Toxicity is dose-related; a single acute ingestion of about 150 mg/kg or more is potentially toxic.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A nurse is teaching parents after their infant received routine immunizations. Which instruction is appropriate for managing mild fever and injection-site soreness?
Answer: B. Weight-appropriate acetaminophen and a cool compress to the injection site are recommended for mild post-vaccine fever and soreness. Aspirin is contraindicated in children because of Reye syndrome risk. Routine prophylactic antipyretics before vaccination are not recommended as they may blunt the immune response.
Question 2 of 5
A nurse uses the FLACC scale to assess pain in a 2-year-old child who cannot self-report. Which approach to pain assessment does this represent?
Answer: A. The FLACC scale (Face, Legs, Activity, Cry, Consolability) is a behavioral observation tool for clients who cannot verbally rate pain, such as young children. It is appropriate when self-report is impossible. A 0 to 10 numeric scale and the Wong-Baker FACES require some self-report; physiologic signs alone are unreliable.
Question 3 of 5
A child has recovered from acute rheumatic fever with carditis. The nurse teaches the family about long-term prophylaxis. Which medication is used to prevent recurrence?
Answer: A. Long-term penicillin prophylaxis is given to prevent recurrent streptococcal infections and further cardiac damage in children who have had rheumatic fever. This is continued for years per guidelines.
Question 4 of 5
A parent reports the child has a documented anaphylactic reaction to eggs. Which routine childhood vaccine historically raised the most concern but is now considered safe in this situation per current guidelines?
Answer: B. Influenza vaccine is grown in eggs, but current guidelines state that children with egg allergy, including anaphylaxis, can receive the influenza vaccine with standard precautions. The MMR vaccine, though once a concern, contains negligible egg protein and is also safe.
Question 5 of 5
Why is aspirin contraindicated for fever in a child with a viral infection such as influenza or varicella?
Answer: B. Aspirin use in children with viral illnesses such as influenza or varicella is associated with Reye syndrome, a serious condition involving acute encephalopathy and liver dysfunction. Acetaminophen or ibuprofen is used instead for fever.
Keep the streak going with more questions like these, each with a full rationale.
What is acetaminophen poisoning in children?
Toxicity damages the liver when the body's glutathione stores are depleted by a toxic metabolite. Key principle: the antidote N-acetylcysteine is most effective within 8-10 hours of ingestion, so timing and the Rumack-Matthew nomogram guide treatment.
Key points to remember
- Toxicity is dose-related; a single acute ingestion of about 150 mg/kg or more is potentially toxic.
- Clinical course has four stages: early stage may be asymptomatic or show only nausea, vomiting, and malaise.
- Stage 2 (24-72 hours) brings right upper quadrant pain and rising liver enzymes despite the child feeling better.
- Peak hepatotoxicity (stage 3) occurs at 72-96 hours with jaundice, coagulopathy, and possible liver failure.
- N-acetylcysteine (NAC) is the antidote; it replenishes glutathione and is most effective if given within 8-10 hours.
- The Rumack-Matthew nomogram uses a serum acetaminophen level drawn at least 4 hours post-ingestion to predict toxicity.
Nursing priorities
- Determine the exact dose, formulation, and time of ingestion immediately.
- Obtain a serum acetaminophen level no earlier than 4 hours after ingestion to plot on the nomogram.
- Administer activated charcoal if the child presents within about 1 hour and the airway is protected.
- Administer N-acetylcysteine (oral or IV) as ordered without delay when toxicity is likely.
- Monitor liver function tests, PT/INR, ammonia, and renal function and assess for bleeding.
Labs & values
Patient teaching
- Store all medications, including liquid pediatric products, locked and out of a child's reach.
- Use only the dosing device that comes with the product and dose by the child's weight, not age alone.
- Do not combine multiple products that both contain acetaminophen, as doses add up.
- Call Poison Control at 1-800-222-1222 immediately for any suspected overdose, even before symptoms appear.
Red flags: report now
- Do not delay N-acetylcysteine waiting for a level when ingestion was large or time is uncertain; the antidote loses efficacy after 8-10 hours.
- Jaundice, confusion, bleeding, or rising INR signal hepatic failure and require urgent escalation.
- Never give activated charcoal to a child with a decreased level of consciousness or unprotected airway (aspiration risk).
References
Clinical references for this topic
