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Question about swelling and bug bites

Nurses   (8,026 Views 12 Comments)
by ChristyMNOP ChristyMNOP (Member)

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First of all-this is not asking for medical advice. I'm just wondering how much swelling has to occur before you become concerned that something else is going on with your patient? Assume that neurovascular status seems to be intact for now. Just how much swelling-1 inch around the bite, several inches? An entire limb? And for how long-longer than 12 hours without going down, 24 hours without going down, etc?

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sirI has 30 years experience as a MSN, APRN, NP and specializes in Education, FP, LNC, Forensics, ED, OB.

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What is the admitting dx of the patient? How old. What were the admitting s/s? What meds did the PCP RX?

Need additional information.

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63 Posts; 1,636 Profile Views

Ok, no admitting dx, and meds are diphenhydramine q4 and hydrocortisone cream topically q6 with cold compresses. The question is really at what point should swelling respond to treatment? 12h, 24h, and what are some signs that swelling is impeding circulation.

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sirI has 30 years experience as a MSN, APRN, NP and specializes in Education, FP, LNC, Forensics, ED, OB.

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No admitting dx?

Is this your patient?

Without a dx, we would be remiss offering advice.

You might contact the PCP if you suspect your patient is compromised.

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63 Posts; 1,636 Profile Views

I'm sorry, I'm not asking for advice, I just want to know at what point would a nurse be concerned about swelling after a bug bite. Sort of like a case study question with the background listed above.

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sirI has 30 years experience as a MSN, APRN, NP and specializes in Education, FP, LNC, Forensics, ED, OB.

14 Followers; 19 Articles; 13,071 Posts; 136,751 Profile Views

Without additional admitting information, it is difficult to answer you, ChristyMNOP.

Here are links to insect bites from eMedicine:

http://www.emedicine.com/DERM/topic467.htm

http://www.emedicinehealth.com/insect_bites/page4_em.htm

Hope this helps.

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loricatus specializes in ED, ICU, PACU.

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Ok, no admitting dx, and meds are diphenhydramine q4 and hydrocortisone cream topically q6 with cold compresses. The question is really at what point should swelling respond to treatment? 12h, 24h, and what are some signs that swelling is impeding circulation.

From personal experience---hydrocortisone cream can set the wound up for infection (reduces immunity) which could lead to cellulitus. Please be sure that you are dealing only dealing with a 'bug bite' versus cellulitus, which could lead to sepsis if untreated. Also, certain insects/'bugs' can cause more harm that just an typical localized reaction. I think these are the reasons why the other poster seeks the medical diagnosis for the patient you are referring to. It would be wise not to assume something is a simple bite when standard treatments for minor bites do not offer relief in a time frame specified on the OTCs packaging. For the answer to the signs question-the same s/s for compartment syndrome (the P's).

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crissrn27 has 8 years experience as a RN and specializes in nursery, L and D.

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I've seem some pretty serious cellulitis from bug bites. If there was any question in my mind that a bite didn't seem to be responding to routine treatment I would contact my PCP.

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CrufflerJJ has 5 years experience as a RN and specializes in ICU.

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First of all-this is not asking for medical advice. I'm just wondering how much swelling has to occur before you become concerned that something else is going on with your patient? Assume that neurovascular status seems to be intact for now. Just how much swelling-1 inch around the bite, several inches? An entire limb? And for how long-longer than 12 hours without going down, 24 hours without going down, etc?

Pedi response to "normal" mosquito bites seems to vary a lot from a small wheal (as with our son), versus a 0.5-1" diameter red/raised/warm "bump" (on our daughter). Our daughter was adopted from Hunan Province China, and in reading some of the adoption -Lists, many kids from that province have pretty intense reactions to mosquito bites. It takes days for the red bumps to go down with our daughter, versus just a short while with our son (or us "adults" in the family).

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sirI has 30 years experience as a MSN, APRN, NP and specializes in Education, FP, LNC, Forensics, ED, OB.

14 Followers; 19 Articles; 13,071 Posts; 136,751 Profile Views

OP has received excellent advice.

Thread closed.

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