Discussion Board, NURS 300 week 4:

A 43-y/o man is brought to the emergency room after being stung multiple times by hornets while cutting grass. He has welts over most of his body, is itching all over, exhibits extreme anxiety, and shows tachycardia of 150 on the cardiac monitor, B/P 108/65. His frantic wife states that he is allergic to penicillin and has reacted to bee stings in the past.

Discuss what happens during a type I hypersensitivity reaction as well as indicate responses to major mediators and clinical manifestations. The clients wife asks the nurse to explain to her what is going on. How would the nurse respond? After primary exposure to an environmental antigen, the body produces antibodies against the antigen. These antibodies live on the cell membrane of mast cells and basophils (Saif, 2001). Upon subsequent exposures, the antibodies recognize the antigen as foreign and begin an inflammation cascade in an effort to contain and eliminate it. This is a normal inflammatory response, but when the body is hypersensitive to the antigen, a Type 1 hypersensitivity reaction occurs. The reaction to the antigen is rapid because the cells are already formed and specific to the invader. The mast cells release histamine, which increases blood flow and edema in the respiratory system, along with dizziness caused by a decrease in blood pressure. When multiple systems are involved, anaphylaxis can occur with stomach cramps, vomiting, shock and possible death (Huether & McCance, 2012). The hypersensitivity reaction is treated with epinephrine, which will stop the inflammation cascade by counteracting the histamine response resulting in degreasing heart rate, blood flow and edema (Seif, 2001). Mrs. X, I see that you are anxious about what is happening to your husband. He is having an allergic reaction to the venom form the hornet stings. You said that he has reacted to bee stings in the past. This means that his reaction this time may be more intense than before because his body has already formed antibodies to the venom. This is a normal response that helps to begin the healing after and insect sting. Your husband seems to be hypersensitive to the venom and has an increased heart rate, itching and welts that are caused by a release of histamine in his system. We are giving him epinephrine to counteract that now. The changes in his body are making him anxious, but he should start feeling better soon. It is also important that from now on your husband avoids activities that will expose him to bees and hornets. If he is stung in the future, his reaction could be more intense and include a headache, dizziness, wheezing, stomach cramps, vomiting and even severe shock. In the event of another bee or hornet sting, it is important that your husband is treated immediately to prevent these symptoms from developing. Your doctor will be prescribing an EpiPen for him to have with him all the time. It looks scary, but it is easy to use and I will return in 10 minutes with one to teach both of you how to use it. Is there anything else you wish to know?
Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (5th ed.). St Louis,MO: Mosby Elsevier

Saif, M. W. (2001). Bee sting and urticarial. Patient Care 35(2).