Anaphylactic Shock Fall 2010 Student

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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?