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5/28/2018 Critical Phase

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a.) EvidenceIs there sufficient evidence to draw any conclusion at this time?There isnt enough evidence to draw any conclusion at this time yet.Mainly because you, as the nurse

have not seen how much exposure Betty has to the poison-ivy plant, or if she really did touch theirritating parts of the plant. Signs of poison-ivy/plant dermatitis hasnt been shown yet (at least thatswhat the Critical Thinking Exercise says), so maybe not.But we should always consider safety/prevention as something very important to the health and well-

being of our patients(my answer is continued on [g])

b.) Agents that causes poison ivy: Background Info:(http://www.allallergy.net/fapaidfind.cfm?cdeoc=1211)Family: Anacardiaceae.The culprit behind the rash is a chemical in the sap of poison ivy plants called urushiol (oo-roo-shee-ohl).

Its name comes from the Japanese word "urushi," meaning lacquer. Urushiol is the same substance thattriggers an allergic reaction when people touch poison oak and poison sumac plants. Poison ivy

(Toxicodendron radican), Eastern poison oak (Toxicodendron quercifolium), Western poison oak(Toxicodendron diversilobum), and poison sumac (Toxicodendron vernix) are all members of the same

family -- Anacardiaceae.It contains a lacquer-like resin in it's sap, composed of active substances that provokes a sensitising

c.) Effects of poison ivy on the skin:History:The individual may complain of itching in the affected area and may report a previous reactionto a particular suspected substance. The individual often reports working or recreating outdoors,

particularly within the past 24 to 72 hours prior to the onset of the illness. It usually occurs on hands orexposed skin of the legs and arms. Air transfer of the plant allergens can lead to extensive dermatitis onthe face and other exposed areas. In severe allergic reaction (anaphylaxis), patients may complain of

difficulty breathing and dizziness.Physical exam:The skin is generally red and swollen. The early stages typically presents as reddened

(erythematous) and swollen (edematous) skin followed by development of small and large blisters(vesicles and bullae, respectively). The blisters may ooze and then crust over with scab formation. It iscommonly seen as streaks or lines of blisters on the arms or legs. In patients with anaphylaxis, swelling of

the face, throat, and lips (angioedema); difficulty in breathing; and loss of consciousness may occur.

Tests:Tests are usually not required. Bacterial cultures may be indicated when a secondary infection issuspected.

d.) Immediate treatment of poison ivy. (http://www.mdguidelines.com/poison-ivy-oak-sumac-or-other-

plant-dermatitis)Treatment consists primarily of identifying the offending agent.Clothing worn by the individual when he or she contracted poison ivy itches/plant dermatitis should bewashed to remove residual toxic chemicals.The individual should also wash the skin with mild soap, or just plain water (to remove some of the

allergenic chemicals), preferably within 10 to 15 minutes (this will help prevent development of the rashaltogether).

If the rash is mild, cool compresses with water or milk, oatmeal bath, calamine lotion (an astringent agent

to dry up secretions) and oral antihistamines to reduce itching (pruritus) are recommended. Burrow'ssolution may be useful also.Application of topical corticosteroid creams may help in mild to moderate erythema (redness), before

blisters appear.

Oral or injectable corticosteroids may be required for severe cases and those involving the genitals orface.If a secondary infection has developed, antibiotics should be used. Anaphylaxis is considered a medicalemergency, and such patients need to be sent to the hospital emergency department immediately.


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If a patient with anaphylaxis is having trouble breathing, inhaled bronchodilators (e.g., albuterol orepinephrine) should be administered to help open the airway.

Injection of epinephrine may be necessary to quickly reverse the most severe effects of the plantdermatitis/poison ivy reactions.

e.) Contraindicated treatments for poison ivy.

- Allergies to Aliphatic Alcohols (eg methanol, ethanol)- Do not massage area (avoid massaging the area) = (unless affected area is widespread, in which case this(referring to massage) is an absolute contraindication)- Vaccination according tohttp://www.bt.cdc.gov/agent/smallpox/faq/screening.asp = vaccinations should

be contraindicated during poison ivy skin problems

f.) What implications and priorities should for nursing care should be drawn at this time?If poison ivy plants, they may develop a full blown case of poison ivy dermatitis.

Priorities include:1.) Not letting plant-dermatitis occur from the poison ivy exposure

2.) Cleaning our skin and other areas thoroughly3.) Remove items exposed to poison-ivy to avoid exposing it to other people

4.) The patient should remain itch-free as always.5.) Counteract the effects of the poison-ivy which has not shown yet through medications (egBenadryl)

6.) Identifying the plant if it really is poison-ivy (by asking questions)Considering the fact that no symptoms of poison-ivy rashes have erupted, it is important to follow theguidelines on how to handle poison-ivy exposure.

1.)The first thing you should do is gently clean the area with cool water.2.) Never used soap since this can spread the urushiol, the irritating oil from the poison ivy plant .

3.) Usually cleansing must be done within the first 15 minutes to give you any hope of avoiding afull blown case of poison ivy.4.) Keep in mind that around a lot of people have a more serious allergic reaction to the poison

ivy plant and may develop severe symptoms such as facial swelling and extreme blistering. If

you fall into this category, see your doctor immediately.

g.) Does the evidence support your conclusion?There is not enough evidence to create a conclusion on this matter

But since the situation is considered as an emergency, it should be noted that medical practitioners need tohave an initial diagnosis of what the problem is.Safety should always be considered first, and even though nothing has happened yet (concerning the factthat nobody in the group at the Critical Thinking Exercise is showing signs of poison ivy reactions) it isalways important perform primary/secondary interventions.

h.) Are there alternative perspectives to your arguments?Facts:

You can't spread poison ivy by coming into contact with a person who has it, unless that person hasurushiol (as mentioned above which states that it is the causative agent of poison-ivy) on their skin. Youcan, however, pick it up by touching a dog that has gotten poison ivy on its fur, or by touching the bladeof a weed whacker that you just used to cut down the plants.Myth:You can't get poison ivy from a dead plant.Reality:Urushiol can linger on surfaces -- including the poison ivy plant -- for several years, even afterthe plant has diedIn other words, other perspectives to my argument of Bettys cabin mate could bepoison -ivy could be

catching, considering the fact that Betty just recently touched the plant, there could be uroshiol still
http://www.bt.cdc.gov/agent/smallpox/faq/screening.asphttp://www.bt.cdc.gov/agent/smallpox/faq/screening.asphttp://www.bt.cdc.gov/agent/smallpox/faq/screening.asphttp://www.bt.cdc.gov/agent/smallpox/faq/screening.asp


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hanging out on her clothes/skin (since we didnt know yet if Betty was touching/wiping her hands or theplant with her clothes)

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