NURSING MANAGEMENT OF A PATIENT WITH ANAPHYLACTIC SHOCK

PRESENTED BY S. KARTHIKEYANI

ANAPHYLACTIC REACTION
IT IS AN ACUTE SYSTEMIC HYPERSENSITIVITY REACTION THAT OCCUS WITHIN SECONDS TO MINUTE AFTER EXPOSURE TO A VARIETY OF FOREIGN SUBSTANCES IN A SENSITIZED PERSON

ANAPHYLACTOID REACTION
IT IS THE RESULT OF DIRECT RELEASE OF CHEMICAL MEDIATORS FROM MAST CELLS & BASOPHILS TRIGGERED BY NON-ANTIGENIC AGENTS.

ANTIBODIES REACT WITH ANTIGENS IN A VARIETY OF WAYS

BY COATING BY NEUTRALIZING BY PRECIPITATING

IMMUNITY

ACTIVELY ACQUIRED IMMUNIZATION PASSIVELY ACQUIRED IMMUNIZATION

IMMUNOGLOBULINS
ANTIBODIES THAT ARE FORMED BY LYMPHOCYTES AND PLASMA CELLS IN RESPONSE TO AN IMMUNOGENIC STIMULUS CONSTITUTE A GROUP OF SERUM PROTEINS CALLED IMMUNOGLOBULINS . FIVE CLASSES OF IMMUNOGLOBULINS IgE, IgD, Igg, Igm, IgA
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T CELLS
IT IS A SECOND TYPE OF LYMPHOCYTE WITH MAJOR ROLE IN THE IMMUNE SYSTEM, ASSIST THE `B` CELLS IN THE PRODUCTION OF ANTIBODIES. LYMPHOKINES

COMMON CAUSES ANAPHYLACTIC REACTION

FOOD INSECT STINGS CHEMICALS AND FOREIGN PROTEINS DRUGS PHYSICAL EXERCISE IDIOPATHIC IV INFUSION BLOOD TRANSFUSION
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TYPE `IV` REACTION DELAYED HYPERSENSITIVITY

SENSITIZED `T` CELLS REACT WITH ANTIGEN AT OR NEAR INJECTION SITE RELEASE LYMPHOKINES ATTRACTS, ACTIVATES MACROPHAGES RELEASE OF LYSOZYME DAMAGE TO SURROUNDING TISSUE
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CVS

CLINICAL PRESENTATION
TACHYCARDIA PALPITATION HYPOTENSION SHOCK

RESP

DYSPNOEA STRIDOR WHEEZE EXCESSIVE COUGH CYANOSIS LARYNGEAL OEDEMA TIGHTNESS IN CHEST OR THROAT CARDIO RESPIRATORY ARREST
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CLINICAL PRESENTATION (contd.,)

GI NAUSEA VOMITING DIARRHOEA ABDOMINAL CRAMPS

RENAL SKIN

DECREASED OR NO URINARY OUTPUT

PRURITIS UTRICARIA FLUSHING OF FACE COLD CLAMMY SKIN ANGIODEMA
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CLINICAL PRESENTATION (contd.,)

CNS

SYNCOPE ALTERED SENSORIUM SEIZURES COMA GENERAL HEADACHE UNEASINESS SUBNORMAL TEMPERATURE
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MANAGEMENT OF ANAPHYLAXIS
AIMS:
1. 2. 3. 4. RESTORE EFFECTIVE BREATHING INCREASE CARDIAC OUTPUT REDUCE ANXIETY EDUCATE THE PATIENT
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ANAPHYLAXIS
EMERGENCY MANAGEMENT 1. 2. 3. 4. 5. 6. 7. 8. 9. POSITION AVOID FURTHER EXPOSURE TO CAUSATIVE ALLERGENS ADMINISTER OXYGEN CHECK VITAL SIGNS ESTABLISH IV LIFELINE SENT CALL FOR MO DO NOT RUN FOR MO DO NOT BE PANICKY DUTY NURSING OFFICER/NURSING ASSISTANT CAN START TREATMENT
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PHARMACOTHERAPY
DRUG PHENERGAN HYDROCORTISONE DOSE 25-50 mg 100300mg 220mg 1:3ml., 200mg ROUTE IM/IV IV

DERRIPHYLLIN
ASTHALIN DOPAMINE

IV/INFUSION
NEBULISATIO N INFUSION
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PHARMACOTHERAPY
DRUG ADRENALINE MILD REACTION DOSE ROUTE

0.3 TO 0.5ML (1:1000)

0.3 TO 0.5ML (1:1000) 1 TO 3 ML (1:10,000) 1 TO 4 gm/min

S/C

MODERATE REACTION SEVERE REACTION

IM

IV/ET INFUSION
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ANAPHYLAXIS
LATE MANAGEMENT

1.POSITION 2.SUCTION 3.BE ALERT TO ALL AIRWAY OBSTRUCTION 4.MONITOR SPO2 5.ABG ANALYSIS 6.RECORD ECG 7.CHEST XRAY 8.DEEP BREATHING EXERCISE 9.PROVIDE SPUTUM MUG 10. DISCOURAGE SCRATCHING 11.APPLY CALAMINE LOTION 12.CLOTHING 13. EMOTIONAL DISTURBANCE
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HEALTH TEACHING
TEACH THE PATIENT, THE POTENTIAL SERIOUSNESS OF THE REACTION RECOGNISE SYMPTOMS MEDIC ALERT BRACELETS HEALTH RECORD EMERGENCY KIT AUTO INJECTION EXERCISE INDUCED ANAPHYLAXIS
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CONCLUSION
IF YOU KNOW THE ENEMY (ANAPHYLAXIS) AND KNOW YOURSELF, YOU NEED NOT FEAR THE RESULTS OF HUNDRED BATTLES. IF YOU KNOW YOURSELF BUT NOT THE ENEMY (ANAPHYLAXIS) FOR EVERY VICTORY GAINED YOU WILL ALSO SUFFER A DEFEAT. IF YOU KNOW NEITHER THE ENEMY (ANAPHYLAXIS) NOR YOURSELF, YOU WILL SUCCUMB IN EVERY BATTLE
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