Deck 75: Emergency Preparedness: Bioterrorism and Management of Poisoning

Question 1

From what you learned in Chapter 14, identify the cholinergic antagonist used to treat organophosphate poisoning.

Answer 1

In organophosphate poisoning, the acetylcholine (ACh) accumulates due to the inhibition of "acetylcholinesterase (AChE) enzyme". The organophosphate poisoning is mostly caused due to exposure to insecticides or nerve agents.
Mechanism of action: The serine hydroxyl residue on AChE is phosphorylated by organophosphates, which inactivates the AChE. AChE plays a critical role in nerve functioning. The irreversible blockage of AChE leads to accumulation of acetylcholine and thus results in overstimulation of muscle.
The neurotoxic affects associated with organophosphate poisoning include cholinergic syndrome, intermediate syndrome, organophosphate-induced delayed polyneuropathy (OPIDP), and chronic organophosphate-induced neuropsychiatric disorder (COPIND).
The cholinergic syndrome is caused due to acute organophosphate poisoning. The symptoms of this condition include miosis, sweating, respiratory difficulties, shortness of breath, slowed heart rate, cyanosis, vomiting, diarrhea, etc.
Atropine is a non-selective and reversible antagonist of muscarinic acetylcholine receptors. Atropine sulfate along with an oxime is used to combat the effects of the acute organophosphate poisoning that lead to cholinergic syndrome. Thus, it is classified as an anticholinergic drug.
Hence, to reverse the effects of organophosphates, atropine is used.

Question 2

Remember the nurse manager "Carol Boler" at the beginning of the chapter? Now read the remainder of the case study. Based on the information presented within this chapter, respond to the critical thinking questions that follow.

As an emergency department nurse in a busy urban hospital, Carol Boler participates in frequent emergency practice drills to be prepared for mass casualty events and acts of bioterrorism. Although there have been no incidents yet, she knows that with a military base nearby, there is a chance that such an incident could occur. She is working with unit staff to plan a series of staff education meetings to discuss bioterrorism threats.
Discuss the mode of transmission and symptoms associated with Y. pestis exposure.

Answer 2

Yersinia pestis is a gram negative, non-motile, rod-shaped, anaerobic infectious bacterial strain that can infect both humans and animals. It causes the disease called bubonic plague. It was discovered in the year 1894 by Alexandre Yersin. It acts by suppressing and avoiding normal immune system responses such as phagocytosis and antibody production.
The different modes of transmission of Yersinia pestis are as follows:
• Inhalation of aerosolized droplets
• Flea bite
• Direct contact (rarely)
Plague is mainly transmitted by rodents, especially, the rats. The symptoms of the disease include fever with chills, severe abdominal pain, muscle ache, diarrhea and vomiting, bleeding from the mouth, rectum or nose, gangrene, and lethargy.

Question 3

As a school nurse, you have been asked to speak to a group of mothers about accidental poisonings in young children.
Outline the information you need to present to this audience.

Answer 3

Accidental poisoning is a condition in which the individual causes harm to their body unknowingly and unwantedly. This condition is mostly seen in young children as they are enthusiastic and try to recognize the things by keeping them into their mouth.
Accidental poisoning in young children may occur due to a number of factors, which includes ingestion of drugs, household cleaning compounds, cosmetic, etc.
The following are the some of the practices that help in prevention of poisoning and to decrease the severity of poisoning.
• Keep all the drugs reach out of children
• Remove the cloths and flush the skin of the cloths, which is contaminated
• Administer the adsorbents such as charcoal to decrease or prevent the absorption,
• Do not administer ipecac syrup
• Make a call to an emergency health care unit or a poison control center
• Try to identify the exact cause of poisoning
• Allow the patient to have fresh air
• Do not induce vomiting by tickling at the back of the throat

Question 4

From what you learned in Chapter 49, name the antibiotic class to which ciprofloxacin belongs and describe its mechanism of bactenocidal action.

Question 5

Remember the nurse manager "Carol Boler" at the beginning of the chapter? Now read the remainder of the case study. Based on the information presented within this chapter, respond to the critical thinking questions that follow.

As an emergency department nurse in a busy urban hospital, Carol Boler participates in frequent emergency practice drills to be prepared for mass casualty events and acts of bioterrorism. Although there have been no incidents yet, she knows that with a military base nearby, there is a chance that such an incident could occur. She is working with unit staff to plan a series of staff education meetings to discuss bioterrorism threats.
When discussing the bioterrorism threat with a group of staff nurses, which informatron regarding smallpox should be included?

Question 6

As a school nurse, you have been asked to speak to a group of mothers about accidental poisonings in young children.
What recommendations should you give to the group about the use of ipecac syrup?

Question 7

From what you learned in Chapter 67, describe the therapeutic use of 1-131 in treating thyroid disease.

Question 8

Remember the nurse manager "Carol Boler" at the beginning of the chapter? Now read the remainder of the case study. Based on the information presented within this chapter, respond to the critical thinking questions that follow.

As an emergency department nurse in a busy urban hospital, Carol Boler participates in frequent emergency practice drills to be prepared for mass casualty events and acts of bioterrorism. Although there have been no incidents yet, she knows that with a military base nearby, there is a chance that such an incident could occur. She is working with unit staff to plan a series of staff education meetings to discuss bioterrorism threats.
Identify the nursing assessments and interventions that the nurse should initiate when a patient is exposed to anthrax.