Nurse Ejay is assigned to telephone triage. A client called who was stung by a honeybee and is asking for help. The client reports pain and localized swelling but has no respiratory distress or other symptoms of anaphylactic shock. What is the appropriate initial action that the nurse should direct the client to perform?
A. Removing the stinger by scraping it
B. Applying a cold compress
C. Taking an oral antihistamine
D. Calling 911
Correct Answer: A. Removing the stinger by scraping it.
Since the stinger will continue to release venom into the skin, removing the stinger should be the first action that the nurse should direct to the client. Within the first few minutes after the sting, the stinger should be removed via scraping with a credit card rather than squeezing/tweezing to avoid further venom exposure.
Option B: Uncomplicated local reactions can be treated with supportive care (ice packs, NSAIDs/APAP for pain, H1/H2 blocker). Cold compress follows the administration of antihistamine. Large local reactions should also be treated with supportive care along with glucocorticoids (usually a burst course of prednisone 40 to 60 mg per day for 3 to 5 days) to decrease the inflammatory response and improve symptoms.
Option C: After removing the stinger, an antihistamine is administered. H1 and H2 antagonists block the effects of histamine decreasing pruritus, erythema, and urticaria. Corticosteroids (prednisone, methylprednisolone, dexamethasone) act to decrease inflammation and immune response to the antigen.
Option D: The caller should be further advised about symptoms that require 911 assistance. Systemic reactions (anaphylaxis) are life-threatening and should be managed as such. ABCs first. The airway can be lost within seconds to minutes, so intubate early. As with any anaphylactic reaction, epinephrine, corticosteroids, H1 and H2 antagonists, and intravenous (IV) fluids should be given immediately.
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