Nursing diagnosis – RISK FOR CONTAMINATION

RISK  FOR  CONTAMINATION

DEFINITION

Accentuated risk of exposure to environmental contaminants in

doses sufficient to cause adverse health effects

RISK FACTORS

External

(temperature, wind, geographic

• Environmental contaminants

area)

in the home

• Playing in outdoor areas

• Exposure to heavy metals or

where environmental contami-

chemicals, bioterrorism,
atmospheric pollutants, disas-
ter, radiation

nants are present
• Social factors, such as
overcrowding, sanitation,

• Insufficient or absent use of

poverty, personal and house-

decontamination protocol

hold hygiene practices, lack

• Flooding, earthquakes, atmos-

of access to healthcare

pheric pollutants, or other
natural disasters

Internal
• Age (less than 5 years or older

• Contamination of aquifers by

adult)

septic tanks

• Female gender

• Industrial plant emissions,

• Concomitant or previous

discharge of contaminants by
industries

exposures
• Developmental characteristics

• Intentional or accidental con-

(gestational age during exposure)

tamination of food and water
supply

• Nutritional factors or dietary
practices

• No or inappropriate use of

Preexisting disease states: gen-

protective clothing

der, occupation, history of

• Physical factors, such

smoking; presence of bacteria,

as climactic conditions

viruses, toxins, vectors

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Populations

• Risk management

EXPECTED OUTCOMES

The patient/community will

• Remain free from adverse effects of contamination.

• Utilize health surveillance data system to monitor for contamina-

tion incidents.

• Participate in mass casualty and disaster readiness drills.

• Remain free from contamination-related health effects.

• Have minimal exposure to contaminants.

SUGGESTED NOC OUTCOMES

Community Disaster Readiness; Community Health Status; Health

Beliefs: Perceived Threat; Knowledge: Health Behavior; Knowledge:

Health Resources; Risk Control

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INTERVENTIONS AND RATIONALES

Determine: Monitor individuals for therapeutic effects, side effects,

and compliance with postexposure drug therapy. Drug therapy may

extend over a long period of time and will require monitoring for

compliance as well as therapeutic and side effects.

Perform: Conduct surveillance for environmental contamination;

notify agencies authorized to protect the environment of

contaminants in the area. Early surveillance and detection are criti-

cal components of preparation.

Assist individuals in relocating to safer environment to decrease

their risk of contamination.

Modify environment to minimize risk. Modification of the

environment will decrease the risk of actual contamination.

Implement decontamination of persons, clothing, and equipment

by using approved procedure. Victims may first require decontami-

nation before entering health facility to receive care in order to pre-

vent the spread of contamination.

Use appropriate isolation precautions: universal, airborne, droplet,

and contact isolation. Proper use of isolation precautions prevents

cross-contamination by contaminating agent.

Inform: Provide accurate information on risks involved, preventive

measures, use of antibiotics and vaccines to reduce anxiety and

increase compliance.

Attend: Assist community members with feelings of fear and vulner-

ability. Interventions aimed at supporting an individual’s coping help

the person deal with feelings of fear, helplessness, and loss of

control that are normal reactions in a crisis situation.

Manage: In conjunction with other healthcare providers, schedule

mass casualty and disaster readiness drills. Practice in handling con-

tamination occurrences will decrease the risk of exposure during

actual contamination events.

SUGGESTED NIC INTERVENTIONS

Bioterrorism Preparedness; Communicable Disease Management;

Community; Community Disaster Preparedness; Environmental Man-

agement: Safety; Environmental Risk Protection; Health Education;

Health Policy Monitoring; Health Screening; Immunization/

Vaccination Management; Risk Identification; Surveillance: Safety

Reference

Chung, S., & Shannon, M. (2005). Hospital planning for acts of terrorism

and other public health emergencies involving children. Archives of Disease
in Childhood, 90(12), 1300–1330.

Nursing diagnosis – CONTAMINATION

CONTAMINATION

DEFINITION

Exposure to environmental contaminants in doses sufficient to cause

adverse health effects

DEFINING CHARACTERISTICS

(These are dependent on the causative agent. Agents cause a variety

of individual organ responses as well as systemic responses.)

• Pesticides: Have dermatological, GI, neurological, pulmonary, and

renal effects. Categories include insecticides, herbicides, fungicides,
antimicrobials, and rodenticides.

• Chemicals: Have dermatological, immunological, neurological, pul-

monary, and renal effects. Categories include petroleum-based agents,
anticholinesterases, Type I agents act on proximal tracheobronchial
tract, Type II agents act on aveoli and produce systemic effects.

• Biologicals: Have dermatological, GI, neurological, pulmonary, and

renal effects.

• Radiation: Have dermatological, GI, neurological, pulmonary, and

renal effects. Categories include internal such as exposure through
ingestion of radioactive material or external such as direct contact
with radiological material.

• Pollution: Have dermatological and pulmonary effects. Categories

include trash, raw sewage, industrial waste.

RELATED FACTORS

• External: Chemical contamination of food or water, exposure to

bioterrorism, radiation, and exposure to areas of contamination.

• Internal: Extremes of age, nutritional factors, preexisting disease

states, pregnancy, previous exposure.

ASSESSMENT FOCUS    (Refer  to  comprehensive  assessment  parameters.)

• Populations

• Risk management

EXPECTED OUTCOMES

The patient/community will

• Have minimized health effects associated with contamination.

• Utilize health surveillance data system to monitor for contamina-

tion incidents.

• Utilize disaster plan to evacuate and triage affected members.

• Minimize exposure to contaminants.

SUGGESTED NOC OUTCOMES

Anxiety Level; Community Health Status; Fear Level

INTERVENTIONS AND RATIONALES

Determine: Triage, stabilize, transport, and treat affected community

members. Accurate triage and early treatment provide the best

chance of survival to affected persons.

79
Monitor individuals for therapeutic effects, side effects, and com-

pliance with postexposure drug therapy. Drug therapy may extend

over a long period of time and will require monitoring for compli-

ance as well as therapeutic and side effects.

Perform: Help individuals cope with contamination incident; use

groups that have survived terrorist attacks as useful resource for vic-

tims to aid in support; those with experience can share reactions

and useful coping mechanisms.

Help individuals deal with feelings of fear, vulnerability, and grief

to minimize risk of traumatic stress.

Decontaminate persons, clothing, and equipment using approved

procedure. Victims may first require decontamination before entering

health facility to receive care in order to prevent the spread of con-

tamination.

Use appropriate isolation precautions, including universal,

airborne, droplet, and contact isolation. Proper use of isolation pre-

cautions prevents cross-contamination.

Inform: Provide accurate information on risks involved, preventive

measures, and use of antibiotics and vaccines to enhance the use of

protective measures.

Attend: Encourage individuals to talk to others about their fears.

Interventions aimed at supporting an individual’s coping can help

the person deal with feelings of fear, helplessness, and loss of

control that are normal reactions in a crisis situation.

Manage: Collaborate with other agencies (local health department,

emergency medical services, state and federal agencies). Communica-

tion and collaboration among agencies increase ability to handle

crises efficiently and correctly.

SUGGESTED NIC INTERVENTIONS

Anxiety Reduction; Crisis Intervention; Environmental Management;

Infection Control; Health Education; Triage

Reference

Chung, S., & Shannon, M. (2005). Hospital planning for acts of terrorism

and other public health emergencies involving children. Archives of Disease
in Childhood, 90(12), 1300–1307.