This happened in real time this AM....I will post my nursing dx later but am curious to see what you all think of this.
Student with no reported history of asthma or allergies presents stating "I'm having an allergy attack or asthma." Student is a frequent enough visitor that I know her face but has had no unusual occurrences.
Initial VS BP 137/94, HR 116 RR 15, PSO2 98%. Breath sounds diminished at the tops of lung fields bilaterally, nothing adventitious at the bases of lungs. Lips pink, arms flushed, conjunctiva reddened, student stating throat is swelling and tongue is swelling. She reports chest tightness but is able to make 10-word sentences and is not tripod positioning for comfort. She denies nausea.
I am armed with two EpiPens for "unknown allergens." I have no standing orders for Benadryl or albuterol.
Reassessment 12 minutes later after calming her down, calling dad (on the way) and cold water to drink: BP 141/81, HR 113, RR 12, PSO2 98%, diminishment of itching sensation on tongue, throat is itching but reduction in the sensation of swelling. Bilateral breath sounds WNL on the left upper and lower lung fields. Right upper lung fields diminished sounds, front and back, no diminishment on the lower right fields. She is reporting that "it's easier to breathe." No nausea.
Reassessment as dad arrived to take her away (10 minutes after second reassessment) BP 134/84, HR 116, more profound flushing of face, and conjunctiva are pronouncedly reddened, but reduced sensation of swelling tongue. Throat is "itching," skin on her arms is flushed. Dad left to take her to the doctor.
What do you think? Asthma, panic attack, or something else?
I just read that article and thought the same thing. I have two teachers at my school who have these weird reaction to fruits and veggies. Neither carry an EpiPen.
They don't need one for this reaction, actually. It doesn't progress to anaphylaxis typically. I was just talking with our school physician about this (mainly around lunch and triggering fruits) and a stock epi pen can cover this in the extremely rare chance it did present as anaphylaxis.
Usually the offending food will only bother folks during their allergy season. It is very interesting!
They don't need one for this reaction, actually. It doesn't progress to anaphylaxis typically. I was just talking with our school physician about this (mainly around lunch and triggering fruits) and a stock epi pen can cover this in the extremely rare chance it did present as anaphylaxis.
Usually the offending food will only bother folks during their allergy season. It is very interesting!
Hmmm, I have a young lady who has OAS and she most definitely carries an Epi pen , had a HUGE reaction at allergy testing...the list of what she is allergice to loooong! Looking forward to her graduating...but I hear there are 6 more epi pens coming into next years frosh class. Can't wait!
Hmmm, I have a young lady who has OAS and she most definitely carries an Epi pen , had a HUGE reaction at allergy testing...the list of what she is allergice to loooong! Looking forward to her graduating...but I hear there are 6 more epi pens coming into next years frosh class. Can't wait!
Interesting - the huge reaction at allergy testing may mean it is more than OAS. I've have a few student have a mild allergy test reaction with OAS; their doctor didn't write a scrip for an epi-pen, but did have an allergy action plan that involves benadryl.
But I also have a couple of students like you describe - hard to find something they aren't allergic to! :).
Interesting - the huge reaction at allergy testing may mean it is more than OAS. I've have a few student have a mild allergy test reaction with OAS; their doctor didn't write a scrip for an epi-pen, but did have an allergy action plan that involves benadryl.
But I also have a couple of students like you describe - hard to find something they aren't allergic to! :).
Specializes in ICU/community health/school nursing.
Per the student, parent took her home, gave her Benadryl, and did not take her to the doctor. Which means that nobody confirmed the weird diminishment I heard in her chest.
She says she's fine today. Benadryl would take care of the mysterious allergens and the sedation side effect would help the anxiety.
Until it occurs again. I understand deductibles can add up, but c'mon, this could have been serious. It is so frustrating to be the recipient of complaints, especially chronic, and the parents seem less than interested to find the cause and get a cure.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Anxiety can cause the skin to itch, have chest tightness, and feelings of throat closing. Tough read with teenage girls. I would just have the epi ready in case the O2 sat dropped or there was visible swelling of the lips.
Perhaps I'd have been overreacting, but I would have called 911 because this girl needed Benadryl and you had no order for it,
and no way to quickly get an order. I think you risked your license and her life.
She did not administer the Benadryl, her parent did. School nursing is unique that the community is overall healthy and, unlike acute or chronic care, you don't assume the worst first. You also don't have the luxury of another licensed person to consult with. You get a little bit more liberal in your treatments. Anxiety presents many different ways AND children, gasp!, sometimes cry wolf. I wouldn't feel bad activating 911 for an Oscar worthy performance, but my job is to keep butts in seats.
GdBSN, RN
659 Posts
Oooops...this is the one I read. If Raw Fruits Or Veggies Give You A Tingly Mouth, It's A Real Syndrome : The Salt : NPR