Lead Poisoning
You are the triage nurse at the community clinic when a young mom and her 2 year old boy walks in. You immediately noticed the child is looking pale and weak. The mom states the child was vomiting and is refusing to eat. She states they recently moved because they bought an older house in the city. The mom also mentioned that her child seems tired and sluggish.
What additional questions should a nurse ask?
What is the nurse's main concern here, please explain?
Where can lead be found?
Initial assessments include VS 105/65, HR 100, RR 20, Temp 97F, O2 94%. Child weighs 10 kg. Decrease in skin turgor. Child is complaining of abdominal pain.
Mom and the patient are awaiting a Nurse Practitioner to see the child.
What vital signs are concerning at this time?
What is skin turgor test and what does decreased skin turgor mean in this case?
What lab tests is the nurse anticipating to be ordered?
What treatments are expected to be done for the child?
The Nurse Practitioner (NP) completes the physical assessment and orders a blood workup from a capillary sample that includes CBC, BMP and lead levels. She requests a peripheral IV placed and fluids started immediately. The NP inquired when the patient had his last bowel movement. The Mom answered this morning.
Test result arrived and they are as follow:
Lead level of 33 μg/dL.
Go to the CDC web site and look at the required treatment for children with this lead level. https://www.cdc.gov/nceh/lead/advisory/acclpp/actions-blls.htm
Describe what the next step will be based on your findings.
What are your main concerns at this point?
NP also ordered a venous blood work to be sent out to confirm the capillary test results. The nurse learns that Mom is a single mom with 3 other children at home. She qualifies for government assistance, however, she is refusing it because she believes that “receiving handouts is unacceptable.”
Based upon the mother's statement, what education can the nurse provide.?
What entity/department does the nurse need to involve in this situation?
Please review your answers. Without changing your answers, is there anything you would have done differently? Please provide a rationale for your decisions.
What is the mother's beliefs and practices? Perhaps if we learn more about her beliefs and reasons for refusal for governmental assistance, we would be better suited to tailor support to her and her family while providing cultural awareness and understanding.
Before moving in were there any inspections or checks done on the house for lead paint etc. Are there any old toys in the house that were left by previous owners? This may also be a potential source for lead exposure.
We are recommending assessment of consciousness and awareness, balance of fluid intake and output, monitoring of body temperature and blood pressure, blood tests - liver function tests. We are recommend informing epidemiological services because we think it's lead poisoning.
Where was the child possibly exposed to lead? In the home if it was built before 1978 through paint and dust? Or a water or soil source? Finding out where they were exposed is important to prevent further exposure to the child and future exposure to other children/ people.
When did the child start exhibiting symptoms? When did the family move into the home? Are the other children living in the home or experiencing symptoms?
Has the other 3 children she has at home exhibited any of the same symptoms as the 2-year old that has been brought into the clinic?
Is it appropriate to ask the mother why she feels that accepting government assistance is "unacceptable?" Perhaps with that knowledge, the patient education can be more focused to the family situation/views.
Are there any recent changes in the child's behavior, mood, or temperament since the move into the house? Does the child specifically exhibit any irritability or changes in social interactions?
Hi! Does the mother have governmental assistance/uninsured, on her own insurance, or experiencing financial instability/unstable home life? Figuring out if any of these issues are experienced by the family can help justify why the mother feels defeated that she can not provide her children everything they need. This will also help aid education efforts/ approaches for the mother in the future