Bioterorism—are you ready for the silent killer? - Home Study Program

AORN Journal,  Sept, 2002  by Kristina Stillsmoking

• E-mail
• Print
• Link

HEALTH ASSESSMENT

Obtaining certain information from a suspected exposed patient allows caregivers to be better prepared to understand the possibility of an escalating crisis situation and treat the patient quickly. Nurses need to be aware of the heightened possibility of a biological threat, whether it is natural or planned, so an epidemic can be recognized early and possibly averted. If a patient has a suspicious diagnosis, the facility's infection control officer and local public health department should be alerted immediately for consultation and direction. Perioperative nurses should be alert to the following items when doing preadmission paperwork.

* Possibility of exposure--Has the patient experienced any suspicious smells, powders, funny tasting foods, or unusual cloudiness not related to cigarette smoke during a public event? Has the patient recently traveled to another state or outside the country?

* Allergies--Does the patient have medical allergies that might manifest as symptoms that could confuse the diagnosis of the presenting complaint? This information will aid in determining chemical therapy to be used during treatment.

* Medical examination--Does the patient present with any unusual lesions or pustules on his or her trunk or extremities? How long has the patient had them? Is the patient having difficulty breathing and why? Does the patient exhibit any flaccid paralysis, and has he or she coughed up bloody sputum? What was the patient's general health condition before this visit?

* Past medical history--Have past visits outside the country affected the patient's health? Does the patient have a history of immunocompromise disease?

* Laboratory findings--Do the laboratory tests and findings show the need for further follow-up to differential diagnose from possible exposure history?

STEPS TO TREATMENT

As in the treatment of any compromised patient, management of the airway, breathing, and circulation should be instituted immediately, along with standards for decontamination and treatment of a creditable exposure. Airway adjuncts should be implemented depending on assessment of the patient's symptoms or complaints. Breathing support should be initiated via endotracheal intubation and ventilator support or nasal/mask oxygen. The patient's circulation should be supported through chemical therapy, fluid challenge, or chest compressions. Decontamination should be completed as deemed necessary by the presenting history and physical evidence and should include clothing. Usually the facility's infection control officer and the public health department will be involved at this level too. Caregivers should follow their hospital disaster preparedness policies and procedures. Medications and chemical therapy will be determined by the presenting history, physical complaints, differential laboratory and imaging diagnosis, and the patient's past history. It may take several hours to several days to make a solid diagnosis due to the confusion of presenting signs and symptoms that are similar to everyday flu.