NUR 113: DISASTER NURSING

STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR

Session # 19

Materials:
LESSON TITLE: Preparing for Terrorism: Nuclear
Book, pen and notebook
Radiation Exposure
LEARNING OUTCOMES:
References:
Upon completion of this lesson, the nursing student can:
Veenema, T.G. (2019) Disaster Nursing and
1. Define radiation. Emergency Preparedness for Chemical,
2. Describe the 3 basic types of radiation. Biological, and Radiological Terrorism and other
3. Recognize common types of radiological incidents and Hazards 4th Edition
emergencies.
4. Describe the clinical signs of radiation exposure.

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: What are the types of chemical agents?

MAIN LESSON (40 minutes)

RADIATION refers to ionizing radiation— radiation with enough energy to create ion pairs in matter. Ultraviolet light can
do this, as can x-rays, gamma rays, and other kinds of radiation. Visible light is also radiation, but it is not energetic
enough to cause ionizations, so it cannot normally cause problems. By comparison, ionizing radiation can damage our
DNA, causing health effects in sufficiently high doses.

Types of Radiation
1. Alpha Radiation - Alpha radiation can cause a great deal of damage to the living cells it encounters, but has
such a short range in tissue that external alpha radiation cannot penetrate the dead cells of the epidermis to
irradiate the living cells beneath.
2. Beta Radiation - Beta particles are electrons or positrons and are both lighter than alpha particles and possess a
lower electrical charge. This means that they are not nearly as damaging, although they will penetrate up to a
centimeter into tissue.
3. Gamma Radiation - Gamma rays are energetic photons, similar to x-rays. Gamma radiation is much less
damaging than alpha radiation and is about as damaging as beta radiation. Unlike alpha and beta radiation,
gamma radiation will penetrate the whole body, so it will deliver radiation doses to internal organs as well as to
the skin.

Artificial Sources of Radiation

• Medical Equipment
• Radiopharmaceuticals
• Industrial instruments
• Food irradiation facilities
• Nuclear research laboratories
• University research reactors
• Nuclear weapons
• Nuclear power plants

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Measuring Radiation
1. Curie: Amount of material
2. Rem: Absorbed dose
3. Half-Life: Time for decay to ½ the original amount

Clinical signs of Radiation exposure

1. Nausea and vomiting
2. Erythema
3. Blistering, ulcerated tissue, possible necrosis
4. Depression in red and white blood cell count
5. Elevated levels of chromosomal aberrations

Health Effects of Radiation Exposure

1. Prodromal Syndrome
- Patients with prodromal syndrome have likely been exposed to at least 1 Sv (100 rem)
- Patients exhibiting symptoms like vomiting or bloody diarrhea within 30 minutes of exposure
have likely received a lethal dose of radiation
2. Hemotopoietic Syndrome
- Hematopoietic syndrome begins to appear at doses of 3 to 8 Sv (300 to 800 rem)
- This leads to a reduction in blood cell counts as older cells die and are not replaced, it leaves
the patient open to infection and other related problems.
3. Gastrointestinal Syndrome
- Exposure to 10 Sv (1000 rem) or more.
- Radiation exposure in this range sterilizes dividing crypt cells, leading to loss of cells from villi.
4. Cerebrovascular Syndrome
- Exposure to exceptionally high doses of radiation (in excess of 100 Sv or 10,000 rem) will result
in damage to the central nervous system, normally among the most radiation-resistant parts of
the body.
- Usually results in death within several hours to a few days of exposure.

Radiological Incidents and Emergencies

• Traffic accident involving a truck carrying research or medical radioactive isotopes
• Terrorist attack with an RDD (or “dirty bomb”)
• Fire in a hospital or university radioactive waste storage facility
• Unplanned radioactive release from a commercial nuclear power station
• Detonation of a nuclear weapon
• Loss of a radioactive soil-density gauge or well-logging gauge
• Accidental exposure of a maintenance technician to radiation from an industrial linear accelerator
• Radiation burns to the fingers from the beam of an x-ray diffractometer in a soil science laboratory
• Accidental overexposure to an angiography patient from excessive flouoroscopy, resulting in radiation burns to
the skin.
• Spill of radioactive liquids in a research laboratory

Radiation Detection
• Cannot be seen
• Cannot be smelled
• Cannot be tasted
• Cannot be felt
• CAN ONLY BE DETECTED BY INSTRUMENTS

Protection from Radiation

1. Minimize time you are exposed
2. Stay as far away as possible from the source of radiation
3. Use the thickest possible shielding between you and the radiation source.

Indications of a Radiological Event

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 A radiological event, such as a radiological dispersal device otherwise known as a dirty bomb, may be indicated by an
explosive release of a fine powder or solid material. Early symptoms seen in people exposed to high doses of radiation
include skin reddening, hair loss, widespread incidents of nausea, vomiting, headaches, and a weakened immune system.
Depending on the scenario, these acute radiation symptoms may not be seen from a dirty bomb explosion because high
radiation levels may not extend very far, and the people exposed to these levels may be killed by blast effects, as with a
conventional bomb. The effects of lower exposures to radiation include a long-term increase in certain types of cancers.

Radiation Response

General guidelines indicate that a radiological event has occurred when a radiation dose rate of 0.01 rem/hour or
greater is noted. Short term exposures of a few hours to doses around 10 rem/hour may still not have significant human
health effects, however, it is generally recommended that first responders not enter these areas, with the possible
exception of a very short-term rescue.
General dose guidelines for sheltering, evacuating, and relocating the public are much lower than for emergency
response personnel in recognition that people living in the contaminated area will have long-term, continuous exposure to
greater than normal radiation levels. These longer-term doses are calculated over a 24-hour or annual period.

Response to a Radiological Event

• Identify presence of radiation beyond normal background
• Isolate and contain affected area -- mitigate spread of contamination
• Shelter-in-place or evacuate depending on dose rates
• Provide needed immediate medical treatment

Radiological emergency response should be initiated when excessive radiation is measured. The affected area
should be mapped to identify the extent of radiological contamination and to determine the boundaries of the area to
isolate and contained. Isolation includes stopping all traffic that may spread contamination, and preventing spread by
gravity into sewer drains.
Estimated dose rates and doses should be used in making decisions regarding public evacuation or sheltering. Short
term medical treatment can include wound treatment to preclude infections since radiation exposure can compromise the
immune system. Certain drugs can be used if the exact radioactive material has been identified.

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. There has been a radioactive explosion nearby. The emergency room nurse must triage and manage the
decontamination of the clients systematically. Which of the following clients would be decontaminated first?
a. A client with severe injuries.
b. A client with minor injuries.

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 c. A client with the least injuries.
d. A client with the most injuries.
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

2. All are true about Radiation Detection except:

a. Cannot be seen
b. Cannot be smelled
c. Can be tasted
d. Cannot be felt
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

3. All except one are forms of radiation

a. Alpha radiation
b. Beta radiation
c. Gamma radiation
d. Proton radiation
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

4. When taking care of a patient undergoing radiation therapy, the nurse should
a. Be with the patient all the time
b. Minimize time together with patient
c. Use hazmat
d. Wash hands
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

5. What clinical manifestation should alert the nurse to possible fatal exposure to radiation?
a. Elevated levels of chromosomal aberrations
b. Redness in the chest
c. Decreased in WBC count
d. Presence of white spots all over the body
ANSWER: ________
RATIO:____________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

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: ________

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 RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
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5. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

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: CAT: 3-2-1

Instructions:
1. As an exit ticket at the end of the class period
2. After the lesson, have each student record three things he or she learned from the lesson.
3. Next, have them record two things that they found interesting and that they’d like to learn more about.
4. Then, have students record one question they still have about the material.
5. Review the students’ responses. You can use this information to help develop future lessons and
1. determine if some of the material needs to be taught again.

Three things you learned:

1. ______________________________________
2 ______________________________________
3. ______________________________________

Two things that you’d like to learn more about:

1. ______________________________________
2. ______________________________________

One question you still have:

1. ______________________________________

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