TOPIC: Occupational Health Nursing

(Case study: Application of the nursing process)

Case Scenario:
Leslie Johnston, a 23-year old woman, was transferred by her employer into her job that required her to
work with chemicals used in photolithography. Leslie became concerned when she noticed that the label on
one of the pieces of equipment warned of possible adverse effects on reproduction. Because of her concern
and related issues, she went to the on-site health clinic to talk with YOU, the occupational health nurse.
You as the occupational health nurse invited Leslie onto his office to ask her questions and do a brief
health history. Leslie reported that she had been “excellent” until recently, but that she had not feel well since
transferring to her new position. She explained that she may be pregnant, but this was unconfirmed, she
questioned whether vague physical complaints (fatigue, headaches, and occasional queasiness) might be
related to working with chemicals, a pregnancy, or another reason.
You reassured Leslie that you had been employed at the company for 8 years, and you were aware
that there were no restrictions in Leslie’s work area for pregnant women. You pulled up her health file from his
computerized database and gave her a set of health history forms to complete. You also had her read and sign
several forms related to confidentiality and assured her that none of her health information would be shared
with their employer without her consent.

TASK 1: Formulate a nursing care plan for Leslie with this content below and utilize the ONCP format given.
Assessment
Subjective data

 Complete general health and occupational health histories.

 Assess Leslie’s work area with an industrial hygienist to determine whether there might be problems,
such as leaking equipment or problems with ventilation.
 After performing a modified physical assessment, discuss the symptoms Leslie was experiencing.
 Refer Leslie to her personal health care provider for further evaluation and to obtain a pregnancy test.
 Encourage Leslie to inform her supervisor and myself if the pregnancy test result is positive so we can
adapt her assignments to her condition.
 Review the most current industrial hygiene data appropriate to the area.

Diagnosis
Individual:

 Risk for possible adverse pregnancy outcomes

 Stress related to concern regarding possible exposure to harmful chemicals
 Vague physical complaints of unknown etiology
 Risk for chemical exposure
 Possible pregnancy

Community (Workplace):

 Potential for exposure of employees to unsafe chemicals and/or working conditions.

Planning
Individual:

Short-term goals
 Reduce stress experiences.
 Determine reason for her vague physical complaints.
 Determine pregnancy status.
 Determine potential exposure levels and review side effects of chemicals.

Long-term goals
 Ensure that the environment is safe for future pregnancies (if Leslie is not pregnant at present).
 Collaborate with Leslie and her supervisor on possible work restrictions.

Community (Workplace):
 Short-term goals
 Company personnel (e.g., the occupational health nurse, the industrial hygienist, and all others who are
directly affected) will be knowledgeable in safe handling of all hazardous chemicals.
 All company policies regarding safety and exposure will be followed.

Long-term goals
 All employees who work with and around potentially hazardous chemicals will undergo periodic
instruction and confirmation of knowledge about proper procedures.
 Policies on handling of chemicals and related information will be reviewed periodically as required by
law.
 Work areas will be monitored per policy for compliance with safe practices.
 There will be no incidents involving worker exposure to chemicals.

Intervention
Individual:

As Leslie’s health nurse, I will conduct a physical examination and identify any obvious physical
abnormalities. Because Leslie’s chief complaints were fatigue, occasional headache, and queasiness, I will
encourage her to make an appointment with her primary care provider or gynecologist for a more extensive
workup and to assess for pregnancy.
With Leslie’s permission, I will the industrial hygienist to counsel her regarding the policies of the
company, to explain what chemicals might potentially hazardous, and to review procedures and restrictions.
Make a request to the hygienist to send a team Leslie’s work to take air samples, check lighting, and perform
other tests to ensure there were no problems.

Community (Workplace):

The assigned industrial hygiene team will sample the environment for chemical exposure per
established procedure. They will also set up a plan to have the area more frequently observed pending the
results of the tests. The hygienist will assure me and Leslie that he would communicate any work restrictions or
changes to the personnel department and Leslie’s supervisor if needed.

Evaluation
Individual:

Community (Workplace):

Levels of prevention

Primary

Secondary

Tertiary