Never delay IM epinephrine in anaphylaxis to give antihistamines or steroids first.
Before you read
Test yourself first: 5 questions
Question 1 of 5
A child with moderate croup is prescribed a single dose of oral dexamethasone and nebulized racemic epinephrine in the emergency department. What is the priority nursing action after the racemic epinephrine is given?
Answer: B. Racemic epinephrine reduces airway edema quickly, but rebound stridor can occur as the effect wears off. The child must be observed for at least 2 to 3 hours after administration before discharge to detect return of obstruction.
Question 2 of 5
A client is receiving a norepinephrine infusion through a peripheral IV that has become infiltrated, and the surrounding tissue is pale and cool. After stopping the infusion, which antidote does the nurse anticipate to prevent tissue necrosis?
Answer: A. Norepinephrine extravasation causes intense vasoconstriction that can lead to tissue ischemia and necrosis. Phentolamine, an alpha-adrenergic blocker, is injected into the affected area to reverse vasoconstriction and restore perfusion. Vasopressors would worsen the ischemia.
Question 3 of 5
The nurse administers IV norepinephrine to a client in septic shock. Which assessment finding indicates the medication is having the desired effect?
Answer: A. Norepinephrine is a potent vasopressor that increases systemic vascular resistance and raises blood pressure to improve perfusion. The desired effect is an increase in blood pressure toward the target (for example, a mean arterial pressure of 65 mmHg or greater) with improved organ perfusion. A falling blood pressure, decreasing urine output, and worsening hypotension indicate the drug is not achieving its goal.
Question 4 of 5
A client in refractory ventricular fibrillation has received epinephrine. Which antiarrhythmic does the nurse prepare to administer next per ACLS?
Answer: A. Amiodarone 300 mg IV/IO is the recommended antiarrhythmic for shock-refractory VF or pulseless VT after epinephrine. A second dose of 150 mg may follow. Lidocaine is an acceptable alternative, but adenosine and verapamil are not used for pulseless ventricular arrhythmias.
Question 5 of 5
A client in pulseless ventricular tachycardia is receiving CPR. After the first defibrillation and resumption of compressions, which medication is given first per ACLS?
Answer: A. Epinephrine 1 mg IV/IO every 3 to 5 minutes is the first medication given in pulseless VT/VF after the initial shock and CPR. It increases coronary and cerebral perfusion pressure through alpha-mediated vasoconstriction. Amiodarone is added for refractory shockable rhythms after epinephrine.
Keep the streak going with more questions like these, each with a full rationale.
What is epinephrine?
It causes bronchodilation, vasoconstriction, and increased heart rate and contractility. Key principle: in anaphylaxis give it intramuscularly into the outer thigh without delay.
Key points to remember
- It is the first-line treatment for anaphylaxis, given IM into the vastus lateralis (outer thigh).
- It reverses airway swelling and bronchospasm and raises blood pressure through vasoconstriction.
- In cardiac arrest it is given IV/IO every 3-5 minutes.
- Side effects include tachycardia, hypertension, tremor, anxiety, and palpitations.
- It has a short duration, so symptoms of anaphylaxis can return and require a second dose.
Nursing priorities
- For anaphylaxis, give IM epinephrine immediately into the outer thigh.
- Monitor heart rate, blood pressure, airway, and oxygen saturation closely.
- Be ready to repeat the dose if anaphylaxis symptoms persist or return.
- Maintain airway and prepare for advanced support.
- Verify correct concentration and route to prevent dosing errors.
Patient teaching
- Carry two auto-injectors at all times and inject into the outer thigh through clothing if needed.
- Always call 911 after using it because symptoms can return.
- Replace the device before its expiration date and check the solution is clear.
Red flags: report now
- Never delay IM epinephrine in anaphylaxis to give antihistamines or steroids first.
- Report severe hypertension, chest pain, or arrhythmia after administration.
- Symptoms can recur; keep the patient under observation.
References
Clinical references for this topic
