Question

Your 52-year-old next-door neighbor comes to your house and tells you that he woke up an hour ago with swollen lips and swelling of his lower face. He tells you that in the past hour his tongue also has become swollen, making it difficult for him to speak clearly. He is supposed to leave in 2 hours for the airport for a week-long business trip. When you ask him whether this has ever happened to him before, he says “No,” and wonders if he is “coming down with something.” When you ask him which medications he has taken today, he tells you that he took his usual 81 mg of aspirin and his usual lisinopril 10 mg on arising this morning. He asks whether he should just take diphenhydramine (Benadryl) and head for the airport. 1. What should your first assessment be? Provide a rationale for your answer. 2. Do you think he has angioedema or anaphylaxis? Explain your choice. 3. Are either of his usual medications associated with this type of response? 4. Should you advise him to take the diphenhydramine and go on his trip as planned? Why or why not? 5. What should your next action be?

Answer 1

Answer 1. The first assessment in this case is to assess patient swollowing ability, feeling of lump in the throat or stridor. If a patient present with any of  these symptoms immediate intervention has to be given.

rationale: if a patient present with swollowing inability, or feeling of a lump in the throat or stridor it might lead to airway obstruction and breathing difficulties causing  serious life threatening condition.

Answer 2. patient is having Angioedema.

Angioedema is a severe condition of type 1 hypersensitivity reaction that can occur in any parts of the body , but mostly seen on the face, lips,tongue , larynx and neck. The reaction involves all layers of the skin, mucous membranes, subcutaneous tissues, and the blood vessles of the affected area. It is common associated with the use of ACEIs and  NSAIDs, but can also occur with exposure to any drugs or chemicals.

Answer 3. The patient is taking lisinopril 10 mg and Aspirin 81 mg. Lisinopril is an ACEIs( angiotensen-converting enzyme inhibitors) and Aspirin is a NSAID ( non steriodal anti inflammatory drug). Both ACEIs and NSAID have a hight association with angioedema.

Answer 4. diphenhydramine is a very useful drug to treat Angioedema because the hypersensitivity reaction is mediated throught antibodies and release of vasoactive amides . The patient should be recommended to take diphenhydramine . Patient should be on close monitor for atleast  2 to 6 hours after the drug therapy. If the condition does not occur again patient can carry on with his normal plans .

Answer 5. Determine the cause of angioedema, teach patient to avoid the triggering agent, instruct to seek medical help as soon as signs and symptoms shows up. Evaluate the care given to the patient base upon the patient needs and priority.