Ch. 42: Pediatric Emergencies-Poisoning Flashcards
What age is a risk factor for poisoning?
Younger than 6
What are examples of some other risk factors for poisoning?
- Improperly stored meds, household chemicals, and hazardous substances
- Exposure to plants, cosmetics, and heavy metals (all are potential sources of toxic substances)
- LEAD ingestion from lead-based paint, soil contamination
What are the symptoms of acetaminophen (tylenol) poisoning 2-4 hours after ingestion?
N/V
Sweating
Pallor
What are the symptoms of acetaminophen (tylenol) poisoning 24-36 hours after ingestion?
Improvement in the child’s condition
What are the symptoms of acetaminophen (tylenol) poisoning 36 hours-7 days or longer after ingestion?
This is the hepatic stage!!!
- Pain in RUQ
- Confusion
- Stupor
- Jaundice
- Coagulation disturbances
What is the final stage to acetaminophen poisoning (like was never treated)?
Death or gradual recovery
What are acute poisoning signs for acetylsalicylic acid (aspirin)?
N.V Disorientation Diaphoresis Tachypnea Tinnitus Oliguria Lightheadedness Seizures
What are chronic poisoning signs for acetylsalicylic acid (aspirin)?
Subtle version of acute manifestations
Bleeding tendencies
Dehydration
Seizures (more severe though compared to acute poisoning seizures)
What are the 4 poisoning periods for a child who got poisoned with supplemental iron?
- Initial period
- Latency period
- Systemic toxicity period
- Hepatic injury period
When and what happens in the initial period of iron poisoning?
Initial: 30 min-6 hr after ingestion
Vomiting Hematemesis Diarrhea Gastric pain Bloody stool
When and what happens during the latency period of iron poisoning?
Latency: 2-12 hours after ingestion
Improvement in condition
When and what happens during the systemic toxicity period of iron poisoning?
Systemic toxicity: 4-24 hours after ingestion
METABOLIC ACIDOSIS HYPERglycemia Bleeding Fever Shock Possible death
When and what happens in the hepatic injury of iron poisoning?
Hepatic injury: 48-96 hours after ingestion
Seizures or coma
What are hydrocarbons?
Gasoline, kerosene, lighter fluid, paint thinner, turpentine
What are some objective data signs of ingesting hydrocarbons?
Gagging, choking, coughing, N.V
Lethargy, weakness, tachypnea, cyanosis, grunting, retractions
What are corrosives?
Household cleaners, batteries, denture cleaners, bleach
What are some objective data signs of ingesting corrosives?
- Pain in burning in mouth, throat, and stomach
- Edematous lops, tongue, and pharynx with WHITE mucous
- VIOLENTLY vomiting with hemoptysis
- Drooling, anxiety, shock
What are low-dose exposure signs of lead poisoning?
Easily distracted Impulsive HYPERactive Hearing impairment Mild intellectual difficulty
What are high-dose exposure signs of lead poisoning?
Cognitive delays varying in severity
Blindness
Paralysis
Coma, seizures, death
What are other manifestations seen with lead poisoning?
KIDNEY impairment
Impaired CALCIUM function
Anemia
What is the intervention for acetaminophen poison?
N-acetylcysteine (Mucomyst) –given PO
What are some interventions for acetylsalicylic acid (aspirin) poisoning?
Activated charcoal Gastric lavage Sodium bicarbonate Oxygen and ventilation Vit. K Hemodialysis (for severe cases)
What are some interventions for supplemental iron poisoning?
Emesis or lavage
Chelation therapy using deferoxamine mesylate
Is it okay to induce vomiting if the child is in for ingesting a hydrocarbon?
NO DO NOT INDUCE VOMITING
Since we can’t induce vomiting for hydrocarbon poisoning, what do we do?
Intubation with cuffed endotracheal tube is done prior to decontamination–treatment of chemical pneumonia
What are the nursing interventions for treatment of a child who ingested a corrosive?
Airway maintenance NPO No attempt to neutralize the acid Don't induce vomiting Analgesics for pain
What is the intervention used for lead poisoning?
Chelation therapy using calcium EDTA
What 2 poisons do we NOT induce vomiting?
Hydrocarbon and corrosive poisoning
What are some poison prevention methods?
- Keep toxic things out of reach
- Lock cabinets that have potentially harmful substances
- Don’t take meds in front of kids!, get rid of unused meds!, don’t tell a child their medicine is candy!!!
- Use NON-mercury thermometers
- Eliminate lead-based paint in environment
- Hand hygiene prior to eating
- DO NOT store food in lead asked containers
Who do we do routine screenings for lead levels–like what age?
1, 2, and 3 years of age this is done
A nurse is teaching a patient about acetaminophen poisoning. Which of the following statements by the nurse should be included in the teaching?
A. “Nausea begins 24 hours after ingestion”
B. “Pallor can appear as early as 2 hours after ingestion”
C. “Jaundice will appear in 12 hours if your child is toxic”
D. “Children can have 4grams of acetaminophen a day”
B
A. Nausea begins 2-4 hours after ingestion
B. CORRECT–Pallor starts 2-4 hours after ingestion
C. Jaundice appears 36h-7d later
D. Max dose for children in
-2-5 years= 720mg/d
-6-12= 2.6 g/d
A nurse is caring for a child who has swallowed paint thinner. The child is lethargic, gagging, and cyanotic. Which of the following is an appropriate action for the nurse to take?
A. Induce vomiting with syrup of ipecac
B. Insert a NG tube and administer activated charcoal
C. Prepare for intubation with a cuffed endotracheal tube
D. Administer chelation therapy using defroxamine mesylate
C
A. Inducing vomiting= CONTRAININDICATED
B. Activated charcoal is for aspirin poisoning
C. CORRECT!
D. Chelation therapy= lead poisoning treatment
