Nursing Care W/ Medical Effects Of Nuclear, Biological, And Chemical Agents

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radiation is found in

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foods, sunlight, cigarettes, etc

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acute radiation syndrome is

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an acute illness which follows a roughly predictable course over a period of time ranging from few hours to several wks after exposure to ionizing radiation

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exposure of more than 1000 REMS causes ...

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rapid onset of symptoms, 100% mortality in 72 hrs

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the 4 important factors that leads to sx with acute radiation syndrome are

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high dose, high dose rate, whole body exposure, penetrating radiation

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whole body exposure is

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explain later

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sx associated w/ GI radiation exposure are

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damages intestinal liniing so causes
N&V w/in the first 2-4 hours, diarrhea, associated w/ sepsis and opportunistic infections

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the priority tx for radiation exposure

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are the ABC's

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time needed for bone marrow to start working after an acute radiation exposure is called

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hemopoetic recovery

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an electrolyte used as an emergency tx to keep the thyroid from absorbing radiation is

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potassium iodide

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epogen is used to

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stimulate RBC production after acute radiation exposure

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human leukocyte antigen

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a genetic test to help determine possible bone marrow donors (post radiation exposure)

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b/c there is no antidote for radiation exposure, tx is usually

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supportive

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early sx such as N&V, bloody diarrhea, increased ICP, and microvascualr leaks are____

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an indication of the severity of the radiation dose

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how big is the risk of medical personnel being exposed to radiation via contaminated PT's

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minimal

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measures to minimize radiation exposure therefore radiation complications are

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time, distance and shielding

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When is the best time to perform a surgery on PT w/ acute radiation exposure

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first 24-48 hrs

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what is the best way to determine the avaliability of WBC, RBC, and platlets after radiation exposure

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CBC

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what specimens are collected to determine exposure to radiation

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urine and feces

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geiger counter

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test used to determine the amount of external radiation contamination

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type and screen determines

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bone marrow donors for transplant r/t radiation

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lab values needed to support the tx of bloody diarrhea and other coagulation problems

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PT, PTT, INR

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three types of radiation

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alpha beta and gamma rays

(x rays are often classified as well)

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REM

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The amount of damage that is suspected from a particular type of radiation dose

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3 ways radiation can be absorbed

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external irridation, contamination w/ radioactive materials, & incorporation of radioactive material into body cells, tissues and organs

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time range that radiation damage can occur

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seconds to years

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four classes of chemical agents

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nerve, vesicants, cyanide (blood), and pulmonary

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the ablility of an agent to vaporize or evaporate and form a gaseous vapor

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volatility

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the ablility of an agent to persist as a liquid, contaminate terrain and material

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persistance agent

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one of the most common neurotransmitters

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ACH

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Nerve agents

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the class of chemicals called organophosphates--have a physiological effect similar to insectisides

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the most toxic of all posion agents are

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nerve agents

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S&S of nerve agetns

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increased secretions, saliva, tears runny nose, secretions in airways, GI tract, sweating

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atropine, 2-PAMcl, diazepam

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3 antidotes (tx ) for nerve agents

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antagonizes mucarinic effects, dries sevretions, relaxes smooth muscles, and should be given IM, IV, or ETT

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atropine

(except if hypoxic, then given IM)

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decreases seizure activity, seizure induced brain injury---give to severly intoxicated PTS whether convulsing or not

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valium (diazepam)

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vesicant agents aka

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blistering agents

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S&S of vesicant agents

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resp failure (r/t airway injury), sepsis (r/t bone marrow damage), decreaesd WBC, impaired immune system

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sulfer mustard, poision Ivy, industrial chems, cancer chemotherapeutics and sunlight are

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types of vesicants that cause blistering

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tx for vesicants are

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bronchodilators, antibiotic PRN, PEEP or CPAP.

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most common vesicant

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Mustard sulfur/gas--systemically toxic; similar to radiation-

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blood agent aka

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cyanide agent

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blood agents damage cells by binding to ___ in the ____ preventing cells from using ____

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Fe+, mitochondria, O2

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classic symptom seen in cyanide exposure

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cherry red skin (flushed)

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tx for cyanide exposure

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amyl nitrite/soduim nitrite
sodium thiosulfate,
O2
hyperventilate
Bicarb and IV fluids

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classic pulmonary agent

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phosgene

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easlily absorbed in mucuous membranes, eye/airway irritation, dyspnea, depayed pulmonary edema

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S&S of phosgene

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smell of newly mown Hay

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phosgene

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tx for pulmonary edema after phosgene exposure is

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steriods

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tx for pulomary agent (phosgene) exposure

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bronchodilators
Vent w/ PEEP

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Has a great need for de-contamination
when possible should be done simultaneously with antidotes and airway support

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liquid agent exposure

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antibiotics used to tx anthrax

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cipro, doxycycline, and PCN

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initial onset of sx = flu like

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inhalation anthrax

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three types of anthrax exposure

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inhalation
cutaneous
GI

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onset of a vesicle,
then central necrosis
progresses to black eschar

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cutaneous antrax