Toxic Ingestion, Inhalation, Overdose for Progressive Care Certified Nurse (PCCN)
Included In This Lesson
Outline
Toxic Ingestion, Inhalation, Overdose
Definition/Etiology:
- Toxin Ingestion/Inhalation/Overdose
- Ingestion – Exposure to a substance by swallowing
- Tylenol
- Inhalation – Exposure through the respiratory tract, typically a gas inhalation
- Carbon Monoxide
- Overdose – Opioids vs cocaine and amphetamine
- Ingestion – Exposure to a substance by swallowing
- Etiology
- Unintentional
- Occupational – Work in a garage
- Therapeutic error – Too much Tylenol
- Intentional
- Substance abuse
- Prescription/Illicit drugs
- Overdose
- Intent to die
- Substance abuse
- Unintentional
Pathophysiology:
- Poisoning involves four elements:
- The poison – cause
- The poisoned organism – subject
- The injury to the cells – effect
- The symptoms and signs of death – consequence
- Variables of poisoning
- Substance involved
- Time of exposure
- Intent of exposure
- Route of exposure (ingested vs inhaled)
- Amount of ingested or inhaled
Noticing: Assessment & Recognizing Cues:
- Tylenol
- Anorexia
- N/V
- Malaise
- Hepatotoxic – Tylenol has affinity for the liver!
- RUQ pain
- Jaundice
- Signs/Sx Hypoglycemia
- Carbon Monoxide
- Confusion/ ↓LOC
- Skin = bright red/pink
- blurred vision
- SOB
- poor 02 Sat
- Overdose
- Excitatory (Cocaine, LSD, Meth)
- Dilated pupils
- Tachycardia
- Hyperthermia
- Tremors
- Delirium/Hallucinations/Agitation
- Inhibitory (Opioids, Benzodiazepines)
- Constricted pupils
- Bradycardia
- Hypothermia
- Sedation/Stupor/Coma
- Excitatory (Cocaine, LSD, Meth)
Interpreting: Analyzing & Planning:
- Labs (as indicated)
- Liver Function
- ↑ AST & ALT
- Tylenol Levels
- Suspected Overdose = High
- Carboxyhemoglobin
- complex of carbon monoxide and hemoglobin (Hb) that forms in red blood cells upon contact with carbon monoxide.
- Culprit Drug
- Serum Toxicology
- Urine Drug Screen
- Liver Function
- Diagnostics
- CXR – inhalation injury (pulm edema)
- ECG – Arrhythmias
- CT head – R/O other cause altered mental status
Responding: Patient Interventions & Taking Action:
- Poison Control
- Doctor usually calls – expert algorithms
- Inhalation Interventions
- Maintain airway -inhalation causes airway edema
- Gag reflex
- Aspiration risk
- Suction Ready
- Supplemental 02
- Possible ventilator
- Maintain airway -inhalation causes airway edema
- Ingestion Interventions
- Gastric Lavage “Stomach Pump
- OG or NG tube
- Confirm with X Ray
- Saline, Tap Water or Activated charcoal
- Gastric Lavage “Stomach Pump
- Pharmacological
- N-acetylcysteine (NAC) – Tylenol Antidote
- 100% Oxygen – Carbon Monoxide poisoning
- Benzos – Cocaine
- Narcan – reverses Opioid Respiratory and/or CNS depression
- IV dextrose
- Most drugs are liver toxic!
- Symptoms of hypoglycemia (e.g., altered mental status, cool, clammy skin, coma
- Nonpharmacological
- Hemodialysis
- Hemoperfusion
- Blood is pumped through a cartridge containing activated charcoal and/or carbon, which absorbs toxins
Reflecting: Evaluating Patient Outcomes:
- Maintain adequate airway and ventilation
- Patient remains hemodynamically stable
- Patient returns to baseline neurologic status
- Return of core temperature to within a normal temperature range of 36.1°C to 37.2°C (97°F–99°F).
Linchpins (Key Points):
- Notice – Rute and intent
- Inhalation vs Ingestion vs Overdose
- Interpret -History & Labs
- Dictates the Intervention
- Respond – Pharmacology & Interventions
- Airway and/or Gastric Lavage
- Reflect – Hemodynamics & LOC
- Temperature is another huge factor with overdose
Transcript
References
- AACN, & Hartjes, T. (2023). AACN Core Curriculum for Progressive and Critical Care Nursing (8th ed.). Elsevier Health Sciences (US).
- Dennison, R. D., & Farrell, K. (2015]). Pass PCCN!. Elsevier Health Sciences (US).
- Kupchik, N. (2017). Ace The Pccn®!: You can do it!: Practice question review book. Nicole Kupchik Consulting, Inc.
- Stone, L. M. (2018). Certification and Core Review for High Acuity, Progressive, and Critical Care Nursing (7th ed.). Elsevier Health Sciences (US).
- Trivium Test Prep. (2019). Pccn review book 2019-2020: Pccn Study Guide and Practice Test Questions for the Progressive Care Certified Nurse Exam.
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