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TAKING AN EXPOSURE HISTORY 263 G Taking an Exposure History Appendix G provides two examples of environmental and occupational history-taking forms that could be used by nurses in a variety of practice settings. The first form, Comprehensive Occupational and Environmental History, was created for a faculty development workshop on Environmental and Occupational Health offered by the University of Maryland at Baltimore (June, 1993), the second, Occupational and Environmental Health History Form, is reprinted, with permission, from Alyce B. Tarcher's Principles and Practice of Environmental Medicine (Plenum Publishing Co., 1992). Both forms enable nurses and other health professionals to assess individual risk and the need for prevention, to diagnose and treat occupational and environmental illnesses, and to develop a sensitivity to the environmental conditions in a community that may contribute to ill health. Taking an exposure history also provides an opportunity for nurses to enhance their relationship with patients by learning more about an individual's workplace, home, and community environments.
TAKING AN EXPOSURE HISTORY 264 COMPREHENSIVE OCCUPATIONAL AND ENVIRONMENTAL HISTORY
TAKING AN EXPOSURE HISTORY 265
TAKING AN EXPOSURE HISTORY 266
TAKING AN EXPOSURE HISTORY 267 KEY OCCUPATIONAL AND ENVIRONMENTAL HEALTH QUESTIONS TO BE ASKED WITH ALL HISTORIES 1. What are your current and past, longest held jobs? 2. Have you been exposed to any radiation or chemical liquids, dusts, mists, or fumes? 3. Is there any relationship between current symptoms and activities at work or at home?
TAKING AN EXPOSURE HISTORY 268
TAKING AN EXPOSURE HISTORY 269 Occupational Exposure 1. Describe any health problems or injuries related to present or past jobs. 2. Have you or your coworkers had health problems or injuries? 3. Do you believe you have health problems related to your present or past work? 4. Have you been off of work because of a work-related illness or injury? If so, describe: 5. Have you worked with a substance that caused a skin rash? What was the substance? Describe your reaction. 6. Have you had trouble breathing, coughing, or wheezing while at work? If so, describe: 7. Do you have any allergies? If so, describe: 8. Have you had difficulty conceiving a child? 9. Do you have any children who were born with abnormalities? 10. Do you smoke or have you ever smoked cigarettes, cigars, or pipes? For how long and how many per day? 11. Do you smoke on the job? 12. Have you ever worked at a job or hobby in which you came into direct contact with any of the following substances through breathing, touching, or direct exposure? If so, please place a checkmark beside the substance. Acids Halothane Alcohols (industrial) Heat (severe) Alkalis Isocyanates Ammonia Ketones Arsenic Lead Asbestos Manganese Benzene Mercury Beryllium Methylene chloride Cadmium Nickel Carbon tetrachloride Noise (loud) Chlorinated naphathalenes PBBs Chloroform PCBs Chloroprene Perchloroethylene Chromates Pesticides Coal dust Phenol Cold (severe) Phosgene Dichlorobenzene Radiation Ethylene dibromide Ethylene dichloride Rock dust Silica powder Fiberglass Solvents
TAKING AN EXPOSURE HISTORY 270 Styrene Trinitrotoluene Talc Vibration Toluene Vinyl chloride TDI or MDI Welding fumes Trichloroethylene X rays If you have answered ''yes" to any of the above, please describe your exposure on a separate sheet of paper. Environmental Exposure 1. Do you live in the central city or in a rural, urban, or suburban area? 2. Have you ever changed your residence or home because of a health problem? If so, describe: 3. Do you live in the immediate vicinity of a refinery, smelter, factory, battery recycling plant, hazardous waste site, or other potential pollution source? 4. Do you (and your child) live in or regularly visit a building with peeling or chipped lead paint (e.g., built before 1960)? Has there been recent, ongoing, or planned renovation or remodeling of this structure(s)? 5. Do any members of your household have contact with dusts or chemicals in the workplace that are then brought into the home? 6. Do you have a hobby that you do at home? If so, describe: 7. Do you fumigate your home or use pesticides in and around your home and on a pet? Do you use mothballs? 8. What cleaning agents and solvents are used in your home? 9. Is there evidence of mold in your home? 10. Which of the following do you use in your home? Air conditioner Humidifier Electric stove Wood stove Air purifier Gas stove Fireplace Unvented kerosene heater or gas heater 11. What is your source of drinking water? Community water system Private well Bottled water