facial edema and difficulty breathing - page 3

by nursingstu14 3,107 Views | 28 Comments

Hi I am only in my second week of nursing school and I am having trouble with my first case study. I have a case study about a patient who is having an allergic reaction to a medication. She is experiencing facial edema, red... Read More


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    @GrnTea: i was responding to Esme12 about it being a real patient or not. Now, about what you responded I wasn't trying to choose diagnoses first and support second. From what information I was given I decided to have risk for skin integrity as my nursing diagnoses. I decided on that just because i believe its the best I can do based off from the background info provided. I wasn't given VS or anything of that sort so i cant really get much from what the case study included. Im trying my best. Im new to this and reading all the text books in trying to find good nursing interventions. I hope i didnt offend you in any way. I hope you dont think Im just trying to get answers. I really have no one to help me and I found this website and so far its helping me. I did however and take your advice and purchased the NANDA-l Nursing Diagnoses to help me. THank you.
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    Quote from nursingstu14
    This is not a real patient.
    I actually think that makes it much harder.
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    Quote from nursingstu14
    @GrnTea: i was responding to Esme12 about it being a real patient or not. Now, about what you responded I wasn't trying to choose diagnoses first and support second. From what information I was given I decided to have risk for skin integrity as my nursing diagnoses. I decided on that just because i believe its the best I can do based off from the background info provided. I wasn't given VS or anything of that sort so i cant really get much from what the case study included. Im trying my best. Im new to this and reading all the text books in trying to find good nursing interventions. I hope i didnt offend you in any way. I hope you dont think Im just trying to get answers. I really have no one to help me and I found this website and so far its helping me. I did however and take your advice and purchased the NANDA-l Nursing Diagnoses to help me. THank you.
    You do need a good care plan book......I use Ackley: Nursing Diagnosis Handbook, 9th Edition and Gulanick: Nursing Care Plans, 7th Edition they both have online care paln constructors that can be VERY helpful. GrnTea isn't' offended ....she and I tag team here helping the students....we like to have the students show us first so we best know where you are going off track to make you the best nurse you can be......((HUGS)).

    We are here to help. give us the whole picture from the start and we'll guide you
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    Quote from nursingstu14
    I cannot use the diagnoses of airway obstruction since its the most obvious diagnoses (according to my professor). That is the reason why i chose risk for impaired skin integrity. Thanks though =)

    Since she has facial edema, excessive fluid retentions of the face, Im thinking for an intervention would be drug therapy on removing the excess fluid retention. My rationale would be if diuretics were prescribed it will increase kidney water and sodium excretion. Another intervention could be nutrition therapy, which can involve restrictions of both fluid and sodium intake to control fluid volume. And since she has itching and red swollen blotches an intervention can be some sort of ointment/medication to reduce the itching which will prevent the patient from scratching and making her blotches worse. If patient continues to scratch they can tear skin which will increase chance of skin infection/ integrity.

    What do you guys think?
    No. Can you, as a nurse, prescribe diuretics? Your interventions need to be NURSING interventions. Medications are medical interventions. "Medicate as ordered" may be an appropriate nursing intervention in some situations (mainly pain) but if you- as a nurse- cannot intervene by deciding that the patient needs diuretics or ointment. This patient will undoubtedly receive an antihistamine but that has to be ordered by the physician.

    Also, this patient is not experiencing edema because of an issue with fluid retention. You need to look up the pathophysiology of anaphylaxis. The patient also doesn't have a chronic problem with edema that would warrant dietary modifications... this patient has something acute going on that needs to be addressed NOW before she arrests.

    Impaired skin integrity is WAY DOWN on your list of priority nursing diagnoses for this patient.
    GrnTea likes this.
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    Quote from nursingstu14
    @GrnTea: i was responding to Esme12 about it being a real patient or not. Now, about what you responded I wasn't trying to choose diagnoses first and support second. From what information I was given I decided to have risk for skin integrity as my nursing diagnoses. I decided on that just because i believe its the best I can do based off from the background info provided. I wasn't given VS or anything of that sort so i cant really get much from what the case study included. Im trying my best. Im new to this and reading all the text books in trying to find good nursing interventions. I hope i didnt offend you in any way. I hope you dont think Im just trying to get answers. I really have no one to help me and I found this website and so far its helping me. I did however and take your advice and purchased the NANDA-l Nursing Diagnoses to help me. THank you.
    Let's look at the information you were given:

    Quote from nursingstu14
    Yes, she's having an allergic reaction to the medication cefazolin. And sorry for not mentioning it but cant do anaphylaxis either. So, heres the whole case:

    A 69 yr old Mexican American woman is admitted for total knee replacement surgery. Following surgery, an order was written for cefazolin sodium (Ancef) 2 gm intravenous piggybank every 8 hrs for 24 hrs. She received her first dose after surgery. Thirty mins after the medication was started, the patient calls the nurse and reports "itching all over" and difficulty breathing. The nurse notes facial edema and audible wheezing. The skin is red with large swollen blotches over her arms, trunk and back. Patient states, "I had this happen to me before when I took a drug called amoxil. The doctor said i am allergic to amoxil."

    I believe she is experiencing swelling to the face because of the allergic reaction from the medication not from sodium in her diet. So, it doesn't make sense when i wrote for one of my interventions to be nutrition therapy. I chose that for when she goes home she would be educated in what not to eat so swelling doesn't get worse. Maybe the sodium in her med order is adding to the swelling too. Cefazolin is meant for bacterial infection so maybe she has an infection which is contributing to her swelling. But that wouldnt cause swelling to her face because its her knee....Swelling is the body's reaction to an injury, which in the patients case is her knee surgery. =/ im not sure what to say.

    risk for dehydration??

    Im sorry if i miss it. I don't really know. Im completely new to this i have no medical background what so ever? Im researching all of this as I'm going in my textbooks and internet.
    This patient is only receiving 24 hrs of antibiotics- she's not receiving the antibiotics for an infection. Many hospitals/surgeons give 24 hrs of antibiotic coverage following surgery to prevent post-op infections. Cefazolin is a commonly prescribed antibiotic for this purpose.

    The patient does not need to be educated to eat a low sodium diet so that the swelling doesn't get worse when she goes home. The patient is experiencing an ACUTE allergic reaction... once that's taken care of, the swelling will go down. The sodium in the cefazolin (cefazolin sodium) also has nothing to do with her swelling... the patient is allergic to the medication she was given.

    I believe you do have enough information here to make priority nursing diagnoses. The patient states that she is having difficulty breathing and has hives. She also told you she has had a previous reaction to an antibiotic in the same family as the one she was given... that's enough information to conclude that she's having an allergic reaction to this antibiotic and that action needs to be taken immediately. So, what do you think will happen and what are your priorities for this patient? Skin integrity is not a priority... that can be dealt with once the patient is stabilized.
    GrnTea likes this.
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    Quote from Esme12
    GrnTea isn't' offended ....she and I tag team here helping the students....we like to have the students show us first so we best know where you are going off track to make you the best nurse you can be......((HUGS)).

    We are here to help. give us the whole picture from the start and we'll guide you
    Quite right. Of course I'm not offended. I think we may have been typing at the same moment about that. We love students

    As to risk of impaired skin integrity, the defining characteristics (this means, "required elements," at least one) for that are:
    destruction of skin layers
    disruption of skin surface
    invasion of body structures

    There are a number of related (causative) factors, but even though you might be tempted to choose "pharmaceutical agents" because she had one, she doesn't have any of the required elements, so that nursing diagnosis is out, o-u-t, out.

    You should have your NANDA in a few days (holiday today) so let's see what you come up with! Isn't this cool? You, clever person, are going to be soooo far ahead of your classmates because you know where to look this stuff up now....and if any faculty disagrees with you on any of them, you just whip it out and open it to the right page.
    Last edit by GrnTea on Jan 21, '13
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    Quote from GrnTea
    Quite right. Of course I'm not offended. I think we may have been typing at the same moment about that. We love students
    ((HUGS))
    nursingstu14 likes this.
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    Thanks Esme12 and GrnTea! I really appreciate your help. Im really stressed out and I'm a crying roller coaster. I didn't pass my first exam i got a 79%. Eighty and above is considered passing and the majority of my classmates passed. I felt like a failure/ incompetent. I feel lost even though Im reading and researching. Im not really understanding but for now I just have to try my best and keep going. So, thank you SO MUCH for clearing things up for me. I needed the help! Ill let you guys know what i come with
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    ((HUGS)) Hang in there.....let me know if you need help.
    nursingstu14 likes this.


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