Asthma & Safety

Promoting Safety with Children and Asthma

Key Learning Objectives

  • Identify four principles of emergency treatment for poisonings.

  • Nursing care protocols for children with lead, Tylenol, aspirin, corrosive, and hydrocarbon poisonings.

  • Provide anticipatory guidance to parents regarding accident prevention based on developmental milestones.

  • Explain pathophysiology of asthma and related symptoms.

  • Discuss medical treatment strategies for children with asthma in the emergency room vs. pediatric units.

  • Educate families prior to discharge regarding major asthma medications:

    • Fast-acting (e.g., Albuterol)

    • Corticosteroids (e.g., Prednisone, Flovent)

    • Leukotriene receptor antagonists (e.g., Singulair)

Important Medications and Treatment Plans (Asthma aka RAD)

  • Asthma Management:

    • Quick relief medications (bronchodilators) help open airways, may increase heart rate as a side effect (e.g., Albuterol).

    • Long-term management includes maintenance inhalers to prevent attacks.

    • Importance of family education on steroid inhaler use (e.g., rinsing mouth to prevent thrush).

    • >60 RR puts child at aspiration risk, put the child on NPO.

  • Accident Prevention Guidelines:

    • Stress importance of safety practices amongst various age groups (infants, toddlers, etc.).

    • Strategies for supervision and preventing common accidents (e.g., drowning, aspiration).

Recognizing Symptoms of Asthma Attacks

  • Common Symptoms Indicating Attack:

    • Labored breathing, wheezing, tachycardia, nasal flaring, inability to complete sentences, and retractions.

  • Management Protocols should account for:

    • Continuous assessment of respiratory status.

    • Deployment of rescue therapies (e.g., nebulizers) upon recognition of symptoms.

  • Magical Number: Respiratory rate above 60 indicates proceed with caution concerning feeding to avoid aspiration risk.

Poisoning Protocols and Treatments

  • Four Principles of Emergency Treatment for Poisonings:

    1. Stabilization: Assess and secure airway, breathing, and circulation (ABCs). Provide supportive care.

    2. Identification: Determine the substance, amount, time of exposure, and route. Obtain history from caregivers.

    3. Decontamination: Prevent further absorption by removing or inactivating the poison. Methods include gastric lavage, activated charcoal, or irrigation for skin/eye exposures.

    4. Antidotes/Specific Treatment: Administer specific antidotes if available, or provide targeted supportive care.

  • Nursing Care Protocols for Specific Poisonings:

    • Lead Poisoning:

      • Sources: Old paint, contaminated soil, certain toys, traditional remedies.

      • Symptoms: Developmental delay, irritability, loss of appetite, weight loss, abdominal pain, vomiting, constipation, lethargy, seizures.

      • Treatment: Chelation therapy (e.g., EDTA, succimer) to remove lead from the body. Environmental remediation is crucial.

      • Nursing Care: Monitor for neurodevelopmental effects, ensure adequate hydration, educate parents on lead avoidance strategies.

    • Tylenol (Acetaminophen) Poisoning:

      • Mechanism: Overdose depletes glutathione, leading to toxic metabolite accumulation and liver damage.

      • Symptoms: Initial symptoms often mild (nausea, vomiting, lethargy); liver damage manifests later (jaundice, right upper quadrant pain).

      • Treatment: Administer activated charcoal if presenting early (within 1-2 hours); N-acetylcysteine (NAC) is the antidote, most effective within 8 hours of ingestion.

      • Nursing Care: Monitor liver function tests (ALT, AST), PT/INR, glucose. Maintain hydration. Educate on safe dosing and proper storage.

    • Aspirin (Salicylate) Poisoning:

      • Mechanism: Overstimulates the respiratory center, leading to respiratory alkalosis, followed by metabolic acidosis. Uncouples oxidative phosphorylation.

      • Symptoms: Nausea, vomiting, tinnitus, hyperventilation, diaphoresis, fever; severe cases may involve altered mental status, seizures, hemorrhage.

      • Treatment: Gastric lavage or activated charcoal if early. Alkalinization of urine with sodium bicarbonate to enhance excretion. Hemodialysis for severe cases or refractory acidosis.

      • Nursing Care: Monitor acid-base balance, electrolytes, glucose. Administer IV fluids. Control fever. Monitor for bleeding.

    • Corrosive (Alkali/Acid) Poisoning:

      • Types: Drain cleaners (alkali), battery acid (acid), strong household cleansers.

      • Symptoms: Severe pain in mouth/throat/chest, drooling, dysphagia, vomiting, respiratory distress (stridor).

      • Treatment: DO NOT induce vomiting. Immediate dilution with small amounts of water or milk, if appropriate and patient is cooperative. Endoscopic evaluation to assess mucosal injury. Supportive care for pain and airway compromise.

      • Nursing Care: Maintain airway, manage pain, NPO status, monitor for perforation or stricture formation, educate parents on safe storage.

    • Hydrocarbon Poisoning:

      • Types: Gasoline, kerosene, lighter fluid, paint thinners, furniture polish.

      • Primary Concern: Aspiration into the lungs, leading to chemical pneumonitis.

      • Symptoms: Coughing, choking, gagging, difficulty breathing, cyanosis; CNS depression if absorbed systemically.

      • Treatment: DO NOT induce vomiting. Risk of aspiration is high. Supportive care for respiratory distress (oxygen, ventilation if needed). Monitor for aspiration pneumonia.

      • Nursing Care: Monitor respiratory status closely (rate, effort, oxygen saturation). Avoid gastric lavage unless a large amount with systemic toxicity is suspected and a cuffed endotracheal tube is in place to protect the airway. Educate parents on child-resistant packaging and storage.