Question

Scenario #2 Pre-Simulation Information:

NAME: John Tram

AGE:     49 years old

DOB:     December 2, 1970

WEIGHT:   235 pounds (107 kg)

HEIGHT: 72 inches (183 cm)

PMH: HTN, Herpes Zoster

John Tram is a 49 yo male that has been diagnosed with Herpes Zoster that was prescribed Acyclovir 800mg po five times daily. John took 2 doses and after the 2^nd dose noticed facial and oral swelling, increased difficulty breathing, and difficulty swallowing. These symptoms started about 1 hour ago and have been getting progressively worse.

He arrives in the emergency department for treatment.

1. From the provided information, what are your concerns?

2. What orders do you anticipate for this client?

3. What supplies do you anticipate you will need to care for this client?

John Tram

DOB:     December 2, 1970

MR: 4328469 - JT

MEDICATIONS

• Epinephrine 0.3mg IM of 1:1000 concentration STAT; repeat in 10 min prn
• Solumedrol 125mg IVP now
• Diphenhydramine 50mg IVP now
• Ranitidine 50mg IVP now
• IV NS fluid bolus of 1000mL now

ORDER SET

• 2 Large bore peripheral IV (Both already started)
• 12 Lead EKG
• Assess breath sounds every 10 minutes
• Vital signs every 10 minutes
• Continuous EKG monitoring
• Oxygen at level to maintain SpO2 of >95%

Scenario #2 Simulation Information and Questions:

The nurse assesses the client and notes wheezing, severe hypotension, tachycardia, edema of the tongue and throat.

1. What ESI Level would you triage this patient as?

2. What are your priority assessments?

3. What are your priority interventions?

Scenario #2   Post-Simulation Questions:

1. What route(s) can epinephrine be administered? What is the concentration for epinephrine for the treatment of anaphylaxis?

2. Describe the mechanism of action for the medications ordered for the treatment of anaphylaxis.

3. What are signs/symptoms of anaphylactic shock?

4. What education will you provide to this patient prior to discharge?

Answer 1

Scenario #2 post simulation question :

-What are the routes of epinephrine administration?

Epinephrine product improved in the USA of anaphylaxis,recommends IM( intramuscular injection) into the anterior lateral aspect of the thigh but also epinephine, when given intramuscularly or subcutaneously, has a rapid onset of action

-What are the concentration of epinephrine for the treatment of anaphylaxis?

Epinephrine 1:0000 dilution(1mg in 1mL),0.2 to 0.5mg(0.01mg/kg in children; maximum dose 0.3 mg), IM injection for 5 to 15 minutes,depending on the severity of anaphylaxis that should needs to control the symptoms

Mechanism of action:

Adrenaline :-stops your blood pressure from falling to Low by stimulating these receptors, causing the blood vessels to narrow. This also redirects blood to vital organs. Other life threatening symptoms that the adrenaline reverses include throat tightness, hives ,itching and skin swelling

Epinephrine :-Through its action on Alpha -1 receptors,epinephrine induces increased vascular smooth muscle contraction, pupillary dilator muscle contraction, and intestinal Sphincter muscle contraction. Other significant effects include increased heart rate, myocardial contractility, and running released via Beta -1 receptors

-Sign and symptoms of anaphylactic shock

Symptoms include our skin Rash Nausea, vomiting ,difficulty breathing and shock

Whole body: painting, light headedness,low blood pressure, dizziness flashing

Respiratory: difficulty breathing, Rapid breathing ,shortness of breath or wheezing

Skin: hives ,swelling under the skin, blue skin from poor circulation or rashes

Gastro-intestinal: Nausea or vomiting

Also common: fast heart rate, feeling of impending Doom, itching, tongue swelling, difficulty swallowing, facial swelling, impaired voice, mental confusion, or nasl congestion

Health education prior to discharge

Instruct patient to avoid future exposed to antigens and administer prescribe emergency drug to treat the anaphylaxis

Be careful during exercise- do not exercise right after eating, stop exercising right away if there is developed any signs and symptoms of anaphylaxis

Identify and avoid known triggers. Read food labels for ingredients. Look for triggers in your environment

Wash clothes with a mild detergents. Itching and scratching can be decreased by wearing cotton fibres

Keep the skin moisturized with tropical skin moisturizer

Avoid antigens like animals, dust ,sprays and perfumes

Maintain room temperature at 20 degree Celsius to 22.2 degree Celsius.