Case study - Pediatric anaphylaxis: Nursing

Nurse Anya works in the emergency department and is caring for Pablo, a 10-year-old who’s having difficulty breathing following a bee sting. After settling Pablo in his room, Nurse Anya goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Pablo’s care, by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.   
  First, Nurse Anya recognizes important cues, including Pablo’s vital signs which are temperature 98.2 F or 36.8 C, heart rate 128 beats per minute, respiratory rate 30 breaths per minute and labored, blood pressure 94/56 mmHg, and oxygen saturation 89 percent on room air.  

She notes angioedema to Pablo’s eyelids, lips, and tongue. She also notices that Pablo appears anxious.  

While auscultating Pablo’s lungs, Nurse Anya hears wheezing in the upper lobes. She asks Pablo’s father, Ramón, who’s at the bedside, about the onset of Pablo’s symptoms. 
  Nurse Anya: Has Pablo had a reaction to a bee sting before? 

Ramon: Well, he’s been stung once before, but nothing like this happened. 

Nurse Anya: Did you give Pablo any medicine before coming to the hospital? 
  Ramon: No, we came straight here. 
  Nurse Anya then analyzes these cues. She understands that Pablo’s first exposure to a bee sting caused his body to produce antibodies against bee venom, sensitizing him.  

Then, on his second exposure, the antibodies triggered the release of chemical mediators, causing smooth muscle contraction and bronchoconstriction, leading to Pablo’s wheezing and difficulty breathing.  

The reaction also caused systemic vasodilation, leading to decreased blood pressure and tachycardia, as well as increased vascular permeability, resulting in angioedema. Nurse Anya recognizes that Pablo needs immediate airway management.