Anaphylactic Shock: Management (Nursing)

by Rhonda Lawes, PhD, RN

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    00:00 Now, how do we manage all of this? Well, we're back to that Layer 3, right.

    00:05 We've been through that in the rest of this video.

    00:08 Now we're going to talk about what are the actions that you can take with anaphylactic shock.

    00:14 First of all, teach the client to know their triggers, avoid their triggers, and we also want them to carry a personal EpiPen.

    00:23 Okay, so teach them to avoid their triggers.

    00:26 But they have to know their triggers in order to avoid them, and have them always carry an EpiPen if they're at risk.

    00:32 So here's what an EpiPen looks like.

    00:35 It causes peripheral vasoconstriction.

    00:38 Can let's walk through this.

    00:39 We just went through a big deal on anaphylactic shock.

    00:43 So epinephrine is one way that you can manage this in the hospital, we would give epinephrine, but out in the community, you can also give epinephrine.

    00:53 Now, it causes peripheral vasoconstriction.

    00:56 Okay, that's going to support the blood pressure, and bronchodilation.

    01:00 Yey. Two things that'll be really helpful.

    01:04 So in the initial phases, the earlier the patient can receive this EPI, the better, right.

    01:09 It's going to help bring up that blood pressure.

    01:11 It's also going to help open up those airways so they can breathe.

    01:14 This is counteracting the effects of that histamine that was sent out into the body when the patient was exposed to their allergen.

    01:22 Now, side effects. It does not feel good, after you have a dose of EPI.

    01:27 When we say tachycardia, people feel like their heart is going to explode in their chest, sometimes.

    01:33 But it is life saving when it's given appropriately.

    01:36 So epinephrine can be used, both in the community with a healthcare providers prescription and patient education, teaching them how to use it, but it's also what would be used in the hospital.

    01:48 Now that we have adjunctive therapy up there.

    01:50 Please notice adjunctive therapy.

    01:54 If someone is at the point of anaphylactic shock, diphenhydramine is not going to fix the problem.

    01:59 Histamine receptor blockers are not going to fix the problem.

    02:02 But if you have a mild reaction, you can actually use these to help deal with that histamine.

    02:08 But we may give these in addition, but remember, these are slow acting.

    02:13 If someone is in anaphylactic shock, nobody's talking about diphenhydramine in the ER, right? They're going straight for the epinephrine.

    02:22 But this can be used as adjunctive therapy and this is current mood block ongoing release of histamine from the reaction. So it's not a primary treatment.

    02:32 I just want to make sure you are not confused on that.

    02:35 The primary treatment is going to be epinephrine.

    02:38 So what's your goal? Just like in any shock, maintain that airway.

    02:43 Keep an oxygen sat of 92 to 95%.

    02:45 Monitor if they need to have a mask or if it's so severe, they need to be intubated to protect that airway.

    02:51 I want to restore any fluid volume loss that they may have, but be very careful with this, because the problem and anaphylaxis really wasn't fluid loss.

    03:01 So if they're in the hospital, this may be necessary.

    03:07 Now, what's unique about the nursing care for someone in anaphylaxis? Well, again, we told you, we're going to monitor their SPO2 in the forehead is a fair place to do that.

    03:18 for someone who has been in anaphylactic shock.

    03:20 You want to make sure that you get the medications to them quickly.

    03:23 What is the dose of medication that we're going to give? Definitely, epinephrine is the one that's needed to reverse that anaphylactic reaction.

    03:32 We want to maintain a blood pressure with an MAP, that's over 65.

    03:39 Let's take a look at what epinephrine looks like in the community.

    03:43 This is what an EpiPen looks like. It's a personal EpiPen.

    03:46 Now the dosage on these is different between adults and children.

    03:51 So a dose of 0.3 mil volume is meant for an adult or a child who is 30 kilograms or more.

    04:00 Okay, so I'll show you how to use these in just a minute.

    04:03 But I want you to keep in mind dosage matters.

    04:06 The person must wait at least 30 kilograms to give them this dose.

    04:10 Now if the patient is particularly large, the health care provider will adjust that dosage is what is best for that patient.

    04:18 Now there's a junior pen or a little small pen.

    04:21 And that's meant for pediatric clients.

    04:23 And this is meant for clients that are between 15 kilograms and 30 kilograms.

    04:29 So remember, dose is weight based for epinephrine in the community.

    04:33 So first, you're going to take that and you're going to form a fist around the EpiPen, so you have good hold on it, then you're going to pull off the safety cap.

    04:41 Now, let me tell you, I'm gonna walk through this in slow motion.

    04:45 When someone is experiencing this, you do this really fast.

    04:48 So what's important is that you practice it.

    04:51 That you know how to use it, and the patient knows how to use it quickly.

    04:55 One other important person, make sure the family members or the partners, or the circle of people around this person, also know how to use this EpiPen in case of an emergency.

    05:06 So you've got the pen, you've pulled off the cap, and you want to take that orange end of it about 10 centimeters away from the outer mid thigh.

    05:14 See how we have it in the picture. So outer, mid thigh.

    05:18 So pretty much where everyone's arm is going to end up, unless you have particularly long arms.

    05:23 You're going to swing it because you want some force and you're going to jab it into the thigh at a 90 degree angle and hold it there for 10 seconds.

    05:32 You want to make sure that all that medication is in.

    05:35 Now, you'll notice that he's wearing his clothes. Yes.

    05:37 You did this right through the clothing in an emergency.

    05:41 And you're going to remove it after those 10 seconds and massage the injection site.

    05:46 Now, you can actually repeat this every five to 15 minutes if the signs and symptoms continue.

    05:53 And you want to make sure that those have resolved.

    05:56 See monitoring a patient after this administration is extremely important.

    06:01 If someone is having to use an EpiPen you should be calling 911.

    06:05 Right. If you're at the point where they can't breathe and they're having trouble, you should call 911.

    06:10 Seek medical attention to make sure that there's follow up that there's not further anaphylactic reaction or airway.

    06:17 Because this can reoccur after the EPI wears off, the patient can re-experience those symptoms.

    06:23 So you want to make sure that you go immediately and seek medical attention.

    06:27 Now, storage for this is pretty simple.

    06:29 Has to be at room temperature. So I live in a particularly hot state.

    06:35 This would not be something that you leave in your car.

    06:37 You want to make sure that you don't keep it in a spot that's extremely warm.

    06:41 Now, we're going to take a look at kind of how everything all fits together in anaphylactic shock. So that's the type of shock we're talking about.

    06:50 First column is cardiac output.

    06:52 Now that's going to be decreased in anaphylactic shock.

    06:55 Heart rate, ooh, that's going to be elevated.

    06:59 CVP, that's kind of always the wild card, might be the same, might be elevated.

    07:04 Now, don't get frustrated about that.

    07:08 It's just, it is what it is.

    07:10 You always want to be aware when something is outside of the normal range.

    07:14 But with CVP you might have either response.

    07:17 Now, PCWP is a wedge pressure.

    07:20 Cannot be measured unless you have a PR catheter through your right atrium, your right ventricle into your pulmonary artery.

    07:27 PCP is also called a PCWP is also called a wedge pressure.

    07:33 We're going to expect that that is going to be decreased, as is the systemic vascular resistance. Another reading that we get with a PR catheter.

    07:42 And finally O2 saturation is going to be obviously decreased in an anaphylactic reaction because we know their airway becomes so swollen they can't take in enough oxygen.

    07:53 So that's it.

    07:54 You've made it all the way through the anaphylactic shock section.

    07:58 And this is just a brief summary.

    08:00 Now, when you're studying, make sure you go back and ask yourself, why does this happen? Why could that happen? And you do that much better in encoding information in your brain and doing well on your test and as a professional.

    About the Lecture

    The lecture Anaphylactic Shock: Management (Nursing) by Rhonda Lawes, PhD, RN is from the course Shock (Nursing).

    Included Quiz Questions

    1. Peripheral vasoconstriction
    2. Bronchodilation
    3. Peripheral vasodilation
    4. Bronchoconstriction
    5. System vasodilation
    1. Epinephrine
    2. Diphenhydramine
    3. Cetirizine
    4. Dimenhydrinate
    1. 0.15 mg
    2. 0.3 mg
    3. 0.5 mg
    4. 0.05 mg
    1. They can be injected through clothes
    2. They should be injected into the outer thigh
    3. The blue side should make contact with the thigh
    4. They are only to be administered if anaphylactic shock occurs in an area far from a hospital
    5. It should be repeated every one to two minutes until symptoms resolve or help arrives

    Author of lecture Anaphylactic Shock: Management (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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