Which steps would the nurse take for managing an adolescent who sustained drug poisoning
See also:Poisoning – acute guidelines for initial management Show
Key points
For 24 hour advice, contact the Poisons Information Centre 13 11 26 Background
Children requiring assessment
Risk assessmentHistoryIntentional overdose or accidental Dose: Stated or likely dose taken Consider the possibility of co-ingestions, either accidental or deliberate Examination
Investigations
Acute Management
Single
acute paracetamol ingestion Nomogram for acute single dose paracetamol poisoning Multiple supratherapeutic paracetamol ingestion Sustained Release Paracetamol
Sustained release paracetamol ingestion
N-Acetyl cysteine (NAC) infusion instructions
Dose calculated based on actual body weight. For patients >110 kg, calculate the dose based on 110 kg body weight. NAC may be diluted in 5% glucose or 0.9% sodium chloride (normal saline). It can also be diluted in combination glucose-sodium chloride solutions not exceeding these concentrations including 0.45% sodium chloride in 5% glucose, and 0.9% sodium chloride in 5% glucose. The volume and choice of fluid for each stage of the infusion needs to be appropriate for the age and weight of the child and clinical circumstances. In the adolescent patient, it is generally appropriate to follow the standard published recommendations for NAC administration. The volume of NAC needs to be included in the TOTAL volume of the infusion to avoid under-dosing (volumes specified in tables below are TOTAL volumes – ie NAC volume plus fluid volume combined). Children or adolescents >40 kg (recommended ceiling weight 110 kg):
NOTE: this results in a total of 750 mL of fluid which is inappropriate for smaller children. For children ≤20 kg body weight:
**For infants, even smaller volumes may be required. Doses can be diluted in 100 mL bags if available (note: the entire dose must be administered over the specified time.). For infants who are fluid restricted with concerns about fluid overload and a smaller total volume is required, contact hospital pharmacist for advice.
MonitoringAt 18 hours into the NAC infusion (2 hours before completion), send bloods for:
The NAC infusion should be discontinued only once the:
Dosing Errors Consider consultation with local paediatric team whenAdmission should be considered for all children and young people with an intentional overdose. Consult Victorian Poisons Information Centre 13 11 26 for advice Consider transfer whenChildren requiring care beyond the comfort level of the hospital For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services. Consider discharge when
Assessing risk and connecting to community services
Discharge information and follow-up: Parent Information: Poisoning prevention for children Poisons Information Centre: phone 13 11 26 YSAS (Youth Support and Advocacy Service): Outreach teams across Melbourne and regional Victoria for young people experiencing significant problems with alcohol and/or drug use YoDAA: Victoria’s Youth Drug and Alcohol Advice service - provides information and support for youth AOD needs or anyone concerned about a young person Infoxchange Service Seeker: Search for local community support services eg local doctor, dentist, counselling services, drug and alcohol services. Additional notesAnaphylactoid reactions to NAC may occur (wheeze, rash). In these cases, cease the infusion for 30 minutes, give promethazine then recommence the infusion at half the previous rate. Slowly increase to the full rate over 30 minutes. Last updated February 2021 Which of the following actions are in keeping with the principles of standard precautions?Standard precautions consist of the following practices: hand hygiene before and after all patient contact. the use of personal protective equipment, which may include gloves, impermeable gowns, plastic aprons, masks, face shields and eye protection. the safe use and disposal of sharps.
Which should the nurse include when teaching a client with C diff about decreasing the risk of transmission to family members?Clean their hands with soap and water or an alcohol-based hand rub before and after caring for every patient. This can prevent C. diff and other germs from being passed from one patient to another on their hands.
What is an example of the nurse using surgical asepsis?Examples of surgical asepsis include the use of disposable sterile supplies, such as syringes, needles, and surgical gloves; and the use of reusable sterile equipment, such as surgical instruments (Fig. 5a).
Which complication would the nurse be aware of when using physical restraints quizlet?Which complication would the nurse be aware of when using physical restraints? Rationale: Constipation can result from immobility. Incontinence can be caused by the inability to get out of bed in time to use the toilet.
|