CHAPTER 2FUNDAMENTALS OF NURSING POTTERATI FUNDAMEN.docx

CHAPTER 2
FUNDAMENTALS OF NURSING: POTTER
ATI FUNDAMENTALS
CHAPTERS 1,2
SAFETY AND INFECTION CONTROL
CHAPTERS 27,28 FUNDAMENTALS OF NURSING
CHAPTER 10,11,12,13,14 ATI FUNDAMENTS
In patient safety, critical thinking is an ongoing
process.Standards have been developed by American Nurses
Association and The Joint Commission.Use of the nursing
process when planning care promotes safety.
Safety in Health Care Organizations
A Safe EnvironmentIncludes meeting patients’ physical and
psychosocial needsApplies to all places where patients receive
careIncludes patients’ and health care providers’ well-
beingReduces risk of injury and transmission of

pathogensMaintains sanitation and reduces pollution
Environmental HazardsPhysical hazards:
LightingObstaclesBathroom hazardsMotor vehicle
accidentsPoisonFires
Falls
Transmission of pathogens
Pollution
Disasters
Natural
Man-made
Fire SafetyKeep open spaces (e.g., hallways) free of
clutter.Make sure fire exits are clearly marked.Know the
locations of all fire alarms, exits, and extinguishers.Know the
telephone number for reporting fires.Know the agency’s fire
drill and evacuation plans.Never use the elevator in the event of
a fire.Turn off oxygen and appliances in the vicinity of a fire.In
the event of fire, maintain the respiratory status of a client on
life support manually with the use of an Ambu-bag
(resuscitation bag) until the client can be moved away from the
fire.Use the RACE mnemonic to set priorities in the event of a
fire.Use the PASS mnemonic to remember how to use a fire
extinguisher.
Evacuation Procedures
Ambulatory clients may be directed to walk on their own to a
safe area and may be able to help move clients in
wheelchairs.Bedridden clients are generally moved from the
scene of a fire on stretchers, in their beds, or in

wheelchairs.Appropriate transfer techniques must be used to
carry a client from the area of a fire.Fire department personnel
at the scene of a fire can help evacuate clients.
Safety - The Primary concern when caring for clients
All employees need to know:
the institution's fire evacuation routine
the location of fire alarms
the location of fire extinguishers
how to use the fire extinguisher
the location of fire exits
The "hang tag“ (ON FIRE EXTINGUISHERS) should be
checked for date of last inspection (usually annually)
List the phone number for reporting fires close to all phones in
the facility
facility rescue plans:
FIRE SAFETY
FIRE EXTNGUISHERS
The most common water extinguishers are suitable for class A
fires only. Never use water to extinguish class C fires due to
the risk of electrical shock.
Dry chemical extinguishers come in a variety of types and are
suitable for a combination of class A, B, and C fires (liquids
and electrical fires)
filled with foam or powder and pressurized with nitrogen

may leave a harmful residue that reduces the likelihood of re-
ignition
Carbon dioxide (CO2) extinguishers
used for class B and C fires
do not work well on class A fires because they may not be able
to displace oxygen to put the fire out and the fire may re-ignite
do not leave a harmful residue
Electrical SafetyElectrical equipment must be maintained in
good working order and should be properly grounded.Inform the
client that any electrical equipment that the client brings into
the healthcare facility must be inspected for safety before it is
used.Check electrical cords and outlets for exposed, frayed, or
otherwise damaged wires and loose or missing parts.Do no
overload electrical circuits.Read warning labels on all
equipment; never operate unfamiliar equipment.Use safety-type
extension cords only when absolutely necessary, and secure
them to the floor with the use of electrical tape.
Electrical SafetyNever run electrical wiring under a
carpet.Never pull a plug by the cord; always grasp the plug
itself.Never use electrical appliances near sinks, bathtubs, or
other water sources.Always disconnect a plug from the outlet
before cleaning equipment or appliances.If a client sustains an
electrical shock, turn off the electricity before touching the
client.A malfunctioning piece of equipment must be removed
from the client’s vicinity, and the appropriate hospital
maintenance personnel must be notified
Electrical Safety

Electrical safety overview for home settings
To reduce the risk of electric shock, make sure that ground fault
circuit interrupter (GFCI) protection is provided for outlets at
kitchen counters, in bathrooms, and at outdoor receptacles; test
GFCIs regularly
Check the wattage of light fixtures and lamps to make sure they
are the correct wattage; incorrect wattage can cause overheating
that can lead to a fire
Use safety closures to "child-proof" electrical outlets
Many avoidable electrical fires can be traced to misuse of
electric cords, e.g., overloading circuits or extension cords,
running cords under rugs
Handling Hazardous and Infectious MaterialsNursing
ResponsibilitiesIdentify situations that involve the potential for
exposure to hazardous or infectious materials (e.g., radiation,
infectious wastes, contaminated needles).
Follow agency protocols for handling biohazardous and
infectious materials.
Ensure that nursing staff understand and follow these protocols.
Handle all infectious materials as hazards.
Dispose of waste in designated areas only, using the proper
containers for disposal.
Ensure that infectious material is labeled properly.
Dispose of all sharps immediately after use in a closed
puncture-resistant disposal container that is leak proof and
labeled or color coded.
Radiation Safety Precautions
Most nuclear medicine therapy clients are treated with
radioactive iodine-131 (I-131). Iodine-131 has a half-life of 8
days and emits both beta particles and gamma rays. Gamma rays

have properties like x-rays and present a potential external
hazard. Some clients may be undergoing implant therapy, where
a sealed source of radioactive material (usually a gamma
emitter) is placed in a body cavity close to the tumor.Use these
simple techniques to reduce the hazards associated with gamma
rays:
Mark the client's room with appropriate signage
Place client in a private room
Place wristband on client indicating that the client is receiving
internal radiation therapy
Put on shoe covers and protective gloves before entering the
client's room; remove equipment before exiting the room
Internal Radiation Implant Safety
Organize nursing tasks to minimize exposure to the radiation
source.
Rotate nursing assignments
Do not allow a pregnant nurse to care for the client.
Do not allow pregnant women or children visit the client.
Limit visitors to 30 minutes per day and warn them to remain at
least 6 feet from the source of radiation.
Keep all bed linens and dressings in the client’s room until the
implant is removed.
Keep a lead container in the client’s room.
Wear gloves

When handling secretions/excretions of a client receiving
systemic isotopes; flush toilet twice
When changing linens of clients receiving systemic isotopes
Plan care to minimize time at the client's bedside
Work quickly, but effectively and courteously
Maintain the greatest distance possible from the client
consistent with effective care
Restrict care to a maximum of 30 minutes to one (1) hour every
eight (8) hours
Prepare meal trays outside the room
Position items within client's reach so as to facilitate as much
self-care as possible
Schedule only one radioactive client to a nurse at a time
Ensure a long handled forceps and a lead container are in the
client's room in case of implant dislodgement
In the event that a source becomes dislodged, notify the
Radiation Oncologist
Do not attempt to handle the dislodged implant unless trained to
do so
Wear a dosimeter film badge to measure radiation exposure
while caring for client to monitor exposure; have it checked per
agency policy
Wear a lead shield to reduce the transmission of radiation.
No pregnant nurses, visitors, or children should be allowed near
the client
Read more about radiation safety on the Occupation Safety &
Health Administration (OSHA) Web site.

Poison control
High risk groups are young children and older adultsGoals of
therapies
before the body absorbs poison, remove it, (either through
vomiting or gastric lavage) or neutralize it (using activated
charcoal, for example)
give supportive care, i.e., manage shock, seizures, aspiration
give the correct antidote to neutralize poison
speed the elimination of any absorbed poison
Points to remember-Poisons
Never induce vomiting unless instructed to do so by a
poison center or health care provider. If you suspect someone
has taken poison, take the poisonous substance with you to the
emergency room. Call the local poison control center to
determine appropriate treatment for the specific poison.
Fall prevention
Assesses client for risk factors Use Guidelines to prevent client
fallsUse the mnemonic FRAIL MOM & DAD for assessing the
geriatric client in the primary care setting:
F alls
R elative or caregiver strain
A ctivities of daily living
I ncontinence

L iving situation
M emory Impairment
O culo-otic impairment (visual and auditory problems)
M alnutrition
D rugs
A dvance directives
D epression
ERGONOMIC PRINCIPLES FOR HEALTHCARE WORKERS
To prevent injury, the nurse needs to use good body mechanics
and observe ergonomic principles when providing care.When
planning to move a client, the nurse must assess the client’s
ability to stand, balance, transfer, and use assistive devices to
move about.The nurse needs to ensure that staff members
understand the principles of good body mechanics and use
proper body mechanics.The nurse needs to arrange for adequate
help and use mechanical lifting aids as much as possible.The
nurse should provide information to the client about the lift or
move and encourage the client to assist as much as possible.
When moving the client, the staff person with the heaviest load

coordinates efforts of the team involved by counting to three.
The staff person positions self close to the client (or object
being lifted).
The staff person keeps the back, neck, pelvis, and feet aligned
and avoids twisting; the arms and legs (not the back) are used,
and the knees are kept flexed and the feet kept wide apart.
The staff person sets (tightens) abdominal and gluteal muscles
in preparation for the move.
When transferring a client onto a stretcher, a slide board should
be used.
Ergonomic Principles for Healthcare Workers
Protect self from falls and injuries using correct body
mechanics
When moving objects, avoid pulling; push instead
When moving clients or objects
arrange for help
lift simultaneously with assistance or, better yet, use
mechanical aids
flex the knees
keep back, neck, pelvis, and feet aligned
widen the base of support, keeping feet apart
avoid twisting of the body
use arms and legs for lifting and moving, not the back
balance load and keep it centered on the
Incident Reports
An incident report is a form that is completed after an
unanticipated occurrence.This type of report is used as a tool
for identifying risk situations and improving client care.Other
terms for “incident” include unusual event, irregular

occurrence, and variance.
Nursing Responsibilities
Be aware of the situations that require completion of an incident
report.Follow specific agency guidelines for documentation.Fill
out the report completely, accurately, and factually.Contact the
client’s physician to report the incident; the physician will need
to complete the incident report and sign the report.Ensure that
the incident report form is not copied or placed in the client’s
record and that no reference to completing an incident report
form appears in the client’s record.Document a complete entry
in the client’s record regarding an incident. The incident report
is not a substitute for documentation of the event.When a client
injury occurs or an error in care is made, assess the client
frequently.
Home SafetyNursing Responsibilities Assess the home
environment, taking into consideration the client’s condition
and limitations; look for fire alarms, adequate lighting, stair and
bathroom handrails, and safe appliances.Initiate modifications
to the client’s home as necessary.Teach the client about safety
related to the client’s condition and with regard to any
equipment that the client is using (e.g., disposal of insulin
syringes).Teach parents about safety measures for the child; the
toddler, the preschooler, and the young school-age child must
be protected from accidental poisoning.
Home Safety

Ensure that parents understand car safety and the use of car
seats for the infant and child.
Ensure safety for older adults. Diminished eyesight and
impaired memory may result in accidental ingestion of
poisonous substances or an overdose of a prescribed medication;
a medication organizer will help prevent such errors.
The phone number for a poison control center should be
displayed on the telephone itself; the number should be called
in any case of suspected poisoning.
The nurse needs to provide instructions to laypersons about
interventions to take in the event of an accidental poisoning.
Diagnosis
Nursing diagnoses for patients with safety risk:
Risk for falls
Impaired home maintenance
Risk for injury
Deficient knowledge
Risk for poisoning
Risk for suffocation
Risk for trauma
INFECTION CONTROL
Definition
An infection is the result of an interaction between a susceptible
host and an infectious agent (bacteria, viruses, fungi, parasites)
; a clinical syndrome caused by the invasion and multiplication
of a pathogen in the body.
Infection

A. Types of infections1. Community acquired2.
Hospital acquired (also called nosocomial infections)
Health Care–Associated Infection Types of HAI infection:
Health Care–Associated Infection
Risk factors
Number of health care employees with direct contact with the
patient
Types and numbers of invasive procedures
Therapy received
Length of hospitalization
Major sites for HAI infection
Surgical or traumatic wounds
Urinary and respiratory tracts
Bloodstream
Nature of InfectionCommunicable disease is the infectious
process transmitted from one person to another.If pathogens
multiply and cause clinical signs and symptoms, the infection is
symptomatic. If clinical signs and symptoms are not present, the
illness is termed asymptomatic.Hand hygiene is the most
important technique to use in preventing and controlling
transmission of infection.

Stages of an infectious process
Incubation period
The time between entrance of the pathogen and the first
symptoms
Incubation periods vary with host and organism
If host defenses are successful, an infection may disappear
without progression to next stage
Examples of incubation periods for specific diseases
Mumps: 18 days
Varicella (Chicken Pox): 2 to 3 weeks
Prodromal stage
Time from onset of nonspecific findings, i.e., fatigue, malaise,
to more specific findings
The pathogen is multiplying
The host is most contagiousNot all diseases have prodromal
periods
Invasive phase (or period of illness)
When a person exhibits the specific findings of the disease
the host is trying to fight off the disease
Given unsuccessful host defenses, the invasive phase can
progress to death
Examples of findings for specific diseases
Mumps: swelling of the parotid glandCommon cold: sore throat,
congestion

Convalescence: when the acute findings begin to disappear and
the body returns to normal health
Complications of infection
Relapse - some infections may reactivate, often because they
were not treated thoroughly or the client did not comply with
treatment
Local complications - local infections may form abscesses
Systemic complications - pathogen may enter bloodstream and
cause septicemia
Defenses Against InfectionNormal flora: helps to resist
infection by releasing antibacterial substances and inhibiting
multiplication of pathogenic microorganisms.Innate
Defenses(born with): skin, mucous membranes,
WBCs(phagocytosis), interferon, etc
Chain of transmission
Causative agent (pathogen)
Reservoir
Portal of exit - way to get out of reservoir of host
Transmission route - way to reach susceptible host
Portal of entry - way to gain entrance

Susceptible host
After the pathogen enters the host, illness depends on 4 factors
Number of pathogen organisms
Duration of the exposure
Health status of host, including age, physical, mental, and
emotional health
Genetic status of host's immune system
Medical Asepsis
Referred to as "clean technique"
Any therapy, protocol or medical procedure used to reduce the
number and spread of microorganisms
Practices that reduce pathogens include:
Hand washing - the single most effective and important way to
prevent the spread of microorganisms
Friction - loosens the microorganisms so they can be removed
Soap - non-antimicrobial soap and water -or- with antimicrobial
soap and water if contact with spores, e.g., Clostridium difficile
or Bacillus anthracis
Medical Asepsis
No artificial fingernails or extenders, particularly if duties
include direct contact with individuals at high risk for
infections, e.g., ICU or operating rooms
Use of disinfectants and antiseptics on people and objects
Disinfectant - a substance that reduces the number of
microorganisms (but does not eliminate them)
Bleach solutions
Zephirin (and other quaternary ammonium compounds)

Medical Asepsis
Antiseptic - a substance that can be applied to skin to reduce the
number of microorganisms
Alcohol
Betadine®
Practices that interrupt transmission
Use of personal protective equipment (PPE)
Gloves
Gown
Mask with shield or goggles
Equipment, i.e., 1-way valve in CPR mask
Surgical Asepsis
Surgical asepsis includes the practices that destroy all
microorganisms and their spores
Steam under pressure
Gas
Radiation
Chemicals
Surgical Asepsis
Sterile technique involves procedures that keep an object or
area free from living organisms
A sterile object remains sterile only when touched by another
sterile object, or, in other words, sterile touching sterile remains
sterile
The skin cannot be sterilized and is, therefore, non-sterile
Surgical Asepsis

Surgical asepsis is used for many procedures, including
Care of surgical wounds, i.e., dressing changes
Catheterizations
Tracheostomy care
Suctioning
Surgery
Surgical Asepsis
Principles of surgical asepsis
Only sterile objects may be placed on a sterile field
Always hold your hands above the level of your elbows
Do not reach over the sterile field
The edges of a sterile field or container are considered
contaminated (depending on the resource, this is approximately
1 to 2 inches surrounding the border)
Surgical Asepsis
A sterile object becomes contaminated under the following
conditions:
Sterile touching clean becomes... contaminated
Sterile touching contaminated becomes... contaminated
Sterile touching questionable is... contaminated
A sterile object or sterile field that is not in the range of vision
is... contaminated
An object held below a person's waist is... contaminated
When a sterile object comes in contact with a wet, contaminated
surface, it is considered contaminated (through capillary action)
A sterile object becomes contaminated with prolonged exposure
to air

Standard precautions
used for care of all clients
used to prevent the spread of microorganisms
synthesizes the major features of universal precautions and
body substance isolation
universal (blood and body fluid) precautions - designed to
reduce the risk of transmission of bloodborne pathogens
body substance isolation - designed to reduce the risk of
transmission of pathogens from moist body substances
Apply to
blood
all body fluids, secretions, and excretions, except sweat,
regardless of whether or not they contain visible blood
non-intact skin
mucous membranes
Hand hygiene includes using an instant alcohol hand antiseptic
before and after providing patient care, washing hands with
soap and water when they are visibly soiled, and performing a
surgical scrub.
Handwashing is the act of washing hands with soap and water,
followed by rinsing under a stream of water for 15 seconds.
Personal protective equipment (PPE) - designed to reduce the
risk of transmission of microorganisms from both recognized
and unrecognized sources of infection in health care settings
gloves
masks
gowns

protective eyewear
head covering
Transmission-based precautions
Contact: direct and indirect
direct contact transmission: microorganisms are transferred
from one infected person to another person without a
contaminated intermediate object or person
indirect contact transmission: transfer of an infectious agent
through a contaminated intermediate object or person
(especially contaminated hands of health care workers)
gown and glove for all contact
examples of opportunities for contact transmission:
epidemiologically important organisms, e.g., VRE; excessive
wound damage; fecal incontinence
Droplet precautions: transmission involves contact of the
conjunctivae or the mucous membranes of the nose or mouth of
a susceptible person with large particle droplets containing
microorganisms generated from someone who either exhibits a
disease or who is a carrier of the microorganism
requires close contact (typically within 3 feet or less) between
the source client and a susceptible person
use of a standard surgical mask within 3 feet of the client is
required
respiratory droplets are generated when an infected person
coughs, sneezes, or talks, or during procedures such as
suctioning, endotracheal intubation, cough induction by chest
physiotherapy and cardiopulmonary resuscitation

examples of infectious agents transmitted through droplet route:
group A streptococcus (for the first 24 hours of antimicrobial
therapy), adenovirus, rhinovirus, Neisseria meningitis,
pertussis, influenza virus
Cough Etiquette
Cover your nose/mouth with a tissue when you cough, and
promptly dispose of the contaminated tissue.
Place a surgical mask on a patient if it does not compromise
respiratory function or is applicable; this may not be feasible in
pediatric populations.
Perform hand hygiene after contact with contaminated
respiratory secretions
Maintain spatial separation greater than 3 feet from persons
with respiratory infection
Airborne transmission: microorganisms dispersed over long
distances that remain infective over time and distance
infectious agents remain active in the air over a long period of
time and are dispersed over long distances by air currents,
which are inhaled by susceptible individuals
preventing the spread of airborne pathogens requires
the use of special air handling and ventilation systems
wearing respiratory protection with NIOSH-certified N95 or
higher level respirator for all health care workers
examples of microorganisms spread through airborne route:
rubeola virus (measles), varicella-zoster virus (chickenpox),
Mycobacterium tuberculosis

IMMUNIZATION
Acquired immunity
any form of immunity that is not “innate”
obtained during life
natural or artificial
naturally acquired immunity is obtained by
the development of antibodies resulting from an attack of
infectious disease
the transmission of antibodies from the mother through the
placenta to the fetus or to the infant through the colostrum
IMMUNIZATION
Artificially acquired immunity is obtained by
vaccination
injection of an antiserum, also called an immune globulin such
as a hepatitis immune globulin, after hepatitis exposure
Passive or active
passive immunity results from antibodies that are transmitted
through
the placenta to the fetus
the colostrum to an infant
injection of antiserum (immune globulin) for treatment or
prophylaxis
IMMUNIZATION
Passive immunity is not permanent and does not last as long as
active immunity
active immunity is when the body produces its own antibodies
as a reaction to exposure to an antigen

REFER TO IMMUNIZATION TABLES HANDOUT
Disease reporting
Reporting of nationally notifiable diseases
voluntary - to the Centers for Disease Control and Prevention
mandated (by legislation or regulation) - at the state levelThe
list of notifiable diseases varies from state-to-state, but
internationally quarantinable diseases, e.g., cholera, plague,
yellow fever, are reported in compliance with the World Health
Organization's International Health Regulations
Points to remember-Infection
Infection control with the use of standard precautions,
transmission precautions and medical and surgical asepsis
decreases the spread of infection.The major sites for nosocomial
infections are urinary and respiratory tracts, blood, and
wounds.All nosocomial infections that occur in hospitals must
be tracked and recorded by risk management.Hand washing is
the most effective method of preventing infection; friction is the
most important variable.Standard precautions are used for
contact with all body fluids (except sweat).Standard precautions
are used for all clients and transmission precautions are used for
all clients with transmittable organisms.Special (N95) respirator
masks are necessary to care for clients under airborne
precautions who have tuberculosis or other airborne infectious
conditions.Protective (neutropenic) isolation is used for clients
with immunosuppression and low white blood counts.Disease
reporting of "notifiable diseases" is mandated at the state level
(through legislation or regulation).

Points to remember-Infection
Use of isolation precautions (refer to the Centers for Disease
Control's Guideline for Isolation Precautions: Preventing
Transmission of Infectious Agents in Healthcare Settings for
more complete information)
Standard Precautions
Contact Precautions
Droplet Precautions
Airborne Precautions
DISASTER PREPAREDENESS
Overview of emergency preparedness and responseAn
emergency can be brought on by a disaster, which is any event
initiated by a person or by nature, or a combination of bothA
formal emergency preparedness plan of action is required to
respond to a disaster
personal and family preparedness plan
formal institutional plan
DISASTER PREPAREDENESSThe Federal Emergency
Management Agency (FEMA) identifies
four disaster management phases:
mitigation
preparedness
response
recovery
Three levels of disaster, ranging from minor (Level III) to major
(Level I)

Various rating systems exist and nurses should know and
understand the rating systems
treated first: individuals who have life-threatening injuries that
are readily correctable
treated last: individuals who have no injuries, or noncritical
injuries, and who are ambulatory, as well as individuals who are
dying or are dead
In the health care agency - emergency department triage
involves dividing those who need care into one of the following
three categories:
emergent – individuals who have life-threatening injuries and
need immediate attention are given the highest priority
urgent – individuals with non-life-threatening injuries
nonurgent – individuals with no immediate complications and
who can wait for treatment
Specific hazards associated with disastersBioterrorismChemical
emergenciesRadiation emergenciesMass casualtiesNatural
disasters and severe weatherRecent outbreaks and incidents,
e.g., salmonella

Bacterial agents
causative agent: Bacillus anthracis
exposure:
integumentary system (most common): direct skin contact with
spores; in nature, contact with infected animals or animal
products
respiratory tract: inhalation
gastrointestinal system: eating undercooked or raw infected
dairy products
oropharyngeal
Bacterial agents
exposed individuals do not spread infection
clinical indicators of anthrax infection: symptoms can appear
within 7 days of coming in contact with the bacterium for all
types of anthrax
skin: localized itching followed by papular lesions that turns
vesicular; becomes black eschar after 7 to 10 days
inhalation: initially low-grade fever, cough, malaise, fatigue,
myalgias, sweating, and chest discomfort but progressing to
high fever, respiratory distress, shock and death within 24 to 36
hours
Bacterial agents
treatment
decontamination
remove clothing; do not pull anything over the head
decontaminate in area outside of treatment area: using large
amounts of water, shower with soap or wash with soap and

running water; flush eyes with running water for 15 minutes
antibiotics
ciprofloxacin hydrochloride (Cipro), drug of choice
penicillin G procaine (Wycillin)
doxycycline (Vibramycin)
note: do not use extended-spectrum cephalosporins or
trimethoprim/sulfamethoxazole due to resistance of anthrax to
these drugs
Bacterial agents
vaccine available, but not to the general publicPlague
causative agent: Yersinia pestis
zoonotic infection carried on rodents and their fleas
Y. pestis destroyed by sunlight and dryness, although bacterium
can survive for 1 hour after release
exposed individuals can spread infection
Bacterial agents
disease states: bubonic plague, pneumonic plague and
septicemic plague
clinical indicators of pneumonic plague
rapidly deteriorating pneumonia
fever, chest pain, bloody or watery sputum
treatment: individuals with the plague need immediate treatment
or death will occur within 24 hours after the first symptoms
Bacterial agents
isolate exposed individuals
treat with antibiotics
streptomycin

gentamycin (Garamycin)
doxycycline (Vibramycin)
ciprofloxacin hydrochloride (Cipro)
supportive treatment: oxygen, IV fluids and respiratory support
are usually needed
f. vaccine: not available
Viral agents Smallpox
Viral agents
causative agent: variola virus
exposed individuals can spread infection via direct contact or
prolonged face to face contact
clinical indicators of smallpox disease
initially (sometimes contagious): high fever (101 to 104 degrees
Fahrenheit), malaise, head and body aches
rash (most contagious): start as small, red spots on the tongue
and mouth; the spots become open sores and then spread to the
rest of the body becoming pustules that crust and scab-over
individuals are contagious until all scabs have fallen off
Viral agents
Treatment
no specific drug treatment or cure
if the smallpox vaccine is given within 1 to 4 days after
exposure to the disease, illness may be prevented or be less
severe
individuals diagnosed with smallpox and everyone they have
had close contact with will need to be isolated
vaccine:

has not been given routinely in the U.S. since 1972
it is unknown how long immunity lasts after immunization
Viral hemorrhagic fever (VHF)
used to describe a severe multisystem syndrome caused by four
different families of viruses, including arenaviruses, filoviruses,
bunyaviruses, and flaviviruses
the vascular system is damaged and the body’s ability to
regulate itself is impaired
usually accompanied by hemorrhage, but this is not the life-
threatening aspect of these diseases
disease states include: Ebola, Marburg, yellow fever, Argentine
hemorrhagic fever
Viral hemorrhagic fever (VHF
the viruses are zoonotic, residing in and totally dependent on
their animal hosts
an animal reservoir host, e.g., rodents
arthropod vector, e.g., ticks, mosquitoes
Biological toxins (chemical agents)Sulfur mustard or mustard
gas (H, HD, or HT): a blister agent/vesicant
human-made chemical warfare agent
powerful irritant and blistering agent that damages the skin,
eyes, and respiratory tract

damages DNA
may smell like garlic, onions, or mustard
effects of sulfur mustard usually last 1 to 2 days in
environment, but can be present for weeks to months in a cold
climate
rarely fatal but potentially long term health effects
clinical indications of VHF
initially: high fever, muscle aches, weakness
severe disease: subcutaneous and internal bleeding, bleeding
from body orifices; shock, delirium, seizures, and coma
treatment:
supportive therapy
no effective treatment or cure
vaccine: vaccines only for yellow fever and Argentine
hemorrhagic fever
exposure to a vapor (released into the air), an oily-textured
liquid (released into the water), or to a solid form
clinical indications of exposure
skin: redness and itching immediately after exposure eventually
resulting in yellow blistering
eyes: irritation, pain, swelling, and tearing with mild to
moderate exposure; severe exposure can cause light sensitivity,
pain, or blindness lasting up to 10 days
respiratory tract: runny nose, sneezing, hoarseness, bloody nose,
sinus pain, shortness of breath, and cough
digestive tract: abdominal pain, diarrhea, fever, nausea,
vomiting

Post exposure treatment: remove sulfur mustard from the body
antidote: none
shower with soap or wash thoroughly with soap and running
water; flush eyes with running water for 15 minutes but do not
cover eyes with bandages
inhalation: leave area of exposure; get fresh air, provide
oxygen, and support breathing
Sarin (GB) nerve gas
human-made chemical warfare agent
clear, colorless, tasteless liquid that can evaporate into a
odorless gas
extremely toxic, acts very quickly
breaks down the enzyme acetylcholinesterase, which results in
excessive concentrations of acetylcholine in nerve synapses and
leads to overstimulation of parasympathetic nerves in the
smooth muscles
impairs normal functioning of nervous system
can cause seizures, loss of consciousness, and respiratory
failure in minutes
exposure via inhalation, ingestion, and/or absorption through
eyes and skin
clinical indications of exposure
low to moderate doses: runny nose, watery eyes, blurred vision,
drooling, cough and chest tightness, diarrhea, drowsiness,
weakness, headache, changes in heart rate and blood pressure

large doses: loss of consciousness, seizures, paralysis,
respiratory
Post-exposure treatment
post-exposure treatment
antidotes: soldiers typically have an antidote kit containing
these two medications
atropine (Atropine): binds to one type of acetylcholine receptor
on the post-synaptic nerve
pralidoxime chloride (2-PAM chloride): blocks sarin from
binding to any free acetylcholinesterase
decontaminate before transport to treatment facility
flush eyes first for 15 minutes
remove clothing (without pulling over the head) and shower
with soap and large amounts of water or 0.5 % solution of
sodium hypochlorite (bleach), or use absorbent powders such as
flour or talcum powder
Post-exposure treatment
do not induce vomiting if swallowed; administer activated
charcoal
note: can contaminate rescuers by direct contact or off-gassing
vapor of contaminated skin or clothing
supportive measures: maintain airway, assist ventilation, and
protect client; administer diazepam for seizure activity
Strychninea. the primary natural source: the plant
Strychnos nux vomicai. a strong poison; typically used to kill
ratsii. white, odorless, bitter crystalline powderiii. very
small amount able to cause extremely serious adverse effectsiv.

impairs functioning of neurotransmitters resulting in
severe, painful muscle spasms without affecting consciousness
Strychnine
exposure
injection (mixed with street drugs)
ingestion (food or water contamination)
inhalation (release into air, smoked or snorted in street drugs)
Strychnine
clinical indications of strychnine poisoning
initially or with low level exposure:
apprehension, agitation, painful muscle spasms
the client is conscious and in extreme pain
later findings or high level exposure: uncontrollable arching of
back and neck, hyperreflexia and muscle twitches, rigid
extremities, seizures, difficulty breathing, brain death
Strychnine
Post exposure treatment: most victims die of asphyxia before
reaching the hospital
no specific antidote exits
decontaminate in area outside of treatment area
remove clothing; do not pull anything over the head to remove
using large amounts of water, shower with soap or wash with
soap and running water
flush eyes with running water for 15 minutes

Strychnine
do not induce vomiting or give fluids to drink
supportive care
IV fluid resuscitation
cooling therapy for fever
anticonvulsants (diazepam, phenytoin, Phenobarbital),
antispasmodic agents and muscle relaxants
Ricin
a plant protein toxin derived from the beans of the castor plant
exposure: through air, food or water
in the form of a powder, a mist, a pellet
may also be dissolved in water or weak acid
Ricin
clinical indications: effects depend on whether it was inhaled,
ingested, or injected; death can occur within 36 to 72 hours of
exposure
inhalation: respiratory distress, fever, cough, nausea, chest
tightness; pulmonary edema
ingestion: vomiting and diarrhea that may become bloody;
dehydration; low blood pressure; may include hallucinations,
seizures and multi-system failure
skin and eye exposure: redness and pain
Ricin
post exposure treatment

treatment: get ricin off or out of the body as quickly as possible
no available antidote
decontamination
shower with soap or wash with soap and running water
thoroughly
flush eyes with running water for 15 minutes
Ricin
Inhalation:
leave area of exposure to get fresh air
provide oxygen and support breathing
Ingestion
do not induce vomiting; remain NPO
administer large dose of activated charcoal
gastric lavage
aggressive fluid resuscitation and electrolyte repletion
if necessary, medicate to control seizures and treat hypotension
Radiation emergencies
Causes of radiation emergencies
radioactive material contaminates food/water
a bombing or destruction of a nuclear reactor
exploding a nuclear weapon
nuclear weapon attack
radiation dispersal device (dirty bomb)
Contamination via

wounds
ingestion
inhalation
Severity of signs and symptoms of radiation sickness depends
on how much radiation has been absorbed
mild radiation sickness (absorbed dose of 1-2 Gy): nausea and
vomiting, headache, fatigue, weakness within 24 to 48 hours
after exposure
very severe radiation sickness (absorbed dose of 3.5-5.5 Gy):
nausea and vomiting less than 30 minutes after exposure to
radiation, dizziness, disorientation, hypotension; usually fatal
Treatment
get inside and stay in an undamaged building
decontamination
remove clothing and shoes
gently washing with soap and water
for damaged bone marrow:
filgrastim (Neupogen): a protein-based medication which
promotes the growth of white blood cells
pegfilgrastim (Neulasta): also increases white blood cells and
prevents subsequent infections

For internal contamination (chelating agents)
potassium iodide (KI): used to prevent absorption of radioiodine
in the thyroid gland
Prussian blue: a type of dye that binds to particles of
radioactive elements (cesium and thallium)
diethylenetriaminepentaacetic acid (DTPA): binds to particles
of the radioactive elements plutonium, americium and curium
supportive treatment for infections, headache, fever, diarrhea,
dehydration; end-of-life care
Mass casualties
Explosions or blasts can cause unique patterns of injury
primary: injury from over-pressurization force impact
secondary: injury from projectiles
tertiary: injury from displacement of victim by the blast wind
quaternary: all other injuries, i.e., burns, toxic exposures
Predominant injuries involve multiple penetrating injuries and
blunt traumaAll bomb events have the potential for chemical
and/or radiological contamination
Mass casualties
Treatment
lung injurieshigh flow oxygen sufficient to prevent hypoxemia
via non-rebreather mask, CPAP or ET tubeensure tissue
perfusion but avoid volume overloadprompt decompression for
clinical evidence of pneumothorax or hemothorax
abdominal injury: clinical signs can be subtle at first; observe
for acute abdomen or sepsis
ear injuries: tinnitus or deafness will warrant written
communication
admit 2nd and 3rd trimester pregnancies for monitoring

Mass casualties
crush injuries: sudden release of a crushed extremity may result
in reperfusion syndrome (acute hypovolemia, renal failure,
metabolic abnormalities)IV fluid replacement (up to
1.5L/hour)to help prevent renal failure: mannitol to maintain
diuresis at least 300 mL/hour; dialysis may be neededto treat
acidosis: IV sodium bicarbonate until urine pH reaches 6.5 (to
prevent myoglobin and uric acid deposition in the kidneys)
Mass casualtiesmonitor injured areas for the 5 P’s: pain, pallor,
parasthesias, pain and pulselessnessmonitor for sepsis
Natural disasters and severe weather
Clustered under this category are: earthquakes, extreme heat,
floods, hurricanes, tornadoes, tsunamis, volcanoes, wildfires,
landslides/mudslides, winter weatherTraumatic events following
natural disasters are characterized by a sense of horror,
helplessness, serious injury, or the threat of serious injury or
deathEmergency preparedness includes being ready for any type
of hazard
Mass casualties
injuries resulting in nonintact skin or mucous membrane
exposurehepatitis B immunization (within 7 days)tetanus toxoid
vaccine
Recent outbreaks and incidents, e.g., salmonella, E. coli ,
H1N1, melamine (in food products

REFERENCES FUNDAMENTALS OF NURSING POTTERATI
FUNDAMENTALS OF NURSING NCSBN HESI RESOURCES
Fire Extinguishers
Fire extinguishers are divided into four categories, based on
different types of fires for which they are used.
Category Uses
Class A Ordinary combustible materials, such as paper, wood,
cardboard, and most plastics
Class B Flammable or combustible liquids, such as gasoline,
kerosene, grease, and oil
Class C Electrical equipment, such as appliances, writing,
circuit breakers and outlets
Class D Chemical laboratories; for fires that involve
combustible metals, such a s magnesium, titanium,
potassium and sodium
Infection Type Examples
central nervous
system infections
meningitis, encephalitis
childhood & vaccine-
preventable
infections
chicken pox, diphtheria, tetanus, mumps (infectious parotitis),
pertussis
(whooping cough), poliomyelitis, rubella (also known as
German
measles), rubeola (measles)
gastrointestinal
infections
staphylococcal food poisoning, botulism
acute bacterial, viral
gastroenteritis

salmonella, gastroenteritis, viral hepatitis
hemolymphatic
infections
mononucleosis, cytomegalovirus, toxoplasmosis
respiratory infections influenza, tuberculosis, histoplasmosis,
pharyngitis, scarlet fever,
rheumatic fever, pneumonia
sexually transmitted
infections
gonorrhea, chlamydia, syphilis, genital herpes, chancroid,
AIDS, genital
warts
urinary tract infections cystitis, pyelonephritis

CHAPTER 2FUNDAMENTALS OF NURSING POTTERATI FUNDAMEN.docx

Recommended

Recommended

More Related Content

Similar to CHAPTER 2FUNDAMENTALS OF NURSING POTTERATI FUNDAMEN.docx

Similar to CHAPTER 2FUNDAMENTALS OF NURSING POTTERATI FUNDAMEN.docx (20)

More from walterl4

More from walterl4 (20)

Recently uploaded

Recently uploaded (20)

CHAPTER 2FUNDAMENTALS OF NURSING POTTERATI FUNDAMEN.docx