Question

B.N., a 41-year-old female who is a dental hygienist, has had several surgeries over the past five years due to a knee injury. She presents to the outpatient surgery department today for her last reconstructive surgery. Her past medical history indicates she had asthma as a child and had one occurrence of contact dermatitis. She tells you she has no known drug allergies.

You start B.N.’s IV and perform a saline flush. Within three minutes, B.N. states that her IV site itches, and a few minutes later she begins to complain of tightness in her throat.

Subjective Data

* States IV site itches

* States throat and neck feel tight and says “I feel like I can’t breathe”

Objective Data

* Vital signs: Temp 98.8° F, Heart rate 120, Respiratory rate 32, Blood pressure 100/60

* Oxygen saturation 85%

* Wheezing in all lung fields

* Restless

* Swelling at IV site

#1. What type of altered immune response is B.N. experiencing?

#2. What is the apparent causative factor and what were potential sources of exposure?

#3. What are the priority nursing interventions in this situation? What medications might you expect the health care provider to prescribe?

Answer 1

#1. Here B.N' s subjective data is that he/she is having IV site itching and feels like he / she can't breathe. We can also witness this through the objective Data. Therefore the altered immune response here B.N experience's is "allergic reaction". Allergic reaction means any substance that causes sensitivity to one's body when it come contact with one's body. Example : skin,eye etc.

#2.The apparent causative factor for the allergic reaction can be a reaction from the IV catheter. Because the IV catheters are made of different materials which can be allargic to the patient. Usually the IV catheters are made from Silicone, polyethylene, nylon etc..This can be only one reason.The second reason can be of the medication given.But here only saline flush has been administred.The saline flush is sodium chloride which is a base and in some cases it can produce some adverse effects such as itching, breathing problems,rashes.The potential sources of exposure is also the same explained above that is either it can be the IV catheters reaction or else can be of the reaction from the saline flush.

#3.The priority nursing interventions in this situation is that

•The nurse should provide a cold application at the site of swelling.

•The nurse should monitor the vital signs intervally.

•The nurse provides psychological support to the patient.

•The nurse provides medications according to physicians order to get rid of the present problems.

The medications that can be prescribed are

• First of all the medication which reduces the allergic reaction should be given, that is; Antihistamines which reduces or can reduce the allergic reaction.Example: Cetirizine,Diphenhydramine

•Bronchodilators can be prescribed because the patient was having wheezing on all lung sides.

• Also Adrenaline can be prescribed because this medication is mainly used in allergic reactions.

But the first thing is to do is that if we are seeing any allergic reaction during the medication time then immediately we should discontinue the medication which cause the reaction.

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