Guide — Emergency Nursing
Bites & Stings Nursing Care
Most bites and stings are minor; a few are deadly. The exam-day wins are knowing the snakebite don’ts (no ice, no tourniquet, no cut-and-suck), spotting the sting that’s becoming anaphylaxis, and telling the two dangerous spiders apart.
9 min read · Emergency Nursing
Educational use only. Antivenom, antibiotic, rabies prophylaxis, and anaphylaxis management decisions follow provider orders, poison-control guidance, and your facility’s protocols. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Overview
Bites and stings span venom effects, allergic reactions, and infection. The nursing job is to recognize the dangerous ones early, avoid the harmful folk remedies, and watch for the systemic reaction — especially anaphylaxis from stings, the most common cause of death from this category. Poison control is a key partner for envenomation and antivenom decisions.
Key Concepts
Snakebite — the don’ts matter most
For a venomous (pit viper) bite: keep the patient calm and still, immobilize the limb at or slightly below heart level, remove constricting items (rings), mark the swelling edge with times, and get antivenom (CroFab/Anavip) where indicated. Do NOT apply ice, a tourniquet, incise and suck, or apply electric shock — all increase tissue damage or systemic spread. Watch for local necrosis, coagulopathy, and compartment syndrome. (Coral snake — “red on yellow, kill a fellow” — causes neurotoxicity; effects can be delayed.)
The two dangerous spiders
Black widow: a neurotoxic venom causing painful muscle rigidity/cramping (abdomen, mimicking an acute abdomen), sweating, and hypertension — supportive care, pain/muscle relaxants, antivenom for severe cases. Brown recluse: a cytotoxic venom causing a painful lesion that can become a necrotic ulcer (the “red, white, and blue” sign) — local wound care, observation, and delayed debridement; antivenom isn’t standard.
Stings → anaphylaxis is the killer
Bee/wasp/hornet stings usually cause local pain and swelling, but a sting can trigger anaphylaxis — the priority emergency. Remove a stinger by scraping (don’t squeeze), watch for systemic allergic signs (airway swelling, wheeze, hypotension, urticaria), and give IM epinephrine first-line for anaphylaxis. Patients with known severe allergy carry an epinephrine auto-injector.
Ticks, marine stings, and mammal bites
Ticks: remove promptly with steady straight traction at the skin; watch for Lyme (erythema migrans bull’s-eye) and other tick-borne illness. Jellyfish: rinse with vinegar/seawater (not fresh water), remove tentacles, hot-water immersion for many species. Animal/human bites: high infection risk (cat bites and human bites especially) — irrigate, often leave open, antibiotics, update tetanus, and assess rabies risk (wash thoroughly; post-exposure prophylaxis for high-risk exposures).
Assessment Findings
Identify what bit/stung the patient and when. Assess the local wound (fang marks, swelling — mark and time the edge for snakebite, lesion appearance for spiders) and screen for systemic effects: airway/breathing and circulation for anaphylaxis; neuromuscular signs (widow, coral snake); bleeding/bruising and labs for pit-viper coagulopathy; and signs of evolving infection. Check neurovascular status distal to a swelling limb (compartment syndrome), tetanus and rabies status, and allergy history. Continuously monitor the unstable patient.
Nursing Priorities
Treat anaphylaxis immediately
For systemic allergic reaction: IM epinephrine first, airway support and oxygen, IV fluids for hypotension, and adjuncts (antihistamines, steroids) — then monitor for biphasic reaction.
Manage envenomation correctly
Immobilize and position the bitten limb, remove constricting items, mark progression, control pain, consult poison control, and administer antivenom as ordered (watch for antivenom reactions). Avoid the harmful field remedies and reassure the patient to stay calm and still.
Wound, tetanus, and rabies care
Clean and irrigate wounds, follow open-vs-closed decisions, give antibiotics for high-risk bites, update tetanus, and assess rabies exposure and prophylaxis. Remove stingers/ticks by the correct technique.
Monitor for the complications
Compartment syndrome (rising pain, tense swelling, neurovascular change), coagulopathy and bleeding (pit viper), necrosis (recluse), neurotoxicity (widow, coral), and infection. Escalate changes early.
Therapeutic Communication Considerations
Bites and stings are frightening and folklore-laden — patients arrive having tried tourniquets or suction. Correct misinformation gently and explain why the “help” harms. Anaphylaxis is terrifying; calm, decisive action reassures. For patients with new severe sting allergy, the teaching about carrying epinephrine is life-or-death and worth the time. With dog/animal bites, navigate the emotional attachment to the pet while completing rabies risk assessment and any reporting.
Patient & Family Education
For sting-allergic patients: always carry two epinephrine auto-injectors, use it at the first sign of a systemic reaction and call 911, and seek evaluation even after using it (biphasic reactions); consider allergy referral for immunotherapy. General prevention: avoid disturbing snakes/spiders/nests, wear protective footwear/gloves outdoors, do tick checks after being outside, and don’t handle wild or stray animals. Teach correct field response — for snakebite: stay calm, immobilize, no ice/tourniquet/cutting, get to care fast; remove ticks with steady traction; scrape out stingers. Cover wound-care and infection warning signs and the importance of completing rabies prophylaxis if started.
NCLEX Pearls
- ✦Snakebite: immobilize at/below heart level, remove rings, mark swelling; NO ice, NO tourniquet, NO incision/suction.
- ✦Sting anaphylaxis = IM epinephrine FIRST; scrape (don’t squeeze) a stinger; watch for biphasic reaction.
- ✦Black widow = neurotoxic (muscle rigidity/cramping); brown recluse = cytotoxic (necrotic ulcer).
- ✦Animal/human bites: high infection risk → irrigate, antibiotics, tetanus, assess rabies; cat and human bites are worst.
- ✦Remove ticks with steady straight traction; jellyfish — rinse with vinegar/seawater, not fresh water.
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with Emergency Nurses Association (ENA) · AHA ACLS / PALS Guidelines · Advanced Trauma Life Support (ATLS). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →