Pediatric Nursing Q 185
An unconscious child is brought to the emergency room due to Tylenol poisoning. Which of the following is the most appropriate nursing action?
A. Administer mucomyst P.O
B. Gastric lavage with activated charcoal
C. Gastric Lavage with activated charcoal and mucomyst
D. Administer ethylenediaminetetraacetic acid (EDTA)
Correct Answer: B. Gastric lavage with activated charcoal.
In an unconscious child with Tylenol poisoning, the priority intervention is to administer gastric lavage with activated charcoal to decrease the absorption of Tylenol. If the patient presents within 1 hour of ingestion, GI decontamination may be attempted. In alert patients, activated charcoal can be used. Orogastric lavage or whole bowel irrigation is not effective.
Option A: This is not correct due to the risk of aspiration. All patients with high levels of acetaminophen need admission and treatment with N-acetyl-cysteine (NAC). This agent is fully protective against liver toxicity if given within 8 hours after ingestion. NAC works through multiple routes.
Option C: Activated charcoal inactivates mucomyst. NAC can be administered both intravenously (IV) and orally. The IV form has shown to decrease the length of the hospital stay and may be better tolerated by the patient as the oral form has a foul rotten egg odor and taste. The oral form also requires 18 doses given 4 hours apart, with the total treatment time being 72 hours.
Option D: This is the drug of choice for lead poisoning. Ethylenediaminetetraacetic acid (EDTA) is a medication used in the management and treatment of heavy metal toxicity. It is in the chelating class of drugs.