TLO 2.6b Environmental safety, child Flashcards
Developmental stages: birth to 4 mo
Able to grasp objects
Starting to roll over
Developmental stages: 4-7 mo
Rolls over Sits Crawls Oral fixation Good eye hand coordination
Developmental stages: 8mo-1 yr
Stands Walks Climbs Pulls and throws objects Good pincer grasp Explores
Developmental stages: toddlers, 12-36 mo
Walk alone by 12-13 mo Running by 18 mo, but falls easily 2-3yr can walk up and down stairs 2.5 yr can jump using both feet, stand on one foot and tiptoe Climb steps with alternating feet
Developmental stages: preschooler, 3-5 yr
Rides tricycle
by age 5 can swim, skate and jump rope
Developmental stages: school age, 6-12 yr
Become involved in complex social and motor behaviors
Developmental stages: adolescent, 12-20yr
Begins with appearance of secondary sex characteristics until cessation (ending) of body growth
Driving vehicle, motorcycles
Less parental supervision
Experiment with alcohol, drugs, risky behaviors
Daredevils
What injury’s prevention education is needed for parents?
Aspiration Burns Suffocation/drowning Motor vehicles Falls Poisonings Bodily damage
Infant aspiration of foreign objects?
Leading cause of injuries under 1 year. Objects <1.25” completely obstruct the airway
Inspect toys for danger and keep out of reach
Food items: hot dogs, hard candy, nuts, grapes
Pacifiers: nipple separate from holder
Baby powder: severe/fatal aspiration pneumonia
Balloons
Crib linens and pillows
Suffocation:
wedging between a bed/crib and wall
crib slats <6” apart
Oronasal obstruction by a plastic bag
Birth to 4mo prevention of aspiration/strangulation
Never prop a bottle for feeding, hold infant
Know CPR, chocking procedures
Use 1 piece pacifiers
Never shake baby powder or let infant play with bottle
Suffocation:
no latex balloons
no crib toys strung across bed/playpen
remove blankets from face when in car seat
Age 4-7 mo prevention of aspiration/strangulation
Keep all small objects out of reach (buttons/beads)
No food that could block airway (hot dogs, seeds, candy)
Teething biscuits with caution
Know poison control 800-222-1222
Suffocation:
no latex balloons
no crib toys strung across bed/playpen
remove blankets from face when in car seat
Age 8-12 mo prevention of aspiration/strangulation
No small objects on floor or within reach
Solid food must be cut small and fed in small amounts
No plastic bags
No toys with strings
Toddler prevention of aspiration/strangulation
Toddlers
Avoid large chucks of meat, no whole hot dogs
No fruit with pits
No fish with bones
No dried beans, hard candy, gum, nuts, popcorn, grapes or marshmallows
No small toys
Remove drawstring from clothes
Infants and motor vehicle injury prevention
Transport in approved, rear facing seat in back seat
-from birth to 20lbs or as close to 1 year as possible
-middle of back seat reduces risk of injury by 43%
-5 pt harness restraint system is safest
-head roll to support infants head
-teach how to properly restrain in car seat
Auto related hyperthermia
-heat of 80 degrees outside can quickly reach 109 degrees inside care
-at 107 degrees, brain cells are damaged and internal organs shut down leading to death
Toddler motor vehicle injury prevention
Toddler
Safety seat position upright and facing forward >20lbs/1yr old
Place in safety seat until 30-40lbs, 5 pt harness restrain system
Preschool and school age motor vehicle injury prevention
Preschool/school age
Booster seats for child <4’ 9” and weigh 35-80lbs (usually between 4-8 yr)
Specially designed car restrains until 8-12 yr
Supervise at all times
-child over 3 yrs involved in pedestrian injuries, run into traffic
-motor vehicle back over child
-never allow a child to play in a car
Adolescent motor vehicle injury prevention
Provide competent drivers education; insist on safety belt use
Teach safe pedestrian behaviors, walk with friends, if followed go to nearest people, do not walk in secluded areas
Reinforce dangers of alcohol and drugs while driving
No texting/cell phones when driving
Poisoning
Major cause of death in children <5yr
The average home contains >500 toxic substances
1/3 of poisoning occur in the kitchen
Type of poisons?
Corrosives Hydrocarbons Acetaminophen Salicylate Iron Plants
Corrosives
What are they?
Assessment?
Treatment?
Drain, toilet, oven cleaners Denture cleaners Bleach Assessment: severe burning pain in mouth, throat, stomach swollen mucous membranes of mouth, lips, tongue, pharynx vomiting drooling and inability to clear secretions shock anxiety and agitation Treatment: assess breath, LOC call poison control do not induce vomiting dilute with water or milk (<4 oz.) maintain patent airway NPO
Hydrocarbons
What are they?
Assessment?
Treatment?
Gasoline Kerosene Lighter fluid Turpentine/paint thinner Mineral seal oil (furniture polish) Assessment: gaging, chocking, coughing, N/V, lethargy, weakness respiratory symptoms: tachy, cyanosis, retractions, grunting can cause severe pneumonia Treatment: Poison control Do not induce vomiting Symptomatic treatment of chemical pneumonia
Acetaminophen
What are they?
Assessment?
Treatment?
Acetaminophen: inhibits synthesis of prostaglandins
Most common drug poisoning
Toxic dose 150mg/kg or greater
Assessment: 4 stages
Initial 2-4 hr: N/V, sweating, pallor
Latent period: 24-36 hour, patient improves
Hepatic involvement: lasts up to 7 days and be permanent: pain in right upper quad, jaundice, confusion, stupor, coagulation abnormalities
patient who do not die in hepatic stage gradually recover
Treatment:
Antidote, N-acetylcysteine (Mucomyst)- decreases buildup of hepatotoxic metabolites. Prevention of lessening of liver damage. Need STAT
Can be given orally. Diluted in juice or soda due to foul odor of rotten eggs
I loading does and up to 17 maintenance doses
May be given IV
Aspirin
What is it?
Assessment?
Aspirin (acetylsalicylic acid)- platelet aggregation inhibitor
Assessment:
Acute poisoning, severe toxicity (200-280mg/kg):
N/V, disorientation, dehydration, diaphoresis, hyperpnea, hyperpyrexia, oliguria, tinnitus, coma, convulsions
Chronic poisoning, >100 mg/kg/day for 2+ day, chronic can be more serious
Same as acute but subtle onset, like viral illness.
Dehydration, coma, seizures, bleeding tendencies
Aspirin treatment?
Hospitalization required for severe toxicity
NO Ipecac (vomiting inducing liquid), contraindicated
Lavage may be effective within the first hour of ingestion: serious complications (GI perforation, hypoxia, aspiration)
Activated charcoal, important to give early, GI decontamination, absorbs toxins
Cathartic (sorbitol, sodium or magnesium)
External cooling for hyperpyrexia
Anticonvulsants
Oxygen and ventilation for resp depression
Vitamin K for bleeding
Hemodialysis
Monitor labs: liver, renal, CBC, clotting times, drug levels
Iron
5 stages?
Iron: mineral supplement or vitamin with iron
Ingestion of 60 mg/kg is dangerous
5 stages
Initial period: 1/2 to 6 hr: vomiting, hematemesis (vomiting blood), diarrhea, hematochezia (bloody stools), gastric pain (toxicity not likely if no GI symptoms w/in 6 hr)
Latency: 2-12 hr: patient improves
Metabolic acidosis: fever, hyperglycemia, bleeding, shock, death may occur
Hepatic injury: 48-96 hr: seizures, coma
Pyloric stenosis: rarely occurs, develops at 2-5 wk
Plant poisoning
Assessment?
Treatment?
Plants
May cause local irritation of oropharynx and entire GI tract
May cause respiratory, renal and CNS symptoms
Dermatitis with local reaction, poison ivy
Treatment: Poison control Induce vomiting Wash skin or eyes Supportive care
Burns: causes and prevention
Significant causes in infants -scalding water -excessive sunburn -burns from house fire, electrical wires, sockets, heating elements (radiators, registers, floor furnaces) Prevention: -smoke detectors -hot water temp <120 degrees -check bath water -microwave heating, check temp -avoid direct sun for first 6 mo -keep electrical outlet covered -never hold child while smoking, drinking hot beverage
Burn treatment
Minor burns:
1st and 2nd burns, no longer than 3”
cool burns, running cool water for 10-15 min
bandage keeps air off burn, reduces pain, protects blistered skin
Caution:
NO ICE
No egg whites, butter or ointments
Don’t break blister
First aid care of burns
Minor burns:
apply cool water, do not disturb blister, do not apply anything to wound, cover with clean cloth
Major burns:
stop the burning process, assess for airway, removed burned clothing or jewelry, cover wound, keep victim warm, transport to hospital
Drowning safety and prevention
Drowning can occur in 1-2” of water
Infants <1 yr drown in toilets, bathtubs, buckets
Organized swimming instruction is not recommended for children <4 may lead to false sense of security.
Infant/toddlers are also at increased risk of seizures and infection from swallowing large amounts of water
Prevention:
Supervised at all times in or around water
Life jackets
Locked fencing
Pool owners are required to have fencing and locked gates per city code
Bodily injury causes
Sharp, jagged edged objects Long pointed articles Small article can be in nose/ear Excessive noise from toys resulting in sensorineural hearing loss High rate of battering injury to infants 0-5mo (child abuse?) Animal attacks Stranger education Homicide Hand hygiene for infection prevention
Bodily injury prevention
Store sharp, pointed articles away from children No forks until 18 mo Avoid noise producing toys Constant supervision of child and pets Awareness of shaken baby syndrome
Lead poisoning sources
Lead does not decompose
Sources:
Old paint and soil near heavily trafficked areas is tracked into home
Hand to mouth activities, inhalation, ingestion
Water and food
Cosmetics, pottery, hobbies, occupations of adult may contribute
Lead poisoning pathophysiology
Toxic levels: concerned with BLL of 5 mcg/dl (blood levels for screening)
Can affect any part of body, renal, hematologic, neurologic
Developing brain and nervous system is of most concern, permanent damage
settle in bones and teeth and is stored (75-90%)
***Competes with calcium and iron absorption
Children with iron deficiency absorb lead more readily
Lead poisoning symptoms, prevention, treatment?
Symptoms: rarely have symptoms, N/V, constipation, anorexia, abdominal pain
Prevention/treatment: screening at 1 and 2 yr, provide family with education
Chelation therapy: removes lead from circulation blood, tissues and organs
Calcium disodium edetate (Calcium EDTA) and succimer acid. Many treatments may be necessary to stabilize blood lead levels
Can lead to hypocalcemia and death
Must have adequate intake and urine output
Monitor renal, hepatic, hematologic
