Ch. 42: Pediatric Emergencies-Poisoning

Question 1

What age is a risk factor for poisoning?

Answer 1

Younger than 6

Question 2

What are examples of some other risk factors for poisoning?

Answer 2

• 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

Question 3

What are the symptoms of acetaminophen (tylenol) poisoning 2-4 hours after ingestion?

Answer 3

N/V
Sweating
Pallor

Question 4

What are the symptoms of acetaminophen (tylenol) poisoning 24-36 hours after ingestion?

Answer 4

Improvement in the child’s condition

Question 5

What are the symptoms of acetaminophen (tylenol) poisoning 36 hours-7 days or longer after ingestion?

Answer 5

This is the hepatic stage!!!

• Pain in RUQ
• Confusion
• Stupor
• Jaundice
• Coagulation disturbances

Question 6

What is the final stage to acetaminophen poisoning (like was never treated)?

Answer 6

Death or gradual recovery

Question 7

What are acute poisoning signs for acetylsalicylic acid (aspirin)?

Answer 7

N.V
Disorientation
Diaphoresis
Tachypnea
Tinnitus
Oliguria
Lightheadedness
Seizures

Question 8

What are chronic poisoning signs for acetylsalicylic acid (aspirin)?

Answer 8

Subtle version of acute manifestations
Bleeding tendencies
Dehydration
Seizures (more severe though compared to acute poisoning seizures)

Question 9

What are the 4 poisoning periods for a child who got poisoned with supplemental iron?

Answer 9

1. Initial period
2. Latency period
3. Systemic toxicity period
4. Hepatic injury period

Question 10

When and what happens in the initial period of iron poisoning?

Answer 10

Initial: 30 min-6 hr after ingestion

Vomiting
Hematemesis
Diarrhea
Gastric pain
Bloody stool

Question 11

When and what happens during the latency period of iron poisoning?

Answer 11

Latency: 2-12 hours after ingestion

Improvement in condition

Question 12

When and what happens during the systemic toxicity period of iron poisoning?

Answer 12

Systemic toxicity: 4-24 hours after ingestion

METABOLIC ACIDOSIS
HYPERglycemia
Bleeding
Fever
Shock
Possible death

Question 13

When and what happens in the hepatic injury of iron poisoning?

Answer 13

Hepatic injury: 48-96 hours after ingestion

Seizures or coma

Question 14

What are hydrocarbons?

Answer 14

Gasoline, kerosene, lighter fluid, paint thinner, turpentine

Question 15

What are some objective data signs of ingesting hydrocarbons?

Answer 15

Gagging, choking, coughing, N.V

Lethargy, weakness, tachypnea, cyanosis, grunting, retractions

Question 16

What are corrosives?

Answer 16

Household cleaners, batteries, denture cleaners, bleach

Question 17

What are some objective data signs of ingesting corrosives?

Answer 17

• Pain in burning in mouth, throat, and stomach
• Edematous lops, tongue, and pharynx with WHITE mucous
• VIOLENTLY vomiting with hemoptysis
• Drooling, anxiety, shock

Question 18

What are low-dose exposure signs of lead poisoning?

Answer 18

Easily distracted
Impulsive
HYPERactive
Hearing impairment
Mild intellectual difficulty

Question 19

What are high-dose exposure signs of lead poisoning?

Answer 19

Cognitive delays varying in severity
Blindness
Paralysis
Coma, seizures, death

Question 20

What are other manifestations seen with lead poisoning?

Answer 20

KIDNEY impairment
Impaired CALCIUM function
Anemia

Question 21

What is the intervention for acetaminophen poison?

Answer 21

N-acetylcysteine (Mucomyst) –given PO

Question 22

What are some interventions for acetylsalicylic acid (aspirin) poisoning?

Answer 22

Activated charcoal
Gastric lavage
Sodium bicarbonate
Oxygen and ventilation
Vit. K
Hemodialysis (for severe cases)

Question 23

What are some interventions for supplemental iron poisoning?

Answer 23

Emesis or lavage

Chelation therapy using deferoxamine mesylate

Question 24

Is it okay to induce vomiting if the child is in for ingesting a hydrocarbon?

Answer 24

NO DO NOT INDUCE VOMITING

Question 25

Since we can't induce vomiting for hydrocarbon poisoning, what do we do?

Answer 25

Intubation with cuffed endotracheal tube is done prior to decontamination--treatment of chemical pneumonia

Question 26

What are the nursing interventions for treatment of a child who ingested a corrosive?

Answer 26

``` Airway maintenance NPO No attempt to neutralize the acid Don't induce vomiting Analgesics for pain ```

Question 27

What is the intervention used for lead poisoning?

Answer 27

Chelation therapy using calcium EDTA

Question 28

What 2 poisons do we NOT induce vomiting?

Answer 28

Hydrocarbon and corrosive poisoning

Question 29

What are some poison prevention methods?

Answer 29

- 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

Question 30

Who do we do routine screenings for lead levels--like what age?

Answer 30

1, 2, and 3 years of age this is done

Question 31

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"

Answer 31

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

Question 32

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

Answer 32

C A. Inducing vomiting= CONTRAININDICATED B. Activated charcoal is for aspirin poisoning C. CORRECT! D. Chelation therapy= lead poisoning treatment