HPS

Location: Emergency Department History/Information: This child is a previously

healthy 3 year old who is brought to the Emergency Department (ED) by his aunt
and uncle. He has been visiting with them while his parents are away at a class
reunion. He had been complaining of an earache 2 teaspoons of and the aunt states
I touched his forehead and it felt hot. His aunt gave him liquid acetaminophen
about 8 hours ago. He fell asleep and started to sweat so the aunt gave him another
2 teaspoons of acetaminophen about 4 hours ago. They brought him to the ED
because he was lethargic, complaining of a stomach ache and vomited twice. On
exam, the patient's skin is pale and diaphoretic. He is responsive to tactile stimuli
and cries quietly. The aunt brought the bottle of acetaminophen with her. The nurse
notes that the child was dosed with the concentrated infant drops (80mg/0.8mL).
Healthcare Providers Orders: Vital signs every hour; notify healthcare provider for
RR greater than 40 Check SpO2 with vital signs Cardiac monitor D5/0.25% NS IV at
65mL/hour Acetaminophen level and CBC STAT Electrolytes, BUN, creatinine,
glucose Toxicology screen Liver function test Urine specimen Strict Intake and
Output Nothing by mouth Contact Poison Control center Place nasogastric tube for
instillation of activated charcoal

1. Uses history information and assessment data to plan and provide care to a pediatric
patient with acetaminophen poisoning (ANALYSIS).
2. Anticipates orders and therapy, including medications, for the preschool patient with
acetaminophen poisoning (ANALYSIS).
3. Performs age appropriate nursing management interventions for the pediatric patient
with poisoning (APPLICATION).
4. Evaluates the patient response to interventions and modifies the nursing care as
appropriate for the preschooler with acetaminophen overdose (ANALYSIS).
5. Provides instructions for the home management of a complex medication regime
(APPLICATION).

HPS
1. What are the symptoms of acetaminophen overdose?
4 stages: stage 1: (2-4 hr after ingestion) Nausea, vomiting, sweating and pallor.
Stage 2 : (24-36 hr ) Patient improves
Stage 3: hepatic involvement: (May last more than 7 days and be permanent)
Stage 4: Patients who do not die in hepatic stage gradually recover.
2. Discuss factors that predispose pediatric patients to acetaminophen overdose?
Drugs are metabolized quickly in young children, slower gastric emptying, liver immaturity,
medications given at wrong time and frequency, wrong dosage, developmental age
characteristics of young children predispose them to poisoning ingestion.
3. What are the physiological consequences of an acetaminophen overdose?
When you consume acetaminophen, your body turns it into a metabolite that is toxic to your
liver. When your liver cant effectively remove the toxin from your body, the organ may be
damaged. The dose of medication may be too high for your body size, or you may have a
poorly functioning liver.
4. What diagnostic tests are used to validate toxicity from the acetaminophen overdose?

Liver function tests (alanine aminotransferase [ALT], aspartate aminotransferase [AST]),

bilirubin [total and fractionated], alkaline phosphatase)
Prothrombin time (PT)
Glucose
Renal function studies (electrolytes, BUN, creatinine)
ECG
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)
5. Identify the potential complications for acetaminophen overdose.
Hepatotoxicity is the number one complication of acetaminophen toxicity.
6. What is the treatment protocol for use of N-acetylcysteine?
N-acetylcysteine is the most effective antidote for acetaminophen overdose if given to a patient
within 8 to 10 hours; however, it may be effective for up to 24 hours after ingestion during stage

1.Healthcare providers also may consider gastric decontamination with gastric lavage within 1
hour of ingestion or use activated charcoal within 4 hours of ingestion. The use of gastric lavage
may be challenging in children due to the small size of the pediatric nasogastric tube. Given
orally but is first diluted in fruit juice or soda because of the antidotes offensive odor. Given as 1
loading dose and usually 17 maintenance doses in different dosages. May be given IV, but use is
investigational. Loading dose of 140 mg/kg, followed by 17 doses at 70 mg/kg each. Medication
is administered every 4 hours until completed. Duration of treatment is 72 hours.
7. Outline and prioritize a teaching plan for preventing acetaminophen overdose.
Use your childs weight to determine dosing and make sure that the formula is meant for his or
her age group.
Follow the dosing instructions on each individual package of medication. Do not assume that
multiple packages can be measured in the same way. Even if both packages are the same brand,
they could have different dosing instructions due to recent changes in formula concentrations
ordered by the FDA.
Secure medications in locked drawers or cabinets. Keep records of the medications your child is
taking and share them with caregivers. Ask caregivers to record the time they gave your child
medicine, and the dose.
Read the labels on all medications you use or give to your children. Avoid taking multiple
products that list acetaminophen as an ingredient.
Keep poison control number handy as well as record and make sure caregivers record last dosage
and amount.