NR 328 Pediatric Nursing Pre-simulation
Johnny Parker
When caring for a client with an overdose, the nurse should anticipate various system alterations. The overdose can lead to a gastric upset in the gastrointestinal system. It is essential to monitor the client’s electrolyte levels, including potassium (K), sodium (Na), and acid/base balance, mainly when vomiting occurs. The client may also experience neurological symptoms such as tiredness, irritability, weakness, fever, lightheadedness, fainting, confusion, or coma.
Due to the potential liver toxicity of acetaminophen, which was mentioned in this case, the hematological system may be affected. This can result in changes in liver enzyme levels. Additionally, the client may experience pain in the upper right side and signs of hepatoxicity, such as yellowing of the eyes and skin. Respiratory system alterations may include compensatory mechanisms such as fast or difficult breathing. Sometimes, the client may require supplemental oxygen to maintain adequate oxygenation.
NR 328 Pediatric Nursing Pre-simulation
Regarding potential complications, hepatotoxicity and gastrointestinal upset are significant concerns for this client’s current condition. Based on the assessment findings, several nursing interventions take priority for this client. It is essential to focus on hydration to address nausea and vomiting and prevent dehydration. The nurse should closely monitor vital signs, capillary refill, mucus membranes, and skin turgor, as these are indicators of the adequacy of circulating volume. Additionally, tracking the amount and types of fluid intake and measuring urine output is essential for monitoring possible dehydration and disturbances in electrolyte balance.
The nurse should also discuss strategies to stop vomiting to prevent further fluid loss. Reviewing electrolyte and renal function test results is crucial, as fluid and electrolyte shifts and decreased renal function can negatively impact the client’s recovery. If necessary, administering and monitoring intravenous fluids, total parenteral nutrition (TPN), and electrolyte supplements should be implemented to correct fluid and electrolyte imbalances and prevent cardiac dysrhythmias.
NR 328 Pediatric Nursing Pre-simulation
Pediatric populations at risk for poisoning include infants, toddlers, preschoolers, and school-aged children. In cases of poisoning, gastrointestinal decontamination is necessary. Three commonly used agents for this purpose are activated charcoal, which absorbs any remaining acetaminophen in the stomach and may induce vomiting; acetylcysteine, used to reduce the accumulation of a hepatotoxic metabolite in acetaminophen overdose; and gastric lavage, a procedure that involves pumping the stomach to remove ingested toxins.
When a child ingests a poison, it can impact their nutrition. In the case of an acetaminophen overdose, common symptoms such as nausea, vomiting, and loss can lead to a decreased desire to eat, potentially resulting in a nutritional deficit. In such cases, intravenous fluids may be necessary to maintain hydration and provide essential nutrients.
NR 328 Pediatric Nursing Pre-simulation
Nurses can employ various strategies to maintain family-centered care during a medical crisis. These include educating the family on preventive measures like securing cabinets and keeping harmful medications out of reach of children. Involving social support groups can provide assistance and guidance during difficult times. It’s a decision-making process regarding their child’s care, and the nurse can also assist the family with their needs and provide the necessary support. Certain aspects of care can be delegated to other healthcare team members. For instance, monitoring vital signs can be assigned to nursing assistants or support staff under the supervision of the nurse. Additionally, assistance with eating and supportive care can be delegated within the scope of practice.
During an assessment of a pediatric patient who has ingested high levels of acetaminophen, the nurse may observe various findings during an ABC head-to-toe physical assessment. In the HEENT (Head, Eyes, Ears, Nose, and Throat) examination, the child’s eyes may exhibit a yellowish discoloration, indicating potential liver involvement. At the same time, other aspects of the assessment may appear within normal limits. Excessive sweating (diaphoresis) may require supplemental oxygen to support respiratory function.
Unusual bleeding or bruising in the cardiac/hematology examination may suggest possible abnormalities in blood clotting. Yellowing of the skin (jaundice) may indicate potential liver dysfunction. Gastrointestinal symptoms can include pain in the right upper quadrant of the abdomen, nausea, vomiting, anorexia (loss of appetite), and diarrhea. The child may also exhibit extreme tiredness and irritability in the mental assessment. Flu-like symptoms and signs of jaundice may also be present. These assessment findings provide valuable information for guiding further interventions and treatment decisions for pediatric patients who have ingested high acetaminophen levels.
