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Can a nurse diagnose anaphylaxis?

A case study about diagnosing and treating conditions

A nurse diagnoses a cond​​ition

 

Courtney can hear the two approaching even before 8-year-old Aidan and his counsellor arrive at the nurse’s cabin. Still snuffling after being stung, Aidan shows Courtney his red, swollen ar​m. 

As she sits him down to examine him more closely, she listens to a recounting of the event. Aidan is visibly anxious, his skin flushed and blotchy and his breathing a little wheezy. Her concern increased, she asks Aidan a few more questions and continues her assessment. She can see swelling beginning around his mouth and his breathing becoming more laboured. Checking Aidan’s pulse, she finds it rapid. She’s certain Aidan doesn’t have any allergies – she’s reviewed all camper medical forms. A quick double check confirms this. Courtney runs systematically through her assessment – a rapid pulse, anxiety, red blotchy rash, facial angioedema and wheezy, laboured breathing.

In her clinical judgment, these are signs of anaphylaxis. She knows the treatment is prompt administration of epinephrine. Deciding on her next steps, Courtney calmly explains to Aidan that he’s likely reacting to the bee sting. Handing her cell phone to the counsellor, she asks him to call 9-1-1 and the camp director.

Can Courtney treat Aidan without an order?

Yes, under the Regulation, Courtney is authorized to diagnose and treat conditions. This includes administering Schedule I medications without an order to treat certain conditions. The Scope of Practice for RNs sets standards, limits and conditions under which Courtney can give epinephrine to treat anaphylaxis. The standards for acting within autonomous scope of practice outline her accountabilities and responsibilities when she carries out an activity autonomously.

What does Courtney do?

Following the camp’s anaphylaxis protocol, Courtney carefully draws up the correct dose of epinephrine for Aidan’s age. She explains to Aidan that she needs to give him a little poke of medicine to make his breathing easier. Reassuring him that it will be quick, she talks him through the injection.

Within minutes, Aidan‘s breathing becomes less laboured and his facial swelling decreases. When Courtney checks his pulse, she’s relieved to find that its quality has improved. At that moment, the camp director arrives and Courtney quietly outlines the event and her actions. While the camp director calls Aidan’s parents, Courtney documents the incident and monitors him. Uncertain of how long the wait for emergency services will be, she follows the protocol and administers a dose of diphenhydramine.

When the ambulance arrives a short time later, she gives a quick report to the paramedic. As Aidan is loaded into the ambulance, she assures him that his parents will meet him at the hospital. When the ambulance carrying Aidan and the camp director pulls away, Courtney breathes a sigh of relief.

How is Courtney meeting the Standards for acting within autonomous scope of practice?

Before treating Aidan, Courtney assessed him and concluded, or diagnosed, that anaphylaxis associated with a bee sting was the likely cause of his signs and symptoms. She knew she could improve or resolve Aidan's condition with nursing activities – including administering epinephrine.  In deciding to treat, Courtney considered the risks, benefits and possible outcomes. In her judgment, the outcome was reasonably predictable and the benefits outweighed risks. She knew she had the competence to administer the epinephrine safely and manage any outcomes. She followed an evidence-based protocol and knew her actions were within organizational policy. Courtney understood she was solely accountable for her decision to treat Aidan and confident it was the right one.

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