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care for a poisoned patient
- General nursing care for patients with gastrointestinal poisoning
1. Ensure the airway is clear and sufficient oxygen reaches all parts of the body by:
o Performing a blood gas analysis from an arterial sample as previously explained.
o Monitoring vital signs and measuring central venous pressure.
o Preparing to connect the patient to a ventilator if needed.
o Administering oxygen in the following cases:
➡️ Shock
➡️ Loss of consciousness
➡️ Cyanosis
o Preventing stomach contents from entering the respiratory system by keeping the patient lying on their side with their head down, using an artificial airway, and suctioning.
o Connecting the patient to an ECG monitor.
o Attaching a urinary catheter to monitor kidney function.
o Collecting a venous blood sample to analyze toxin levels.
o Assessing the patient’s neurological status.
2. Collect incident history:
o What the patient ingested, quantity, time since ingestion, symptoms, age, weight.
o If the toxic substance is unknown, contact the local poison control center for guidance or information on the appropriate antidote.
3. Treat shock.
4. Remove or inhibit absorption of the toxic substance:
o Induce vomiting under the previously mentioned conditions.
o Perform gastric lavage and retain a sample for analysis.
o Administer activated charcoal.
o Provide a suitable purgative if appropriate.
5. Administer the antidote to reduce the toxicity of the substance.
6. Address hypoxia, which can cause dizziness, and take steps to prevent injury to the patient.
7. Facilitate toxin elimination from the body through:
o Administering diuretics to help the kidneys excrete the toxin and prevent accumulation.
o Blood purification.
o Repeated doses of activated charcoal.
8. Monitor central venous pressure.
9. Observe and correct fluid and electrolyte imbalances.
10. Maintain body temperature within the normal range.
11. Administer pain relievers cautiously as prescribed to ensure the body’s vital functions are maintained, as severe pain can disrupt these functions.
12. Assist in collecting samples of blood, urine, stomach contents, or vomit.
13. Continuously evaluate the patient’s condition and monitor for coma.
14. Monitor and manage complications, such as:
o Low blood pressure
o Irregular heartbeat
o Dizziness
15. Provide discharge instructions:
o Educate the patient about warning signs of complications and when to return to the hospital or contact medical help.
o If the poisoning was a suicide attempt, recommend psychiatric evaluation.
o If the poisoning was accidental, provide guidance on how to prevent future incidents for the patient or other family members.
The goal is to improve the oxygen supply to the brain and heart muscles and accelerate the elimination of carbon monoxide by:
- Administering 100% oxygen at normal pressure.
- Drawing a blood sample to analyze the level of carbon monoxide bound to hemoglobin and the oxygen level, and continue administering oxygen until the carbon monoxide bound to hemoglobin reaches 5%.
- Continuously monitoring the patient and observing any abnormalities that may arise from the brain being deprived of oxygen for an extended period (maximum of 4-5 minutes), as exceeding this time can cause permanent damage to the nerve cells in the central nervous system.
- If this happens unintentionally, other individuals in the same area should be examined (in cases of carbon monoxide poisoning).
- Consult a psychiatrist if the poisoning was due to suicide.
Nursing care in case of poisoning through skin absorption of the toxic substance:
1. Expose the skin to running water while removing any clothing and personal items that have come into contact with the toxic substance (shoes, wedding ring, etc.).
2. Attempt to identify the substance causing the poisoning in order to treat it with the appropriate antidote.
3. Provide full care for the skin in case of burns (as previously explained).
4. Advise the patient to re-examine the areas exposed to the toxic substance 24 to 72 hours later, or within 7 days.
Nursing care in case of snake poisoning:
1. Gather a baseline of information for later comparison.
2. Do not use ice, pressure, heparin, or corticosteroids during the acute phase (6-8 hours) after exposure.
3. Administer intravenous fluids in case of low blood pressure. If a vasoconstrictor is used, it should be used for a short period.
4. Perform a surgical exploration of the bite, which is rare.
5. Monitor the patient closely for no less than 6 hours and never leave the patient alone.
Nursing care in case of drug poisoning:
1- Ensure the safety of the airway and breathing:
• Use an endotracheal tube and secure it with its balloon, providing artificial respiration when needed.
• Analyze an arterial blood sample to check blood acidity and gases.
• Administer oxygen.
2- While ensuring proper breathing, also ensure the heart is functioning to intervene appropriately:
• Perform an ECG and connect the patient to a heart monitor.
• Take a blood sample to check glucose, sodium, potassium, urea, creatinine levels, and blood poisoning.
• Begin administering intravenous fluids.
3- Administer the antidote as prescribed based on the name of the toxin the patient ingested. Use Narcan, glucose (50% in water for cases of low blood sugar).
4- Remove the drug from the stomach (as previously explained).
5- Measure temperature from the rectum:
- Ensure the patient's safety.
- Monitor for dizziness.
- Insert a urinary catheter.
6- Clinically examine the patient to ensure there is no:
- Insulin shock.
- Meningitis.
- Brain hemorrhage.
- Hemiplegia.
7- Attempt to obtain the incident history either from the patient or those with him, and never leave the patient alone.
8- Transfer the patient to the intensive care unit if unconscious, and also for psychological consultation.
