Ch 14 Early Childhood Health Problems
Terms in this set (61)
When do 49% of ingestion accidents occur?
younger than 6
Why are infants and toddlers more prone to ingestion?
because they explore through oral experimentation and they don't have a mature sense of taste
If you believe your child has ingested a harmful substance...
call poison control first!
What do you do after poison control?
Assess - treat child not poison
How do you assess the child suspected of ingestion?
look at vitals, mental status, ABCs and then establish vascular access
How does ipecac work?
emetic that works by irritating the gastric mucosa and stimulates the vomiting center
True or False:
Ipecac is not recommended for at home use
odorless, tasteless, fine black powder that absorbs any compounds and creates a stable complex (less common now).
- have to administer within 1 hour of ingestion to work
If kid won't drink the activated charcoal, what can you do?
mix it with chocolate milk or fruit syrup
Four potential complications to monitor for on a person taking activated charcoal
vomiting and possible aspiration, constipation, intestinal obstruction
Why isn't gastric lavage used that often?
Associated with serious complications --> gastrointestinal perforation, hypoxia, aspiration
When must you do gastric lavage for it to be effective?
within 1 hour of ingestion
When would gastric lavage be used?
if a sustained release was used or it was life threatening
Nursing actions when using gastric lavage
patient might be sedated.
What size tube is used for gastric lavage?
-N-acetylcysteine for acetaminophen poisoning.
-Oxygen for carbon monoxide inhalation.
-Naloxone for opioid overdose.
-Flumazenil for benzodiazepines.
-Digibind for digoxin.
-Amyl nitrate for cyanide.
-Antivenin for certain poisonous bites.
Which methods have been the most successful in preventing poisonings?
passive methods such as child-resistant caps and less tablets in a container
What is the most common accidental drug poisoning in children?
Steps for emergency treatment
2. terminate exposure.
3. identify poison.
4. prevent poison absorption.
If the child has been poisoned and has a traumatic injury, which takes priority?
If the poison is topical, what do you do to terminate exposure?
rinse all body surfaces with warm water or saline
How do you prevent poison absorption?
Place the child in a side-lying, sitting, or kneeling position with the head below the chest to prevent aspiration.
What do you do for aspirin overdose?
How often do you give activated charcoal?
every 4 hours if bowel sounds are present
How can lead be introduced into the body?
inhaled (paint chips in the air) or ingested (hand to mouth behavior of toddlers)
Which systems are most affected by lead?
hematologic, renal, neurologic
What is the patho for lead poisoning?
lead settles in bones and teeth and competes with calcium. It also can enter the brain and alter neurotransmitter activity.
Which condition has lead toxicity been linked to?
anemia - because lead interferes with the binding of iron to the heme molecule
Clinical manifestations of lead poisoning include...
nausea, vomiting, constipation, anorexia, and abdominal pain. Additional clinical manifestations are hypophosphatemia, glycosuria, and aminoaciduria
Chronic lead toxicity can affect...
growth and reproductive system
Mercury thermometers are no longer recommended because if they are broken, the inhaled vapors can cause toxicity. To prevent inhalation, clean up spilled mercury quickly, using disposable towels and rubber gloves, and wash hands well afterward.
What is a classic sign of mercury poisoning?
acrodynia (painful extremities)
How do you treat mercury poisoning?
True or False:
Lead poisoning is rarely symptomatic
Which chelation agents could be used for lead poisoning?
calcium disodium edetate.
What organ should you be monitoring during chelation therapy?
the kidneys because they excrete everything. Watch I&Os and ensure adequate hydration
Use extreme caution with chelating agents. Incidences of child death from hypocalcemia have been recorded when Na2EDTA (edetate sodium, Endrate) was substituted for CaNa2EDTA (calcium disodium edetate) and used as a chelating agent
Adequate urinary output must be ensured with administration of calcium EDTA. Children receiving the drug intramuscularly must be able to maintain adequate oral intake of fluids.
What are the most serious consequences of lead poisoning?
lead encephalopathy, permanent brain damage, behavioral changes, seizures, paralysis
True or False:
Chelation IM shots are relatively painless
They are very painful. Give local anesthetic first
What is the most common form of maltreatment?
the failure of a parent or guardian to provide for the child's basic needs and an adequate level of care
What are the three types of neglect?
physical, emotional, psychological
What is the difference between emotional neglect and emotional abuse?
neglect is a lack of affection, attention, etc, whereas abuse is a deliberate attempt to destroy or impair a child's self-esteem
What causes abusive head trauma?
caused by violently shaking of infants and young children.
What happens when they are shaken?
Brain rotates within the skull --> shearing forces tear blood vessels and neurons --> intracranial bleeding and bilateral retinal hemorrhages
Stress to parents the danger of shaking infants (shaking can cause AHT). Education must include coping mechanisms on caring for children with inconsolable crying
What are some of the signs of abusive head trauma?
Some symptoms associated with physical abuse are...
Severe symptoms of physical abuse are...
seizures, posturing, alterations in LOC, apnea, bradycardia, and death
If physical abuse continues, what are some of the long-term effects?
seizure disorders, visual impairments, developmental delays, hearing loss, cerebral palsy, mild to profound mental/cognitive impairments
Munchausen Syndrome by Proxy (facticious disorder by proxy)
Caregiver fabricates signs and symptoms of illness in child (the proxy) to gain attention from medical staff
Common symptoms reported for facticious by proxy are...
seizures, nausea and vomiting, diarrhea; and altered mental status; usually only witnessed by the perpetrator
Who is at highest risk for being abused?
children under 1, children with disabilities and premature infants
Incompatibility between the history and the injury is probably the most impor- tant criterion on which to base the decision to report suspected abuse
the use, persuasion, or coercion of any child to engage in sexually explicit conduct (or any simulation of such conduct) or producing visual depiction of such conduct, or rape, molestation, prostitution, or incest with children
What is the "typical" abuser?
male that the victim knows
True or False:
There must be blood relation to be considered incest
When should you do forensic testing on an abused child?
if it happened within 72-96 hours
When children report potentially sexually abusive experiences, take their reports seriously, but also cautiously to avoid alarming the child or falsely accusing someone
The priority is to remove the child from the abusive situation to prevent further injury