Thoughts??

Posted
by KeeperOfTheIceRN KeeperOfTheIceRN, ADN Member Nurse

Has 4 years experience.

Trying to see if you guys would have done things differently...

Had an afterschool staff member approach me today stating they felt like they were having an allergic reaction to the dipping sauce they ate with their chicken wrap. They stated they had NKA and had eaten this meal before. Face was flushed but no swelling. C/o scratchy throat. They were located in another building so we walked back to my office after they stated they felt OK to do so. O2 sats were normal. They denied SOB, difficulty breathing, or feeling like their throat/tongue was swelling. HR was normal. Lungs were clear. They did not appear to be in any distress. I administered 25 mg of Benadryl and had them stay in my office for observation. Approximately 10 mins after the meds, they stated they were feeling better. O2 sats were sill perfect, HR was still normal (I kept my pulse ox on them the whole time) and their face was no longer flushed. At the 15 minute mark, they verbalized continued improvement. I encouraged them to call their roommate to come pick them up as I did not want them driving home since they had taken Benadryl. Friend arrived right at the 30 minute mark after meds and they stated they were feeling much better and were ready to leave. I did instruct them to go to the ER should the symptoms return or worsen to which they verbalized understanding.

We do not have stock epi on any of my campuses but I do have one set of pens that was abandoned that I held on to. It was last checked at the beginning of the year and was still good at that time. I was hesitant to use them as the first response, but was ready to do so at the first sign of decline. But I'm curious...would you have used one or opted to go the route I took?

NutmeggeRN, BSN

Specializes in kids. Has 39 years experience. 8 Articles; 4,555 Posts

I think you were OK, with no buccal/laryngeal swelling or SOB or decreased O@ sat. You gave the appropriate follow intervention. 

BrisketRN, BSN, RN

Has 4 years experience. 916 Posts

I would have done the same as you did.

GdBSN, RN

Specializes in School Nurse. Has 9 years experience. 648 Posts

You did a great job! 

nmr79

nmr79

218 Posts

I would have done (and have done in the past) the same thing. 

kidzcare

kidzcare

Has 5 years experience. 3,393 Posts

The only thing I would've added is checking BP. Low or dropping BP is a symptom of anaphylaxis. The one time I've given epi, I took the student's BP and it was fine, 5 minutes later it had dropped and her O2 was also low. 

Great job!

Edited by kidzcare

KeeperOfTheIceRN, ADN

Has 4 years experience. 655 Posts

1 hour ago, kidzcare said:

The only thing I would've added is checking BP. Low or dropping BP is a symptom of anaphylaxis. The one time I've given epi, I took the student's BP and it was fine, 5 minutes later it had dropped and her O2 was also low. 

Great job!

Goodness! I didn't even think to check their BP but will definitely add that in the event something like this occurs again. I don't know about anyone else, but this week has been nothing but office visit after office visit! By the time this one got to me, I felt like I had been running nonstop in a marathon! Thanks Kidz!

Edited by KeeperOfTheIceRN

amoLucia

amoLucia

Specializes in retired LTC. 7,735 Posts

Now would be the time to implement a new epi policy since the need is always there, altho unexpected.

KeeperOfTheIceRN, ADN

Has 4 years experience. 655 Posts

1 hour ago, amoLucia said:

Now would be the time to implement a new epi policy since the need is always there, altho unexpected.

Yes, it's definitely something that has been on my radar for a while. But with it just being me, myself, and I for my entire district, I just haven't had the time to really sit down and get it all done. ?

Jedrnurse, BSN, RN

Specializes in school nurse. Has 30 years experience. 2,776 Posts

On 4/21/2021 at 4:30 PM, KeeperOfTheIceRN said:

Yes, it's definitely something that has been on my radar for a while. But with it just being me, myself, and I for my entire district, I just haven't had the time to really sit down and get it all done. ?

What are the expectations of your role when you're the only nurse in the district?

KeeperOfTheIceRN, ADN

Has 4 years experience. 655 Posts

On 4/24/2021 at 2:37 PM, Jedrnurse said:

What are the expectations of your role when you're the only nurse in the district?

All of your "typical" school nurse duties ? I maintain all health records, perform all State mandated screenings, provide training to staff for various topics, handle all office visits (when on campus), perform all health related data entry, I travel to each campus periodically, communicate with parents etc. etc. And, new this year, I am the "COVID contact" for my district. I will add, I was recently given the green light to hire help on one of my campuses so I now have 1 extra nurse, but they are part time. 

JenTheSchoolRN, BSN, RN

Specializes in School nursing. 3,029 Posts

Do you have a school physician? This is the time to perhaps discuss a standing order for Epi. I have one and it applies to anyone on campus that should need epi - students, staff, or even a visitor. 

But I would have done the same here with your staff member even with my stock epi on hand.

I've used stock epi x2 for unknown new onset allergies in my school nursing career thus far - one with a student with unknown allergy that was fine with localized hives that torpedoed right into wheezing with stridor in less them 30 seconds. Never grabbed epi so fast!