Amka Oxendine (iHuman)

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 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

Deniesingestion ofsalicylates, ETOH or other substances within in 24 hr. Four hourslater after waking up

had second thoughts and call EMS.

58 kg. Full Code. VS q1hr x4, a2hr, q4hr. NPO. NIKA. SI precautions until psychiatrist

1. What is your primary concersfor 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 ofs/s of liver failure: anorexia, n/v,

fatigue, excessive sweating and confusion.

The interventions I would perform:

1. Assessing time of ingestion***, Quantity/Strength, and reason.

2. Consider evaluating for other co-ingestions(e.g.,salicylates, tricyclic antidepressants,

ethanol, ethylene glycol, methanol) especially since this is a known suicide attempt.

3. 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.

4. Utilize oxygen therapy if pt is noted to be in respiratory distress.

5. Give IV fluid and draw labsfor Paracetamol blood level.

6. Provide antidote of N-acetylcysteine as prescribed.

7. Activated charcoal should be administered as soon as possible, usually within 1- 2 hours of

the exposure as prescribed.

2. What medications do you anticipate the health care provider would prescribe while the

patient is in the hospital and why?

1. Activated charcoal to halt the absorption of acetaminophen in the stomach typically

within 1-2 hours of exposure. It acts by binding to the pharmaceutical drugs or poisons

i.e. organophosphates and decreasing the systemic absorption of toxic agents.

2. N-Acetylcysteine is a precursor of glutathione. It enhances sulfate conjugation of

unmetabolized APAP, functions as an anti-inflammatory and antioxidant, and has positive

inotropic effects. It increases local nitric oxide concentrations and promotes

microcirculatory blood flow, enhancing local oxygen delivery to peripheral tissues.

3. Cimetidine to slow the effect of acetaminophen

4. Anti-emetics to assist with n/v

5. 0.9% NS to provide hydration from fluid loss due to nausea

EHR findings:

58 kg. Full Code. VS q1hr x4, a2hr, q4hr. NPO. NIKA. SI precautions until psychiatrist

IP MEDS:

NAC 150mg/kg IV in 200 ml D5w over 60 mins IV, then 50mg/kg 500 mL IV in 4hr and 100,g/kg in 1000

mL over 16hr IV

NS 75mL/hr

Albuterol 2.5 mg q20min x 3 doses continuous prn bronchospasm

Diphendrdraminine 50 mg IV prn rash

EKG.

Hx: Depression dx: age 15. On antidepressant therapy since 16.

Meds: Fluoxetine 20 mg 1 tab po daily NKDA

Social: Freshman at college, lives in dorms. Server at local restaurant. Single Denies etoh/cig. +exercise

Tylenol level: 150 ug/mL **toxic >250

12 EKG: NSR

EHR MC ANSWERS: Nausea, Abd pain, pale, warm, diaphoretic skin, elevated APAP levels, SI

precautions