Chapter 38 Assessment and Management of Patients With Allergic Disorders

A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated?

IgE -Immunoglobulin E (IgE) is involved with an allergic reaction. IgA combines with antigens and activates complement. IgB coats the surface of B lymphocytes. IgG is the principal immunoglobulin formed in response to most infectious agents.

A patient has had a "stuffy nose" and obtained Afrin nasal spray. What education should the nurse provide to the patient in order to prevent "rebound congestion"?

Only use the Afrin for 3 to 4 days once every 12 hours. -Adrenergic agents, which are vasoconstrictors of mucosal vessels, are used topically in nasal (Afrin) and ophthalmic (Alphagan P) formulations in addition to the oral route (pseudoephedrine [Sudafed]) (Karch, 2012). The topical route (drops and sprays) causes fewer side effects than oral administration; however, the use of drops and sprays should be limited to a few days to avoid rebound congestion.

Which of the following allergies is responsible for most severe food allergy reactions?

Peanuts -Peanut and tree nut allergies are responsible for most severe food allergy reactions and resulting highest patient death rate.

The nurse working in the ED is asked to explain allergy testing to a patient who experienced an allergic reaction to an unknown allergen. Which test indicates the quantity of allergen necessary to evoke an allergic reaction?

Radioallergosorbent testing (RAST) -RAST is a radioimmunoassay that measures allergen-specific IgE. The RAST indicates the quantity of allergen necessary to evoke an allergic reaction. Provocative testing involves the direct administration of the suspected allergen to the sensitive tissue, such as the conjunctiva. The scratch test does not indicate the quantity of allergen.

While monitoring the patient's eosinophil level, the nurse suspects a definite allergic disorder when seeing an eosinophil value of what percentage of the total leukocyte count?

15% to 40% -Eosinophils, which are granular leukocytes, normally make up 0% to 3% of the total number of WBCs (Fischbach & Dunning, 2009). A level between 5% and 15% is nonspecific but does suggest allergic reaction. Higher percentages of eosinophils are considered to represent moderate to severe eosinophilia. Moderate eosinophilia is defined as 15% to 40% eosinophils and may be found in patients with allergic disorders

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

Jabs the autoinjector into the outer thigh at a 90-degree angle. -To self-administer epinephrine, the client should remove the autoinjector from its carrying tube, grasp the unit with the black tip (injectiing 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.

A client is diagnosed with atopic dermatitis and asks the nurse why her skin is so dry and itchy. The nurse integrates knowledge of which of the following as the primary reason when responding to the client?

Changes in lipid content. -Excessive dryness and resultant itching of the skin with atopic dermatitis are related to changes in the lipid content, sebaceous gland activity, and sweating. Pruritus and hyperirritability of the skin are related to the large amounts of histamine in the skin. Overall, atopic dermatitis involves significant elevations of serum IgE and peripheral eosinophilia.

A nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in her teaching plan?

Use a topical skin moisturizer daily. -The nurse should instruct the client to use a topical skin moisturizer daily to help keep the skin hydrated. Likewise, the client should be encouraged to bathe daily. To minimize irritation, the client should wear only cotton fabrics. The client should maintain a room temperature between 68° F (20° C) and 72° F (22.2° C).