Leaded Liam — Lead Poisoning
Pica, old paint chips, blood lead ≥3.5 mcg/dL — remove the source, chelate if high
Liam, age 2, lives in a house built in the 1940s with peeling paint on the windowsills, and he has been caught chewing on paint chips. His mother reports he has been unusually irritable and constipated lately.
Liam lives in an older home with peeling paint and has a habit of eating non-food items (pica), putting him at risk for lead poisoning. Early lead toxicity is often subtle — irritability, abdominal pain, constipation and mild developmental delay — while severe toxicity causes encephalopathy, seizures and permanent cognitive damage. The critical nursing priority is identifying and removing the lead source from the environment; chelation therapy is reserved for significantly elevated levels.
Read Leaded Liam's full story →The story arc
The setup
Liam's family recently moved into an older rental home, and Liam, at the age where putting things in his mouth is normal exploration, is found chewing paint chips from a windowsill.
The turn
Over several weeks Liam becomes more irritable, loses his appetite, complains of belly pain, and becomes constipated.
The crisis
A screening blood lead level comes back at 48 mcg/dL, and Liam's mother mentions he has seemed clumsier and less talkative than before.
The save
The nurse coordinates chelation therapy, reports the case to public health for home inspection and lead abatement, and teaches the family to remove Liam from the source immediately and improve his diet with iron and calcium to reduce lead absorption.
NCLEX study section — Lead Poisoning
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Pediatrics
Take this chapter into practice questions on the same topic.