YIKE! Help with care plan for snake bite

TakeTwoAspirin, MSN, RN, APRN · Nov 5, 2008

No pain? I would have thought this would be a painful bite from a copperhead. FYI one of my dogs was bitten with a copperhead, and was in a lot of pain (to the point of being in shock). Also, even after the bite "healed" there was a lot of tissue necrosis and he needed surgery on his let to remove the dead tissue. I don't know how long it takes for venom to show it's full effects. I know some have a slower onset than others. Out of curiosity, did they admit him for observation? My dog had to have a $500 one-time-only shot of anti-venom, but I honestly don't know whether they would do the same thing for a person as a prophylactic.

NS2010 · Nov 5, 2008

How about these interventions:

Maintain/teach asepsis for dressing change and wound care

Teach pt. signs of infection. Redness, swelling, increased pain, drainage.

Daytonite, BSN, RN · Nov 5, 2008

not oddball at all if you live out here in the west. people get bit by these things all the time. one of the docs at loma linda university did a series on cable tv a couple of years ago about snake bites (tlc channel?) anyway, venom, whether it comes from a snake, a bug or a fish, does a real number on a person.

care planning is about determining the patient's nursing problems. that requires following the steps of the nursing process. step 1 is assessment which includes knowing what the venom can do to the person and looking for all the signs and symptoms of it. (read the articles listed above.) it is not just what you are seeing on the skin. think about how the body is reacting to the venom. the doctor may or may not have ordered doses of antivenin. the body is still going to kick into the inflammatory response (https://allnurses.com/forums/f50/histamine-effect-244836.html). depending on where this gentleman was bit, he is most likely having big time swelling in the affected body part. that is the inflammatory response. all that swelling has consequences and it is not just impaired skin integrity i'm talking about. ineffective tissue perfusion and disturbed sensory perception can occur. people have had their limbs amputated because of complications related to bites from venomous critters.

had a patient who had been bitten by some kind of venomous spider on his thigh. he was hospitalized for several weeks. his thigh was twice the size of his other leg and red as a beet at first, then purple the necrotic. we were doing daily circumference measurements of it, doing neurovascular checks of his feet and constantly checking his pulses with a doppler. his sensation in that leg was much diminished compared to the other leg. he was getting all kinds of iv antibiotics. eventually, the skin around the bite area for about a 4 inch diameter began to slough off! he ended up with necrotic tissue that the doctor debrided away and said he might need plastic surgery to cover! all over a little spider bite! nasty business.

what goals and interventions should i use for this person?

goals are the results you expect to see as a result of your interventions. your interventions are based upon the symptoms that the patient has. like physicians, we also treat the responses (signs and symptoms) that the patient has that make up the problem. you posted none of that information except that he had swelling, but you didn't mention where. what do you do to relieve swelling from an injury?

he's perfectly fine otherwise.

i would re-think that idea. the venom, once in the body, affects it systemically. if he is fine, why is he hospitalized?

queenjean · Nov 5, 2008

Just FYI, we often give CroFab to our copperhead, cottonmouth and rattlesnack bite victims.

http://en.wikipedia.org/wiki/CroFab

I'm in NE Kansas, we get several a year in our small community hospital. I'm concerned not only with infection and perfusion to the affected extremity (the only bites I've seen have been on the hands or feet), but I'm also concerned about a reaction to the CroFab. We have to do heart and lung assessments, have to pt on tele, and VS q 15 minutes during the CroFab infusion. Vascular assessments Q1-4 hrs (depending on pt's condition) and heart and lung assessments q4 hrs when not receiving the CroFab. I'll measure the circumference of the limb at least twice a day, as well as update the demarcation of the cellulitis. Because of the frequency of assessments, CroFab is only given in the ICU in our hospital.

And let me tell you, this is an expensive hospitalization. CroFab is VERY PRICEY. Depending upon how many times we run it, it usually ends up being between 10 grand and 20 grand worth of medication--and we also have to fly it in; we only keep enough on hand for one dose as it is very expensive and doesn't keep long.

phoenixfire · Nov 6, 2008

Thanks so much for all your help. I've looked back over my notes from that day (he was discharged before the end of my shift), and although his hand and arm were swollen, I was told there was no antivenom for copperheads. He was given rocephin and tylenol, thats it. This gentleman was in a very good mood (considering), and was a very cooperative pt. I only had him for a few hours, so all I know is that they were measuring the circumference of the affected arm, and that he was on isotonic fluids (NS @ 125mL/hr). I was also told that he had to keep the affected arm elevated so that the venom could get into his lymphatic system to be flushed out. He told me that the ER doctor told him to take the makeshift tourniquet he came in with off.

This care plan isn't due until Monday, so I have some time to go back and make sure I didn't miss anything.