Case study - Accidental ingestion: Nursing

CASE STUDY - ACCIDENTAL INGESTION
	KEY POINTS	NOTES
INTRODUCTION	Emergency department 2-year-old Accidental acetaminophen ingestion
RECOGNIZING AND ANALYZING CUES	Recognize cues Temperature: 98.6 F (37 C) Heart rate: 118 Respiratory rate: 30 Blood pressure: 92/52 mmHg Pale, sweating Restless, whimpering, easily consoled Pain: 3/10 No abdominal tenderness Approximately 13-160mg acetaminophen pills Emesis x2 Analyze cues Weight: 12.7 kg (28 lbs) Toxic dose: 150 mg/kg Toxicity level exceeded for age and weight Risk of hepatotoxicity
PRIORITIZING HYPOTHESES, GENERATING SOLUTIONS, AND TAKING ACTIONS	Priority hypothesis Impaired liver function Generate solutions No signs of hepatic injury Take action Elevated acetaminophen level Normal liver enzyme levels Orders for activated charcoal, N-acetylcysteine, and IV fluids Education on preventing future ingestion Contact poison control
EVALUATING OUTCOMES	Normal liver enzymes Acetaminophen level undetected Temperature: 98.9 F (37.2 C) Heart rate: 98 Respiratory rate: 22 Blood pressure: 102/60 mmHg Comfortable, relaxed, drinking juice Outcome met

Nurse Olivia works in the emergency department and is caring for Daisy, a 2-year-old who was brought in by Ellen, Daisy’s caregiver, after accidentally ingesting acetaminophen. After settling Daisy in her room, Nurse Olivia goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Daisy’s care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Olivia recognizes important cues including Daisy’s vital signs which are temperature 98.6 F, or 37 C, heart rate 118 beats per minute, respiratory rate 30 breaths per minute, and blood pressure 92/52 mmHg. Nurse Olivia notes Daisy is pale and sweating. She also notices Daily is restless, whimpers occasionally, and is easily consoled by Ellen, so she determines Daisy’s pain rating is 3 out of 10 according to the Face, Legs, Activity, Cry, and Consolability, or FLACC, scale. A gentle abdominal assessment reveals no tenderness.

Nurse Olivia: Ellen, can you tell me about what happened before you brought Daisy here?

Ellen: Well, I was at home making dinner, when I noticed Daisy chewing while holding an open bottle of our acetaminophen pills.

Nurse Olivia: How long ago was that?

Ellen: About two hours ago. I must’ve left the bottle open after I took some pills for my headache. Then the phone rang, and I completely forgot to put the lid back on.

Nurse Olivia: Do you have any idea how many pills she ingested?

Ellen: I think she had about 13; it was a new bottle and I had only taken a couple for myself.

Nurse Olivia: Do you know how many miligrams are in each pill?

Ellen: 160 milligrams.

Nurse Olivia: Okay. Then, after you discovered Daisy had taken the medicine, what happened next?

Ellen: I called Poison Control right away, and they asked me how many pills were in the bottle too. Then they told me to bring Daisy to the hospital immediately.

Nurse Olivia: You did the right thing. Have you noticed any changes in Daisy appearance or behavior?

Ellen: She has vomited twice.

Sources

"Wong’s essentials of pediatrics. (11th ed.)" Elsevier (2022)

"Wong’s nursing care for infants and children. (11th ed.)" Elsevier (2019)

"Perry’s Maternal Child Nursing Care in Canada, (3rd ed.)" Elsevier (2022)

Case study - Accidental ingestion: Nursing

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