Download Anaphylactic reaction

Nursing interventions for preventing anaphylactic reactions
• Be aware of the danger of anaphylactic reactions and the
early signs of anaphylaxis.
• Ask the patient about previous allergies to medications,
foods, stings, latex, pollen, peanuts, tree nuts, eggs, and so on.
• Before giving a foreign serum or other type of antigenic agent,
ask the patient or caregiver whether he’s had it before.
• Avoid giving medications to patients with hay fever, asthma,
or other allergic disorders unless necessary.
• Avoid giving parenteral medications unless absolutely necessary, because anaphylactic reactions are more likely to occur
when the agent is given parenterally.
• Perform a skin test before administering materials known to
produce anaphylactic reactions (such as horse serum). Remember that negative skin test results don’t always indicate safety
and that skin testing can precipitate anaphylaxis in highly sensitive patients. Have epinephrine, I.V. infusions, and intubation
and tracheostomy equipment available as precautionary measures.
• If the patient is an outpatient, keep him in the office, hospital,
or clinic for at least 30 minutes after injecting any agent. Caution the patient to return or to call 911 if symptoms develop.
• Warn patients who are highly sensitive (such as to insect
bites and stings) to carry kits equipped to treat insect stings
(epinephrine). Instruct the patient, family, and significant others
on how to use the emergency supplies.
• Encourage patients with allergies to wear medical identification tags or bracelets.
Source: Brunner and Suddarth’s Textbook of Medical-Surgical Nursing, 11th ed., Lippincott Williams & Wilkins, 2007.
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Anaphylactic reaction
An anaphylactic reaction is an acute systemic hypersensitivity reaction that occurs within seconds or minutes after exposure to certain
foreign substances, such as medications (penicillin, iodinated contrast material), and other agents, such as latex, insect stings (bee,
wasp, yellow jacket, hornet), or foods (eggs, peanuts). Repeated
administration of parenteral or oral therapeutic agents (repeated
exposures to penicillin) may also precipitate an anaphylactic reaction when initially only a mild allergic response occurred.
An anaphylactic reaction is the result of an antigen–antibody interaction in a sensitized person who, because of previous exposure, has
developed a special type of antibody (immunoglobulin) for that particular allergen. The antibody immunoglobulin E (IgE) is responsible for most of the immediate type of human allergic responses. The
person becomes sensitive to a particular antigen after producing IgE
to that antigen. A second exposure to the same antigen results in a
more severe and more rapid response.
An anaphylactic reaction produces a wide range of clinical manifestations, especially respiratory symptoms (difficulty breathing and
stridor secondary to laryngeal edema), syncope, pruritus, swelling of
mucous membranes, and a sudden hypotension secondary to massive vasodilation.
Managing an anaphylactic reaction
Establishing a patent airway and ventilation is essential. Early endotracheal intubation is essential to preserve airway patency, and
oropharyngeal suction may be necessary to remove excessive secre-
Assessing for anaphylaxis
Be alert for the following signs and symptoms:
Respiratory signs
• Nasal congestion
• Pruritus
• Sneezing and coughing
• Possible respiratory distress that progresses rapidly (caused
by bronchospasm or edema of the larynx)
• Chest tightness
• Other respiratory difficulties, such as wheezing and dyspnea
Skin manifestations
• Flushing with a sense of warmth and diffuse erythema
• Generalized pruritus over the entire body (indicates developing general systemic reaction)
• Urticaria (hives)
• Massive facial angioedema possible with accompanying upper respiratory edema
Cardiovascular manifestations
• Dysrhythmia
• Pallor
• Weak peripheral pulse
• Hypotension
• Circulatory failure, leading to coma and death
Gastrointestinal problems
• Nausea
• Vomiting
• Colicky abdominal pains
• Diarrhea
tions. Resuscitative measures are used, especially for patients with stridor and progressive pulmonary edema. If glottal edema occurs, emergent cricothyroidotomy may be necessary to provide an airway.
Simultaneously with airway management, aqueous epinephrine is administered as prescribed to provide rapid relief of the hypersensitivity
reaction. Epinephrine may be administered again, if necessary and as
prescribed, and administered in one of these routes of administration, as
ordered:
• subcutaneous injection for mild, generalized symptoms
• intramuscular injection when the reaction is more severe and progressive, and with the knowledge that vascular collapse will delay absorption of the medication
• intravenous (I.V.) route (aqueous epinephrine diluted in saline solution and administered slowly), used in rare instances when there’s a
complete loss of consciousness and severe cardiovascular collapse. This
method may precipitate cardiac dysrhythmias, so cardiac monitoring
with a readily available defibrillator is necessary. This method is controversial and usually isn’t recommended because it can lead to more
distress than initially present. An I.V. infusion of saline solution is initiated to provide for emergency access to a vein and to treat hypotension.
Additional treatments may include:
• antihistamines (diphenhydramine [Benadryl]) to block further histamine binding at target cells
• aminophylline titrated by I.V. drip for severe bronchospasm and
wheezing refractory to other treatment
• albuterol (Proventil, Ventolin) inhalers or humidified treatments to
decrease bronchoconstriction
• crystalloids, colloids, or vasopressors to treat prolonged hypotension
• positive inotropes for reduced cardiac output; oxygen to enhance tissue perfusion
• I.V. benzodiazepines (diazepam [Valium]) for control of seizures, and
corticosteroids (hydrocortisone [Solu-Cortef]) for prolonged reaction
with persistent hypotension or bronchospasm
After the acute symptoms have been treated, the patient is usually admitted to the hospital for observation and should be taught how to prevent future anaphylactic reactions.