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Consider when you should refer patients to emergency care versus treating as an outpatient

The treatment of anaphylactic shock varies depending on a patient’s physiological response to the alteration. Immediate medical intervention and emergency room visits are vital for some patients, while others can be treated through basic outpatient care.

Consider the January 2012 report of a 6-year-old girl who went to her school nurse complaining of hives and shortness of breath. Since the school did not have any medication under her name to use for treatment and was not equipped to handle her condition, she was sent to an emergency room where she was pronounced dead. This situation has raised numerous questions about the progression of allergic reactions, how to treat students with severe allergies, how to treat students who develop allergic reactions for the first time, and the availability of epinephrine in schools. If you were the nurse at the girl’s school, how would you have handled the situation? How do you know when it is appropriate to treat patients yourself and when to refer them to emergency care?

To Prepare

. Review “Anaphylactic Shock” in Chapter 24 of the Huether and McCance text, “Distributive Shock” in Chapter 10 of the McPhee and Hammer text, and the Jacobsen and Gratton article in the Learning Resources.

. Identify the multisystem physiologic progression that occurs in anaphylactic shock. Think about how these multisystem events can occur in a very short period of time.

. Consider when you should refer patients to emergency care versus treating as an outpatient.

. Select two patient factors different from the one you selected in this week’s first Discussion: genetics, gender, ethnicity, age, or behavior. Reflect on how the factors you selected might impact the process of anaphylactic shock.

Post an explanation of the physiological progression that occurs in anaphylactic shock. Then, describe the circumstances under which you would refer patients for emergency care versus treating as an outpatient. Finally, explain how the patient factors you selected might impact the process of anaphylactic shock.

Readings Required

** Huether, S. E., & McCance, K. L. (2017). Understanding pathophysiology (6th ed.). St. Louis, MO: Mosby.

Chapter 23, “Structure and Function of the Cardiovascular and Lymphatic Systems”

This chapter examines the circulatory system, heart, systemic circulation, and lymphatic system to establish a foundation for normal cardiovascular function. It focuses on the structure and function of various parts of the circulatory system to illustrate normal blood flow.

Chapter 24, “Alterations of Cardiovascular Function”

This chapter presents the pathophysiology, clinical manifestations, evaluation, and treatment of various cardiovascular disorders. It focuses on diseases of the veins and arteries, disorders of the heart wall, heart disease, and shock.

Chapter 25, “Alterations of Cardiovascular Function in Children”

This chapter examines cardiovascular disorders that affect children. It distinguishes congenital heart disease from acquired cardiovascular disorders.

** Hammer, G. G. , & McPhee, S. (2014). Pathophysiology of disease: An introduction to clinical medicine. (7th ed.) New York, NY: McGraw-Hill Education.

Chapter 11, “Cardiovascular Disorders: Vascular Disease”

This chapter begins with an overview of the vascular component of the cardiovascular system and how the cardiovascular system is normally regulated. It then describes three common vascular disorders: atherosclerosis, hypertension, and shock.

**American Heart Association. (2012). Retrieved from http://www.heart.org/HEARTORG/

**Million Hearts. (2012). Retrieved from http://millionhearts.hhs.gov/index.html

**National Heart, Lung, and Blood Institute. (2012). Retrieved from http://www.nhlbi.nih.gov/

Instructor Requirements

As advanced practice nurses, we are scholars, nurse researchers and scientists. As such, please use Peer-Reviewed scholarly articles and websites designed for health professionals (not designed for patients) for your references. Students should be using the original citation in Up to Date and go to that literature as a reference. The following are examples (not all inclusive) of resources/websites deemed inadmissible for scholarly reference:

1. Up to Date (must use original articles from Up to Date as a resource)

2. Wikipedia

3. Cdc.gov- non healthcare professionals section

4. Webmd.com

5. Mayoclinic.com

– This work should have Introduction and Conclusion

– It should have at least 3 current references

– APA format

– At least 2 pages, references page not included

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