Poisoning is a serious concern in any healthcare setting, as it can have severe consequences for patients. In order to prevent poisoning, nurses must be able to identify patients at risk and implement interventions to reduce that risk. The NANDA nursing diagnosis of “Risk of Poisoning” is used to identify patients who are at risk for poisoning and to guide nursing interventions to prevent it.
NANDA Nursing Diagnosis Definition
According to NANDA International, the official definition of “Risk of Poisoning” is: “The potential for harm or injury related to the ingestion, inhalation, or skin or eye contact with harmful substances, as evidenced by factors such as history of exposure, presence of toxic substances, or alterations in vital signs.”
Defining Characteristics
- History of exposure to toxic substances
- Presence of toxic substances in the environment or on the patient’s skin or clothing
- Alterations in vital signs such as tachycardia, hypertension, or changes in level of consciousness
- Symptoms such as nausea, vomiting, or dizziness
- Evidence of skin or eye irritation or chemical burns
Related Factors
- Access to toxic substances
- Lack of knowledge about the toxic properties of substances
- Impairments in cognitive or physical function
- Certain medications that may interact with toxic substances
- Environmental factors such as poor ventilation or hazardous waste disposal
- Occupational exposure
Risk Population
Individuals who are at a higher risk for poisoning include:
- Young children and infants
- Elderly individuals
- Individuals with cognitive or physical impairments
- Individuals with a history of substance abuse
- Individuals who work with or are exposed to toxic substances
- Individuals living in homes or environments with poor ventilation or hazardous waste disposal
Associated Problems
- Organ damage or failure
- Seizures or coma
- Death
- Increased length of hospital stay
- Decreased functional ability
- Decreased quality of life
Suggestions for Use
To prevent poisoning, nurses should take the following steps:
- Assess the patient’s risk for poisoning by taking a thorough history and identifying any potential sources of exposure.
- Implement safety measures to limit the patient’s access to toxic substances, such as keeping medication out of reach of children or providing protective clothing for patients working with hazardous materials.
- Educate the patient and their family about the dangers of poisoning and how to prevent it, including proper storage and disposal of hazardous materials.
- Monitor the patient’s vital signs and symptoms and report any changes to the healthcare provider immediately.
- Administer appropriate treatments and interventions, such as decontamination or administering an antidote if the patient has been exposed to a toxic substance.
- Regularly assess and adjust the patient’s medications to minimize the risk of interactions with toxic substances.
Suggested Alternative NANDA Diagnoses
- Ineffective Airway Clearance
- Impaired Gas Exchange
- Impaired Skin Integrity
- Impaired Verbal Communication
- Risk for Injury
Usage Tips
- This diagnosis should be used in conjunction with other diagnoses that may be contributing to the patient’s risk of poisoning, such as Ineffective Airway Clearance or Impaired Skin Integrity.
- It is important to monitor the patient’s response to interventions and adjust as necessary.
- It is also important to consider the patient’s overall health history and any previous exposure to toxic substances.
- In cases where the patient has been exposed to a toxic substance, referral to a toxicologist or poison control center may be necessary.
NOC Results
- Tissue Integrity: This outcome measures the effectiveness of interventions in maintaining the integrity of the patient’s skin and mucous membranes, which can be damaged by toxic substances.
- Respiratory Status: This outcome measures the effectiveness of interventions in maintaining a patent airway and ensuring proper oxygenation, which can be compromised by toxic substances.
- Communication: This outcome measures the patient’s ability to communicate effectively, which can be impaired by toxic substances.
- Safety: This outcome measures the patient’s overall level of safety, including their risk of poisoning.
- Comfort: This outcome measures the patient’s level of comfort and the effectiveness of interventions to reduce discomfort related to poisoning.
NIC Interventions
- Airway Management: This intervention involves maintaining a patent airway through techniques such as suctioning, positioning, and mechanical ventilation, which can be compromised by toxic substances.
- Decontamination: This intervention involves removing toxic substances from the patient’s skin or clothing to minimize the risk of further exposure.
- Medication Management: This intervention involves administering appropriate medications, such as antidotes or activated charcoal, to counteract the effects of toxic substances and prevent further harm to the patient.
- Environmental Management: This intervention involves identifying and addressing any environmental factors that may contribute to the patient’s risk of poisoning, such as poor ventilation or hazardous waste disposal.
- Patient Education: This intervention involves educating the patient and their family about the risk of poisoning and how to prevent it, including proper storage and disposal of hazardous materials.
- Patient Monitoring: This intervention involves regularly monitoring the patient’s physical and cognitive status, vital signs, and symptoms, and adjusting interventions as necessary to minimize the risk of poisoning.
Conclusion
The NANDA nursing diagnosis of “Risk of Poisoning” is crucial for identifying patients who are at risk for poisoning and implementing interventions to prevent it. By understanding the diagnosis and related factors, nurses can take appropriate action to promote safety and reduce the risk of poisoning in at-risk patients.