Objective 4-5

Treatment for Acetaminophen poisoning

- Antidote N-acetylcysteine (Mucomyst) is equally effective given intravenously or orally. When given orally may first be diluted in fruit juice or soda because of the antidote's offensive odor. An antiemetic may be given if vomiting occurs. - Given as 1 loading dose followed by 17 additional doses in different dosages. IV administration is given as a continuous infusion.

Activated charcoal is not recommended and has become less common. What circumstances may activated charcoal be considered?

- Child may have ingested large amounts of carbamazepine, dapsone, phenobarbital, quinine, or theophylline - Time to activated charcoal administration is within 1hr after poison ingestion - Child has intact airway

Major development accomplishments for infant from Birth to 4 months

- Exhibits involuntary reflexes (e.g., crawling reflex may propel infant forward or backward; startle reflex may cause the body to jerk) - May roll over - Has increasing eye-hand coordination and voluntary grasp reflex

Risk factors for asphyxia and animal bites (A)

- Food: cylindrical items such as hot dogs, hard candy, peanutes, almonds - Toys: small toys such as legos - Small objects: batteries, buttons, beads, dried beans, syringe caps, safety pins - Pacifiers (should be one piece) - baby powder (avoid shaking powder over infant) - domestic dogs/cats (supervise)

Clinical Manifestations of ingesting hydrocarbons (gas, kerosene, lighter fluid, turpentine, paint thinner)

- Gagging, choking, and coughing - Burning throat and stomach - Nausea - Vomiting - Alterations in sensorium, such as lethargy - Weakness - Respiratory symptoms of pulmonary involvement • Tachypnea • Cyanosis • Retractions • Grunting

Treatment for Ingestion of Corrosives (toilet cleaners, dishwasher detergent, batteries, bleach)

- Inducing emesis is contraindicated (vomiting redamages the mucosa). - Contact the PCC immediately. If the PCC or medical advice and treatment not immediately available, it may be appropriate to dilute corrosive with water or milk (usually ≤120 ml [4 oz]). - Do not neutralize. Neutralization can cause an exothermic reaction (which produces heat and causes increased symptoms or produces a thermal burn in addition to a chemical burn). - Maintain patent airway as needed. - Administer analgesics. - Give oral fluids when tolerated. - Esophageal stricture may require repeated dilations or surgery.

Treatment of Hydrocarbon ingestion (gas, kerosene, lighter fluid, turpentine, paint thinner)

- Inducing emesis is generally contraindicated. - Gastric decontamination and emptying are questionable even when the hydrocarbon contains a heavy metal or pesticide; if gastric lavage must be performed, a cuffed endotracheal tube should be in place before lavage because of a high risk of aspiration. - Symptomatic treatment of chemical pneumonia includes: HIGH HUMIDITY, OXYGEN, HYDRATION, ACETMINOPHEN

Risk factors for suffocation and sleep position (S)

- Latex balloons - Plastic bags - Bed surface (sofa, adult bed, soft bedding) - Pillows or soft cushions - Blankets - Prone sleeping ( back is best)

Clinical Manifestations of Corrosives (toilet cleaners, dishwasher detergent, batteries, bleach)

- Severe burning pain in the mouth, throat, and stomach - White, swollen mucous membranes; edema of the lips, tongue, and pharynx (respiratory obstruction) - Coughing, hemoptysis - Drooling and inability to clear secretions - Signs of shock (pale ,cold, clammy, tachypnea, tachycardia) - Anxiety and agitation

Risk factors for Falls (F)

- Stairs - Diaper changing table - Crib (particularly drop-side) - Infant carriers - car seat restraints - high chair (make sure to restrain) - infant walkers - windows, screens - televisions (could be tipped off furniture)

Potential complications from use of activated charcoal

- Vomiting - Aspiration - Constipation - Intestinal obstruction

Risk factors for Electrical Burns

- electrical outlets - hot hair combs - Water ( check temp for baths) - fireplace - stove, liquids - cigarettes

Risk factors for Automobile Safety (A)

- leaving child in vehicle - air bags - car seat restraint (improper use, not used)

Risk Factors for Poisoning, Ingestions (P)

- medication, ointments, cream, lotions - Plants* - Cleaning solutions - Inhalation (gas, chemicals, etc...)

What certain condition may gastric lavage be used for poisoning treatment?

- presentation within 1 hour of ingestion of a toxin - ingestion in a patient who has decreased gastrointestinal motility - the ingestion of a toxic amount of sustained-release medication - large or life-threatening amount of poison

Risk factors for Drowning (D)

- Bath tubs - Pools, fountains, ponds - 5-gallon buckets

Gastric lavage is no longer recommended for treatment of poisoning and is associated with what complications?

- GI perforation - Hypoxia - Aspiration

What are the 3 leading causes of accidental deaths for infants?

- Suffocation - Motor vehicle accident - Drowning

As children gain increased locomotor and manipulative skills plus their natural curiosity, what is needed to keep them safe?

Constant vigilance, awareness, and supervision

Antidote for carbon monoxide poisoning

Oxygen

Review Box 9.1 pg 306 for Safety and Injury Prevention in infants Birth to 12 months

Review Box 9.1 pg 306 for Safety and Injury Prevention in infants Birth to 12 months

SAFE PAD acronym stands for?

S- Suffocation, sleep position A- Asphyxia, animal bites F- Falls E- Electric burns or burns P- Poisoning, ingestions A- Automobile safety D- Drowning *common infant injuries

Antidote for benzodiazepines overdose

Flumazenil

Antidote for Cyanide poisoning

amyl nitrate

Antidote for digoxin toxicity

digoxin immune FAB (Digibind)

Parental Guidance for 6-12months

• Prepare parents for child's "stranger anxiety." • Encourage parents to allow child to cling to them and avoid long separation from either parent. • Guide parents concerning discipline because of infant's increasing mobility. • Encourage use of negative voice and eye contact rather than physical punishment as a means of discipline. • Encourage showing most attention when infant is behaving well, rather than when infant is crying. • Teach injury prevention because of child's advancing motor skills and curiosity. • Encourage parents to leave child with suitable caregiver to allow some free time. • Discuss readiness for weaning. • Explore parents' feelings regarding infant's sleep patterns.

Parental Guidance from Birth - 6 months (RN to Parent)

• Teach parents car safety with use of federally approved restraint, facing rearward, in the middle of the back seat—not in a seat with an air bag. • Understand each parent's adjustment to newborn, especially mother's postpartum emotional needs. • Teach care of infant and help parents understand his or her individual needs and temperament and that the infant expresses wants through crying. • Reassure parents that infant cannot be spoiled by too much attention during the first 4 to 6 months. • Encourage parents to establish a schedule that meets needs of child and themselves. • Help parents understand infant's need for stimulation in environment. • Support parents' pleasure in seeing child's growing friendliness and social response, especially smiling. • Plan anticipatory guidance for safety. • Stress need for immunizations. • Prepare for introduction of solid foods.

Emergency Treatment >> Poisonings

1. Assess the victim: • Initiate cardiorespiratory support if needed (circulation, airway, breathing). • Assess mental status; reevaluate routinely. • Take vital signs; reevaluate routinely. • Evaluate for possibility of concomitant trauma or illness; treat prior to initiation of gastric decontamination. 2. Terminate exposure: • Empty mouth of pills, plant parts, or other material. • Flush any body surface (including the eyes) exposed to a toxin with large amounts of moderately warm water or saline. • Remove contaminated clothes, including socks and shoes, and jewelry. Ensure protection of rescuers and health care workers from exposure. • Bring victim of an inhalation poisoning into fresh air. 3. Identify the poison: • Question the victim and witnesses. • Observe the circumstances surrounding the poisoning (e.g., location, activity before ingestion). • Look for environmental clues (empty container, nearby spill, odor on breath) and save all evidence of poison (container, vomitus, urine). • Be alert to signs and symptoms of potential poisoning in the absence of other evidence, including symptoms of ocular or dermal exposure. • Call the poison control center (PCC) or other competent emergency facility for immediate advice regarding treatment. 4. Prevent poison absorption: • Place the child in a side-lying, sitting, or kneeling position with the head below the chest to prevent aspiration.

Antidote for Acetaminophen

N-acetylcysteine

Antidote for opioid overdose

Naloxone (Narcan)

Clinical Manifestations of poisonous ingestion of Acetaminophen

Occurs in four stages post ingestion: 1. 0 to 24 hours • Nausea • Vomiting • Sweating • Pallor 2. 24 to 72 hours • Patient improves • May have right upper quadrant abdominal pain 3. 72 to 96 hours • Pain in right upper quadrant • Jaundice • Vomiting • Confusion • Stupor • Coagulation abnormalities • Sometimes renal failure, pancreatitis 4. More than 5 days • Resolution of hepatoxicity or progress to multiple organ failure • May be fatal **This is the most common accidental drug poisoning in children. **Toxicity occurs from acute ingestion. Toxic dose is 150 mg/kg or greater in children.

Nurses must be aware of the possible causes of injury in each age-group to provide?

anticipatory/preventative teaching **preventative teaching ideally begins during pregnancy

Antidote for certain poisonous bites

antivenin

What is a major factor in fatal accident involving children?

lack of proper child restraint

A carseat is best placed in what position for infant?

rear-facing

Activated charcola is mixed with water or a saline cathartic. In order to increase child's acceptance of activated charcoal what could the nurse do?

the nurse should mix it with small amounts of chocolate milk, fruit syrup, or cola drinks and serve it through a straw in an opaque container with a cover (e.g., a disposable coffee cup and lid) OR an ordinary cup covered with aluminum foil or placed inside a small paper bag. **for small children, a nasogastric tube may be required to administer activated charcoal

What is The first and most important principle in dealing with a poisoning?

treat the child first, not the poison

Home safety education improve poison prevention. Nurses should educate parents in order to prevent a recurrence. What are nursing care guidelines regarding poison prevention?

• Assess possible contributing factors in occurrence of injury, such as discipline, parent-child relationship, developmental ability, environmental factors, and behavior problems. • Institute anticipatory guidance for possible future injuries based on child's age and developmental level. • Initiate referral to appropriate agency to evaluate home environment and need for injury-proofing measures. • Provide assistance with environmental manipulation, such as lead removal, when necessary. • Educate parents regarding safe storage of toxic substances. • Advise parents to take drugs out of sight of children. • Teach children the hazards of ingesting nonfood items • Advise parents against using plants for teas or medicine. • Discuss problems of discipline and children's noncompliance and offer strategies for effective discipline. • Instruct parents regarding correct administration of drugs for therapeutic purposes and to discontinue drug if there is evidence of mild toxicity. • Advise parents to contact the poison control center (PCC; 800-222-1222) or practitioner immediately when a poisoning occurs. • Tell them to post the number of the regional PCC with an emergency phone list by the telephone. • Include by the telephone the home address with nearest cross street in case an ambulance is needed. (In an emergency, family members may not remember the house address, and babysitters may not be aware of the information.)

Most common ingested poisonous agents

• Cosmetics and personal care products (deodorants, makeup, perfume, cologne, mouthwash) • Medications (acetaminophen, acetylsalicylic acid, ibuprofen, opioid analgesics, benzodiazapines, amphetamines) • Household cleaning products (bleaches, laundry pods, disinfectants) • Foreign bodies, toys, and miscellaneous substances (desiccants, thermometers, bubble-blowing solutions)