POISONING

Presented by: Group 1 BSN 2

ACETAMINOPHEN TOXICITY
By: Edel Cornelio P. Carlos, Emmalyn Ruth D. Bautista and Ana Mae C.
Renardo
Acetaminophen overdose means taking more
than it is safe to take. It may also be called
acetaminophen poisoning. Acetaminophen is
called paracetamol in countries outside the
United States. When used correctly,
acetaminophen is a safe drug that decreases
pain and fever. Many medicines contain
acetaminophen, including some that you can
buy without a prescription.
WHAT CAUSES AN ACETAMINOPHEN
OVERDOSE?
The most acetaminophen that is safe for most people to take is
4,000 milligrams (4 grams) in a 24-hour period. An overdose
means you have taken more than is safe in a 24-hour period. The
following are ways an unplanned overdose may happen:
You take more than the recommended dose. You might
accidentally take too much if your pain or fever did not go away
after the recommended dose. You may also get too much if you
take acetaminophen for too many days in a row.
 You accidentally take more than one medicine at a
time. Many medicines contain acetaminophen along with other
drugs. These include medicines for colds, the flu, allergies, or
trouble sleeping. You may have taken more than one medicine
that contains acetaminophen, and the total was too much.
You take an extended-release form. When you take extended-
release pills, the medicine stays in your body longer. You are
supposed to take these medicines less often than you would
take regular acetaminophen. If you take this medicine too often,
you will have too much in your body at one time.
 SIGNS AND SYMPTOMS
You might not have any signs or symptoms at
first. Early signs and symptoms may make you
feel like you have the flu. Common signs and
symptoms happen during each stage of an
acetaminophen overdose. If the overdose is
treated right away, you might have fewer or
easier symptoms in the later stages.
 First 24 hours:Nausea, vomiting, stomach pain, and loss of
appetite
Paleness
Tiredness
Sweating
24 to 72 hours after the overdose, you may also have any of
the following: Pain in your upper right side
Dark urine
Urinating less often than usual
Skin and the whites of your eyes turn yellow
 72 to 96 hours after the overdose, you may also have any of the
following: Blood in your urine
Fever, lightheadedness, or fainting
Fast breathing or trouble breathing
Extreme weakness or tiredness
Feeling very hungry, or shaking
Blurred vision, a fast heartbeat, or headache that will not go away
Trouble staying awake
Confusion
Coma
 HOW IS AN ACETAMINOPHEN
OVERDOSE DIAGNOSED?
The serum acetaminophen concentration is the basis for
diagnosis and treatment. A diagnostic serum
concentration is helpful, even in the absence of clinical
symptoms, because clinical symtpoms are delayed. The
Rumack-Matthew nomogram interprets the
acetaminophen concentration (in micrograms per
mL), in relation to time (in hours) after ingestion, and is
predictive of possible hepatotoxicity after single, acute
ingestions of acetaminophen.
RECOMMENDED SERUM STUDIES ARE
FOLLOWS:
Liver function tests (alanine aminotransferase [ALT], aspartate aminotransferase
[AST]), bilirubin [total and fractionated], alkaline phosphatase)
Prothrombin time (PT) with international normalized ratio (INR)
Glucose
Renal function studies (electrolytes, BUN, creatinine)
Lipase and amylase (in patients with abdominal pain)
Serum human chorionic gonadotropin (hCG) (in females of childbearing age)
Salicylate level (in patients with concern of co-ingestants)
Arterial blood gas and ammonia (in clinically compromised patients)
 HOW IS AN ACETAMINOPHEN
OVERDOSE/POISONING TREATED
Acetaminophen overdose is a serious problem.
Treatment should be started as soon as possible.
Treatment depends on how much time has passed
since the overdose and if the overdose happened
all at one time. You may be given activated
charcoal medicine to soak up the acetaminophen
that is still in your stomach. Activated charcoal
will make you vomit. Gastric lavage may be
needed to clean out your stomach to get rid of the
 Gastric lavage is also called having
your stomach pumped. You may be
given antidote medicine to stop the
effect of the overdose. You may also
be given medicine to slow down the
effects of acetaminophen
 HOW CAN AN ACETAMINOPHEN
POISONING BE PREVENTED?
Read labels carefully. Read the labels of all the
medicines you take. If your medicine contains
acetaminophen, it will be listed in the active
ingredients section. Acetaminophen may be listed
on the label as APAP, Acetaminoph, Acetaminop,
Acetamin, or Acetam. Check carefully to see if the
acetaminophen is a regular or extended-release
form.
 Do not take more than 1 type of acetaminophen at
a time. Many combination medicines contain
acetaminophen. Make sure the total dose of
acetaminophen you take is not more than 4,000
milligrams (4 grams) in 1 day. Ask your healthcare
provider if you are not sure how much you are taking.
Check other medicines to see if they contain
acetaminophen. Do not take these medicines
together with acetaminophen. The combined
amount of acetaminophen may be too much.
 Take the correct dose. Make sure you take the right amount and
wait the right number of hours between doses. Never take more
than the label says to take. Do not take acetaminophen for more
days than directed. If the medicine came with a device such as a
spoon or dropper, use it to measure your medicine.
Do not take acetaminophen for too many days in a row. Do
not take acetaminophen for more than 10 days to treat pain,
unless your healthcare provider tells you to. Do not take
acetaminophen for more than 3 days to treat a fever, unless your
healthcare provider tells you to. Your pain or fever may need to
be treated another way if it lasts longer than a few days.
LEAD POISONING
By: Mannilyn Grace Cabiguen and Anne Dica Santos
Lead Poisoning
Lead poisoning occurs when lead builds up in the body, often over months or years.
Even small amounts of lead can cause serious health problems. Children younger than 6
years are especially vulnerable to lead poisoning, which can severely affect mental and
physical development. At very high levels, lead poisoning can be fatal.
Lead-based paint and lead-contaminated dust in older buildings are the most common
sources of lead poisoning in children. Other sources include contaminated air, water and
soil.
Adults who work with batteries, do home renovations or work in auto repair shops also
might be exposed to lead
 Why is lead harmful?
Whether it's inhaled, swallowed, or more rarely, absorbed through the skin (just by
touching a product that contains lead), lead can act as a poison.
Exposure to high lead levels in a short period of time is called acute toxicity. Exposure to
small amounts of lead over a long period of time is called chronic toxicity.
Lead is particularly dangerous because once it gets into a person's system, it is
distributed throughout the body just like helpful minerals such as iron, calcium, and zinc
and lead can cause harm wherever it lands in the body.
 Sources of Lead exposure
Lead in paint
Contaminated Soil
Household dust
Pottery
Sources of Lead exposure
Toys
Cosmetics
Herbal or folk medicine
Occupations
Lead Poisoning Symptoms in Newborn
Babies exposed to lead before birth might:
Be born prematurely
Have lower birth weight
Have slowed growth
 Lead Poisoning Symptoms in Children
Developmental delay
Learning difficulties
Irritability
Loss of appetite
Weight loss
Sluggishness and fatigue
Abdominal pain
Vomiting
Constipation
Hearing loss
Seizures
Eating things, such as paint chips, that aren't food (pica)
Health effects of lead poisoning on children

Convulsions
Comma
Death
Children who survive severe lead poisoning may be left with mental retardation
and behavioural disorders
Treatment

For more-severe cases, your doctor might recommend:

Chelation therapy. In this treatment, a medication given by mouth binds with the
lead so that it's excreted in urine. Chelation therapy might be recommended for
children with a blood level of 45 mcg/dL or greater and adults with high blood
levels of lead or symptoms of lead poisoning.
EDTA chelation therapy. Doctors treat adults with lead levels greater than 45
mcg/dL of blood and children who can't tolerate the drug used in conventional
chelation therapy most commonly with a chemical called calcium disodium
ethylenediaminetetraacetic acid (EDTA). EDTA is given by injection.
Prevention
Simple measures can help protect you and your family from lead poisoning:
Wash hands and toys. To help reduce hand-to-mouth transfer of contaminated
dust or soil, wash your children's hands after outdoor play, before eating and at
bedtime. Wash their toys regularly.
Clean dusty surfaces. Clean your floors with a wet mop and wipe furniture,
windowsills and other dusty surfaces with a damp cloth.
Prevention
Remove shoes before entering the house. This will help keep lead-based soil
outside.
Prevent children from playing on soil. Provide them with a sandbox that's
covered when not in use. Plant grass or cover bare soil with mulch.
Eat a healthy diet. Regular meals and good nutrition might help lower lead
absorption. Children especially need enough calcium, vitamin C and iron in their
diets to help keep lead from being absorbed.
Keep your home well-maintained. If your home has lead-based paint, check
regularly for peeling paint and fix problems promptly. Try not to sand, which
generates dust particles that contain lead.
IRON TOXICITY
By: Roxanne Schmidt and Merielle Nicole M. Dangue
IRON TOXICITY
Iron overdose has been one of the leading causes of poisoning deaths in
children younger than 6 years.
Iron is used in pediatric or prenatal vitamin and mineral supplements and
for treatment of anemia.
Iron tablets are particularly tempting to young children because they look
like candy.
Toxic effects begin to occur at doses above
10-20 mg/kg of elemental iron.
Ingestions of more than 50 mg/kg of
elemental iron are associated with severe
toxicity.
 Toxicity is determined by the amount of iron taken per kilogram
of body weight. Because of their small size, kids can quickly
reach a toxic dose if they swallow adult or prenatal
multivitamins because the iron content in each tablet is high.
Iron poisoning occurs because too much iron acts like a
corrosive to the tissues lining the gastrointestinal tract, such as
the stomach and intestines.
Iron is also a cellular toxin; it damages and kills the cells that
make up the tissues of our organs, like the liver.
Iron toxicity can eventually lead to seizures, coma, multiple
organ failure, and death.
 SIGNS & SYMPTOMS
Symptoms of iron poisoning usually become evident within 6
hours after an excessive amount of iron is swallowed.
Nausea
Vomiting (severe)
Abdominal pain
Diarrhea
Bleeding
DIAGNOSIS
The diagnoses of iron poisoning is usually made by observing
your child. A normal physical exam and no symptoms for 6 hours
tells the doctor that the child has experienced either little
poisoning or did not eat any iron-containing substances.
The doctor may draw blood from your child to determine these
levels:
Iron
White blood cell count
Serum glucose (blood sugar)
 The doctor may also ask for an X-ray of your
childs abdomen to confirm whether there are iron
pills in the gastrointestinal tract, although
sometimes the pills can be there and not seen.
Laboratory and imaging tests are not usually
sensitive enough to detect poisoning. Some tests
are also too slow to affect the diagnosis and
management of iron poisoning.
 TREATMENT & MANAGEMENT
Once the child is breathing normally, the child likely will have his
or her whole bowel cleaned by drinking a strong laxative fluid.
Severe poisonings will require IV chelation therapy - a series of
IVs containing deferoxamine mesylate (Desferal), a chemical
that binds to iron in a cell and is then excreted in urine.
Deferoxamine can be administered by IV or injection, but the IV route is
preferred for easier dose adjustment. A change in urine color (to a red-
orange) and low blood pressure are common side effects with
deferoxamine treatment.
Usually children require no more than 24 hours of therapy.
 Orogastric lavage can be considered, but it is
generally only helpful if performed within 1
hour of swallowing the pills. Insertion of the
tube can cause complications, and many pills
may not fit through the ports of a lavage
tube if they are not disintegrated.
If ingestion of other medications is
suspected, the physician may give the child
activated charcoal to drink.
 PREVENTION
To prevent unintentional poisoning:
Store all iron-containing supplements and multivitamins out of
reach and sight of children.
Make sure to replace child-resistant closures tightly after each
use. Although they are not child-proof, they help by slowing
children down, giving parents and caretakers a little extra time
to catch them in the act.
Always consult a health professional before taking any
multivitamin or supplement.
 Keep medications where children cannot get to
them.
Childproof caps are not a guarantee that children
are safe.
Educate your children that unknown pills are not
candy and can be harmful.
Do not take more than one supplement
containing one or more of the same ingredients
prior to consulting your doctor.
 Keep medications in their original containers to
prevent the wrong medication being taken by
mistake.
Make sure medications are kept in child-resistant
containers. Keep medications out of the reach of
children. Remember that the term child-resistant
does not necessarily mean childproof.
Avoid taking medications in front of small
children. Small children may want to imitate your
actions and take the same medication.
NURSING DIAGNOSIS
By: Jasmine Lyn Renee C. Jovero and Mikee B. Zaballa
 ASSESSMENT CUES: NURSING DIAGNOSIS OBJECTIVES AND INTERVENTION RATIONALE EVALUATION
OUTCOMES
Subjective: Nausea and vomiting related Short Term Goal: INDEPENDENT NURSING To have a good and Short Term:
Isinusuka ng anak ko ang INTERVENTIONS: effective nurse-client
to disease process secondary After 1 hour of nursing Establish rapport with the
After 1 hour of nursing
mga kinain niya. as relationship
to iron poisoning. intervention the client patient and the significant Inflammation or irritation intervention the client
verbalized by the mother. will be able to other. of the intestine may be can now demonstrate
demonstrate the Auscultate bowel sounds, accompanied by intestinal the behavior in
Objective: behavior in minimizing noting absence or hyperactivity, diminished minimizing vomiting.
Pale conjunctiva and hyperactive sounds. water absorption and
vomiting. Eliminate smells or foul
mucus membrane diarrhea.
odor from the environment.
Reduces gastric stimulation Long Term:
Client appears weak Long Term Goal: Avoid foods that might
Restlessness cause or exacerbate
and vomiting response. After 1-2 days the
After 1-2 days the patient Might increase abdominal
Choking abdominal cramping like patient is free from
will be free from caffeinated beverages, cramping.
Increased Saliva vomiting. Provides quantitative vomiting.
chocolate, orange juice.
Vital Signs as follows: Measure abdominal girth. evidence of changes in
T: 36.8 Observe skin or mucous gastric or intestinal
RR: 31 bpm membrane dryness, and distention.
PR: 125 bpm turgor. Note peripheral Hypovolemia, fluid shifts
edema. and nutritional deficits
Assess abdomen frequently contribute to poor skin
for return to softness, turgor, edematous tissue.
appearance of normal Indicates return of normal
bowel sounds, and passage bowel function and ability
of flatus. to resume oral intake.
Weigh daily. Initial losses or gains reflect
changes in hydration
Collaborative Reflects organ function and
Monitor BUN, protein, nutritional status and
prealbumin or albumin,
needs.
glucose, nitrogen balance as
Careful progression of diet
indicated.
when intake is resumed
Advance diet as tolerated.
reduces risk of gastric
irritation.
 ASSESSMENT CUES: NURSING OBJECTIVES AND
DIAGNOSIS OUTCOMES
Subjective: Diarrhea related to Short Term:
Simula nang malason the side effects of -- After 2-3 hours of
ang anak ko naging poisoning. nursing interventions, the
malala ang patatae niya. patients mother will gain
As verbalized by the knowledge about diarrhea.
Mother.
Expected Outcome:
Objective: - Verbalize understanding
Evidenced by loose of causative factor.
watery stool - Verbalize the rationale
Increase in bowel for treatment regimen.
sounds.
Weak looking patient Long Term: Restrict solid food intake.
- After 1-2 days of nursing Provide for changes in
interventions, the
patient will be free of
diarrhea.
Expected Outcome:
- Re-establish and maintain
normal bowel movement.
- Reduction infrequency of
stools.
INTERVENTION
INDEPENDENT NURSING
INTERVENTIONS:
Establish rapport with
the patient and the
significant other.
Auscultate the abdomen.
Discuss to the mother
the different causative
factors and rationale for
treatment regimen.
Dependent:
1.) To decrease GI motility and minimize
dietary intake.
Limit caffeine, high fiber 2.) To treat infectious process, decrease
foods and fatty foods.
Dependent:
1.) Administer anti-
diarrheal medication, as
indicated.
2.) Administer medications,
as ordered.
RATIONALE
To have a good and effective nurse-
client relationshipIndependent:
1.) For presence, location and
characteristics of bowel sounds.
2.) For the education of the patients
mother.
3.) To allow for bowel rest and reduce
intestinal workload.
4.) To allow foods that precipitates
diarrhea.
5.) To prevent gastric irritation.
fluid losses.
motility and/or absorb water.
EVALUATION
Short Term:
- After 2-3 hours of
nursing interventions,
the patients mother
shall gain knowledge
about diarrhea and
verbalized
understanding of
causative factors of
diarrhea and rationale
for treatment regimen.
Long Term:
- After 2-3 hours of
nursing interventions,
the patients mother
shall gain knowledge
about diarrhea and
verbalized
understanding of
causative factors of
diarrhea and rationale
for treatment regimen.