NCLEX Review Guide: Bites and Stings

Primary Assessment Priorities

• Airway, breathing, circulation (ABC) - Priority assessment for severe allergic reactions or anaphylaxis
• Identify the type of bite/sting through patient history and visual inspection of wound characteristics
• Assess for signs of systemic reactions including difficulty breathing, swelling, hypotension, or altered mental status
• Document time of incident, location on body, and any first aid measures already taken

Hymenoptera Stings (Bees, Wasps, Hornets)

• Honeybee stings leave a barbed stinger that must be removed by scraping, not squeezing to avoid injecting more venom
• Local reactions include pain, swelling, and erythema at sting site lasting 24-48 hours
• Anaphylaxis risk - monitor for systemic symptoms including urticaria, bronchospasm, and cardiovascular collapse

Spider Bites

• Black widow spider - neurotoxic venom causing muscle cramps, hypertension, and abdominal rigidity
• Brown recluse spider - cytotoxic venom causing tissue necrosis with characteristic bull's-eye appearance
• Most spider bites are harmless and present as minor local reactions

Snake Bites

• Venomous snakes cause systemic envenomation with coagulopathy, cardiovascular effects, and tissue damage
• Non-venomous snake bites present as puncture wounds without systemic symptoms
• Antivenom administration may be required for venomous bites based on severity scoring

Immediate Interventions

1. Remove stinger if present by scraping with credit card or fingernail
2. Clean wound thoroughly with soap and water
3. Apply cold compress to reduce swelling and pain
4. Elevate affected extremity if possible
5. Administer tetanus prophylaxis if indicated

Medication Management

• Epinephrine - First-line treatment for anaphylaxis, administered intramuscularly in anterolateral thigh
• Antihistamines (diphenhydramine, loratadine) for allergic reactions and itching
• Corticosteroids for severe local reactions or delayed hypersensitivity
• Analgesics for pain management - avoid aspirin in children due to Reye's syndrome risk

Signs Requiring Immediate Intervention

• Anaphylaxis symptoms - difficulty breathing, swelling of face/throat, rapid pulse, dizziness
• Signs of secondary infection - increased redness, warmth, purulent drainage, red streaking
• Systemic envenomation signs - altered mental status, bleeding, hypotension
• Tissue necrosis or compartment syndrome in extremity bites

Prevention Strategies

• Wear protective clothing when outdoors, especially in wooded or grassy areas
• Use insect repellent containing DEET on exposed skin
• Avoid wearing bright colors or floral patterns that attract insects
• Carry epinephrine auto-injector if history of severe allergic reactions

When to Seek Medical Care

• Signs of allergic reaction or anaphylaxis
• Bite from venomous snake or spider
• Signs of infection developing 24-48 hours post-bite
• Systemic symptoms or worsening local reaction

• Don't squeeze bee stingers - this injects more venom into tissue
• Avoid applying heat to bite sites - increases venom absorption and tissue damage
• Don't use tourniquets for snake bites - can cause tissue necrosis
• Never attempt to suck venom from bite wounds - ineffective and dangerous