childhood poisonings
emergency poisoning treatment
1. assess the victim (circulation, airway, breathing) 2. terminate exposure (empty mouth, flush body surfaces, remove contaminated clothing) 3. identify the poison (question them, observe circumstances, look for clues, be alert to s/s, call PCC) 4. prevent poison absorption (place pt side-lying, sitting, or kneeling position with head below the chest to prevent aspiration)
What do you do when someone is exposed to a poison?
*assess* - remove the poison from them if they still have it - see if they are breathing/conscious/have a pulse - if they do, call poison control center - if they don't perform CPR and call 911
poison prevention
- assess possible factors; discipline, parent-child relationship, developmental ability, environmental factors, and behavior problems - evaluate home environment - assist with environment manipulation; lead removal - educate safe storage of toxic substances - teach hazards of ingesting nonfood items - advise parents to contact poison control center
lead can affect any part of the body
- hematologic system - renal system - neurological system (most common in young children due to developing brain and nervous system)
acetaminophen poisoning
- most common accidental drug poisoning in children because it has a good taste - toxic dose: 150 mg/kg or more in children - treatment: N-acetylcysteine (Mucomyst) - smells like rotten eggs, dilute with fruit juice or soda
manifestations of acetaminophen poisoning
- n/v, sweating, pallor - may improve a few days in, pain in RUQ - jaundice, vomiting, confusion, stupor, coagulation abnormalities - sometimes renal failure, pancreatitis - organ failure - may be fatal
Which statement by the parent of an 18-month-old child most indicates to the nurse that the child needs laboratory testing for lead levels? 1. "My child does not always wash after playing in the dirt" 2. "My child drinks two cups of milk everyday" 3. "My child has more temper tantrums than other kids" 4. "My child is smaller than other kids of the same age"
1. "My child does not always wash after playing in the dirt"
lead poisoning screening questions
1. does your child live in or regular visit a house that was built before 1950? 2. does your child live in or regularly visit a house built before 1978 with recent or ongoing renovations or remodeling within the past 6 months? 3. does your child have a sibling or playmate who has or had lead poisoning?
When developing a plan of care for a toddler who has taken an acetaminophen overdose, which intervention should the nurse expect to include as part of the initial treatment? 1. frequent blood level determination 2. gastric lavage 3. tracheostomy 4. electrocardiogram
2. gastric lavage
When teaching the mother of a toddler diagnosed with lead poisoning, what should the nurse include as the most serious complication if the condition goes untreated? 1. cirrhosis of the liver 2. stunted growth rate 3. neurologic deficits 4. heart failure
3. neurologic deficits
What predisposes children to poisonings?
developmental characteristics children are curious and love to put things in their mouths
blood lead level
if greater than 70, immediately provide diagnostic testing and initiate chelation therapy
sources of lead
lead based paint, lead solder, lead crystal, battery casings, lead fishing sinkers, lead curtain weights, lead bullets, other sources, occupational exposure most common: lead based paint or lead contaminated soil
lead exposure on neurological system
low-dose exposure: distractibility, impulsivity, hyperactivity, hearing impairment, mild intellectual deficits high-dose exposure: cognitive impairment, paralysis, blindness, convulsions, coma, death
nursing care management for lead poisoning
prevent initial exposure or further exposure, identify sources, take a careful history, reducing lead in child's environment, reduce infection pain, monitor for toxic side effects of chelation agents, discharge planning
chelation therapy
removing lead from circulating blood and some lead from organs and tissues - not an antidote but serves a similar purpose because it removes the toxin from the body, it does not counteract any effects of the lead - ensure adequate fluid intake, urine output, renal, hepatic, and hematological parameters should be monitored
