Ch. 14 Wong's - Evolve Case Study - Case #5: Heavy Metal Poisoning & Case #6: Ingestion of an Injurious Agent & Case #7: Salicylate Ingestion
Case Study #7: What are the clinical manifestations of salicylate toxicity?
- Hyperventilation - Hyperpyrexia - Confusion - Loss of consciousness - Coma - Death
Case Study #7: Discuss essential elements of initial advice to give to this parent.
- Praise parent for calling and seeking medical advice. - Contact Poison Control Center (PCC) before initiating any intervention - Save all evidence of poison, including the bottle, vomitus, and urine. - Arrange for child to get to an emergency facility for management. A lethal dose of salicylates may have been taken and should be assessed further. Rationale: Parents are advised to call the PCC before initiating any intervention because instructions on labels of many household products are not correct treatment measures. Therefore, praising the parents for calling and seeking medical advice reinforces this desired behavior. Evidence of the poison, such as the bottle, vomitus, and urine, can assist the practitioner in determining the degree of poisoning and the required treatment. The extent of poisoning by oral ingestion is difficult to evaluate because of the absence of evidence. Patients should be further assessed to initiate early treatment if required.
Case Study #7: Discuss essential nursing considerations in salicylate poisoning.
- Remove the poison. - Observe for latent effects from overdose. - Assist with medical treatments of complications. - Prevent recurrence of poisoning. Rationale: Once the poison has been removed, the most important nursing consideration in salicylate poisoning is treatment of the child, which requires immediate assessment of the ABCs of airway, breathing, and circulation. Continued assessment of the patient's condition will alert the nurse to latent effects from the ingestion. The nurse is also responsible for assisting with medical treatments of complications. Anticipatory guidance and discharge planning should include poison prevention instruction to prevent the recurrence of poisoning of any substance.
Case Study #6: The most appropriate response by the nurse to the mother is to: A. Call the poison control center (PCC) immediately and follow the center's instructions—in addition, call the child's pediatrician's office. B. Contact the local hospital's emergency department, after making the child vomit by giving 2½ bottles of syrup of ipecac, followed by a 4- to 6-ounce glass of milk. C. Watch the child for the next 4 hours, and if the child acts differently in any way, call the PCC. D. Dilute any perfume swallowed by giving the child two 6-ounce glasses of milk, and observe the child for the next 2 hours. If the child acts differently in any way, call the clinic back for an appointment.
A. Call the poison control center (PCC) immediately and follow the center's instructions—in addition, call the child's pediatrician's office. Rationale: A potential poisoning may or may not require emergency intervention. The mother should first call the PCC, where they will advise her of home treatment and whether to transport the child to the hospital. The most toxic ingredient is probably alcohol, and the child may be asleep because he is drunk; treatment, if needed, should begin long before any additional symptoms appear. Because milk, fluid volume, and food do not alter ipecac's effectiveness, the common suggestion of forcing fluids is unnecessary, and milk can decrease the adsorptive power of activated charcoal, if used. For maximum benefit in removing the poison, ipecac should be administered within 1 hour of a toxic ingestion. Evidence indicates that the information given by PCCs is more accurate than instructions given by hospital emergency departments.
Case Study #5: The most appropriate response by the pediatric telephone triage nurse is: A. "Call her pediatrician for a medical opinion as soon as the doctor's office opens the following day." B. "A potential poison should be diluted with copious amounts of fluids. Make the child drink 6 to 8 ounces of milk or water every hour for the next 4 to 6 hours, and then call the emergency department at the hospital." C. "Call the poison control center (PCC) and follow their instructions for home care. The child should then be taken to the local hospital's emergency department." D. "Contact the local hospital's emergency department and follow their instructions; they can best tell if it is necessary to take the child to the emergency department and when it is least busy."
C. "Call the poison control center (PCC) and follow their instructions for home care. The child should then be taken to the local hospital's emergency department." Rationale: Pool cue chalk has a very high lead content; it is not harmless. Children under the age of 6 are most at risk for lead poisoning because of their developing nervous systems, and three to five times more lead is absorbed in children than in adults. The most serious and irreversible side effects of lead intoxication are on the nervous system. Diagnosis is made based on measurement of blood lead levels. The objective of treatment is to remove lead in the body and prevent further accumulation of the metal, and this must be done initially in a hospital setting. Increased recovery rate from acute poisonings is largely attributable to vigorous use of supportive measures after symptoms appear. Based on the initial telephone assessment, the PCC counsels the caller to begin treatment at home or to bring the child to an emergency facility. Evidence indicates that the information given by PCCs is more accurate than instructions given by hospital emergency departments.
