Anaphylaxis

Anaphylaxis

1. ANAPHYLAXIS

2. HYPERSENSITIVITY Hypersensitivity is an altered immune response that results in harm to the client.

3. TYPES OF HYPERSENSTIVITY • Immediate hypersensitivity Type 1 IgE – Mediated hypersensitivity Type 2 Cytotoxic hypersensitivity Type 3 immune complex – mediated hypersensitivity Delayed hypersensitivity Type 4 hypersensitivity

4. Type 2 Cytotoxic hypersensitivity

5. Type 3 immune complex – mediated hypersensitivity

6. Type 4 hypersensitivity

7. Anaphylaxis (Type 1 IgE – Mediated hypersensitivity)

8. Definition

9. I ncidence 4–100 per 100,000 persons per year The risk is greatest in young people and females Death from anaphylaxis is most commonly triggered by medications.

10. Substances Known To Trigger Anaphylaxis In Sensitized Persons Hormones Insulin Vasopressin Parathormone Enzymes Trypsin Chymotrypsin Penicillinase

11. Substances Known To Trigger Anaphylaxis In Sensitized Persons Pollens • Ragweed • Grass • Seeds Foods • Egg • Seafoods • Nuts • Grains • Beans • Cottonseed oil • Chocolate

12. Substances Known To Trigger Anaphylaxis In Sensitized Persons Vitamins • Thiamine • Folic acid Insect venom • Yellow jacket • Hornet • Paper wasp • Honey bee

13. Substances Known To Trigger Anaphylaxis In Sensitized Persons Occupational agents • Rubber products • Industrial chemicals Antibiotics • Penicillins • Cephalosporins • Amphotericin b • Nitrofurantain

14. Substances Known To Trigger Anaphylaxis In Sensitized Persons Local anaesthetics • Procaine • Lidocaine Medical diagnostic agents • Sodium dehydrocholate • Sulfabromophthalein Antiserum • Antilimphocyte gamma globulin

15. Pathophysiology Sensitization stage Antigen (allergens) invades the body Plasma cells produce large amounts of class IgE antibodies against allergen IgE antibodies attach to mast cells in body tissues

16. Pathophysiology Subsequent sensory response More of same allergen invades body Allergen combines with IgE attached to mast cells, which triggers release of histamine from mast cell granules Histamine causes blood vessels to dilate and become leaky which promotes edema; stimulate release of large amounts of mucus and causes smooth muscles to contract

17. Pathophysiology

18. classification Anaphylactic shock Biphasic anaphylaxis Pseudoanaphylaxis or anaphylactoid reactions

19. Clinical manifestations

20. Clinical manifestations

21. Diagnostic evaluation Health history Physical examination Allergy testing White blood cell count Radioallergosorbent test (RAST)

22. M anagement Immediate treatment for anaphylaxis Parenteral epinephrine An adrenergic agonist (sympathomimetic) drug that has both vasoconstricting and bronchodialating effects mild reactions subcutaneous injection of 0.3ml to 0.5ml of 1:1000 epinephrine

23. M anagement With injected toxins such as a bee sting, an additional amount equivalent to one half the above may be injected directly into the site of sting and a tourniquet is applied above it to prevent further systemic absorption . Intravenous epinephrine is using a 1:100000 concentrations may be used in the client with a more severe anaphylactic reaction.

24. M anagement Corticosteroids Antihisatmines Combination of antihistamines and sympathomimetic agents

25. Other treatment • Airway management takes the highest priority for clients with an acute anaphylactic reaction. Insertion of an endotracheal tube or emergency tracheostomy may be required to maintain airway patency with severe laryngospasm • Plasmapheresis : Removal of harmful components in the plasma may be used to treat immune complex responses such as glomerulonephritis.

26. Nursing Management Ineffective airway clearance related to bronchospasm or laryngeal edema • Administer oxygen • Assess respiratory rate and pattern, level of consciousness and anxiety, use of accessory muscles for respiration, chest wall movement, audible stridor; auscultate lung soundsand any adventitious sounds. • Insert a nasopharyngeal tube or oropharyngeal airway and arrange for immediate intubation if indicated • Administer subcutaneous epinephrine as prescribed. • Provide calm reassurance

27. Nursing Management Decreased cardiac output related to peripheral vasodialation and increased capillary permeability from the release of histamine • Monitor vital signs frequently • Assess skin colour , temperature, capillary refill, edema and other indicators of peripheral perfusion • Monitor level of consciousness • Administer warmed intravenous solutions of ringer lactate or normal saline as prescribed • Insert an indwelling catheter and monitor urinary output frequently • Once breathing is established place the client with legs elevated

28. SEPTICAEMIA

29. Introduction Septicemia is bacteria in the blood that often occurs with severe infection. Septicemia is a serious and even life threatening infection of the blood Usually it is caused by bacterial infection, but fungi and other organisms also cause this wide spread infection of the blood stream

30. DEFINITION Invasion of the bloodstream by virulent microorganisms and especially bacteria along with their toxins from a local seat of infection accompanied especially by chills, fever, and prostration

31. INCIDENCE 18 million cases per year Sepsis occurs in 1–2% of all hospitalizations Due to it rarely being reported as a primary diagnosis (often being a complication of cancer or other illness), the incidence, mortality, and morbidity rates of sepsis are likely underestimated

32. INCIDENCE

33. RISK FACTORS • The very young and the elderly • infections • People in an intensive care unit • People with weakened immune systems • People with pre-existing medical conditions • People with devices such as IV catheters, breathing tubes, or other devices • People with extensive burns • People with severe trauma

34. ETIOLOGY Bacteria usually spill over from the primary infection site into the blood and are carried throughout the body thereby spreading infection to various systems of the body. • Osteomyelitis • Meningitis • Endocarditis • UTI • Peritonitis

35. PATHOPHYSIOLOGY

36. CLINICAL MANIFESTATIONS • Chills • High fever • Rapid breathing • Rapid heart rate • Confusion • Red spots on skin • Sweating • Signs of related disease • Shock • Organ dysfunction • Flushing • Aches • Hypotension

37. DIAGNOSTIC EVALUATION • History collection • Physical examination • Blood culture • Blood gases • CBC • Clotting studies • CSF culture • Platelet count • Urine culture

38. MANAGEMENT • Broad spectrum Antibiotics • IV fluids • Oxygen inhalation • Plasma and other blood products • Vasopressors • Steroids

39. NURSING MANAGEMENT Goal of nursing management are • Infection control • Support tissue perfusion • Prevent complications • Provide information about disease process, treatment needs

40. NURSING MANAGEMENT • Provide isolation to patient • Control visitors • Wash hands with antimicrobial hand wash before and after each activity • Provide frequent position change • Deep breathing exercises/ coughing exercises • Follow standard precautions while caring patient

41. NURSING MANAGEMENT Wear mask and gown and gloves when providing direct care to prevent cross infection • Dress wound with aseptic technique if present • Limit use of invasive devices/ procedures if possible • Maintain TPR and BP • Maintain intake output chart • Obtain blood, sputum, urine, and wound culture initially • Initiate broad spectrum antibiotics as prescription • Assess patient’s hemodynamic parameters every hour

42. EVIDENCE BASED PRACTICE

43. EVIDENCE BASED PRACTICE Umbilical cord-derived mesenchymal stem (stromal) cells for treatment of severe sepsis: a phase 1 clinical trial . A single intravenous infusion of allogeneic MSCs up to a dose of 3 × 106 cells/kg was safe and well tolerated in 15 patients with severe sepsis.

44. EVIDENCE BASED PRACTICE Recurring acute urticaria and abdominal pain: Consider a diagnosis of alpha- galactose anaphylaxis

45. EVIDENCE BASED PRACTICE BACKGROUND : Food urticaria is common and generally benign, and it may be of viral or idiopathic aetiology . A food origin of the allergy is frequently sought but rarely found. Mammalian meat anaphylaxis, or alpha- galactose (α-gal) anaphylaxis, is a rare and recently discovered entity. PATIENTS AND METHODS: Herein, we report a case of alpha- galactose (α-gal) anaphylaxis in a 60-year-old woman presenting four episodes of acute urticaria with signs of anaphylaxis occurring a few hours after meals containing mammalian meat (beef meat, pork meat and offal). The diagnosis was confirmed by a positive gelatine prick-test and the presence of α-gal IgE .

46. EVIDENCE BASED PRACTICE DISCUSSION: In the event of acute urticaria associated with systemic symptoms, in particular gastrointestinal signs, allergy to α- galactose should be considered.