Peds Final Review - Poisonings

Question 1

Poisoning, particularly by ingestion, is common cause of childhood injury and illness

Answer 1

Most poisonings occur in children under the age of 6, with a peak at age 2

Question 2

The exploratory behavior, curiosity, and oral-motor activity of early childhood place the hild at risk for poisonings.

Answer 2

About 90% of poisonings occur in the home

Question 3

Nursing Assessment:

Answer 3

1. Child found near source of poison
2. Gastrointestinal disturbance: nausea, abdominal pain, diarrhea, vomiting
3. Burns of mouth, pharynx
4. Respiratory distress
5. Seizure, changes in level of consciousness
6. Cyanosis
7. Shock

Question 4

Nursing Diagnosis

Answer 4

Risk for poisoning related to …..

Deficient knowledge (home safety) related to…..

Question 5

Nursing interventions

Answer 5

1. Identify the poisonous agent quickly!
2. Assess the child’s respiratory, cardiac, and neurologic status
3. Instruct parent to bring any emesis, stool, etc. to the emergency department
4. Determine the child’s age and weight

Question 6

Teach parents that it is not recommended to induce vomiting in any way because it may cause more damage.

Answer 6

Use of syrup of ipecac is no longer recommended.

Question 7

LEAD POISONING

It is estimated that 2.2% of children under 6 years of age living in the United States have blood levels greater than 10 mcg/dl

Answer 7

Children 6 years of age and younger are most vulnerable to the effects of lead

Question 8

Although numerous sources of lead can result in exposure in young children, the major cause of lead poisoning is deteriorating lead-based paint

Answer 8

Lead enters the body through ingestion, inhalation, or I the case of an unborn child, placental transfer when the mother is exposed.

The most common route is ingestion either from hand-to-mouth behavior via contaminated hands, fingers, toys, or pacifiers.

Or eating sweet-tasting loose paint chips found in a home built before 1950’s or in a play area.

Question 9

Lead can affect any part of the body, but the renal, neurologic, and hematologic systems are the most seriously affected.

Answer 9

The blood lead level (BLL) test is currently used for screening and diagnosis.

Erythrocyte protoporphyrin (EP) test is a good indicator of early toxic effects of lead) and remains useful as a clinical tool, along with the BLL test, to help estimate the potential body burden of lead in a child.

Question 10

Nursing Assessment:

Answer 10

Screen for lead poisoning using CDC guidelines of blood lead surveillance and other risk factor data collected over time to establish the status and risk of children throughout the state.

Question 11

Nursing Assessment:

In areas without available data, universal screening is recommended.

Answer 11

A. All children should have a BlL test at the ages of 1 and 2 years

B. Collect blood in a capillary tube, and send to the lab

C. During collections, avoid contamination of the blood specimen and lead on the skin.

Question 12

Nursing Assessment:

Any child between 3 and 6 years of age who has not been screened should also be tested.

Answer 12

Obtain a history of possible sources of lead in the child’s environment.

Do a physical assessment

Question 13

Physical Assessment:

General signs:

Answer 13

Anemia
Acute crampy abdominal pain
Vomiting
Constipation
Anorexia
Headache
Lethargy
Impaired growth

Question 14

Physical Assessment:

Central nervous system signs (Early)

Answer 14

Hyperactivity
Aggression
Impulsiveness
Decreased interest in play
Irritability
Short attention span

Question 15

Physical Assessment:

Central nervous system signs (Late)

Answer 15

Mental retardation
Paralysis
Blindness
Convulsions
Coma
Death

Question 16

Nursing Diagnosis For lead poisoning:

Answer 16

Risk for poisoning related to sources of lead in the environment

Interrupted family processes related to child’s access to lead in the environment

Risk for injury related to ingested or inhaled lead

Question 17

Nursing Interventions For Lead Poisoning:

Answer 17

Identify sources of lead in the environment

Assist family to obtain sources of help for removing lead from the environment

Do not vacuum hard-surfaced floors or windowsills or window wells in homes built before 1960, because this spreads dust

Wash and dry child’s hands and face frequently, esp. before eating

Wash toys and pacifiers frequently

Make sure that home exposure is not occurring from parental occupations or hobbies

More lead is absorbed on an empty stomach.

Hot water can contain higher levels of lead because it dissolves lead more quickly than cold water; so use only cold water for consumption (drinking, cooking, and esp. for making infant formula)

Question 18

Acetaminophen Poisoning

Answer 18

Most common accidental drug poisoning in children

Question 19

Acetaminophen Poisoning

Answer 19

Toxic dose is 150mg/kg or greater in children

Question 20

Acetaminophen Poisoning

Answer 20

Multiple formulation and concentrations make chronic acetaminophen toxicity a significant problem

Question 21

Acetaminophen Poisoning

Initial period: 2 – 4 hrs after ingestion

Answer 21

Nausea, Vomiting, Sweating, Pallor

Question 22

Acetaminophen Poisoning

Latent period (24 – 36 hours)

Answer 22

Patient improves

Question 23

Acetaminophen Poisoning

Hepatic involvement ( may last up to 7 days and be permanent)

Answer 23

Pain in RUQ, 
Jaundice, 
Confusion, 
Stupor, 
Coagulation abnormalities

Death in the hepatic stage or gradual recovery

Question 24

Acetaminophen Poisoning Treatment:

Answer 24

Antidote N-acetylcysteine (Mucomyst) can usually be given orally

Dilute with fruit juice or soda

Give loading dose, then 17 maintenance doses