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Case Study: Insect-Stings and Pediatric Anaphylaxis A 12-year-old boy is brought to the emergency department after being stung by a bee. He had been well until he was stung on his right forearm, while playing in the yard. He initially complained of localized pain and swelling. Fifteen minutes later, he began to complain of shortness of breath. His parents observed him to be wheezing. He also said that he felt very weak and dizzy. His parents brought him immediately to the local emergency department. Exam: VS T 37.1, P 120, R 39, BP 69/45. He is in mild respiratory distress. He is drowsy and pale, but awakens when you talk to him. He has generalized urticaria. He has no conjunctival edema. His lips and tongue are not swollen. His voice sounds normal. Heart tachycardic without murmurs. His lung examination shows mild wheezing and fair aeration with minimal retractions. His abdomen is soft and non-tender. His face is moderately pale. The bee sting site on his right forearm is unremarkable with no foreign body seen. He appears to in early anaphylactic shock and he is immediately given subcutaneous epinephrine and an albuterol updraft with improvement of his symptoms. An IV is started, but since his condition is improving, he is not given IV epinephrine. He is given diphenhydramine IV, cimetidine IV, methylprednisolone IV, and an IV fluid bolus of normal saline.
The second question is:
Analysis (Analyzing Cues)
Which client conditions are consistent with the cues? Do the cues support a particular client condition? What cues are a cause for concern? What other information would help to establish the significance of a cue?
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