Reference no: EM133606769

Case Study- Hypersensitivity A 69-year-old woman was being treated for hypertension with ramipril 20 mg. Her past medical history was also significant for type-2 diabetes, coronary artery disease, two previous myocardial infarctions, a cerebrovascular accident 30 years before, and multiple episodes of angioedema from different foods and sulfonamides. She was brought to the ED via ambulance having symptoms of generalized itching, swelling of the lips and tongue, and stridor. She had eaten lunch with a new sauce while at work and subsequently experienced generalized itching, shortness of breath, and tongue and eye swelling. She did not have her epinephrine auto-injector (Epi-Pen) with her. Symptoms worsened, and the patient called EMS. She was treated with SQ epinephrine 0.3 mg, IV methylprednisolone 125 mg, and IV diphenhydramine 50 mg. At the ED, she received another 0.3 mg of epinephrine SQ, IV famotidine 40 mg, and nebulized ipratropium 0.5 mg/albuterol 0.083%. IV methylprednisolone 60 mg was continued every 6 hours, diphenhydramine was changed to 50 mg orally every 8 hours, and oral famotidine was continued as 40 mg twice daily. She was sent to the ICU. An allergist was consulted, and ramipril was discontinued. The patient improved overnight and was transferred to a medical floor on a prednisone taper. She was discharged on day 2 and was advised to follow up with her primary care doctor and an allergy specialist.

Questions:

1. What medical history is significant regarding her risk of a hypersensitivity reaction?

2. Explain the medications given. Include classification, use, check dosing and route.

3. Why was patient sent to ICU?

4. Why is prednisone tapered?

5. What type of reaction did the patient experience?

6. Explain angioedema.

7. What labs will the RN anticipate?

8. What emergency equipment should be available?