You're the Sleuth, Installment Two

At clinical yesterday, my patient displayed interesting symptoms that left everybody guessing. Test your clinical knowledge with this scenario:

A 52 year old female has breast cancer and is 1 day post-masectomy of the left breast. Three lymph nodes were removed during the surgery. So far her recovery is uneventful except for complaints of "itching like crazy" on her left arm, right flank and head.

She asks you to check for a rash because "it feels so bad there must be something like a rash there." You see no rash, only redness where she has scratched the skin.

Her arms and hands are edematous (swollen) bilaterally, with the left side more swollen than the right.

This patient has not received any opiates (including morphine) for the past 24 hours. She is receiving Tylenol (Acetaminophen) PO for pain, Benadryl (Diphenhydramine) PO to relieve itching, and Cipro (Ciprofloxacin) PO to prevent a post-op infection.

What are your first impressions as to what could cause these symptoms?

Stop now to formulate your hypotheses.

Later in the shift the patient applies warm water to the itching area and states that this partially relieves the itching.

Thirty minutes later you observe a rash of fine papules on the patients hand and arm that looks like this:


What has caused these symptoms? What are the priority nursing interventions? What orders do you anticipate from the doctor?

Leave your comments and stay tuned to find out what happened. I will post the answer tomorrow!