NUR 254 CHAP 38
Hypersensitivity
A reflection of excessive or aberrant immune response Sensitization: initiates the buildup of antibodies Types of hypersensitivity reactions: Anaphylactic: type I Cytotoxic: type II Immune complex: type III Delayed-type: type IV
Allergic Reaction
Allergen triggers the B cell to make IgE antibody, which attaches to the mast cell. When that allergen reappears, it binds to the IgE and triggers the mast cell to release its chemicals.
Allergy
An inappropriate, often harmful response of the immune system to normally harmless substances Hypersensitive reaction to an allergen initiated by immunologic mechanisms that is usually mediated by IgE antibodies
Collaborative Problems and Potential Complications
Anaphylaxis Impaired breathing Nonadherence to therapeutic regimen
Immunoglobulins and Allergic Response
Antibodies (IgE, IgD, IgG, IgM, and IgA) react with specific effector cells and molecules and function to protect the body IgE antibodies are involved in allergic disorders. IgE molecules bind to an allergen and trigger mast cells or basophils. These cells then release chemical mediators such as histamine, serotonin, kinins, SRS-A, and neutrophil factor. These chemical substances cause the reactions seen in allergic response.
Other Allergic Disorders
Contact dermatitis Atopic dermatitis Drug reactions (dermatitis medicamentosa) Urticaria and angioneurotic edema Food allergy Serum sickness Latex allergy
Rhinitis—Planning
Goals may include Restoration of normal breathing pattern Increased knowledge about the causes and control of allergic symptoms Improved coping with alterations and modifications Absence of complications
Allergic Rhinitis
Hay fever, seasonal allergic rhinitis A common respiratory allergy presumed to be mediated by a type I hypersensitivity Affects 10% to 25% of the population Symptoms include sneezing and nasal congestion, clear watery discharge, nasal itching, itching of throat ands soft palate, dry cough, hoarseness, headache May affect the quality of life, producing fatigue, loss of sleep, and poor concentration
Rhinitis—Assessment
Health history Include personal and family history Allergy assessment Subjective data include symptoms and how the patient feels before symptoms become obvious Note relationship between symptoms and seasonal changes, emotional problems, or stress Identify nature of antigens, seasonal changes in symptoms, and medication history
Management of Patients With Allergic Disorders
History and manifestations; comprehensive allergy history Diagnostic tests CBC: eosinophil count Total serum IgE Skin tests: note precautions! Screening procedures
Rhinitis—Diagnoses
Ineffective breathing pattern related to allergic reaction Deficient knowledge about allergy and the recommended modifications in lifestyle and self-care practices Ineffective individual coping with chronicity of condition and need for environmental modifications
Rhinitis—Intervention: Teaching
Instruction to minimize allergens Use of medications Desensitization procedures
False An antibody, not an antigen, is a protein substance developed by the body in response to and interacting with a specific antigen, not antibody.
Is the following statement true or false? An antigen is a protein substance developed by the body in response to and interacting with a specific antibody.
Rhinitis—Intervention: Breathing
Modify the environment to reduce allergens Reduce exposure to people with URI Take deep breaths and cough frequently
Medication
Oxygen, if respiratory assistance is needed Epinephrine used for anaphylactic reactions Histamines Corticosteroids
Chemical Mediators
Primary Histamine Eosinophil chemotactic factor of anaphylaxis Platelet-activating factor Prostaglandins Secondary Leukotrienes Bradykinin Serotonin
Prevention and Treatment of Anaphylaxis
Screen and prevent! Treat respiratory problems, oxygen, intubation, and cardiopulmonary resuscitation as needed Epinephrine 1:1,000 subcutaneously Auto injection system: EpiPen May follow with IV epinephrine IV fluids
Cetirizine (Zyrtec) A common second-generation nonsedating antihistamine used to treat allergies is cetirizine (Zyrtec). First-generation antihistamines include chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), and hydroxyzine (Atarax).
What is a common second-generation nonsedating antihistamine used to treat allergies? Cetirizine (Zyrtec) Chlorpheniramine (Chlor-Trimeton) Diphenhydramine (Benadryl) Hydroxyzine (Atarax)
4 hours A "rebound" anaphylactic reaction can occur 4 to 10 hours after an initial attack even when epinephrine has been given.
When could a "rebound" anaphylactic reaction occur after an initial attack even when epinephrine has been given? 1 hour 2 hours 3 hours 4 hours
Atopy
refers to the allergic reactions characterized by IgE antibody action and a genetic predisposition
Allergen
the substance that causes the allergic response