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