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Anaphylactic Shock
FALL 2010Dr. Diane Stuenkel
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N125 Course Objectives
Describe the characteristics ofanaphylactic & septic shock.
Discuss the clinical manifestations. Discuss the medical management,
including pharmacology.
Use the nursing process to formulate acare plan for select clients.
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ATI Shock Objectives
Assist with relevant laboratory, diagnostic, & therapeuticprocedures within the nursing role Perform & document appropriate assessments based upon
the clients problems Apply knowledge of patho to planning care for clients with
specific alterations in body systems, including recognizingassociated signs & symptoms
Interpret data that need to be reported immediately Explore resources, make referrals, collaborate with
interdisciplinary team, and ensure continuity of client care Evaluate & plans of care as needed based on priorities of
care and promotion of recovery Provide client teaching Recognize/respond to emergency situations and
evaluate/document the clients response Adapt the plan of care
ATI Book p. 341
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Review
Normal Immune ResponseActive and Passive Acquired Immunity
Antigens
Lymphoid Organs Lymphocytes
B lymphocytes
T lymphocytesAltered Immune Response
Hypersensitivity Reactions Type I: IgE-Mediated Reactions
Lewis et al. 219 - 233
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Shock
Acute widespread process of
inadequate perfusion . . .
inadequate oxygenation to vital organs &tissues throughout the body
results in cellular, metabolic, &
hemodynamic derangements.
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Classification of Shock
Maldistribution of blood flow
Distributive = vasodilation
SepticAnaphylactic
Neurogenic
Low Blood Flow Cardiogenic & Obstructive
Hypovolemic shock
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Distributive Shock
Diffuse vasodilation and increasedcapillary permeability
systemic vascular resistance (SVR).
With fluid resuscitation, effectivecirculating volume cardiac output associated with a low-to-
normal blood pressure.
autoregulation and the pattern ofperipheral blood flow distribution are
disrupted.
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AnaphylacticShock
Hypersensitivity (allergic reaction) Type I
Immediate, Systemic reaction
Life threatening
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Risk Factors
Host Defenses
Nature of the Allergen
Concentration of the Allergen Route of Entrance
Exposure
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Triggers
Venom/insect bites
Foods
Latex etc Dyes and contrast
Medications
Immunotherapy Skin testing
Exercise
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Etiology
Antigen/Allergen circulation WBC
production Immunoglobulin E (IgE=
antibodies)
activation ofmast cellsand basophils degranulate and
release mediators (chemicals), i.e.,
histamine receptors in various organs binds to receptors many reactions
or S & S
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Effects of Histamine Release
Smooth muscle contraction vascular permeabilityVasodilationHypotension secretion of mucus
itching
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Review
Lewis et al, 2007 p. 226
Table 14-10
Fig 14-11
p. 227
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Clinical Manifestations -
Respiratory Nasal congestion
Itching
Sneezing & coughing Chest tightness
Wheezing,
dyspnea, & cyanosis
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Skin Manifestations
Flushing + sense of warmth & diffuse erythema Generalized itching Urticaria Pruritus
Massive facial angioedemapossible upper respiratoryedema
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Cardiovascular Manifestations
Tachycardia or bradycardia
Peripheral vascular collapse as indicated
by Pallor Imperceptible pulse
Palpitations
B/P Circulatory failure coma and death
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Gastrointestinal/GU Problems Nausea
Vomiting
Colicky abdominal pains Diarrhea
Incontinence
Vaginal bleeding
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Neurologic Manifestations
Restlessness
Uneasiness
ApprehensionAnxiety
Decreased LOC
Dilated pupils
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Complications
Cardiovascular collapse
Respiratory failure
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Management
Prompt identification of signs andsymptoms
Immediate intervention Goal is to maintain a patent airway and
ventilation
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Medical TreatmentIMMEDIATE and DIRECT
Airway/Oxygen Epinephrine SC or IV
IV fluids Crystalloid or colloid solutionAntihistamines PO, IM, IV (Benadryl) Steroids -- hydrocortisone Potential: Inotropic agents and
vasoconstrictor agents
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Subsequent Treatment
Establish airway
Hypotension - LR/ NSAdditional bronchodilatorsAminophyliline
Histamine-1 antihistamineschlorpheniramine
H2-Receptor antagonist Zantac IVCorticosteroids: hydrocortisone
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Anaphylactic Reactions for Adults
Contemplate when similar history of severe allergic-typereaction + respiratory difficulty and/or B/P particularly ifskin changes present
O2 Tx Stridor, wheeze, respiratorydistress or s&s of shock
Epinephrine (Adrenaline) 1:1000
solution 0.5 ml (500 mcg) IV =severe; .2 -.5 SC if moderate
Repeat in 5mins if noclinical improvement
Antihistamine 10-20 mgIM or slow IV
Hydrocortisone 100 500mg IV or IV slowly
S&S of shock 1 2 liters ofIV fluid
+
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If the patient has gone into shock, whenthe blood pressure rises to an average of~ 90 or 100 systolic, generally the patientis out of the woods and should do well.
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Nursing Care
AssessmentWhat is the nurses priority assessment?
ABCs
Vital signs
Degree of respiratory distress, angioedema
Obtain history
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Nursing Diagnosis
Ineffective breathing pattern RTbronchospasm and laryngeal edema
Decreased Cardiac Output RT tovasodilation
Anxiety RT respiratory distress and life-
threatening situation
What is the nursing diagnosis priority?
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Nursing Interventions
Restoring Effective Breathing
Increasing Cardiac Output
Reducing Anxiety
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Patient Education & HealthPromotion
Risks for anaphylaxis
Educate regarding early S&S
Clothing Exercise-induced anaphylaxis
Wear ID band
Read labelsAdvise patient to know sensitivities
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Teaching
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Key
Identify
Intervene
Prevent Progression
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Medications to review & know*
- Epinephrine** - Aminophylline
- Chlorpheniramine - Diphenhydramine**
- Glucagon - Methylprednisolone- Norepinephrine - Prednisone
- Ranitidine - Solu-Medrol
* Use, side effects, & nursing precautions
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Clinical Assignment
1) Where can you obtain latex-freeitems in your facility?
2) Your assigned patient is at highestrisk for what type of shock?
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