CE Module: Association Between Acute Kidney Injury Hospital Visits and Environmental Heat Stress at a Nicaraguan Sugarcane Plantation

This issue of Workplace Health & Safety contains a Continuing Nursing Education Module for 1.0 contact hour of continuing nursing education credit which will be awarded by AAOHN upon successful completion of the posttest and evaluation.

A certificate will be awarded when the following requirements are met by the participant: (1) Participant logs onto the AAOHN LMS website at www.aaohn.org/education/online-learning-center and enrolls in the course ($10 members; $15 non-members); (2) The completed posttest and course evaluation are entered online at http://www.aaohn.org by April 2027; (3) A score of 75% is achieved by the participant.

Upon completion of this lesson, the occupational health nurse will be able to:

• Explain the association(s) between acute kidney injury (AKI)–related hospital visits and environmental heat stress at a Nicaraguan Sugarcane Plantation.

• Describe the environmental and pathophysiological determinants of occupational heat stress in this population of sugarcane workers.

• Identify effective occupational health interventions utilized to lower AKI incidence in this population of sugarcane workers.

The American Association of Occupational Health Nurses, Inc. is an Approved Provider of continuing nursing education by the American Association of Occupational Health Nurses, Inc., an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. The American Association of Occupational Health Nurses, Inc. is additionally approved as a CNE provider by the California Board of Registered Nursing (#CEP9283).

Contact hours received for successful completion of the posttest and evaluation may be used for relicensure, certification, and re-certification.

• 1. The authors refer to heat stress as a non-traditional cause of AKI. What are traditional causes of AKI discussed in this article?

• b. Diabetes

• c. Use of non-steroidal anti-inflammatories

• d. a. & b.

• e. All the above

2. Identify the two major aims of this study:

a. Compare and contrast levels of heat stress affecting different classifications of sugarcane workers.

b. Describe the association between environmental heat stress and AKI and how the incidence of hospital visits changed across the 6 years of the study with heat stress interventions.

c. Describe the difference between rates of heat stress among men compared with women and how heat stress can be classified.

d. Describe the association between environmental health stress and AKI and the resultant changes in creatinine and electrolyte levels.

3. According to the authors, what are the major environmental determinants of occupational heat stress?

a. Physical workload, heat index, humidity, and wind speed

b. Physical workload, metabolic heat production, humidity, and clothing

c. Ambient temperature, humidity, velocity of surrounding air, and solar radiation

d. Elevation, temperature, distance from large bodies of water and solar radiation.

4. A recent meta-analysis (Liu et al., 2021) found a ______ increase in the risk of kidney disease per 1°C increase in ambient temperature. Fill in the blank.

a. 1%

b. 10%

c. 5%

d. 25%

5. The Occupational Safety and Health Administration (2022) concluded that agricultural workers may be more sensitive to adverse kidney outcomes due to what two factors?

a. Higher work demands in both hot and cold work environments.

b. Lack of heat acclimatization and dehydration during peak harvest seasons

c. Higher environmental heat exposure and higher metabolic heat production than the general population

d. Lack of education and lack of appropriate personal protective equipment.

6. Before hiring, sugarcane workers at this plantation were screened for kidney dysfunction. What threshold for serum creatinine disqualified a worker?

a. Serum creatinine > 1.3 mg/dl for men and 1.0 mg/dl for women

b. Serum creatinine > 1.0 mg/dl for men and 0.9 mg/dl for women

c. Serum creatinine >1.0 mg/dl in any worker, male or female

d. Screening for serum creatinine was not done as it was deemed discriminatory.

7. The physical workload involved in outdoor manual occupations like repair and management of irrigation tubes and canals, seeding, weeding, and pest control is significantly lower than that of manual sugarcane cutting. True or False.

8. The role of the nurse “health promoters” at this plantation included:

a. Management of minor workplace injuries

b. Education, monitoring of fluid intake and hydration.

c. Reminders to take shade and cooling breaks.

d. Identification of early signs of heat stress and referral

e. b. & c. only

f. All the above

9. More men than women workers had measured increases in serum creatinine. Men were assumed to be engaging in more heavy work in hot environments, but differences could be due to:

a. Different levels of non-steroidal anti-inflammatory drug usage (NSAIDs)

b. Biological sex differences

c. Differences in number and duration of “shade breaks”

d. Vast differences in fluid intake between men and women

10. The most significant “take away” from this study was:

a. Heat stress is an unavoidable hazard for agricultural workers and is difficult to mitigate or eliminate.

b. Heat stress related kidney injury is not detectable until years after exposure.

c. Men are more resistant to occupational heat stress than women due to lower metabolic heat production.

d. Kidney injury became less common with rest and shade interventions and early diagnosis of heat induced kidney injury.