Anaphylaxis: Understanding the Condition

This assignment delves into the complex topic of anaphylaxis, examining its pathophysiology, triggers, clinical manifestations, and treatment strategies. It draws upon various academic sources to provide a comprehensive understanding of this life-threatening allergic reaction. Key aspects covered include the role of histamine and other mediators, biphasic reactions, the importance of immediate medical intervention, and emerging research on managing anaphylaxis.

NURSING

Anaphylaxis is a life threatening allergic reaction and can take place immediately by
coming in contact with allergen (Brockow and et.al., 2015). Common signs and symptoms of
anaphylaxis are wheezing, tightness in chest, dizziness, confusion, rashes or itchy swollen skin,
shortness in breath, selling in tongue or lips, diarrhoea, vomiting and weak pulse rate (Marrs &
Lack, 2013). The present essay is about a 56 year old farmer named Jim Palmer who is brought
to emergency department this morning due to severe cellulitis in left lower leg. In emergency
department at first he was provided with 1 gram Flucloxacillin and then second dose was given
with further assessment.
Sign and symptoms of anaphylaxis in relation with ABCDE approach
Allergens get inserted into the body through many routes like, during inhalation,
ingestion of food, parenteral or may be due to contact with skin. When body get first exposure
with allergens it forms Immunoglobulins E (Ig E) antibodies for the specific antigens (Moghimi,
2014). Then IgE antibodies get attached to the high affinity Fc receptors present on basophils and
mast cells. After the attachment of antigen to antibodies, IgE triggers the degranulation of the
mast cells. Chemical substance like histamine, prostaglandin D2, leukotrienes, nitric oxide,
eosinophils and neutrophils have various effects on specific organs and leads to clinical
manifestation.
Clinical manifestations increase the vascular permeability, vasodilation and myocardial
dysfunction which results in hypotension and cardiovascular collapse (Sala-Cunill and et al.,
2015). The first step for treating patient is to examine the sign and symptoms and relate them
with ABCDE approach. This process help in identifying the problems and major medical risk
associated with patient.. In hospital Jim received a dose of Flucloxacillin 1 gram intravenous in
emergency department after that second dose was also given to him (Aun and et al.,2014).
In ABCDE, A stands for Airway examination. This is concerned with looking for signs
of obstruction that causes central cyanosis, breathlessness and wheezing sound (Rohacek,
Edenhofer, Bircher, & Bingisser, 2014). In Jim’s case, ten minutes after giving second dose he
started feeling tightness in throat and some wheezing sound was audible while he breathed.
Obstruction in airways is because of swelling of throat and trachea (Snyder, 2016). During
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clinical manifestation dysfunction in myocardial result in damage to heart muscles that decrease
the pumping ability of heart and neutrophils released during degranulation process secrete many
chemicals including various enzymes that degrade the protein and causes the damage to tissue of
airways. This damage in airways results in swelling and tightness in throat. These obstructions
and can be treated by simple methods like airway suction or airway manoeuvres. In some case
when latter mentioned methods fail to work tracheal intubation can be performed (Humbert and
et al., 2014).
Second approach is B which stands for Breathing examination. In this respiratory rate is
counted along with the depth of each breath. Many physical evaluations are done to identify
breathing problems like, assessing pattern of breathing, looking for deformity in chest, checking
position of trachea, listening to the sound of breathe and taking reading on pulse oximeter
(Commins, 2017). In Jim’s case, there was wheezing sound while he breathed along with high
breathing rate of 26 breath/minute. Main reason of breathing problem is obstructed airways due
to swelling in trachea or may be due to infection in the lungs caused by bacteria, fungi and
viruses. Thealternation in tone of smooth muscles of respiratory tract result in bronchospasm i.e.
it causes constriction in muscles of bronchiole wall that cuases difficulty while breathing (Ye and
et al., 2015). In pathophysiology of anaphylaxis during degranulation process many chemicals
are released like eosinophil, neutrophils, basophils and lymphocytes. These all cells contribute to
allergic response and as a result eosinophils generate vast amount of toxic material similarly to
the mast cells that irritate the trachea which results in the breathing problems.
Third approach for assessing is C i.e. Circulation examination regarding heart rate, blood
pressure, capillary refill time, temperature of body, colour of hands and digits and by assessing
the condition of veins. In case of Jim, this examination indicated blood pressure of around 99
mm Hg systolic pressure on palpation, capillary refill time of less than 4 seconds and blood
glucose level is 5.3 mmols/L. Temperature of body was found to be 37.4 degree, heart rate of
about 130 beats per minute and peripheries were cool and clammy. The major concern is
regarding the increased capillary refill time which is because of the decreased peripheral
perfusion and is the sign of shock. High heart rate may lead to heart dysfunction and heart
muscle disease, tumours and infections so there is need of immediate treatment. Blood pressure
remains normal because of increase in peripheral resistance to reduce the cardiac output (Rolla
and et al., 2013). Else the blood glucose level and temperature is found to be normal.
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Fourth examination is for Disability. This is the check for consciousness of patients.
AVPU methods is used to assess the conscious level which includes A for alertness, V for
response to voice stimuli, P for response to painful stimuli and U is for unresponsiveness for all
stimuli. Many other examinations are performed like assessing the pupil size and blood glucose
level to check hypoglycaemia (Takazawa, Mitsuhata & Mertes, 2016). In case of Jim, his
consciousness level keeps on decreasing and at last he become drowsy and was responding only
to sound. Main reason behind loss of consciousness is hypoxia, it results due to the deficiency of
oxygen in blood. Due to short breathing problem heart is not able to pump adequate amount of
oxygenated blood and finally result in hypoxia (Anderson, Malone, Shanahan, & Manning,
2015). The most common treatment method for hypoxia is supplying patient with oxygen
therapies.
Final test is regarding E i.e. Examination of the full exposure of body to check any sign
of rashes, redness witch itching, signals of swollen skin and check for swelling in tongue and lips
(Sidhu, Whitfield, Mercer, Cross, & Charlesworth, 2013). Jim was facing problems related to
wide spread urticarial rash which was red in appearance and hot to touch. There were also sign of
swelling in lips, fingers and toes. This whole examination indicated that Jim Palmer was dealing
with Anaphylaxis, as these were the common symptoms that occur in this type of disease.
ISBAR report based on physical examinations
It is the mnemonic created to facilitate the safe transfer of critical information. It is
originated from the concept of SBAR which was the most frequently used mnemonic in
healthcare other environment (Panesar & Sheikh, 2014). Here in ISBAR,
I - Identification
Patient’s name: Jim Palmer
Age: 56 years
Gender: Male
S –Situation
Immediate clnical situation:Currently patient is in emergency department and was brought in
morning due to severe cellulitis in his left lower leg. He was provided with one dose of
Flucloxacillin 1 gram intravenous after that I also provided him with second dose of
Flucloxacillin.
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B –Background information of patient
When Jim was brought in emergency he was having cellulitis in left leg and was provided
with dose of Flucloxacillin. When second dose of Flucloxacillin was given to him after ten
minutes he started feeling breathlessness along with the tightness in throat. Jim was also having
bilateral chest moments and wheezing sound was audible while breathing. Some vital tests were
performed and my observations are breathing rate is up to 26 breaths/minute, blood pressure of
99 mm Hg systolic pressure on palpation. The heat rate of Jim was high having 130 beats per
minute, temperature of body noticed was 37.4 degree Celsius and SaO2 level is 91 % on right
articular of heart.
A – Assessment
For proper assessment of Jim ABCDE approach was used. During assessment many
problems were identified. By Airway examination it was identifies that the Jim was having
obstruction in trachea which resulted in the increasing breath rate. During Breathing examination
it was observed that he was having bilateral chest moment and was complaining for the tightness
in throat that resulted in the breathing problems and central cyanosis. While performing the
circulation examination it was found that heart rate was quite high and the oxygen-haemoglobin
saturation level was very low that need immediate treatment. In the disability treatment it was
found that Jim was loosing consciousness and becoming drowsy. AVPU method was used to
determine the level of consciousness where A is for Alertness, V is for response to vocal stimuli,
P is for response to painful stimuli and finally U is for total unconsciousness for all types of
stimuli (Ring and et al., 2014). Due to high breathing rate and increasing heart rate the heart is
not able to pump proper amount of oxygenated blood that result in the deficiency of oxygen in
tissue. This condition is known as hypoxia, and absence of proper treatment can result in lungs
damages and in severe cases may also lead to traumas.
Final examinations is concerned with exposure to full body check-up and in case of Jim
his body is having wide spread urticarial rashes with redness and itching along with the swelling
on lips, fingers and toes.
R – Recommendation
After performing with overall assessment, there are few recommendations regarding the
immediate treatment for Jim. First and the foremost is treatment of lower level of oxygen-
haemoglobin saturation by providing oxygen therapy. After this many other problems like
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breathing problem, increasing heart rate along with breathing rate can cause serious issues if not
treated at proper time. Treatment of the rashes on body of Jim along with swelled toes, fingers
and lips is also of major concern (Physical Examination & Health Assessment, 2012).
From the above essay it can be concluded that nurses play an important role in primary
treatment of patients brought in emergency department. The ABCDE approach is the best
technique for assessing the patient. It provides nurses with information regarding the problems
faced by the particular patient. Further it can be inferred that ISBAR is the best available method
for transferring critical information in much safer way.
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REFERENCES
Books and journals
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