HELP: anaphylactic attack

[nursetracy4444]

PLEASE help a confused student with too many choices!

In a clinic, your patient has received an allergy shot, s/s clearly indicate an anaphylactic attack. What are the top three priority nursing interventions and brief rational? Keep in mind you're in a medical clinic. These are the choices.......

a. Initiate oxygen at 2L/min per nasal cannula

b. Administer albuterol (Proventil) via a nebulizer

c. Initiate IV access with a large-bore (18 ga.) catheter

d. Administer epinephrine (Adrenalin) 0.3 mL subcutaneously

e. Obtain a full set of vital signs

f. Initiate oxygen at 15L/min per non-rebreather mask

g. Administer cimetidine (Tagament) IV piggyback

h. Notify the physician

i. Initiate an epinephrine infusion intravenously

j. Administer diphenhydramine (Benadryl) orally

k. Apply an ice pack to the site of the skin test

l. Apply zinc & iron oxide (Calamine) lotion to the reddened blotches

m. Open the patient's airway

n. Attach the patient to the cardiac monitor

o. Administer methylprednisolone (Solumedrol) intravenously

[nursej22, MSN, RN]

Here is my order:

1) Notify the physician. This is a potential code situation and step one is get some help. He/she may need to manage the airway, or they can administer drugs while you call 911.

2) O2 per non-rebreather mask. The patient's airway is swelling and you need to provide as much oxygen as possible. repositioning to open the airway will not be enough.

3) Epi subq. You need to stop or slow the inflammatory response and you don't have time to establish IV access.

Now some people may say airway is always first, but I would be yelling for help while I'm hooking up the Os and grabbing the epi pen.

[Baloney Amputation, BSN, LPN, RN]

Well, you'd want to stop the reaction immediately (or buy some time until the patient is in the ER) and you'd also want to protect the airway, so I'd go from there for picking answers.

[casi, ASN, RN]

My problem with the epi option the poster has is that it's an IV admin. With the options given, especially since the poster is in nursing school. I'd yell for help and then start with the ABC's.

Nursing instructors love the ABC's answers.

[Baloney Amputation, BSN, LPN, RN]

Option D gives the epi option as subcutaneously, which should be available in a clinic giving allergy shots.

[nursej22, MSN, RN]

My problem with the epi option the poster has is that it's an IV admin. With the options given, especially since the poster is in nursing school. I'd yell for help and then start with the ABC's.

Nursing instructors love the ABC's answers.

Option d in the OP is for epi subq. I've never worked in a clinic, but my guess is that any place giving allergy shots has an epi readily available.

[nurse12b]

I am highly allergic to shell fish and the last time I was exposed to shrimp I was in my car and I made it to the pharmacy. I went to the pharmacist and she saved my life by giving me childrens liquid Benadryl, but dosed for me of course. I was on the phone with my sister during the whole time, an ambulance was called and they came and they said they would have done the same thing but through a shot. Believe me you won't have time to get an IV in, the problem is not the O2, you can have the O2 on full blast at 15lpm its not going to help if the o2 can't get through the inflamation. But, your in a clinic call the Dr. they will most likely give Epi.

[GilaRRT]

1) Open airway

2) Give Epi: IM not SubQ, give IM or even IV if needed

3) Start IV, see above

Putting a nonrebreather on somebody who cannot ventilate is an exercise in futility, therefore it's not in my top three.

[wtbcrna, MSN, DNP, CRNA]

1. Give Epi SubQ- Epi is the only thing that is going to immediately stop the reaction

2. Open patient's airway

3. Place on NRB O2

4. Notify physician

5. Start IV

6. VS

7. Give Benadryl

8. Give Solumedrol

You always give EPI 1st, then benadryl, and finally steroids. Mainly d/t onset and length of action of each one.

[gtoko]

D Epi 1 st.

[GilaRRT]

Being that open airway is an option, we must assume a closed airway. Likely, opening the airway will be the first consideration.

[Flare, ASN, BSN]

My first thought is that you can't give the Epi unless you have some type of standing order.

My picks - assuming we have no standing orders -

Open airway, get vitals, notify MD.

If there is a standing order for Epi then i'd do that before notifying MD. I;ve seem quite a few instances of a panic attack mimicking anaphylaxis without the drop in BP, so i'd still want vitals.