24/09/2026
Child NMC OSCE nurses - New Allergy APIE
Most likely to have medication or food allergy I would imagine not lifetrhatening so mild reaction or has been stbailse dprior to your assessment.
✅Assessment priorities
Start with A–E and don't get distracted by the rash.
A – Airway: swelling, hoarse voice, stridor, throat tightness
B – Breathing: RR, SpO₂, wheeze, work of breathing
C – Circulation: HR, BP, CRT, pallor and perfusion
D – Disability: conscious level, anxiety, pain, blood glucose where appropriate
E – Exposure: rash, urticaria, angioedema, skin changes
Then establish:
• What was the suspected trigger?
• When did exposure occur?
• When did symptoms begin?
• Previous allergies/reactions?
• Relevant medical history, including asthma and eczema
• Child and family concerns and understanding
✅Planning 2 nursing needs/problems
Consider:
• Risk of deterioration, allergy and compromised in airway, breathing or circulation
• Anxiety and emotional support
• Child and family education on allergy management
✅Implementation
Know the difference between treating an allergic reaction and treating anaphylaxis.
Anaphylaxis = IM adrenaline is first-line treatment.
Persistent skin symptoms after stabilisation = an oral non-sedating antihistamine such as cetirizine. This could be a medication in this station.
✅ Evaluation Key Recommendations
Handover allergy: ensure red wristband and documentation
Continue observations and PEWS monitoring as per PEWS policy.
Assess for signs of respiratory distress, swelling, rash
Referral to an allergy specialist where indicated
An individual allergy/anaphylaxis action plan
Education for parents/carers
Education for the child at an age-appropriate level
School/nursery information and emergency planning
Training in adrenaline auto-injector use where prescribed
Follow up on any social issues, housing, safeguarding if applicable, parent smoker
Administration of prescribed medications and antihistamines
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