4-7. Nursing Services
Providing nursing care in a hospital without CPS is influenced by the amount of protective gear worn by the nursing staff and the patients. The patients may be in their MOPP gear, in a PPW, or wearing only their protective mask; any of which will interfere with care. The nursing staff will wear the same level of protection as the patients.
a. Direct assessment of a patient's vital signs is extremely limited at MOPP Levels 3 or 4; however, a carotid artery pulse can be taken by palpating the neck area. The patient's respiratory rate and level of consciousness may be assessed visually. Palpitation of the blood pressure through a PPW may be possible if it is relatively strong, or at least in the normal range. The patient's temperature cannot be monitored; this is an area of concern due to the possibility of heat stress.
b. Only gross neurological signs can be assessed through the PPW or when the patient is in MOPP Levels 3 or 4. However, even this assessment is complicated by the presence of miosis and by the health care provider's mask. Urinary output and cardiac monitoring is continued uninterrupted for patients wearing a mask only and for patients in the PPW.
c. Oral hygiene and bathing are postponed until a safe environment is available (MOPP Level 2 or less). All toileting will occur within the hospital complex using ISO contained latrines, chemical toilets, bedpans, urinals, buckets, or containers with plastic liners. Waste from improvised containers must be placed in containers with covers or in plastic bags and sealed to control odors and prevent spread of infectious material within the facility.
d. At MOPP Levels 3 and 4, feeding must be postponed. A nutritional assessment is needed to determine how long each patient can tolerate a fasting state when MOPP Level 3 or Level 4 remains in effect for over 24 hours.
e. Intravenous (IV) medications are mixed in a clean area and then transported in a protective wrap (multilayers of plastic, medical chest, or layered cardboard) to the user. However, IV solutions, blood, and injections can be given to patients on an unprotected ward. Normally, oral medications are only given at MOPP Level 2 or lower.
f. Treatment procedures that have the potential of contaminating the patient's pulmonary or circulatory systems are conducted only at MOPP Level 2 or below. However, EMT procedures may have to be performed in the contaminated treatment area, or the patient decontamination area.
g. Continuous oxygen therapy requires a collective protection environment or a CB filter supported respirator.
h. Delivery of nursing care at MOPP Level 3 or Level 4 is limited due to the sensory restrictions of MOPP gear. Time is taken to reassure the patients on a personal basis, as much as possible, and by routinely monitoring the ward environment. Communications are difficult and identities are masked. Maintain the identity of personnel by using handwritten name tags for staff and patients (including patients in PPW).