A client taking lisinopril develops sudden swelling of the lips and tongue with hoarseness and difficulty swallowing. Which action should the nurse take?
1Administer the scheduled lisinopril with food and reassess the swelling after the blood pressure decreases.
2Give an oral antihistamine and observe the client in the waiting area for improvement in the swelling.
3Stop lisinopril, activate emergency care, support oxygenation, and prepare for immediate airway management.✓ Correct answer
4Apply a cold compress to the face and arrange a routine follow-up visit to discuss a different medication.
Explanation
Lisinopril can cause angioedema involving the lips, tongue, glottis, or larynx at any time during treatment. Hoarseness and difficulty swallowing indicate possible airway obstruction. Lisinopril is discontinued promptly, emergency care is activated, oxygenation is supported, and equipment and personnel for definitive airway management are prepared. Oral medication and delayed observation are inadequate.
Clinical reasoning ACE inhibitor angioedema is mediated largely by bradykinin and can progress rapidly to upper-airway obstruction. Visible swelling may underestimate laryngeal involvement.
Decision rule Tongue swelling, hoarseness, dysphagia, or breathing difficulty while taking an ACE inhibitor is an airway emergency: discontinue the drug, call for emergency support, and prepare a definitive airway.