Symptoms are associated with hypersensitivity and anaphylaxis

Full Answer Section

• Cardiovascular: Dizziness, lightheadedness, fainting, rapid and weak pulse, low blood pressure (hypotension), cardiac arrest  
• Gastrointestinal: Nausea, vomiting, diarrhea, abdominal cramps  
• Other: Confusion, anxiety, feeling of impending doom

Differentiating Hypersensitivity and Anaphylaxis from Other Conditions:

Nurses need to differentiate hypersensitivity and anaphylaxis from other conditions that may present with similar symptoms. This involves a thorough assessment of the patient's history, physical examination, and consideration of the onset and progression of symptoms.

• Allergic Reactions (Non-Anaphylactic): These reactions typically involve one organ system (e.g., skin rash only) and are milder and self-limiting. Anaphylaxis involves multiple organ systems and is rapidly progressive.  
• Asthma Exacerbation: While both can involve wheezing and difficulty breathing, anaphylaxis often has accompanying skin and cardiovascular symptoms that are not typical of asthma alone.
• Vasovagal Syncope: Fainting can occur in both, but anaphylaxis usually has preceding allergic symptoms like hives or swelling and respiratory distress. Blood pressure is typically low in anaphylaxis.  
• Panic Attack: Anxiety can mimic some symptoms like rapid heart rate and shortness of breath, but anaphylaxis usually has objective signs like hives, swelling, and a drop in blood pressure.
• Other Conditions: Depending on the primary symptoms, nurses may need to differentiate from conditions like infections (which may cause rash and fever), cardiac events (chest pain), or gastrointestinal illnesses (vomiting and diarrhea). The context of exposure to a potential allergen is crucial in suspecting hypersensitivity or anaphylaxis.  

Key differentiators for Anaphylaxis include:

• Rapid onset of symptoms (minutes to hours after exposure to a trigger).  
• Involvement of multiple organ systems (e.g., skin and respiratory, or cardiovascular and gastrointestinal).  
• Life-threatening symptoms such as breathing difficulties, significant drop in blood pressure, or loss of consciousness.  

Steps to Take if the Nurse Suspects Anaphylaxis:

Anaphylaxis is a medical emergency requiring immediate intervention. If a nurse suspects anaphylaxis, the following steps should be taken immediately:  

1. Call for Help: Activate the emergency response system or call for immediate medical assistance (e.g., call the emergency number in Kenya, which is 999).  
2. Assess the Patient:
   • Airway: Check for airway patency, listen for stridor or other abnormal sounds.  
   • Breathing: Assess respiratory rate and effort, listen for wheezing, check oxygen saturation if possible.  
   • Circulation: Check pulse rate and blood pressure. Assess for signs of shock (e.g., pale, cool, clammy skin, altered mental status).
3. Administer Epinephrine (Adrenaline): This is the first-line treatment for anaphylaxis. If the patient has a prescribed epinephrine auto-injector (like an EpiPen), assist them in using it immediately into the mid-outer thigh. If epinephrine is available in injectable form and the nurse is trained and authorized, administer it intramuscularly.  
4. Position the Patient: Lay the patient flat with legs elevated to help maintain blood pressure, unless they are having difficulty breathing, in which case they may need to sit up or be placed in a semi-recumbent position. Pregnant women should be positioned on their left side. Do not allow the patient to stand or walk.  
5. Administer Oxygen: If available, administer high-flow oxygen to help with breathing.  
6. Monitor Vital Signs: Continuously monitor the patient's airway, breathing, circulation, and mental status.
7. Administer Other Medications as Prescribed: Depending on the situation and medical orders, other medications like antihistamines and bronchodilators may be administered, but epinephrine is the priority.
8. Document: Carefully document the event, including the time of onset of symptoms, the suspected trigger, the patient's signs and symptoms, the interventions taken, and the patient's response.
9. Prepare for Further Treatment: Be prepared for potential intubation, CPR, and other advanced life support measures if the patient's condition deteriorates.
10. Educate the Patient and Family: After the acute episode, provide education on avoiding the trigger, recognizing future symptoms, and how to use an epinephrine auto-injector if prescribed. Ensure they have a written anaphylaxis action plan.

In summary, while hypersensitivity encompasses a range of allergic reactions, anaphylaxis is its most severe form, characterized by rapid onset and multi-system involvement with life-threatening potential. Nurses must be vigilant in recognizing the signs and symptoms of anaphylaxis and act swiftly by administering epinephrine and providing supportive care. Accurate differentiation from other conditions is crucial for timely and appropriate management.

Sample Answer

Hypersensitivity reactions are immune responses that are exaggerated or inappropriate, leading to tissue damage and inflammation. Anaphylaxis is the most severe and life-threatening type of hypersensitivity reaction.

Symptoms of Hypersensitivity:

Hypersensitivity reactions can manifest with a wide range of symptoms depending on the type of reaction and the organs involved. Common symptoms include:

• Skin: Rash, hives (urticaria), itching (pruritus), swelling (angioedema), eczema
• Respiratory: Sneezing, runny nose (rhinorrhea), nasal congestion, itchy throat, cough, wheezing, shortness of breath, throat tightness
• Gastrointestinal: Nausea, vomiting, diarrhea, abdominal pain
• Eyes: Itchy, watery, red eyes (allergic conjunctivitis)
• Systemic: Fatigue, headache

Symptoms of Anaphylaxis:

Anaphylaxis is a severe, rapid-onset, and potentially fatal systemic hypersensitivity reaction. It often involves multiple organ systems. Key symptoms include:

• Skin: Hives, itching, flushing, angioedema (swelling of the lips, tongue, throat, face)
• Respiratory: Difficulty breathing, wheezing, stridor (high-pitched breathing sound), throat tightness, hoarse voice, persistent cough