A patient comes into the ED in respiratory distress with stridor and cyanosis. The patient was sick a few days ago with flu-like symptoms, a dry cough, sweats, and mild chest pain, but then the patient felt better for a couple days and was able to return to work at the wool mill before suddenly feeling much worse. Of the following, to which does the nurse suspect the patient has been exposed?


•Inhalation of Anthrax occurs when a person inhales spores that are aerosolized. However, it may be transmitted cutaneously as well if they come in direct contact with the spores. Note that Anthrax is not contagious. Symptoms include fever and chills, chest discomfort and shortness of breath, dizziness, a non-productive cough, nausea, stomach pains, headache, sweats (often drenching), extreme tiredness, and body aches. The patient may feel better for a day or two, then will usually progress to respiratory distress, stridor, cyanosis, and death. The mortality rate is nearly 100%.

•Anthrax spores may be inhaled by workers in leather factories or wool mills who come in contact with contaminated animals, though there is also a concern of Anthrax being used as an agent of bioterrorism in recent years.

Incorrect options:

•Smallpox is a potential agent of bioterrorism. The first symptoms of Smallpox include fever, malaise, head and body aches, and sometimes vomiting. The fever is usually high, in the range of 101 to 104 degrees Fahrenheit. Prolonged face-to-face contact is generally required to spread smallpox from one person to another. Smallpox also can be spread through contact with infected bodily fluids or contaminated bedding or clothing. A person becomes most contagious with the onset of rash, which starts in the mouth and face and spreads, first as bumps, then pustules and scabs. The infected person is contagious until the last smallpox scab falls off.

•Boltulism is a serious paralytic illness caused by a nerve toxin that is produced most commonly by the bacterium Clostridium botulinum. Foodborne botulism is caused by eating foods that contain the botulinum toxin (such as improperly preserved, canned foods). Botulinum toxin can be absorbed through the GI or respiratory tract, but not through the skin. It is highly toxic. Initial symptoms of botulinum toxin exposure are ptosis, diplopia, dysarthria, dysphagia, descending flaccid paralysis, difficulty breathing, and the victim eventually requires mechanical ventilation.

•Pneumonic Plague presents with fever, weakness, and rapid onset pneumonia with shortness of breath, cough, chest pain, and sometimes bloody sputum. Nausea and abdominal pain may occur. Without early intervention, pneumonic plague will usually cause respiratory failure, shock, and rapid death.


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