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 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 1. 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: 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 labs for 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. This study source was downloaded by 100000887544919 from CourseHero.com on 07-09-2024 15:49:35 GMT -05:00 https://www.coursehero.com/file/84063863/iHumanAmkaOxendinedocx/ 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