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PEDIATRIC ACCIDENTS - FOREIGN BODY ASPIRATION,

DROWNING & POISONING

Session Objectives:

• Review disease/disorder overview.

• Discuss the etiology and pathology.
• Review signs and symptoms of the illnesses.
• Address nursing interventions including medications
• Review child and family education needs.

Points of Emphasis:

Foreign Body Aspiration

• Common cause of mortality and morbidity in children
• Caused by foreign body slipping in to trachea
• Risk Factors:
o ability to stand and walk, explore surroundings
o improving fine motor skills
o running around when eating
o lack molars to grind food
• Signs & Symptoms
o Partial obstruction with good air exchange-coughing, wheezing, crying.
o Partial obstruction with poor air exchange-ineffective cough, cyanosis, clutching throat,
universal distress signal.
o Complete obstruction-unable to make sounds, no coughing crying or speaking.
Cyanosis and clutches neck.
• Nursing Interventions
o Conscious Choking Infant-Alternate 5 back blows and 5 chest thrusts
o Unconscious Infant-start CPR
o Conscious Choking Child-1 year to puberty, series of 5 abdominal thrusts. Repeat until
obstruction is dislodged.
o Unconscious Choking Child-Open mouth, look for obstruction, if visible one finger
sweep. If unsuccessful, start CPR.

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• Educational Needs
o No running while eating
o Chew food well
o Toddlers-no hot dogs, raw carrots, grapes, peanuts. Cut food to pea sized pieces.
o No small toys where toddlers can reach them.

Drowning

• Child exposed to severe hypoxia

• Cause of death is asphyxia from airway obstruction, laryngospasm (dry drowning), aspiration of
liquid (wet drowning), or initially resuscitated and death occurs minutes to days after
resuscitation (delated death or post-immersion syndrome)
• More boys drown than girls
• Most drownings from 1-2 years old and 15-19 years old
• Signs & Symptoms
o Hypothermia
o Wheezing, crackles, pallor, cough with frothy sputum
o Alert, any level of CNS compromise to profound coma
o Bradycardia, tachycardia
• Nursing Interventions-on site
o Call for help
o Remove from water, keep warm
o Start breaths, once out of water start compressions
o C-spine precautions
• Nursing Interventions-in hospital
o Immediate resuscitation, treatment for respiratory failure
o Manage airway
o Neurologic assessment
o Volume expansion
o Monitor ABGs, electrolytes, blood glucose, pulse oximetry
• Educational Needs
o Return to ER if child develops dyspnea, cough, fever
o Never leave child unattended near water
o Childproof home and pool
o Teach children to swim, avoid false sense of security
o Boating safety with coastguard PDFs
o Older children-do not swim alone, jump or dive into water that is unknown to you

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Poisoning

• A poison is a substance that causes harm if it gets into the body

• Can be accidental, suicidal or homicidal
• Exposure can be acute or chronic
• Poisoning can be ingested, inhaled, contact with skin or eyes or by injection
• Toddlers during 2nd year of life most at risk. Male children more at risk.
• Signs & Symptoms
o Odor, sweating
o Burns around mouth
o Blindness
o Seizures, abnormal movements, delirium, coma
o Respiratory symptoms
• Nursing Interventions
o Use of antidote-often not available and very few antidotes for commonly encountered
poisons
o Antidotes available for-salicylate poisoning, acetaminophen poisoning and lead toxicity.
o Decrease absorption, hasten elimination
o Flush eyes or skin
o If not contraindicated-induce vomiting
o Hydrate and correct acidosis, hyperkalemia, hypoglycemia
o If comatose- maintain airway, cardiac monitor, monitor neuro status
• Educational needs
o Keep poison control phone number available
o Follow instructions from Poison Control Center
o Store medications and cleaning in locked cabinets in original containers
o Reinforce need to supervise children
o save any vomit, stool or urine for testing

References:

• Arikian, Veronica P, PhD., RN, et al, The Basics, (2012) Kplan, Inc.
• Kaplan NCLEX Content Review Guide, 3rd edition, (March 2017) New York, NY
• Marilyn J Hockenberry PhD, RN-CS, PNP, FAAN; David Wilson, MS, RN C(inc); Cheryl C. Rogers,
PhD, RN, CPNP, CPON. Hockenberry:Wongs Essentials of Pediatric Nursing, 10th ed. 2017
• Benjamin Wedro MD, FACEP, FAAEM, Drowning (dry, wet, near), retrieved 3,2018
www.medicinenet .com/drowning/article htm (2016)

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