INDIVIDUAL CONTAMINATION Nursing Care Plan

Individual Contamination

Risk for Individual Contamination
NANDA-I Definition
Exposure to environmental contaminants in doses sufficient to
cause adverse health effects
Defining Characteristics
Defining characteristics are dependent on the causative agent.
Causative agents include pesticides*, chemicals*, biologics*,
waste*, radiation*, and pollution*.
Pesticide Exposure Effects
Pulmonary
Anaphylactic reaction
Asthma
Irritation to nose and throat
Burning sensation in throat
and chest
Pulmonary edema
Shortness of breath
Pneumonia
Upper airway irritation
Dyspnea
Bronchitis
Pulmonary fibrosis
COPD
Bronchiolitis
Airway hyperreactivity
Damage to the mucous
membranes
of the respiratory
tract

Neurologic
Reye’s-like syndrome
Confusion
Anxiety
Seizures
Decreased level
of consciousness
Coma
Muscle fasciculation
Skeletal muscle myotonia
Peripheral neuropathy
Pinpoint pupils
Blurred vision
Headache
Dizziness
CNS excitation
Depression
Paresthesia
Gastrointestinal
Nausea, vomiting, diarrhea, and flu-like symptoms
Dermatologic
Chloracne
Cardiac
Cardiac dysrhythmia, tachycardia, bradycardia, conduction
block, and hypotension
Hepatic
Liver dysfunction
Chemical Exposure Effects
Pulmonary
Irritation of nose and throat, dyspnea, bronchitis, pulmonary
edema, and cough
Neurologic
Headache
Ataxia
Confusion
Seizures
Lethargy
Unconsciousness
Coma
Lacrimation
Ataxia
Vertigo
Mood changes
Delirium
Hallucinations
Nystagmus
Diplopia
Psychosis
CNS depression
Tremors
Weakness
Paralysis
Memory changes
Encephalopathy
Hearing Loss
Parkinson’s-like syndrome
Euphoria
Narcosis
Syncope
Hyperthermia
Renal
Acetonuria and renal failure

Gastrointestinal
Nausea
Vomiting
Ulceration of the GI tract
Metabolic acidosis
Endocrine
Hyperglycemia, hypoglycemia
Dermatologic
Dermatitis
Irritation of the skin and
mucous membranes
Mucosal burns of eyes, nose,
pharynx, and larynx
Conjunctivitis
Hyperpigmentation of skin and
nails
Dermal burns
Immunologic
Altered blood clotting and bone marrow depression
Reproductive
Shortening of menstrual cycle
Cardiac
Hypotension and chest pain
Ophthalmic
Pupil changes, blurred vision, severe eye pain, corneal irritation,
temporary or permanent blindness
Hepatic
Jaundice
Hepatomegaly
Hepatitis
Pancreatitis
Biologic Exposure Effects
Bacteria
Anthrax (Bacillus anthracis): fever, chills, drenching sweats,
profound
fatigue, minimally productive cough, nausea and
vomiting, and chest discomfort
Cholera (Vibrio cholerae): profuse watery diarrhea, vomiting, leg
cramps, dehydration, and shock
Salmonella (Salmonellosis): fever, abdominal cramps, diarrhea
(sometimes bloody), localized infection, and sepsis
E. coli (Escherichia coli 0157:H7): severe, bloody diarrhea and
abdominal
cramps; mild or no fever
Viruses
Smallpox (Variola virus): high fever, head and body aches, vomiting,
and skin rash with bumps and raised pustules that crust,
scab, and form a pitted scar

Ebola hemorrhagic fever (Ebola filovirus): headache, fever, joint
and muscle aches, sore throat, and weaknesses followed by
diarrhea,
vomiting, stomachache, rash, red eyes, and skin rash
Lassa fever (Lassa virus): fever, retrosternal pain, sore throat,
back pain, cough, abdominal pain, vomiting, diarrhea, conjunctivitis,
facial swelling, proteinuria, and mucosal bleeding
Toxins
Ricin: respiratory distress, fever, cough, nausea, tightness in
chest, heavy sweating, pulmonary edema, cyanosis, hypotension,
respiratory failure, hallucinations, seizures, and blood in
urine
Staphylococcal enterotoxin B: fever, headache, myalgia, malaise,
diarrhea, sore throat, sinus congestion, rhinorrhea, hoarseness,
and conjunctivitis
Radiation Exposure Effects
Oncologic
Skin cancer, thyroid cancer, and leukemia
Immunologic
Impaired response to immunizations, bone marrow suppression,
autoimmune diseases
Genetic
DNA mutations, teratogenic effect including smaller head or
brain size, poorly formed eyes, abnormally slow growth, and
mental retardation
Neurologic
CNS damage, malfunctions of the peripheral nervous system,
neuroautoimmune changes, and disturbances in neuroendocrine
control
Dermatologic
Burns, skin irritation, dryness, inflammation, erythema, dry or
moist desquamation, itching, blistering, and ulceration
Systemic radiation poisoning
Nausea, fatigue, weakness, hair loss, changes in blood chemistries,
hemorrhage, diminished organ function, and death
Ophthalmic
Cataracts, degeneration of the macula
Cardiovascular
Changes in cardiovascular control, irregular heartbeat, changes
in the electrocardiogram, development of atherosclerosis,
hypertension,
and ischemia
Pulmonary
Disturbances in respiratory volume, increase in the number of
allergic illnesses, atypical cells in the bronchial mucosa
Gastrointestinal
Pathologic changes in the digestive system, inflammation of the
duodenum, spontaneously hyperplasic mucous membranes

Waste Exposure Effects
Coliform bacteria: diarrhea and abdominal cramps
Giardia lamblia (protozoa): diarrhea, abdominal cramps, nausea,
and weight loss
Cryptosporidium (protozoa): diarrhea, headache, abdominal
cramps, nausea, vomiting, and low fever
Hepatitis A (enteric virus): lassitude, anorexia, weakness, nausea,
fever, and jaundice
Helminths (parasitic worms): diarrhea, vomiting, gas, stomach
pain, and loss of appetite
Fever
Pollution Exposure Effects
Pulmonary: coughing, wheezing, labored breathing, pulmonary
and nasal congestion, exacerbated allergies, asthma exacerbation,
pain when breathing, and lung cancer
Cardiac: chest pain
Neurologic: headaches, developmental delay
Reproductive: reduced fertility
Ophthalmic: eye irritation
Related Factors
Pathophysiologic
Presence of bacteria, viruses, and toxins
Nutritional factors (obesity, vitamin, and mineral deficiencies)
Pre-existing disease states
Gender (females have greater proportion of body fat, which
increases
the chance of accumulating more lipid-soluble
toxins
than men; pregnancy)
History of smoking
Treatment Related
Recent vaccinations
Insufficient or absent use of decontamination protocol
Inappropriate or no use of protective clothing
Situational (Personal, Environmental)
Flooding, earthquakes, or other natural disasters
Sewer-line leaks
Industrial plant emissions; intentional or accidental discharge of
contaminants by industries or businesses
Physical factors: climactic conditions such as temperature, wind;
geographic area

Social factors: crowding, sanitation, poverty, personal and household
hygiene practices, and lack of access to health care
Biologic factors: presence of vectors (mosquitoes, ticks, rodents)
Bioterrorism
Occupation
Dietary practices
Environmental
Contamination of aquifers by septic tanks
Intentional/accidental contamination of food and water supply
Concomitant or previous exposures
Exposure to heavy metals or chemicals, atmospheric pollutants,
radiation, bioterrorism, and disaster
Use of environmental contaminants in the home (pesticides,
chemicals, radon, tobacco smoke)
Playing in outdoor areas where environmental contaminants are
used
Type of flooring surface
Maturational
Developmental characteristics of children
Children younger than 5 years of age
Older adults
Gestational age during exposure
NOC
Anxiety Level, Fear Level, Grief Resolution, Health Beliefs: Perceived Threat,
Immunization Behavior, Infection Control, Knowledge: Health Resources, Personal
Safety Behavior, Community Risk Control, Safe Home Environment

Goal
Individual adverse health effects of contamination will be
minimized.

Interventions
General Interventions
Help Individuals Cope With Contamination Incident; Use Groups
That Have Survived Terrorist Attacks as a Useful Resource for
Victims
• Provide accurate information on risks involved, preventive
measures, use of antibiotics, and vaccines.
• Assist victims in dealing with feelings of fear, vulnerability, and
grief.
• Encourage victims to talk to others about their fears.
• Assist victims in thinking positively and moving to the future.
Specific Interventions
• Employ skin decontamination with dermal exposures.
• Clinical effects on body systems vary with exposure to specific
agents. Monitor carefully and provide supportive care.
• Employ appropriate isolation precautions: universal, airborne,
droplet, and contact isolation.
Monitor the Client for Therapeutic Effects, Side Effects, and
Compliance With Postexposure Drug Therapy
Decontamination Procedure
• Primary decontamination of exposed personnel is agent
specific.
• Remove contaminated clothing.
• Use copious amounts of water and soap or diluted (0.5%)
sodium hypochlorite.
• For secondary decontamination from clothing or equipment of
those exposed, use proper physical protection.

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