NRS 410 Discuss what symptoms are associated with anaphylactic shock and how the nurse differentiates these from other conditions or issues

NRS 410 Discuss what symptoms are associated with anaphylactic shock and how the nurse differentiates these from other conditions or issues

NRS 410 Discuss what symptoms are associated with anaphylactic shock and how the nurse differentiates these from other conditions or issues

Food allergies affect 8% of children in the U.S., with up to two students in every classroom at risk for allergic reactions, including anaphylaxis, and up to 25% of students may experience their first allergic reaction while at school (Kao et al., 2018). Students with food allergies are at high risk of encountering a potential allergen. Meals are a regular part of the school day. Food is part of lesson plans, fundraisers, celebrations and rewards, and other school-wide activities; food allergens may also be in nonfood products used for crafts and science materials (Kao et al., 2018). Other potential allergy triggers can be insects, medications, and latex. Students can present with different symptoms, which can occur within a few minutes to a few hours. Mild symptoms can progress to anaphylaxis quickly; therefore, recognition of the early signs and prompt treatment is critical. Epinephrine is the first-line treatment for anaphylaxis, and proper administration of epinephrine in the vastus lateralis muscle is critical for efficacy; a second dose can be given 5 to 15 minutes later if needed as it is rapidly metabolized (Bingemann et al., 2021). If epinephrine is given, 911 must be called, as even if symptoms improve, there is the possibility of symptom recurrence.

Students with known allergies often carry or have their EpiPen stored with the school nurse. However, with the potential for students to react without previous history, schools must keep stock doses for emergencies. The school nurse has a role in anaphylaxis prevention and preparedness, programming, and policy; they collaborate with students, families, providers, and school personnel to create, implement, and evaluate individualized healthcare plans for students at risk for anaphylaxis (Bingemann et al., 2021). School nurses create an emergency care plan to educate nonmedical school staff on steps to prevent and manage a medical emergency. The school nurses can work on multiple school campuses and are not on-site all the time, so they have a key role in educating nonmedical school staff to recognize s/s of anaphylaxis, administer epinephrine, and activate emergency medical services (Bingemann et al., 2021). Ensuring the school staff knows how to react will save students’ lives.


Bingemann, T. A., Nanda, A., & Russell, A. F. (2021). Pharmacology update: School nurse role and emergency medications for treatment of anaphylaxis. NASN School Nurse36(5), 264–270.×211021902

Kao, L. M., Wang, J., Kagan, O., Russell, A., Mustafa, S., Houdek, D., Smith, B., & Gupta, R. (2018). School nurse perspectives on school policies for food allergy and anaphylaxis. Annals of Allergy, Asthma & Immunology120(3), 304–309.

My child’s school nurse once shared with me about the tragic death of an 11-year-old who died after brushing her teeth with a prescription toothpaste that contained milk protein (Recaldent); the child had a severe milk allergy. Imagine the horror that this family has experienced. I never knew that dental products could contain milk proteins, did you?

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As Twitchell et al (2015) suggest, food allergies are an important public health concern among children in the U.S; they also shared a recent needs assessment among school nurses that indicated that though most nurses identified their baseline knowledge of food allergies as strong or very strong, they were highly interested in increasing their knowledge. Specifically, they had interest in learning how to teach school staff about food allergies and develop food allergy management plans.


Children tend to share their meals or trade items from one another’s lunch boxes. They are innocently unaware of one another’s allergies or intolerances, and this is when problems arise. A school nurse can promote and guide creation of a prevention plan and process and monitor for its implementation. Should prevention become intervention, the school nurse can teach all staff about the signs and symptoms of a serious allergic reaction and who among school personnel are equipped to provide emergency medication. The nurse can review with the allergic student how to use an epinephrine auto-injector by using a “trainer” injector with no needle and no medication. The school nurse can also develop a protocol for obtaining “stock” epinephrine for use on anyone who is demonstrating signs and symptoms of anaphylaxis.




Twichell, S., Wang, K., Robinson, H., Acebal, M., & Sharma, H. (2015). Food allergy knowledge and attitudes among school nurses in an urban public school district. Children2(3), 330–341.

Severe allergic reaction that is rapid in onset is characterized by edema in many tissues, including the larynx, and is

NRS 410 Discuss what symptoms are associated with anaphylactic shock and how the nurse differentiates these from other conditions or issues
NRS 410 Discuss what symptoms are associated with anaphylactic shock and how the nurse differentiates these from other conditions or issues

often accompanied by hypotension, bronchospasm, and cardiovascular collapse in severe cases (Cheever, 2018). This is very dangerous for anyone and should be treated immediately, that’s why its important for a nurse to know how to quickly intervene. The nurse should assess ABCs and vital signs. CPR should be initiated immediately if the student is in cardiac arrest, along with oxygen if they’re wheezing or finding it difficult to breath, and epinephrine injection administered. The person should then be transported to the local ED for observation and monitoring because of risk for “rebound” or delayed reaction 4 to 8 hours after the initial reaction (Cheever, 2018).


Cheever, J.L.H.K. H. (2018). Lippincott coursepoint enhanced for brunner & suddarth’s textbook of medical-surgical nursing (14th Edition). Wolters kluwer health.

Anaphylaxis is defined as a severe life-threatening generalized or systemic hypersensitivity reaction characterized by rapidly developing airway and/or circulation problems. It presents with very different combinations of symptoms and apparently mild signs and can progress to fatal anaphylactic shock unpredictably. The difficulty in recognizing anaphylaxis is due, in part, to the variability of diagnostic criteria, which in turn leads to a delay in administration of appropriate treatment, thus increasing the risk of death.

Alvarez-Perea, A., Tanno, L. K., & Baeza, M. L. (2019). How to manage anaphylaxis in primary care. Clinical and translational allergy7, 45.

Anaphylaxis is a severe allergic reaction that occurs quickly after exposure to the triggers. After exposure to the stimuli and developing the condition, the body’s immune system releases chemicals that narrow the airways, dropping the blood pressure, thus leading to shock(Krčmová & Novosad, 2019). The key symptoms of the condition include a weak pulse, nausea, vomiting, skin rash, dizziness, and difficulty breathing. All these conditions develop suddenly, immediately after the exposure. The condition majorly affects the skin, pulmonary, and cardiovascular systems. Various conditions mimic the symptoms of anaphylaxis. The closest differential diagnosis is Idiopathic urticarial, which originates from an immediate reaction to allergic needs such as food, medications, stings, and chemicals. The body’s immunity responds by causing primary skin rashes and blockage of the breathing system, symptoms that mimic anaphylaxis (DeTurke et al., 2019). Other differential diagnoses include stroke and epileptic seizures for neurological syndromes, asthma for respiratory distress, and Dystonic reactions for the swollen tongue. A nurse can thus establish anaphylaxis due to the rapid attack on the skin, pulmonary system, upper airway, and cardiovascular system, causing upper airway edema, hypotension, skin swelling, seizures, dizziness, and difficulties in breathing, among others.

The symptoms cut across various organs against the other diagnoses associated with a single body system. For example, idiopathic urticarial affects the skin and the breathing system but does not cause hypotension. The other differential diagnoses do not cause sudden skin swelling, thus enabling the nurse to diagnose anaphylaxis. After establishing that a patient has anaphylaxis, the nurse should lie down with legs elevated and perform CPR if the patient is experiencing chronic breathing difficulties. The other step is using an epinephrine autoinjector pressed into the patient’s thighs. According to Mayo Clinic (2021), an epinephrine autoinjector is an effective intervention for anaphylaxis and can help save the patient’s life. After the patient recovers from the exacerbation, the nurse can take them through the treatment process, including medication prescription, education, and monitoring.


DeTurke, S., Reddy, S., Pellegrino, A., & Wilson, J. (2019). Anaphylactic Shock. Clinical Management of Shock: The Science and Art of Physiological Restoration, 7-20.


Krčmová, I., & Novosad, J. (2019). Anaphylactic symptoms and anaphylactic shock. Vnitřní lékařství, 65(2), 149-156.