A 55-year-old client who started enalapril 5 mg orally twice… | MyMerci
Adverse Effects/Contraindications/InteractionsPA
Question
A 55-year-old client who started enalapril 5 mg orally twice daily 3 days ago presents to the emergency department with swollen lips and tongue, hoarse voice, and mild stridor. Vital signs: BP 138/82, HR 102, RR 24, SpO2 95% on room air. Which set of actions reflects the priority sequence?
1Hold the enalapril, prepare for emergent airway management with intubation supplies at bedside, and administer IM epinephrine per provider order or standing protocol.✓ Correct answer
2Apply ice to the lips and tongue, give acetaminophen for discomfort, and reassess in 1 hour.
3Administer the next scheduled enalapril dose, place the client in high-Fowler, and obtain a stat CBC.
4Give oral diphenhydramine 50 mg, monitor SpO2 every 30 minutes, and discharge with antihistamine prescription if symptoms decrease.
Explanation
ACE inhibitor angioedema — airway emergency ACE inhibitor angioedema is a life-threatening, non-allergic, bradykinin-mediated reaction that can occur from hours to years after initiation. Hallmarks: lips·tongue·face·glottis swelling, hoarseness, stridor, and rapid airway compromise. Antihistamines and corticosteroids are not effective (this is bradykinin-, not histamine-, mediated), but IM epinephrine, fresh frozen plasma, icatibant (bradykinin B2 antagonist), and C1-esterase inhibitor have been used per protocol. The first nursing actions are: hold the offending drug forever (lifelong contraindication, including ARB cross-reactivity in some patients), prepare for emergent intubation/cricothyrotomy, position upright, and administer IM epinephrine if standing protocol or order. The condition can deteriorate within minutes — never delegate observation only or rely on oral antihistamine.
In-depth explanation
Clinical reasoning summary ACE inhibitor angioedema — airway emergency ACE inhibitor angioedema is a life-threatening, non-allergic, bradykinin-mediated reaction that can occur from hours to years after initiation. Hallmarks: lips·tongue·face·glottis swelling, hoarseness, stridor, and rapid airway compromise. Antihistamines and corticosteroids are not effective (this is bradykinin-, not histamine-, mediated), but IM epinephrine, fresh frozen plasma, icatibant (bradykinin B2 antagonist), and C1-esterase inhibitor have been used per protocol. The first nursing actions are: hold the offending drug forever (lifelong contraindication, including ARB cross-reactivity in some patients), prepare for emergent intubation/cricothyrotomy, position upright, and administer IM epinephrine if standing protocol or order. The condition can deteriorate within minutes — never delegate observation only or rely on oral antihistamine.