What clinical manifestation should the nurse practitioner expect in a client potentially having a hypersensitive reaction, hypertension, wheezing, vomiting, or diaphoresis?

Clinical Manifestations of Hypersensitivity Reactions

Wheezing is the most important clinical manifestation the nurse practitioner should expect when assessing a client for a potential hypersensitivity reaction after taking a new medication.

Understanding Hypersensitivity Reactions

Hypersensitivity reactions, including anaphylaxis, are serious, potentially life-threatening allergic reactions that can occur rapidly after exposure to an offending agent, such as a new medication. According to the Journal of Allergy and Clinical Immunology, anaphylaxis often produces signs and symptoms within minutes of exposure, and the more rapidly it occurs, the more likely it is to be severe and potentially life-threatening 1.

Key Clinical Manifestations

When assessing for a hypersensitivity reaction, the nurse practitioner should look for:

1. Respiratory symptoms:

   • Wheezing - a high-pitched whistling sound during breathing, indicating bronchospasm and lower airway involvement
   • Dyspnea (shortness of breath)
   • Stridor (upper airway obstruction)
   • Respiratory distress

2. Cardiovascular symptoms:

   • Hypotension (NOT hypertension)
   • Tachycardia
   • Syncope or near-syncope

3. Cutaneous symptoms:

   • Urticaria (hives)
   • Angioedema
   • Flushing
   • Pruritus (itching)

4. Gastrointestinal symptoms:

   • Nausea
   • Vomiting
   • Abdominal pain
   • Diarrhea

Why Wheezing is the Critical Sign

Among the options presented (hypertension, wheezing, vomiting, or diaphoresis), wheezing is the most significant clinical manifestation for several reasons:

1. Respiratory compromise is one of the defining features of anaphylaxis according to established clinical criteria 1.

2. Bronchospasm with wheezing represents a potentially life-threatening airway involvement that can rapidly progress to respiratory failure 1.

3. The FDA label for epinephrine, the first-line treatment for anaphylaxis, specifically lists bronchospasm as one of the key manifestations of allergic reactions requiring emergency treatment 2.

Differentiating from Other Manifestations

• Hypertension is NOT typically associated with hypersensitivity reactions. In fact, hypotension is the characteristic cardiovascular manifestation of anaphylaxis 1. The vasodepressor (vasovagal) reaction, which can be confused with anaphylaxis, typically presents with normal or increased blood pressure 1.

• Vomiting, while it can occur in anaphylaxis, is not as immediately life-threatening as respiratory symptoms and is often a secondary manifestation 1.

• Diaphoresis (sweating) can occur in hypersensitivity reactions but is a non-specific symptom that can also be present in vasovagal reactions and is not a primary indicator of anaphylaxis 3.

Clinical Decision Making

When evaluating a patient who recently took a new medication and may be experiencing a hypersensitivity reaction:

1. First assess respiratory status:

   • Listen for wheezing, which indicates bronchospasm
   • Check for other signs of respiratory distress (stridor, dyspnea)

2. Then assess cardiovascular status:

   • Check for hypotension (NOT hypertension)
   • Evaluate heart rate (typically tachycardia)

3. Look for supporting evidence:

   • Cutaneous manifestations (urticaria, angioedema)
   • GI symptoms (nausea, vomiting, abdominal pain)

Immediate Management

If wheezing is present along with other signs of hypersensitivity reaction:

1. Administer epinephrine intramuscularly into the vastus lateralis (mid-outer thigh) 1
2. Place patient in a supine position (unless respiratory distress is severe) 1
3. Administer oxygen 4
4. Consider additional treatments after epinephrine (antihistamines, bronchodilators) 1
5. Monitor vital signs continuously 4

Conclusion

When assessing a client who reports taking a new medication and may be experiencing a hypersensitivity reaction, the nurse practitioner should prioritize assessment for wheezing as the most critical clinical manifestation among the options presented. Wheezing represents potentially life-threatening respiratory compromise that requires immediate intervention with epinephrine to prevent progression to respiratory failure and possible death.