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?