Case Study

[GdBSN, RN]

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

[JenTheSchoolRN, BSN, RN]

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!

[NutmeggeRN, BSN]

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!

[JenTheSchoolRN, BSN, RN]

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! :).

[NutmeggeRN, BSN]

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! :).

Right??!

[grammy1]

Is she back today? Any new info?

[ruby_jane, BSN, RN]

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.

All's well that ends well, right?

[MrNurse(x2), ADN]

All's well that ends well, right?

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.

[ruby_jane, BSN, RN]

Until it occurs again.

Oh so true! I'm going to amend my phrasing to include that from now on.

[Kooky Korky, BSN, RN]

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.

Yes, it turned out ok this time, thank God.

I know it bothered you because you are here on AN asking, so please consider that this could have become a life or death issue

pretty quickly. Can you get a standing order for Benadryl or for 911 in a case like this?

It's a situation akin to what nurses have to deal with in long-term care when a pt falls and the nurse is supposed to decide, without

benefit of X rays, whether the pt has a fracture or not. You are asked to decide, without benefit of any imaging or labs, whether

this girl is going to quit breathing or what. It's a tough call. I would always want to err on the side of caution and if someone doesn't

agree with or like my decision, well it's not their life or license on the line is it?

[Esme12, ASN, BSN, RN]

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.

[MrNurse(x2), ADN]

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.