pn 104, chapter 33: Assessment and Management of Patients with Allergic Disorders

A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder?

For their immunosuppressant effects Explanation: Drug therapy using anti-inflammatory and immunosuppressive agents is the mainstay for alleviating symptoms. Some antineoplastic (cancer) drugs also are used for their immunosuppressant effects. Antineoplastic drugs do not decrease the body's risk of infection; an autoimmune disease is not a neoplastic disease. Drugs are not ordered just so the client has strong drug therapy.

The nurse is teaching a client about a recent order for loratadine to help with seasonal allergies. What client statements indicate no further teaching is required? Select all that apply.

"Taking my medication on an empty stomach is a must." "Drinking two or three alcoholic drinks a week is okay." "Sucking on ice chips will help if my mouth is dry." "Being careful driving is important after taking the medication." "It is recommended that I buy a humidifier for my bedroom." Explanation: Client education includes instructing the client to take the medication on an empty stomach to prevent food from interfering with absorption. Avoid alcohol because the medication can cause increased drowsiness. A side effect is dry mouth, and sucking on ice chips will help. Being careful when driving is important because the medication can cause drowsiness. Using a humidifier will help decrease the negative symptoms associated with humidity.

A client with a history of anaphylactic reactions to insect stings has just been stung by a wasp. Place the steps in the correct order that the client will follow for self-administration of an EpiPen. Use all options.

Remove the gray safety-release cap Inject the black tip into the outer thigh Massage the injection area Call the emergency medical response number (911) Explanation: When using an EpiPen, the client removes it from the carrying tube, grasps the unit with the black tip pointed downward, forms a fist around the unit, and removes the gray safety-release cap. Then the client holds the black tip near the outer thigh and swings and injects it firmly into the outer thigh until hearing a click with the device perpendicular to the thigh. Next, the client holds the device firmly against the thigh for about 10 seconds, then removes it and massages the area for 10 seconds. Lastly, the client or another person calls 911 and seeks emergency medical attention.

The nurse is planning care for a client with atopic dermatitis. Which information will the nurse include when teaching the client self-care for the condition? Select all that apply.

Use a mild soap when bathing. Wear clothing made of cotton. Take antihistamines early in the day. Crusting of lesions is a sign of healing. Apply a skin cream that contains glycerol. Correct response: Atopic dermatitis is a type I immediate hypersensitivity disorder involving IgE antibodies that causes dry, pruritic, hypersensitive skin. It often begins with small, red, pruritic papules that stimulate intense itching, leaving erythematous, excoriated areas of skin. This often triggers an "itch-scratch cycle" where rubbing or scratching the skin causes further irritation, redness, and skin breakdown. Treatment of clients with atopic dermatitis involves avoidance of irritative agents, use of anti-inflammatory topical agents, and moisturization of the skin. The client should be advised to use mild soap when bathing and to wear clothing made of cotton. Thick cream moisturizers and emollients that contain glycerol should be used as these will keep the skin hydrated. Antihistamines may be used however should be taken at bedtime because they are sedating. The presence of purulence or honey-colored crusts suggests S. aureus infection and antibiotics are needed to eradicate infection.

The nurse is educating a client about allergy management at home. What client statements indicate no further teaching is required? Select all that apply.

"I have pull shades on all of my windows." "I bought a wooden chair for my living room." "I picked out a new tufted bedspread for my bed." "I will vacuum my floors once a week." "I only let my dog sleep with me every other day." Explanation: Using pull shades on windows and using steam for heating will help reduce environmental allergens such as dust. Rugs on floors will hold allergens in and floors need to be vacuumed every day. Dogs may bring allergens into the client's home, especially when in close proximity while sleeping.

The nurse is teaching a client after a medication allergic reaction has occurred. What is the most important action for the nurse to teach the client to take to prevent anaphylaxis?

Avoid potential allergens. Explanation: Strict avoidance of potential allergens is the most important preventive measure for the patient at risk for anaphylaxis. People who have experienced food, medication, idiopathic, or exercise-induced anaphylactic reactions should always carry an emergency kit containing epinephrine for injection to prevent the onset of the reaction upon exposure, but avoiding potential allergens is more important. Desensitization, based on controlled anaphylaxis with a gradual release of mediators, is an effective treatment option, but it is more important to avoid allergic triggers. The medical alert bracelet will assist those rendering aid to the patient who has experienced an anaphylactic reaction, but it's better to avoid the reaction in the first place.

The client presents to the emergency department with a suspected allergic reaction to the antibiotic they were given at the quick care clinic to treat their pneumonia. What are the priority actions the nurse should take? Select all that apply.

Evaluate for hypertension. Insert an intravenous line. Administer Vitamin K. Take vital signs. Place oxygen on the client. Check for diplopia. Explanation: Hypertension is seen in clients with cardiac and stroke. The nurse would see hypotension caused by dilation of blood vessels. Inserting an intravenous line should be done in case the client needs to be given medications or fluids. Vitamin K is administered to reverse the effects of Coumadin, not for an allergic reaction. Taking vital signs is important to determine if they are normal or require treatment. Placing oxygen on a client will help relieve dyspnea caused by constriction of airways, and swollen tongue and throat. Diplopia would be seen in clients with muscular disorders, neurological disorders, and migraines.

After teaching a client how to self-administer epinephrine, the nurse determines that the teaching plan has been successful when the client demonstrates which action?

Jabs the autoinjector into the outer thigh at a 90-degree angle Explanation: To self-administer epinephrine, the client should remove the autoinjector from its carrying tube, grasp the unit with the black tip (injecting end) pointed downward, form a fist around the device, and remove the gray safety release cap. Then the client should hold the black tip near the outer thigh and swing and jab firmly into the outer thigh at a 90-degree angle until a click is heard. Next, the client should hold the device firmly in place for about 10 seconds, remove the device, and massage the site for about 10 seconds.

Which intervention is the single most important aspect for the client at risk for anaphylaxis?

Prevention Explanation: Prevention involves strict avoidance of potential allergens for the individual at risk for anaphylaxis. If avoidance of or exposure to allergens is impossible then the individual should be prepared with an emergency kit containing epinephrine for injection to prevent the onset of the reaction upon exposure. While helpful, there must be no lapses in desensitization therapy because this may lead to the reappearance of an allergic reaction when the medication is reinstituted. A medical alert bracelet will assist those rendering aid to a client who has experienced an anaphylactic reaction. antihistamines may not be effective in preventing anaphylaxis.

A patient with a history of allergies comes to the clinic for an evaluation. The following laboratory test findings are recorded in a patient's medical record:Total serum IgE levels: 2.8 mg/mLWhite blood cell count: 5,100/cu mmEosinophil count: 4%Erythrocyte sedimentation rate: 20 mm/hThe nurse identifies which result as suggesting an allergic reaction?

Serum IgE level Explanation: Normally, serum IgE levels are below 1.0 mg/mL. The patient's level is significantly elevated suggesting allergic reaction. The other values are within normal parameters.

A client has begun sensitivity testing to determine the allergen which caused an anaphylactic reaction 3 weeks ago. In scratch testing, which part of the body is more sensitive to allergens?

back Explanation: The scratch or prick test involves scratching the skin and applying a small amount of the liquid test antigen to the scratch. The tester applies one allergen per scratch over the client's forearm, upper arm, or back. The back is more sensitive than the arms.