Case Study Accidental Poisoning Student Copy Hockenberry:

Case Study Accidental Poisoning Student Copy Hockenberry: Wong’s Essentials of Pediatric Nursing, 11th Edition Case Study Accidental Poisoning Scenario: A 5-year-old child is brought by ambulance to the emergency department (ED) for lethargy. The child was found, by his grandmother, lying on the floor unresponsive with emesis. The grandmother called 911. The child’s assessment upon arrival to the ED is as follows: Temperature: 98.9 °F Pulse: 60 beats per minute (bpm) Respirations: 16 breaths per minute and irregular Blood pressure: 75/45 mmHg Pulse oximetry: 99% on 5 L oxygen via nasal cannula Glucose: 272 mg/dL Physical Assessment Lethargic and unresponsive Dusky in appearance Capillary refill: 4 seconds Extremity pulses: +2 and cool to touch Abdomen: round, soft and nondistended and pain is not noted upon palpation Past medical history: unremarkable Per grandmother, the child came to their house for a visit 2 days ago and has been fine until he was found lying on the floor. 1. NGN Item Type: Enhanced Hot Spot (Recognize Cues) Highlight or place a check mark next to the assessment findings that require immediate follow-up by the nurse. 2. NGN Item Type: Extended Multiple Response Which of the following immediate actions should the nurse take? Select all that apply. Administer a fluid bolus as ordered. B. Draw blood for an arterial blood gas and basic metabolic panel. Turn oxygen down to 2 liters. Administer inotropic support with dobutamine. Assess vaccination history. Prepare to intubate the child. Scenario: The child does not respond to immediate interventions and begins to deteriorate. The child requires intubation along with vasopressors. The child is admitted to the pediatric intensive care unit (PICU). Abnormal lab results include: Creatinine: 1.75 mg/dL Glucose: 312 mg/dL Serum lactate: 11.5 mg/dL pH: 7.28 PCO2: 27 mmHg PO2: 162 mmHg Bicarbonate: 12.6 mEq/L 1. NGN Item Type: Extended Drag and Drop Choose the most likely options for the information missing from the statements below by selecting from the lists of options provided. The child’s laboratory data indicates a decrease in both ________1_________ and ________1_________ . Based on this data, the nurse suspects that the child is experiencing __________2__________ . The nurse anticipates that the child will need the following interventions: __________3_____________ and __________3_____________. Options for 1 Options for 2 Options for 3 PCO2 Respiratory alkalosis Sodium bicarbonate Creatinine Metabolic alkalosis Antibiotics pH Metabolic acidosis Inotropes glucose Respiratory acidosis Sedation 2. NGN Item Type: Extended Multiple Response Based on the data, what possible complications should the nurse anticipate Select all that apply. Shock B. Hypertension Death Tachycardia Renal complications Scenario: During the admission discussion, the grandmother notes that her purse was emptied on the floor next to the child and both of her medication bottles were opened. The grandmother shows the nurse her medications, diltiazem and amlodipine, and indicates that some medication may be missing. NGN Item Type: Matrix Use an X to indicate which of the potential nursing actions are essential and appropriate for the nurse to perform at this time for the child. Potential Nursing Action Appropriate Nursing Action Educate the child’s grandmother on safe medication storage. Contact poison control regarding the possible ingestion of medications. Notify the provider regarding the new information and possible ingestion of grandmother’s medications. Administer activated charcoal for gastrointestinal decontamination. Obtain a urine drug screen. Maintain airway. Monitor cardiac status. Initiate an isotonic fluid bolus of 100 mL/kg. Administer Calcium chloride PO. Scenario: After 4 days of hospitalization the child is ready for discharge. After providing discharge instructions to the grandmother, the nurse assesses the grandmothers understanding. NGN Item Type: Matrix For each statement, use an X to indicate whether the nurse’s discharge instructions were Effective (helped the grandmother understand the discharge instructions), Ineffective (did not help the grandmother understand the discharge instructions), or Unrelated (not related to the discharge instructions). Statements Effective Ineffective Unrelated “I will keep my medications in child proof containers and out of reach of my grandchildren.” “I will continue to take my medications as scheduled.” “I will continue to monitor my grandchild and return to the emergency department if she has any problems breathing.” “I can keep my nonprescription medications within my grandchild’s reach.” “Poison control should only be contacted if I witness the medication being taken.”

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."