Question

The school nurse is reviewing the medications of Dante,a fourth grader who has multiple allergies, including a severe nut allergy. Dante has asthma also and has been ordered the following metered dose inhalers:

  Ventolin (Salbutamol), 2 puffs, PO, TID, to be given at 0600, 1400 and, 2200.

  Atrovent (Ipratropium Bromide), 2 puffs, PO, TID, to be given at 0600, 1400 and, 2200.

  Flovent (Fluticasone), 2 puffs, PO, BID, to be given at 1000 and 2200

1. What education would be provided to the cafeteria staff to minimize the risk of Danté’s having an anaphylactic reaction?

2. What instructions would the school nurse provide to those who may be in a position to administer a single dose of epinephrine?

3. What assessment data would be essential to determine the effectiveness of the epinephrine for Danté before and after an anaphylactic reaction?

4. It is 2200 and your client should receive all three puffers. In what order would you administer these medications?5. If the patient developed acute asthma induced by beta-blockers, explain why he might not respond to being treated by a drug such as salbutamol.

6. Physician ordered 500mg of Levofloxacin IV. Pharmacy sent you a pre-made bag of Levofloxacin 500mg in a 100ml bag of NS for your patient. Physician order reads: administer Levofloxacin IV over 90 minutes. The drop factor of tubing is 60gtts/ml. What is the drip rate?

Answer 1

1, Staff education is important in school to avoid risk for those who have a food allergy. educate the cafeteria staff
-To identify the student who is having a food allergy with parents' cooperation and protecting student privacy and confidence and have a picture of each child in separate locations but not visible in the public to identify the student correctly.
-Identify the potential allergens and modify the meal plan for those students having an allergy.
-Read the food label before preparing the meals and snacks.
-Prepare the kitchen to promote allergens' safety by avoiding cross-contact with potential food allergens.
-Encourage the child to wash the hand before and after consuming food.
-Have rapid access to epinephrine auto-injector if there is food allergy occur. post the symptoms of anaphylaxis in the cafeteria by everyone can see.
-Have parent involvement in the food menu.
2, Anaphylaxis is a life-threatening hypersensitivity for a particular substance. As per Food Allergy Reseach and Education(FARE), anaphylaxis affects under 18 years of age. the school nurse or another qualified person to use an epinephrine auto-injector should follow the
-the technique for identifying the symptoms of anaphylaxis like wheezing, itching, difficulty breathing, low blood pressure, swollen lips, etc.
-Epinephrine auto-injector is a disposable drug with a spring-activated needle. This is a ready to use and easily available system to treat single anaphylaxis episode. it could be discarded carefully after each use.
-the school nurse or authorized physician prescription for each school at minimum epinephrine auto-injector one regular and one junior injector for elementary school and one regular injector for junior high school, middle school or high school, injector should be kept on hand as a backup.
-The qualified supervisor responsible for stocking the epinephrine injector should be restocked again as soon as possible after checking the expiry date.
-It should be stored at room temperature and a well-marked location and easy access.
-It should not be kept in a refrigerator or extreme heat.
- the medicine solution should be clear and colorless. if it is brown or any discoloration should be disposed of immediately.
-when symptoms occur administer injector and call 911 to save the victim
-to administer epinephrine remove the cap or cover and tip on outside the thigh center way between hip and knee at 90 degrees to the thigh, can be administered through clothing also in case of emergency. wait for the click, hold in place for 10 sec and remove it and dispose of the needle.
-Observe the child until emergency personal arrive.
-document the time, date and student name, class in the chart.
3, Assess the student weight, allergic reaction, vital signs, history of the previous reaction, etc.
For students less than 55Ibs you administer 0.15mg, for students more than 55Ibs administer 0.30mg. Don't raise them an upright position, make them lie down and lower extremity elevated, make them sit up if they have breathing difficulty.
After adminster the injector monitor student airway and breathing, vital signs, victim response.call 911 to take the student to the emergency department for further evaluation.
4, Ventolin should be 1st dose bronchodilator to reduce airway constriction and restore normal airflow.
Atrovent should be 2nd dose it is anticholinergic to prevent bronchospasm.
Flovent should be 3rd dose to treat bronchospastic disorder to control the inflammation.
Inhaled b2 agonist(Ventolin) should be used before glucocorticoid (Flovent) to provide bronchodilation before the antiinflammatory drug(Flovent).ventolin should be taken a few minutes before the Flovent inhaler.