facial edema and difficulty breathing

KelRN215, BSN, RN · Jan 21, 2013

@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:

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.

nurseprnRN, BSN, RN · Jan 21, 2013

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. :)

Esme12, ASN, BSN, RN · Jan 21, 2013

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 · Jan 22, 2013

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. :unsure: 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 :)

Esme12, ASN, BSN, RN · Jan 22, 2013

((HUGS)) Hang in there.....let me know if you need help.