Hereditary Angioedema: An Emergency Nursing Perspective

Abstract

A 24-year-old female patient presents to the emergency department with painful non-pitting, non-pruritic facial swelling, reporting a history of 2 self-resolving episodes of these symptoms. She has no known allergies and no significant medical history but does report a positive family history of undiagnosed intermittent facial or extremity swelling. The patient is awake; alert; oriented to person, place, time, and purpose; and able to follow commands. Her lung sounds are clear to auscultation, and her heart sounds have a regular rate and rhythm, with no murmurs, clicks, or rubs. Her abdomen is soft and nontender, with bowel sounds present in all quadrants. The patient’s skin is pink; warm; dry; and free of any rash, redness, or lesions. Her vital signs and laboratory results are all within normal limits. Diphenhydramine, epinephrine, and prednisone are administered, with no improvement in symptoms. The patient is admitted for observation, and an allergist is consulted. Low levels of C1 inhibitor and C4 confirm a diagnosis of type I hereditary angioedema (HAE). Jillian Wade, Member, Greater Los Angeles County Chapter, is Graduate Student, Adult-Gerontology Acute Care Nurse Practitioner Program, California State University, Los Angeles, CA; and Staff Nurse, Emergency Care Center, St. Joseph Hospital of Orange, Orange, CA. Thomas W. Barkley Jr is Coordinator, Adult-Gerontology Acute Care Nurse Practitioner Program, and Director of Nurse Practitioner Programs, School of Nursing, California State University, Los Angeles, CA.