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OCCUPATIONAL DERMATITIS
OCCUPATIONAL DERMATITIS
Name
Course
Instructor
Institution
City and State of Institution
Date
Occupational Dermatitis
Occupational dermatitis is a skin inflammation that affects an individual in the line of duty or when they contact a hazardous substance. The disease occurs when a worker gets in contact with any biological, physical, or chemical substance associated with the disease. Most of the workers affected include caterers, cleaners, gardeners, florists, medical personnel, mechanics, and other industrial workers (Canadian Centre for Occupational Health & Safety, 2008). Occupational dermatitis is often associated with type IV cell-mediated allergy.
Rubber gloves, food products, coins, alcohol-based sanitizers, cleaning agents, and other chemical compounds cause an inflammation of the skin of the worker. Prolonged exposure to cleaning agents such as water, soaps, detergents, and disinfectants causes irritation and inflammation of the skin. Preparing and handling selected foods such as sugars, citrus fruits, flour, spices, meat, vegetables, and fish causes skin inflammation. The biological substances, mainly include insects, animals, plants, bacteria, fungi, and arthropods. Chemical agents include aldehydes, acids, alcohols, salts, solvents, heavy metals, and esters (Stellma, 1998).
Occupational dermatitis is the most common occupational disease in many countries, including the United States. Every year, the incidence rate of occupational dermatitis is 0.5–1.9 cases per 1000 full-time workers with about 3200 infected individuals. 55% of the cases are caused by cleaning agents while 40% of dermatitis incidences occur due to food irritants. Most of the infections are not fatal since they are treatable and manageable at an early diagnosis. Statistics indicate that the number of dermatitis has reduced drastically over the years, for example, the numbers dropped from the 400s in the 1990s to the 100s between 2004 and 2005. The incidence rate also reduced significantly between 1996 and 2009. The workers at the highest risk of contracting the disease include barbers, hairdressers, beauticians, glass cutters, chemical manufacturers, and ceramic workers (Rycroft, 2001).
Occupational dermatitis occurs when the skin is damaged or external agents diminish its protective capacity. The external agents damage the skin by removing water and essential oils and fats from the dermis, making the skin prone to the penetration of the harmful substances. Once the substances penetrate the skin, they mix with the skin proteins in the body and the formed combination is transported to other body parts by the white blood cells. The white blood cells protect the body against foreign substances. Thus, when the external agents penetrate the body, they fight them through the immune system (Kanerva, 2000). The white blood cells recognize the agents as foreign substances and trigger the release of chemicals called lymphokines that damage the tissues. The lymphokines cause swelling, itching, redness, pain and the formation of blisters on the skin. The inflammation often occurs in the area of contact with an agent, but it could spread to other body parts of the sensitized individual (Rom and Markowitz, 2007). The incubation period is twelve hours and severe symptoms appear three to four days after contact.
The disease mainly affects the hands because they are the most active organs at the workplaces. However, other body parts could be affected. The feet, groin, and axillae are affected when an individual wears clothes contaminated with chemicals. Dust irritants will cause inflammation in areas of the body where dust collects, such as sock line, collar line, flexural areas, and belt line. The neck and face are affected by vapor or mist contaminants that may splash or settle in these areas. Occupational dermatitis manifests itself through various symptoms (Johansen, Frosch, and Lepoittevin, 2010). The inflammation is manifested through reddening of the area of contact, scaling of the skin, hyperpigmentation, itching, fissures, burning sensation and vesicles on the affected part, and pain.
Several contributing factors predispose an individual to the disease. Hot working environments cause excessive sweating that causes hazardous chemicals to dissolve into the skin. Dry air also causes the skin to chap, exposing it to allergens. Cuts and scratches on the skin create an avenue for the hazardous substances to penetrate the body causing the disease. Operating grinding machines and other sharp machineries could cause friction and cuts that compromise the skin’s protection against the substances. Preexisting skin conditions may also contribute to the development of the disease. Age and other hereditary factors that vary among individuals could pose as risk factors to occupational dermatitis.
Diagnostic techniques of occupational dermatitis include a historical examination of an individual’s occupation, the working environment, and the substances involved in the workplace. Other confirmatory tests include a patch test where an allergen or irritant is applied on the skin; inflammation of the contact area indicates sensitivity to the test agent. However, the tests should be carried out meticulously to avoid false positives since excessive application of the agents could yield false results (Sickness Absence Recording Tool, 2014).
Occupational dermatitis can be prevented by observing some precautionary measures. Employers should identify potential skin irritants and sensitizers and replace them with safer products that have low skin reactivity. Employers should also provide appropriate personal protective equipment at the workplace depending on the nature of the job. For example, gardeners and florists handling harsh chemicals should be provided with gloves and gas masks, mechanics and construction workers should have coveralls and gas masks to protect them from hazardous fumes and chemicals. Employees should undergo regular health surveillance to establish potential risks when an individual is exposed to a hazardous agent. Employees should also undergo training in skin care and hygiene procedures, usage and maintenance of PPE, and reporting procedures during emergencies. Employers, in conjunction with representatives of the workers’ unions, should encourage employees to have minimal exposure to hazardous chemicals, carry out regular skin checkups, and promote good personal hygiene and housekeeping procedures (Health and Safety Executive, 2014).
Both drug and non-drug approaches can manage occupational dermatitis. Affected people should be encouraged to wash their hands regularly with non-perfumed products and dry them thoroughly. The patient should remove rings and other ornaments, clean them thoroughly, and not wear them until the condition has resolved completely. Complete avoidance of the irritant is the most effective management technique of the disease. Drug management includes the use of topical corticosteroid creams to treat severe cases of the disease. In the case of itching on the affected areas, antihistamines are effective in relieving the discomfort. Chronic and steroid resistant cases can be treated using second line agents such as psoralen combined with ultraviolet A, azathioprine and cyclosporine (Fisher, 2008).
Occupational dermatitis is a skin condition associated with various workplaces that expose the workers to harsh chemicals and substances. The most hazardous substances include cleaning agents, rubber chemicals, and food irritants. Working in wet and moist areas is also a major predisposing factor to the disease. Workers handling the above mentioned agents are at the highest risk, but the duration of exposure determines the severity of the disease. Avoiding the agents and proper skin care are the main ways of preventing and managing the disease. Severe cases are managed using drugs such as corticosteroid creams (Draper, 2011). Workers should avoid exposure to irritants and hazardous agents at the workplace and observe personal hygiene techniques in order to avoid contracting dermatitis. Constant exposure sans proper hygiene and PPE makes the workers vulnerable to the disease.
References
Canadian Centre for Occupational Health & Safety, 2008. Dermatitis, irritant contact. [Online] (updated 15 Oct. 2008) Available at: <http://www.ccohs.ca/oshanswers/diseases/dermatitis.html> [Accessed 6 May 2014].
Draper, R., 2011. Contact and occupational dermatitis. [Online] (updated 22 Jun. 2011) Available at: <http://www.patient.co.uk/doctor/Contact-and-Occupational-Dermatitis.htm> [Accessed 6 May 2014].
Fisher, A., 2008. Fisher’s contact dermatitis. Shelton: PMPH-USA.
Health and Safety Executive, 2014. Dermatitis. [Online] Available at: <http://www.hse.gov.uk/food/dermatitis.htm> [Accessed 6 May 2014].
Johansen, J, Frosch, P. J, and Lepoittevin, J., 2010. Contact Dermatitis. New York: Springer.
Kanerva, L., 2000. Handbook of occupational dermatology. New York: Springer.
Rom, W. N, and Markowitz, S. B., 2007. Environmental and occupational medicine. New York: Lippincott Williams & Wilkins.
Rycroft, R., 2001. Textbook of contact dermatitis. New York: Springer.
Sickness Absence Recording Tool, 2014. Information on occupational dermatitis. [Online] Available at: <http://www.iom-world.org/sicknessabsence/occderm.htm#> [Accessed 6 May 2014].
Stellma, J. M.,1998. Encyclopaedia of occupational health and safety. Brussels: International Labour Organization.
Obstructive Sleep Apnea
Obstructive Sleep Apnea
Patrice Fraser
Pace University Top of Form
Title: Obstructive sleep apnea in adults
Date: 10/23/2014
Reviewer:
FOCUSED CLINICAL QUESTION
In adults 19 years and older, what is the effectiveness of Continuous Positive Airway Pressure (CPAP) (applied via a tight-fitting mask) in improving the cardiovascular prognosis in obstructive sleep apnea (OSA) patients?
SEARCH STRATEGY
An extensive search for information from EMBASE databases, MEDLINE, National Clearinghouse Guidelines, Google Scholar, PubMED, CINAHL, Cochrane Database of Systematic Reviews, and JBI ConNECT.
CLINICAL BOTTOMLINE
OSA is a common disorder affecting persons of all age groups but prevails mostly in adults. The increasing rates of obesity seem to increase OSA prevalence rates. OSA involves repeated collapse of air passages during sleep, leading to complete or partial stoppage of breathing (apnea or hypopnea, respectively), sometimes as frequent as once in a minute. The most common OSA symptoms include daytime sleepiness and poor sleep quality, although most patients tend to be asymptomatic. OSA has been ranked a public health issue owing to the mortality and morbidity rates associated with it, attendant comorbidities (among them diabetes), and deterioration of life quality. Studies have established that prior to diagnosis, OSA patients do have high health care use, frequently visit hospital, and incur greater costs in healthcare than after diagnosis.
The inconsistent OSA definition, debates about respiratory abnormality levels that come with the disease, and the most appropriate diagnosis approach complicate OSA treatment. For instance, the apnea-hypopnea index (AHI) is a metric used to diagnose OSA and classify the severity of the disease, but no current AHI threshold exists indicating the need for treatment. The normal practice is diagnosis with OSA if one has an AHI greater than 15 events per hour or an AHI of between 5 and 14 with documented ischemic disease, stroke history, hypertension, or symptoms of longer daytime sleepiness, mood disorders, impaired cognition, or insomnia. Persons with frequent events per hour (30) are more at risk of adverse outcomes.
A PubMed review revealed that CPAP provides pneumatic splitting of the upper passage way hence is effective for the reduction of AHI. Partial reduction of pressure at expiration can supplement CPAP modes of administration. PAP application through moth, nose or oronasal interface is the most preferred treatment for OSA1. (Level I)
A Cochrane review established that although other oral appliances provide improved sleep, CPAP is more effective. Oral appliances should not serve as first treatment but should be preserved for those patients unable to tolerate CPAP. (Level I)
A Google Scholar article revealed that OSA is an independent risk factor for stroke. However, little is known about the function of CPAP on mortality in stroke patients. (Level I)
CHARACTERISTICS OF THE EVIDENCE
The evidence summary is based on a structured search of the literature and selected evidence-based health care databases. Evidence included in the summary is from:
A task force report of clinical guidelines for the evaluation, management and long-term care of obstructive sleep apnea in adults.
A systematic review of studies on oral appliances for obstructive sleep apnea
A case analysis of oral appliances for obstructive sleep apnea treatment in patients with low CPAP compliance
A study of under pressure pulmonary arterial hypertension
A study on mortality reduction effects of CPAP treatment on patients with OSA and Ischemic stroke.
PRELIMINARY NUMBER OF SOURCES IDENTIFIED
The most up-to-date articles that informed this study included three clinical practice guidelines and two research studies, which analyzed the effectiveness of Continuous Positive Airway Pressure (CPAP) applied via a tight-fitting mask to treat obstructive sleep apnea (OSA) in improving the cardiovascular prognosis in such patients
Issues I encountered
Fewer sources were available that specifically relate the application of CPAP to OSA treatment.
Accessing some of the sources in full proved difficult because most of them were in summary or review forms. The online libraries were of little help too.
Questions for Class
Should Continuous Positive Airway Pressure be adopted as the most effective way of improving cardiovascular prognosis in OSA patients?
What methods are your institutions using to improve cardiovascular prognosis in OSA patients?
Can patients effectively administer CPAP on their own?
What challenges have your institution encountered while using CPAP?
Top of FormKeywords
Obstructive sleep apnea (OSA); cardiovascular prognosis; Continuous Positive Airway Pressure (CPAP)
Best Practice Recommendation (in order of the references below)
Physical examination can suggest high risk and should include respiratory, neurologic, and cardiovascular systems. One should pay specific attention to signs of the airway narrowing, presence of obesity, or the presence of other disorders, which can lead to OSA development or its consequences. Features to be evaluated, which may suggest OSA presence (Grade A) include larger neck circumference (>16 inches in women, >17 inches in men), body mass index ≥30 kg/m2,the presence of retrognathia, macroglassia, lateral peritonsillar narrowing, elongated/ enlarged uvula, tonsillar hypertrophy, nasal abnormalities (turbinatehypertrophy, valve abnormalities, deviation, polyps), high arched palate, a Modified Mallampati score (3 or 4), and/or overjet.
There is increasing evidence, which suggests that oral appliances improve sleep disordered breathing and subjective sleepiness compared to a control. CPAP is more effective in the improvement of sleep-disordered breathing than oral appliances (Grade A). The difference in the symptomatic response between the two treatments is insignificant, although it is impossible to rule out an effect and favor either therapy. Until more definitive evidence is discovered on the effectiveness of oral applications in relation to CPAP (long-term complications and symptoms), it is more appropriate to recommend oral application therapy to patients suffering from mild symptomatic OSA and those patients who cannot tolerate CPAP therapy.
There are no correlations between oral appliances (potential predictors of OSA) and the response to mandibular advancement devices.
Long-term CPAP treatment in ischemic stroke and moderate/ severe OSA is linked to a decrease in excess risk mortality.
OSA, as with other complex diseases, it is important for critical and progressive care nurses to give patients emotional and education assistance. It is imperative for OSA patients to be very active in communicating problems to health care providers and cooperate with them in managing the disease. OSA comes with crucial lifelong patient responsibilities, which require intensive patient education and including their families.
References
Epstein, L. J., Kristo, D., Strollo, P. J. Jr., Friedman, N., Malhotra, A., Patil, S. P.,
Ramar, K., Rogers, R., Schwab, R. J., Weaver, E. M., and Weinstein, M. D. (2009). Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine: Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med, 5(3), 263-276. Retrieved October 1, 2014 from National Guideline Clearinghouse. >> HYPERLINK “http://www.guideline.gov/content.aspx?id=15298&search=continuous+positive+airway+pressure” http://www.guideline.gov/content.aspx?id=15298&search=continuous+positive+airway+pressure (Level I)
Lim, J., Lasserson, T. J., Fleetham, J. and Wright, J.J. (2014). Oral appliances
for obstructive sleep apnoea. Cochrane Database of Systematic Reviews, 12(10). Retrieved October 1. 2014 from Cochrane Database of Systematic Reviews. >> HYPERLINK “http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004435.pub3/abstract” http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004435.pub3/abstract (Level I)
Marchese-Regona, R., Manfredini, D., Mion, M., Vianello, A., Staffieri, A., and
Guarda-Nardini, L. (2014). Oral appliances for the treatment of obstructive sleep apnea in patients with low C-PAP compliance: a long-term case series. Cranio 32(4), 254-259. Retrieved October 1, 2014 from PubMED. >> HYPERLINK “http://www.ncbi.nlm.nih.gov/pubmed/25252763” http://www.ncbi.nlm.nih.gov/pubmed/25252763 (Level III)
Martínez-García, M. A., Soler-Cataluña, J. J., Ejarque-Martínez, L., Soriano, Y.,
Román-Sánchez, P., Illa, F. B., Canal, J. M. M., and Durán-Cantolla, J. (2009). Continuous Positive Airway Pressure Treatment Reduces Mortality in Patients with Ischemic Stroke and Obstructive Sleep Apnea. American Journal of Respiratory and Critical Care Medicine, 180(1), 36-41. Retrieved October 1, 2014 from Google Scholar. >> HYPERLINK “http://www.atsjournals.org/doi/abs/10.1164/rccm.200808-1341OC” l “.VCxWpN69-IU” http://www.atsjournals.org/doi/abs/10.1164/rccm.200808-1341OC#.VCxWpN69-IU (Level I)
Weber, C., Silver, M., Cromer, D., Kaminski, S., Wirick, T., and Vallejo, J. (2011).
Under Pressure: Pulmonary Arterial Hypertension . . . A Mother’s Struggle. Critical Care Nurse, 31(4), 87-94. Retrieved 1 October, 2014 from CINAHL Database. >> HYPERLINK “http://ccn.aacnjournals.org/content/31/4/87.full” http://ccn.aacnjournals.org/content/31/4/87.full (Level II)
Recommended Practice
CPAP treatment
EQUIPMENT
CPAP machine
CPAP humidifier
CPAP mask
PREPARATION OF PATIENT
Put patient on the machine for a few nights
Predict patient compliance with the device by using
Built-in smart cards
Communication modem
Web-based system
Record the hours of machine use and the interface usage
PROCEDURE (IMPROVING COMPLIANCE)
Early and Continuous education (Level I)
Education should be conducted by the physician, the sleeping partner and the spouse of the patient
This makes the patient have a better “first impression” of CPAP hence getting ready for its use
Education should cover CPAP advantages and disadvantages
Initiation of CPAP therapy (Level I)
CPAP starts after the couple of nights trial
Upon producing the device patient should know
what it is
how to do titration
why the device is being used
what to expect throughout the nights
Issues related to leaks, swallowing, talking and mouth-breathing should be clarified
Assure patient to keep in touch in case any mechanical problems arise
Immediate Individual Follow-up (Level I)
Call patient several times in the first week to discuss the therapy
Encourage the patient
Monitoring Compliance and Efficacy (Level I)
Check compliance 3 to 6 months following its initial setup
Assess usage of equipment (use and application hours)
Check the device settings
Ensure good condition of interface (masks, pillows, etc)
Discuss the assessment results
Reinforce the need for adherence
Correct anything that could affect compliance
Long-term Support (Level I)
Annual visit to the clinic is necessary to assess the usage of the device
Changes in patient body conditions (e.g. weight loss/ gain) could warrant pressure alterations in the device
Choice of Interface/ Mask Fit (Level I)
The pillows and nasal masks should be of correct size
Nasal pillow is essential for patient with claustrophobia
Oronasal mask essential for patient with persistent mouth leak or nasal congestion
Replace broken headgear/ supply tube/ interface immediately
Nasal Congestion, Steroids/ Antihistamines (Level I)
Difficulty in breathing creates compliance difficulty
Nasal sprays with antihistamines essential for patient with congestion
Group Support (Level I)
Gather CPAP patients for support
Support groups help to:
share tips of coping with CPAP
discuss health effects of CPAP
explore CPAP effect on sleep partner relationship
reinforce CPAP education
bear each other’s burden
REFERENCE
Marchese-Regona, R., Manfredini, D., Mion, M., Vianello, A., Staffieri, A., and
Guarda-Nardini, L. (2014). Oral appliances for the treatment of obstructive sleep apnea in patients with low C-PAP compliance: a long-term case series. Cranio 32(4), 254-259. (Level III)
OHS LOGOS: (Mark an X beside the logos to be included)
X Patient Information
X Wash Your Hands
X Standard Precautions
Take Care With Sharps
X Clinical Competency
X Back Care Manual Handling
Spills Are Hazardous
X Resident Education
X Maintain Electrical Safety
Cytotoxic Chemotherapy
Radiation Hazard
X Safety Testing
Observational Development
I nKenyian Goodacre
Professor Leslie
Psy 301
April 5, 2015
Observational Development
In order to understand the development psychology of the child, I choose to observe a child who knows things around him and can express himself easily. This led me, to choosing my neighbor’s child, a five-year old boy named Jacob. He is from the neighborhood and well known to me, he seems like a normal boy although he does not have any permanent friends that he plays with everyday, he seems to hop from friend to friend. At the young age of five years he is in the preschool stage of development. This is the self-awareness and imagination stage in which a child starts understanding the things around him. at this point the child begins to know what their real identity is. It is also at this phase that they get to understand that their behaviors have consequences and those consequences at the time they will not be positive if their behavior was not positive.
A child at this age stands out from other kids, therefore I began observing his character and or how he interacts with other children. For instance, the physical characteristic of this child is that he has a great appetite and eats more frequently. The energy in his body is usually burnt rapidly making it necessary for the child to eat a lot. Due to the many activities during the day, the child can also be said to be exhausted and tends to retire early in the evening. They have to rest early for their bodies to regain the lost energy. At this age, the child is also responsible for toileting. At some points, however, it may happen accidentally, especially if the child was busy doing something else and simply forgets to go to the bathroom. The child might also need some assistance in issues such as dressing and putting on shoes. Though he has an idea of how it is done, he might not be able to do it perfectly. Lastly the child is observed playing in one position or with one activity for a good amount of time but keeps changing various positions and activities frequently. He cannot sit for a long time in one place therefore, he is always constantly moving.
The other characters that would make this child stand out from others are the emotional characteristics he poses. For example he always tends to blame others for his own mistakes. He is not quick to accept that the mistake was his and always lays the blame on others. It was also observed that the child was afraid of the dark. This point shows that the child has become aware of the dangers posed by others especially those that are not friendly. In some situations, the child can also be said to be verbally aggressive. If he has not accorded enough attention, the child may at times try to get his way by being verbally aggressive. At this age, the child will always want the approval and support of others, whether it is adults or his peers.
At the time of observation, the child was out playing outside with other kids his own age. Jacob seems to enjoy playing with other children and want to participate in all activities. At one point, he is seen busy trying to mold something with the soil. He then rushes to show it to his friends, saying it is his dad’s car. Somewhere before he gets to his friends he drops it and then aggressively blames its destruction on one of his peers. After sometimes, he moves on as if nothing had happened, not showing any anger even for that child he accused of destroying his dirt creation.
These behaviors can be said to relate well with the characteristics of a child at his aged discussed above. For instance, the child can be said to be friendly and corporative by the way he enjoys playing with other kids. He is also seen trying to mold a car from the soil, showing he is attempting to understand the nature and things around him. He then forgets the issues and moves on showing that he is resilient, forgiving, and forgetful in a childlike sense.
Work cited
Lemma, Alessandra. “Psychodynamic Therapy: The Freudian Approach”. In W. Dryden.
Handbook of individual therapy. Thousand Oaks, Calif: Sage. 2002