Anaphylactic Shock

FALL 2010
Dr. Diane Stuenkel
N125 Course Objectives

 Describe the characteristics of

anaphylactic & septic shock.
 Discuss the clinical manifestations.
 Discuss the medical management,
including pharmacology.
 Use the nursing process to formulate a
care plan for select clients.
 ATI Shock Objectives
 Assist with relevant laboratory, diagnostic, & therapeutic
procedures within the nursing role
 Perform & document appropriate assessments based upon
the client’s problems
 Apply knowledge of patho to planning care for clients with
specific alterations in body systems, including recognizing
associated 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 client’s response
 Adapt the plan of care
ATI Book p. 341
 Review
 Normal Immune Response
 Active and Passive Acquired Immunity
 Antigens
 Lymphoid Organs
 Lymphocytes
 B lymphocytes
 T lymphocytes

 Altered Immune Response

 Hypersensitivity Reactions
 Type I: IgE-Mediated Reactions

Lewis et al. 219 - 233

Shock

Acute widespread process of

inadequate perfusion . . .
inadequate oxygenation to vital organs &
tissues throughout the body

results in cellular, metabolic, &

hemodynamic derangements.
Classification of Shock
 Maldistribution of blood flow
 Distributive = vasodilation
 Septic
 Anaphylactic

 Neurogenic

 Low Blood Flow

 Cardiogenic & Obstructive
 Hypovolemic shock
Distributive Shock
 Diffuse vasodilation and increased capillary
permeability
 ↓ systemic vascular resistance (SVR).
 With fluid resuscitation, ↑ effective circulating
volume
 ↑ cardiac output associated with a low-to-
normal blood pressure.

 autoregulation and the pattern of

peripheral blood flow distribution are
disrupted.
 Anaphylactic Shock

 Hypersensitivity (allergic reaction) – Type I

 Immediate, Systemic reaction
 Life threatening
Risk Factors

 Host Defenses
 Nature of the Allergen
 Concentration of the Allergen
 Route of Entrance
 Exposure
Triggers
 Venom/insect bites
 Foods
 Latex etc
 Dyes and contrast
 Medications
 Immunotherapy
 Skin testing
 Exercise
 Etiology

Antigen/Allergen  circulation  WBC

production  Immunoglobulin E (IgE =
antibodies) activation of mast cells
and basophils  degranulate and
release mediators (chemicals), i.e.,
histamine  receptors in various organs
 binds to receptors  many reactions
or S & S
Effects of Histamine Release

 Smooth muscle contraction

 ↑ vascular permeability
 Vasodilation
 Hypotension
 ↑ secretion of mucus
 itching
Review

 Lewis et al, 2007

 p. 226
 Table 14-10
 Fig 14-11

 p. 227
Clinical Manifestations -
Respiratory
 Nasal congestion
 Itching

 Sneezing & coughing

 Chest tightness

 Wheezing,

dyspnea, & cyanosis

 Skin Manifestations
 Flushing + sense of warmth & diffuse erythema
 Generalized itching
 Urticaria
 Pruritus
 Massive facial angioedema

possible upper respiratory

edema
Cardiovascular Manifestations

 Tachycardia or bradycardia
 Peripheral vascular collapse as indicated
by
 Pallor
 Imperceptible pulse

 Palpitations

 ↓ B/P

 Circulatory failure  coma and death

Gastrointestinal/GU Problems
 Nausea
 Vomiting
 Colicky abdominal pains
 Diarrhea
 Incontinence
 Vaginal bleeding
Neurologic Manifestations

 Restlessness
 Uneasiness
 Apprehension
 Anxiety
 Decreased LOC
 Dilated pupils
Complications

 Cardiovascular collapse
 Respiratory failure
Management

 Prompt identification of signs and

symptoms
 Immediate intervention
 Goal is to maintain a patent airway and
ventilation
Medical Treatment
IMMEDIATE and DIRECT
 Airway/Oxygen
 Epinephrine SC or IV
 IV fluids
 Crystalloid or colloid solution
 Antihistamines – PO, IM, IV (Benadryl)
 Steroids -- hydrocortisone
 Potential: Inotropic agents and
vasoconstrictor agents
Subsequent Treatment

Establish airway
Hypotension - LR / NS
Additional bronchodilators
Aminophyliline
Histamine-1 antihistamines
chlorpheniramine
H2-Receptor antagonist – Zantac IV
Corticosteroids: hydrocortisone
 Anaphylactic Reactions for Adults
Contemplate when similar history of severe allergic-type
reaction + respiratory difficulty and/or ↓ B/P particularly if
skin changes present

Stridor, wheeze, respiratory

O2 Tx distress or √ s&s of shock

Repeat in 5mins if no
Epinephrine (Adrenaline) 1:1000 clinical improvement
solution 0.5 ml (500 mcg) IV =
severe; .2 -.5 SC if moderate
•Hydrocortisone 100 – 500
mg IV or IV slowly
Antihistamine 10-20 mg
IM or slow IV
+ •S&S of shock – 1 – 2 liters of
IV fluid
 If the patient has gone into shock, when
the blood pressure rises to an average of
~ 90 or 100 systolic, generally the patient
is out of the woods and should do well.
Nursing Care

 Assessment
What is the nurse’s priority assessment?
 ABC’s
 Vital signs
 Degree of respiratory distress, angioedema
 Obtain history
Nursing Diagnosis

 Ineffective breathing pattern RT

bronchospasm and laryngeal edema
 Decreased Cardiac Output RT to
vasodilation
 Anxiety RT respiratory distress and life-
threatening situation

What is the nursing diagnosis priority?

Nursing Interventions

 Restoring Effective Breathing

 Increasing Cardiac Output
 Reducing Anxiety
Patient Education & Health Promotion

 Risks for anaphylaxis

 Educate regarding early S&S
 Clothing
 Exercise-induced anaphylaxis
 Wear ID band
 Read labels
 Advise patient to know sensitivities
Teaching
Key

 Identify
 Intervene
 Prevent Progression
Medications to review & know*

- Epinephrine** - Aminophylline
- Chlorpheniramine - Diphenhydramine**
- Glucagon - Methylprednisolone
- Norepinephrine - Prednisone
- Ranitidine - Solu-Medrol

* Use, side effects, & nursing precautions

Clinical Assignment

 1) Where can you obtain latex-free

items in your facility?
 2) Your assigned patient is at highest
risk for what type of shock?