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Medication-Induced Anaphylactic
Hypersensitivity:
A Concept Mapping
Presented by:
A. Enriquez, RN
A. Martin, RN
H. de Guzman, RN
L. Roaquin, RN
T. Cui, RN
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Anaphylactic Hypersensitivity
• Most severe form of hypersensitivity
• Acute systemic hypersensitivity reaction thatoccurs within seconds or minutes after exposureto certain foreign substances.
• Result of an antigen-antibody interaction in a
sensitized individual who has developed aspecial type of immunoglobulin that is specificfor that allergen
• IgE is responsible for most of the immediate
type of human allergic responses
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Anaphylactic Hypersensitivity
• Mr. E is a 37 y/o male who presents to thehospital at 9:08am
• With complaints of severe abdominal cramping,n/v, dizziness, tingling and numbness of extremities.
• As reported, he took ibuprofen for muscularpain after shift that day
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Anaphylactic Hypersensitivity
• According to the patient, it was his first time totake ibuprofen since he used to take paracetamolfor pain management.
• He was diagnosed to have HTN 2 years ago.
• Complies with the therapeutic regimen but do
not regularly take his medicine due to busy schedule
• Asthma is common in their bloodline
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Assessment:
• Upon admission, there was complaint of chestpain, throat tightness, dyspnea, tingling &
warmth sensation, odynophagia, altered mentalstatus but conversant,
• BP: 80/50, PR: 125, RR: 24, afebrile uponadmission, (+) angioedema & lacrimation, with
conjunctival injection, presence of nasal flaring,stridor upon auscultation, diffuse abdominaltenderness upon palpation, and generalizedurticaria
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Diagnostic Workup:
• IgE = 626 U/mL
• Histamine (U) = 495 nmol/g crt
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Case Study
• Mr. E is a 37 y/o single male
• c/o of throat tightness
• Hx: HTN, asthma
• Used to smoke (6 years ago) and drinksoccasionally (1-3 bottles a week)
• Uses paracetamol for muscle pain; first to takeibuprofen
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Case Study
• Other S/sx included are generalized urticaria,altered mental status, dyspnea, chest tightness,abdominal cramping and n/v
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Risk Factors
Exposure to antigen(ibuprofen)
Hereditary (Hx of Asthma)
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Pathophysiology
Exposure to antigen(ibuprofen)
Hereditary (Hx of Asthma)
Release of inflammatory mediators
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Diagnosis/Presenting Problem
Exposure to antigen(ibuprofen)
Hereditary (Hx of Asthma)
Release of inflammatory mediators
Medication-Induced Anaphylactic Reaction
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Assessment Findings
Exposure to antigen(ibuprofen)
Hereditary (Hx of Asthma)
Release of inflammatory mediators
Medication-Induced Anaphylactic Reaction
Smooth MuscleContraction
Vasodilation
Inc. vascularPermeability
Integumentary S/Sx
Rhinnorhea
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Diagnostic Procedure
Exposure to antigen(ibuprofen)
Hereditary (Hx of Asthma)
Release of inflammatory mediators
Medication-Induced Anaphylactic Reaction
Smooth MuscleContraction
Vasodilation
Inc. vascularPermeability
Integumentary S/Sx
Rhinnorhea
IgE = 626 U/mL
Histamine = 495
nmol/g CRT
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MedicationsSmooth Muscle
Contraction Vasodilation
Inc. vascularPermeability
Integumentary S/Sx
O2 administrationranitidine
epinephrine0.9% NaCl IV methylprednisolone diphenhydramine
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Nursing DiagnosisSmooth Muscle
ContractionSmooth Muscle
ContractionInc. vascularPermeability
Integumentary S/Sx
O2 administrationranitidine
epinephrine0.9% NaCl IV methylprednisolone diphenhydramine
Ineffective respiratory function r/t excessive
secretions asmanifested by stridor
Decreased cardiacoutput related todecreased venous
return as evidenced by dyspnea,
decreasedperipheral pulses
and peripheralcyanosis
Ineffective tissueperfusion related to
mismatch of
ventilation with blood flow asevidenced by
altered mentalstatus and
peripheral cyanosis
Risk for impairedskin integrity
related toimmunologic
factors asevidenced by hives,
pruritus anderythema
Activity intolerancerelated to oxygenationimbalances of supply
and demand ascharacterized by chest
pain and dyspnea
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Nursing Care InterventionsA. Independent
Insert an I.V. line for giving emergency drugs and volume expanders.
Continually reassure the patient and explain all tests and treatments toreduce fear and anxiety.
Monitored V/S regularly including pain episodes and O2 saturation
Auscultated lung fields and heart tones & notified MROD for significant
changes
Assessed LOC & orientation
Checked peripheral pulses & observed extremities for color, capillary refill,
& sensation
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Nursing Care InterventionsA. Independent
Kept environment quiet & calm, provided relaxing techniques
Ensured physical rest with passive exercises
Provided information to patient & SOs regarding disease process,
diagnostics, medications & interventions
Observe for complications associated with anaphylaxis, such as vascular
collapse and acute respiratory insufficiency or obstruction.
Closely observe a patient with known allergies for anaphylaxis when giving
a drug with high anaphylactic potential.
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Nursing Care Interventions
B. Dependent
Administered medications, and O2 therapy as
prescribed and evaluated body response accordingly.
Rapidly infuse I.V. fluids to fill vasodilated
circulatory system and raise blood pressure. Titrate
vasopressors based on blood pressure response asordered.
Administered O2 as prescribed. If hypoxia continues,
prepare to help insert an artificial airway.
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Ecologic Model
Anaphylactic Shock
Idiopathic:
Ibuprofen
(NSAIDs)
Hypertension
Medication:
Lisinopril Family History of
Bronchial Asthma
Anaphylaxis MR. E
Unresolved
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Evidenced-Based Practice
Title:
A Role for Platelet-Activating Factor in Anaphylaxis
Purpose:
To evaluate the relationship between PAF, PAFacetylhydrolase, and the severity of anaphylaxis,patients with acute allergic reactions were studiedprospectively at the time of presentation to theemergency department of a university teachinghospital.
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Evidenced-Based Practice
Clinical Question:
• Does Platelet activating factor (PAF) levels andPlatelet activating factor acetylhydrolase activity determine the severity of anaphylaxis?
• Does Platelet activating factor (PAF) levels and
Platelet activating factor acetylhydrolase activity determine the risk of an individual foranaphylactic shock?
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Evidenced-Based Practice
Summary & Conclusion:
• The results of the study implicates that therelationship between PAF acetylhydrlase and theseverity of anaphylaxis is inversely proportional.
• The higher the individual’s level of PAF
acetylhydrolase the lower the severity of his/heranaphylaxis is.
• PAF acetylhydrolase deficiency is anindependent risk factor for fatal anaphylaxis
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Evidenced-Based Practice
Significance:
These data provide the rationale for thedevelopment of drugs to selectively block theactions of PAF, both as rescue therapy in cases of acute anaphylaxis and potentially as long-term
preventive treatment for those at highest risk forfatal anaphylaxis.
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Theoretical Basis of Care
Orem’s Self -Care Deficit Theory
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Ethico-Moral & Legal Issues
Ethico-MoralPrinciples:▫ Autonomy
▫ Nonmalifecence
▫ Beneficence
▫ Justice
▫ Veracity
Legal Responsibilities:▫ Patient’s advocate
▫ Administeringmedication
▫ Informed consent
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Thank You!!!
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