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Occupational & Environmental Health > Direct Care In The Occupational Setting > Flashcards

Direct Care In The Occupational Setting Flashcards

0
Q

Advanced practice nursing

A

An umbrella term for a licensed registered nurse prepared at the graduate degree level as a clinical specialist, nurse anesthetist, nurse midwife or nurse practitioner

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1
Q

Direct care

A

Hands on clinical care delivery to individual clients

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2
Q

Primary care

A

The provision of integrated, accessible and coordinated health care service

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3
Q

Characteristics of primary care

A
  1. Person centered, wholistic, all levels of prevention
  2. Provided in partnership with clients, context of family and community
  3. Provided by multidisciplinary health care team, goal improving outcomes
  4. “Health care providers” and “clinicians” used to describe those who provide primary care
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4
Q

Professional and regulatory parameters of practice

A
  1. Standards (Standard I: Assessment and Standard II: Diagnosis)
  2. Competencies (Category I: Clinical and Primary Care)
  3. Licensure laws (scope of practice)
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5
Q

Nurse licensure compact

A

A mutual recognition model if nurse licensure that allows a nurse to have one license (in state of residency) and to practice (physical and electronic) in other states, subject to each states practice law and regulation

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6
Q

Range and scope of direct care services may include the following:

A
  1. Care for occupational and non occupational conditions
  2. First aid
  3. Emergency care
  4. Minor acute care
  5. Chronic illness management
  6. Full service primary care
  7. 24 hour call
  8. Prevention based services
  9. Case management of occupational and non occupational health problems
  10. Home care
  11. Telehealth services
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7
Q

Examples of prevention based services

A
  1. Health promotion and screening programs and services
  2. Pre placement programs
  3. Immunizations
  4. Health surveillance
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8
Q

Telehealth

A

Refers to the use of electronic information to support long distance health service delivery, health education and health administration

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9
Q

Direct care services can be offered to:

A
  1. Workers
  2. Dependents
  3. Retirees
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10
Q

Service providers onsite may include

A
  1. Occupational and environmental health nurses
  2. Clinical nurse specialists in occupational health
  3. Adult or family nurse practitioners who specialize in occupational and environmental health
  4. Family or primary care physicians or doctors of osteopathy who specialize in preventive medicine/ occupational medicine
  5. Physical therapists
  6. Occupational therapists
  7. Massage therapists
  8. Mental health professionals
  9. Other providers based on a needs assessment
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11
Q

Rationale for providing on site direct care services:

A
  1. Greater convenience for workers
  2. Less down time resulting from absence due to sickness and visits to offsite health care providers
  3. Greater opportunity for case management to monitor quality, outcomes and cost of care
  4. Fast and accurate determination of work related etiology
  5. Opportunity for timely prevention/ loss control activities at worksite
  6. Accommodations are made by onsite providers who are knowledgeable about the work site
  7. Opportunity to reinforce safe work practices with each worker encounter
  8. Ability to tailor direct care services to the risk profile of the company
  9. Cost savings by controlling duplicate health care services and reducing absence from sickness
  10. Opportunity to reinforce self care approach to health
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12
Q

Factors to evaluate to determine if direct care is needed onsite

A
  1. Hazard profile of company
  2. Geographic proximity to nearest emergency facilities
  3. Injury and illness statistics (both occupational and nonoccupational)
  4. Demographics of the work force
  5. Health benefit coverage
  6. Company philosophy about direct care activities for workers
  7. Financial and personnel resources
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13
Q

Demographics of work force that would be a factor in determining need for onsite direct care

A
  1. Number of workers
  2. Age
  3. Gender
  4. Length of employment with firm
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14
Q

Health care coverage components that would be a factor in determining need for onsite direct care

A
  1. Number of workers with coverage

2. Inclusion or exclusion of preventive and mental health services

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15
Q

Ethical considerations for direct care in the occupational setting

A
  1. Confidentiality of personal health information of workers and their dependents must be safeguarded according to professional codes of conduct and state and federal laws
  2. Provider must balance the “duty to warn” against right to privacy of worker/dependent
  3. Prioritize direct care services and do not duplicate direct care services that could be funded through health care insurance coverage
  4. Workers have the right to know about hazards in work setting and must be notified of an exposure or abnormal physical finding
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16
Q

Legal considerations for direct care in the occupational setting

A
  1. Documentation must be done according to professional codes of conduct and AAOHN standards
  2. APNs can prescribe medications
  3. Activities related to care of clients must comply with OSHA standards and state law for ensuring direct care providers are free from disease
  4. Potential liability arises if there is malpractice by the direct care provider
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17
Q

Professional considerations for direct care in the occupational setting

A
  1. Providers must be competent to perform direct care activities and must practice within the states business and professions code and scope of practice
  2. AAOHN standards guide professional practice
  3. Outcomes of clinical care must be measured and clinical care evaluated using continuous quality improvement model
  4. Standardized language for occupational and environmental health nursing must be adopted to document both processes
  5. Secure data management systems must be created not only for individual care but also population based disease management
  6. Policies and procedures outlining practice understandings and consultation/referral mechanisms must be delineated
  7. Direct care activities must be linked to prevention activities at the worksite
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18
Q

Primary emphasis of direct care activities

A
  1. Health promotion

2. Health protection

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19
Q

Health promotion

A
  • Begins with people who are basically healthy

- Uses strategies related to personal life style

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20
Q

Health promotion activities may include

A
  1. Physical exercise
  2. Weight control
  3. Nutrition
  4. Reduction of the use of alcohol
  5. Reduction of the use of tobacco
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21
Q

Health protection strategies

A
  • Are related to environmental or regulatory measures that confer protection on large population groups
  • Include food and drug safety and environmental health initiatives
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22
Q

Three levels of prevention

A
  1. Primary
  2. Secondary
  3. Tertiary
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23
Q

Unique knowledge needs for direct care in occupational health

A
  1. Physical and mental requirements of a workers job
  2. Work processes
  3. Potential hazards
  4. Personal protective equipment
  5. Link between work site exposure and adverse health effects
  6. Link between worker health status and a safe work environment
  7. Clinical practice guidelines and evidence based practice for treatment and disability management
  8. Clinical care philosophy that promotes safe work as therapeutic
  9. Counsel, educate and coach effectively
  10. Excellent communication skills
  11. Ability to manage multiple health and illness conditions
  12. Awareness of connection between physical and psychosocial aspects of illness
  13. Medical record documentation that safeguards personal health information in employment settings
  14. Legal standards that may specify care components for screening or surveillance
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24
Q

Examples of knowledge of the physical and mental requirements of the worker’s job known by OHN

A
  1. Essential job criteria

2. Reasonable accommodations in compliance with the Americans with Disabilities Act

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25
Q

Examples of topics an OHN would need to be able to effectively counsel, educate and coach on

A
  1. Risk communication
  2. Self care
  3. Return to work
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26
Q

Why are excellent communication skills required by the OHN

A
  1. Coordinate care
  2. Share rationale for treatment
  3. Advocate for injured workers and their families through the workers compensation/ disability systems
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27
Q

Example of how the OHN manages multiple health and illness conditions

A

By interfacing with nurse case managers employed by insurance carriers, health plans and/or employers

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28
Q

Examples of legal standards that specify care components for screening and surveillance

A
  1. OSHA standard for asbestos

2. Department of Transportation requirements

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29
Q

Operational requirements for forest care activities in an occupational health setting

A
  1. Facility/ equipment requirements
  2. Supplies
  3. Administrative needs
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30
Q

Examples of facility/ equipment requirements for direct care activities

A
  1. Private space to maintain confidentiality
  2. Client gowns and sheets
  3. Hand washing facility
  4. Locked file cabinet for medical records
  5. Small refrigerator for medications and specimens
  6. Emergency response equipment
  7. Equipment to conduct examinations
  8. Screening equipment
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31
Q

Examples of emergency response equipment needed for direct care activities

A
  1. Oxygen
  2. AED
  3. Electrocardiogram
  4. Intravenous lines
  5. Allergic response equipment
  6. Eyewash
  7. Decontamination area
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32
Q

Examples of equipment to conduct examinations needed for direct care activities

A
  1. Clinic table
  2. Light source
  3. Blood pressure equipment
  4. Oto-ophthalmoscope
  5. Stethoscope
  6. Reflex hammer
  7. Tuning forks (256 and 512 Hz)
  8. Cotton swabs
  9. Tongue depressors
  10. Peak flow meters
  11. Goniometer for range of motion
  12. Jamar to measure grip strength
  13. Tape measure
  14. Gloves
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33
Q

Examples of screening equipment needed for direct care activities

A
  1. Audiometer or sound booth

2. Spirometer

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34
Q

Examples of supplies needed for direct care activities in an occupational health setting

A
  1. Medications
  2. Safe needle devices and needle disposal units
  3. Miscellaneous supplies
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35
Q

Examples of medications needed for direct care activities

A
  1. Vaccinations
  2. Epinephrine
  3. Prescribed medications
  4. Over the counter medications
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36
Q

Examples of miscellaneous supplies needed for direct care activities

A
  1. Splints
  2. Ice packs
  3. Eye patches
  4. Suture kits
  5. Urine drug testing
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37
Q

Examples of administrative needs for direct care activities in occupational health setting

A
  1. Systems and supplies for record keeping
  2. Educational material
  3. List of referrals
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38
Q

Examples of systems and supplies for record keeping needed for direct care activities

A
  1. Intake form
  2. Informed consent form for treatment, operations and procedures
  3. Billing
  4. Health history questionnaire for initial visit and follow-up
  5. Encounter form
  6. Referral form
  7. Lab/x-ray form
  8. Prescription pads
  9. Physical therapy order forms
  10. Reappointment process
  11. Release of medical information forms
  12. Workers compensation forms
  13. Other mandatory reporting
  14. Recording in OSHA 300 log
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39
Q

Components of acceptable educational materials for direct care activities

A
  1. Culturally sensitive materials
  2. Simple text and liberal use of diagrams
  3. Manage literacy and language range
  4. Selected consumer oriented health websites for self care education
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40
Q

Example of list of referrals

A
  1. Community resources
  2. Providers
  3. Organizations
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41
Q

Health history

A

Provides a database of subjective data that encompasses all aspects of the individual’s health including current and past occupational and environmental exposures

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42
Q

Purposes of a health history are:

A
  1. To establish a health care relationship
  2. To identify active and potential physical and mental health problems
  3. To determine a risk profile for preventable health concerns
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43
Q

Components of a comprehensive health history include:

A
  1. Client profile
  2. Chief complaint
  3. History of present illness
  4. Past medical history
  5. Medications and allergies
  6. Family history
  7. Personal and social history
  8. Health habits
  9. Occupational and environmental health history
  10. Review of systems
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44
Q

Components of client profile

A
  1. Demographic data
  2. Age
  3. Sex
  4. Nationality
  5. Job title
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45
Q

Chief complaint

A

Reason for visit

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46
Q

Main reasons for visit

A
  1. Illness
  2. Injury
  3. Prevention focused
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47
Q

History of present illness

A
  • HPI
  • includes questions about the seven symptom descriptors and supportive positive and negative data from other sections of the database
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48
Q

Seven symptom descriptors are:

A
  1. Location/radiation
  2. Setting
  3. Quality
  4. Quantity/severity
  5. Chronology
  6. Aggravating/alleviating factors
  7. Associated manifestations
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49
Q

Location/radiation

A
  • Where exactly is the pain/symptom located

- Trace where it radiates

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50
Q

Setting

A

What were you doing when you noticed the symptom?

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51
Q

Quality

A
  • How bad is it?
  • On a 1-10 scale, with 10 being the worst, how would you rate your symptom?
  • What is the functional impact of the symptom?
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52
Q

Chronology

A
  • When did this start?
  • Is it getting better, worse?
  • How long does each episode last?
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53
Q

Aggravating/alleviating factors

A
  • What makes it worse?
  • What makes it better?
  • Describe specific work activities that may have caused or aggravated symptom
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54
Q

Associated manifestations

A

Are there any other symptoms associated with it?

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55
Q

Supportive positive/negative data related to the symptom include:

A
  1. Past medical history
  2. Family history
  3. Personal/social history
  4. Occupational/environmental history
  5. Review of systems
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56
Q

Past medical history for supportive positive/negative data

A
  • PMH
  • Focus on any prior work up for the same symptom; any significant prior injury/illness that might contribute to current complaint
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57
Q

Family history for supportive positive/negative data

A

Any significant family history of an illness that might contribute to current complaint?

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58
Q

Personal/social history for supportive positive/negative data

A
  • Are there any contributing factors from diet, alcohol, smoking, drug use, exercise?
  • Any new stressors?
59
Q

Occupational/environmental history for supportive positive/negative data

A
  • Is there anything in your work or home environment that could contribute to this symptom?
  • Any coworker or family member with similar complaints?
60
Q

Review of systems for supportive positive/negative data

A

-Are there any related symptoms not previously mentioned?

61
Q

Past medical history

A
  1. Prior illnesses
  2. Hospitalizations
  3. Surgeries
  4. Obstetrical history
  5. Current immunization status
62
Q

Medications and allergies

A
  1. OTC use
  2. Illicit use
  3. Prescribed use
  4. Allergies (note response to determine a true allergy vs a sensitivity)
63
Q

Family history

A
  1. Genetic/hereditary risk factors
  2. Chronic disease in family
  3. Any significant family problems
64
Q

Personal and social history

A
  1. Status of current relationships
  2. Satisfactions
  3. Future goals
  4. Stressors
  5. Coping style
  6. Housing
  7. Education
  8. Literacy level
  9. Any financial concerns
  10. Violence potential (is there a gun kept in the home?)
65
Q

Health habits

A
  1. Exercise
  2. Alcohol
  3. Diet
  4. Smoking
  5. Illicit drugs
  6. Sleep
  7. Seat belt use
66
Q

Occupational and environmental health history

A

A complete listing of past and current paid and unpaid positions, including military experience, and any exposures, injuries and impairments

67
Q

Review of systems

A

A checklist of symptoms, by body system, that may prompt recall of an important symptom within the past 6 months

68
Q

Components of a problem specific history include:

A
  1. Client profile
  2. Chief complaint
  3. History of present illness
  4. Key occupational health questions to help determine work relatedness
69
Q

Key occupational health questions to determine work relatedness

A
  1. Is the symptom temporally related to work
  2. Is the symptom temporally related to a change in a work process
  3. Does the symptom improve or go away when away from work
  4. Do co workers have similar complaints
  5. Is the worker exposed to an agent that is known to cause the symptoms? Does the symptom cause any difficulty with work?
70
Q

Goals of the occupational and environmental exposure history are to:

A
  1. Identify current or past exposures
  2. Reduce or eliminate current exposures
  3. Reduce adverse health effects
71
Q

Purposes of occupational and environmental exposure history are to:

A
  1. Identify asymptomatic occupational/environmental illness
  2. Provide epidemiologic correlation between symptoms and activities or exposures
  3. Help to correctly diagnose occupational or environmental health problems, and stimulate prevention activities at the work site so others are not similarly exposed
  4. Help prevent aggravation or existing injury/illness
  5. Allow assessment of synergistic risks
  6. Aid in teaching and counseling about health and safety rights and responsibilities, self care strategies, and risk reduction activities at work
72
Q

Screening occupational/environmental health tool described by Blue and colleagues

A
  • A focused screening tool for use in the primary care setting, to identify high risk jobs or home exposures
  • Based on the pneumonic WHACS
73
Q

WHACS

A
  1. What do you do
  2. How do you do it
  3. Are you concerned about any exposures on or off the job
  4. Coworkers or others exposed
  5. Satisfied with your job
74
Q

A comprehensive occupational and environmental exposure history includes the following:

A
  1. Exposure history
  2. Work history
  3. Environmental history
75
Q

Exposure survey

A

Selected questions include current exposure to metals, dust, loud noise; use of protective equipment; any recent job changes

76
Q

Work history

A
  1. Occupational profile

2. Occupational exposure history

77
Q

Occupational profile

A
  1. Job title
  2. Type of industry
  3. Dates of employment
78
Q

Occupational exposure inventory

A
  1. Missing more than one day of work because of an illness related to the job
  2. A job change because of any health problems or injuries
79
Q

Example of a format for occupational and environmental health history- exposure survey

A
  1. Are you currently exposed to metals, dusts or fibers, chemicals, fumes, radiation, biologic agents or loud noise, vibration or extreme heat or cold
  2. Have you been exposed to any of the above in the past
  3. Do any household members have contact with metals, dust, fibers, chemicals, fumes, radiation or biologic agents
  4. Do you know the names of the metals, dusts, fibers, chemicals, fumes or radiation that you are/were exposed to
  5. Do you get the material on your skin or clothing
  6. Are your work clothes laundered at home
  7. Do you shower at work
  8. Can you smell the chemical or material you are working with
  9. Do you use protective equipment such as gloves, masks, respirators or hearing protectors
  10. Have you been advised to use protective equipment
  11. Have you been instructed in the use of protective equipment
  12. Do you wash your hands with solvents
  13. Do you smoke at the workplace or at home
  14. Are you exposed to secondhand tobacco smoke at the workplace or at home
  15. Do you eat at the workplace
  16. Do you know of any co workers experiencing similar or unusual symptoms
  17. Are family members experiencing similar or unusual symptoms
  18. Has there been any change in the health or behavior of family pets
  19. Do your symptoms seem to be aggravated by a specific activity
  20. Do your symptoms get worse or better at work, at home, on weekends; on vacation
  21. Has anything about your job changed in recent months (duties, procedures, overtime)
  22. Do you use any traditional or alternative medicine
80
Q

Environmental history

A

Selected questions include:

  1. Living next to an industrial plant or dump site
  2. Source of drinking water
  3. Year home was built
81
Q

Critical aspects of the exposure history require

A
  1. Quantifying the amount, duration, and frequency of exposure (dose)
  2. Detailing route of exposure (inhalation, dermal, ingestion, mucous membrane)
  3. Separating acute vs chronic exposures
  4. Separating acute vs chronic health effects
  5. Taking an environmental exposure history
82
Q

Example of a format for occupational and environmental health history- work history- occupational profile

A
  1. Current job title
  2. Current type of industry
  3. Name of current employer
  4. Date current job began
  5. Are you still working in this job, if no when did job end
  6. Describe job
  7. Fill in table of all jobs including short term, seasonal, part time employment and military service (include dates of employment, job title and description of work, exposures and protective equipment)
  8. Have you ever had a job or hobby in which you came into contact with exposure hazards either by breathing, touching or ingesting
83
Q

Job or hobby hazards that were contacted by either breathing, touching or ingesting to ask about

A
  1. Acids
  2. Alcohols (industrial)
  3. Alkalis
  4. Ammonia
  5. Arsenic
  6. Asbestos
  7. Benzene
  8. Beryllium
  9. Cadmium
  10. Carbon tetrachloride
  11. Chlorinated naphthalenes
  12. Chloroform
  13. Chloroprene
  14. Chromates
  15. Coal dust
  16. Dichlorobenzene
  17. Ethylene dibromide
  18. Ethylene dichloride
  19. Fiberglass
  20. Halothane
  21. Isocyanates
  22. Ketones
  23. Lead
  24. Mercury
  25. Methylene chloride
  26. Nickel
  27. PBBs
  28. PCBs
  29. Perchloroethylene
  30. Pesticides
  31. Phenol
  32. Phosgene
  33. Radiation
  34. Rock dust
  35. Silica powder
  36. Solvents
  37. Styrene
  38. Talc
  39. Toluene
  40. TDI or MDI
  41. Trichloroethylene
  42. Trinitrotoluene
  43. Vinyl chloride
  44. Welding fumes
  45. X-rays
  46. Others
84
Q

Example of a format for occupational and environmental health history- work history- occupational exposure inventory

A
  1. Have you ever been off of work more than one day because of an illness related to work
  2. Have you ever been advised to change jobs or work assignments because of any health problems or injuries
  3. Has your work routine changed recently
  4. Is there poor ventilation in your workplace
85
Q

Example of a format for occupational and environmental health history- environmental history

A
  1. Do you live next to or near an industrial plant, commercial business, dump site or non residential property
  2. Do you have any of the following at home (air conditioner, fire place, air purifier, wood stove, central heating- gas or oil, humidifier, has stove, electric stove
  3. Have you recently acquired new furniture or carpet, refinished furniture or remodeled your home
  4. Have you weatherized your home recently
  5. Are pesticides or herbicides (bug or weed killers, flea and tick sprays, collars, powders or shampoos) used in your home, garden or on your pets?
  6. Do you or any household member have a hobby or craft
  7. Do you work on your car
  8. Have you ever changed your residence because of a health problem
  9. Does your drinking water come from a private well, city water supply or grocery store
  10. Approximately what year was your home built
86
Q

Pneumonic for environmental exposure history

87
Q

I-PREPARE

I

A

Investigate potential exposures

  1. Have you ever been sick after coming in contact with a chemical
  2. Do you have symptoms that improve away from work or home
88
Q

I-PREPARE

P (1st P)

A

Present work

  1. Are you exposed to solvents, dusts or fumes?
  2. Do you know where to find MSDS
  3. Do you wear your work clothes home
89
Q

I-PREPARE

R (1st R)

A

Residence

  1. When was your residence built
  2. What type of heating do you have
90
Q

I-PREPARE

E (1st E)

A

Environmental concerns

  1. Are there any environmental concerns in your neighborhood?
91
Q

I-PREPARE

P (2nd P)

A

Past work

  1. What are your past work experiences
92
Q

I-PREPARE

A

A

Activities

  1. What activities or hobbies do you have
  2. Do you garden, fish or hunt
93
Q

I-PREPARE

R (2nd R)

A

Referrals and resources

  1. Agency for Toxic Substances and Disease Registry
  2. Association of Occupational and Environmental Clinics
  3. Environmental Protection Agency
  4. Material Safety Data Sheets
  5. Occupational Health and Safety Administration
  6. Local health department, environmental agency, poison control
94
Q

I-PREPARE

E (2nd E)

A

Educate

  1. Are materials available to educate the patient
  2. Have prevention strategies been discussed
  3. What is the plan for follow-up
95
Q

Limitations of the health history include the following:

A
  1. Reliability of informant may be compromised because of language and communication barriers
  2. Family and social history may be emotionally charged for the individual
  3. Provider may fail to collect and/or pursue significant data from occupational and environmental history
  4. Workers may lack knowledge about exposures
96
Q

Ways workers may lack knowledge about exposures

A
  1. Workers may lack understanding of the health implications of certain activities
  2. There may have been inadequate time during clinic encounter to gather data
  3. Providers may not know what to do with information if collected
97
Q

Purposes of physical examination in the occupational setting are to:

A
  1. Identify disease
  2. Detect disease process in presymptomatic stage
  3. Determine biological marker/ target organ measures at baseline; compare measures at time of surveillance
  4. Determine any impairment that may impact the ability to do the job or may necessitate an accommodation
  5. Document baseline objective findings, if there is prior impairment and potential future apportionment
98
Q

Several things must be considered when conducting a physical examination

A
  1. Primary purpose of the examination and use of the data will determine the scope of the physical examination
  2. Examination findings or absence of findings, should be charted in an objective and non judgmental fashion
  3. The ethical principle of nonmaleficence is of primary concern
  4. Findings should be summarized and recorded consistently, so that any abnormalities from baseline can clearly be detected over time
99
Q

Techniques for physical examination

A
  1. Inspection
  2. Palpation
  3. Percussion
  4. Auscultation
100
Q

Inspection

A

Uses sight to look at the individual and to observe variations from the norm or from previously observed state

101
Q

Palpation

A

Uses light and deep touch to feel with hands and fingers to check temperature, moisture, texture, size, pulsation, vibrations, presence of joint swelling, nodules, masses, joint mobility and organ size and location

102
Q

Percussion

A

Is the direct striking of a finger against skin or the indirect striking of a finger against a finger lying against an individual’s skin. This technique is used to assess tenderness and/or to determine the density, size and location of underlying organs

103
Q

Examples of percussion sounds

A
  1. Tympanic
  2. Resonant
  3. Hyperresonant
  4. Dull
  5. Flat
104
Q

Auscultation

A

The process of listening directly with the bell or the diaphragm of the stethoscope to assess sounds produced by the various organs and tissues

105
Q

Types of sounds where you auscultate with the bell of stethoscope

A

Lower pitched sounds

106
Q

Types of sounds where you auscultate with the diaphragm of stethoscope

A

For higher pitched sounds

107
Q

Methods used to conduct physical examination consider the following:

A
  1. The examination should be performed systematically; it’s depth and scope depend on its purpose and proficiency of the direct care provider
  2. If the person reports a specific symptom more in depth testing of that area is indicated
  3. Abnormal physical assessment findings should be matched with symptoms through a clinical decision making process
  4. Laboratory/ diagnostic studies
108
Q

Resource for review of health assessment/ physical examination skills

A

Rasmor and Brown, 2001 and 2003

109
Q

Clinical decision making

A

The process of analyzing subjective and objective data and establishing a working definition of the health problem

110
Q

Steps in clinical decision making:

A
  1. Identify abnormal findings
  2. Cluster these findings into logical groups
  3. Localize findings anatomically
  4. Interpret findings in terms of probable process
  5. Make one or more hypotheses about the nature of the client’s problem
  6. Test the hypothesis
  7. Establish a working definition of the problem, the “assessment” and share rationale of how the subjective and objective data and laboratory findings link to support the working diagnosis
  8. Outline a plan
111
Q

Examples of types of abnormal findings:

A
  1. Symptoms
  2. Physical signs
  3. Laboratory results
  4. Recent worksite sampling results
  5. Recent surveillance results
112
Q

Examples of types of probable processes:

A
  1. Pathologic
  2. Pathophysiologic
  3. Psychopathologic
113
Q

Pathologic process

A

Involving an abnormality in a body structure

114
Q

Pathophysiologic process

A

Involving an abnormality in body function

115
Q

Psychopathologic process

A

Involving a disorder of mood or thinking

116
Q

In occupational health, probable process includes…..

A

The toxicology of the substance, specifically determining the dose-response and known target-organ effect

117
Q

What provides additional objective data for the toxicology of a substance?

118
Q

Steps for making a hypothesis about one or more of the client’s problems

A
  1. Select the most specific and central findings around which to construct your hypothesis
  2. Match your findings against all conditions you know can produce them
  3. Eliminate the hypotheses that fail to explain the findings
  4. Weigh the probabilities
  5. Consider life-threatening, do not miss conditions and conditions that are treatable
119
Q

When making a hypothesis about a client’s problem, one step is weighing the probabilities. This is based on:

A
  1. Client’s risk profile
  2. Extent of exposure
  3. Epidemiology of the condition
  4. Temporal issues
  5. Toxicology of the exposure
120
Q

In occupational health testing a hypothesis often includes….

A

Removal from exposure or modification of work duties, with monitoring for changes in symptoms

121
Q

When making a working diagnosis it is important to…..

A

Include the client’s response to the working diagnosis and how he or she is coping with this diagnosis

122
Q

Other questions to consider when evaluating the working diagnosis:

A
  1. Is it a work-related condition, caused by work?
  2. Is it a pre-existing condition aggravated by work?
  3. Is it related to environmental health concerns?
  4. Is it not related to work or the environment?
  5. Does work pose any additional risks for injury/ or any difficulties?
  6. Is the person physically and emotionally capable of meeting the essential criteria of the job, with or without accommodation?
123
Q

Steps to outlining a plan

A
  1. Diagnostic interventions
  2. Therapeutic interventions
  3. Client education
  4. Date of follow-up visit
  5. Indicate if it is a recordable-reportable condition
  6. Temporary work restrictions or accommodations
124
Q

Components of plan

Diagnostic interventions

A

What additional laboratory tests or x-rays need to be ordered

Is any environmental sampling needed

125
Q

Components of plan

Therapeutic interventions

A

What will be prescribed today

This includes:

  1. Medications
  2. Exercise
  3. Modified work duties
  4. Ice
  5. Splints
126
Q

Components of plan

Client education

A

Describes the education and counseling provided at this visit

127
Q

Components of plan

Information included in return to clinic instructions

A
  1. Date of scheduled follow-up visit
  2. Advising client to return to clinic sooner if condition worsens
  3. Advising client to return to clinic with questions
  4. Advise the worker regarding urgent care or emergency settings to access if needed
128
Q

Components of plan

Recordable-reportable conditions

A

Is it OSHA recordable on the OSHA 300 log

According to state work comp laws is it reportable

Are there any other mandatory reporting requirements such as LOC or suspected pesticide exposure

129
Q

Components of plan

Temporary work restrictions/ accommodations

A

Direct communication with supervisor is often needed

Diagnosis is kept confidential

130
Q

The decision making process repeats itself with…..

A
  1. Follow-up appointments

2. Collection of new subjective, objective and laboratory data

131
Q

Cognitive tool/ mnemonic to stimulate possible diagnoses

A

OVINDICATES

132
Q

OVINDICATES

A 
O: occupational
V: vascular
I: inflammatory
N: neoplastic
D: degenerative or drug
I: infectious
C: congenital
A: autoimmune
T: trauma
E: endocrine
S: social/ psychologic
133
Q

Application of OVINDICATES clinical decision making and reaching a diagnosis process for

Headache

Occupational

A

Carbon monoxide exposure at work

134
Q

Application of OVINDICATES clinical decision making and reaching a diagnosis process for

Headache

Vascular

A

Vascular migraine headache

135
Q

Application of OVINDICATES clinical decision making and reaching a diagnosis process for

Headache

Inflammatory

A

Cervical sprain

136
Q

Application of OVINDICATES clinical decision making and reaching a diagnosis process for

Headache

Neoplastic

A

Brain cancer

137
Q

Application of OVINDICATES clinical decision making and reaching a diagnosis process for

Headache

Degenerative or drug

A

DJD of neck

Caffeine withdrawal

138
Q

Application of OVINDICATES clinical decision making and reaching a diagnosis process for

Headache

Infectious

A

Sinusitis

Meningitis

139
Q

Application of OVINDICATES clinical decision making and reaching a diagnosis process for

Headache

Congenital

140
Q

Application of OVINDICATES clinical decision making and reaching a diagnosis process for

Headache

Autoimmune

A

Temporal arteritis

141
Q

Application of OVINDICATES clinical decision making and reaching a diagnosis process for

Headache

Trauma

A

Subarachnoid bleed

142
Q

Application of OVINDICATES clinical decision making and reaching a diagnosis process for

Headache

Endocrine

A

Pituitary adenoma

143
Q

Application of OVINDICATES clinical decision making and reaching a diagnosis process for

Headache

Social/psychological

A

Stress

Somatoform disorder

Malingering

144
Q

Examples of prevention opportunities that can result from direct care and clinical decision making in the occupational setting include:

A
  1. When a worker presents with a work-related injury, it may signify a breakdown in a control measure. It is critical to do an accident investigation to correct this problem at the root cause, so coworkers are not similarly exposed
  2. When a worker presents with a work related injury or illness, it may be viewed as a sentinel event. Case finding screening activities an seek other workers who may have been similarly exposed but are still asymptomatic

Occupational & Environmental Health (49 decks)

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