copyright © 2008 delmar. all rights reserved. part iii public health nursing practice

Copyright © 2008 Delmar. All rights reserved.

Part III

Public Health Nursing Practice


Chapter 10

Environmental Health Risk


3

Environmental Health

• Aspects of human health, including quality of life, determined by the following problems in the environment: – Physical– Chemical– Biological– Social – Psychological


4

Magnitude of Health Issues

• Center for Disease Control and Prevention– Assesses U.S. health status– National Health and Nutrition Exam Study

• Annual survey• Interviews • Physical exams• Laboratory test


5

Chemical Exposure

• Some chemical exposures occur in all settings, while some occur in specific settings:– Homes– Workplace– Schools– Communities


6

Biological Exposure

• Common in our environment– Pathogenic organisms

• Food poisoning– Salmonella

• Cryptosporidium– Drinking water

• Pathogenic microbes passed from child to child


7

Interventions

• Public health nurse interventions– Food handling and storage education– Media alerts regarding unhealthy water– Hand washing awareness in the school setting


8

Radiological Exposure

• Two categories1. Ionizing

• Visible light• Infrared

– Microwaves

• Radio frequencies– Radon


9

Radiological Exposure

• Two categories2. Nonionizing

• UV waves


10

Multidisciplinary Approaches

• Interdisciplinary team– Toxicologists– Geologists– Sanitarians– Industrial hygienists– Research/surveillance experts


11

Multidisciplinary Approaches

• Interdisciplinary team– Epidemiologists– Biostatisticians– Housing experts– Animal control technicians


12

Environmental Health Assessment

• I PREPARE pneumonic– I – Investigate potential exposures– P – Present work– R – Residence– E – Environmental concerns– P – Past work– A – Activities– R – Referrals and resources– E – Educate


13

Community Level Assessment

• What is the nature of the exposure?

• Where is the exposure coming from?

• What is the route of exposure?

• What are the health effects associated with the exposure?


14

Community Level Assessment

• What are the special vulnerabilities of the population at risk?

• What are the risks or probability that a health effect will occur?


15

Environmental Toxicology and Epidemiology

• Toxicology – Study of poisons or chemicals– More research needed regarding chemical

mixtures and associated health risks


16

Environmental Toxicology and Epidemiology

• Epidemiology– Study of environmental exposures and

disease outcomes– Occupational exposures

• Lung cancer and asbestos• Union Carbide


17

Epidemiological Study Challenges

• Difficulty finding a nonexposed population

• When studying indoor exposures:– Mobility

• Housing stock changes

– Inaccurate histories• Residence history


18

Epidemiological Study Challenges

• When studying indoor exposures:– Smoking history– Other

• Genetics, lifestyle, exposure to other carcinogens, heating/cooling preference


19

Environmental Risk at Home

• Lead– Lead-based paint in older homes

• Learning• Language disturbances


20

Environmental Risk at Home

• Lead– Lead-based paint in older homes

• Anemia• Hypertension• Peripheral nerve damage• Kidney damage• Reproductive problems


21

Levels of Prevention

• Primary – Removal of exposure

• Secondary – Blood lead level screening in children

• Tertiary – Minimize harm and symptoms


22

Radon

• Radioactive gas – Colorless, odorless– Naturally occurring

• Second leading cause of lung cancer

• Interventions– Test for presence– Dilution


23

Carbon Monoxide

• Odorless, colorless gas– Product of combustion from gas-driven

appliances

• Acute poisoning is life threatening


24

Carbon Monoxide

• Chronic low level exposure symptoms:

– Headache, drowsiness, poor cognition, flu-like symptoms, depression

• Intervention – Carbon monoxide detectors


25

Drinking Water Contaminates

• Microbial – Bacterial– Viral– Parasites

• Chemicals– Inorganic– Organic


26

Drinking Water Contaminates

• Radionuclides– Gross alpha radiation

– Radiation

• Interventions– Water treatment devices


27

Consumer Products

• Chemical makeup information available to the public – National Library of Medicine Website– Freedom of Information Act (FOIA)– Workplace

• Material Safety Data Sheets (MSDS)


28

Environmental Health Risk at School

• Indoor air quality– Sick building syndrome

• Pesticide use– Integrated pest management

• Location of school– Brownfield site– Noise pollution


29

Community Environmental Risk

• Two categories of water quality contamination– Point source

• Regulated by EPA

– Nonpoint source


30


• Air pollution– 1990 Clean Air Act


31


• Criteria pollutants– Sulfur dioxide– Nitrous Dioxide– Carbon Monoxide– Particulate Matter– Lead– Ozone


32


• Soil contamination– Brownfields– Superfund


33


• Agriculture production– Pesticides– Antibiotic and growth hormone

• Global Warming– Greenhouse effect


34

Environmental Risks at Work

• 1970 Occupational Safety and Health Act (OSHA)– Right to a healthy and safe workplace– Right to submit a complaint – Right to request an inspector


35

Environmental Risks at Work

• Occupational related diseases: – White lung– Black lung– Brown lung


36

Occupational Risks

• Biological exposure– Pathogenic microbes– Viruses

• Radiological exposure– X-Ray– Radiological implants


37

Occupational Risks

• Chemical exposure – Anti-chemotherapeutic drugs– Cleaning products

• Other– Lifting– Needle sticks– Workplace violence


38

Vulnerable Populations

• Pregnant women

• Infants – Breast milk


39

Vulnerable Populations

• Children– Breathe, eat, drink more per body weight– Closer to ground level

• Hand to mouth

– Growth and development

• Elderly


40

Environmental Justice and Advocacy

• Equity in environmental quality

• Public Health Nurse Advocacy– Risk Communication

• Message• Messenger• Audience• Content• Context


41

Policies

• Precautionary Principle

• Global chemical policies– Kyoto Agreement– Stockholm Convention on Persistent Organic

Pollutant– European Union’s Registration

• Evaluation and Authorization of Chemicals Program


42

EnvironmentalInfrastructure Responsibilities

• U.S. Environmental Protection Agency (EPA)– Clean Air Act– Safe Drinking Water Act– Food Quality Protection Act


43

EnvironmentalInfrastructure Responsibilities

• State/Local Level– Food safety inspections

• Rodent control

– Lead-based paint• Zoning


44

Public Health Nursing Competencies

• Institute of Medicine 1995 Report– “Nursing, Health, and the Environment”

• Provided a road map for the public health nurse role in environmental health and recommended competencies for all public health nurses

copyright © 2008 delmar. all rights reserved. part iii public health nursing practice

Documents

child slide

health status national

health effects

school setting slide

associated health risks

environmental toxicology

asbestos union carbide

nonionizing uv waves