Anaphylactic shock is a severe allergic reaction that can be triggered by medications, foods, insect bites or stings. It results from the interaction of allergens with immunoglobulin E antibodies, causing the release of histamine and other mediators from mast cells. This leads to respiratory distress, decreased blood pressure, hives, and potentially death. Treatment involves stopping exposure to the trigger, administering epinephrine, antihistamines and steroids, monitoring breathing and circulation, and managing symptoms. Nurses assess for allergies and anaphylaxis risk factors, and provide care to address impaired breathing, circulation issues, skin problems and pain.

1. ANAPHYLACTIC SHOCK

2. INTRODUCTION
• n anaphylactic reaction is an acute systemic
hypersensitivity reaction that occurs within
seconds or minutes after exposure to certain
foreign substances, such as medications
(penicillin, iodinated contrast material and other
agents such as latex, insect stings (bee, wasp ,
yellow ,jacket,hornet,) or foods(eggs ,peanuts ).
• This is an acute generalized hypersensitivity
reaction occurring within minutes after exposure
to an allergen and manifests with respiratory
distress and vascular collapse.

3. Pathophysiology
• Anaphylaxis results from the interaction of an
allergen with specific immunoglobulin E(IgE)
antibodies bound to mast cells and basophils
in the skin and lungs. The mast cell releases
histamine and other mediators that act on
various organs to produce a wide range of
clinical manifestations.

4. • Increased mucus secretion, increased bronchial
smooth muscle tone and airway edema
contribute to respiratory symptoms.
• Cardiovascular effect include vasodilatation and
capillary leakage leading to intravascular volume
depletion and hypotension.
• Histamine release in skin cause urticarial skin
lesions.
• In anaphylactic reaction exposure to an
substance cause direct release of mediators, a
process Histamine a that is not mediated by IgE.

5. ETIOLOGY
• Food allergy-fish, shell fish, milk, eggs, nuts
• (hazel nuts peanuts).
• Insect stings-bee and wasp bites.
• Drugs penicillin, intravenous anesthetics,
ovoid analgesic, aspirin, NASAID.
• Vaccines and antisera .
• Intravenous radio contrast media.

6. CLINICAL FEATURES
RESPIRATORY SIGNS
• Nasal congestion
• Pruritus
• Sneezing and coughing
• Possible respiratory distress that progresses
rapidly (caused by bronchospasm or edema of
larynx.
• Other respiratory difficulties, such as wheezing
and dyspnea.
• Chest tightness.

7. SKIN MANIFESTATION
• Flushing with a sense of warmth and diffuse
erythmia.
• Generalized pruritus over the entire body
(indicates developing general systemic
reaction ).
• Urticaria (hives).
• Massive facial angioedema possible
accompanying upper respiratory edema.

8. CARDIOVASCULAR MANIFESTATION
• Dysrhythmia
• Pallor
• Weak peripheral pulse.
• Hypotension .
• Circulatory failure, leading to coma and death.

9. GASTROINTESTINALMANIFESTATION
• Nausea Vomiting
• Colicky abdominal pain.
• Diarrhea.

10. MANAGEMENT
1. IMMEDIATE MANAGEMENT: Life saving measures.
• Stop offending agent/ drug immediately.
• Maintain airway and adequate breathing .
• Maintain adequate circulation-place IV cannula with
wide bore and start isotonic saline.
• Monitor central venous pressure if feasible. Administer
oxygen if patient is hypoxic or in respiratory distress.
•

11. DRUG THERAPY
• EPINEPHRINE: Epinephrine. Administer
adrenaline 03-05 ml. 1:1000 solution (1 mg/ml)
IM (IV in rare case) Iimediately.
• ANTIHISTAMIN: Give diphenhydramine 50-100
mg intravenously.
• HYDROCORTISONE: Administer hydrocortisone
100-200 mg 6 hourly, followed by prednisolone.
This prevents delayed recurrence of symptoms.

12. NURSING MANAGEMENT
NURSING ASSESSMENT:
• Assess any kind of allergy or previous
reactions to antigens.
• Assess patient's understanding of previous
reactions and steps taken by the patient and
the family to prevent further exposure to
antigens.

13. NURSING DIAGNOSIS
• Impaired gas exchange related to ventilation
perfusion imbalance.
• Altered tissue perfusion related to decreased
blood flow secondary to vascular disorders
related to anaphylactic reaction.
• Ineffective breathing pattern related to the
swelling of the nasal mucosa wall.
• Impaired skin integrity related to changes in
circulation.
• Acute pain related to gastric irritation.

14. NURSING INTERVENTION