Case Study – Anaphylaxis
M.J. is a 45 yo Caucasian female. Following a dinner with her friends, where she consumed 2 glasses of wine and shrimp stir-fry, she presented to the emergency room complaining of “Feeling hot and itch all over. Something bad is happening”. Her initial vital signs were T 99.8 °F temporal, heart rate 100 bpm, respiratory rate 28 bpm, and blood pressure 100/58 mmHg. Oxygen saturation 85% on room air. Her physical assessment noted: • Red skin rash around the face, neck, and hands • Bilateral wheezing in all lung field • Swelling to the lips • “I am having troubles catching my breath” After being seen by the attending physician, M.J is diagnosed with anaphylaxis reaction and the following medication are prescribed: • Oxygen 2L nasal cannula, titrate to keep sats above 90% • Intravenous solution of 0.9% at a keep vein open rate • Epinephrine 0.3 mg IV Stat • Diphenhydramine 25 mg liquid IV now • Prednisone 20 mg PO now M.J. makes a full recovery and is discharged home with a prescription for an Epipen and to follow-up with an Allergist. Assignment: 1. Explain the pathophysiology of anaphylaxis? 2. Name three nursing priorities? 3. List a short-term (before discharge) and a long-term (within one week) SMART goal for the patient? 4. What is the classification, action, and therapeutic effect (reason) for each medications? 5. List drug interactions or contraindications to be concerned about for each drug? 6. What adverse effects/side effects does the nurse need to monitor for each medication? 7. What are some ethical or legal issues to consider with this case?