A propósito de un caso: intervenciones enfermeras a una paciente con shock anafiláctico en la UCI

espanolIntroduccion y objetivos Se presenta el plan de cuidados de una senora de 42anos con shock anafilactico secundario a la ingesta de amoxiclavulanico, con compromiso de la via aerea superior por angioedema de laringe. Previamente tuvo 2 episodios de angioedema. La incidencia de este fenomeno oscila entre 3,2 y 10casos/100.000 personas/ano. Observacion clinica Se realizo una valoracion donde destacaron tres necesidades alteradas: respiracion y circulacion (preciso ventilacion mecanica invasiva y perfusion de noradrenalina), eliminacion (requirio furosemida para mantener diuresis horarias aceptables) e higiene y proteccion de la piel (presento hiperemia generalizada, edema labial, lingual y orofaringeo). El Comite de Etica de Investigacion Clinica del Hospital solicito el consentimiento informado de la paciente para el acceso a la historia clinica. Intervenciones De acuerdo con las necesidades destacadas, se priorizaron siete diagnosticos segun la taxonomia NANDA: riesgo de respuesta alergica, riesgo de infeccion, riesgo de perfusion renal ineficaz, disminucion del gasto cardiaco, deterioro de la ventilacion espontanea, riesgo de nivel de glucemia inestable y riesgo de motilidad gastrointestinal disfuncional. Discusion y conclusiones Los criterios de resultados evidenciaron una evolucion favorable pasadas 24h. El desarrollo del lenguaje estandarizado NANDA-NOC-NIC en el caso clinico presentado nos permitio organizar metodologicamente el trabajo enfermero, facilitando el registro y normalizando la practica. Como limitacion, no se dispuso de niveles plasmaticos de histamina y triptasa para valorar la evolucion del cuadro anafilactico. Destacar la importancia de la educacion sanitaria en una paciente con antecedentes de angioedema. EnglishIntroduction and objectives The care plan of a 42-year-old woman with anaphylactic shock, secondary to ingestion of amoxicillin/clavulanic acid, with upper airway involvement due to laryngeal angioedema, is presented. Previously she had had two episodes of angioedema of unknown origin. The incidence of this phenomenon is between 3.2 and 10 cases/100,000 people/year. Clinical observation An evaluation was made and three altered necessities stood out: breathing and circulation (she needed mechanical ventilation and noradrenalin perfusion), elimination (she required furosemide to keep an acceptable diuresis time), and hygiene and skin protection (she presented generalised hyperaemia, lip, lingual and oropharyngeal oedema). The hospital's Clinical Research Ethics Committee requested the patient's informed consent to access her clinical history. Interventions According to the altered necessities, seven diagnoses were prioritised according to NANDA taxonomy: risk of allergic response, risk of infection, risk of ineffective renal perfusion, decreased cardiac output, impaired spontaneous ventilation, risk of unstable blood glucose level, and risk of dysfunctional gastrointestinal motility. Discussion and conclusions Scores of outcome criteria showed a favourable evolution after 24hours. The development of a standardised NANDA-NOC-NIC language in the clinical case presented allowed us to organise the nursing work, facilitating recording and normalising clinical practice. As a limitation of this case, we didn’t have serial plasma levels of histamine and tryptase to assess the evolution of anaphylactic symptoms. Highlight the importance of health education in a patient with a history of angioedema.