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Part III
Public Health Nursing Practice
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Chapter 10
Environmental Health Risk
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3
Environmental Health
• Aspects of human health, including quality of life, determined by the following problems in the environment: – Physical– Chemical– Biological– Social – Psychological
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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
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5
Chemical Exposure
• Some chemical exposures occur in all settings, while some occur in specific settings:– Homes– Workplace– Schools– Communities
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Biological Exposure
• Common in our environment– Pathogenic organisms
• Food poisoning– Salmonella
• Cryptosporidium– Drinking water
• Pathogenic microbes passed from child to child
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Interventions
• Public health nurse interventions– Food handling and storage education– Media alerts regarding unhealthy water– Hand washing awareness in the school setting
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Radiological Exposure
• Two categories1. Ionizing
• Visible light• Infrared
– Microwaves
• Radio frequencies– Radon
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9
Radiological Exposure
• Two categories2. Nonionizing
• UV waves
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10
Multidisciplinary Approaches
• Interdisciplinary team– Toxicologists– Geologists– Sanitarians– Industrial hygienists– Research/surveillance experts
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11
Multidisciplinary Approaches
• Interdisciplinary team– Epidemiologists– Biostatisticians– Housing experts– Animal control technicians
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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
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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?
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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?
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15
Environmental Toxicology and Epidemiology
• Toxicology – Study of poisons or chemicals– More research needed regarding chemical
mixtures and associated health risks
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Environmental Toxicology and Epidemiology
• Epidemiology– Study of environmental exposures and
disease outcomes– Occupational exposures
• Lung cancer and asbestos• Union Carbide
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Epidemiological Study Challenges
• Difficulty finding a nonexposed population
• When studying indoor exposures:– Mobility
• Housing stock changes
– Inaccurate histories• Residence history
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Epidemiological Study Challenges
• When studying indoor exposures:– Smoking history– Other
• Genetics, lifestyle, exposure to other carcinogens, heating/cooling preference
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Environmental Risk at Home
• Lead– Lead-based paint in older homes
• Learning• Language disturbances
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Environmental Risk at Home
• Lead– Lead-based paint in older homes
• Anemia• Hypertension• Peripheral nerve damage• Kidney damage• Reproductive problems
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Levels of Prevention
• Primary – Removal of exposure
• Secondary – Blood lead level screening in children
• Tertiary – Minimize harm and symptoms
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Radon
• Radioactive gas – Colorless, odorless– Naturally occurring
• Second leading cause of lung cancer
• Interventions– Test for presence– Dilution
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Carbon Monoxide
• Odorless, colorless gas– Product of combustion from gas-driven
appliances
• Acute poisoning is life threatening
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Carbon Monoxide
• Chronic low level exposure symptoms:
– Headache, drowsiness, poor cognition, flu-like symptoms, depression
• Intervention – Carbon monoxide detectors
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Drinking Water Contaminates
• Microbial – Bacterial– Viral– Parasites
• Chemicals– Inorganic– Organic
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Drinking Water Contaminates
• Radionuclides– Gross alpha radiation
– Radiation
• Interventions– Water treatment devices
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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)
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Environmental Health Risk at School
• Indoor air quality– Sick building syndrome
• Pesticide use– Integrated pest management
• Location of school– Brownfield site– Noise pollution
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Community Environmental Risk
• Two categories of water quality contamination– Point source
• Regulated by EPA
– Nonpoint source
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Community Environmental Risk
• Air pollution– 1990 Clean Air Act
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Community Environmental Risk
• Criteria pollutants– Sulfur dioxide– Nitrous Dioxide– Carbon Monoxide– Particulate Matter– Lead– Ozone
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Community Environmental Risk
• Soil contamination– Brownfields– Superfund
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Community Environmental Risk
• Agriculture production– Pesticides– Antibiotic and growth hormone
• Global Warming– Greenhouse effect
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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
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Environmental Risks at Work
• Occupational related diseases: – White lung– Black lung– Brown lung
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Occupational Risks
• Biological exposure– Pathogenic microbes– Viruses
• Radiological exposure– X-Ray– Radiological implants
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Occupational Risks
• Chemical exposure – Anti-chemotherapeutic drugs– Cleaning products
• Other– Lifting– Needle sticks– Workplace violence
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Vulnerable Populations
• Pregnant women
• Infants – Breast milk
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Vulnerable Populations
• Children– Breathe, eat, drink more per body weight– Closer to ground level
• Hand to mouth
– Growth and development
• Elderly
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Environmental Justice and Advocacy
• Equity in environmental quality
• Public Health Nurse Advocacy– Risk Communication
• Message• Messenger• Audience• Content• Context
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Policies
• Precautionary Principle
• Global chemical policies– Kyoto Agreement– Stockholm Convention on Persistent Organic
Pollutant– European Union’s Registration
• Evaluation and Authorization of Chemicals Program
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EnvironmentalInfrastructure Responsibilities
• U.S. Environmental Protection Agency (EPA)– Clean Air Act– Safe Drinking Water Act– Food Quality Protection Act
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EnvironmentalInfrastructure Responsibilities
• State/Local Level– Food safety inspections
• Rodent control
– Lead-based paint• Zoning
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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