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Marisol Jimenez is a 7-year-old girl who was diagnosed with a peanut sensitivity as a toddler. She presents at her pediatrician's office at 8:30 Monday morning after her mother, Luisa, called to report that Marisol had developed urticaria and tightness in her throat Sunday night. As the nurse working with Marisol's pediatrician, you conduct an initial assessment and patient interview with Marisol and Ms. Jimenez. Ms. Jimenez reports that Marisol developed a similar rash last year after eating peanut butter cookies at a friend's birthday party; the throat tightness is a new symptom, however. Ms. Jimenez limits Marisol's exposure to peanuts, but Marisol's grandmother recently emigrated from Mexico and speaks little English. Ms. Jimenez is having difficulty getting her to understand Marisol's "peanut problems." As a result, the grandmother served Marisol sopapillas fried in peanut oil at dinner last night. Ms. Jimenez has given Marisol two 12.5-mg doses of diphenhydramine (Benadryl) 6 hours apart, one at 2100 hours last night and the other at 0300 this morning, per the doctor's previous instructions for treating Marisol's sensitivity. In the past, her symptoms cleared up after the second dose, but Marisol tells you that the itchiness "just won't stop" and that her.
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