3650519
Descripción
Fichas por Natashia Reyes, actualizado hace más de 1 año
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Creado por Natashia Reyes
hace alrededor de 9 años
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| Pregunta | Respuesta |
| ANAPHYLAXIS Causes Incidence | Food allergy major cause of anaphylaxis in children. Others, penicillin, abx, insect stings, immunizations, allergy, chemotherapy, blood, contrast dye, peanuts, milk, eggs, wheat, shellfish other, Latex allergy mostly in children with spina |
| Pathophysiology | Allergen binds with IgE on mast cells and basophils causing degranulation and release of histamine! Histamine precipitates bronchoconstricition, bronchospasm, and edema from increased vascular permeability. Other systems for GI itching, tingling, vomiting, diarrhea, pain, integumentary urticaria (a rash of welts on skin) |
| Signs and Symptoms Most Serious Features | Sneezing, tightness or tingling of mouth/face, subsequent swelling of lips and tongue, severe flushing, urticaria, and itching of skin especially head and trunk, rapid development of erythema, Sense of impending Doom!!! These are usually followed by GI and Respiratory symptoms N&V, diarrhea, cramping, rhinorrhea, stridor, wheezing, hoarseness Most Serious: Laryngospasm, edema, cyanosis, hypotensive shock, vascular collapse, cardiac arrest |
| NURSING MNEMONIC | |
| Biphasic Reaction | May occur several hours after inital attack resolves as secondary or Biphasic and happen hours to several days after initial |
| DIAGNOSTICS What Will Serum Study Display What Will Identify Cause What Will Confirm Food Allergy | Elevated IgE for antigen exposure Skin/RAST test confirms antigen skin pricking test, allergen specific IgE serum level, atopy patch test |
| Acute Intervention | NPO!!!! Benadryl IV, first drug of choice epinephrine, oral diphenhydramine (histamine inhibitor such as rantiidine, cimetidine, or corticosteroids may be indicated-dexamethasone IV |
| Epinephrine Dosage Child | 0.01mg/kg/dose of 1:1000 concentration Epi Pen 0.3mg for children 25kg (55lbs) and above Epi Pen Jr 0.15 for whicren 10-25kg (22-55lbs) |
| In a Hospital Emergency Setting Anaphylactic Management Priority How to Administer Epinephrine Position of Child | Ensure Adequate Airway!!!! -Administer Epinephrine if insect sting tourniquet proximal to site of sting then admin to uninvolved then involved area with repeat dosing in 5-10 min -administer oxygen if available -aminister corticosteroids and antihistamines as ordered -Keep child warm and lying flat or with feet slightly elevated -Start an IV line |
| What May be Available for Children WIth Life Threatening Insect Sting Anaphylaxis Does Everyone go to ER How long do you Observe Child in Hospital Setting | Venom immunotherapy, yes everyone who experiences allergic reaction, held at least 4-6 hours after episode is resolved to ensure prompt intervention in a biphasic reaction |
| NURSING ASSESSMENT ACUTE INTERVENTION | Airway, Respiratory rate and effort (child 3-5 y/o 22-25 breaths/min, 5-12y/o is 19-22 breaths/min, 12 and above 12-19breaths/min, heart rate 2-5 is 70-110 bpm, peripheral pulses, capillary refill time, oxygen saturation, urine output 1-2ml/kg/hr and LOC |
| What Should be Available At All Times for Nurse What Access is Priority What Do You Do In Vascular Collapse Patient with Heart Palpitations and Tachycardia | laryngoscope, intubation tray, trachestomy kit, code cart Start IV access with Large Bore Needle in at least one site preferably two for meds If vascular collapse administer extra fluids (crystalloids or colloids) and plasma volume expander Heart palpitations and tachycardia are normal in this situation |
| How to Administer Epinephrine What if Child is Clothed What if Fluids and Such Don't Bring up BP | Hold against thigh and administer can go through clothing Hold in position for 10 seconds after Administer Vasopressors such as dopamine and dobutamine Critical care unit ER ICU, |
| How to Prevent Insect Stings | Wear white or khaki colors not dark, bright, or decorative wear fitted clothes, long sleeves, pants, shoes, use unscented soap, lotion, and do apply insect skin protectant avoid orchards, flowers, blooming trees, and shrubs stay away form picnic areas keep out of garden keep car windows closed when driving place screens on all windows, cover all garbage cans Move away "Slowly" from approaching insects (questionable book intervention at its best) |
| SHOCK | |
| RECOGNIZING SHOCK |
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