Unit 3: Spider Bites

Question 1

The Brown Recluse spider

Answer 1

• venom contains multiple enzymes that make it hemotoxic
• bites can sometimes progress to extensive local necrosis
• initially painless bite to painful blistering that occurs within 2 to 8 hours of the bite and then to a more serious ulceration within 72 hours; necrosis can form
• bite then slowly heals over several weeks to months

Question 2

Black Widow Spider

Answer 2

• releases neurotoxic venom
• causes diffuse muscle pain, spasms and rigidity, and extreme stomach pain
• can include, arthralgias, fever, hypertension, vomiting, and hyperreflexia
• latrodectism (the illness caused by the bite of Latrodectus spiders) resolves in 3 to 7 days

Question 3

The Hobo Spider

Answer 3

• bite can result in extensive derma necrosis and permanent scarring (think of gross hobo)
• completely painless initial bite, progressing to painful induration and erythema within 30 minutes, then multiple small blisters within 15 to 35 hours, and then finally progressing to serous exudate encrusting a cratered wound within 72 hours
• lesions heal spontaneously
• severe headache, vomiting, weakness, fatigue, and vision impairment within 10 hours of the bite

Question 4

Medical Management

Answer 4

• oral or IV analgesics
• antihistamines and antibiotic tx for secondary wound infections
• tetanus vaccine suggested for prophylaxis b/c spider bites can become infected w/ tetanus spores

Question 5

Treatment for a Brown Recluse Bite

Answer 5

-CBC
-Serum glucose
-Platelet count
-BUN and creatinine
-PT and a PTT
-Fibrinogen
-Renal function tests
-Urinalysis
>these studies are aimed at identifying signs of hemolysis and intravascular coagulation
-Treatments: oral corticosteroids, dapsone, colchicine, or hyperbaric oxygenation (work to reduce effects of the dermonecrosis)
-antibiotics if signs of infection

Question 6

Treatment for Black Widow Bite

Answer 6

• CBC, Blood glucose, CK, and urinalysis; often identify leukocytosis, elevated CK and proteinuria
• Treatment: opioids or muscle relaxants
• calcium gluconate 10% IV may relieve muscle rigidity

Question 7

Treatment for Hobo Bite

Answer 7

• symptomatic

- excision of the necrotic tissue as indicated

Question 8

Nursing Management: Assessment and Analysis

Answer 8

• venom of the brown recluse and hobo spiders contain enzymes that are hemotoxic and result in local tissue necrosis
• black widow venom is neurotoxic and causes diffuse pain

Question 9

Nursing Diagnoses

Answer 9

• Impaired skin integrity
• Pain
• Ineffective airway clearance

Question 10

Nursing Assessments

Answer 10

• Vital Signs
• Pain Assessment
• Skin assessment; color, size, and drainage

Question 11

Assessment: Vital Signs

Answer 11

-black widow spider bite may result in hypertension (pain)

Question 12

Assessment: Pain

Answer 12

-spider bites can result in severe pain at the site

Question 13

Assessment: Skin assessment; color, size, and drainage

Answer 13

may help identify type of spider involved

Question 14

Nursing Actions

Answer 14

• Cleanse wound thoroughly; minimize infection
• Apply cold compresses and elevate affected extremity; minimizes swelling
• Administer medications; Antivenin if available, pain medications, antibiotics, and tetanus

Question 15

Antivenin

Answer 15

• given if available

- counteracts the neurotoxic and hemotoxic effects of venom spider bites

Question 16

Patient Teaching

Answer 16

-wound care; keeping the wound clean and reporting any changes or worsening immediately to provider

Question 17

Evaluating Care Outcomes

Answer 17

• successful tx of a spider bite requires prompt intervention, administration of antivenin if available, and symptom management
• well-managed patient is discharged home hemodynamically stable with pain under control and clear wound care instructions

Question 18

Connection Check: The nurse is caring for a patient who presents 4 hours after a spider bite to the hand. The hand is slightly swollen, and there are areas of redness and painful blistering. The nurse correlates these symptoms with what type of spider bite?
A. Brown recluse
B. Black widow
C. Hobo Spider
D. Tarantula

Answer 18

A. Brown recluse