NORCET -4 , 2023
Medical & Surgical Nursing
Easy
The nurse knows that in which of the following poisoning case gastric lavage is not recommended?
Appeared in: NORCET -4 , 2023
Explanation
- Gastric lavage is contraindicated in corrosive poisoning due to the high risk of perforating the already damaged esophagus or stomach.
- The procedure can induce vomiting, which causes re-exposure of the esophagus to the corrosive agent, leading to a second chemical burn and worsening the injury.
- Instead of lavage, management for corrosive ingestion focuses on dilution (if appropriate and done early), supportive care, and managing complications like airway obstruction and perforation.
Why Other Options Were Wrong
- Option A: Gastric lavage can be a treatment option for arsenic poisoning to remove the unabsorbed heavy metal from the stomach.
- Option C: Gastric lavage is a standard and often critical part of the initial management of organophosphorus poisoning to decontaminate the stomach.
- Option D: For plant-based poisonings like Dhatura, gastric lavage is used to remove unabsorbed seeds and toxins from the gastrointestinal tract.
Related Visual
- Visual 1: Diagram - An illustration showing the path of a gastric lavage tube and highlighting the weakened, friable tissue of the esophagus and stomach after corrosive ingestion, with a warning icon indicating the risk of perforation.
- Visual 2: Flowchart - A decision-making flowchart for ingested poisons, showing the initial assessment (ABCs), identification of the substance, and branching pathways for 'Corrosive/Hydrocarbon' (leading to 'No Lavage/Emesis') versus 'Other Toxins' (leading to 'Consider Lavage/Charcoal').
Clinical Relevance
- Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Contraindications for Gastric Lavage in Poisoning in acute care settings.
- The single most important nursing action before any decontamination procedure is to identify the ingested substance. Treating a corrosive poisoning with lavage can be a fatal error.
- The priority in any poisoning case is always the ABCs: Airway, Breathing, and Circulation. Stabilize the patient before initiating decontamination.
- Nurses must be prepared to manage complications of corrosive ingestion, including severe pain, airway edema, shock, and signs of perforation (e.g., rigid abdomen, fever).
How to Approach the Question
- First, identify the negative framing of the question with the keyword 'not'. This means you are looking for a contraindication.
- The question asks when gastric lavage is NOT recommended. This requires you to know the risks associated with the procedure.
- Consider the nature of each poison. 'Corrosive' implies a substance that burns and destroys tissue on contact.
- Think about the mechanics of gastric lavage: a tube is physically inserted down the esophagus into the stomach.
- Connect the two concepts: inserting a tube into tissue that has been chemically burned and weakened would be extremely dangerous and could cause a perforation.
- Evaluate the other options: Arsenic, organophosphorus, and Dhatura are toxins that do not physically destroy the GI tract lining on contact, so removing them via lavage is a valid treatment goal.
Concept Tested & Keywords
- Concept Tested: Contraindications for Gastric Lavage in Poisoning
- Stem keywords: gastric lavage, poisoning, not recommended
- Lead-in keywords: not
- Negative lead-in flag: The question asks for a situation where gastric lavage is NOT recommended, which is a contraindication.
Question ID
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Practise the full NORCET -4 , 2023
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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