Lead Contaminated Soil

Stella Mendoza

Background scenario

Stella Mendoza is a 32 year-old mother of three. She is seeing the community health nurse in the inner-city neighborhood clinic. She has just completed her gardening chores at the informal community garden they keep behind her apartment house. She and her 12-year-old daughter, Maria, have brought the nurse some lettuce from the garden.

Interview

Stella Mendoza:

"I have been so tired lately and my stomach seems to be bothering me quite a bit. I can't seem to keep anything down. You would think that the gardening and fresh air would make be feel better."

"I've also had a headache that I can't seem to shake."

"We have a nice vegetable garden. I planted the broccoli, lettuce and carrots this spring. They are doing great."

"We live over by the old smelter site, there is a marker in the park and I can remember when they dynamited the old smokestack. I was younger but I remember it well. It always smelled around there, but now, there is a nice view of the water. I'm glad they tore it down."

Stella's daughter, Maria:

"She's been acting kind of strange—not quite herself."

"She usually enjoys the garden so much. It usually puts her in such a good mood. She even brought you some lettuce that she grew herself."

"It seems like nothing cheers her up these days."

"My younger sister, Cassie, she is not doing well either. She sleeps, and is not good at school. Bad grades."

"I kind of ache all over." Examination

Vital signs:

Temperature: 98.5°F Respiratory rate: 20 Blood pressure: 145/84 Pulse: 85

Temperature: 98.0°F Respiratory rate: 24 Blood pressure: 105/78 Pulse: 90

Observation:

You examine both Stella and Maria.

Palpation:

Both complain of abdominal tenderness and muscle pain. Maria complains that her joints feel like they are aching.

Percussion:

No remarkable findings.

Auscultation:

Lungs are clear in both women.

Laboratory reports:

Stella's blood lead level (BLL): 44 ug/dL Maria's BLL: 34 ug/dL

As time passes

The nurse arranges to have the other members of the family tested for blood lead levels. She also arranges to have other members of the community who are growing produce in the informal community garden to be tested along with the soil of the garden. You coordinate with the public health department to assess the home and garden to identify lead sources.

Background education Lead is a dense, bluish-gray metallic element used in storage batteries, electric cables, pipe lining, tanks, x-ray apparatus, and as protective shielding for radioactive material. It is found in paints and pigments, ink, glass, rubber, ceramics, chemicals, and batteries. It is sometimes found in water, food, household dust and soil. Lead is very toxic to humans and animals when swallowed or inhaled.

Lead in soil is mostly from leaded gasoline and lead-based paint from buildings. It tends to concentrate in the first three to six inches of soil. Lead levels in contaminated soil range from 500 ppm (parts per million) to over 3,000 ppm. Soil next to houses painted with exterior lead based paint can contain lead levels as high as 10,000 ppm.

The primary source of lead exposure in a garden is from breathing or eating produce dusty or covered with lead-rich dust from the soil in the garden. In general, lead is not taken up into the fruiting parts of vegetable and fruit crops (such as strawberries), but it can sometimes accumulate in leafy vegetables (such as lettuce). The only way to know how much lead is in soil is to have it tested. Soils with total lead levels less than 500 ppm generally produce crops that are safe to eat. Soil high in organic matter with pH between 6.5 and 7.0 tend to bind lead in the soil, reducing the amount absorbed by plants. Planting fruiting crops, like tomatoes, eggplant, peppers, peas, beans, corn and squash is preferred in high lead areas. These fruiting crops should be given preference to leafy vegetables such as lettuce and spinach, and root crops, such as carrots and radishes. Leafy vegetables should not be grown in soil with more than 500 ppm and gardening should not be done at all in soil with more than 1,000 ppm.

Lead poisoning, or plumbism, is a leading cause of pediatric health problems. Diagnosis is made via blood and urine testing. Children with elevated lead levels in their blood may show no symptoms or nonspecific symptoms, such as irritability, stomachaches, poor appetite, diarrhea, colic, distractibility and lethargy. The onset of symptoms is usually abrupt, with persistent and forceful vomiting, reduced muscle coordination, seizures, lowered consciousness, and, if severe, intractable seizures and coma. In adults, lead poisoning may include personality changes, headache, metallic taste, anorexia, vomiting, constipation, diarrhea, and colicky abdominal pain. Symptoms may abate if the individual is removed from exposure, but will recur with renewed exposure.

The effects of lead are usually felt after it has accumulated in the body over a period of time. Chronic elevated lead levels can cause brain and nervous system damage, behavior and learning problems, slowed growth, hearing problems, seizures, and headaches. Impaired learning and motor skill deficits may persist even after lead levels have returned to normal. Adults can suffer from pregnancy and reproductive difficulties, hypertension, digestive problems, nerve disorders, renal disease, memory and concentration lapses, and muscle and joint pain. Blood lead levels of 10 mcg/dL or greater are dangerous to children. Treatment includes removing the source, and giving calcium disodium ethylenediaminetetraacidic acid, or EDTA, a chelating agent. Lead is removed from the body by displacing the calcium in EDTA and forming a stable complex that is excreted in the urine. Children with blood lead levels greater than 10 mcg/dL should be monitored in a follow-up program.

Two- to 3-year-old children absorb lead at nearly five times the rate of adults. They also tend to eat dirt and nonfood items, such as paint chips. Lead ingested while pregnant or nursing is passed to the fetus or infant. Defects in nutrition enhance lead absorption, retention, and toxicity risk.

The community health nurse intervenes to reduce lead poisoning by assessment education, and cooperation with various community agencies to eliminate the source of the problem. Assessing the environment to determine risks includes examining new or old industrial sites near the child's house, looking for chipped or peeling paint in structures built before 1978, and examining hobbies, and activities that might expose the child to sources of lead.

Preventative measures to reduce the risk of lead toxicity, include screening checks, education the child and/or parent to wash hands, keep fingers out of the mouth, wear gloves while working in soil, and provide a healthy diet. Children under age 6 with elevated blood lead levels should not eat leafy vegetables or root crops grown in contaminated soil, or near very busy roads. All produce should be washed well and root crops peeled to remove dust and soil.

List your findings and conclusions:

Lead poisoning due to eating lettuce leaves from contaminated soil.

Nursing diagnoses:

00081 Ineffective community therapeutic regime management (risk for) 00080 Ineffective family therapeutic regime management (risk for) 00001 Imbalanced nutrition: Less than body requirements 00015 Risk for constipation 00085 Impaired physical mobility 00093 Fatigue 00112 Risk for delayed development 00125 Deficient knowledge (related to lead poisoning) 00130 Disturbed thought process 00133 Chronic pain 00134 Nausea 00146 Anxiety Quiz

1. Stella Mendoza and her daughter, Maria, have been diagnosed with lead poisoning. What is an appropriate nursing diagnosis for this case? a. Poisoning b. Nausea c. Impaired memory d. Feeding self-care deficit

2. Lead exposure while working in a garden is most likely to be responsible for a client's illness. The nurse knows that the primary source of lead would be a. Eating fruiting crops, like tomatoes, eggplant, peppers, and squash b. Breathing or eating dust from lead-rich soil c. Breathing contaminated air from industrial areas d. Eating vegetables that have been covered with a thick layer of mulch

3. Leaded gasoline and lead-based paint from buildings contributes to lead levels in soil. Soils adjacent to housed painted with exterior lead-based paint may contain lead levels as high as a. 500 ppm. b. 5,000 ppm. c. 7,000 ppm. d. 10,000 ppm.

4. A community center asks the public health nurse to discuss the dangers of lead poisoning. The nurse tells a group of residents that lead is used in the production of a wide variety of products. She notes that lead is usually found in a. fiberglass components. b. photographic materials. c. water, food, and soil. d. tomatoes, peppers, and squash.

5. Children with elevated lead levels in their blood may show no symptoms or nonspecific symptoms. The onset of symptoms when present in children is usually abrupt. What is a symptom that children may exhibit? a. 1 to 5 days of painful diarrhea b. 1 to 5 days of persistent and forceful vomiting c. 1 to 5 days of elevated body temperature d. 1 to 5 days of restlessness and ineffective sleeping 6. The effects of lead taken internally are usually felt during a specific time period. How long does it usually take before symptoms are felt? a. Immediately after ingestion b. Within 2 to 4 weeks after ingestion c. After it has accumulated in the body over time d. Within 8 hours after ingestion

7. Two- to 3-year-old children absorb lead at a higher rate than adults. They also tend to eat dirt and nonfood items, such as paint chips. At what rate do children absorb lead compared to adults? a. Twice the rate of adults b. Half the rate of adults c. Three times the rate of adults d. Five times the rate of adults

8. The community health nurse intervenes to reduce lead poisoning by assessment education, and cooperation with various community agencies to eliminate the source of the problem. Which of the following would be a specific nursing assessment to determine risks? a. Testing soil around new or old industrial sites near schools. b. Testing chipped and peeling paint in structures built before 1958. c. Examining hobbies and activities that might expose children to sources of lead. d. Testing ground water for lead exposure.

9. The nurse is asked what preventative measures may be taken to reduce the risk of lead poisoning while working in an urban community garden. What is an important preventative measure that people can take to reduce the risk of lead poisoning? a. Move to the country. b. Buy fruits and vegetables from the supermarket. c. Enforce a clean hands policy. d. Reduce contact with outdoor pets.

10. It is important to take precautions with soil content and plan crops before raising a garden. What is not considered a good garden safety precaution? a. The only way to know how much lead is in your soil is to have it tested. b. Planting fruiting crops is preferred in high lead areas. c. Diluting contaminated soil with water will ensure safety. d. Soil high in organic matter helps to prevent lead from being absorbed by plants. Copyright  2002 Delmar Learning, a division of Thomson Learning, Inc., ALL RIGHTS RESERVED