Pathophysiology: Distributive shock is the type of shock that occurs when blood volume is not lost from the

body but is distributed to interstitial tissues where it cannot circulate and deliver oxygen. It can be caused by a loss of sympathetic tone, blood vessel dilation, pooling of blood in venous and capillary beds and increased blood vessel permeability/capillary changes (neural induced) or the presence of chemicals (chemical-induced). Chemical induced shock has 3 common origins: anaphylaxis, sepsis, and capillary leak syndrome. The chemicals are usually exogenous but also can be induced by endogenous substances. Anaphylaxis is one result of type I allergic reactions. It begins within seconds to minutes after exposure to a specific allergen in a susceptible person. The result is widespread loss of blood vessel tone and decreased cardiac output. Risk Factors: A personal history of anaphylaxis, allergies or asthma and a family history. Causes: A # of allergies can trigger anaphylaxis, the most common triggers include, certain medications esp. penicillin, foods such as peanuts, walnuts, pecans, fish, shellfish, milk and eggs, Insect stings from bees, yellow jackets, wasps, hornets, and fire ants. Less common include latex, muscle relaxants used during general anesthesia and exercise. Also symptoms are sometimes caused by aspiring, NSAIDS, and IV contrast. Signs and Symptoms: Skin reactions, including hives along with itching, flushed or pale skin, feelings of
warmth, sensation of a lump in your throat, constriction of the airways and a swollen tongue or throat, which can cause wheezing and trouble breathing, a feeling of impending doom, a weak and rapid pulse, N/V/D. dizziness or fainting.

Diagnostic Testing: Dr. will ask questions about allergies or any previous allergic reactions you ve had; To help
confirm diagnosis, you may be tested for allergies with skin tests or blood tests, you may also be asked to keep a detailed list of what you eat, or to stop eating certain foods for a time. The dr. will also rule out other conditions that could be causing symptoms.

Medications: CPR if you stop breathing or your heart stops, you may also get epinephrine, O2, IV antihistamines,
cortisone, and a beta agonist such as albuterol

Priority Nursing Diagnosis: Ineffective Tissue Perfusion r/t laryngeal edema aeb respiratory distress Assessments: 1) Monitor respiratory status and observe for changes hourly, 2) Assess pt for the sensation of a
narrowed airway q30 min 3) Auscultate Lung sounds and report changes q2-4 hrs 4) Assess for presence of angioedema q30 min 5) Assess pulse ox q2-4hrs and ABG s daily 6)Assess level of anxiety prn

Interventions: 1) Position the pt upright, 2) Instruct the pt to breathe deeply and slow down respiratory rate 3)
Administer Oxygen as prescribed 4) Provide reassurance and allay anxiety by staying with the pt during acute distress 5) Maintain patent airway. Anticipate emergency intubation or tracheostomy if stridor occurs 6) Administer medication as ordered (Epinephrine, Corticosteroids, Antihistamines, Bronchodilators, Glucagon, and provide IV fluids) 7) Maintain a calm, assured manner 8) Assure the pt and significant others of close, continuous monitoring that will ensure prompt intervention.

Education: The best way to prevent is to avoid substances that you know cause this severe reactions, Wear a
medical alert bracelet, alert your dr to your drug allergies, keep a properly stocked emergency kit with prescribed medications available at all times, If you re allergic to stinging insects, exercise caution when they re nearby, Avoid

wearing sandals or walking barefoot in the grass, If you have specific food allergies, carefully read the labels. Carry self-administered epinephrine (EpiPen)

Expected Outcome: Patient s breathing pattern is restored as evidenced by eupnea, regular respiratory rate or
rhythm, and improved lung sounds. .