Case study 3
Janice Wu, a community health nurse, is visiting a new client in a nursing home in an inner-city area. As she enters the nursing home, she notices that several of the residents are doing calisthenics in the yard. Some of the residents are sitting on the sidelines and appear quite short of breath. When Janice checks to make sure they are all right, they tell her that they usually have a hard time breathing when they exercise on humid days like today. The residents say that they usually try to continue their exercises because it is one of the few activities that get them out of the building. They also enjoy the social aspects of the exercise sessions. Many of them state that they have always been active and want to maintain their strength and mobility as long as possible. They express fears of being bedridden and unable to care for themselves.
After Janice is sure that all of the residents will be all right, she goes on to see her client. When she enters the building, she notices that it is quite hot inside, even though all the windows and doors are open. Although it is only 10 A.M., it promises to be a humid summer day. After seeing her client, Janice talks to the director about the heat in the building. The director tells her that the building is always hot and that the air conditioning has never worked properly. The last time the service people came to fix the air-conditioning unit, they said it could not be repaired and would have to be replaced. The nursing home is run by a large national corporation, and the director says she has been told they will have to wait until the next budget year (October) before money will be available for a new air conditioner. Fortunately, the heating system is separate, so there will be heat when the colder weather starts. The director says that staff members have been particularly careful about maintaining hydration in the residents during the hot weather, but many of the residents seem fatigued and listless with the heat.
What hazards are present in the natural, built, and social environments in this situation? What health effects, if any, are these hazards causing?
What level(s) of prevention is (are) warranted in this situation? What might Janice do to intervene?
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