ADN 106 exam 3: topic: Allergic disorders

Type II: Cytotoxic Reactions

Cytotoxic= cell death Involves binding either the IgG or IgM antibody to a cell bound antigen, may lead to eventual cell and tissue damage. The reaction is the result of mistaken identity when the system identifies a normal constituent of the body as foreign and activated the complement cascade. Examples include: myasthenia gravis, goodpasture syndrome, pernicious anemia, hemolytic disease of the newborn, TRANSFUSION REACTIONS, and thrombocytopenia.

A client presents to the clinic with reports of itching and hives after taking an aspirin this morning. What medication does the nurse anticipate administering that blocks histamine receptors?

Diphenhydramine

Allergic Rhinitis

Hay Fever, Seasonal allergic rhinitis -A common respiratory allergy presumed to be mediated by a type I hypersensitivity. -Affects 12% of adults Major Symptoms: serous nasal discharge, nasal congestion, sneezing, nose and throat itching. Can affect quality of life, sleep disturbance, impairment of daily activities, and missed school and work. Can take Claritin, Cetirizine, etc

Assessment of patient with allergic rhinitis

Health history includes personal and family history. -Allergy assessment -Subjective data includes symptoms and how the patient feels before symptoms become obvious. -Note relationship between symptoms and seasonal changes, emotion problems, or stress. -Identify nature of antigens, seasonal changes in symptoms, and medication history.

Cell mediator related to allergies

Histamine

Benadryl (Diphenhydramine)

Histamine Blocker, used for not so severe reactions like hives, itching, etc. May cause drowsiness, dry mouth

Assessment of patients with allergic disorders

History and manifestations; comprehensive allergy history

Other common causes of anaphylaxis include

Insect stings (bees, wasps, yellow jackets, ants) Latex: medical and nonmedical products containing latex Animal serums

Patient Teachings for allergic rhinitis

Instruction to minimize allergens, use of medications, importance of keeping appointments, Desensitization procedures.

Nonatopic reactions

Lack Genetic Component, Latex

Allergic Reaction

Manifestation of tissue injury resulting from interaction between an antigen and an antibody. Body encounters allergens that are types of antigens. Bodys defenses recognize antigens as foreign. Series of events occurs in attempt to render the invaders harmless, destroy them and remove them from the body.

Nursing Interventions to improve breathing with allergic rhinitis

Modify the environment to reduce allergens, reduce exposure to people with URI's, take deep breaths and cough frequently.

Type IV: Delayed or Cellular Reaction

Occurs 1 to 3 days after exposure to an antigen. The reaction, which results in tissue damage, involves activity by lymphokines, macrophages, and lysozymes. Erythema and itching are common; a few examples include contact dermatitis, graft versus host disease, Hashimoto's thyroiditis, and sarcoidosis.

Common food causes of anaphylaxis

Peanuts, Tree nuts(walnuts, cashews, almonds), Shellfish(Shrimp,lobster, crab), fish, milk, eggs, soy, wheat

Prevention/Management of Anaphylaxis

Screen and prevent. Treat Respiratory problems, oxygen, intubation, cardiopulmonary resuscitation as needed. Epinephrine: 1:1000 subcutaneously Epipen: auto-injection system May follow with IV epinephrine. IV Fluids

A client is receiving immunotherapy as part of the treatment plan for an allergic disorder. After administering the therapy, the client states "I guess i can go home now", Which response by the nurse would be most appropriate?

"You need to stay about another half-hour so we can make sure you don't have a reaction."

Anaphylaxis

-Mild, moderate and severe systemic reactions. -Symptoms are sudden in onset and progress in severity over minutes to hours. Symptoms: Flushing, Urticaria, angioedema, hypotension, bronchoconstriction Most Common cause: antibiotics, penicillin

Medications used to treat allergic reactions

-Oxygen: if respiratory assistance is needed -Epinephrine: used for anaphylactic reactions -Histamines -Corticosteroids

Goals for patients with Allergic Rhinitis

-Restoration of normal breathing pattern -Increased knowledge about the causes and control of allergic symptoms -Improved coping with alterations and modifications -absence of complications

The nurse is talking with a client who was stung by a bee and began having difficulty breathing. What serious complication from injected venom should the nurse discuss with the patient?

Airway obstruction

Latex Allergy

Allergic reaction to natural rubber proteins. Implicated in rhinitis, conjunctivitis, contact dermatitis, urticarial, asthma, anaphylaxis. Prevalence has been decreasing due to the use of non latex gloves.

IgE

Allergy

Epinephrine is given

Always given IM. typically in the thigh.

A patient has been diagnosed with an allergy to peanuts. What is a priority for this patient to carry at all times?

An Epipen

Allergy

An inappropriate, often harmful response of the immune system to normally harmless substances. Hypersensitive reaction to an allergen initiated by immunologic mechanisms that is usually mediated by IgE antibodies

Potential complications/problems of allergic rhinits

Anaphylaxis, impaired breathing and nonadherence to therapeutic regimen.

Common medication causes of anaphylaxis

Antibiotics (penicillin and sulfa drugs, allopurinol, radiocontrast agents, anesthetic agents(lidocaine, procaine), vaccines, hormones(Insulin, vasopressin, adrenocorticotropic hormone), aspirin and NSAIDS.

The nurse is interviewing a client being admitted to the hospital and inquired about any allergies the client has. The client states being allergic to aspirin and penicillin. What intervention should the nurse provide immediately to prevent complications related to allergies?

Apply an allergy bracelet and flag the chart

T Lymphocytes

Assist B cells, secrete substances that destroy target cells and stimulate macrophages, digest antigens and remove debris.

Atopic Reactions

Asthma, allergic rhinitis, atopic dermatitis, Familial

Two types of Reactions

Atopic, and Nonatopic

Graft Versus Host Disease

Body rejects skin graft, causes tissue death

Diagnostic Tests for Allergic Disorders

CBC-eosinophil count Total Serum IgE Skin tests: prick, scratch and intradermal Monitor patients for at least 30 minutes after skin tests

Type I: Anaphylactic Reaction

Characterized by vasodilation, increased capillary permeability, smooth muscle contraction and eosinophilia. Examples include: extrinsic asthma, allergic rhinitis, systemic anaphylaxis and reactions to insect stings.

Other Allergic Disorders

Contact Dermatitis, Atopic Dermatitis, drug reactions (Dermatitis medicamentosa), Urticaria and angioneurotic edema, hereditary angioedema and cold urticaria, food allergies (Peanuts is most common), latex allergies.

Types of Hypersensitivity reactions

Type I: Anaphylactic, most severe Type II: Cytotoxic Type III: Immune Complex Type IV: Delayed

Hypersensitivity

abnormal heightened reaction to a stimulus of any kind

Cetirizine (zyrtec)

antihistamine, may experience dry nasal mucosa, thickening of bronchial secretions

Loratadine (Claritin)

antihistamine, may experience headache, edema

Histamine (preformed in mast cells)

causes Vasodilation, smooth muscle contraction, increased vascular permeability and increased mucus secretions.

Type III: Immune complex Reaction

marked by acute inflammation resulting from formation and deposition of immune complexes. The joints and kidneys are particularly susceptible to this kind of reaction, which is associated with systemic lupus erythematosus, serum sickness, nephritis, and rheumatoid arthritis.

Irritant contact dermatitis

occurs when irritating substances temporarily damage the epidermis. Diagnostic testing: clinical picture, and appropriate negative patch tests Treatment: corticosteroids, antibiotics and antihistamines

B lymphocytes

programmed to produce one specific antibody, stimulates production of plasma cells, antibody production, results in outpouring of antibodies

Atopy

refers to IgE-mediated diseases, such as allergic rhinitis, that have a genetic component

Allergic Contact Dermatitis

results from contact of skin and allergenic substance, has a sensitization period of 10 to 14 days. Diagnostic testing: Patch testing Treatment: corticosteroids, and oral antihistamines

Allergen

the substance that causes the allergic response