Unrecognized Pre-Hospital Anaphylactic Hypersensitivity

7/28/2019 Unrecognized Pre-Hospital Anaphylactic Hypersensitivity

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Medication-Induced Anaphylactic

Hypersensitivity:

A Concept Mapping

Presented by:

A. Enriquez, RN

A. Martin, RN

H. de Guzman, RN

L. Roaquin, RN

T. Cui, RN



Anaphylactic Hypersensitivity

• Most severe form of hypersensitivity

• Acute systemic hypersensitivity reaction thatoccurs within seconds or minutes after exposureto certain foreign substances.

• Result of an antigen-antibody interaction in a

sensitized individual who has developed aspecial type of immunoglobulin that is specificfor that allergen

• IgE is responsible for most of the immediate

type of human allergic responses




• Mr. E is a 37 y/o male who presents to thehospital at 9:08am

• With complaints of severe abdominal cramping,n/v, dizziness, tingling and numbness of extremities.

• As reported, he took ibuprofen for muscularpain after shift that day




• According to the patient, it was his first time totake ibuprofen since he used to take paracetamolfor pain management.

• He was diagnosed to have HTN 2 years ago.

• Complies with the therapeutic regimen but do

not regularly take his medicine due to busy schedule

• Asthma is common in their bloodline



Assessment:

• Upon admission, there was complaint of chestpain, throat tightness, dyspnea, tingling &

warmth sensation, odynophagia, altered mentalstatus but conversant,

• BP: 80/50, PR: 125, RR: 24, afebrile uponadmission, (+) angioedema & lacrimation, with

conjunctival injection, presence of nasal flaring,stridor upon auscultation, diffuse abdominaltenderness upon palpation, and generalizedurticaria



Diagnostic Workup:

• IgE = 626 U/mL

• Histamine (U) = 495 nmol/g crt



Case Study

• Mr. E is a 37 y/o single male

• c/o of throat tightness

• Hx: HTN, asthma

• Used to smoke (6 years ago) and drinksoccasionally (1-3 bottles a week)

• Uses paracetamol for muscle pain; first to takeibuprofen



Case Study

• Other S/sx included are generalized urticaria,altered mental status, dyspnea, chest tightness,abdominal cramping and n/v



Risk Factors

Exposure to antigen(ibuprofen)

Hereditary (Hx of Asthma)



Pathophysiology



Release of inflammatory mediators



Diagnosis/Presenting Problem




Medication-Induced Anaphylactic Reaction



Assessment Findings





Smooth MuscleContraction

Vasodilation

Inc. vascularPermeability

Integumentary S/Sx

Rhinnorhea



Diagnostic Procedure





Smooth MuscleContraction

Vasodilation


Integumentary S/Sx

Rhinnorhea

IgE = 626 U/mL

Histamine = 495

nmol/g CRT



MedicationsSmooth Muscle

Contraction Vasodilation


Integumentary S/Sx

O2 administrationranitidine

epinephrine0.9% NaCl IV methylprednisolone diphenhydramine



Nursing DiagnosisSmooth Muscle

ContractionSmooth Muscle

ContractionInc. vascularPermeability

Integumentary S/Sx

O2 administrationranitidine

epinephrine0.9% NaCl IV methylprednisolone diphenhydramine

Ineffective respiratory function r/t excessive

secretions asmanifested by stridor

Decreased cardiacoutput related todecreased venous

return as evidenced by dyspnea,

decreasedperipheral pulses

and peripheralcyanosis

Ineffective tissueperfusion related to

mismatch of

ventilation with blood flow asevidenced by

altered mentalstatus and

peripheral cyanosis

Risk for impairedskin integrity

related toimmunologic

factors asevidenced by hives,

pruritus anderythema

Activity intolerancerelated to oxygenationimbalances of supply

and demand ascharacterized by chest

pain and dyspnea



Nursing Care InterventionsA. Independent

Insert an I.V. line for giving emergency drugs and volume expanders.

Continually reassure the patient and explain all tests and treatments toreduce fear and anxiety.

Monitored V/S regularly including pain episodes and O2 saturation

Auscultated lung fields and heart tones & notified MROD for significant

changes

Assessed LOC & orientation

Checked peripheral pulses & observed extremities for color, capillary refill,

& sensation



Nursing Care InterventionsA. Independent

Kept environment quiet & calm, provided relaxing techniques

Ensured physical rest with passive exercises

Provided information to patient & SOs regarding disease process,

diagnostics, medications & interventions

Observe for complications associated with anaphylaxis, such as vascular

collapse and acute respiratory insufficiency or obstruction.

Closely observe a patient with known allergies for anaphylaxis when giving

a drug with high anaphylactic potential.



Nursing Care Interventions

B. Dependent

Administered medications, and O2 therapy as

prescribed and evaluated body response accordingly.

Rapidly infuse I.V. fluids to fill vasodilated

circulatory system and raise blood pressure. Titrate

vasopressors based on blood pressure response asordered.

Administered O2 as prescribed. If hypoxia continues,

prepare to help insert an artificial airway.



Ecologic Model

Anaphylactic Shock

Idiopathic:

Ibuprofen

(NSAIDs)

Hypertension

Medication:

Lisinopril Family History of

Bronchial Asthma

Anaphylaxis MR. E

Unresolved



Evidenced-Based Practice

Title:

A Role for Platelet-Activating Factor in Anaphylaxis

Purpose:

To evaluate the relationship between PAF, PAFacetylhydrolase, and the severity of anaphylaxis,patients with acute allergic reactions were studiedprospectively at the time of presentation to theemergency department of a university teachinghospital.




Clinical Question:

• Does Platelet activating factor (PAF) levels andPlatelet activating factor acetylhydrolase activity determine the severity of anaphylaxis?

• Does Platelet activating factor (PAF) levels and

Platelet activating factor acetylhydrolase activity determine the risk of an individual foranaphylactic shock?




Summary & Conclusion:

• The results of the study implicates that therelationship between PAF acetylhydrlase and theseverity of anaphylaxis is inversely proportional.

• The higher the individual’s level of PAF

acetylhydrolase the lower the severity of his/heranaphylaxis is.

• PAF acetylhydrolase deficiency is anindependent risk factor for fatal anaphylaxis




Significance:

These data provide the rationale for thedevelopment of drugs to selectively block theactions of PAF, both as rescue therapy in cases of acute anaphylaxis and potentially as long-term

preventive treatment for those at highest risk forfatal anaphylaxis.



Theoretical Basis of Care

Orem’s Self -Care Deficit Theory



Ethico-Moral & Legal Issues

Ethico-MoralPrinciples:▫ Autonomy

▫ Nonmalifecence

▫ Beneficence

▫ Justice

▫ Veracity

Legal Responsibilities:▫ Patient’s advocate

▫ Administeringmedication

▫ Informed consent



Thank You!!!

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Unrecognized Pre-Hospital Anaphylactic Hypersensitivity