EDN: Anaphylaxis, Anaphylactic Shock

Anaphylaxis

life threatening hypersensitivity or pseudo allergic reaction to exogenous agent.

Type 1

What type of hypersensitivity reaction is anaphylaxis?

b. Immunotherapy

Which of the following is an IgE-mediated cause of anaphylaxis?
a. Radiocontrast media
b. Immunotherapy
c. Exercise
d. Cold exposure

antibiotics and NSAIDs

common medications known for allergic reactions?

pseudo allergic

Anaphylactic reaction is a ___________ reaction

Anaphylactic reaction

needs prior exposure

Anaphylactoid reaction

does not need prior exposure

Anaphylactic reactions

1st exposure no allergies occur, 2nd exposure allergies occur because antibodies are already developed. The immunoglobulins are triggered.

Anaphylactoid reaction

without prior exposure, allergic response is activated

immunoglobulin E or IgE

The initial exposure to the allergy-inducing agent (allergen) results in the formation of antibodies called

IgE immunoglobulin E

immunoglobulin for allergies?

primary immune response

initial / first exposure is called

mast cells

activation of this causes release of chemical mediators

Mast cells and basophils

are both dispersed throughout the body and will wait for the next allergen exposure.

mast cells

cells found in tissues?

basophils

cells found in the blood

secondary immune response

Subsequent exposure to the allergen produces _______________ immune response

DEGRANULATION

The antigen and the IgE interact to trigger rupture of mast cells called

Histamine

are released by mast cells, which is the MOST important cause of symptoms

1. massive vasodilation

2. increase capillary permeability

3. smooth muscle contraction

Anaphylaxis can lead to ________ (3) due to the release of histamine, which can lead to shock if untreated.

Distributive shock

what type of shock is anaphylaxis related?

urticaria, pruritus', erythema, angioedema

give an cutaneous manifestation of anaphylaxis?

hypotension, tachycardia

VITAL SIGNS of patient Anaphylaxis

Antihistamine

medicine of choice for allergies.

HISTAMINE

Most important cause of symptoms

• histamine

• eosinophilic chemotactic factor of anaphylaxis (ECF-A)

• leukotrienes

• platelet-activating factors (PAF)

• kinins

• prostaglandins

Mast cells then release chemical mediators such as

Ineffective breathing pattern

what is the PRIORITY nursing diagnosis for Anaphylaxis

bronchospasm and laryngeal edema

Ineffective breathing pattern related to ______________and _________

vasodilation

decreased cardiac output related to ____________ (2nd Priority Nursing Dx)

find the cause and discontinue it

what is the very first step in first line and initial treatment?

Epinephrine

Hydrocortisone

Diphenhydramine or Chlorphenamine

In the ER, no matter what allergy is presented, if there are signs of redness in the skin or difficulty in breathing, use these 3 medicines:

what is the 3 medications given FIRST LINE / INITIAL TREATMENT?

0.5 mg IM / vastus lateralis or SQ adult dose

Epinephrine dosage

Epinephrine

Monitor heart rate and blood pressure because it can induce hypertension (d/t tachycardia)

provide oxygen

what is the 3rd step for management of anaphylaxis first line and initial treatment?

Hydrocortisone

Decreases inflammation within the airways

100-250 mg IV bolus adult dose

Dose for Hydrocortisone?

Hydrocortisone

in the management of anaphylaxis what is the ONLY IV route medication given the rest are given IM?

1. find the cause and discontinue it

2. give epinephrine IM

3. provide oxygen

4. give antihistamine or beta-2 adrenergic agonist IM

5. give corticosteroids IV

step by step of anaphylaxis management

Vastus lateralis

what location in IM is emergency meds administered exact?

chlorphenamine and paracetamol

component of neozep

Epinephrine

Caution: Can cause hypertension and tachycardia, so monitor BP and heart rate closely.

Hydrocortisone

Blocks the release of pro-inflammatory cytokines and mediators (e.g., histamine, leukotrienes).

H1 receptor blockers

what drug class of antihistamine is diphenhydramine and chlorphenamine?

Diphenhydramine & Chlorphenamine (Antihistamines)

Prevents histamine from binding to H1 receptors, reducing symptoms like itching, swelling, and vasodilation.

Diphenhydramine

crosses the blood-brain barrier, causing drowsiness.

SAFETY! raise siderails to prevent falls due to drowsiness

nursing consideration for diphenhydramine and chlorphenamine

Diphenhydramine & Chlorphenamine (Antihistamines)

Rapid IV infusion can cause vasodilation and dizziness due to sudden systemic absorption. This happen in what drug given for the management of anaphylaxis?

Terbutaline

Selectively stimulates β2 adrenergic receptors, relaxing bronchial smooth muscles and opening airways.

selective beta-2 adrenergic agonist

what class is terbutaline?

Terbutaline

Unlike epinephrine, it does not significantly increase heart rate, making it safer for patients with cardiovascular risks.

Terbutaline

Aside from anaphylaxis, this is also given to pregnant women to relax uterine smooth muscle, preventing premature contractions.

0.5 mL SQ

what is the dosage of terbutaline?

Terbutaline

Given after epinephrine in mild cases, especially in pregnant women.

tocolytic drug

are medications used to suppress or delay preterm labor by relaxing the uterus and inhibiting contractions, like terbutaline what drug class is this?

uterotonics

tocolytics vs

Find the cause and discontinue it.

what is the FIRST STEP for management in anaphylaxis?

brightly or black, perfumes, hair spray

People allergic to venom stings should avoid wearing __________ colored clothes, __________, and ____________

moderation

For exercise-induced anaphylaxis, patient should exercise in ___________, preferably with another person, and in a controlled setting, where assistance is readily available.

2 hours

Advise that if food is associated with exercise-induced anaphylaxis, wait at least __________ after eating to exercise

epinephrine diphenhydramine, hydrocortisone

what are 3 medications for anaphylaxis?

0.5 mg IM

What is the recommended epinephrine dose for adults during an anaphylactic reaction?

bronchodilators like salbutamol + ipatropium

Which medication is used to reverse bronchospasm during anaphylaxis?

IV normal saline and vasopressors

Hypotension and shock are treated with

diphenhydramine or chlorphenamine

are given to block the effects of histamine by relieving itching and urticaria

corticosteroids like hydrocortisone

are given to decrease vascular permeability and diminish the migration of inflammatory cells; may be helpful in preventing late-phase responses

bronchodilators

are given to relax bronchial smooth muscle

Provide IV fluid resuscitation

What nursing intervention is essential for maintaining cardiac output in anaphylaxis?

c. Diphenhydramine

Which antihistamine is classified as an H1 receptor blocker?
a. Ranitidine
b. Omeprazole
c. Diphenhydramine
d. Famotidine

Monitor vital signs continuously

What action should be taken immediately after injecting epinephrine?

cardiovascular collapse and respiratory failure

Which of the following complications can result from untreated anaphylaxis?