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2015-02-02 20:31:43
COHN Occupational Health Nursing

For studying for COHN-S certification exam
Show Answers:

  1. What agents cause dec libido/hormonal alterations?
    Lead, mercury, manganese, carbon disulfide
  2. Agents that cause sperm toxicity
    Lead, DBCP, carbaryl, toluenediamine, dinitrotoluene, ethylene dibromide, stryene, acetone, ethylene glycol, monoethyl ether, welding, perchloroethylene, mercury, heatt, military radar, kepone, bromine, radiation,
  3. Agents that cause spontaneous abortion in female partner
    Solvents, lead, mercury
  4. Males: agents that cause congenital malformations in offspring
    Pesticdes, chlorophenates, solvents
  5. Males: agents that cause neurobehavioral disorders in offspring
    Alcohols,cyclophosphamide, ethylene bromide, lead, opiates
  6. Males: agents that cause cancer in offspring
    Solvents, paint, pesticides, petroleum products
  7. Pregnancy effects: heavy metals
    Neuro and behavioral defects
  8. Effects in pregnancy: organic solvents
    Ab, inc risk in birth defects, fetal solvent syndrome
  9. Pregnancy effects: antineoplastic agents:
    Spont ab
  10. Pregnancy effects: antivirals
    Ab, sperm effects in maoes, teratogenesis in females
  11. Pegnancy effects: estrogenic/antiestrogenic compounds
    Ab, sperm effects in males, teratogenic effects in females
  12. Pregnancy effects: immunosuppressives
    Ab, sperm effects in males, teratogenesis in females
  13. Aluminum: systems affected
    Nervous, respiratory
  14. Arsenic: systems affected
    Nervous, liver, GI, resp, hematopoietic, endocrine
  15. Cadmium: systems affected
    Renal, nervous, GI, resp, bone, CV
  16. Chromium: systems affected
    Renal, nervous, liver, resp, skin
  17. Cobalt: systems affected
    Nervous, GI, resp, endocrine, skin, CV
  18. Copper: systems affected
    GI, hematopoietic
  19. Effect on pregnancy: carcinogens/mutagens
    Males: sperm effects, offspring of exposed females: teratogenesis, cancer
  20. Effect on pregnancy: waste anesthetic gases
  21. Effect on pregnancy: sterilants and disinfectants
  22. Effects on pregnancy: PCBs
    Congenital PCB synd, mild neonatal growth/behavioral effects
  23. Effects on pregnancy: pesticides
    Male and female reproductive effects
  24. Flouride: systems affected
    Nervous, resp, bone, skin
  25. Iron: systems affected
    Nervous, liver, GI, resp, HP, endocrine
  26. Lead: systems affected
    Renal, nervous, HP, endocrine
  27. Manganese: systems affected
    Nervous, resp
  28. Mercury: systems affected
    Renal, nervous GI, resp
  29. Nickel: systems affected
    Nervous, resp, skin
  30. Selenium: systems affected
    Renal, GI, skin
  31. Silver: systems affected
    Resp, skin
  32. Thallium: systems affected
    Renal, nervous, liver, GI, resp, bone
  33. Zinc: systems affected
    GI, HP, bone
  34. Chemicals that cause infertility
    Anesthetics, cadmium, chloroprene, ethylene dibromide, lead, manganese
  35. Agents that cause menstrual disorders
    Aniline, benzene, carbon disulfide, chloroprene formaldehyde, lead, toluene
  36. Agents that cause female fecundity
  37. Agents that cause prematurity/low birth weight
    Cadmium, CO, formaldehyde, mercury. toluene. vinyl chloride
  38. Agents that cause birth defects
    Antineoplastics, benzene, lead
  39. Agents that contaminate breast milk
    Benzene, cadmium, DDT, dieldrin, lead, mercury
  40. Hazards related to abrasive blasting
    Silica and metal dust
  41. Hazards related to cosmetology
    Chemical exposures
  42. Hazards related to farming
    Pesticide exposures, heat illness, heavy lifting, hazardous equipment
  43. Hazards related to grinding, polishing and buffing
    Toxic dust inhalation (metals, abrasives)
  44. Hazards related to painting
    Solvent inhalations
  45. Hazards related to meat wrapping
    Ortho (standing/lifting) fume exposure from wrap 
  46. ANSI work type classifications
    • Struck by
    • Caught in, under, between
    • Struck against
    • Fall from height
    • Fall on same level
    • MVA
    • Overexertion
    • Repetitive trauma
    • Other causes physical trauma (electric current, radiation, temperature extremes, chemicals, tissue abrasions)
  47. Marker model: activities that constitute professional practice
    • 1. Establishing standards for prof. practice
    • 2. Credentialling (licensure, performance monitoring, certification and testing)
    • 3. CE
    • 4. Performance appraisals compared to established standards
    • 5. Audit procedures and data collection
    • 6. Monitoring for a quick check of quality of care
    • 7. Ongoing problem identification and monitoring
    • 8. Resource utilization monitoring
    • 9. Continuous risk management
  48. Four specialty areas of ergonomics
    • Human factors engineering: gauges, warding buzzers, signs, instructions, controls
    • Anthropometry: design of clothing, machines, furniture and tools
    • Occup. biometrics: studies effects of work on muscles/connective tissues and devleopement of M-S disorders
    • Work physiology: deals with ways work affects the CVS, resp system and skeletal muscles with goal of preventing body fatigue
  49. Raynaud's syndrome:
    • Vibration
    • Numbness, tingling, ashen skin, loss of feeling and control
  50. Four aspects of an ergonomic program
    • Worksite analysis
    • Hazard prevention and control
    • Medical management
    • Training and education
  51. Administrative controls: meaning
    Policies/procedures; do not remove hazards, but attempt to control it 
  52. Rotator cuff tendintis:
    • Working with hands over head
    • Shoulder pain and stiffness
  53. Carpal tunnel syndrome:
    • Tingling, numbness, loss of sensation, pain in thumb, IF, MF half of RF
    • Repetitive/forceful manual tasks
  54. De Quervain's Disease: cause
    Excessive twisting/gripping
  55. Definitions:
    • Has potential to cause cancer through:
    • Initiation (genetic mutations occur)
    •   Body can repair/prevent cancer@this point
    • Promotion (changes are stimulated to be cancer)
  56. Dose-response: 
    • Correlation between dose and effect
    •      Effective: positive therapeutic effect
    •     Threshold: dose at which drug begins to have an effect
  57. Latency period
    Time between moment of exposure to a chemical and when an observable effect is realized
  58. Definition: toxic vs. hazard
    Toxic: has potential to cause harm to organism

    Hazard: potential for damage is severe enough that it can result in poisoning

    Thus, every toxic chemical is not necessarily toxic. Toxicity cannot be altered, but safe work practices can control hazards.
  59. Definition:
    • Poison: chemical that produces illness or death when a person is exposed to only small quantities
    • Technically: chemical  with an LD50 of 50 mg or less per kg of body weight. The lower the LD50, the great the toxicity

    Toxin: chemical that produces a negative effect. 

    All poisons are toxins, but not all toxins are poisons
  60. Asphyxiants: simple/chemical
    Simple: displace oxygen in the air (carbon dioxide)

    Chemical: block absorption of oxygen in body at cellular level: eg carbon monoxide
  61. 3 sources that dictate classification as a substance as a hazard
    • 1. Scientific literature/exposure limit guides
    • TLVs (threshold limit values) published by American Conference of Govt. Hygenists (ACGIH)
    • 2. Legal requirements: OSHA, federal, state, and local regs
    • 3. Data gathered from worker evaluatons: work process assessment, worksite assessment, biological sampling and environmental sampling
  62. Integrated sampling
       Active/passive sampling
    • Integrated sampling: moves known volume of air through filter over a specific period of time
    •     Active: air physically forced through filter using a sampling pump
    •     Passive: Air is not mechanically forced through filter, but allowed to pass at natural rates as by diffusion
  63. Mutagenic effect
    One that results in change (mutation) to the DNA of organism
  64. Threshold limit value-time weighted average (TLV-TWA)
    Time-weighted avg concentration that all workers are exposed to during a normal 40-hr work week and to which no negative effects are observed. Typical, consistently repeated exposure that produces to harm to workers
  65. Theshold limit value-short term exposure limit (TLV-SEL)
    Concentration workers can be exposed to continuously over a short period of time where no noticeable negative effects are observed.
  66. Threshold limit value-ceiling (TLV-C)
    Concentration considered top, threshold limit. exposure level at which noticeable and negative effects are realized. Should never  be surpassed.
  67. Grab sampling
    Uses container to collect a sample of air which is analyzed for concentration of contaminants. Instant, point in time assessment, so NOT best technique for assessing exposure levels throughout day. Used if you want to determine contaminant levels at a time when it is known that levels are high
  68. Information required in MSDS
    • -Name of material per label
    • -Chemical and common name of all ingredients
    • -Physical and chemical characteristics of every hazardous ingredient
    • -Physical hazards of chemicals
    • -Health hazards of chemicals including signs and symptoms of exposures and health conditions that can be made worse by exposure
    • -Primary routes of entry
    • -Exposure limits
    • -Carcinogenic status
    • -Necessary control measures
    • -Precautions for safe handling
    • -Emergency and first-aid measures
    • -Date of preparation of MDSS
    • -Contact information of all parties responsible for preparaton of MDSS
  69. Ranking system for acute chemical toxicity
    • Classification/Lethal Dose for adult/Example
    • 1. Practically nontoxic: >15 -15g/kg (more than one quart-sugar)
    • 2. Slightly toxic: 5-15 g/kg (one pint to one quart-salt)
    • 3. Moderately toxic:  .5-5 g/kg (one ounce to one pint 2,4-D herbicide)
    • 4. Very toxic: 50-500 mg/kg (one tbsp- one oz-arsenic acid)
    • 5. Extremely toxic:  5-50 mg/kg (7 gtts to one tsp-nicotine)
    • 6. Supertoxic: <5 mg/kg (<7 gtts-botulin toxin)
  70. Biological Exposure Indices (BEIs)
    • Provide a measurement to which results of biological monitoring tests can be compared
    • Provide warning of exposure and not an indication of the negative effects of a substance
  71. Occupational Health and Safety Act
    • 1970
    • Excludes: self-employed, farms that don't employ outside help and industries regulated by other federal agencies
    • Created OSHA
    • Companies can be inspected at any time without advance notice
    • Created NIOSH which performs and funds OH and safety related research
  72. Family Medical Leave Act:
    year/how much leave/employee notice

    Up to 12 weeks of unpaid leave within a year without demotion or losing job

    Employee must give 30 days leave whenever possible
  73. FMLA: Valid reasons
    • Birth and care of a child
    • Adoption or foster placement of a child
    • Care of a parent, spouse or child with serious health condition
    • Worker's own ability to work due to a serious health condition
  74. FMLA: 2 qualifying conditions
    • Work for employer has at least 50 workers within a 75 mi radius
    • Must have worked for 12 months for at least 1250 hours
  75. Knowles four principles of adult education
    • Independent learning: give them self-directed activities
    • Previous experience: use learner's experience as a base
    • Readiness to learn: take advantage of moments when learners are receptive to information (pregnancy, diagnosis with illness)
    • Problem-oriented learning: address the specific concerns and problems of the learner, making learning experience relevant and specific
  76. Ways to categorize epidemiologic data
    • a: number of individuals exposed who have the diseae
    • b: number of individuals exposed who do NOT have the disease
    • c: Number of individuals unexposed who have the disease
    • d: Numbers of individuals unexposed who do NOT have the disease

    • Total number exposed: a+b/Total number unexposed: c+d
    • Total number with disease: a+c/Total number without the disease: b+d
  77. Relative risk
    • Disease rate in exposed/disease rate in unexposed
    • a/(a+b)  /  c/(c+d)
  78. Levels of prevention
    • Primary: eliminating or reducing risks
    • Secondary:  early detection and initial management
    • Tertiary: after disease is detected and is irreversible, rehab and return to optimal level of health within confines of disease
  79. Tort
    Wrong committed against a person or their property: fraud, invasion of privacy, defamation
  80. Nursing Negligence:
    Actions that compromise the standard of care to which all nurses are supposed to be committed
  81. Malpractice
    Neglect of a patient due to unprofessional conduct or lack of skill
  82. OSHA recordkeeping requirements
    Applies to employers with more than 11 employees

    Recorded in OSHA 300 log
  83. What must be recorded in OSHA 300 log
    • Injuries that result in :
    • Death
    • Missed days of work
    • Job restrictions
    • LOC
    • Serious injuries or illnesses that are diagnosed by a physician or those that require major medical treatment
    • Needlesticks/HBBF exposure
    • Privacy cases must also be reported
  84. Epidemiological triad
    Host, agent, environment
  85. OSHA access to employee exposure and medical records standard
    • Standard requires that the worker or a delegated rep must have access to the occ health records
    • Provided without charge within 15 days
    • Requires signed consent: which records, purpose of the release, to whom they are being released, date, authorization time period, authority by which records are being requested and identification of the employe
    • Not allowed to take originals
  86. Worker's comp: benefits
    • Income replacement for time ee is unable to work
    • Support for dependents in case of work-related death
    • Hospital, medical and funeral expenses
    • In some cases, related travel and parking expenses
  87. Workers comp: conditions
    • Must be provided whether or not accident was a result of employee neglect
    • If accepted, employee no longer to seek legal action against employer
  88. ADA: definition of disabled
    Have a physical or mental condition that limits their ability to participate in life activties
  89. ADA: provisions
    • Applies to employers with more than 15 employees
    • Cannot deny an individual a job  because of disability
    • Persons with disabilities must be provided with reasonable accomodations
    • EEOC enforces
  90. Disease frequency
    Number of events/Number of people at risk X population constant k

    Usually reported per 100,000
  91. Periods of development in perinatal toxicology
    • Implantation (6-7 days): embryonic death
    • Organogenesis (7 days-2 mos): birth defects
    • Embryonic period (0-3 mos): birth defects
    • Fetal Period (3-9 mos): developmental and behavioral deficits, endocrine and immune dysfunction, cancer
    • Neonatal period (after birth): functional defects
  92. ANSI: 5 different types of chemicals
    • Dusts: solid particles that result from physical processes, like handling, crushing, grinding
    • Fumes: solid particles that result form condensation of gases or due to chemical reactions like oxidatin
    • Mists: drops of liquid that are suspened in the air due to the change of a gas to a liquid or by dispersing a liquid by splashing or foaming
    • Vapors: the gaseous state of a liquid that is commonly found in its solid or liquid state
    • Gases Fluid that tend to stay in the gaseous state and can only changed into a liquid or solid state by a combination of increasing pressure and decreasing temperature
  93. Permissable exposure limits (PEL)
    • OSHA publishes
    • Based on TLVs developed by ACGIH
    • PELs not updated as frequently as TLVs, so TLVs may be more accurate/updated
  94. Recommended exposure limits: RELs
    • Published by NIOSH
    • Time weighted for up to a 10 hour day of  a 40 hour workweek