Following the traumatic event, PTSD is common and is one of the serious health concerns that is associated with comorbidity, functional impairment, and increased mortality with suicidal. Increases the force of myocardial contraction. Exposure to high levels of carbon monoxide for 1 to 3 minutes may lead to death. Clinical Reasoning Cases in Nursing 7th Edition Julie S Snyder, Mariann M Harding. Asbestos fibres are easily inhaled and carried into the lower regions of the lung where they can cause fibrotic lung disease (asbestosis) and changes in the lining of the chest cavity (pleura). The primary form of metabolizing arsenic is methylation. Lead may be found in soil and water systems. Learn about the causes, symptoms, diagnosis and treatment of lead poisoning with flashcards on Quizlet. Basophilic stippling is considered a pathognomonic finding in lead poisoning in conjunction with hypochromic microcytic anemia (although normocytic anemia can be appreciated as well) and deposition of lead in the gingiva and joints. Study with Quizlet and memorize flashcards containing terms like Which disease process places a client at increased risk for infection Select all that apply. Cholinergic crisis is a clinical condition that develops as a result of overstimulation of nicotinic and muscarinic receptors at the neuromuscular junctions and synapses. age 1. Many children who have lead poisoning look and act healthy. lateral B. The increase in muscle mass associated with exercise is an example of physiologic hypertrophy. Study with Quizlet and memorize flashcards containing terms like WHICH IS THE MOST LIKELY CAUSE OF AN UNCONSCIOUS PATIENT WITH CHERRY RED LIPS DIABETIC KETOACIDOSIS FOOD POISONING CARBON MONOXIDE POISONING CARDIOVASCULAR ACCIDENT, WHICH IS THE BEST DESCRIPTION OF THE TERM CHLOASMA -DIFFUSE BROWN HYPERPIGMENTATION OF THE CHEEKS AND FOREHEAD IN PREGNANCY -HYPERPIGMENTATION OF THE AREOLA IN. Remove lead source, possibly surgically. Click the card to flip . A rash resembling a sunburn, particularly on your palms and soles. Lightheadedness or dizziness. Bacterial food-borne pathogens Yersinia and shigella. The heavy metals most commonly associated with poisoning of humans are lead, mercury, arsenic and cadmium. A 10-year-old child sustained burns of the extremities in a house fire. There are a few types of hemochromatosis,. These are all ways to prevent lead poisoning. call local poison control center before any intervention. Family history. Your patient is a conscious 4-year-old female who has ingested a medication prescribed. common in infants. The nurse analyzes these results as indicating which condition 1. Uremia, a clinical condition associated with worsening renal function, is characterized by fluid, electrolyte, hormone imbalances, and metabolic abnormalities. - Low blood pressure and muscle cramps do not cause this type of injury. C) constriction of the urethra by the prostate gland in men and the placement of the urethra near the anus in women. 1 followed by Hispanics (42. Severe abdominal cramping. Chelation therapy. Lead is dangerous when it is inhaled into the lungs because it is. A burn client is receiving the open method for wound treatment. By 2030, 75 of the United States population will be obese. The school nurse sees a 14-year-old child who presents with fatigue and a nagging cough of three weeks' duration that has become productive with thick mucus and is much worse at night. Cramps and constipation 4. Asbestos fibres are easily inhaled and carried into the lower regions of the lung where they can cause fibrotic lung disease (asbestosis) and changes in the lining of the chest cavity (pleura). 1 of children in the same age group with FeTIBC>30 showed lead poisoning (Yip and Dallman, 1984). Pica is a condition that mostly affects pregnant people and children. Lightheadedness or sudden dizziness. painful joints. - Lead poisoning is not identified as a mechanism to cause this type of injury. Salicylates like aspirin, codeine, and antihistamines like diphenhydramine HCL should be avoided throughout pregnancy. Extremely severe lead poisoning has been associated with a renal Fanconi syndrome, particularly in children. 100 B. estimated 16 per 100,000 employed adults (due to occupational exposure) demographics. Discourage the child's pica by providing nutritious snacks. A gastrointestinal anthrax infection results from eating undercooked meat from an infected animal. The morphology associated with Hemoglobin C disease is low RBCs and microcytosis. Stomachaches 2. Microbiology chapter 19. ABGs are used to assess changes in pH (acid-base status), arterial oxygen tension and saturation (PaO 2 and SaO 2), carbon dioxide (PaCO 2), and bicarbonate (HCO 3). Nausea and vomiting 5. It can affect your gastrointestinal tract from your throat to your colon. Cocaine abuse is a major worldwide health problem. First, arsenic is absorbed by cells in the blood stream. The nutritional status of individuals affects the clinical outcomes. Obesity is defined as a BMI that exceeds 29 kgm2. Glycosuria is a clinical manifestation caused by the effects of lead toxicity on the renal system. During the assessment, the man mumbles a word and becomes comatose. Artificial active immunity 3. It is an aspect of occupational safety and health. Transport in a position of comfort and provide oxygen for patients with a decreased level of consciousness. Dehydration from vomiting and diarrhea. Study with Quizlet and memorize flashcards containing terms like The greatest risk of lead poisoning is to poor children under 6 years of age living in urban areas. Lead Poisoning. absorbed into the bloodstream. Arsenic toxicities are associated with all of the following EXCEPT Wernicke&39;s encephalopathy. Lead toxicity is a particularly insidious hazard with the potential of causing irreversible health effects. Systemic lupus erythematosus (SLE) is a systemic autoimmune disease with multisystemic involvement. estimated 1. Figure 15. Patients or parents should be advised to. - safe during all stages of pregnancy. Hypoxia is low levels of oxygen in your body tissues. Blood lead concentrations have decreased dramatically in U. Study with Quizlet and memorize flashcards containing terms like Which statement describes the cause of heparin-induced A. Provide a patent airway, ventilation, and high-concentration oxygen. children over the past 4 decades. The morphology associated with lead poisoning is Hypochromic and microcytic. Your patient is a conscious 4-year-old female who has ingested a medication prescribed. Clinical Course and Factors Associated With Hospitalization and Critical Illness Among COVID-19 Patients in Chicago, Illinois. Hyperreflexia and myoclonus are rare in NMS. Clinical disease physical signs and symptoms resulting from a sufficiently absorbed toxicant dose. Disorientation c. Which statement made by the student nurse indicates ineffective learning A. Have the patient drink one glass of milk. The wrist remains partially flexed due to an opposing action of flexor muscles of the forearm. Symptoms of Lead Poisoning. Basophilic stippling. It can even cause the heart to stop. This article is for information only. The WHO Guideline for Clinical Management of Exposure to Lead recommends a blood lead concentration of 5 micrograms per decilitre (gdL) as a. Engaging in performance-improvement endeavors 4. Secondary peritonitis. stumbling when walking. As the level of lead in the blood rises over 10 gdL, the levels of 1,25-dihydroxyvitamin D fall. 24 micromolL) 1,6 . Salicylates like aspirin, codeine, and antihistamines like diphenhydramine HCL should be avoided throughout pregnancy. AVTA d. They may be unable to stop. The clinical presentation varies widely, depending upon the age at exposure, the amount of exposure, and the duration of exposure. Children are at greatest risk in houses where paint is peeling or those where renovation with paint removal is occurring. What condition is associated with these. 1 of children in the same age group with FeTIBC>30 showed lead poisoning. Arterial oxygen level can be accurately determined by ABG testing. treatment may involve chelation therapy. Testing household water, ceramics, and paint for lead can help identify potential sources of lead. diagnosed with meningitis, Which clinical manifestation will the nurse anticipate when providing care to a toddler who is diagnosed with acute lead poisoning, Early signs of cerebral palsy in a toddler child and more. The patient with anemia may experience tachycardia, palpitations, pallor, and cyanosis. anterior, The duration of the QRS complex should be milliseconds or less in a healthy adult. Beta-carotene is the most well-known form of 2 clinically significant forms of vitamin A preformed vitamin A and provitamin A carotenoids. Provide a patent airway, ventilation, and high-concentration oxygen. Decreases conduction through the SA and AV nodes. Injected poisons usually cause reaction at the injection site An immediate. Test your knowledge of lead poisoning and how to protect your family. A child with lead poisoning may not have visible signs or symptoms. Asthma Anemia Metabolic acidosis Systemic infection. Disorientation c. Clinical Course and Factors Associated With Hospitalization and Critical Illness Among COVID-19 Patients in Chicago, Illinois. Test your knowledge with verified questions and answers from various textbooks and sources. They can be demonstrated to be RNA. Iron deficiency anemia. What diseasecondition are they associated with Abnormal basophilic granules of iron found inside of RBCs on routine blood stain. Dec 14, 2018 A high, toxic dose of lead poisoning may result in emergency symptoms. Lead poisoning primarily affects young children and can lead to a wide range of cognitive. These include severe abdominal pain and cramping. It can cause many symptoms, including Losing weight without trying. Which clinical condition is most commonly associated with too rapid of an ascent from a deep dive. In rare cases, botulism can also be caused by medical treatment or bioterrorism. Lead is dangerous when it is inhaled into the lungs because it is. -bc lead toxicity. Have the patient drink one glass of milk. (E) Erythrocyte basophilic stippling, a visible change in the appearance of red blood cells. Persistent cognitive impairments can be seen in levels of <7. Study with Quizlet and memorize flashcards containing terms like True or False A child has to ingest loose lead paint chips to get lead poisoning. Engaging in performance-improvement endeavors 4. When your body temperature drops, your heart, nervous. nervous system damage and pain and numbness. A child with lead poisoning may not have visible signs or symptoms. Mood disorders. Slow, chronic blood loss from an ulcer or other source within the body can use up the body's store of iron, leading to iron deficiency anemia. The nurse tells the smoker that due to persistent irritation of the lungs from carcinogens, columnar cells may turn into squamous. Figure 15. Lead poisoning is a preventable yet concerning public health issue that demands immediate attention. Chronic lead poisoning may uncommonly be associated with a lead line in the mouth This is a line of hyperpigmentation on the gingiva adjacent to the teeth. Exposure to high levels of carbon monoxide for 1 to 3 minutes may lead to death. As a result, the extensor muscles in the posterior compartment remain paralyzed. 4 of children (ages 112 years) with FeTIBC<10 had lead poisoning, while only 1. It can affect your gastrointestinal tract from your throat to your colon. starting the prescribed intravenous infusion d. This results in a decreased availability of oxygen to the tissues. What are some symptoms of moderate salicylate symptoms nausea, vomiting, tinnitus, hyperpnea, tachychardia, fever, lethargy, electrolyte disturbances, dehydration, confusion. Asymptomatic lead poisoning has become more common in children. Study with Quizlet and memorize flashcards containing terms like Which type of immunity will clients acquire through immunizations with live or killed vaccines 1. , confusion, memory loss, developmental delay. increased serum lead. Fever b. LEAD stands for the main symptoms of lead poisoning. Lead circulates in the body bound to red blood cells. Severe abdominal cramping. Heavy metal poisoning may occur as a result of industrial exposure, air or water pollution, foods, medicines, improperly coated food containers, or the ingestion of lead-based paints. Study with Quizlet and memorize flashcards containing terms like What should the nurse teach parents about their newborn&39;s diagnosis of phenylketonuria (PKU), A nurse is teaching the parents of an infant with eczema about the foods that are most allergenic. The nurse tells the smoker that due to persistent irritation of the lungs from carcinogens, columnar cells may turn into squamous. The most likely cause would be ischemia. Which clinical manifestation would be most suggestive that the poison was a corrosive product a. Study with Quizlet and memorize flashcards containing terms like What should the nurse teach parents about their newborn&39;s diagnosis of phenylketonuria (PKU), A nurse is teaching the parents of an infant with eczema about the foods that are most allergenic. Provide a patent airway, ventilation, and high-concentration oxygen. Leg pain or swelling, or both, usually in the back of the lower leg. It should be noted that toxic metals, including lead, can be transmitted from a mother to. what are some sign and symptoms of lead poisoning. Study with Quizlet and memorize flashcards containing terms like A client has had a carotid endarterectomy. e Atrophy of thymus in childhood. Lead poisoning Basophilic stippling can also occur in the absence of anemia in animals with lead poisoning. Study with Quizlet and memorize flashcards containing terms like A young patient is brought to the emergency department by friends, who say they found him unresponsive at his home. 100 B. Diagnosis is clinical, supplemented by measurement of the anion gap, arterial blood gases, and serum salicylate levels. headache, fatigue, irritability, difficulty concentrating. Lead toxicity is a particularly insidious hazard with the potential of causing irreversible health effects. During the assessment, the man mumbles a word and becomes comatose. stumbling when walking. Lab results indicate blood lead level 52 gdL. There are no symptoms. It is more common with chronic than acute toxicity. Renal effects. Most commonly, the symptoms of. One, some, or all responses may be correct. It occurs typically when lead poisoning is associated with poor oral hygiene. Organic lead, because of its higher lipid solubility, causes greater toxicity and affects the neurological system predominantly. Study with Quizlet and memorize flashcards containing terms like 1. Risk factors, sources, and prevention of childhood lead poisoning include Risk factors Children younger than six years of age (and particularly those younger than 36 months) are more susceptible to the toxic. The nurse explains that this is necessary because toddlers, A nurse is caring for a toddler who has undergone bone marrow transplantation. Dimercaprol has not been associated with serum enzyme elevations during therapy or with cases of clinically apparent liver injury with jaundice, but its general use has been quite limited. Leg pain or swelling, or both, usually in the back of the lower leg. Treatment is with activated charcoal and alkaline diuresis or hemodialysis. Natural active immunity 2. Study with Quizlet and memorize flashcards containing terms like Which type of immunity will clients acquire through immunizations with live or killed vaccines 1. in older cities like chicago, automatically start screening for lead when. If symptoms do occur, they are often confused with symptoms of other illnesses. Lead level <45 mcg indicates which method of ingestion Common in which age group < 45 mcg indicates inhalation. Vomiting or diarrhea. Chelating agents are capable of binding to toxic metal ions to form complex structures which are easily excreted from the body removing them from intracellular or extracellular spaces. Hypertrophy may occur as the result of normal physiologic or abnormal pathologic conditions. 7 o F (9. integrate the best evidence with one's clinical expertise. Perform abdominal thrusts to clear the airway, followed by high-concentration oxygen. Detect health problems at an early stage slow or halt the progress of an existing disease, injury, or other health problem. Fluorosis is a cosmetic condition that affects the teeth. - safe during all stages of pregnancy. The liver also may swell, and fats may build up. Which organ system is of most concern because of the condition's irreversible effects, 2 A 6-year-old child is admitted with an acute infection and dehydration. 7 o F (9. cognitive deficits, delayed growth and development. Organic lead, because of its higher lipid solubility, causes greater toxicity and affects the neurological system predominantly. Three leading causes of death in the United States are associated with obesity cardiovascular disease, type. Heat stroke, What percentage of burns is involved using. The laboratory results show cobalamin levels of. Clinical Manifestations 5-10 mcgdL -impaired mental function, decreased IQ scores, cognitive deficits, antisocial behavior, poor education outcomes 10-70 -loss of recently acquired skills, drowsiness, irritability, lack of energy, constipation, trouble sleeping Severe poisoning >70 Encephalopathy, seizures, coma, death. Gastroesophageal reflux disease (GERD) is a chronic gastrointestinal disorder characterized by the regurgitation of gastric contents into the esophagus. what is the mechanism for the anemia. Patients are assessed for safety hazards and potential sources of injury as the first step in the nursing process. Medically Supervised Withdrawal. ABGs are used to assess changes in pH (acid-base status), arterial oxygen tension and saturation (PaO 2 and SaO 2), carbon dioxide (PaCO 2), and bicarbonate (HCO 3). The recommendations are for GI decontamination after ingestion of lead;nutritional interventions in children and pregnant and lactating women; andchelation therapy in children, adolescents, adults and. As early as the second century BCE, physicians understood the link between lead exposure and neurocognitive disease,1 and some scholars have wondered whether the extensive use of sapa, a syrup of. During the assessment, the man mumbles a word and becomes comatose. HHS Vulnerability Disclosure Humans have been using lead for a variety of applications since millennia, and concomitant with this use has developed an ancient recognition of the adverse effects of lead on the human body. valentina olivar, japan porn tgp
Study with Quizlet and memorize flashcards containing terms like The nurse is teaching a woman with gestational diabetes the technique to inject insulin. . Which clinical condition is associated with lead poisoning quizlet
call local poison control center before any intervention. The eating of nonnutritive, nonfood substances is inappropriate to the developmental. Fatigue 6. Baking c. One, some, or all responses may be correct. Renal effects. There are usually no symptoms of lead poisoning. Several epidemiological and clinical studies have found a link between chronic lead exposure and elevated blood pressure Vaziri and Gonick, 2008. People with it feel compelled to eat non-food items, such as dirt and things that are dangerous. Patient B&39;s exposure to cold conditions of 48. Increased hunger. This can occur from the ingestion of beverage ethanol, commonly known as alcohol, and non-beverage ethanol, present in substances such as mouthwash, cologne, and cough medicine. Disorientation c. The release of the guidance coincides with International Lead Poisoning Prevention Week 2021. In addition, resolution of NMS typically requires an average of nine days, compared with less than 24 hours (usually. Patient A is at high risk of death after being exposed to high concentrations of carbon monoxide. It may cause poisoning if inhaled or ingested. woman comes to the clinic for a follow-up visit because of FATIGUE. During the assessment, the man mumbles a word and becomes comatose. , 1981, Yip and Dallman, 1984, iron deficiency was significantly associated with lead poisoning. What clinical manifestation would be most suggestive that the poison was a corrosive product a. Heavy metal poisoning may occur as a result of industrial exposure, air or water pollution, foods, medicines, improperly coated food containers, or the ingestion of lead-based paints. Chronic lead poisoning may uncommonly be associated with a lead line in the mouth This is a line of hyperpigmentation on the gingiva adjacent to the teeth. Study with Quizlet and memorize flashcards containing terms like WHICH IS THE MOST LIKELY CAUSE OF AN UNCONSCIOUS PATIENT WITH CHERRY RED LIPS DIABETIC KETOACIDOSIS FOOD POISONING CARBON MONOXIDE POISONING CARDIOVASCULAR ACCIDENT, WHICH IS THE BEST DESCRIPTION OF THE TERM CHLOASMA -DIFFUSE BROWN HYPERPIGMENTATION OF THE CHEEKS AND FOREHEAD IN PREGNANCY -HYPERPIGMENTATION OF THE AREOLA IN. The nurse is counseling a heavy smoker about the dangers of smoking. 1 of children in the same age group with FeTIBC>30 showed lead poisoning (Yip and Dallman, 1984). Possible signs and symptoms of toxic shock syndrome include A sudden high fever. Study with Quizlet and memorize flashcards containing terms like A father calls the clinic because he found his young daughter squirting Visine eyedrops into her mouth. 5 mgdL or more indicates lead poisoning, according to the new CDC standard. Disorientation c. If symptoms do occur, they are often confused with symptoms of other illnesses. The second most common is ciguatera poisoning. CBC reveals a DECREASED HEMATOCRIT of 32 and an MCV THAT IS LOW AT 68fL What is the most likely diagnosis when the following additional features are described (1) An ELEVATED red-cell distribution width (RDW) and a HIGH PLATELET COUNT (2) A LOW SERUM. If symptoms occur, they are often confused with symptoms of other illnesses. Children between 1 and 4 years of age. Vomiting or diarrhea. in young children who ingest lead-contaminated dust through hand-to-mouth behaviour or some individuals with pica who eat large quantities of lead compounds, e. The Burton line or gingival lead line is a dark blue line along the gums that signifies lead poisoning. What amount of salicylate would be a severe toxicity based on dose 300-500 mgkg. Lead may be found in soil and water systems. For which clinical manifestations indicating that the client may be experiencing a pulmonary embolus should the nurse assess the client Select all that. what are some sign and symptoms of lead poisoning. Pica is often an overlooked phenomenon and its association with iron deficiency and lead poisoning has been known for centuries. In this treatment, a medication given by mouth binds with the lead so that it&39;s excreted in urine. What should the nurse tell the parent differentiates rubeola from rubella, A nurse is caring for a 6-year-old child who has undergone laparoscopic appendectomy. Study with Quizlet and memorize flashcards containing terms like Lead poisoning is common through, What ages are at the highest risk for lead poisoning, Lead poisoning causes what type of anemia and more. It results from consuming contaminated food and water. headache, fatigue, irritability, difficulty concentrating. USDA b. Congestive heart failure d. Hypertrophy may occur as the result of normal physiologic or abnormal pathologic conditions. Exposure to excessive levels of lead poisoning may lead to learning and behavioral problems in children and brain and kidney damage. Study with Quizlet and memorize flashcards containing terms like A 6-year-old male diagnosed with vesicoureteral reflux is experiencing urine reflux from the urinary bladder into a grossly dilated ureter and calyces. compulsive eating of nonnutritive substances such as clay or ice. They may also cause metabolic imbalances that can secondarily. Parenteral medications. paint flakes, over time. The nurse tells the smoker that due to persistent irritation of the lungs from carcinogens, columnar cells may turn into squamous. Which of these clients should the nurse assess first. Blood glucose, nurse is planning care for a human immunodeficiency virus (HIV) positive child. Nervous system (neurological) problems that may include seizures. Lead poisoning primarily affects young children and can lead to a wide. Test paint and dust in homes. Lead intoxication is one of the most well-described environmental. a sudden. Fresh features from the 1 AI-enhanced learning platform. Supporting clinical history classically entails environmental or occupational exposure to lead. Sometimes mistakenly characterized as a universal antidote, activated charcoal (AC) is the most frequently employed method of gastrointestinal decontamination in the developed world. -Early stages of diseases but may have no symptomsminimalExamples. Drooping eyelids. Vitamin A belongs to the category of lipid-soluble compounds called retinoic acids. chloride d. Learn about the causes, symptoms, diagnosis and treatment of lead poisoning with flashcards on Quizlet. Learn about the causes, symptoms, diagnosis and treatment of lead poisoning with flashcards created by wrightwayj. Hypoxia can vary in intensity from mild to severe and can present in acute. NJ&x27;s urban municipalities had the greatest number of minority residentsinthe state and the percentage of reported cases of lead poisoning in 02. Beta-carotene is the most well-known form of 2 clinically significant forms of vitamin A preformed vitamin A and provitamin A carotenoids. One, some, or all responses may be correct. Wrinkling of skin e. The school nurse suspects pertussis (whooping cough), because vaccine protection wanes in 5-10 years. Strabismus is a disorder in which the optic axes cannot be directed to the same object; this causes difficulty in focusing from one distance to the other. Study with Quizlet and memorize flashcards containing terms like A microcyte is defined as having a diameter less than which value, A patient with a vitamin B12 deficiency might have an anemia classified as, A normal size red cell with a. the developing brain is in a critical formative stage. Study with Quizlet and memorize flashcards containing terms like Which of the following leukemias is most often associated with an autoimmune hemolytic anemia ALL Acute myeloblastic leukemia CLL CML, What is the sequence of maturity for the erythroid series Basophilic normoblast, pronormoblast, polychromatic normoblast, orthochromatic. 234 If the blood lead level of a preschooler is found to be between 20 and 44 mcgdL, the nurse should provide lead education to the family. Clinical neurology texts stress that central nervous system effects are characteristic of childhood lead poisoning while peripheral nervous system effects are more prevalent with adult poisoning (e. Smoking is the leading cause of burns, reported fires, deaths, and injuries involving home medical oxygen. 2,512 solutions. Asbestos fibres are easily inhaled and carried into the lower regions of the lung where they can cause fibrotic lung disease (asbestosis) and changes in the lining of the chest cavity (pleura). cognitive deficits, delayed growth and development. ) Wet mount and culture or point-of-care testing of a vaginal swab specimen for trichomoniasis. 24 micromolL) 1,6 . It involves the accumulation of small fat droplets around liver cells, specifically around the venules, and approaches the portal tracts. Sep 29, 2023 Congenital sideroblastic anemias Congenital sideroblastic anemias are caused by a germline pathogenic variant affecting a nuclear or mitochondrial gene. Exposure to high levels of carbon monoxide for 1 to 3 minutes may lead to death. Increased intracranial pressure (ICP), 2. Aspirate before injecting Clean injection site with alcohol Insert the needle at a 45- to 90-degree angle Inject insulin slowly After injection, cover. ) Serum sample for HIV infection, hepatitis B, and syphillis. Dehydration from vomiting and diarrhea. empty the mouth to clean the residue of the drug. Administer the iron through a straw. Baking c. 55 - 69 ugdl. Test your knowledge with verified questions and answers from various textbooks and sources. Have the patient drink one glass of milk. A burn client is receiving the open method for wound treatment. DO NOT use it to treat or manage an actual poison exposure. Holding may meet needs and reduce tension on the suture line. What is the most appropriate nursing action, The nurse suspects that a child has ingested some type of poison. Supporting clinical history classically entails environmental or occupational exposure to lead. . 40mm hedp