Case Study: Osteoporosis and anaphylactic shock Essay

Case Study: Osteoporosis and anaphylactic shock Essay

Case Study: Osteoporosis and anaphylactic shock Essay

Osteoporosis and Anaphylactic Shock Case Study
Osteoporosis is a health condition in which the bones become weak and brittle following low calcium levels. It mainly occurs when the process of new bone creation cannot keep up with old bone removal. Thus, the body responds with diminished bone density, early bone loss, and an increased risk of fractures. An anaphylactic shock, also known as anaphylaxis, is a severe allergic reaction mainly caused by various medications, food allergens, or insect bites, causing the body to respond in hypotension, sudden narrowing of the airways, and shortness of breath (McLendon & Sternard, 2022). This essay presents the application of nursing knowledge to address a case study involving an osteoporosis patient who has had an anaphylactic shock.

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The case study involves Jade, a 60-year-old female patient suspected to be in an anaphylactic shock after being on analgesia, prophylactic antibiotics, and anticoagulants. The suspected anaphylactic reaction is addressed using IV adrenaline and hydrocortisone. The paper will include the pathophysiology of anaphylactic shock, pharmacology, specific nursing care, and discharge education that should be provided to the patient. The research parameters that I will apply in this essay include the use of medical databases and the use of google scholar to identify peer-reviewed sources. I will also use current sources that are up to seven years old.
Pathophysiology of Anaphylactic Shock
When a severe allergic reaction occurs, the blood vessels instantly precipitate hyperdilation, leading to severe hypotension. There is also decreased perfusion, which contributes to low arterial pressure and thus decreases oxygenation in the blood cells. Additionally, blood circulation throughout the body is inhibited by the dilated blood vessels, thus forcing the body to respond through the symptoms of anaphylactic shock. These symptoms manifestations include; fast breathing, increased heart rate, cyanotic skin, decreased urinary output, and hypoperfusion of the brain.
According to McLendon and Sternard (2022), when the body is re-exposed to a particular antigen, it rapidly releases stored chemical mediators. These chemical mediators include histamine, prostaglandin, platelet activation factor, and leukotrienes. Histamine increases vascular permeability and vasodilation, thus causing hypoperfusion of tissues, whereby the body reacts in cardiac contraction and increased heart rate. Ebo et al. (2019) note that prostaglandin potentiates peripheral vasodilation, leading to hypoperfusion of vital organs. Platelet activation factors increase vascular permeability, while leukotrienes affect airway modeling and increase vascular permeability.
In this case, Jade’s clinical manifestations of anaphylactic shock included hives, tachycardia, hypotensive, and swollen tongue and lips. The pathophysiological changes that led to the swelling of the tongue and the lips include vasodilation and increased permeability of membranes, leading to the fluids escaping to the extracellular spaces. According to Ebo et al. (2019), vasodilation of blood vessels in anaphylactic reactions affects the blood vessels’ capacity and volume, leading to low blood pressure and hypotension. Similarly, Jade’s hypotension results from the reduced blood volume and increased blood vessel capacity. The body’s homeostatic mechanisms to increase blood pressure increase the heart rate, thus leading t tachycardia (Blumein & Griffiths, 2022), the same case with Jade’s tachycardia.
Pharmacology
Two drugs on the medication list likely caused Jade’s anaphylaxis reaction: paracetamol and Cephazolin. Paracetamol or acetaminophen is used to treat fever and mild to moderate pain. Jade’s prescription included paracetamol 1g PO QID. Paracetamol is an analgesic that works by signaling the brain to block prostaglandin production, thus actively influencing transient receptor vanilloid1 and cannabinoid 1 receptors, thus reducing pain (Offor et al., 2022). Paracetamol’s usual dosage in adults is 3g per day. In the case study, Jade’s prescription is slightly above the recommended dosage since the current prescription is 1g PO QID, which means she is taking about 4g per day. Popiołek et al. (2019) note that some adverse drug reactions related to paracetamol include allergic reactions, tachycardia, and low blood pressure. One of the nurses’ considerations when administering paracetamol is ensuring the prescribed dosage aligns with the recommended dosage.
Cephazolin is the other medication likely to have caused the anaphylactic reaction. Cephazolin is a first-generation beta-lactam antibiotic. According to the National Center for Biotechnology Information (2021), cephazolin binds and inactivates protein-binding penicillin on the inner membrane of the bacteria cell wall, thus interfering with its cell wall strength and rigidity, therefore weakening it and leading to cell lysis. The normal dosage for cephazolin is 500mg-1g for every 6-8 hours. Some common adverse drug reactions for this medication include developing an infection on the injection site, hives, diarrhea, vomiting, and loss of appetite. The nursing consideration is identifying whether the patient has had a hypersensitivity reaction to cephazolin.
The two drugs that were used to manage the anaphylactic reaction were IV adrenaline and hydrocortisone. IV adrenaline, also known as epinephrine, is an Alph/Beta agonist used to treat symptoms of cardiac arrest and severe allergic reactions (Anaphylaxis). According to Dalal and Grujic (2022), adrenaline exerts its pharmacological effects on alpha and beta-adrenergic receptors, thus inducing increased vascular smooth muscle contraction, leading to myocardial contractility and heart rate. The normal dosage for IV adrenaline is 1 mg/mL (1:1000): 0.05 to 2 mcg/kg/min IV (Dalal & Grujic, 2022). The adverse drug reactions for the drug include dizziness, chest pains, palpitations, nausea, weakness, and pulmonary edema. The nursing consideration in administering epinephrine is to titrate the IV dosage to achieve the desired mean arterial pressure.
The other drug that was used was hydrocortisone. Hydrocortisone is an anti-inflammatory drug that binds to the glucocorticoid receptor and contributes to downstream effects such as inhibiting inflammatory transcription factors like phospholipase A2. According to Liyanage, Galappatthy & Seneviratne (2017), the normal hydrocortisone dosage is 5mg per kg/approximately 250mg intravenously. Some common adverse drug reactions of hydrocortisone include dizziness, excessive tearing, and decreased urine discharge.
Specific Nursing Care
Immediate nursing interventions are crucial when a patient is found unresponsive to medication. In the case study, Jade was found unresponsive 10 minutes after administering an antibiotic. The first and most essential action was initiating a code blue. According to Spitzer et al. (2019), code blue is an emergency code used by hospitals to describe a critical status in a patient. It is mainly initiated when a patient is in an emergency requiring cardiopulmonary resuscitation. Nurses are usually the first responders to code blue emergencies since they are the ones at the bedside and the first to notice signs of clinical unresponsiveness and deterioration. Therefore, the immediate intervention is initiating the code blue to alert other care providers and the entire code team, thus ensuring action is taken as soon as possible.
The other specific nursing intervention is obtaining the patient’s vitals and sharing the information with the code team. Vitals observations and assessment should be done, including noting the abnormal manifestations such as tachycardia, hypotension, and hives. The nurse should, after that, share the information acquired with the other team members. It is, however, worth noting that each code team member has a specific role to play in addressing the emergency. After sharing the information, the nurse should keep close to the care provider to provide any other necessary information and responses about the patient.
Furthermore, the nurse must perform CPR on the patient as the team organizes itself to take further action. The other nursing interventions at this stage include monitoring the patients’ oxygenation and airway sensation. The nurse is most importantly expected to monitor and evaluate the code blue process. According to McGrath et al. (2021), monitoring and evaluating the process helps ensure that the patient gets the required attention and informs learning to improve future code blue processes.
The specific nursing care interventions after Jade has stabilized are the interventions that aim at maintaining stability and improvement. The specific nursing interventions to help the patient improve include administering oxygen and medications as prescribed. The others include providing a calm environment and providing assurance for the patient to reduce anxiety.
Discharge Education
From the case study, it is evident that the patient has a knowledge deficit regarding osteoporosis. Therefore, the discharge education for the patient will include osteoporosis risk factors and how she should take care of herself. Additionally, she is obese, lives sedentary, smokes 7-10 cigarettes daily, and takes at least two glasses of wine daily. Oh et al. (2021) note that patient-centered and holistic discharge education should consider all the health aspects of the patient. Similarly, I will include the abovementioned factors in the discharge education content.
Barron et al. (2020) state that the most profound osteoporosis risk factors include eating disorders, low-calcium intake, gastrointestinal surgery, and age. I will advise Jade to maintain a balanced diet and ensure she takes the right portions with the right frequency, thus preventing eating disorders. Jade is likely to restrict her food intake to address her obesity. Therefore, encouraging her to take the right food amounts is essential. Barron et l. (2020) note that severe food restriction is a major osteoporosis risk factor due to weak bones. In addition, I will encourage her to increase calcium in her diet since osteoporosis is caused by continuous low calcium intake. Since she is at menopausal age, a significant osteoporosis risk factor, I will encourage her to take hormone replacement therapy to prevent the menopausal age factor from leading to osteoporosis. Finally, I will encourage her to adhere to the prescribed medications to enhance desirable patient outcomes.
Conclusion
In conclusion, anaphylactic shock reactions are severe health conditions that may lead to death if the patient does not receive the required attention urgently. Paracetamol and cephazolin are the medications that would have caused the anaphylactic reaction in the case study. Care providers should assess whether the patient is allergic to a certain medication before prescription and administration. Nurses play a significant role before and after the code blue process. Discharge education should be patient-centered and holistic.

References
Barron, R. L., Oster, G., Grauer, A., Crittenden, D. B., & Weycker, D. (2020). Determinants of imminent fracture risk in postmenopausal women with osteoporosis. Osteoporosis International, 31, 2103-2111. https://doi.org/10.1007/s00198-020-05294-3
Blumlein, D., & Griffiths, I. (2022). Shock: etiology, pathophysiology, and management. British Journal of Nursing (Mark Allen Publishing), 31(8), 422–428. https://doi.org/10.12968/bjon.2022.31.8.422
Dalal, R. & Grujic, D. (2022) Epinephrine. In: StatPearls [Internet]. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK482160/
Ebo, D. G., Clarke, R. C., Mertes, P. M., Platt, P. R., Sabato, V., & Sadleir, P. H. (2019). Molecular mechanisms and pathophysiology of perioperative hypersensitivity and anaphylaxis: a narrative review. British Journal of Anesthesia, 123(1), e38-e49. https://doi.org/10.1016/j.bja.2019.01.031
Liyanage, C. K., Galappatthy, P., & Seneviratne, S. L. (2017). Corticosteroids in management of anaphylaxis; a systematic review of evidence. European Annals of Allergy and Clinical Immunology, 49(5), 196–207. https://doi.org/10.23822/EurAnnACI.1764-1489.15
McGrath, S. P., McGovern, K. M., Perreard, I. M., Huang, V., Moss, L. B., & Blike, G. T. (2021). Inpatient Respiratory Arrest Associated With Sedative and Analgesic Medications: Impact of Continuous Monitoring on Patient Mortality and Severe Morbidity. Journal of Patient Safety, 17(8), 557–561. https://doi.org/10.1097/PTS.0000000000000696
McLendon, K. & Sternard, B.T. (2022). Anaphylaxis. In: StatPearls [Internet]. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK48212
National Center for Biotechnology Information (2023). PubChem Compound Summary for CID 33255, Cefazolin. Retrieved March 6, 2023, from https://pubchem.ncbi.nlm.nih.gov/compound/Cefazolin.
Offor, S. J., Amadi, C. N., Chijioke-Nwauche, I., Manautou, J. E., & Orisakwe, O. E. (2022). Potential deleterious effects of paracetamol dose regime used in Nigeria versus that of the United States of America. Toxicology Reports. https://doi.org/10.1016/j.toxrep.2022.04.025
Oh, E. G., Lee, H. J., Yang, Y. L., & Kim, Y. M. (2021). Effectiveness of Discharge Education With the Teach-Back Method on 30-Day Readmission: A Systematic Review. Journal of Patient Safety, 17(4), 305–310. https://doi.org/10.1097/PTS.0000000000000596
Popiołek, I., Piotrowicz-Wójcik, K., & Porebski, G. (2019). Hypersensitivity Reactions in Serious Adverse Events Reported for Paracetamol in the EudraVigilance Database, 2007⁻2018. Pharmacy (Basel, Switzerland), 7(1), 12. https://doi.org/10.3390/pharmacy7010012
Spitzer, C. R., Evans, K., Buehler, J., Ali, N. A., & Besecker, B. Y. (2019). Code blue pit crew model: A novel approach to in-hospital cardiac arrest resuscitation. Resuscitation, 143, 158-164. https://doi.org/10.1016/j.resuscitation.2019.06.290

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Case Study: Osteoporosis and anaphylactic shock

Jade, a 60-year-old female, is admitted to the surgical ward following an emergency left femur open reduction and fixation (ORIF). She is currently on analgesia, as well as prophylactic antibiotics and anticoagulant. Jade received an antibiotic ten minutes of ago. You find her unresponsive and initiate a code blue. Upon carrying out vital observations, Jade is tachycardic and profoundly hypotensive at 65/25 mmhg. She has a bilateral wheeze on auscultation, swollen tongue and lips, as well as hives. She is given IV adrenaline and hydrocortisone for a suspected anaphylactic reaction.

Past medical history

• Osteoporosis

• Wrist fracture post fall

• Hypercholesterolemia

Subjective data

• Lactose intolerance

• Two glasses of wine every evening

• Smoker: 7-10 cigarettes per day

• Sedentary lifestyle-fast food several times a week and lack of exercises

• Post-menopause-not on any HRT

• Osteoporosis treatment-noncompliant at times

• BMI 30

Medications

• Clexane 40 mg SC OD

• Paracetamol 1g PO QID

• Fentanyl 500 microgram in 50 mLs Na Chloride (Patient controlled IV administration), 20 microgram bolus with 10-minute lockout time (not used in the last two hours)

• Cephazolin 2g IV TDS

• Atorvastatin 40mg PO OD

The following is to be addressed in your presentation.

1. Pathophysiology

• Discuss the pathophysiology of anaphylactic shock. Include in your answer the pathophysiological changes that have contributed to Jade’s clinical manifestations.

2. Pharmacology

• Identify which drug likely caused the anaphylactic reaction, to include its mechanism of action, normal dosage, ADR’s and any specific nursing consideration. (DO NOT USE TABLES)

• Discuss the two drugs used to manage the anaphylactic reaction. Include in your discussion the mechanisms of action, normal dosage, ADR’s and any specific nursing considerations. (DO NOT USE TABLES)

3. Specific Nursing Care

• Discuss the nursing intervention during the code blue and after stabilisation of Jade.

4. Discharge education

• You identify that Jade has knowledge deficit regarding osteoporosis

. Identify the osteoporosis risk factors that Jade may have, and briefly provide her with specific discharge education.

Specific assignment instructions The aim of this case study presentation is to provide an opportunity for you to apply your new knowledge of specific disease pathophysiology, diagnosis, and treatment (pharmacological, non-pharmacological, nursing, and allied health professional interventions) to a “real life” clinical scenario.

There is a word limit of 1400 words Submission is via Turnitin link in Canvas; Assessment 2 Case study folder A detailed SNM rubric is attached to the end of this document outlining criterions and mark allocation.

Introduction: should include

• An introduction to your topic

• Highlight the main issues (do not copy the case study, summarise only)

• Include a statement that outlines the structure and purpose of the paper.

• Include research parameters

Content: In this area it is necessary to present the topics relevant to the paper.

• Address the pathophysiology question

• Address the pharmacology question

• Address the specific nursing care and discharge questions

• Discussion is supported by your learning, your research and knowledge of your professional responsibilities.

Critical Thinking:Exploration and application of the case study information and relevant evidence-based information to support your discussion

• Research: Journal articles, texts, theoretical knowledge.

• Presentation of resources (Evidence based)

• Appraise, analyse, compare, and discuss the case study applying your theoretical and research knowledge.

• Application to practice e.g. patient-centred care (based on analysis of case study)

• Professional responsibilities.

Structure and presentation:

• As per the assignment requirements as well as SNM guidelines.

• Clear introduction to the topic.

• Well defined sentence structure and paragraph formation leading to a cohesive development and comprehensive discussion of ideas.

• Conclusion that restates the main ideas and summarises the discussion.

Conclusion:

• Wind up of your paper

• Restate your main ideas

• DO NOT introduce new ideas.

• DO NOT use references in conclusion

References:

Work must be both In and End text referenced using APA 7th edition format. The essay requires a minimum of ten (10) quality citations (peer reviewed) journals, (not more than 7 years old), academic texts and quality web sites, e.g., Government (NOT Wikipedia).