April 23 109 Lecture Flashcards
Occurs when any substance interferes with normal body functions after it is swallowed, inhaled, injected, or absorbed.
Poisoning
Who are prone to poisoning?
Infants and toddlers
Why are infants and toddlers prone to poisoning?
Because they explore their environment through oral experimentation, because their sense of taste is not discriminating.
2 major types of poisoning
- Product that never meant to be ingested or inhaled
- Products that can be ingested in small quantities but can be harmful if ingested in large amounts
Example of poisonous products that are never meant to be ingested or inhaled.
✔ shampoo
✔ paint thinner
✔ pesticides
✔ houseplants (leaves)
✔ carbon monoxide
Example of Products that can be ingested in small quantities but can be harmful if ingested in large amounts
✔ drugs/ medicine
✔ medicinal herbs
✔ alcohol
✔ bacterial toxins (food poisoning for e.g. E, Coli)
✔ heavy metals (lead paint)
✔ venom (animal, insects)
Causative agent of staphylococcal Food poisoning
Staphylococcal enterotoxin produced by strains of staphylococcus aureus
Incubation period of staphylococcal Food poisoning
1 - 7 hours
Period of communicability of staphylococcal Food poisoning
Carriers may contaminate food as long as they harbor that organism
Mode of transmission of staphylococcal Food poisoning
Ingestion of contaminated food
Assessment for Staphylococcal Food Poisoning
✔ severe vomiting and diarrhea
✔ abdominal cramping
✔ excessive salivation
✔ Nausea within 2-6 hours of eating
Therapeutic management for Staphylococcal Food Poisoning
Intensive supportive therapy with fluid and electrolyte replacement
Effective drug against staphylococcus
cefotaxime
Prevention for Staphylococcal Food Poisoning
proper refrigeration of food
A poisoning that occurs most commonly in children between the ages 2 and 3 years and in all socioeconomic groups
Poisoning as an unintentional injury
Poisoning as an unintentional injury commonly occurs in what age group?
Between the ages 2 and 3 years and in all socioeconomic groups
Common agents in poisoning as an unintentional injury
✔ soap
✔ cosmetics
✔ detergents or cleaners
✔ plants
What is the best method to deactivate a swallowed poison?
Administration of activated charcoal (orally or by way of an NG tube)
Drug most frequently involved in childhood poisoning today
Acetaminophen Poisoning
Acetaminophen when taken in large doses can cause?
Liver destruction
What will the child experience immediately after ingestion in acetaminophen poisoning?
✔ anorexia
✔ nausea
✔ vomiting
Diagnostic test for acetaminophen poisoning
✔ serum aspartate transaminase (AST/ SGOT) - enzyme made by liver cells
✔ serum alanine transaminase (ALT/ SGPT) - present in liver and heart cells
✔ liver enzymes
Therapeutic Management for acetaminophen poisoning
✔ Activated charcoal - given 1 to 4 hours after consuming
✔ Acetylcysteine -antidote
✔ Continue to observe for jaundice and tenderness over the liver
✔ Assess AST and ALT levels
Loading dose
140 mg/ kg
Maintaining dose
70 mg/kg, repeated q4, in total of 17 hours
Ingestion of a strong alkali, such as lye, which is often contained in toilet bowl cleaners or hair care products
Caustic Poisoning
Areas where caustic poisoning cause burns and tissue necrosis
✔ mouth
✔ esophagus
✔ stomach
5 assessments for caustic poisoning
✔ oral edema
✔ marked edema on mouth and lips
✔ drools saliva
✔ immediate pain in the mouth and throat
✔ inability to swallow
Analgesic used in caustic poisoning to achieve pain relief
morphine
Therapeutic Management for caustic poisoning
✔ assess the child for the degree of pain involved
✔ intubation may necessary to provide a patent airway
✔ assess vital signs closely, especially the respiratory rate
A poisoning where substances contained in products such as kerosene and furniture polish
Hydrocarbon Poisoning
Major effect in hydrocarbon poisoning
respiratory irritation
A poisoning where it is swallowed by small children because it is an ingredient in vitamin preparations, particularly pregnancy vitamins
Iron Poisoning
What can iron poisoning lead to?
signs and symptoms of gastric irritation
Assessment for iron poisoning
immediate effects of nausea and vomiting, diarrhea, abdominal pain
Assessment for iron poisoning after 6 hours
necrosis of the tube lining of GI tract
Assessment for iron poisoning after 12 hours
✔ melena
✔ hematemesis
✔ lethargy and coma
✔ cyanosis
✔ vasomotor collapse
Therapeutic Management for iron poisoning
✔ stomach lavage
✔ administration of cathartic/laxative
✔ Maalox or Mylanta
✔ chelating agent such as IV or IM deferoxamine
✔ exchange transfusion
✔ upper GI x-ray series
✔ liver studies
✔ test any stool passed for occult blood
Other word for lead poisoning
Plumbism
A poisoning that interferes with blood cell function by blocking the incorporation of iron into the protoporphyrin compound that makes up the heme portion of hemoglobin in RBC
Lead Poisoning (Plumbism)
Lead Poisoning (Plumbism) can lead to
hypochromic, microcytic anemia
This is the most serious effect from lead poisoning and occur most in the toddler or preschool child
Lead encephalitis
Assessment for lead poisoning
✔ Anorexia, lethargy, abdominal pain
✔ learning difficulties
✔ 2 successive blood lead levels of > 10 µg/ dL
Usual sources of lead
✔ paint chips or paint dust
✔ home-glazed pottery
✔ fumes from burning
✔ swallowed batteries
Therapeutic Management for lead poisoning
✔ measure intake and output
✔ injections of EDTA (chelating agent)
✔ if the lead level is 15 µg/ dL or higher, child must be removed from the environment
✔ if the lead level is >20 µg/100mL, oral chelating such as succimer may be prescribed
✔ lead levels >45 µg/ 100 mL may be admitted to the hospital for chelation therapy with dimercaprol or edetate calcium disodium
A poisoning where accidental ingestion or through skin or respiratory tract contact when children play in an area that has been recently sprayed
Pesticide Poisoning
Pesticide Poisoning can lead to
muscle paralysis
Assessment for pesticide poisoning
✔ nausea and vomiting
✔ diarrhea
✔ excessive salivation
✔ weakness of respiratory muscles
✔ confusion
✔ depressed reflexes
✔ seizures
Therapeutic management for pesticide poisoning
✔ activated charcoal
✔ remove clothing if contaminated
✔ wash child’s skin and hair
✔ wear gloves while bathing the child
✔ intravenous atropine and cholinesterase reactivator, pralidoxime (Protopam Chloride)
A leading cause of death in children and adolescent
Accidents (trauma/injury)
Why are adolescents vulnerable to multiple and severe trauma?
because they are mobile in bikes, motorcycles and in automobiles and active in sports
2 factors that increases the chance of injury
Speed and congested surroundings
Children are Vulnerable to Injury due to
✔ natural curiosity
✔ Investigative, impulsive, impatient
✔ less careful, hyperactive
✔drive to test on new master skills
✔ attempted activities before developmental readiness
✔ self-assertion and challenges to rules
✔ desire for peer approval
_____ is an event, independent of human will, caused by outside force acting rapidly and resulting in physical or mental injury
Accident
It is an intentional or unintentional damage to the body due to exposure to an external agent
Injury
There can be 3 forms of injury which are:
✔ Thermal
✔ Mechanical
✔ Chemical
It is the leading cause of death and disability in children and young adults
Childhood Accidents
It is the leading cause of death in children over 1 year
Childhood Accidents
Number of deaths associated with childhood accidents worldwide per year
more than 5 million deaths
Incidence of childhood accidents
✔ every hour, 1 child dies from an injury
✔ about 1 in 5 child deaths is due to injury
✔ every 4 seconds, a child is treated for an injury in an emergency department
Common Accidental Injury in INFANTS
✔ cuts
✔ falls
✔ suffocation
✔ ingestion
✔ burns
Preventions for infants in having accidental injury
✔ never keep them alone
✔ do not give them small tiny toys
✔ avoid solid food items, keep away stove, fire
Common Accidental Injury in TODDLERS
✔ thermal
✔ aspiration
✔ drowning
✔ falling
✔ electrocution
Preventions for toddlers in having accidental injury
✔ supervise constantly
✔ avoid negative words
✔ keep away harmful agents
✔ floor should be dry
✔ clothing
Common Accidental Injury in ADOLESCENTS
✔ instrument injury
✔ road traffic accident
✔ electric current
✔ sport injury
Preventions for adolescents
in having accidental injury
✔ safe environment
✔ training
✔ constant supervision
✔ guidance
✔ education
Nurses role in Common Accidental Injury and its Prevention in Different Age Group
✔ fore thought
✔ discipline
✔ time
Nursing responsibilities in Common Accidental Injury and its Prevention in Different Age Group
✔ health education
✔ provision of safe environment
✔ safe child care and prevent the accident from happening
✔ assist in medical care to prevent the disability
✔ take public health measures to prevent road traffic accidents such as teaching them traffic rules, implement policies, etc.
✔ Participate in policy making and research activity in accident prevention
It is the most common chronic rheumatologic disease in children and is one of the most common chronic disease of childhood
JUVENILE RHEUMATIC ARTHRITIS (JRA)
other name for juvenile rheumatic arththritis
Juvenile Idiopathic Arthritis (JIA)
They provide a supportive framework and protective covering for the body, such as the musculoskeletal system and skin and mucous membranes
Connective tissues
Causes of JRA
✔ Genetics
✔ Infectious agents
✔ Female hormones
✔ Environmental factors
✔ Occupational exposures
a specific gene marker in JRA
HLA (human leukocyte antigen)
Example of environmental factors in JRA
exposure to cigarette smoke, air pollution, and insecticides
Clinical manifestations for JRA
✔ Arthritis
✔ Loss of motion
✔ Synovitis
✔ Swelling
✔ Joint inflammation
It is a limitation of joint motion in association with pain, warmth, or erythema of the joint.
Arthritis
A condition where fingers may appear swollen, and the range of motion becomes painful.
Synovitis
Diagnostic tests for JRA
✔ Inflammatory markers
✔ Complete blood count and metabolic panel
✔ Antinuclear antibody test
✔ Radiography
✔ Computed tomography and magnetic resonance imaging (CT SCAN)
✔ Ultrasonography
Management for JRA
✔ Exercise
✔ Synovectomy
✔ Osteotomy and arthrodesis
✔ Total hip and knee replacements
Medications for JRA
✔ Nonsteroidal anti-inflammatory drugs (NSAIDs)
✔ Disease- modifying antirheumatic drugs (DMARDs)
✔ Corticosteroids
✔ Immunomodulators
It is not a simple curve to one side but in fact a more complex three-dimensional deformity that often develops in childhood.
Scoliosis
Greek word of scoliosis
skolios (twisted) and refers to a sideward (right or left) curve in the spine
3 main plane in scoliosis
✔ lateral curvature in frontal - kyphosis
✔ anteroposterior - lordosis
✔ vertebral axial rotation- scoliosis
term used specifically to describe scoliosis that occurs in children younger than 3 years of age
Infantile Scoliosis
Scoliosis occurring in 4 to 9 years of age
Juvenile scoliosis
Scoliosis occurring in 10 to 18 years of age
Adolescent scoliosis
What are the “tip-offs” to scoliosis
✔ uneven waist
✔ leaning to one side
✔ prominent shoulder blade/s
✔ uneven shoulders
✔ elevated hips
When does these “tip-offs” begin?
8 years of age
Types of scoliosis
✔ Functional Scoliosis
✔ Structural Scoliosis
✔ Idiopathic Structural Scoliosis
It is a curvature due to a problem that does not involve the spine, such as having legs that are different lengths or muscle spasms caused by pain
Functional Scoliosis
A type of scoliosis where the curvature is flexible and will go away if the problem that causes to lean to the side goes away
Functional Scoliosis
A type of scoliosis where the spine curvature is not flexible and does not go away with a change in position
Structural Scoliosis
A type of scoliosis where 80% of children and seen in school-aged children at 10 years/ older
Idiopathic Structural Scoliosis
Conditions associated with idiopathic Structural Scoliosis
✔ born with vertebrae that do not develop normally
✔ underlying problem in the brain
✔ cyst or a tumor
✔ cerebral palsy
✔ muscular dystrophy
Causes of scoliosis
✔ Mechanical factors
✔ Genetic and external factors
✔ Other associations include older mothers from poorer families, breech presentations, and premature and low-birth weight babies.
Diagnostic tests for scoliosis
✔ Radiography
✔ Computed tomography (CT) scan
✔ Magnetic resonance imaging (MRI)
RVAD
rib-vertebral angle difference
Non-surgical therapeutic management for scoliosis
✔ electrical stimulation
✔ observation
✔ brace management
✔ exercise therapy
✔ pedicle screw instrument
✔ halo traction
Surgical therapeutic management for scoliosis
✔ growing rods
✔ localizer cast
✔ traction to the pelvis through another sling
✔ pediatric Isola spine system
Nursing management for scoliosis
✔ Degree of curvature
✔ Provide privacy
✔ Assess emotional status
Period of time a child with scoliosis must be reassessed
every 4 - 6 months
Interventions for scoliosis
✔ Promote mobility
✔ Prevent injury
✔ Prevent skin irritation
✔ Promote positive body image
✔ Promote compliance with therapy
