The greatest risk of lead poisoning is to poor children under 6 years of age living in urban areas.
True
Asymptomatic young children may have lead levels sufficiently elevated to cause neurologic and intellectual damage.
True
Lead-based paint from old housing remains the most frequent source of lead poisoning in children.
True
Lead-containing pottery or leaded dishes do not contribute to lead poisoning because food does not absorb lead.
False
Pica is the habitual, purposeful, and compulsive ingestion of nonfood substances.
True
The exposure risk is lower for children living in leaded environments whose diet is deficient in iron and calcium and high in fats because the diet slows the absorption of lead.
False
Lead encephalopathy is associated with blood lead concentration of >100 mg/dl. (Take-away point to remember: lead encephalopathy is associated with high dose lead exposure.)
True
When assessing a possible child poisoning the nurse should first treat the poison not the child.
False
Syrup of ipecac is the first intervention recommended for immediate treatment of poisoning that occurs in the home setting.
False
Erythrocyte protoporphyrin (EP) level is a sensitive indicator of low lead exposure, and is used routinely as a screening test.
False
Acute salicylate poisoning can be considered a more serious intoxication than chronic ingestion.
False
Diagnostic evaluations for lead poisoning include:
a) Blood levels for lead concentration, including screening done on finger and heel sticks with blood collected by venipuncture to confirm diagnosis.
b) Recommended universal screening for all children, w
d) All of the above
The most important point from the CDC recommendation is that the blood level screening reference value for monitoring lead poisoning is based on the 97.5th percentile of the population BLL in children ages 1-5 (currently 5 ug/dL) to id
The first action parents should be taught to initiate in the event of a poisoning is to:
a) Induce vomiting.
b) Take the child to the family physician/nurse practitioner's office or urgent care.
c) Call the Poison Control Center (PCC).
d) Follow the instr
c) Call the Poison Control Center (PCC).
Salicylates and acetaminophen are the two most commonly ingested drugs among children. For each of the following statements regarding ingestion, state (A) if the statement applies to acetaminophen ingestion and (S) if it applies to salicylate ingestion.
a
a) S
b) S, A
c) S
d) A
Identify the developmental characteristics of young children that predispose them to poisoning by ingestion.
a) Oral experimentation
b) Autonomy vs. initiative, increased curiosity and non-compliant behavior
c) Sense of taste is not discriminating
d) Imitation
The primary goal of nurses related to lead poisoning is
Prevent the child's initial or further exposure to lead by identifying possible sources in the environment, careful history taking and educating on ways to reduce lead in the environment..
What early signs of low-dose exposure lead poisoning and its effect on the nervous system should the nurse be alert to when performing an assessment?
a) Decrease in intellectual function
b) Development of learning problems
c) Manifesting behavior problems
Blood level determines the type of intervention needed for the child with lead poisoning. At what level does the child require each of the following?
a) Clinical management, environmental evaluation, and lead hazard control: 20-44 mcg/dl.
b) Chelation therapy: 45-69 mcg/dl
c) Immediate medical treatment: 70 or greater mcg/dl
The most frequent source of acute childhood lead poisoning is non-intact lead-based
Paint and bare soil in the yard.
What characteristics of toxins will determine the severity of the poisoning incident?
a) Type
b) Concentration
c) Route of exposure
There are three main categories of interventions used to decrease effects of toxins in the body. They are:
a) Enhance elimination
b) Decrease absorption
c) Implement toxic specific intervention
Emesis, gastric lavage, activated charcoal, dermal cleansing and eye irrigation are all examples of decreasing _______of poisons.
absorption
The following poisons can not be reduced in the body by using activated charcoal
a) Ethanol
b) Hydrocarbons
c) Alkali
d) Iron
e) Boric acid
f) Lithium
g) Methanol
h) Cyanide (added to list)
What is an average single dose of activated charcoal for an adult? _____ to ___ grams
50 to 100 grams
What are the most common potential complications of gastric lavage?
a) Epistaxis
b) Esophageal perforation
c) Aspiration
Elimination of poisons can be enhanced by the use of the following interventions:
a) Cathartics
b) Whole-bowel irrigation
c) Hemodialysis
d) Hemoperfusion
e) Urine alkalinization
f) Chelating agents
g) Antidote
List three commonly used chelating drugs
a) Calcium disodium edetate or EDTA
b) Succimer or DMSA
c) British antilewisite or BAL
Vitamin C is used to enhance excretion when added to IV fluids used to treat a poisoning resulting from:
a) Amphetamines
b) Quinidine
What is the most important risk factor when administering cathartics to a poisoning victim?
Electrolyte abnormalities
Since lead poisoning can occur in children from all socioeconomic strata, what factors regarding food preparation and diet would you include in a preventative teaching plan for parents of young children?
a) Use only cold water for consumption (making infant formula, drinking, cooking)
b) Wash toys and pacifiers frequently
Why is ipecac syrup contraindicated for the treatment of poisonings? (No longer recommended for routine poison intervention-evidence does not support improved patient outcomes/interferes with effectiveness of other compounds such as activated charcoal, et
a) Ingestion of corrosive substances ? further harm (additional exposure of mucous membranes to corrosive substances)
b) Excessive/Prolonged vomiting ?further harm (fluid/electrolyte imbalances/adverse cardiovascular events)
c) Ingestion of hydrocarbons (
Manifestations of acetaminophen poisoning
Phase 1: Malaise and diaphoresis, nausea, and vomiting.
Phase 2: Right upper quadrant pain, decreased urine output, diminished nausea, and increase in LFTs.
Phase 3: Nausea and vomiting, malaise, jaundice, hypoglycemia, enlarged liver, possible coaglupath
Treatment for acetaminophen overdose
Activated charcoal and n-acetylcysteine.
Aspirin overdose treatment
Treatment is with activated charcoal and alkaline diuresis or hemodialysis. Acute ingestion of > 150 mg/kg can cause severe toxicity. Vitamin K.
NSAID overdose symptoms
Gastroenteritis, abdominal pain, drowisness, abdominal pain, drowsiness, nystagmus, hepatic and renal damage.
NSAID overdose treatment
Activated charcoal, gastric lavage, supportive care.
Symptoms of tricyclic antidepressant overdose
Low doses: anticholinergic effects, agitation, hypertension, tachycardia.
High doses: CNS depression, dysrhythmias, hypotension, respiratory depression.
Tricyclic antidepressant overdose treatment
Multi-dose activated charcoal, gastric lavage, serum alkinzation with sodium bicarbonate, intubation, and mechanical ventilation.
What are some methods to treat depression?
-SSRIs
-SNRIs
-Cognitive behavioral therapy
-MAOIs
-Tricyclic antidepressants
-Electroconvulsive therapy (ECT)
What are the 5 As of Alzheimer's?
-Anomia
-Apraxia
-Agnosia
-Amnesia
-Aphasia
Anomia definition
Having trouble remembering names of things.
Example:
-In the case of anomia, people know what something is, but they do not know what it is called. Presented with a knife, for example, the patient could say "that is for cutting," and could demonstrate pot
Apraxia
Misuse of objects
Example:
-Difficulty remembering which tool or object to use for a task, such as knowing a comb is for the hair on one's head.
-Difficulty remembering all the steps and the order of steps needed to complete a task, such as writing a lett
Agonsia
Misinterpreting sensation, objects and sounds
Example:
-Our elderly may misrecognize her grandchildren as her children. They may no longer recognize their home, car, spouse, children or beloved pet.
-Mary always walks along Fifth and Vine Street; however,
Amnesia
Memory Loss
Example:
-Sufferers may therefore repeat comments or questions several times, for example, or fail to recognize people they met just minutes before.
-Not remembering that they started cooking dinner and left the stove on which led to a fire.
Aphasia
Can't express oneself in speech.
Example:
-Frequent usage of vague terms such as "thing," "there," "that," or nonspecific naming, such as "he," "she," or "it" may also demonstrate language deterioration.
-Aphasia Example: Alzheimer's Person says, "I want
What method is preferred in severe long term depression?
ECT
What are some contraindications for ECT?
-Stroke
-Vascular damage
-Any increased intracranial pressure
What is a major concern that nurses must monitor when a patient has been started on antidepressants therapy?
-Suicide
What are some nursing considerations and responsibilities in caring for patient BEFORE ECT?
-NPO
-Informed consent
-Void and evacuate bowels
-Vitals
-EKG
-Remove glasses, dentures, jewelry, etc.
-Educate
-Administer atropine sulfate
What are some nursing responsibilities during ECT?
-If ECT is too intense administer benzodiazepines
-Monitor vitals
-Monitor EEG
-Monitor any IV sites
-Vitals
-Suction
-Oxygen
-Each seizure should be between 15-20 seconds
-2 minute seizures are dangerous and worrisome
What are some nursing responsibilities in caring for a patient after ECT?
-Can they swallow?
-Do they have a gag reflex?
-Orient them to person, place, and time
-Patient may experience nausea and vomiting
-Provide an environment with quiet, dimly lit and relaxing environment.
What differences are there between alcoholism in the elderly versus the rest of the general population?
-Drink at home
-They binge drink less but drink on more of daily schedule/frequent lower quantities
-Tend to hide their consumption and materials (hide bottles etc.)
What differences are there between suicide in the elderly versus the general population?
-More successful
-The rate is higher in this population
-Methods are more lethal
A patient with Alzheimer disease mumbles incoherently. Which activity is best for this patient?
A)Play cards with another patient.
B) Folding towels.
C)A game of chess.
D)Aerobic exercise.
B) Folding Towels
This is a simple activity that redirects the patients attention. Most likely to perform this task successfully. The others listed are too complicated for a confused patient.
A nurse is assessing a patient for neurocognitive disorder. Which findings are not associated with neurocognitive disorder?
A)Sudden onset of symptoms.
B)Feelings of sadness.
C)Apathy and pessimism
D)Changes in personality and difficulty concentrating
A) Sudden onset of symptoms.
A distinguishing characteristic of neurocognitive disorder is a slow onset of symptoms, which makes it difficult to determine when symptoms first occurred. Neurocognitive disorder progresses to noticeable changes in personalit
4 major factors that influence/contribute to vulnerability?
1. Socioeconomic status- education, health literacy, access to care, age, ethnicity, gender, social isolation
2. Poor health status- Chronic illness, injury, elderly or young, mental or physical disability, immunocompromised
3. Marginalized-disability, ho
Vulnerability is:
* Multdimensional
*Cumulative effect
*Fluid and dynamic state--changes over time
Historical vs. Transient vulnerability
-Sub populations w/ history of ongoing bias/discrimination
-Mutual factors of vulnerability
-May require different interventions
Vulnerable patients' outcomes
-Health Disparities= poor health outcomes
-Chronic stress=decreased immune response
-Hope/Hopelessness=overwhelming sense of powerlessness and social isolation
-Cycle of vulnerability= Predisposing factors<---->health disparities
Transient vulnerability
Last for a short period of time. Unemployment, debt, etc.
Historical Vulnerability
Non-modifiable. Race, sexuality, ethnic group.
Factors that contribute to vulnerability
- Socioeconomic status: lack of adequate social, educational, and economic resources predisposes people to vulnerability
- Poor health status: changes in normal physiologic status predisposes individuals to vulnerability
- common in elderly, young, chroni
Oppressed group behavior
- Horizontal violence - nurses eat their young, domestic violence, intra-racial violence
- Helpless/hopelessness - nothings going to change, no point in trying
- Internalized group norms and devalued characteristics - "im just a nursing student"
- Fear of
Leading cause of vulnerability?
Poverty
What is the nurse's primary role to a person who is vulnerable?
Advocate
Nurses responsibilities to this population?
-Be a good listener
-Establish trust
-Help coordinate services for clients
-Assess all necessary parameters
-Primary, secondary, and tertiary prevention
-Show respect, compassion, and no bias.
What population is most at risk for successful completion of suicide?
1st White men over 65 with guns
2nd Native American men
Population most at risk for homicide?
-Young African American males
-Young hispanic males
What factors cause the elderly to have poorer health outcomes?
-Limited Income
-Ability to care for themselves
-Support systems
-Transportation
-Pain
-Communication
Vulnerable population trends
-Widening disparity
-Access to care, equality of care
-Increased focus on social justice issues
-Nurses are advocates facilitating change
-Increased awareness for culturally competent care
-Healthcare reform
-Changing environment
-Translation services
Implications for nursing practice of vulnerable populations
Community health nursing
Assessment:
Human biology
Lifestyle - employment, leisure
Environment - social, physical, psychological
Healthcare system -accessibility, availability
Planning and implementation
Advocate
Focus on prevention
Case management - know
Systems thinking
A discipline that allows us to see the whole system and the relationships to the parts rather than the isolated parts
Systems (Key Ideas)
-Looking at the big picture
-Holistic way of thinking
-Mutual dependency
-Recognize forces of internal and external environments
-Interconnectedness
-Boundaries separate systems from each other and from their environments
Flaskerud & Winslow Model
Socioeconomic
Human capital: lack of income most consistent predictor of disease and premature death in the U.S.
Social connectedness or integration: those who are marginalized, stigmatized, and discriminated against are not socially connected or integrat
Example of resources in Winslow Model
-Access to healthcare
-Insurance
Example of relative risks in Winslow model
-Immunizations
-Lifestyle behaviors
Health status examples in Winslow model
-Comorbities
-Age
-Race
-BMI
Four main components of Dever's epidemiologic model?
-Environment
-Human biology
-Lifestyle
-Healthcare system
Examples of environment
Housing, climate and rural vs. urban. Environment influences health status: higher rates of asthma in urban areas and higher rates of MS in northern hemisphere.
Examples of human biology
-Genetics
-Medical history
-Age
-Physical assessment findings
Examples of Lifestyle
-Smoking
-Drinking
-Drugs
-Sedentary
-Diet
-Hobbies
What are examples of healthcare system?
-Insurance
-Primary care provider
-Annual appointments
What is the point of the Dever's model?
Get a comprehensive portrait of a person's health.
What is delirium?
-Any deviation from baseline.
-Treat delirium by treating underlying cause (for example UTI).
-Acute
-Not a long term concern but must be treated in short term.
What is Neurocognitive Disorder?
-Insidious deterioration of brain function.
-Deterioration is structural.
-Results in eventual death.
How is dementia diagnosed?
Mini-Cog Test
(Actual test has person draw a clock and correctly write out the time given to them)
What are some somatic symptoms of depression?
Cardiac symptoms, restlessness, inability to concentrate, flushing and SOB with no apparent causes.
What is Pick's disease?
-Frontal and temporal damage.
-Faster than Alzheimer's
-Duration 2-5 years
-Personality change
-Loss of inhibitions
-Age of onset 50-60
What is Lewy Body Disease?
-Hallucinations
-Tremors
-Memory loss
-Progresses rapidly
-Death 8 years after diagnosis
-Decreased decision making
-Similar to Parkinson's
-Antipsychotic drugs cause EPS/contraindicated
The three "shuns" of delirium?
-Hallucinations-seeing things that are not there
-Illusions-Misinterpreted real-life stimuli
-Delusions- False fixed belief
What is Creutzfeldt-Jakobs?
-Deterioration over months
-Most common in European Jews
-There is an infectious basis
-Associated with corneal lens transplants and eating prions.
How do we know for sure what type of NCD a patient has?
Autopsy