Copyright Ò 2002 Delmar, a Thomson Learningô Company

Chen Yang

Background scenario

Chen Yang is a 17-year-old student in the high school band. The band practices in the basement classroom at his high school, which is located in the older section of the school, in an 87-year-old historic building. He has been having breathing problems that is beginning to affect his ability to play the coronet. He has arrived in the sick room to talk to the nurse. During Chen's examination the nurse makes a note to check the school history log.

Interview

Chen:

"We have a concert coming up next week and I am really struggling. I just can't seem to get enough air."

"I thought it was just a cold. I felt so tired at first, but I never got a runny nose or cough."

Our band practice room is in the basement and it has this terrible wet smell.

Could that have anything to do with this?"

“I don’t have asthma. My sister does though.”

Music teacher:

"Chen is the sixth person to report breathing problems in the last two weeks."

"My other students seem to be sick too. Rashes, upper respiratory infections and aggravated asthma have all cropped up this fall. They are not just trying to get out of practice. These are some of my best kids."

Examination

Vital signs:

Temperature: 98.5 °F

Respiratory rate: 20

Blood pressure: 116/76

Pulse: 85

Observation:

Student is pale and slightly short of breath.

Skin is pale.

Eyes appear reddened and weepy.

Palpation:

Abdomen is soft to palpation and non-tender

Auscultation:

Lungs are clear. Wheezes heard on inspiration above trachea.

Background education

Stachybotrys chartarum is a greenish black fungus that grows on material with a high cellulose and low nitrogen content (fiberboard, gypsum board, paper, dust, and lint) when those substances become chronically moist from flooding, excessive humidity, water leaks, or condensation. Buildings are not routinely tested for its presence; so it may remain hidden yet cause illness in humans. This mold may produce spores and small fungus fragments containing toxic chemicals called mycotoxins. Although spores and fragments are usually trapped in the wet, slimy fungal growth, they may become airborne when the fungus dies and dries up. S. Chartarum spores are very small and they can be inhaled into the lungs.

Health effects include allergic rhinitis, rashes, sinusitis, conjunctivitis, wheezing and other breathing difficulties, skin and eye irritation, upper respiratory infections, and aggravation of asthma. Some symptoms are more general, such as inability to concentrate and fatigue. Usually, symptoms disappear after the contamination is removed.

Children are particularly at risk because they are poor historians and do not report symptoms. There has been some evidence linking Stachybotrys with pulmonary hemosiderosis in infants who are generally less than six months old. Pulmonary hemosiderosis is an uncommon condition that results from bleeding in the lungs. In studied cases of pulmonary hemosiderosis, the exposure to Stachybotrys came from highly contaminated dwellings where the infants were continually exposed over a long period of time.

The EPA ranks indoor pollution problems among the top five environmental health risks to the public. Federal reports show that at least 19 percent of the nation's public schools report indoor air-quality problems. Recommendations to contain mold and improve air quality include providing an improved ventilation system, stopping water leaks, and replacing or repairing water damaged sheetrock, wood, insulation, roofing, and other items where mold has the tendency to grow. Carpet should be replaced with tile. Walls painted with oil-based paint will also stop moisture from seeping into the drywall. The goal of intervention is to eliminate the sources of moisture and reduce humidity below 30 to 40 percent. A follow-up inspection and testing is required after the abatement program is complete to ensure that the facility is safe to occupy.

Students at a contaminated facility should be relocated, and affected areas isolated until repaired. Community health nurses assist in identifying cases of illness, tracking the possible primary and secondary sources of the mold, educating students and family, coordinating with school and public health officials to remedy the situation, following up on the resolution of health complaints, and keeping detailed records of possible mold-related exposures and interventions completed.

List your findings and conclusions:

Breathing difficulties caused by Stachybotrys chartarum

Nursing diagnoses:

00093 Fatigue
00032 Ineffective breathing pattern
00126 Deficient knowledge (signs and symptoms of mold exposure)
00146 Anxiety

Quiz

1. Chen Yang is diagnosed with breathing difficulties caused by Stachybotrys chartarum. What is an appropriate nursing diagnoses in this case?

a. Ineffective breathing pattern
b. Risk for powerlessness
c. Ineffective role performance
d. Activity intolerance

2. Mold may produce spores and small fungus fragments containing toxic chemicals. What is the harmful chemical present on spores and small fungus fragments that is released into the air?

a. Myosinose
b. Myositis
c. Myotonia
d. Mycotoxin

3. There has been some evidence linking Stachybotrys with pulmonary hemosiderosis in infants who are generally less than six months old. In case studies of pulmonary hemosiderosis, the exposure to Stachybotrys came from highly contaminated buildings. How might infants have been infected?

a. Infants were exposed to other infected children.
b. Infants would visit occasionally.
c. Infants were continually exposed over a long period of time.
d. Infants were given milk products that were not chilled.

4. While assessing a 6-month-old child, the nurse is asked by the mother about symptoms of exposure to mold. The mother explains that a neighboring housing unit where she had to be remodeled because young children were becoming ill. The nurse knows that some of the symptoms associated with Stachybotrys chartarum include

a. Allergic rhinitis, conjunctivitis, and pneumonia.
b. Dermatitis, wheezing, and fatigue.
c. Sinusitis, bad breath, and skin and eye irritation.
d. Breathing difficulties, upper respiratory infections, and elevated temperature.

5. Stachybotrys chartarum grows on material such as fiberboard, gypsum board, paper, dust, and lint when they become chronically moist from flooding, excessive humidity, water leaks, or condensation. Spores and other parts of the fungus are usually trapped when wet. What is one particular concern?

a. The containment may cause dry rot in sheetrock.
b. The fungus may dry up and the spores may become airborne.
c. The fungus may cause deterioration in the ventilation system.
d. The fungus may spread within the containment area.

6. Stachybotrys chartarum spores are very small and they can be inhaled into the lungs. Why are children in particular at risk?

a. They don't want to take the time to talk about their problems.
b. They don't like to talk to health officials.
c. They do not report symptoms.
d. They are younger and more susceptible to airborne diseases.

7. Implementing procedure to contain mold and improve air quality are extremely important to prevent further exposure. Why is replacing carpet with tile a good preventative measure?

a. Tile is easier to keep clean.
b. Tile does not retain moisture.
c. Tile lasts longer than carpet.
d. Tile is less tactile than carpet.

8. The goal of intervention is to eliminate the sources of moisture and reduce humidity. What is an ideal humidity range in a building?

a. 10 to 20%
b. 60 to 80%
c. 30 to 40%
d. 5 to 10%

9. The EPA ranks indoor pollution problems among the top five environmental health risks to the public. At what rate are air quality problems reported in public schools?

a. 10%
b. 15%
c. 19%
d. 22%

10. Follow-up inspection and testing is required after the conclusion of an abatement program for Stachybotrys chartarum. What does this ensure?

a. The facility has enough available classrooms.
b. The facility's ventilation system is working properly.
c. The facility has posted a proper evacuation plan.
d. The facility is safe to occupy.