A blood lead level (venous) of 3.5 mcg/dL or higher is elevated; there is no truly safe level.
Before you read
Test yourself first: 3 questions
Question 1 of 3
To reduce 'alarm fatigue' and keep clients safe, the nurse should:
Answer: B. Customize alarm parameters appropriately to the client, respond to alarms promptly, and maintain leads/sensors — not silence or disable alarms, which endangers clients.
Question 2 of 3
A client at high risk for falls has a history of getting up unassisted at night. The best intervention is to:
Answer: B. Proactively offer scheduled toileting, keep the call light and personal items within reach, use a night light and bed alarm, and round frequently. Waiting for the client to call often leads to unassisted attempts.
Question 3 of 3
Which strategy best prevents tenfold dosing errors in pediatric medication orders?
Answer: B. Tenfold errors arise from misplaced decimals. Using a leading zero before a decimal point (for example 0.5 mg, never .5 mg) and never using a trailing zero (5 mg, never 5.0 mg) prevents misreading. This is an ISMP-endorsed standard.
Keep the streak going with more questions like these, each with a full rationale.
What is lead poisoning?
Young children are at highest risk because of hand-to-mouth behavior and pica. Key principle: lead toxicity is often silent early but causes irreversible neurologic and cognitive damage, so screening and source removal are essential.
Key points to remember
- A blood lead level (venous) of 3.5 mcg/dL or higher is elevated; there is no truly safe level.
- The most common source is deteriorating lead-based paint and contaminated dust or soil in older housing.
- Early signs are vague: irritability, anorexia, abdominal pain, constipation, fatigue, and developmental delays.
- High levels cause encephalopathy: seizures, altered level of consciousness, ataxia, and increased intracranial pressure.
- Lead interferes with hemoglobin synthesis, producing a microcytic, hypochromic anemia that mimics iron deficiency.
- Chelation therapy (succimer oral, or calcium EDTA and dimercaprol/BAL for severe cases) is used at high levels.
Common causes
- Old paint chips, dust, soil
- Pica behavior, pre-1978 homes
Signs & symptoms
- Irritable, ↓ dev, learning issues
- Anemia, abd pain, constipation
- Encephalopathy if severe
Nursing priorities
- Obtain a venous blood lead level to confirm an elevated capillary screen.
- Identify and eliminate the lead source from the child's environment before discharge home.
- Administer prescribed chelating agents and monitor renal function, hydration, and intake/output.
- Promote adequate iron, calcium, and vitamin C intake, which reduce lead absorption.
- Assess and document developmental and neurologic status and refer for early intervention.
Labs & values
Patient teaching
- Wet-mop floors and wipe windowsills frequently to control lead dust; do not dry-sweep or sand old paint.
- Wash the child's hands and toys often, especially before eating.
- Run cold tap water for 1-2 minutes before use and never use hot tap water for formula.
- Serve iron- and calcium-rich foods, which limit how much lead the body absorbs.
Red flags: report now
- Seizures, lethargy, vomiting, or altered consciousness signal lead encephalopathy and increased ICP, a medical emergency.
- Never discharge a child back to an unremediated lead-contaminated home.
- Do not give BAL (dimercaprol) to a child with a peanut allergy, as it is prepared in peanut oil.
References
Clinical references for this topic
