A community health nurse observes the accumulation of garbage at a neighborhood playground. Which of the following actions should the nurse take first to promote a clean and safe environment?

Rationale for Correct Choices:

• Teach healthcare workers how to distinguish the disease from chickenpox: Smallpox and chickenpox may initially present with similar rash-like symptoms. Rapid and accurate recognition by healthcare workers is critical to implement isolation protocols and prevent further transmission in a bioterrorism event.
• Vaccinate laboratory workers against the disease: Laboratory workers who may handle specimens suspected of containing smallpox virus are at high occupational risk. Pre-exposure vaccination is appropriate for these individuals to protect them during diagnostic and investigative procedures.

Rationale for Incorrect Choices:

• Obtain standing orders to treat infected individuals with ciprofloxacin: Ciprofloxacin is not effective against smallpox, which is caused by a virus. Using an antibiotic would not provide benefit unless there were bacterial complications. The preferred antiviral agent for smallpox is tecovirimat (TPOXX).
• Perform routine screening to identify infected animals: Smallpox does not occur in animals; it has no animal reservoir. Screening animals would not contribute to disease surveillance or prevention and is not a necessary step in smallpox preparedness.
• Implement routine vaccination for the disease for the general public population: Routine smallpox vaccination was stopped decades ago after global eradication. In a bioterrorism scenario, targeted vaccination (ring vaccination) would be used rather than mass immunization.

• Client 1: This client has a minor laceration with minimal drainage and stable vital signs. No signs of shock or infection are present. This injury is not life-threatening and can wait, making this client a low-priority (green-tag) case.
• Client 2: Although this client is experiencing worsening pain and signs of mild hypovolemia, they are alert and have stable vital signs. This client needs prompt care, but not immediate life-saving interventions, making them a delayed (yellow-tag) priority.
• Client 3: The client has a mild head injury with stable neurological signs and no evidence of increased intracranial pressure or altered consciousness. This presentation does not require immediate intervention and would also be triaged as delayed.
• Client 4: This client presents with signs of severe traumatic brain injury—fixed pupils, decorticate posturing, and irregular respirations—which indicate brainstem dysfunction. Although the prognosis is poor, the condition is immediately life-threatening and requires urgent airway and neurological support, making this client a top priority (red-tag).
• Client 5: This client has an open fracture and reports significant pain but has stable vital signs and adequate circulation. The injury requires treatment but is not immediately life-threatening, so they can be managed later (yellow-tag).
• Client 6: The client shows signs of progressing respiratory distress—tripod positioning, retractions, anxiety, and diminished breath sounds—indicating possible airway compromise from inhalation injury. This is an urgent, potentially fatal condition requiring immediate airway management (red-tag).