Allergic Response RCC

Systemic anaphylaxis

*Uticaria, angioedema, flushing, wheezing, mucous production, nausea, and vomiting, feelings of impending doom. -produces peripheral vasodilation, bronchospasm, and laryngeal edema.

Complications of seasonal or allergic rhinitis

*nasal polyps *sinus infections *pulmonary infections *asthma

Wheal

A small, burning or itching swelling on the skin, as from a mosquito bite or from hives.

Treatment for systemic anaphylaxis

Airway support, oxygen, antihistamines, and epinephrine (to support blood pressure and treat bronchospasms)

In a client with an allergy, which of the following findings are likely to be evident when the nurse assesses the pharynx? Select all that apply. a. Rashes or lesions b. Red tonsils c. Excess secretion of lymph d. Production of antibodies e. Mucoid drainage

b, e Rationale-nurse inspects the pharynx for red tonsils and increased production of mucoid drainage.

Treatment for local anaphylaxis

Mild antihistamines (block histamines H1 and H2 receotirs) found in the respiratory and GI tract

Contactants

Plant oils, topical medications, occupational chemicals, cosmetics, metals in jewelry and clothing fasteners, hair dyes, latex.

Anaphylaxis

Rapid and profound allergic response characterized by shock, laryngeal edema, wheezing, stridor, tachycardia, and generalized itching.

Hypersensitivity

*An abnormal sensitivity to a stimulus of any kind. *Activation of a given agent such as pollen or foreign protein.

Mechanisem of an immediate acute hypersensitivity response

*Antigen (allergen) invades the body *Plasma cells produce large amounts of IgE antibodies against the allergen *IgE antibodies attach to mast cells in body tissues *More allergen enters the body *Allergen binding to the IgE on mast cells triggers release of histamine and other chemicals *Histamines causes blood vessels to dilate and become leaky, promoting edema, stimulates release of large amounts of mucous and causes smoothe muscle to contract

Allergens Causing Anaphylactic shock

*Drugs *Insect venom *Animal serums (antitoxin) *Foods *Treatment measures. exp. Whole blood and components, intravenous pyelogram

Local anaphylaxis

*Hay fever, hives, and allergic gastroenteritis -E (IgE) bound to mast cells. These mast cells release packets containing chemical mediators that attract neutrophils and eosinophils-> stimulate uticaria, vasodilation, increased vascular permeability, and smooth muscle spasm (GI tract and bronchi)

Patient care for allergies

*Prevention: History of allergic reactions *Teach client to wear tags identifying allergies to medication, food, insect venom. *Teach those who have had an anaphylactic reaction to carry a kit with epinephrine and how to administer it.

Which organs and structures are primarily involved in allergic reactions?

*Skin *Respiratory passageways *GI tract *Blood *Vascular system

T or F Desensitization is an immunotherapy in which a client receives a single injection of dilute concentration of an allergen

False Rationale-desensitization is an immunotherapy in which a person receives weekly or twice-weekly injections of dilute but increasingly higher concentrations of an allergen without interruption.

Ingestants

Food, drugs. Esp. penicillin

Urticaria

Hives. Raised, irregularly shaped skin eruptions with varying sizes and shapes; eruptions have reddened margins and pale centers.

Inhalants

House dust and mites, insect excrement, animal products(dander, saliva, urine), pollens, spores.

Immediate Hypersensitivity response Type III

Immune complex, which is mediated by IgG antibodies. Responses reach a peak within 6 hours after exposure to an allergen.

90% of food allergies are from

Proteins in milk, egg whites, peanuts, wheat, and soy beans. Other common allergens are fish, shellfish, nuts, corn, and strawberries.

Rash

Small, raised vesicles that are usually reddened; often distributed over the entire body.

Allergic rhinitis

Sneezing, itching, nasal congestion, watery nasal discharge, itching, and redness of the eyes.

Skin test

Specific allergens can be identified by skin testing 3 types: *Scratch or prick test *Patch test *Intradermal injection test

Delayed Hypersensitivity response or Hypersensitivity response Type IV

This is a delayed hypersensitivity response may develop over several hours or days, or it may reach maximum severity after repeated exposure. Exp. blood transfusion reaction, rejection of transplanted tissues, and reaction to a TB skin test.

Antihistamines

Block histamine (H1) receptors. Examples-Benedryl, Atarax, Allegra, Hismanal, Claritin, and Zyrtec

Tyler Harris, a 5-year-old male, is a client in the pediatric unit of the hospital. Tyler is recovering from an anaphylactic reaction to an allergen which brought him to the ED. His mother is quite concerned with the potential reoccurrence of Tyler's reaction. In your discussion with Mrs. Harris, what is one stately she can use to narrow down the possible allergen? Clinical manifestations generally correlate with: a. route of exposure b. respiratory symptoms c. systemic effects d. skin reactions

a. Clinical manifestations generally correlate with route of exposure. Rationale-clinical manifestations generally correlate with the manner in which the allergen enters the body. For example, inhaled allergens usually cause respiratory symptoms, including nasal congestion, runny nose, sneezing, coughing, dyspnea, and wheezing. Inhaled allergens often trigger asthma.

Julie Sexton, a 42-year-old colleague of yours at the hospital, has developed a latex allergy and now uses the pretty purple gloves to avoid a hypersensitivity response. What in Julie's reaction to latex differs from all other types of hypersensitivity responses? a. No antibody production b. Reaction occurs within minutes c. Reaction occurs within 6 hours d. Antibody production

a. No antibody production Rationale-antibody production is not a component of a delayed hypersensitivity response.

A client who is symptomatic after having been stung by a bee is brought to the emergency department. Which of the following is the initial priority nursing assessment? a. Respiratory status b. Level of consciousness c. Heart rate d. Urinary output

a. Respiratory status Rationale-can deteriorate quickly to the point that the client requires immediate intubation.

In its attempt to suppress allergic responses, the body releases several chemicals which have a role in mediating physical reactions. Epinephrine, which interferes with vasoactive chemical release from mast cells, is instrumental in suppressing which type of hypersensitivity response? a. Type I b. Type II c. Type III d. Type IV

a. Type I Rationale- Epinephrine interferes with the release of vasoactive chemicals from mast cells which cause vasodilation during anaphylaxis.

Tyler is recovering from an anaphylactic reaction to an allergen which brought him to the ED. In your first assessment of Tyler, he presents with a peri orbital accumulation of blood, a common occurrence in children. What type of allergic reaction presents "allergic shiners"? a. Type I b. Type II c. Type III d. Type IV

a. Type I Rationale-Less severe localized hypersensitivity responses can include areas under the eyes, referred to as "allergic shiners," which are due to accumulation of blood around the orbit of the eye.

Rudy Foster, a 25-year-old medical student, is visiting the university health center where you practice nursing. He has developed an allergic response to an unknown allergen and is seeking answers to his questions. Which body structures are primarily involved in allergic reactions? Select all that apply. a. Live b. Eyes c. GI tract d. Skin

c, d

Loren Fawcett, an 18-year-old college student, arrived at your ED presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. After stabilizing Loren, you speak with her family and assure them that she will recover. In your nursing management, what was of primary importance in Loren's care upon her admission? a. Inducing vomiting to rid body of allergen b. No options are correct c. Maintaining airway d. Encourage fluids to dilute allergen

c. Maintaing airway Rationale-anaphylaxis is a rapid, profound hypersensitivity response. A massive release of histamine causes vasodilation; increased capillary permeability; angioneurotic edema (acute swelling of the face, neck, lips, larynx, hands, feet, genitals, and internal organs); hypotension; and bronchoconstriction. In an emergency, the primary focus of care is maintaining the airway.

Rudy Foster, a 25-year-old medical student, is visiting the university health center where you practice nursing. He has developed an allergic response to an unknown allergen and is seeking answers to his questions. How can his allergic response manifest? a. Temporary reaction b. Life-threatening reaction c. Localized reaction d. All options are correct

d. All options are correct Rationale-an allergic disorder is manifested in a variety of ways depending on the manner in which the allergen gains entry to the body and the intensity of the response. Some types of allergic manifestations cause temporary, localized discomfort, whereas others are life-threatening.

Grace Walters, a 73-year-old female, is a client on the surgical floor. She is returning from surgical hip repair and has an adhesive patch covering her incision. She has a history of an allergic disorder. Which of the following nursing actions is important when assessing the dressing site of Mrs. Walters? a. Apply pressure to ensure that the patch is firmly in place. b. Ensure that Mrs. Walters is lying down in a comfortable position. c. Though it is important to ensure that the client is comfortable and the patch is firmly in place, it is not as essential as observing for an allergic reaction. Applying moisturizer to the site may interfere with the results of the patch test. d. Apply moisturizer to the site before sticking the patch e. Observe Mrs. Walters for signs of allergic reaction

e. Observe Mrs. Walters for signs of allergic reaction. Rationale-Throughout Mrs. Walters' care, you should observe for signs of allergic reaction. You should be especially alert when administering medicines, applying tapes or adhesive patches on the skin, or administering contrast media for diagnostic testing.

Allergens

Antigen that can cause an allergic response.

Patch test

Application of a concentrated form of the substance to the skin and covers with a patch. After 48 hours, the patch is removed and examined for erythema, edema, and vesicles. The back is more sensitive than the arms.

Immediate Hypersensitivity response Type I

Atopic or anaphylactic, which is mediated by IgE antibodies. Responses occur in minutes. Most severe.

Immediate Hypersensitivity response Type II

Cytotoxic, which is mediated by IgM or IgG antibodies. Responses occur in minutes.

Allergic disorder

Disorder characterized by a hyperimmune response to weak antigens that are usually harmless.

Injectants

Drugs, bee venom.

Desensitization

Form of immunotherapy in which a client receives weekly or twice weekly injections of dilute but increasingly higher concentrations of an allergen without interruption.

Pruritis

Itching skin; accompanies most rashes.

Contact dermatitis

Itching, burning, redness, rash on contact with substance.

Angioedema

Itching, swelling, redness of deeper tissues and mucous membranes.

Food allergy vs. food intolerance

Produces similar symptoms but food intolerance does not have an immune response.

Immunoglobulin

Proteins produced by B lymphocyte plasma cells that bind with antigens and promote the destruction of invading cells; also known as antibodies.

Scratch or prick test

Scratching the skin and applying a drop of antigen to the scratch. After 20 minutes, if a raised wheal and localized erythema appears, the patient is allergic to the antigen.

Intradermal injection test

Usually performed when a scratch test is negative for allergies. A dilute solution of an antigen is injected intradermally. A positive reaction is based on the wheal size and erythema.

Sara Roxbury, a 22-year-old graduate student is undergoing sensitivity testing to define the allergen which is causing her so much difficulty. In your client education before the procedure begins, you indicate the various routes in which an allergen can be introduced. Which of the following is an allergen introduction route? a. Injection b. All options are correct c. Inhalation d. Ingestion

b. All options are correct

Tyler Harris, a 5-year-old male, has recovered from an anaphylactic reaction which brought him to the ED three weeks ago. Tyler has begun sensitivity testing to determine the allergen which caused his anaphylactic reaction. In scratch testing, which part of the body is more sensitive to allergens? a. Upper arm b. Back c. Chest d. Forearm

b. Back The back is more sensitive than the arms.

A male client is prescribed antihistamines. He asks the nurse about antihistamines administration and its adverse effects. What advice should the nurse offer the client? a. Avoid applying skin moisturizers b. Avoid seafood c. Avoid exposure to sunlight d. Avoid alcohol

d. Avoid alcohol Rationale-The nurse should advise a client taking antihistamines to not take it with alcohol or other central nervous system depressants because additive sedative effects can occur.

Allergic shiners

Dark areas under the eyes are due to accumulation of blood around the orbit of the eye.

Food allergy

Nausea, vomiting, diarrhea, abdominal cramping, malaise, itching, wheezing, rash, cough.

Dermatitis medicamentosa

Sudden generalized bright red rash, itching, fever, malaise, headache, and arthralgias.

Loren Fawcett, an 18-year-old college student, arrived at your ED presenting an anaphylactic response to unknowingly ingesting nuts at a family celebration. After stabilizing Loren, you speak with her family and assure them that she will recover. Why type of hypersensitivity did Loren exhibit? a. Type II b. Type IV c. Type III d. Type I

d. Type I, is atopic or anaphylactic, which is mediated by immunoglobulin E (IgE) antibodies