chapter 38
Atopic Dermatitis (eczema)
A type I immediate hypersensitivity disorder characterized by inflammation and hyperreactivity of the skin, often causing pruritus. Pruritus and hyperirritability of the skin are the most consistent features
Contact Dermatitis
A type IV delayed hypersensitivity reaction, Skin inflammation that results from direct skin contact with chemicals or allergens
Four types of contact dermatitis
Allergic, irritant, phototoxic, and photoallergic
Hypersensitivity
An amplified or inappropriate response to an antigen leading to inflammation and destruction of healthy tissue which may result from genetic, hormonal, and environmental factors
Serum Sickness
An immune-complex type III hypersensitivity Traditionally caused by the administration of therapeutic antisera of animal sources for the treatment or prevention of infectious diseases (vaccines)
manifestations and tx of serum sickness
Manifestations begin 6 to 10 days after administration of the medication, tender and swollen joints, gullian barre syndrome (temporary paralysis of upper extrimeites) Treated symptomatically, anithistamines, corticoidsteriods, and may need respiratory support
Allergic Rhinitis
The most common chronic respiratory allergic disease mediated by an immediate (type I hypersensitivity) reaction
Nursing care for Atopic Dermatitis
address body image, self-management, and coping
monitoring the pt with anaphylaxis
airway, breathing, and other vital signs
the severity of anaphylaxis depends on the degree of allergy and the dose of the _____
allergen
photoallergic Contact Dermatitis
allergic contact plus sun exposure to produce response
Immunotherapy indications
allergy desensitization
____ is a clincal response to an immediate (type I) hypersensitivity immunologic rxn b/n a specific antigen and antibody
anaphylaxis
in ____ therapy every attempt is made to remove the allergens that act as precipitating factors
avoidance
_____ dermatitis is an acute or chronic skin inflammation that results from direct skin contact with chemicals or allergens
contact
The most frequent source of exposure to latex is _____
cutaneous, which usually involves the wearing of natural latex gloves
Management of anaphylaxis
depends on the severity of the reactions: epinephirine can be admin sub Q and then IV and can be pushed down endotrach tube, antihistamins and corticoidsteriods to treat urticaria and angioedma. IVF, voulme expanders and vasopressor agents admin to maintian bp and hemo status.
People at risk for latex risk
health care workers, patients with atopic allergies or multiple surgeries, people working in factories that manufacture latex products, females, and patients with spina bifida
_____ involves the admin of gradually increasing quantities of specific allergens to the pt until a dose is reached that is effective in reducing disease severity from natural exposure
immunotherapy
Treatment of Atopic Dermatitis
includes avoidance therapy (use mild soaps and perfumes, humidify the air, corticosteroids, skin care (keep it moisturized), and antihistamines
Angioneurotic edema
involves the deeper layers of the skin, resulting in more diffuse swelling
3 different types of reactions to latex
irrtant, and allergic contact dermatitis and latex allergy
Symptoms of Contact Dermatitis include
itching, burning, erythema, skin lesions (vesicles), and edema
Immunotherapy contriindications
nonadherance, cant do with all things, cant have pulmonary or cardio disease, need to monitor for 30 min, need rescue equipment nearby
Adrenergic agents
pseudophedrine helps relieve symtpoms by narrowing bv in the nasal passageways reacts with bp meds
phototoxic Contact Dermatitis
requires sun and a chemical in combo to damage the epidermis
chain of events for anaphylaxis
response to antigen->release of chemicals mediators->intensified response (release of histamine)->respiratory distress->deterioration (fluid leak in vessels)-> failure of compensatory mechanisms
Allergic Contact Dermatitis
results from contact of skin and allergic substance
irritant Contact Dermatitis
results from contact with a substance that chemically or physically damages the skin on a non-immunologic basis
nursing management for food allergies
teach them avoidance therapy, Patients and family members must know how to recognize and manage the early stages of acute anaphylaxis, teach pt how to read food labels and prep of food
Is the following statement true or false? A patient with phototoxic contact dermatitis will not have a reaction unless he or she experiences sun exposure.
true
the most common used oral adrenergic agent is pseudoephedrine hydrochloride (sudafed)
true
the risk of anaphylaxis is determined by prick and intradermal skin testing
true
clinical manifestations of anaphylaxis
urticaria, profuse watery rhinorrhea, pro-hypotension, stridor, wheezing, and possible cardiac arrhythmia, sense of impending doom or fright
Anaphylaxis
A clinical response to an immediate (type I hypersensitivity) immunologic reaction between a specific antigen and an antibody Occurs when the body's immune system produces antibodies toward a substance that is normally nontoxic
Dermatitis Medicamentosa
(Drug Reactions) A type I hypersensitivity disorder causing skin rashes associated with certain medications and Avoidance (discontinuation) of the offending medication is the priority measure
Urticaria
(hives) is a type I hypersensitive allergic reaction of the skin characterized by the sudden appearance of pinkish, edematous elevations
examples of Antihistamines and s/e
-diphenhydramine (benadryl) s.e: drowsiness -hydroxyzine (atarax) s/e: involuntary motor activity -loratadine (alvert or claritin) s.e: depression -fexofenadine (allegra) s.e: drowsiness
A pt is being seen in the dermatology clinic for urticaria. The nurse would expect which of the following medications to be prescribed for the pt? A. Sudafed B. Benadryl C. Decadron D. NasalCrom
B. Benadryl
Which of the following is the most frequent source of exposure for a latex allergy? A. latex condoms B. IV lines C. hemodialysis equipment D. latex gloves
D. latex gloves
Which of the following reactions would be consistent with a mild reaction to an allergen? A. bronchospasm B. warmth C. periorbital swelling D. throat tingling
D. throat tingling
Allergic Rhinitis Management Avoidance therapy:
Every attempt is made to remove the allergens that act as precipitating factors
Medication therapy for Food Allergies
H1-blockers, antihistamines, adrenergic agents, corticosteroids, and cromolyn sodium
Food Allergy
Results in allergic symptoms and gastrointestinal symptoms
seasonsal occurances induces what certain airborne pollunants
early spring: tree pollen and mold spores early summer: rose pollen and grass pollen early fall: weed pollen and mold spores
if avoidance is impossible what should pt carry at all times?
epi pen
Is the following statement true or false? A nurse who has a latex allergy should be advised to avoid wearing gloves while providing care.
false
systemic symptoms occur with contact dermatitis
false
antihistamines prevent the release of histamine and protect surrounding tissue from the effects of the histamine release
false, dont prevent but do protect
the primary goal in serum sickness therapy is to treat the clinical syndrome prophylatically
false, symptomatically
Substances that most commonly cause anaphylaxis
foods, medications, insect stings, and latex
Latex Allergy
The allergic reaction to natural rubber proteins
Products containing natural rubber latex
ace bandage, band-aid, bp cuff, catheters, pulse ox, tourniquets
Corticosteroids
intranasally: decadron, flonase and nasocort
A patient has been brought to the emergency department in apparent anaphylaxis. The priority aspect of care is: A. Ensuring a patent airway B. Managing the patient's anxiety C. Assessing the patient's circulatory status D. Preventing complications of anaphylaxis
A. Ensuring a patent airway
When reviewing the chart of a pt diagnosed with allergic rhinitis, the nurse understands that this allergic disorder is caused by which type of hypersensitivity reaction? A. Type I B. Type II C. Type III D. Type IV
A. Type I
clincal manifestations of allergic rhinitis
Accompanied by sneezing and nasal congestion; clear, watery nasal discharge; itchy eyes and nose; and lacrimation (tears)
Allergic Rhinitis pharm Management
Antihistamines Adrenergic agents Corticosteroids
What teaching point should the nurse prioritize when providing health education to the family of a child with a newly diagnosed food allergy? A. Managing the GI symptoms of a food allergy B. Strategies for avoiding the offending food C. Techniques for ensuring adequate nutrition
B. Strategies for avoiding the offending food
During a clinical postconference, the instructor is discussing factors r/t the risk of anaphylaxis. Which of the following statements make by the instructor would be inconsistent with the risk of anaphylaxis? A. the severity depends on the degree of allergy B. the severity of previous reactions determines the severity of subsequent reactions C. the severity depends on the dose of the allergen D. the severity of previous reactions does not determine the severity of subsequent reactions
B. the severity of previous reactions determines the severity of subsequent reactions