Anaphylaxis

Goals

Recognise an allergic reaction or anaphylaxis and apply nursing interventions accordingly.
Recognise and describe the systemic physiology in anaphylaxis.
Provide treatment recommendations.

S.Mr de Wild is admitted to your ward due to a flare-up of ulcerative colitis. He has just started new medication for this. He is now asking you to come to him because his symptoms are worsening.
B.Mr de Wild is 52 years old. His history includes ulcerative colitis and cholecystectomy.
A.See ABCDE
R.Please assess the patient using ABCDE and apply interventions where necessary.

A.Clear, moderate swelling of lips and tongue, audible breathing.
B.RR 25 breaths/min, increased work of breathing, using accessory breathing muscles, symmetrical thoracic excursions, normal jugular veins, inspiratory stridor over all lung fields, saturation 91%.
C.Blotchy red skin, CRT 2 sec, HR 98 bpm, normal regular pulse, peripherally warm and dry, BP 103/48 mmHg.
D.Alert on AVPU. Anxious. Glucose 8.2, pupils PEARL.
E.Temp 37.5°C, red rash over trunk, arms and face, facial swelling. No oedema in legs. Urine output: spontaneous 350 ml 1 hour ago.

A.Compromised, increased swelling of lips and tongue, audible breathing.
B.RR 35 breaths/min, increased work of breathing, using accessory breathing muscles, symmetrical thoracic excursions, normal jugular veins, inspiratory stridor over all lung fields, saturation 76%.
C.Blotchy red skin (100%). Peripherally warm. CRT 4 sec. HR 121 bpm regular, BP 78/34 mmHg.
D.Alert on AVPU. Anxious. Glucose 8.2 mmol/l, pupils PEARL.
E.Temp 37.7°C, increasing red skin rash, facial swelling increasing. No oedema in legs.