Anaphylactic Shock Flashcards

1
Q
  • Occurs d/t the introduction of an allergen in the body
  • Leads to mast cells or basophils to release histamine & other chemicals system-wide
A
  • Will decrease tissue perfusion causing shock to occur
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2
Q

Anaphylactic shock is a form of ___ shock

The other types are ___ and ___ shock

A

distributive

neurogenic; septic

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3
Q

How does an allergen enter the body to cause anaphylactic shock?

An allergen can enter various ways such as via an injection, inhalation, oral, or contact w/the skin

A

Known Substances that can cause anaphylactic shock

! Foods (shellfish, peanuts, eggs, milk)
! Rx’s (vaccines, contrast dye, NSAIDs, abx [penicillin])
! Insect venom
! Latex
! Physical exercise
! Unknown cause (idiopathic)

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4
Q
  • Can occur either d/t an immune response where IgE ab’s are created or d/t a non-immune response
A
  • Regardless of the reaction, both cause the same s/s, & occur b/c mast cells or basophils release histamine & other mediators
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5
Q

Anaphylactic reaction: IgE related (immunological)

Pt has to experience ____ for reaction to occur
> Is where the pt has a first-time exposure to an allergen that causes the creation of IgE ab’s

Ab’s attach to the mast cell or basophil & hang out waiting for the 2nd exposure

When the 2nd exposure to the allergen occurs, it causes the mast cells or basophils to release histamine & other substances; this leads to the anaphylactic reaction

A

sensitization

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6
Q

It’s a Type I Hypersensitivity Reaction

  • This means the allergen attaches to IgE ab’s on mast cells and basophils
A
  • This leads to a system-wide release of histamine & other mediators
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7
Q

Anaphylactoid Reaction: NON-IgE related (non-immunological)

  • Pt doesn’t have to be sensitized for the reaction to happen… but can happen w/first-time exposure
A
  • Causes same rxn as anaphylactic, but it’s not via Ig IgE ab’s on the mast cells or basophils
    > Allergens for this type of rxn incl contrast dyes, chemo, NSAIDs
  • These agents directly cause the mast cells & basophils to break down & release histamine
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8
Q

Histamine will cause

  • Dilatation of vessels (lowers BP & tissue perfusion)
  • Bronchoconstriction (narrow airways & resp fail)
  • Inc HR
A
  • Inc permeability of vessels (leads to swelling & depletes intravascular space of fluid that shifts to the interstitial space)
  • Itching
  • Incr contraction of GI stomach muscles & incr gastric secretions (→ n/v/d, GI pain)
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9
Q

s/s of Histamine: Respiratory

✦ dyspnea, wheezing (bronchoconstriction)
✦ swelling of upper airways d/t edema, “tightness”
✦ can’t speak, coughing, stuffy nose, watery eyes

A

Cardiac

✦ tachycardia, hypotension [vasodilation] (may lose consciousness or become dizzy)

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10
Q

GI

✦ n/v/d
✦ GI pain

A

Skin

✦ red, swollen, itchy, hives (vasodilation)

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11
Q

Nursing Interventions & Treatments

✔️ Prevention!
> Know pt allergies
> Consider facility’s prevention measure system

ACT FAST!

A

Allergen (remove it) & Airway (manage w/high flow O2 & continuous VS monitoring)

Call Rapid Response (start CPR, if needed, until help arrives)

Trendelenburg Positon
> will help incr venous return to the heart & incr CO & BP

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12
Q

First-line drug is epinephrine
> Given IM or SC
> May be needed IV if severe hypotension persists
* Causes vasoconstriction which will incr the BP, reduce swelling, & cause bronchodilation

A

Administer other medications per MD order (these meds may be ordered depending on the pt’s status)
> IV fluids
> breathing treatment of albuterol
> antihistamines to target H1 (diphenhydramine) & H2 (ranitidine)
> corticosteroids to prevent a recurrent attack

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13
Q

Stay & monitor pt very closely
! @ risk biphasic anaphylaxis (s/s occur again even if not exposed to allergen; can happen hrs >initial attack; may be less, worse, or same as initial attack)

A

Teach!

  • Pt education
    > Importance of avoiding allergen (may need allergy tests)
    > Wearing bracelets & letting others know about allergen
    > ALWAYS carry an Epi-Pen; administered in middle of outer thigh (replace when expired)
    > Have pt demonstration on how to use
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