Question

The treatment of anaphylactic shock varies depending on a patient’s physiological response to the alteration. Immediate medical intervention and emergency room visits are vital for some patients, while others can be treated through basic outpatient care.

Consider the January 2012 report of a 6-year-old girl who went to her school nurse complaining of hives and shortness of breath. Since the school did not have any medication under her name to use for treatment and was not equipped to handle her condition, she was sent to an emergency room where she was pronounced dead. This situation has raised numerous questions about the progression of allergic reactions, how to treat students with severe allergies, how to treat students who develop allergic reactions for the first time, and the availability of epinephrine in schools. If you were the nurse at the girl’s school, how would you have handled the situation? How do you know when it is appropriate to treat patients yourself and when to refer them to emergency care?

To Prepare

• Review “Anaphylactic Shock” in Chapter 24 of the Huether and McCance text, “Distributive Shock” in Chapter 10 of the McPhee and Hammer text, and the Jacobsen and Gratton article in the Learning Resources.
• Identify the multisystem physiologic progression that occurs in anaphylactic shock. Think about how these multisystem events can occur in a very short period of time.
• Consider when you should refer patients to emergency care versus treating as an outpatient.
• Select two patient factors different from the one you selected in this week’s first Discussion: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the process of anaphylactic shock.

By Day 4

Post an explanation of the physiological progression that occurs in anaphylactic shock. Then, describe the circumstances under which you would refer patients for emergency care versus treating as an outpatient. Finally, explain how the patient factors you selected might impact the process of anaphylactic shock.

Answer 1

Anaphylatic shock is an acute and life threatening reaction to a sensitization substance.Usually an immediate reaction cause massive vasodilation ,release of vasoactive mediators and an increace in capillary permeability.As capillary permeability increases ,fluid leaks from the vascular space into the interstitial space .Anaphylatic shock can lead to respiratory distress ,because of laryngeal edema or severe bronchospasm and circulatory failure,because of massive vasodilation .The patient experiences a sudden onset of symptoms including dizziness,chest pain ,incontinence ,swelling of the lips and tongue,wheezing and stridor.

Quick and decisive action by the nurse is critical to preventing the progression of an anaphylatic reaction to anaphylatic shock.There are 3 stages of shock a which include Compensatory stage,progressive stage,and refractory stage.

In the compensatory stage ,the body activates neural,hormonal and biochemical cmpensatory mechanism in an attempt to overcome the increasing consequences of anaerobic metabolism and to maintain homeostasis.A multisystem response to decreasing tissue perfusion is initiated in the compensatory stage of shock.At this stage ,the body is able to compensate for the changes in the tissue perfusion.if the perfusion deficit is corrected ,the patient will recover with little or no residual aftereffects.if the perfusion deficit is not corrected and the body is unable to compensate ,the patient enters the progressive stage of shock.in this situation i would refer the patient to outpatient department

In the progressive stage aggressive intervventions are necessary to prevent the development of MODS.Continued decreased cellular perfusion and resulting altered capillary permeability are the distinguishing features of this stage.