About
Circulatory shock relating to major allergic reaction. Life-threatening emergency.
Assess
Stridor, wheezes, tachycardia, anxiety, hypotension, tachypnea, inability to breathe, airway obstruction
Complications
Multi-organ dysfunction syndrome, cardiac or respiratory arrest, death
Diagnosis
- Ineffective gas exchange related to edematous airway.
- Ineffective airway clearance related to edematous airway.
- Fear related to inability to breathe.
Goals
- The client will maintain a patent airway.
- The client will have a pulse ox above 90%.
- The client will be able to breathe with respirations between 12-24.
- The client will be free from injury.
Interventions
- Assess and maintain a patent airway.
- Assess and monitor vital signs, pulse-oximetry, lung sounds, telemetry.
- Insert IV lines to establish IV access.
- Administer epinephrine, antihistamines, and bronchodilators as ordered.
- Have endotracheal and/or tracheotomy supplies at bedside in case of emergent need.
- Have Crash cart nearby and prepare to administer CPR if condition deteriorates.
- Give anxiolytics as indicated.
- Remove causative agents/ offending agents.
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