Unit 3: Poisoning Flashcards
Poison
- any substance that is harmful to the body when ingested, inhaled, injected, or absorbed through the skin
- too much of any substance can be poisonous
- unintentional or intentional
Unintentional Poisioning
-if the person taking or giving a substance did not mean to cause harm
Examples of Unintentional Poisonings
- the excessive use of drugs or chemicals for recreational purposes
- accidental exposure to drugs or chemicals for nonrecreational purposes such as a child ingesting cleaning fluid
Intentional Poisoning
-the substance is given or taken with the intention of causing harm
Example of Intentional Poisoning
- can be done with the aim to commit a crime
- goal of committing suicide
The most common poison exposures
-Analgesics
-Cleaning substances
-Cosmetics
-Foreign bodies
-Plants
-Sedative-hypnotics and Anti-psychotics
-Cough and cold preparations
-
Most commonly used drugs resulting in overdose
> Opioids
-heroin, oxycodone, methadone, hydrocodone, and fentanyl
> Benzodiazepines
-alprazolam and diazepam
> Stimulants
-cocaine, methamphetamine
Common Poisoning Agents
- Salicylates
- Acetaminophen
- Sedatives/Hypnotics, barbiturates, benzodiazepines
- Anti-depressants
- Cardiovascular medications (beta blockers)
- Alcohol
Salicylates Poisoning
- includes aspirin or aspirin-containing compounds such as Pepto-Bismol, Kaopectate, Maalox, and some topical creams
- risk factors for salicylate poisoning: accidental ingestion by young children, chronic exposure seen with adults older than 70, dehydration, renal disease resulting in decreased renal clearance, and disorders or conditions associated with increased bleeding risk such as alcoholism, ulcers, and use of anticoagulants, and concomitant use of other NSAIDs like ibuprofen
Acetaminophen Poisoning
- acetaminophen toxicity result of unintentional or intentional poisoning
- Intentional: suicide attempy
- Unintentional: unfamiloiar w/ appropriate dosing, unknowingly takes two or more medications that contain acetaminophen at the same time
- patients with chronic liver disease are predisposed to acetaminophen toxicity b/c of the impaired ability of the liver to metabolize the medication
- acetaminophen overdose can result in liver damage
Sedatives-hypnotics Poisoning
- barbiturates and benzodiazepines are central nervous system depressants
- most sedative-hypnotic poisonings are suicide based
- Risk factors for toxicity: present or hx of alcohol or drug abuse, emphysema, asthma, bronchitis or other lung disease, mental depression, sleep apnea, kidney or liver disease, and elderly age
Anti-depressant Poisoning
- seen in young
- overdose of SSRIs; can be fatal
Cardiovascular Medication Poisoning
- beta blockers
- seen in children and adults
- children, toxicity occurs though accidental exposure to adults unsecured medications
- adults is intentional
Risk Factors for Alcohol Toxicity
- small child can get a lethal dose by drinking a very small amount
- young people, teenagers, or college students binge drink
- occurs frequently in males
- small, thin people more vulnerable to the effects of alcohol b/c the body absorbs the alcohol more rapidly
- chronic health conditions make a person more vulnerable to life-threatening symptoms of alcohol toxicity
- diabetes mellitus may cause a person to experience dangerously low blood sugar levels during and after ingesting alcohol
- combination of alcohol and medications increase risk for fatal alcohol overdose
Decontamination
- process of removing or neutralizing a substance to decrease absorption
- regardless of the poison, decontamination is the first step in treating the patient
- common form: gastrointestinal (GI) decontamination
- other types: flushing the exposed body area or eyes with water to remove or neutralize the substance
Nursing Management: Assessment and Analysis
- general appearance and clinical manifestations seen w/ poisoning are r/t the specific substance, type and amount of exposure, and complicating comorbidities
- LOC changes (drowsiness, sedation, euphoria, impaired memory and judgment, changes in speech patterns, ataxia, or depression) may be present w/ barbiturates or alcohol poisoning b/c of CNS depression
- Tachypnea, crackles on auscultation, and respiratory distress may be seen with salicylate poisonings b/c of the body’s attempt to compensate for the decrease in cellular respiration and the increased O2 consumption, which causes respiratory alkalosis
- tachycardia and/or hypotension may be present in any type of poisoning that results in excessive vomiting, diarrhea, or blood loss d/t bleeding
- prolonged QTs or cardiac dysrhythmias may be seen in overdose of tricyclics and cardiovascular medications
Clinical Manifestations presented w/ overdose of barbiturates and alcohol
>Level of consciousness changes -drowsiness -sedation -euphoria -impaired memory and judgment -changes in speech pattern -ataxia -depression >B/C of Central nervous system depression
Nursing Diagnoses
- Risk for ineffective airway clearance
- Ineffective breathing patterns
- Impaired gas exchange
- Risk for aspiration
-Nursing Assessments for Poisoning
- Vital Signs
- Pulse Oximetry
- Neurological Assessment
- Continuous Cardiac Monitoring
- Lab assessment: Toxicology screen (serum and urine), ABGs, Potassium, Serum glucose, Urine pH, CBC/clotting studies, Liver function tests, and repeat urine and serum medication levels)
Assessments: Vital Signs
- hypotension and tachycardia as a result of volume loss from vomiting and diarrhea
- over dose of beta blockers that affect the heart by controlling the rate or intensity of cardiac contractions, blood vessel diameter, or blood volume may result in hypotension and bradycardia
Assessment: Pulse Oximetry
-poisoning agents result in decreased level of consciousness, potentially resulting in respiratory depression and hypoxia
Assessment: Neurological Assessment
-many types of poisoning cause a decreased level of consciousness, confusion, delirium, or seizures
Assessment: Continuous Cardiac Monitoring
- antidepressants and cardiovascular medications (beta blockers) can cause dangerous dysrhythmias and bradycardia
- Alkalization therapy for salicylate poisoning may deplete potassium, increasing potential for cardiac dysrhythmias
Assessment: Toxicology screen (serum and urine)
-essential in determining the type and amount of poison in the patient
Assessment: Arterial Blood Gases (ABGs)
- Salicylate levels greater than 35 mg/dL cause increases in rate and depth of respirations, resulting in respiratory alkalosis
- Salicylates enter cells disrupting mitochondrial function, causing a metabolic acidosis
Assessment: Serum potassium
-alkalization therapy for salicylate poisoning may deplete postassium
Assessment: Serum Glucose
- hypoglycemia must be ruled out as a cause of decreased LOC
- with increased cellular metabolism in salicylate poisoning, patient may develop hypoglycemia
Assessments: Urine pH
-making the pH of the urine more alkaline increases the clearance of acid-type medications such as salicylates
Assessments: Complete blood count/Clotting Studies
-salicylate poisoning impairs blood clotting and platelet dysfunction and may result in bleeding
Assessment: Liver Function Tests
-acetaminophen overdoses lead to impaired liver function, resulting in elevated liver enzymes
Assessment: Repeat Urine and Serum medication levels
-to assess level of medication or alcohol in the system and assess adequacy of treatment
Nursing Actions
- Airway management, including supplemental O2 and preparations for intubation
- Establish IV access
- ECG
- Administer medications as ordered: IV fluids w/ thiamine, Benzodiazepines, Flumazenil, Sodium Bicarbonate, N-acetylcysteine, Activated charcoal, Glucagon
- Prepare for decontamination through GI, ocular, or dermal irrigation or flushing
Actions: Establish IV access
to facilitate fluid and medication administration for the treatment of overdose
Actions: ECG
to assess for cardiac conduction abnormalities d/t poisoning or potassium depletion
Actions: IV fluids w/ thiamine
-alcoholics are prone to thiamine depletion, making them susceptible to Wernicke-Korsakoff syndrome, which may cause seizures
Actions: Administer Benzodiazepines
for tricyclic or alcohol withdrawal-induced seizures
Actions: Administer Flumazenil
antidote for benzodiazepine overdose
Antidote for Benzodiazepine overdose?
Flumazenil
Actions: Administer Sodium Bicarbonate
-to increase urine pH (alkalize urine) causing alkaline diuresis, increases clearance of acid-type medications such as salicylates
Actions: Administer N-acetylcysteine
an amino acid is given by mouth or IV to prevent or minimize hepatotoxicity w/ acetaminophen toxicity
Actions: Administer activated charcoal
decontamination agent that works by binding the poison, preventing or slowing absorption into the system
Actions: Administer Glucagon
administered for beta blocker toxicity; enhances myocardial contractility and heart rate
Antidote for Beta Blocker Toxicity
Glucagon
-enhances myocardial contractility and heart rate
Nursing Teachings
- Careful use of OTC medications; read labels, be aware of maximum daily doses
- Review early signs of toxicity or overdose w/ patients/family
- Review dangers of alcohol and/or sedative abuse as well as dangers of abrupt withdrawal
- Precaution in the use of aspirin w/ children suffering a viral disorder; aspirin linked with Reye’s syndrome resulting in neurological nd hepatic changes
Evaluating Care Outcomes
- poisoning may be managed w/ prompt recognition and treatment
- well-managed patient is discharged w/ adequate respiratory effort and is hemodynamically stable, understanding the cause and future risk of poisoning
- if poisoning intentional, patient is discharged to a psychiatric facility for tx in hopes of preventing further suicide attempts
Connection Check: The nurse is caring for a patient coming into the ED unconscious after taking an overdose of an unknown substance approximately 1 hour ago. Which of the following actions should the nurse take first? A. initiate gastric lavage B. Insert two-large bore IVs C. Assess vital signs and pulse oximetry D. Insert Nasogastric tube
C. Assess vital signs an pulse oximetry
