Following the initial care of a client with asthma and impending anaphylaxis from hypersensitivity to a drug, the nurse should take which of the following steps next?
A. Administer beta-adrenergic blockers.
B. Administer bronchodilators.
C. Obtain serum electrolyte levels.
D. Have the client lie flat in the bed.
Correct Answer: B. Administer bronchodilators.
Bronchodilators would help open the client’s airway and improve his oxygenation status. Bronchodilators are useful adjuncts in patients with bronchospasm. Patients with previous histories of respiratory disease, most notably asthma are at the highest risk. Treated with inhaled beta-agonists are the first-line treatment in wheezing; albuterol alone or as ipratropium bromide/albuterol. If there is refractory wheezing IV magnesium is appropriate with dosage and treatment similar to severe asthma exacerbations.
Option A: Beta-adrenergic blockers aren’t indicated in the management of asthma because they may cause bronchospasm. Corticosteroids are given for the reduction of length or biphasic response of anaphylaxis. There is minimal literature to support this use specifically in anaphylaxis, but it has been proven effective in reactive airway diseases. Therefore, use, dosages, and proposed mechanism of action mimic those of airway management protocols.
Option C: Obtaining laboratory values wouldn’t be done on an emergency basis. Laboratory testing is of little to no use, as there is no accurate testing for diagnosis or confirmation. Serum histamine is of no use due to transient elevation and late presentation. Serum tryptase can be considered for confirmation of an anaphylactic episode as it remains elevated for several hours, however, as a diagnostic modality, this has low sensitivity.
Option D: Having the client lie flat in bed could worsen his ability to breathe. Airway management is paramount. Thoroughly examine the patient for airway patency or any indications of an impending loss of airway. Perioral edema, stridor, and angioedema are very high risk, and obtaining a definitive airway is imperative. Delay may reduce the chances of successful intubation as continued swelling occurs, increasing the risk for a surgical airway.
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