Anaphylaxis is a severe and acute hypersensitivity, which can easily lead to death of the patient. (2)

Anaphylaxis Case Study

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nIntroduction

nAnaphylaxis is a severe and acute hypersensitivity, which can easily lead to death of the patient. The onset of signs and symptoms usually occur within minutes. Anaphylaxis causes shortness of breath, swelling of throats, low blood pressure, and light-headedness. It can be caused by medications, foods, and insect bites (Khan, & Kemp, 2011). There are different types of anaphylaxis depending on the causative allergen such as insect venom, certain foods and latex. In this case study, some drugs was the main cause of the allergic condition. In the case study, Jim Palmer is suffering from anaphylaxis and has exhibited such signs and symptoms after administration of Flucloxacillin medication (Holbery & Newcombe, 2016). The paper is divided into two parts, where the first part will discuss the pathophysiology/physiology that links to signs and symptoms of anaphylaxis based on ABCDE approach. The second part will describe a structured written handover to the doctor using ISBAR

nPathophysiology

nIn the case of Jim Palmer, the reaction takes place after few minutes following exposure. The patient requires quick management procedure in order to save his life (Logarajah & Alinier, 2014). In this regard, Airway, Breathing, Circulation, Disability, and Exposure (ABCDE) approach is associated to the sign, symptoms, and pathophysiology of anaphylaxis. Prior to the early Anaphylaxis treatment, Jim Palmer must be assessed through the ABCDE pneumonic approach to confirm that he is suffering from the allergic condition (Thim, Krarup, Grove, Rohde & Løfgren, 2012). Therefore, the ABCDE approach helps to rule out other systematic allergic conditions, which may occur in the patient. Physicians are more likely to mistaken vasovagal attack, panic attack, and other allergic diseases for anaphylaxis (Simons, Ardusso, Bilò, El-Gamal, Ledford, Ring, & Thong, 2011).

nAirway Challenges

nJim Palmer had a combination of Circulation, Breathing, and Airway problems, which could easily lead to death. Notably, airway obstructions caused severe signs and symptoms such as angioedema, which indicate the swelling of pharyngeal, neck, laryngeal, and tongue (Rutkowski, Dua, & Nasser, 2012). Consequently, it causes challenges in breathing, swallowing, speaking and hoarse voice. Jim Palmer also felt that his throat was closing up (Thim, Krarup, Grove, Rohde & Løfgren, 2012). Furthermore, he exhibited stridor, which is a high slanted inspiratory voice, which is produced by obstruction of the upper airway.

nBreathing Difficulties

nMoreover, Breathing difficulties were witnessed in the patient as he suffered from shortness of breath. For instance, his respiratory rate was 26bpm. Jim Palmer also began to wheeze which refers to breathing with a rattling or whistling noise in the chest owing to the blockage of the airways (Rutkowski, Dua, & Nasser, 2012). In addition, the patient may begin to exhibit signs of confusion, which is caused by hypoxia resulting from inadequate supply of oxygen getting into the tissues. Similarly, signs of tiredness may also be apparent in the patient (Logarajah & Alinier, 2014). Furthermore, when the anaphylaxis reaction is in the final stages, other signs such as cyanosis may be noted. In this regard, it refers to bluish skin discoloration, which results from insufficient oxygenation or poor circulation of the blood (Muraro, Roberts, Worm, Bilò, Brockow, Fernández Rivas, & Bindslev‐Jensen, 2014). Moreover respiratory arrest occurs when the patient can no longer breathe.

nCirculation Problems

nCirculation problems are also observed in patient suffering from anaphylaxis. More notably, tachycardia is evident which represent unusual faster heart rate of 130bpm regular (Khan, & Kemp, 2011). The patient also records high respiratory rate, which is over 26pbm. The circulatory system normally functions by a combination of vasodilation and vasoconstriction in various organs simultaneously. Nevertheless, the heart is forced to rapidly pump the blood to compensate insufficient supply of blood in vital organs. Similarly, problems such as hypotension occur due to unusually low blood pressure of BP 99mmHg systolic on palpation and syncope which is a short-term consciousness loss because of inadequate blood supply (Muraro, Roberts, Worm, Bilò, Brockow, Fernández Rivas, & Bindslev‐Jensen, 2014). Addition, circulation challenges causes elongated time of capillary refill since the normal time of refill is less than 3 seconds. In particular Jim Palmer has a capillary refill time of more than 4 seconds. The patient also experiences challenges such as diminished level of consciousness as well as cardiac arrest. Anaphylaxis also leads to changes in the electrocardiograph (ECG) and myocardial ischemia (Muñoz-Cano, Picado, Valero & Bartra, 2016).

nCirculation challenges result from inadequate fluid in the circulation system, capillary leak, vasodilation and myocardial depression (Khan, & Kemp, 2011). A slow pulse (bradycardia) is often a late symptom usually preceding cardiac arrest. Significantly, if patient experiencing this condition are forced to stand up or sit up their problem deteriorate (Logarajah & Alinier, 2014).

nDisability Problems

nAnaphylactic patient may demonstrate disabilities such as confusion resulting from hypoxia (Armitage‐Chan, 2010). Particularly, poor supply of oxygen in the tissue may also affect the consciousness level of the patient. Others signs of disabilities include agitation, feeling of looming doom, and collapse (Muraro, Roberts, Worm, Bilò, Brockow, Fernández Rivas, & Bindslev‐Jensen, 2014).

nExposure

nThe skin of a patient suffering from anaphylaxis reaction begins to exhibit mucosal changes. Research has indicated that nearly 80 per cent of patients with this allergic reaction have exposure challenges as the main clinical symptoms (Ring, Grosber, Möhrenschlager & Brockow, 2010). In this regard, other problems of this condition include diffuse erythema, and itchy weal (urticarial) which may be light pink with various sizes and shapes. Palmer had extensive urticarial rash and swelling of his toes, fingers, and lips while his blood glucose was 5.3mmols/l. Furthermore, changes occur in the colour of the skin occur cause with pale or flushed spots. Finally, his skin became clammy and cold (Simons, Ardusso, Bilò, El-Gamal, Ledford, Ring, & Thong, 2011). Angioedema is comparable to urticarial although it encompasses inflammation of deeper tissues especially in the lips, eyelids, throat and mouth. Nonetheless, if the mucosal or skin changes take place without life endangering circulatory, breathing, airway signs it does not imply an anaphylactic reaction. Intravenous allergen especially from a drug may lead to a swifter onset of allergic reactions as compared to bee stings (Ring, Grosber, Möhrenschlager & Brockow, 2010).

nIn this regard, the use of ABCDE pneumonic approach is beneficial to nurses as it helps in identifying and recognizing the life-threatening issues or challenges linked with anaphylaxis (Muñoz-Cano, Picado, Valero & Bartra, 2016). Therefore, in the case study involving Jim Palmer, the practitioner can be sure of anaphylaxis because the patient has Airway problems due to swelling, breathing issues because of respiratory distress, and Circulation difficulties owing to hypotension (Khan & Kemp, 2011). Moreover, Palmer agonizes from disabilities such as changed consciousness level and Exposure issues related to mucosal and skin alterations (Simons, Ardusso, Bilò, El-Gamal, Ledford, Ring, & Thong, 2011).

nConclusion

nJim Palmer has demonstrated signs such as dizziness, light-headedness, tight feeling in the throat, breathlessness, and flushed. For this reason, the patient requires emergency medication, which is based on ABCDE approach (Mulryan, 2011). The approach helps to ascertain the anaphylaxis condition to avoid treatment of other allergic conditions. In addition, the patient should receive emergency care to avoid complications such as brain damage, heart failure, kidney problems and death (Dinakar, 2012). The ISBAR process is also essential because it ensure that the handover from the nurse to the doctor is handled in a clear and effective manner.

nISBAR

nA structured written handover to the doctor is necessary after physical examination of anaphylaxis condition using Introduction, Situation, Background, Assessment, and Recommendation (ISBAR).

nIntroduction

nI am nurse (your name) working in Australian health center. I am writing to inform your that a patient by the name Jim Palmer have shown signs and symptoms associated with serious and acute condition referred to as Anaphylaxis.

nSituation

nJim Palmer is a 53-year-old farmer. He was admitted this morning and his medical record number is MRAXEB 005. Following physical examination he is suffering from severe anaphylaxis. The condition of the anaphylaxis is unstable and deteriorating hence he requires emergency response assistance. Some of the critical symptoms exhibited by the patient include dizziness, light-headedness, obstruction of airway, blood circulation problems, and breathing challenges. He has also exhibited life threatening symptoms hence healthcare must include Cardiopulmonary resuscitation (CPR) and oxygen. Moreover, treatment should also make use of epinephrine because its agonist vasoconstrictors effects which can reduce laryngeal oedema, shock, hypotension and unusual increase of fluid in the intercellular spaces. The treatment of epinephrine should be given immediately to subvert these symptoms. The dose should be administered intramuscularly for every 3-5 minutes when needed.

nBackground

nAfter Jim Palmer was admitted this morning with severe cellulitis to his left lower leg, he had already received one dose of Flucloxacillin 1 gram IV as a slow bolus in the Emergency Department. He was later given the second dose of Flucloxacillin but after ten minutes, he started exhibiting serous signs and symptoms such as dizziness, light-headedness and breathlessness. Following examination using ABCDE approach it was confirmed that he had severe anaphylaxis.

nAssessment

nBased on the above the patient condition is quickly worsening hence he requires treatment immediately. He is unable to breathe normally due to obstruction of the airways leading to narrowing of the larynx. Additionally, he is experiences severe respiratory issues. Similarly, the blood and oxygen supply in the body is diminishing quickly which exposes him to hypotension. Moreover, he has developed complications such as loss of consciousness. He is also suffering from mucosal and skin disabilities including rashes.

nHe is at risk of death if urgent interventions are not undertaken. He should also be treated or admitted in the emergency department. The complications can affect the proper functioning of the heart, which stop the heartbeats. The patient is also at risk of brain damage, which has a significant impact on his memory and change in crucial supply of blood to particular areas of the brain modifying critical chemicals in the brain. The accumulation of carbon dioxide in the brain may also destroy the oxygen supply mechanism.

nRecommendations

nThe patient needs emergency care through administration of epinephrine aiming to minimize the allergic reaction’s severity. Intramuscular injection of this drug should also be repeated after five minutes. In addition, the patient can be treated with antihistamines and cortisone intravenously which assist in minimization of inflammation of the air passages enhancing their capacity to breathe. Finally, emergency care should include supplemental oxygen to enable adequate supply of oxygen.

nReferences

nArmitage‐Chan, E. (2010). Anaphylaxis and anaesthesia. Veterinary anaesthesia and analgesia, 37(4), 306-310.

nCastells, M. C. (Ed.). (2010). Anaphylaxis and hypersensitivity reactions. Springer Science & Business Media.

nDinakar, C. (2012). Anaphylaxis in children: current understanding and key issues in diagnosis and treatment. Current allergy and asthma reports, 12(6), 641-649.

nFuzak, J. K., & Trainor, J. (2013). Comparison of the incidence, etiology, and management of anaphylaxis over time. Pediatric emergency care, 29(2), 131-135.

nHolbery, N., & Newcombe, P. (2016). Emergency nursing at a glance. John Wiley & Sons.

nKhan, B. Q., & Kemp, S. F. (2011). Pathophysiology of anaphylaxis. Current opinion in allergy and clinical immunology, 11(4), 319-325.

nKhan, B. Q., & Kemp, S. F. (2011). Pathophysiology of anaphylaxis. Current opinion in allergy and clinical immunology, 11(4), 319-325.

nLee, J. K., & Vadas, P. (2011). Anaphylaxis: mechanisms and management. Clinical & Experimental Allergy, 41(7), 923-938.

nLinton, E., & Watson, D. (2010). Recognition, assessment and management of anaphylaxis. Nursing Standard, 24(46), 35-39.

nLogarajah, S., & Alinier, G. (2014). An integrated ABCDE approach to managing medical emergencies using CRM principles. Journal of Paramedic Practice.

nLogarajah, S., & Alinier, G. (2014). An integrated ABCDE approach to managing medical emergencies using CRM principles. Journal of Paramedic Practice.

nMulryan, C. (2011). Understanding the basic mechanisms of allergies. Dental Nursing, 7(8).

nMuñoz-Cano, R., Picado, C., Valero, A., & Bartra, J. (2016). Mechanisms of Anaphylaxis Beyond IgE. Journal of investigational allergology & clinical immunology, 26(2), 73-82.

nMuraro, A., Roberts, G., Worm, M., Bilò, M. B., Brockow, K., Fernández Rivas, M., … & Bindslev‐Jensen, C. (2014). Anaphylaxis: guidelines from the European academy of allergy and clinical immunology. Allergy, 69(8), 1026-1045.

nRing, J., Grosber, M., Möhrenschlager, M., & Brockow, K. (2010). Anaphylaxis: acute treatment and management. In Anaphylaxis (Vol. 95, pp. 201-210). Karger Publishers.

nRutkowski, K., Dua, S., & Nasser, S. (2012). Anaphylaxis: current state of knowledge for the modern physician. Postgraduate medical journal, 88(1042), 458-464.

nSimons, F. E. R., Ardusso, L. R., Bilò, M. B., El-Gamal, Y. M., Ledford, D. K., Ring, J., … & Thong, B. Y. (2011). World allergy organization guidelines for the assessment and management of anaphylaxis. World Allergy Organization Journal, 4(2), 13.

nThim, T., Krarup, N. H. V., Grove, E. L., Rohde, C. V., & Løfgren, B. (2012). Initial assessment and treatment with the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. International journal of general medicine, 5, 117.

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