iHuman Amka Oxendine- Pre-work & All Sections with Answer & SBAR note.
19 y/o F, 5’3”, 127 lbs. Dx: Acute acetaminophen ingestion
Brought vis
... [Show More] EMS to ER with c/o abd pain with nausea. EMS reports ingestion of acetaminophen for SI. 58 kg. Full Code. VS q1hr x4, a2hr, q4hr. NPO. NKDA. SI precautions until psychiatrist
Denies ingestion of salicylates, ETOH or other substances within in 24 hr. Four hours later after waking up had second thoughts and call EMS.
58 kg. Full Code. VS q1hr x4, a2hr, q4hr. NPO. NIKA. SI precautions until psychiatrist
What is your primary concers for this patient and what assessments and interventions would be associated with your concerns and why?
My primary concern would be to assess for Airway Breathing Circulation- SOB, CP, and palpitations. I would assess for unusual bleeding as a priority. Next I would perform a neurovascular check, noting PERRLA. I would also be aware of s/s of liver failure: anorexia, n/v, fatigue, excessive sweating and confusion.
The interventions I would perform:
Assessing time of ingestion***, Quantity/Strength, and reason.
Consider evaluating for other co-ingestions (e.g., salicylates, tricyclic antidepressants, ethanol, ethylene glycol, methanol) especially since this is a known suicide attempt.
Since patients with acetaminophen toxicity can develop not only liver failure, but also renal failure, coagulopathy due to liver failure, and acid base disturbances, will monitor for the following additional labs (serum creatinine, urinalysis, lactic acid level, arterial blood gas, venous blood gas). Serial labs will likely be needed to determine the clinical course of the patient.
Utilize oxygen therapy if pt is noted to be in respiratory distress.
Give IV fluid and draw labs for Paracetamol blood level.
Provide antidote of N-acetylcysteine as prescribed.
Activated charcoal should be administered as soon as possible, usually within 1- 2 hours of the exposure as prescribed. [Show Less]