Poisoning, particularly by ingestion, is common cause of childhood injury and illness
Most poisonings occur in children under the age of 6, with a peak at age 2
The exploratory behavior, curiosity, and oral-motor activity of early childhood place the hild at risk for poisonings.
About 90% of poisonings occur in the home
- Child found near source of poison
- Gastrointestinal disturbance: nausea, abdominal pain, diarrhea, vomiting
- Burns of mouth, pharynx
- Respiratory distress
- Seizure, changes in level of consciousness
Risk for poisoning related to …..
Deficient knowledge (home safety) related to…..
- Identify the poisonous agent quickly!
- Assess the child’s respiratory, cardiac, and neurologic status
- Instruct parent to bring any emesis, stool, etc. to the emergency department
- Determine the child’s age and weight
Teach parents that it is not recommended to induce vomiting in any way because it may cause more damage.
Use of syrup of ipecac is no longer recommended.
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
Children 6 years of age and younger are most vulnerable to the effects of lead
Although numerous sources of lead can result in exposure in young children, the major cause of lead poisoning is deteriorating lead-based paint
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.
Lead can affect any part of the body, but the renal, neurologic, and hematologic systems are the most seriously affected.
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.
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.
In areas without available data, universal screening is recommended.
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.
Any child between 3 and 6 years of age who has not been screened should also be tested.
Obtain a history of possible sources of lead in the child’s environment.
Do a physical assessment
Anemia Acute crampy abdominal pain Vomiting Constipation Anorexia Headache Lethargy Impaired growth
Central nervous system signs (Early)
Hyperactivity Aggression Impulsiveness Decreased interest in play Irritability Short attention span
Central nervous system signs (Late)
Mental retardation Paralysis Blindness Convulsions Coma Death
Nursing Diagnosis For lead poisoning:
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
Nursing Interventions For Lead Poisoning:
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)
Most common accidental drug poisoning in children
Toxic dose is 150mg/kg or greater in children
Multiple formulation and concentrations make chronic acetaminophen toxicity a significant problem
Initial period: 2 – 4 hrs after ingestion
Nausea, Vomiting, Sweating, Pallor
Latent period (24 – 36 hours)
Hepatic involvement ( may last up to 7 days and be permanent)
Pain in RUQ, Jaundice, Confusion, Stupor, Coagulation abnormalities
Death in the hepatic stage or gradual recovery
Acetaminophen Poisoning Treatment:
Antidote N-acetylcysteine (Mucomyst) can usually be given orally
Dilute with fruit juice or soda
Give loading dose, then 17 maintenance doses