ANAPHYLAXIS

Activity
1. What are the assessment and diagnostic examination of anaphylaxis?
2. Present the medical management of anaphylaxis by highlighting:
a. Assessment and diagnostic examination
b. Nutritional therapy
c. Pharmacological therapy in MNEMONIC form
3. Present nursing management of patient with anaphylaxis by making a nursing care plan
4. Make your own pathophysiology of anaphylaxis.
5. While conducting a health teaching in a barangay, a mother asks you question how to
prevent anaphylaxis, how are you going to answer the question?

1. Treatment
During an anaphylactic attack, you might receive cardiopulmonary resuscitation (CPR) if you
stop breathing or your heart stops beating. You might also be given medications, including:
 Epinephrine (adrenaline) to reduce your body's allergic response
 Oxygen, to help you breathe
 Intravenous (IV) antihistamines and cortisone to reduce inflammation of your air
passages and improve breathing
 A beta-agonist (such as albuterol) to relieve breathing symptoms
To help confirm the diagnosis:
 You might be given a blood test to measure the amount of a certain enzyme
(tryptase) that can be elevated up to three hours after anaphylaxis
 You might be tested for allergies with skin tests or blood tests to help determine
your trigger

2. MEDICAL MANAGEMENT OF ANAPHYLAXIS

a. Assessment and diagnostic examination

Using an autoinjector
Many people at risk of anaphylaxis carry an autoinjector. This device is a combined syringe and
concealed needle that injects a single dose of medication when pressed against the thigh. Always
replace epinephrine before its expiration date, or it might not work properly.
Using an autoinjector immediately can keep anaphylaxis from worsening and could save your
life. Be sure you know how to use the autoinjector. Also, make sure the people closest to you
know how to use it.
Long-term treatment
If insect stings trigger your anaphylactic reaction, a series of allergy shots
(immunotherapy) might reduce your body's allergic response and prevent a severe reaction in the
future.
Unfortunately, in most other cases there's no way to treat the underlying immune system
condition that can lead to anaphylaxis. But you can take steps to prevent a future attack — and
be prepared if one occurs.
 Try to avoid your allergy triggers.

 Carry self-administered epinephrine. During an anaphylactic attack, you can give

yourself the drug using an autoinjector.
Coping and support
Having a potentially life-threatening reaction is frightening, whether it happens to you,
others close to you or your child. Developing an anaphylaxis emergency action plan can help put
your mind at ease.
Work with your own or your child's doctor to develop this written, step-by-step plan of
what to do in the event of a reaction. Then share your plan with teachers, baby sitters and other
caregivers.
If your child has a severe allergy or has had anaphylaxis, talk to the school nurse and
teachers to find out what plans they have for dealing with an emergency. Make sure school
officials have a current autoinjector.
b. NUTRITIONAL THERAPY
INITIAL DIETARY ASSESSMENT – ADULTS AND CHILDREN
Important patient information to be collected:
• Circumstances of possible food allergic reaction including symptoms and suspected
triggers.
• Does this patient have adequate medical involvement?
• Assess nutritional status including growth in children15.
• Detect unnecessary dietary exclusions in adults and in the child and their mother if she is
breastfeeding.
• Abnormal or unusual eating habits.
• Detailed list of foods consumed without problems, foods suspected of causing symptoms
and foods that
have been avoided (e.g. out of parental fear of a reaction).
• Assess levels of anxiety and possible need for referral to psychological services.
• Assess impact on family’s quality of life
INITIAL DIETARY ASSESSMENT – INFANTS AND CHILDREN
Additional information to be collected for infants and children:
1. Plot weight and length/height and assess growth using appropriate growth charts.
2. Actual daily nutritional intake including breast and formula feeds and night feeds (24-
hour recall or food
records).
3. Feeding history, including:
• Maternal dietary exclusion in breastfed infants:
i. Did the symptoms improve with elimination?
ii. Has the food/s been reintroduced via maternal diet and what was the result?
iii. Are foods being excluded unnecessarily in the mother or the child?
• Feeding behavior (e.g. fussy at breast/bottle or good feeder).
• History of formula changes and whether clinical changes resulted.
4. Complementary foods:
• Timing of weaning and solid food introduction and any reactions to foods.
5. Feeding development:
• Progression with textures of foods.
• Self-feeding skills.
• Mealtime behavior (e.g. duration, sitting arrangements, self-feeding).
• Food refusal of whole food groups and/or refusal of food for long periods of time
without re-acceptance of the food
ASSESSING GROWTH
• Indicates adequacy of macronutrients in diet.
• Children with food allergy may have impaired growth compared to non-allergic
children16
• Failure to thrive can be a result of undiagnosed food allergy (especially non IgE
mediated food
allergy)
. All cases of suspected failure to thrive should be assessed by a pediatrician.
• Cow’s milk, wheat or multiple food allergies have the greatest impact on nutrition and
growth10,17 , therefore, it is important to monitor growth and nutritional intake of
children with these allergies until 2-3years of age.
• Children with food allergies have better nutritional intake with dietary support.
 ANAPHYLAXIS DRUGS STUDY
“PEA” MNEMONICS
NAME OF MECHANISM DOSAGE INDICATION CONTRAINDICATION ADVERSE REACTION NURSING
DRUGS OF ACTION ALERT
Blocks the effects Applies to the Treatment of Hypersensitivity; CNS: NEUROLEPTIC ● Monitor BP,
Promethazine of histamine. Has following various allergic Comatose patients; MALIGNANT pulse, and
inhibitory effect strengths: conditions and Prostatic hypertrophy; SYNDROME, confusion, respiratory rate
on the 12.5 mg; 25 motion sickness. Bladder neck obstruction; disorientation, sedation, frequently in
chemoreceptor mg; 25 Preoperative Some products contain dizziness, extrapyramidal patients receiving
trigger zone in the mg/mL; 50 sedation. alcohol or bisulfites and reactions, fatigue, insomnia, IV doses.
medulla, resulting mg; 25 mg/5 Treatment and should be avoided in nervousness. EENT: ● Assess level of
in antiemetic mL; 50 prevention of patients with known blurred vision, diplopia, sedation after
properties. Alters mg/mL; 6.25 nausea and intolerance; Angle-closure tinnitus. administration.
the effects of mg/5 mL; 25 vomiting. glaucoma; Pedi: May CV: bradycardia, Risk of sedation
dopamine in the mg/25 mL- Adjunct to cause fatal respiratory hypertension, hypotension, and respiratory
CNS. Possesses NaCl 0.9% anesthesia and depression in children 2 tachycardia. depression are
significant analgesia. yr. GI: constipation, drug- increased when
anticholinergic Use Cautiously in: IV induced hepatitis, dry administered
activity. Produces administration may cause mouth. concurrently with
CNS depression severe injury to tissue; Derm: photosensitivity, other drugs that
by indirectly Hypertension; severe tissue necrosis upon cause CNS
decreased Cardiovascular disease; infiltration at IV site, depression.
stimulation of the Impaired liver function; rashes. Hemat: blood ● Monitor patient
CNS reticular Prostatic hypertrophy; dyscrasias. for onset of
system. Glaucoma; Asthma; Sleep extrapyramidal
Therapeutic apnea; Epilepsy; side effects
Effects: Relief of Underlying bone marrow (akathisia—
symptoms of depression; Pedi: For restlessness;
histamine excess children 2 yr., use lowest dystonia—muscle
usually seen in effective dose, avoid spasms and
allergic concurrent respiratory twisting motions;
conditions. depressants; pseudo
Diminished OB: Has been used safely parkinsonism—
nausea or during labor; avoid mask-like face,
vomiting. chronic use during rigidity, tremors,
Sedation. pregnancy; drooling, shuffling
Lactation: Safety not gait, dysphagia).
established; may cause Notify health care
drowsiness in infant; Geri: professional if
Adrenalin® 1 Epinephrine Appears on Beers list. Common adverse reactions these symptoms
 Epinephrine acts mg/mL injection is Sensitive to to systemically occur.
Epinephrine on both alpha and (1:1000) indicated in the anticholinergic effects. administered epinephrine ● Monitor for
snap beta-adrenergic epinephrine emergency NONE include anxiety, development of
receptors. injection, 1 mL treatment of apprehensiveness, neuroleptic
Through its action solution in a allergic reactions restlessness, tremor, malignant
on alpha- single-use clear (Type I) weakness, dizziness, syndrome (fever,
adrenergic glass vial and including sweating, palpitations, respiratory
receptors, 30 mL solution anaphylaxis to pallor, nausea and vomiting, distress,
epinephrine in a multiple- stinging insects headache, and respiratory tachycardia,
lessens the dose amber (e.g., order difficulties. These seizures,
vasodilation and glass vial. Hymenoptera, symptoms occur in some diaphoresis,
increased vascular which include persons receiving hypertension or
permeability that bees, wasps, therapeutic doses of hypotension,
occurs during hornets, yellow epinephrine, but are more pallor, tiredness,
anaphylaxis, jackets and fire likely to occur in patients severe muscle
which can lead to ants) and biting with heart disease, stiffness, loss of
loss of insects (e.g., hypertension, or bladder
intravascular fluid triatoma, hyperthyroidism
volume and mosquitos),
hypotension. allergen Cardiovascular: angina,
Through its action immunotherapy, arrhythmias, hypertension,
on beta- foods, drugs, pallor, palpitations,
adrenergic diagnostic testing tachyarrhythmia,
receptors, substances (e.g., tachycardia,
epinephrine radiocontrast vasoconstriction, ventricula
causes bronchial media) and other r ectopy and stress
smooth muscle allergens, as well cardiomyopathy.
relaxation and as idiopathic
helps alleviate anaphylaxis or Arrhythmias, including fatal
bronchospasm, exercise-induced ventricular fibrillation, have
wheezing and anaphylaxis. occurred, particularly in
dyspnea that may Injectable patients with underlying
occur during epinephrine is organic heart disease or
anaphylaxis. intended for patients receiving drugs that
immediate/urgen sensitize the heart to
t administration arrhythmias
in patients, who
are found to be at
 increased risk for
anaphylaxis,
including
individuals with
a history of
anaphylaxis.
Selection of the
appropriate
dosage strength
is determined
according to
body weight

Adults and Emergency Cardiovascular: angina, Monitor BP,

 It alleviates Children 30 treatment of Hypersensitivity to arrhythmias, hypertension, pulse, respirations,
Adrenalin pruritus, urticaria, kg (66 lbs) Or allergic reactions sympathomimetic amines; pallor, palpitations, and urinary output
Chloride and angioedema More (Type I), narrow-angle glaucoma; tachyarrhythmia, and observe
and may relieve 0.3 to 0.5 mg including hemorrhagic, traumatic, or tachycardia, patient closely
(INJECTION)
gastrointestinal (0.3 to 0.5 mL) anaphylaxis, cardiogenic shock; cardiac vasoconstriction, following IV
and genitourinary of undiluted which may result dilatation, cerebral ventricular ectopy and administration.
symptoms Adrenalin from insect arteriosclerosis, coronary stress cardiomyopathy. Epinephrine may
associated with administered stings or bites, insufficiency, arrhythmias, Rapid rises in blood widen pulse
anaphylaxis intramuscularl foods, drugs, organic heart or brain pressure associated with pressure. If
because of its y or sera, diagnostic disease; during second epinephrine use have disturbances in
relaxer effects on subcutaneously testing stage of labor; for local produced cerebral cardiac rhythm
the smooth in the substances and anesthesia of fingers, toes, hemorrhage, particularly in occur, withhold
muscle of the anterolateral other allergens, ears, nose, genitalia. elderly patients with epinephrine and
stomach, aspect of the as well as Safety during pregnancy cardiovascular disease notify physician
intestine, uterus thigh, up to a idiopathic (category C) or lactation is immediately
and urinary maximum of anaphylaxis or not established. Neurological: .
bladder. 0.5 mg (0.5 exercise-induced disorientation, impaired Keep physician
Epinephrine mL) per anaphylaxis. memory, panic, informed of any
increases injection, psychomotor agitation, changes in intake-
glycogenolysis, repeated every Hypotension sleepiness, tingling. output ratio.
reduces glucose 5 to 10 minutes Associated with
up take by tissues, as necessary. Septic Shock Psychiatric: anxiety, Use cardiac
and inhibits Monitor apprehensiveness, monitor with
insulin release in clinically for Adrenalin is restlessness. patients receiving
the pancreas, reaction indicated to epinephrine IV.
resulting in severity and increase mean Other Have full crash
hyperglycemia cardiac effects. arterial blood Patients with Parkinson's cart immediately
and increased Children Less pressure in adult disease may experience available.
blood lactic acid Than 30 kg (66 patients with psychomotor agitation or a
lbs) hypotension temporary worsening of Check BP
0.01 mg/kg associated with symptoms repeatedly when
(0.01 mL/kg) septic shock. epinephrine is
of undiluted administered IV
Adrenalin during first 5 min,
administered then q3–5min
intramuscularl until stabilized.
y or Advise patient to
subcutaneously report to physician
in the if symptoms are
anterolateral not relieved in 20
aspect of the min or if they
thigh, up to a become worse
maximum of following
0.3 mg (0.3 inhalation.
mL) per Advise patient to
injection, report bronchial
repeated every irritation,
5 to 10 minutes nervousness, or
as necessary. sleeplessness.
Monitor Dosage should be
clinically for reduced.
reaction Monitor blood
severity and glucose & HbA1c
cardiac effects. for loss of
glycemic control
if diabetic.
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION
 Altered tissue After 8 hours of  Monitor client’s Expected patient outcomes
perfusion related nursing airway. Assess the include:
to decreased intervention: client for the  Client maintained
blood  Client will sensation of a an
flow secondary to maintain an narrowed airway. effective breathing
vascular effective breathing  Monitor the pattern.
disorders due to pattern, as oxygenation  Client
anaphylactic evidenced by status. Monitor demonstrated
reactions. relaxed breathing at oxygen saturation improved
normal rate and and gas values. ventilation.
depth and absence  Focus  Client displayed
of adventitious breathing. Instruct hemodynamic
breath sounds. the client to breathe stability.
 Client will slowly and deeply.  Client and
demonstrate  Positioning. Position significant others
improved the client upright as verbalized
ventilation as this position provides understanding of
evidenced by an oxygenation by allergic reaction,
absence of shortness promoting maximum its prevention, and
of breath and chest expansion and management.
respiratory distress. is the position of  Client and
 Client will choice during significant others
display respiratory distress. verbalized
hemodynamic  Activity. Encourage understanding of
stability, as adequate rest and need to carry
evidenced by strong limit activities to emergency
peripheral pulses; within client’s components for
HR 60 to 100 tolerance. intervention, need
beats/min with  Hemodynamic to inform health
regular rhythm; parameters. Monitor care providers of
systolic BP within the client’s central allergies, need to
20 mm Hg of venous pressure wear medical alert
baseline; urine (CVP), pulmonary bracelet/necklace,
output greater than artery diastolic and the
30 ml/hr.; warm, dry pressure (PADP), importance of
skin; and alert, pulmonary capillary seeking
responsive wedge pressure, and emergency care.
 mentation. cardiac output/cardiac
 prevention, and index.
management.  Monitor urine
 Client and output. The renal
significant others system compensates
will verbalize for low blood
understanding of pressure by retaining
need to carry water, and oliguria is
emergency a classic sign of
components for inadequate renal
intervention, need to perfusion.
inform health care
providers of
allergies, need to
wear medical alert
bracelet/necklace,
and the importance
of seeking
emergency care.
 PATHOPHYSIOLOGY OF ANAPHYLAXIS

Allergen may cross-link the mast cell or basophil surface-bound allergen-specific IgE

Cellular degranulation and de novo synthesis of mediators.

\Immunoglobulin e (ige) binds to the antigen (the foreign material that provokes the allergic reaction).

Antigen-bound to Ige

Activates fcεri receptors on mast cells and basophils.

Release of inflammatory mediators such as histamine.

Binding to h1 receptors mediates pruritus, rhinorrhea, tachycardia, and bronchospasm.

Prostaglandin d2 mediates bronchospasm and vascular dilatation, principle manifestations of anaphylaxis.

Leukotriene c4 is converted into ltd4 and lte4,

Mediators of hypotension, bronchospasm, and mucous secretion during anaphylaxis in addition to acting
as chemotactic signals for eosinophils and neutrophils.
QUESTION:
5. While conducting a health teaching in a barangay, a mother asks you question how to
prevent anaphylaxis, how are you going to answer the question?
ANSWER:
5. I Tell her that the best way to prevent anaphylaxis is to avoid substances that cause this severe
reaction. Also: Wear a medical alert necklace or bracelet to indicate you have an allergy to specific drugs
or other substances. Keep an emergency kit with prescribed medications available at all times