Public health encounter with moral and political issues

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DQ 1: A local director of public health will encounter moral and political issues, along with logistical considerations, when faced with the possibility of quarantining or isolating an individual or a group.

Describe a situation when you would employ quarantining of an individual. Describe another situation when you would isolate an individual. For both situations, include any special considerations to provide for the individual’s well-being. Further, include considerations for legal requirements for both situations.

 

DQ2: You live in a coastal community and a Category 4 hurricane is due to make landfall in two days. A mandatory evacuation will go into effect in 12 hours and residents will be housed at an emergency shelter inland.

Research an access or functional need and put yourself in the position of a person with this need. What difficulties would you encounter in this situation? How could public health staff and emergency responders prepare to assist you?

Sample Solution

ith exposed bone, joint, or tendon, or shallow heel ulcer without involvement of the calcaneus( ie. Major tissue loss: salvageable with >3 digital amputations or standard transmetatarsal amputation plus skin coverage). Grade 3 is an extensive deep ulcer of the forefoot and/or midfoot, or full thickness heel ulcer with or without involvement of the calcaneus(ie. Extensive tissue loss: salvageable only with complex foot reconstruction or nontraditional TMA). Patient is a grade 2 for wound because he had a deep ulcer.
Ischemia also has grades 0-3. Grade 0 is ABI (ankle-brachial index) > 0.8, with ankle systolic pressure >100mmHg, toe pressure(TP) >60. Grade 1 is ABI 0.6-0.79, ankle systolic pressure 70-100mmHg, TP 40-59. Grade 2 is ABI 0.4-0.59, ankle systolic pressure 50-70mmHg, TP 30-39. Grade 3 is ABI <0.39, ankle systolic pressure <50mmHg, TP <30.
The third category is foot infection. Grade 0 is no symptoms or signs of infection. Grade 1- infection is present and at least 2 of the following are present: local swelling, erythema >0.5 to <cm around ulcer, local tenderness or pain, local warmth, or purulent discharge. Other causes of an inflammatory response of the skin have been excluded(gout/fracture). Grade 2 is a local infection is present as defined for Grade 1, but extends > 2cm around ulcer, or involves structure deeper than the skin and subcutaneous tissues(eg. Abscess, osteomyelitis, septic arthritis, fasciitis). No clinical signs of systemic inflammatory response. Grade 3 is a local infection that is present as defined for Grade 2, but clinical signs of systemic inflammatory response are present as manifested by 2 or more of the following: temperature >38°C or <36°C; heart rate >90 beats per minute, respiratory rate >20 breaths per minute or PaCO2 <32 mmHg; white blood cell count >12,000 or <4000 (cu/mm) or >10 percent immature band forms present. Patient is grade 2 for foot infection, in which he had a local infection on his foot that was 2cm by 2cm, and involves structure deeper than the skin and subcutaneous tissues.
Based on these considerations, the patient with PAD can be placed into one of four amputation risk categories (very low, low, moderate, high). Patient had to amputate his 2nd and 3rd L toes.

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