Severe Allergies

							Severe Allergies
                  Definition
• Janice Selekman in School Nursing: A
  Comprehensive Text (2006) defines as:

  – An overreaction of the defense role of the
    immune system resulting in hypersensitivity to
    non-self component of the environment or re-
    exposure.
 Classification of Allergic Reaction
• Type I- hypersensitivity Ig-E mediated
  – Examples:
     •   Allergic rhinitis
     •   Atopic dermatitis
     •   Bronchial asthma
     •   Food allergy
     •   Anaphylaxis
  – Severe immediate reaction
  – Within seconds of exposure
 Classification of Allergic Reaction
• Reaction Time: first 30 minutes post allergen
  exposure
  – Symptoms:
     •   Local edema
     •   Smooth muscle contraction
     •   Vasodilatation
     •   Increased permeability of blood vessels (increase in Ig-E)
• Secondary Reaction: 4-12 hours post allergen
  exposure
  – Phase can last 2 days
                      Assessment
• IHP and EAP should include history of events
  – Anaphylaxis
  – Hospitalizations related to allergies
• Precautions recorded on IHP and EAP
  – Avoidance of known allergens
     •   Shell fish
     •   Peanuts and other tree nuts
     •   Egg
     •   Milk
     •   Soy
     •   Wheat
     •   Fish
           Respiratory Assessment
•   Respiratory rate and effort
•   Swelling of lips and tongue
•   Anxiousness
•   Rhinorrhea
•   Dyspnea
•   Choking
•   Hoarseness
•   Stridor
•   Wheezing
            Emergency Treatment
• Anaphylaxis is a medical emergency requiring
  immediate attention!
   – A,B,C’s
      • Airway
      • Breathing
      • Circulation
   – Epinephrine administration
      • 0.01 mL/kg (0.5 mL max) of 1:1000 epinephrine intramuscularly
          – (Clinical Manual of Emergency Pediatrics 4th Ed 2003)
      • Epi-pen® Jr.: children less than 30 kg or 66 lbs.
          – 0.15 mg of a 1:2000 (2mL)
      • Epi-pen® children greater than 30 kg or 66 lbs.
          – .30 mg of 1:1000 (2mL)
          – (Pediatric Dosage Handbook 12th Ed 2005-06)
                 Monitoring
• Increased heart rate is common
• Nausea
• Extended observation in emergency
  department recommended
  – 2nd phase of allergic response occurs in >20%
• Steroid preparation usually administered
  within one hour of reaction to prevent onset
  of 2nd phase.
                Interventions
                                       Policies

• Avoidance of allergens
  – Most effective intervention
• School policy regarding trading of foods
• School policy related to outside foods being
  brought in to the school for celebrations
• Education by school nurse to faculty/staff
                 Education
• Offending allergens
• Early signs of impending anaphylactic reaction
• Administration of epinephrine to staff/faculty
  and student
• 911 call
• Telephone call to parent(s)
                        Care Plan
• Goal: Maintain Airway
• Emergency Action Plan
   – Administer Epi-pen® as prescribed
      • Delayed treatment can result in tragedy
   – Call 911
   – Notify parent(s)

• Samples Goals & Emergency Plan (Source: Computerized
  Classroom Health Care Plans for School Nurses. Brennan,
  C. & Clark, M. 2003, 3rd ed.)
     Administration of Epinephrine
• Remove safety cap
• Place black tip on thigh at right angle to leg
    – Through clothing is okay
• Press hard into thigh until you hear the click
• Hold for 10 seconds against thigh, remove
• Massage area for 10 seconds
• Discard injector
• Call 911 immediately, have one person stay with
  student
• Be prepared to administer CPR
• Notify parents