Question

Ms Scott arrives in the ED by car. She reports having been at the park with her spouse and children when she suddenly started having severe shortness of breath….

1. You need to quickly gather information. What questions do you ask?

2. What assessments do you want to make?

Ms Scott tells you that she has no previously known allergies. On her arm you note a small area that looks like a sting or bite. She quickly remembers that she was stung by a bee in the park and had forgotten because of her concern over her difficulty breathing. Your assessment reveals swelling of the lips/tongue, RR 28 and shallow, 02 sat 88%. Her lung sounds reveal wheezes throughout and you hear a faint, high pitched wheeze coming from her upper airway.

3. What do you need to do first?

4. What orders would you like? Why?

The ED healthcare provider comes in to quickly assess and orders:

• Oxygen 2-4 l/min to keep sat above 92%
• Placement of an oral airway
• NS 100 ml/hr
• Epinephrine 1:1000 – 0.4 mg IM
• Solu-Medrol 125 mg IVP
• Albuterol nebulizers
• Telemetry monitoring
• VS q 30 minutes for 2 hours

5. What is the reasoning for these orders?

After a dose of epinephrine, Solu-Medrol, and a bronchodilator, Ms. Scott begins to improve. Later that day, they decide to discharge her to home with a prescription for an epi pen.

6. What do you absolutely need to teach her before she leaves?

7. What other things would you like to teach her?

Answer 1

1.what questions do you ask

• ,what allergy do you have
• do you have other drug history
• do you have any bad habit

2.what assessment do you want to make

observe the breathjing pattern.

assess the airway, measure vital signs

momitor cardiac rythm,

assess colour of skin

assessment of vital signs

3.what do you need to do first

sitting on upright position

provide oxygen

inform to doctor

remove sting,tick or hair from body

provide other supportive therapy

provide antihistamine

apply cold compress teduce the swelling

4.what orders would you like ? why ?

oxygen is given to patient in case of skin changes present.and also his saturation is 88 %

epinephrine is given to treats breathing difficulty. anaphylaxis a severe allergic reasction that could make breathing difficult.

albuterol nebulizer is not given because it does not relive upper airway edema

solu medrol is given to patient it may help calm the reaction and prevent the returns of symptoms

telemetry monitor is used to assess any variations in patient condition.

5.Epi pen used to treat severe allergic reaction .epinephrine may kept on hand for self injection byba person with a history of an severe allergic reaction.

6.teach about side efect of epipen

teach how to take epi pen.

check the expiry date of epinephrine.

7.health education given regarding ;

follow up care

make sure you always have more than one epi pen auto injector

monitor any swelling of lip,tongue or throat

assess any wheezing or breathing difficulty