outside the health care facility or campus; requires activation of emergency management plan; requires additional personnel

Question 55

Multi-casualty event

Answer 55

can be managed by a hospital using local resources

Question 56

Mass-casualty event

Answer 56

requires the collaboration of multiple agencies and health care facilities to handle the crisis

Question 57

Desired outcome of emergency preparedness

Answer 57

outline ways to meet the extraordinary need for hospital beds, staff, drugs, PPE, supplies, and medical devices

Question 58

Mass casualty triage

Answer 58

rapidly sort ill or injured pts into priority categories based on acuity and survival potential

Question 59

Emergent mass casualty triage

Answer 59

Class I; red tag; immediate threat to life

Question 60

Urgent mass casualty triage

Answer 60

Class II; yellow tag; major injuries that require treatment

Question 61

Nonurgent mass casualty triage

Answer 61

Class III; green tag; minor injuries that do not require immediate treatment

Question 62

Expectant mass casualty triage

Answer 62

Class IV; black tag; expected and allowed to die

Question 63

Medical Reserve Corps (MRC)

Answer 63

volunteer medical and public health care professionals; includes physicians and nurses; may help staff hospitals that face personnel shortages; may set up an acute care center to alleviate emergency department and hospital overcrowding

Question 64

Disaster Medical Assistance Team (DMAT)

Answer 64

made of up civilian, medical, paraprofessional, and support personnel; team is deployed to disaster area with enough medical equipment and supplies to sustain operations for 72 hrs

Question 65

Hospital Incident Command System (HICS)

Answer 65

roles are structured under the hospital or long-term care facility incident commander with clear lines of authority and accountability for specific resources; establishes EOC or command center in designated location with accessible communication technology

Question 66

Emergency Operations Center (EOC) or command center

Answer 66

manages the overall incident; internal requests and communication with field teams and external agencies should be coordinated through the EOC

Question 67

Hospital incident commander

Answer 67

physician or administrator who assumes overall leadership for implementing the emergency plan

Question 68

Medical command physician

Answer 68

physician who decides the number, acuity and resource needs of pts

Question 69

Triage officer

Answer 69

physician or nurse who rapidly evaluates each pt to determine priorities for treatment

Question 70

Community relations or public information officer

Answer 70

person who serves as a liaison between the health care facility and the media

Question 71

Role of nurse in emergency preparedness and response

Answer 71

recommend pts for discharge; CCU nurses need to identify pts who can be transferred out of the unit; remain flexible in mass casualty situation and perform at their highest level to address the needs of both the health care system and the pts

Question 72

Pts able to be discharged early

Answer 72

diagnostic evals and are not bedridden; soon scheduled to be discharged; could be cared for at home with support from family or home health; no critical change for the past 3 days; could be cared for in another health care facility (rehab or long term care)

Question 73

Personal emergency preparedness plan

Answer 73

outlines the preplanned specific arrangements that are to be made for childcare, pet care, and older adult care if the need arises

Question 74

Basic supplies for personal preparedness

Answer 74

backpack; clean clothing; sturdy footwear; potable water; food; flashlight; pocket knife or multi-tool; personal ID with emergency contacts and phone numbers, allergies, medical information; list of cc numbers and bank accounts; towel, soap, hand sanitizer; paper, pens, regional maps; cell phone; sunglasses, eyewear; blanket; work gloves; first aid kit; rain gear; duct tape, plastic sheeting; radio; toiletries; plastic garbage bags, re-sealable plastic bags; matches; whistle; liquid bleach for disinfection

Question 75

Critical Incident Stress Debriefing (CISD)

Answer 75

strict confidentiality of information shared; unconditional acceptance of the thoughts and feelings expressed; group discussion; immediate; small groups of responders/victims; end goal is to prevent PTSD

Question 76

Administrative review

Answer 76

directed at analyzing the hospital or agency response to an event while it is still in the forefront of the minds of everyone who participated; goal is to discern what went right and what went wrong so that changes can be made

Question 77

Psychosocial response of survivors to mass casualty events

Answer 77

be calm and reassuring; establish rapport through active listening and honest communication; offer choices when possible; help survivors adapt to their new surroundings and routines through simple concrete explanations; convey caring behaviors; provide sense of safety and security

Question 78

Impact of Event Scale - Revised (IES-R)

Answer 78

22-item self-administered questionnaire; should not be used for pts with short term memory loss

Question 79

Endemic

Answer 79

the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographical area

Question 80

Epidemic

Answer 80

often sudden increase in the number of cases of a disease above what is normally expected in that population/area

Question 81

Outbreak

Answer 81

defined same as epidemic, but a more limited geographical area

Question 82

Cluster

Answer 82

aggregation of cases grouped in a place/time that are suspected to be greater than the number expected

Question 83

Pandemic

Answer 83

epidemic that has spread over several countries/continents, usually affecting a large number of people

Question 84

How do these diseases “over there” affect me?

Answer 84

Globalization of travel and trade; Spread readily in areas with poor sanitation and hygiene; Some are easily transmitted from person-to-person (airborne, blood, and body fluids); Morbidity and mortality of certain diseases; People are electing not to be vaccinated and/or not to vaccinate their children