Nur 113: DISASTER NURSING

STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR

Session # 10

LESSON TITLE: Infectious Disease Emergencies and Materials:

Coronavirus (Covid-19)
Book, pen and notebook
LEARNING OUTCOMES:
Upon completion of this lesson, the nursing student can: References:

1. Describe the relationships between emergencies and Veenema, T.G. (2019) Disaster Nursing and
infectious diseases. Emergency Preparedness for Chemical,
2. Identify factors contributing to emerging or resurgent Biological, and Radiological Terrorism and other
infections. Hazards 4th Edition
3. List of infectious diseases of high concern.
4. Explain the epidemiological triangle. https://www.cdc.gov
5. Discuss the cause of Covid-19. https://www.who>Diseases
6. Describe the clinical manifestations for Covid- 19.
7. Identify preventive measures for decreasing the
transmission of Covid -19.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: What are the three classifications of burns?

MAIN LESSON (40 minutes)

Infectious Diseases
❖ A major cause of global morbidity and mortality after causing or associated with large scale public health
emergencies. Ninety deaths are caused by only six diseases.
percent of all infection diseases.
Emergencies
❖ Are caused by infectious conditions may occur as the primary event, or a secondary
challenge following or worsening another type of emergency.

The emergence or resurgence of an infectious disease requires the convergence of complex factors
that can be:
• genetic and biological
• physical
• ecological,
• Social
• Political
• behavioral in nature.

Infectious Diseases and Emergencies: Infectious diseases that increase in incidence and prevalence, possibly to the
point of epidemic, pandemic, or emergency, can be classified as being in one of three groups:

■ Emerging—infections that have newly appeared in a human population and have not been previously known,
such as SARS or new strains of avian influenza
■ Reemerging or resurging—infections that have been known but demonstrate a marked increase in incidence or
geographical range, such as the enormous surge of Ebola in West Africa

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 ■ Deliberately emerging—natural or bioengineered agents distributed by individuals as a criminal act of
bioterrorism, such as the anthrax cases in the United States in the fall of 2001

Leading Causes of Infection Disease Death according to WHO in 2017

■ Diarrheal disease
■ HIV/AIDS
■ Malaria
■ Childhood diseases, primarily measles
■ Pneumonia
■ Tuberculosis
■ Hepatitis B

EPIDEMIOLOGICAL TRIANGLE

❖ A model for explaining the organism causing the disease and the condition that allow it to reproduce and spread.

Made up of 3 parts:

1. Agent- the microorganism that actually causes the disease

2. Host- the organism that carries the disease, a human who is susceptible to the disease
3. Environment- factors that support the transmission

FACTORS CONTRIBUTING TO THE SPREAD OF INFECTIOUS DISEASES:

• Microbial adaption and change
• Human susceptibility to infection
• Climate and weather
• Changing ecosystem
• Human demographic and behavior
• International travel and commence

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 • Technology and industry
• Breakdown of public health measures
• Poverty and social inequality
• War and famine

Diseases of particular Importance to address in disaster and emergency planning and response activities are
those that are known to be:
1. Highly contagious
2. Have high mortality rate
3. To which there is no or limited human immunity coupled with either a no available treatment or treatment to which
the organism is resistant

6 Conditions of Particular Importance:

1. Cholera
2. Dengue fever
3. HIV
4. Influenza
5. Marburg hemorrhagic fever
6. Smallpox

CLINICAL PROFILE of CHOLERA

Transmission Clinical Symptoms Diagnosis Therapy

Exposure to drinking water or
food contaminated by feces
of an infected individual
Direct person-to-person
transmission unlikely
Mild infection, little or mild Symptomatic, with definitive Immediate fluid and
gastrointestinal distress diagnosis based on electrolyte
laboratory examination of replacement, with
stool specimen oral rehydration
solution in large
amounts
Severe disease (~5% of Intravenous fluid
cases), profuse, watery and electrolyte
diarrhea, vomiting, leg replacement may
cramps. Intravenous fluid and be needed in
electrolyte replacement may severe cases
be needed in severe cases

Death can occur within hours

if severe disease not treated

CLINICAL PROFILE of DENGUE FEVER

Transmission Clinical Symptoms Diagnosis Therapy
Between • MILD: Principal symptoms are • Clinical symptoms Fever management
people via high fever and at least two of the • Lab tests: early: 1–5 (acetaminophen
mosquitos following: days (virus, viral nucleic only, NO ibuprofen or
• Severe headache with pain acid, antigens) aspirin-containing
behind the eyes • Lab tests: later: after day medications)
• Arthralgia 5 (antibodies) • Fluid management
• Muscle and or bone pain • Differential diagnosis: • Close monitoring
• Rash yellow fever, Japanese for progression to
• Mild bleeding (gums, petechiae) encephalitis, St. Louis warning signs which
• Low white blood cell count encephalitis, Zika and signal severe dengue
• SEVERE: Any of the following West Nile virus
symptoms • During a confirmed
require emergency medical large-scale outbreak,

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 attention. Usually progresses after diagnosis is made
a 2–7-day febrile phase: by clinical signs and
• Severe abdominal pain symptoms
• Red spots on the skin
• Bleeding from nose or gums
(heavy)
• Vomiting blood or black, tarry
stools
• Drowsiness or irritability
• Pale, cold, clammy skin
•Difficulty breathing

CLINICAL PROFILE of HIV/AIDS

Transmission Clinical Symptoms Diagnosis Therapy

Exposure to causal agent
(the HIV retrovirus)
through blood or semen of
infected individual (sexual
activity or sharing injection
equipment most common
routes)
• Maternal infection of fetus
during pregnancy
• Shortly after initial Identification of antibodies Antiviral medication
infection, flu-like through screening test to keep
symptoms possible confirmed through viral load low and
• Impaired immune diagnostic laboratory test support immune
response leads to and assessment of viral function
vulnerability to load • Treatment
opportunistic infections, • Monitoring of viral load guidelines are
which if untreated, may allows for adjustment of regularly updated by
cause death therapy national and
international health
authorities
• Prompt treatment of
Opportunistic
infection, if it occurs
• Use of prophylaxis
during pregnancy/
delivery or
immediately after
occupational
exposure markedly
reduces infection of
newborn or worker

CLINICAL PROFILE of INFLUENZA

Transmission/Isolation Clinical Presentation Diagnosis Therapy
• Transmission between • “Influenza-like” symptoms: • Viral culture Oseltamivir and
persons is due to inhaled • Fever • IFA Zanamivir are both
droplets from infected • Cough • Serologic studies thought to be
individual, once disease is • Sore throat • PCR effective in
in human population • Myalgia treatment and
• Hospitalized patients • Possibly: prevention
are isolated in negative • Pneumonia
pressure rooms to • Severe respiratory disorder, viral
minimize transmission pneumonia
• Atypical presentations:
• Nausea/vomiting
• Diarrhea
• Acute respiratory failure

CLINICAL PROFILE of MARBURG HEMORRHAGIC FEVER

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 Transmission/Isolation Clinical Presentation Diagnosis Therapy

• Human-to-human • Fever • ELISA Supportive Therapy

transmission is possible • Cough • PCR
through bodily fluids, including • Headache • IgG capture ELISA
those of • Conjunctivitis if patient has
the deceased • Petechial rash (primarily truncal) recovered
• Natural reservoir of the • Shock • Viral culture during
disease remains • Liver failure the acute phase
uncertain • Hemorrhaging
• Isolate in negative pressure • Multisystem dysfunction
room
• Universal precautions with N-
95 or HEPA
Mask when giving care

CLINICAL PROFILE of SMALLPOX

Transmission/Isolation Clinical Presentation Diagnosis Therapy

Prolonged, face-to-face • Initial symptoms (2–4 days): Symptomatic, with No specific

contact with the infected • Fever (101–104 degrees) careful attention treatment:
person throughout the • Malaise to distribution and • Supportive
symptomatic period until • Head/body aches appearance of rash therapies only
all scabs have fallen off • Rash stages: • Confirmation with
• Direct contact with bodily • Mouth and tongue (4 days) PCR and viral isolation
fluids or contaminated • Pustular rash, Cover body within
bedding/clothing 24
hours
• Distinguished by bumps in
center of
raised bumps (~10 days):
• Scabbing and resolution (~10
days)

One Health is defined as a collaborative, multisectoral, and transdisciplinary approach—working at the local, regional,
national, and global levels—with the goal of achieving optimal health outcomes recognizing the interconnection between
people, animals, plants, and their shared environment

CORONAVIRUS (COVID -19)

❖ The abbreviated name for novel coronavirus disease 2019, which is a respiratory illness that spreads from person
to person. The virus that causes Covid -19 is a novel coronavirus which was first identified during an investigation
into an outbreak in Wuhan, China. (CDC)
❖ Reported illnesses have ranged from mild symptoms to severe illness and death for confirmed Covid 19 cases.
❖ Symptoms may appear 2-14 days after exposure and include:
Most common symptoms: fever, dry cough, tiredness
Less common symptoms: aches and pain, sore throat, diarrhea, headache, conjunctivitis, loss of taste and smell,
a rash or skin or discoloration of fingers and toes.
Serious symptoms: difficulty of breathing, chest pain, loss of speech or movement

Outcomes:
Symptoms are usually mild and began gradually with some individuals asymptomatic up to 80% of the general
population who are infected recover wit out any need to seek care. Some will develop severe illness (typically in the 2 nd
week of illness). Just as with influenza and other viral infections, older adults and patients with medical problems like
cardiovascular diseases, diabetes, chronic respiratory diseases, and cancer are at increased risk to develop severe

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illness (CDC). Fortunately, it appears that children who are infected with this illness generally present mild symptoms and
severe complications appear.
Seek immediate medical attention if there is severe symptoms. Always call before visiting a doctor or health facility.
People with mild symptoms should manage their symptoms at home.

Some Strategies to Prevent the Spread of Covid 19:

Hand Hygiene: Wash hands with soap and water for at least 20 seconds: before and after contact with clients,
after blowing nose, coughing, or sneezing, after coming from bathroom, before eating, after touching with
contaminated surfaces or equipment and after removing protective personnel protective equipment (PPE).
Facial hygiene: Avoid touching the eyes, nose and mouth. When coughing or sneezing cover with tissue then
throw the tissue in the trash.
Keep it Clean: Clean and disinfect frequently touched objects and surfaces with approved hospital disinfectant
(such as beds, wheelchairs, remote controls, switch)
Monitor Residents and Prepare Yourself: Restrict residents with fever or acute respiratory symptoms to their
room. If they must leave the room for medically necessary procedures, have them wear a face mask.
Sick Restrictions: As with all situations, health care professionals who are ill should stay at home and seek
healthcare advice through the primary healthcare provider.
During a” community spread” Covid 19 event, direct patient care staff will be assessed for illness or fever by
nursing mangers or supervisors before ‘shift start’ time to ensure patent safety. Expect to include a checking of
regular temperature to ensure the clinical staff does not have an active fever.
During a community spread event of Covid 19 visitor access will be restricted by several different measures which
include:
• Posting of warning signs and “Stop” signs outside the facility to describe the current policies for
allowing visitors.
• If visitors are allowed, a screening method that are accounts for the individuals’ exposure risk and if
they are experiencing symptoms of illness.

Diagnosis:
❖ Most patients with confined Covid 19 have developed fewer symptoms of acute respiratory illness which may
include cough and difficulty of breathing.

Epidemiologic factors that may help guide decisions to whether to test include:
• Any persons, including healthcare workers who have close contact with a laboratory confined Covid 19
patient within 14 days of symptom onset.
• Or a history of travel from affected geographical areas within 14 days of symptom onset.

Precautions for Protection:

Droplet isolation: Recently updated CDC guidelines have downgrades Covid 19 from airborne precautions to now
droplet precautions. However, there are some scenarios that call for the use of airborne precautions.
• Covid 19 patients (Non respiratory Treatments)
During all lower risk (Non respiratory treatments) utilize droplet precautions. This includes the utilization of
surgical masks, eye protection, gowns and gloves for patients suspected or confined to have been
infected by Covid 19.
• Covid 19 (Respiratory treatments)
Respiratory treatments that may lead to aerosolization of viral particles include nebulizers, suctioning,
tracheostomy care and application or adjustment of oxygen masks.
If a patient is suspected or confined Covid 19 and has a respiratory treatment that increase the chances
of aerosolization, it is recommended that staff prioritize the use of N95 mask.
Isolate Precaution for Protection/ Quarantine Room: As most non hospital facilities are likely to have airborne
isolation rooms or negative pressure rooms, it is recommended that the individual should be placed in a single
room with closed door (CDC, WHO).

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CHECK FOR UNDERSTANDING (10 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 10 minutes for this activity:

Multiple Choice
1. What are the common symptoms of Covid 19?
a. A new and continuous cough
b. fever
c. tiredness
d. All of the above
ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
2. How is Covid-19 passed on?
a. Through droplets that come from the mouth and nose when sneezes, cough or breathes out.
b. By drinking unclean water
c. In sexual fluids, including semen, vaginal fluids and mucous.
d. All of the above

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. The most effective way for healthcare providers to protect themselves, their family and their patients from
influenza is to:
a. Wear a surgical mask at all times at work.
b. Stay at home if they have respiratory symptoms.
c. Get an annual shot and encourage their family, co-workers and patients to get the flu-vaccine annually.
d. Not to go to work at all.

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. What is the most important hygiene habit to teach young children?

a. Wash hands frequently
b. Use tissue to cover nose when sneezing
c. Take a bath daily
d. Don’t share glass or eating utensil
: ANSWER: ____________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. It is a model for explaining the organism causing the disease and condition that allow it to reproduce and spread.
a. One health
b. Nursing care plan
c. Chain of infection
d. Epidemiological Triangle

ANSWER: ________
RATIONALE:_______________________________________________________________________________
__________________________________________________________________________________________
_________________________________________________________________________________________

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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.
1. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
2. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
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_____________________________________________________________________
5. ANSWER: ________
RATIO:_______________________________________________________________________________________
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_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Activity: Minute Paper

1) What was the most useful or the most meaningful thing you have learned this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
2) What question(s) do you have as we end this session?
_________________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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