NRS 410 Topic 4 DQ 2 Discuss what symptoms are associated with anaphylactic shock

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Topic 4 DQ 2

Aug 8-12, 2022

Discuss what symptoms are associated with anaphylactic shock and how the nurse differentiates these from other conditions or issues. What steps should be taken if the nurse suspects anaphylactic shock?

Barb McGraw

Aug 8, 2022, 5:15 AM

Replies to Barb McGraw

Class, please explain the importance for a school nurse in knowing how to quickly intervene, when an allergic reaction is identified. Include some steps of this intervention.

Mary Bonillos

replied toBarb McGraw

Aug 9, 2022, 9:12 PM(edited)

Replies to Barb McGraw

Food allergies affect 8% of children in the U.S., with up to two students in every classroom at risk for allergic reactions, including anaphylaxis, and up to 25% of students may experience their first allergic reaction while at school (Kao et al., 2018). Students with food allergies are at high risk of encountering a potential allergen. Meals are a regular part of the school day. Food is part of lesson plans, fundraisers, celebrations and rewards, and other school-wide activities; food allergens may also be in nonfood products used for crafts and science materials (Kao et al., 2018). Other potential allergy triggers can be insects, medications, and latex. Students can present with different symptoms, which can occur within a few minutes to a few hours. Mild symptoms can progress to anaphylaxis quickly; therefore, recognition of the early signs and prompt treatment is critical. Epinephrine is the first-line treatment for anaphylaxis, and proper administration of epinephrine in the vastus lateralis muscle is critical for efficacy; a second dose can be given 5 to 15 minutes later if needed as it is rapidly metabolized (Bingemann et al., 2021). If epinephrine is given, 911 must be called, as even if symptoms improve, there is the possibility of symptom recurrence.

Students with known allergies often carry or have their EpiPen stored with the school nurse. However, with the potential for students to react without previous history, schools must keep stock doses for emergencies. The school nurse has a role in anaphylaxis prevention and preparedness, programming, and policy; they collaborate with students, families, providers, and school personnel to create, implement, and evaluate individualized healthcare plans for students at risk for anaphylaxis (Bingemann et al., 2021). School nurses create an emergency care plan to educate nonmedical school staff on steps to prevent and manage a medical emergency. The school nurses can work on multiple school campuses and are not on-site all the time, so they have a key role in educating nonmedical school staff to recognize s/s of anaphylaxis, administer epinephrine, and activate emergency medical services (Bingemann et al., 2021). Ensuring the school staff knows how to react will save students’ lives.

References

Bingemann, T. A., Nanda, A., & Russell, A. F. (2021). Pharmacology update: School nurse role and emergency medications for treatment of anaphylaxis. NASN School Nurse, 36(5), 264–270. https://doi.org/10.1177/1942602×211021902

Kao, L. M., Wang, J., Kagan, O., Russell, A., Mustafa, S., Houdek, D., Smith, B., & Gupta, R. (2018). School nurse perspectives on school policies for food allergy and anaphylaxis. Annals of Allergy, Asthma & Immunology, 120(3), 304–309. https://doi.org/10.1016/j.anai.2017.12.019

Sandra Jeudy

replied toBarb McGraw

Aug 10, 2022, 7:40 AM

Replies to Barb McGraw

Professor McGraw,

It is important for nurses to offer quick interventions when an allergic reaction is identified because it can be a life-threatening allergic reaction requiring an immediate response. In case of an extreme allergic reaction such as anaphylactic shock, nurses should immediately remove the agent that triggered the reaction (Zache et al., 2021). Medications such as epinephrine or Benadryl should be administered immediately. Continual monitoring of the airway is crucial to ensure that the patient can breathe effectively. Nurses should also identify substances that may be causing such reactions to prevent reoccurrence.

Reference

Zache, E., Cajueiro, J. F., Andrade Neto, A. Q., Almeida, L., Colares, R. R., Afonso, J. A. B., & Arenales, A. (2021). Anaphylactic shock with pulmonary eosinophilic infiltration due to honeybee attack in a donkey: Case report. Arquivo Brasileiro de Medicina Veterinária e Zootecnia, 73, 1346-1350. https://doi.org/10.1590/1678-4162-12180

Atoyia Ortiz

replied toBarb McGraw

Aug 12, 2022, 12:12 PM

Replies to Barb McGraw

My child’s school nurse once shared with me about the tragic death of an 11-year-old who died after brushing her teeth with a prescription toothpaste that contained milk protein (Recaldent); the child had a severe milk allergy. Imagine the horror that this family has experienced. I never knew that dental products could contain milk proteins, did you?

As Twitchell et al (2015) suggest, food allergies are an important public health concern among children in the U.S; they also shared a recent needs assessment among school nurses that indicated that though most nurses identified their baseline knowledge of food allergies as strong or very strong, they were highly interested in increasing their knowledge. Specifically, they had interest in learning how to teach school staff about food allergies and develop food allergy management plans.

Children tend to share their meals or trade items from one another’s lunch boxes. They are innocently unaware of one another’s allergies or intolerances, and this is when problems arise. A school nurse can promote and guide creation of a prevention plan and process and monitor for its implementation. Should prevention become intervention, the school nurse can teach all staff about the signs and symptoms of a serious allergic reaction and who among school personnel are equipped to provide emergency medication. The nurse can review with the allergic student how to use an epinephrine auto-injector by using a “trainer” injector with

NRS 410 Topic 4 DQ 2 Discuss what symptoms are associated with anaphylactic shock

no needle and no medication. The school nurse can also develop a protocol for obtaining “stock” epinephrine for use on anyone who is demonstrating signs and symptoms of anaphylaxis.

REFERENCE

Twichell, S., Wang, K., Robinson, H., Acebal, M., & Sharma, H. (2015). Food allergy knowledge and attitudes among school nurses in an urban public school district. Children, 2(3), 330–341. https://doi.org/10.3390/children2030330

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