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Hesi case study: Natural Disaster in a small community Need a SOAP or SBAR note on this case study Meet the Client: Montcalm CountyMontcalm County is a small county on the western coast of the United States with a population of 30,000 citizens. Registered nurses (RNs), licensed practical nurses (LPNs) and advanced practice registered nurses (APRNs) are employed in a variety of settings throughout the community and play a vital role in the development and coordination of the county’s emergency plan. The nurses in this county work collaboratively with one another and other healthcare professionals on the Disaster Management team to respond to the community’s needs in the event of a natural disaster or a mass casualty incident. Planning Jennifer Allen is an RN and nurse manager for the Montcalm County Health Department. One of her primary responsibilities includes the continuous development of the county’s emergency preparedness plan, which follows the principles of disaster management: prevent occurrence of disaster when possible minimize casualties prevent further casualties rescue victims provide first aid evacuate the injured provide definitive medical care promote reconstruction of lives Jennifer Allen, RN holds quarterly education sessions with the county’s volunteer first responders to teach basic first aid and triage. Jennifer continues to update the emergency preparedness plan, which includes four phases of disaster management. Jennifer shares the Montcalm County Emergency Preparedness Plan with the area schools. A Montcalm County school nurse, Jodie Stone, RN, prepares to teach an education class on family disaster planning to the Parent Teacher Organization (PTO). The school nurse successfully implements disaster drills with the students, and they practice safe evacuation routes from the building as one part of the drill. Bryan is the first responder to arrive at the scene because he lives in the downtown area. After helping the pregnant woman find a safe place to sit, Bryan carefully enters the collapsed area of the building. He sees an elderly woman inside the rubble; she is nonresponsive and has no respirations. Bryan attempts to open the woman’s airway, but he is unsuccessful. He codes her as black and moves on to the next victim. Bryan assesses a young boy who is surrounded by debris and lying face down, unconscious, with a large beam across his upper back. He is pale and cool to touch with respirations of 8 breaths per minute and a pulse of 42 beats per minute. Community Resources During a disaster, a team of multidisciplinary members, many of whom are in the healthcare profession, respond to the crisis situation. Representatives from the American Red Cross (ARC) arrive at the scene of the collapsed apartment building. Kayla coordinates the food and water supply and mobilizes the volunteer shelter for nurses to assess current health needs for shelter residents. Medication Administration The ARC shelter is providing residence for 24 clients. Residents arriving at the shelter have not been injured, but many were not able to gather their prescription medications prior to leaving the apartment building. The client receives his insulin and a meal. His blood glucose decreases to 130 mg/dL that evening. Home Health Vanessa McBrayer, RN is a home healthcare nurse in Montcalm County. Her primary objective is to allow individuals to stay at home while receiving a variety of healthcare services that would otherwise require hospitalization. Vanessa is in the home health office preparing for her daily visits when the initial impact of the earthquake is felt. Vanessa and the other home care nurses prepare to institute the home care emergency response plan. Vanessa is assigned a group of clients to contact. Fortunately, the telephone is working in most areas of the county. She is able to reach all but four of the clients or their emergency contacts to ensure they are safe. Delegation and Assignment Douglas, an RN, is the charge nurse for the telemetry unit at Montcalm County Hospital. He was at home enjoying his first day off in 5 days when the impact of the earthquake struck. Douglas makes sure his family is safe, then he drives to the hospital, where he is needed. According to the emergency response plan, one of Douglas’ duties is to utilize available personnel to their full capacity. The student nurse assists with a client’s discharge, and the charge nurse calls housekeeping to prepare the room for another client being admitted to the telemetry unit from the ED. The client admitted to the telemetry unit reported an onset of chest pain during the earthquake. The client has been scheduled for a cardiac catheterization, but the catheterization lab is currently full. Self-Care Douglas feels stress from the hectic atmosphere and the trauma of the day. At times he feels like he wants to cry. Douglas briefly discusses his feelings with the counselor and is surprised to find he feels better. Case Outcome The nurses and other healthcare professionals in Montcalm County continue their recovery efforts. They know that it may take months for community members to heal physically and psychologically. Damaged physical structures will need to be rebuilt, and the community will need to work together to continue revising the emergency preparedness plan based on the evaluation of the response to this disaster.
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