The caregiver of a toddler calls the clinic because the child has accidentally ingested one capsule of amitriptyline found in the medicine cabinet. The caregiver states that the child appears to be acting normally. Which response by the nurse is appropriate?

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11ecbb05_cb69_ecb0_b433_2781de6ffc07_MD0009_00 Amitriptyline is a tricyclic antidepressant (TCA) that can produce cardiac toxicity and neurological disturbances by altering cholinergic pathways, sodium channels, and calcium channels, causing symptoms such as atrioventricular block, hypotension, cardiac arrest, and seizure. TCAs have a narrow therapeutic index and rapid onset of action, so ingestion of even a small amount may be life-threatening for a toddler. Symptoms of toxicity are usually evident within hours of ingestion, but cardiac failure can develop days after. Neurological and hemodynamic assessments, as well as ECG monitoring in an emergency department setting, are recommended (Option B). (Option A) Syrup of ipecac is no longer routinely recommended for oral poisonings. The uncontrolled vomiting and vagal response induced can be harmful after ingestion of toxic substances. Treatments such as oral activated charcoal may be used in the inpatient setting to remove the ingested toxin if the client presents immediately after the ingestion. (Option C) The caregiver should not be instructed to stay home to monitor for symptoms due to the rapid onset of toxicity. (Option D) An outpatient clinic is not sufficiently staffed or equipped for acute management of amitriptyline toxicity. The nurse should refer the client to the nearest emergency department, which is the safest environment for monitoring and treatment. Educational objective: Amitriptyline is a tricyclic antidepressant (TCA) that can cause toxic cardiac and neurological effects in children, even in small doses. Children who have accidentally ingested TCAs should be evaluated immediately in an emergency department.

The Caregiver of a Toddler Calls the Clinic Because the Child