#1 Chapter 37: Assessment and Management of Patients With Allergic Disorders

Severe systemic reactions anaphylactic reaction

- abrupt onset -symptoms progress rapidly to bronchospasm, laryngeal edema, severe dyspnea, cyanosis, and hypotension. - Dysphagia, abdominal cramping, vomiting, diarrhea, and seizures can also occur. - Cardiac arrest and coma may follow.

anaphylactoid response

-triggered by non-immunoglobulin E (IgE)-mediated events - This nonallergenic anaphylaxis reaction may occur with medications, food, exercise, or cytotoxic antibody transfusions.

Chronic rhinitis accounts for an average of ____ to ____ missed work days per patient per year

1 to 2

If the patient is to undergo SIT immunotherapy, the nurse reinforces the primary provider's explanation regarding the purpose and procedure. Instructions are given regarding the series of injections, which usually are given initially every week and then at ____ to _____ -week intervals.

2- to 4 (Specific immunotherapy (SIT))

A patient received epinephrine in response to an anaphylactic reaction at 10:00 AM. The nurse knows to observe the patient for a "rebound" reaction that may occur as early as: 6:00 PM. 2:00 PM. 4:00 PM. 10:00 PM.

2:00 PM.

Intradermal testing

A 0.5- or 1-mL sterile syringe with a 26/27-gauge intradermal needle is used to inject 0.02 to 0.03 mL of intradermal allergen.

After receiving a dose of penicillin, a client develops dyspnea and hypotension. The nurse suspects the client is experiencing anaphylactic shock. What should the nurse do first? Administer the antidote for penicillin, as ordered, and continue to monitor the client's vital signs. Insert an indwelling urinary catheter and begin to infuse I.V. fluids, as ordered. Administer epinephrine, as ordered, and prepare to intubate the client, if necessary. Page an anesthesiologist immediately and prepare to intubate the client.

Administer epinephrine, as ordered, and prepare to intubate the client, if necessary.

The nurse is educating a patient with allergic rhinitis about how the condition is induced. What should the nurse include in the education on this topic? Airborne pollens or molds Topical creams or ointments Ingested foods Parenteral medications

Airborne pollens or molds

The nurse is educating a patient with allergic rhinitis about how thecondition is induced. What should the nurse include in the educationon this topic? a. Airborne pollens or molds b. Ingested foods c. Parenteral medications d. Topical creams or ointments

Airborne pollens or molds

Contact Dermatitis

An inflammation of the skin caused by having contact with certain chemicals or substances; many of these substances are used in cosmetology.

a clinical response to an immediate (type I hypersensitivity) immunologic reaction between a specific antigen and an antibody. The reaction results from a rapid release of IgE-mediated chemicals, which can induce a severe, life-threatening reaction

Anaphylaxis

The nurse observes diffuse swelling involving the deeper skin layers in a patient who has experienced an allergic reaction. The nurse would correctly document this finding as which of the following? Angioneurotic edema Pitting edema Urticaria Contact dermatitis

Angioneurotic edema Condition characterized by urticaria and diffuse swelling of deeper layers of the skin (Angioedema)

_________ is defined as the genetic predisposition to mount an IgE response to inhaled or ingested innocuous proteins

Atopy

Which of the following would the nurse prioritize as the most important action for the patient to take to prevent anaphylaxis? Desensitization Carry an emergency kit Avoid potential allergens Wear a medical alert bracelet

Avoid potential allergens

patient must be monitored after administration of immunotherapy. Why?

Because of the risk of anaphylaxis, injections should not be given by a lay person or by the patient. The patient must remain in the office or clinic for at least 30 minutes after the injection and is observed for possible systemic symptoms.

A junior nursing student is having an observation day in the operating room. Early in the day, the student tells the OR nurse that her eyes are swelling and she is having trouble breathing. What should the nurse suspect? A) Cytotoxic reaction due to contact with the powder in the gloves B) Immune complex reaction due to contact with anesthetic gases C) Anaphylaxis due to a latex allergy D) Delayed reaction due to exposure to cleaning products

C) Anaphylaxis due to a latex allergy

Immediate hypersensitivity, a type I allergic reaction manifestation:

Clinical manifestations have a rapid onset and can include urticaria, wheezing, dyspnea, laryngeal edema, bronchospasm, tachycardia, angioedema, hypotension, and cardiac arrest.

A condition characterized by redness, itching, and large, blisterlike wheals on skin that is exposed to cold.

Cold Urticaria

A client with allergic rhinitis is prescribed a mast cell stabilizer. Which of the following would the nurse expect to be used? Diphenhydramine Cromolyn sodium Certirizine Zafirlukast

Cromolyn sodium

A patient with a family history of allergies has suffered an allergic response based on a genetic predisposition. This atopic response is usually mediated by what immunoglobulin? A) Immunoglobulin A B) Immunoglobulin M C) Immunoglobulin G D) Immunoglobulin E

D) Immunoglobulin E

According to nursing research by Campbell et al., about 65% of patients identified with anaphylaxis who were seen in the emergency department were discharged to home. Of those 65%, one-third were prescribed self-injectable epinephrine. Patient teaching for use of an EpiPen must be included with discharge instructions. Select all the teaching points that apply. Grasp the EpiPen with the black tip pointing downward. Jab firmly at a 45 degree angle to get maximum penetration. Hold for 5 seconds and massage injection area for 5 seconds. Call 911 before injecting epinephrine. Form a fist around the unit. Hold black tip near outer thigh.

Grasp the EpiPen with the black tip pointing downward. Form a fist around the unit. Hold black tip near outer thigh.

Which of the following is a primary chemical mediator of hypersensitivity? a)Serotonin b)Histamine c)Heparin d)Bradykinin

Histamine Explanation: Histamine is a primary chemical mediator of hypersensitivity. Secondary mediators include serotonin, heparin, and bradykinin.

The most common serious allergic reactions to insect stings are from the ______________ family, which includes bees, ants, wasps, and yellow jackets

Hymenoptera

what occurs during an allergic reaction?

In allergic reactions, the body encounters allergens that are types of antigens, usually proteins that the body's defenses recognize as foreign, and a series of events occurs in an attempt to render the invaders harmless, destroy them, and remove them from the body.

Which of the following is a mast cell stabilizer used in the treatment of allergic rhinitis? Intranasal cromolyn sodium (NasalCrom) Tetrahydrozoline hydrochloride (Visine) Pseudoephedrine hydrochloride (Sudafed) Oxymetazoline hydrochloride (Afrin)

Intranasal cromolyn sodium (NasalCrom)

nonatopic disorders

Lack the genetic component and organ specificity of the atopic disorders * Latex allergy

provocative test disadvantages

Major disadvantages of this type of testing are the limitation of one antigen per session and the risk of producing severe symptoms, particularly bronchospasm, in patients with asthma.

_______________ cells, which are located in the skin and mucous membranes, play a major role in IgE-mediated immediate hypersensitivity.

Mast

Histamine release in anaphylaxis causes which of the following? Nasal congestion Feeling of impending doom Urinary urgency Stomach cramps

Nasal congestion

A 6-year-old experienced an allergic reaction to shellfish. The nurse practitioner gave the mother a booklet that includes teaching points about food allergies. The nurse reminded the mother to be vigilant for mild systemic reactions such as: Wheezing and coughing. Nasal congestion and sneezing. Shortness of breath. Bronchospasm.

Nasal congestion and sneezing.

A patient has had a "stuffy nose" and obtained Afrin nasal spray.What education should the nurse provide to the patient in order toprevent "rebound congestion"? a. Be sure to use the Afrin for at least 10 days to ensure thestuffiness is gone b. Use the medication every 4 hours to prevent congestion fromrecurring c. Drink plenty of fluids d. Only use the Afrin for 3 to 4 days once every 12 hours

Only use the Afrin for 3 to 4 days once every 12 hours

_________ and ________ allergies are responsible for the most severe food allergy reactions.

Peanut and tree nut (e.g., cashew, walnut)

Which of the following allergies is responsible for most severe food allergy reactions? Seafood Berries Peanuts Seeds

Peanuts

___________ is the most common medication to cause anaphylaxis.

Penicillin

What is the most common cause of anaphylaxis? a)NSAIDs b)Radiocontrast agent c)Penicillin d)Opioids

Penicillin Explanation: Penicillin is the most common cause of anaphylaxis, accounting for about 75% of fatal anaphylactic reactions in the United States each year. Opioids, NSAIDs, and radiocontrast agents are some of the medications that are frequently reported as causing anaphylaxis.

Which type of contact dermatitis requires light exposure in addition to allergen contact? Allergic Irritant Phototoxic Photoallergic

Photoallergic

Which of the following interventions is the single most important aspect for the patient at risk for anaphylaxis? Use of antihistamines Wearing of medical alert bracelet Prevention Desensitization

Prevention

A patient with a history of anaphylactic reactions to insect stings has just been stung by a wasp. The patient is going to self-administer his EpiPen. Place the steps in the correct order that he would follow. Use all options. 1 Call the emergency medical response number (911) 2 Remove the gray safety-release cap 3 Jab the black tip into the outer thigh 4 Massage the injection area

Remove the gray safety-release cap Jab the black tip into the outer thigh Massage the injection area Call the emergency medical response number (911)

photo allergic reaction

Resembles allergic dermatitis but requires light exposure in addition to allergen contact to produce immunologic reactivity

Phototoxic dermatitis

Resembles the irritant type but requires sun and a chemical in combination to damage the epidermis

An infant is born to a mother who had no prenatal care during her pregnancy. What type of hypersensitivity reaction does the nurse understand may have occurred? a)Bacterial endocarditis b)Rh-hemolytic disease c)Lupus erythematosus d) Rheumatoid arthritis

Rh-hemolytic disease Explanation: A type II hypersensitivity, or cytotoxic, reaction, which involves binding either the IgG or IgM antibody to a cell-bound antigen, may lead to eventual cell and tissue damage. The reaction is the result of mistaken identity when the system identifies a normal constituent of the body as foreign and activates the complement cascade. Examples of type II reactions are myasthenia gravis, Goodpasture syndrome, pernicious anemia, hemolytic disease of the newborn, transfusion reaction, and thrombocytopenia.

A patient asks the nurse if it would be all right to take an over-the-counter antihistamine for the treatment of a rash. What should the nurse educate the patient is a major side effect of antihistamines? Sedation Palpitations Anorexia Diarrhea

Sedation

________ testing is considered the most accurate confirmation of allergy

Skin

Immunotherapy therapeutic failure

Therapeutic failure is evident when a patient does not experience a decrease of symptoms within 12 to 24 months, fails to develop increased tolerance to known allergens, and cannot decrease the use of medications to reduce symptoms.

Which of the following is a contraindication for immunotherapy? Allergic asthma Allergic rhinitis Conjunctivitis Use of a beta-blocker

Use of a beta-blocker Beta blocker blocks the effect of immunotherapy

A client is scheduled to begin immunotherapy. The nurse would explain that the client will receive injections initially at which interval Monthly Weekly Daily Bi-monthly

Weekly

hypersensitivity:

abnormal heightened reaction to a stimulus of any kind

substance that causes manifestations of allergy

allergen

Closely resembling anaphylaxis is an _______________ reaction, which is caused by the release of mast cell and basophil mediators triggered by non-immunoglobulin E (IgE)-mediated events.

anaphylactoid

rapid clinical response to an immediate immunologic reaction between a specific antigen and antibody

anaphylaxis

angioneurotic edema example

angioedema

protein substance developed by the body in response to and interacting with a specific antigen

antibody

There are two types of IgE-mediated allergic reactions:

atopic and nonatopic disorders.

a type I immediate hypersensitivity disorder characterized by inflammation and hyper reactivity of the skin. The term is used synonymously with atopic eczema

atopic dermatitis

The nurse informs and reminds the patient of the importance of keeping appointments for desensitization procedures. Why?

because dosages are usually adjusted on a weekly basis, and missed appointments may interfere with the dosage adjustment.

The use of hand lotion before donning latex gloves can worsen the symptoms of an allergic reaction to latex. Why?

because lotions may leach latex proteins from the gloves, thus increasing skin exposure and the risk of developing true allergic reactions

a substance that stimulates nerve fibers and causes pain

bradykinin

A nurse visits the employee health department because of mild itching and a rash on both hands. During the assessment interview, the employee health nurse should focus on: chemical and latex glove use. medication allergies. laundry detergent or bath soap changes. life stressors the nurse may be experiencing.

chemical and latex glove use.

two groups of antigens

complete protein antigens and low-molecular-weight substances

erythema:

diffuse redness of the skin

The initial medication of choice for a severe allergic reaction is________, administered ________.

epinephrine, in a 1:1000 dilution given subcutaneously

Common symptoms of irritant dermatitis

erythema and pruritus.

foods that a patient with allergies should avoid?

fish, nuts, eggs, chocolate

Low-molecular-weight substances, such as medications, function as _______________ (incomplete antigens), binding to tissue or serum proteins to produce a carrier complex that initiates an antibody response.

hapten

urticaria

hives

Complete protein antigens, such as animal dander, pollen, and horse serum, stimulate a complete _______ response.

humoral

hapten

incomplete antigen

a group of chemical mediators that initiate the inflammatory response

leukotrienes

- T cells secrete substances that direct the flow of cell activity, destroy target cells, and stimulate the ____________. The ____________present the antigens to the T cells and initiate the immune response.

macrophages macrophages

Most allergic reactions are either type___ or type ____ hypersensitivity reactions.

one or 4

Screening for allergies before a medication is prescribed or first given is an important preventive measure. A careful history of any sensitivity to suspected antigens must be obtained before administering any medication, particularly in _________ form, because this route is associated with the most severe anaphylaxis.

parenteral

in dermatitis medicamentosa All routes of administration are potentially fatal, but drugs given _________ incur the greatest risk.

parenterally

The most common cause of anaphylaxis, accounting for 75% of fatalreactions in the United States, is

penicillin

The antibodies prepare the antigens so that the ________cells of the blood and the tissues can dispose of them.

phagocytic

rhinitis medicamentosa

rebound nasal congestion commonly associated with overuse of over-the-counter nasal decongestants

chemical mediator that acts as a potent vasoconstrictor and bronchoconstrictor

serotonin

Adrenergic Agents

stimulate the sympathetic nervous system and induce symptoms characteristic of the fight-or-flight response *vasoconstrictors of mucosal vessels,

Patients who suspect that a new rash may be caused by a drug allergy (newly prescribed medications, especially antibiotics such as penicillin or sulfa medications). pt should do what?

stop taking the medication immediately and contact their prescribing clinician, who will determine whether the medication and the rash are related.

total Serum Immunoglobulin E Levels

support the diagnosis of allergic disease.

atopy:

term often used to describe immunoglobulin E-mediated diseases (i.e., atopic dermatitis, asthma, and allergic rhinitis) with a genetic component

atopic march

the presence of atopic characteristics, events, or conditions that develop into more permanent disease

Patients who receive high-dose or long-term corticosteroid therapy must be cautioned not to stop taking the medication suddenly. Doses are tapered when discontinuing this medication. Why?

to avoid adrenal insufficiency.

A negative response on a skin test cannot be interpreted as an absence of sensitivity to an allergen. Such a response may occur with insufficient sensitivity of the test or with the use of an inappropriate allergen in testing.

true

urticaria:

type I hypersensitive allergic reaction of the skin that is characterized by the sudden appearance of edematous, pink or red wheals of variable size from 2 to 4 mm, and general pruritus.

atopic dermatitis

type I hypersensitivity involving inflammation of the skin evidenced by itching, redness, and a variety of skin lesions

___________ (hives) is a type I hypersensitive allergic reaction of the skin that is characterized by the sudden appearance of edematous, pink or red wheals of variable size from 2 to 4 mm, and general pruritus.

urticaria

People who are allergic to insect venom may require _______________________, which is used as a control measure and not a cure.

venom immunotherapy

atopic dermatitis medical treatment for itching?

wearing cotton fabrics; washing with a mild detergent; humidifying dry heat in winter; maintaining room temperature at 20°C to 22.2°C (68°F to 72°F); using antihistamines such as diphenhydramine; and avoiding animals, dust, sprays, and perfumes.

A patient comes to the clinic with pruritus and nasal congestion after eating shrimp for lunch. The nurse is aware that the patient may be having an anaphylactic reaction to the shrimp. These symptoms typically occur within how many hours after exposure? 6 hours 12 hours 24 hours 2 hours

2 hours

The nurse in an allergy clinic is educating a new patient about the pathology of the patients health problem. What response should the nurse describe as a possible consequence of histamine release? A) Constriction of small venules B) Contraction of bronchial smooth muscle C) Dilation of large blood vessels D) Decreased secretions from gastric and mucosal cells

B) Contraction of bronchial smooth muscle - H1 receptors are found predominantly on bronchiolar and vascular smooth muscle cells

A patient is learning about his new diagnosis of asthma with the asthma nurse. What medication has the ability to prevent the onset of acute asthma exacerbations? A) Diphenhydramine (Benadryl) B) Montelukast (Singulair) C) Albuterol sulfate (Ventolin) D) Epinephrine

B) Montelukast (Singulair) Leukotriene modifiers, such as zafirlukast (Accolate) and montelukast (Singulair), block the synthesis or action of leukotrienes and prevent the signs and symptoms associated with asthma

A patient is brought to the emergency department (ED) in a state of anaphylaxis. What is the ED nurses priority for care? A) Monitor the patients level of consciousness. B) Protect the patients airway. C) Provide psychosocial support. D) Administer medications as ordered.

B) Protect the patients airway.

type I hypersensitivity involving inflammation of the skin evidenced by itching, redness, and a variety of skin lesions

atopic dermatitis

A patient was prescribed an oral antibiotic for the treatment of sinusitis. The patient has now stopped, stating she developed a rash shortly after taking the first dose of the drug. What is the nurses most appropriate response? A) Encourage the woman to continue with the medication while monitoring her skin condition closely. B) Refer the woman to her primary care provider to have the medication changed. C) Arrange for the woman to go to the nearest emergency department. D) Encourage the woman to take an OTC antihistamine with each dose of the antibiotic.

B) Refer the woman to her primary care provider to have the medication changed.

A health care provider prescribed Flonase, an intranasal corticosteroid, for a patient with a severe case of allergic rhinitis. The nurse told the patient that there is a delayed response to full benefits from the drug. The patient took his first dose on February 2. The patient should expect that the drug will be fully effective no later than: February 12. February 9. February 15. February 6.

February 15.

Parenterally administered drugs

injecting directly into the body, bypassing the skin and mucous membranes

A client is receiving immunotherapy as part of the treatment plan for an allergic disorder. After administering the therapy, the client states, "I guess I can go home now." Which response by the nurse would be most appropriate? a) "You need to stay about another half-hour so we can make sure you don't have a reaction." b)"It's okay to leave but make sure to call us if you start to feel strange after an hour or so." c) "You must stay here so that you can get another injection of a different substance to which you're allergic." d)"We need to schedule your next appointment first and then you can leave."

"You need to stay about another half-hour so we can make sure you don't have a reaction." Explanation: Although severe systemic reactions are rare, the risk of serious and potentially fatal anaphylaxis exists. Therefore, the client needs to remain in the office or clinic for at least 30 minutes after the injection to be observed for possible systemic symptoms. The client should not be allowed to leave until 30 minutes pass. If more than one allergen is being used, the injections typically occur at the same time.

The nurse is providing care for a patient who has experienced a type I hypersensitivity reaction. What condition is an example of such a reaction? A) Anaphylactic reaction after a bee sting B) Skin reaction resulting from adhesive tape C) Myasthenia gravis D) Rheumatoid arthritis

A) Anaphylactic reaction after a bee sting b) is a type IV C) type II D) type III

Immunotherapy is safe during pregnancy

False! Immunotherapy should not be initiated during pregnancy; for patients who have been receiving immunotherapy before pregnancy, the dosage should not be increased during pregnancy.

Which of the following body substances causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle? Serotonin Prostaglandin Bradykinin Histamine

Histamine

First-Generation H1 Antihistamines (Sedating)

-Diphenhydramine (Benadryl) -Chlorpheniramine (Chlor-Trimeton) -Hydroxyzine (Atarax)

A patient was seen in the clinic 3 days previously for allergic rhinitisand was given a prescription for a corticosteroid nasal spray. Thepatient calls the clinic and tells the nurse that the nasal spray is notworking. What is the best response by the nurse? a. "You need to come back to the clinic to get a different medicationsince this one is not working for you" b. "You may be immune to the effects of this medication and willneed something else in its place" c. "The full benefit of the medication may take up to 2 weeks to beachieved" d. "I am sorry that you are feeling poorly but this is the onlymedication that will work for your problem"

"The full benefit of the medication may take up to 2 weeks to beachieved"

How is Intradermal testing performed

1st. A 0.5- or 1-mL sterile syringe with a 26/27-gauge intradermal needle is used to inject 0.02 to 0.03 mL of intradermal allergen. 2nd. The needle is inserted with the bevel facing upward and the syringe parallel to the skin. 3rd. The skin is penetrated superficially, and a small amount of the allergen solution is injected to create a bleb (raised area) approximately 5 mm in diameter. 4th. A separate sterile syringe and needle are used for each injection.

antiallergy medication, allergen immunotherapy has the potential to alter the allergic disease course after ____ to ___ years of therapy. Because it may prevent the progression or development of asthma or multiple or additional allergies, it is also considered to be a potential preventive measure

3 to 5

A nurse is caring for a patient who has allergic rhinitis. What intervention would be most likely to help the patient meet the goal of improved breathing pattern? A) Teach the patient to take deep breaths and cough frequently. B) Use antihistamines daily throughout the year. C) Teach the patient to seek medical attention at the first sign of an allergic reaction. D) Modify the environment to reduce the severity of allergic symptoms.

D) Modify the environment to reduce the severity of allergic symptoms.

A patient is experiencing an allergic reaction after receiving a dose ofpenicillin. What should the nurse look for in the patient's initialassessment? a. Dyspnea, bronchospasm, and/or laryngeal edema b. Hypotension and tachycardia c. The presence and location of pruritus d. The severity of cutaneous warmth and flushing

Dyspnea, bronchospasm, and/or laryngeal edema

A patient has a sensitivity to ragweed and tells the nurse that it comesat the same time every year. When does the patient typically notice thesymptoms? a. Early spring b. Early fall c. Summer d. Midwinter

Early fall

A nurse practitioner working in an allergy clinic is treating a patient who is allergic to ragweed. She advises the patient to expect an increase in symptoms during which of the following seasons? Early fall Late spring Early summer Early spring

Early fall Explanation: Ragweed has a seasonal occurrence in early fall. Tree pollen and mold spores occur in the spring. Rose and grass pollen occur in the summer.

Nursing students are reviewing various medications that can be used to treat allergic disorders. The students demonstrate understanding of the information when they identify which of the following as an intranasal corticosteroid? a)Fexofenadine b)Fluticasone c)Zileuton d)Cromolyn sodium

Fluticasone Explanation: Fluticasone is an example of an intranasal corticosteroid. Cromolyn sodium is a mast cell stabilizer. Zileuton is a leukotriene-receptor inhibitor. Fexofenadine is a second-generation antihistamine.

Which of the following terms refers to an incomplete antigen? Allergen Antibody Hapten Antigen

Hapten *Unable to induce an immune response by itself, they require carrier molecule to act as a complete antigen. Explanation: A hapten is an incomplete antigen. An allergen is a substance that causes manifestations of allergy. An antigen is a substance that induces the production of antibodies. An antibody is a protein substance developed by the body in response to and interacting with a specific antigen.

Dermatitis medicamentosa

Hypersensitivity reaction to a drug.

The nurse working in an allergy clinic is preparing to administer skin testing to a patient. Which of the following routes is the safest for the nurse to use to administer the solution? Subcutaneous Intramuscular Intravenous Intradermal

Intradermal Explanation: The intradermal route is the correct route of administration for skin testing and therefore a safe route. Another safe route is epicutaneous. The type of skin testing being performed determines whether the nurse will administer the solution via the epicutaneous or intradermal route.

A patient with a history of allergies comes to the clinic for an evaluation. The following laboratory test findings are recorded in a patient's medical record: Total serum IgE levels: 2.8 mg/mL White blood cell count: 5,100/cu mm Eosinophil count: 4% Erythrocyte sedimentation rate: 20 mm/h The nurse identifies which result as suggesting an allergic reaction? Serum IgE level Erythrocyte sedimentation rate White blood cell count Eosinophil count

Serum IgE level

Secondary Chemical Mediators (3)

leukotrienes, bradykinin, serotonin Leukotrienes: group of chem mediators that initiates the inflammatory response Bradykinin: sub that stimulates nerve fibers and causes pain Serotonin: chem mediator that acts as potent vasoconstrictor and bronchoconstrictor

T cells

lymphocyte cells that can cause graft rejection, kill foreign cells, or suppress production of antibodies

Insulin-allergic patients with diabetes and those who are allergic to penicillin may require desensitization. Desensitization is based on controlled anaphylaxis, with a gradual release of mediators.

a conditioning technique designed to gradually reduce anxiety about a particular object or situation

substance that induces the production of antibodies

antigen

WBC count is normal except with ________

inflammation or infection

A patient was seen in the clinic 3 days previously for allergic rhinitis and was given a prescription for a corticosteroid nasal spray. The patient calls the clinic and tells the nurse that the nasal spray is not working. What is the best response by the nurse? "I am sorry that you are feeling poorly but this is the only medication that will work for your problem." "The full benefit of the medication may take up to 2 weeks to be achieved." "You may be immune to the effects of this medication and will need something else in its place." "You need to come back to the clinic to get a different medication since this one is not working for you."

"The full benefit of the medication may take up to 2 weeks to be achieved."

Immunotherapy Contraindications

-The use of beta-blocker or angiotensin-converting enzyme inhibitor therapy (may mask early signs of anaphylaxis) - Presence of significant pulmonary or cardiac disease or organ failure - Inability of the patient to recognize or report signs and symptoms of a systemic reaction - Nonadherence of the patient to other therapeutic regimens and nonlikelihood that the patient will adhere to the immunization schedule (often weekly for an indefinite period) - Inability to monitor the patient for at least 30 minutes after administration of immunotherapy - Absence of equipment or adequate personnel to respond to allergic reaction if one occurs

Subcutaneous Immunotherapy

-most common method -serial injection of one or more antigens that are selected in each particular case on the basis of skin testing. -Specific treatment consists of injecting extracts of the allergens that cause symptoms in a particular patient. -patient must be monitored after administration of immunotherapy. - Maintenance booster injections are given at 2- to 4-week intervals for a period of several years,

Atopy

-state of hypersensitivity to an allergen-allergic -genetic predisposition -asthma, allergic rhinitis, and atopic dermatitis

several precautionary steps must be observed before skin testing with allergens is performed: (3)

1. Testing is not performed during periods of bronchospasm. 2. Epicutaneous tests (scratch or prick tests) are performed before other testing methods, in an effort to minimize the risk of systemic reaction. 3. Emergency equipment must be readily available to treat anaphylaxis.

Goals of immunotherapy (3)

1. reducing the level of circulating IgE, 2. increasing the level of blocking antibody IgG 3. reducing mediator cell sensitivity.

Type III hypersensitivity reactions involve the binding of antibodies toantigens. List two possible results: ________ and ________ (Disease)

1. systemic lupus erythematosus 2. rheumatoid arthritis 3. serum sickness

A school nurse is caring for a child who appears to be having an allergic response. What should be the initial action of the school nurse? A) Assess for signs and symptoms of anaphylaxis. B) Assess for erythema and urticaria. C) Administer an OTC antihistamine. D) Administer epinephrine.

A) Assess for signs and symptoms of anaphylaxis.

A patient has been brought to the emergency department by EMS after being found unresponsive. Rapid assessment reveals anaphylaxis as a potential cause of the patients condition. The care team should attempt to assess for what potential causes of anaphylaxis? Select all that apply. A) Foods B) Medications C) Insect stings D) Autoimmunity E) Environmental pollutants

A) Foods B) Medications C) Insect stings

A patient with multiple food and environmental allergies tells the nurse that he is frustrated and angry about having to be so watchful all the time and wonders if it is really worth it. What would be the nurses best response? A) I can only imagine how you feel. Would you like to talk about it? B) Lets find a quiet spot and Ill teach you a few coping strategies. C) Thats the same way that most patients who have a chronic illness feel. D) Do you think that maybe you could be managing things more efficiently

A) I can only imagine how you feel. Would you like to talk about it?

A patient has been admitted to the emergency department with signs of anaphylaxis following a bee sting. The nurse knows that if this is a true allergic reaction the patient will present with what alteration in laboratory values? A) Increased eosinophils B) Increased neutrophils C) Increased serum albumin D) Decreased blood glucos

A) Increased eosinophils

After the completion of testing, a childs allergies have been attributed to her familys cat. When introducing the family to the principles of avoidance therapy, the nurse should promote what action? A) Removing the cat from the familys home B) Administering OTC antihistamines to the child regularly C) Keeping the cat restricted from the childs bedroom D) Maximizing airflow in the house

A) Removing the cat from the familys home

The nurse is planning the care of a patient who has a diagnosis of atopic dermatitis, which commonly affects both of her hands and forearms. What risk nursing diagnosis should the nurse include in the patients care plan? A) Risk for Disturbed Body Image Related to Skin Lesions B) Risk for Disuse Syndrome Related to Dermatitis C) Risk for Ineffective Role Performance Related to Dermatitis D) Risk for Self-Care Deficit Related to Skin Lesion

A) Risk for Disturbed Body Image Related to Skin Lesions

A nurse has asked the nurse educator if there is any way to predict the severity of a patients anaphylactic reaction. What would be the nurses best response? A) The faster the onset of symptoms, the more severe the reaction. B) The reaction will be about one-third more severe than the patients last reaction to the same antigen. C) There is no way to gauge the severity of a patients anaphylaxis, even if it has occurred repeatedly in the past. D) The reaction will generally be slightly less severe than the last reaction to the same antigen.

A) The faster the onset of symptoms, the more severe the reaction.

A patient has sought care, stating that she developed hives overnight. The nurses inspection confirms the presence of urticaria. What type of allergic hypersensitivity reaction has the patient developed? A) Type I B) Type II C)MType III D) Type IV

A) Type I

A 5-year-old boy has been diagnosed with a severe food allergy. What is an important parameter to address when educating the parents of this child about his allergy and care? A) Wear a medical identification bracelet. B) Know how to use the antihistamine pen. C) Know how to give injections of lidocaine. D) Avoid live attenuated vaccinations.

A) Wear a medical identification bracelet.

A nurse at an allergy clinic is providing education for a patient starting immunotherapy for the treatment of allergies. What education should the nurse prioritize? A) The importance of scheduling appointments for the same time each month B) The importance of keeping appointments for desensitization procedures C) The importance of avoiding antihistamines for the duration of treatment D) The importance of keeping a diary of reactions to the immunotherapy

B) The importance of keeping appointments for desensitization procedures

A child has been diagnosed with a severe walnut allergy after suffering an anaphylactic reaction. What is a priority for health education? A) The need to begin immunotherapy as soon as possible B) The need for the parents to carry an epinephrine pen C) The need to vigilantly maintain the childs immunization status D) The need for the child to avoid all foods that have a high potential for allergies

B) The need for the parents to carry an epinephrine pen

A patient has presented with signs and symptoms that are consistent with contact dermatitis. What aspect of care should the nurse prioritize when working with this patient? A) Promoting adequate perfusion in affected regions B) Promoting safe use of topical antihistamines C) Identifying the offending agent, if possible D) Teaching the patient to safely use an EpiPen

C) Identifying the offending agent, if possible

A nurse has included the nursing diagnosis of Risk for Latex Allergy Response in a patients plan of care. The presence of what chronic health problem would most likely prompt this diagnosis? A) Herpes simplex B) HIV C) Spina bifida D) Hypogammaglobulinemia

C) Spina bifida

A patient has been living with seasonal allergies for many years, but does not take antihistamines, stating, When I was young I used to take antihistamines, but they always put me to sleep. How should the nurse best respond? A) Newer antihistamines are combined with a stimulant that offsets drowsiness. B) Most people find that they develop a tolerance to sedation after a few months. C) The newer antihistamines are different than in years past, and cause less sedation. D) Have you considered taking them at bedtime instead of in the morning?

C) The newer antihistamines are different than in years past, and cause less sedation.

__________________, a type IV delayed hypersensitivity reaction, is an acute or chronic skin condition caused by contact with an exogenous substance that elicits an allergic response.

Contact dermatitis

Which of the following individuals would be the most appropriate candidate for immunotherapy? A) A patient who had an anaphylactic reaction to an insect sting B) A child with allergies to eggs and dairy C) A patient who has had a positive tuberculin skin test D) A patient with severe allergies to grass and tree pollen

D) A patient with severe allergies to grass and tree pollen -This type of therapy provides an adjunct to symptomatic pharmacologic therapy and can be used when avoidance of allergens is NOT possible.

The nurse is providing health education to the parents of a toddler who has been diagnosed with food allergies. What should the nurse teach this family about the childs health problem? A) Food allergies are a life-long condition, but most families adjust quite well to the necessary lifestyle changes. B) Consistent use of over-the-counter antihistamines can often help a child overcome food allergies. C) Make sure that you carry a steroid inhaler with you at all times, especially when you eat in restaurants D) Many children outgrow their food allergies in a few years if they avoid the offending foods.

D) Many children outgrow their food allergies in a few years if they avoid the offending foods.

Allergic contact dermatitis

Delayed hypersensitivity (type IV) reaction. Usually affects only area in contact with latex; reaction is usually to chemical additives used in the manufacturing process rather than to latex itself.

This disorder is the leading cause of fatal anaphylaxis, comprising 43% of deaths from anaphylaxis.

Dermatitis Medicamentosa (Drug Reactions)

________________, a type I hypersensitivity disorder, is the term applied to skin rashes associated with certain medications.

Dermatitis medicamentosa

The nurse is preparing to administer a medication that has an affinity for H1 receptors. Which medication would the nurse administer? a)Ranitidine (Zantac) b)Diphenhydramine (Benadryl) c)Omeprazole (Prilosec) d) Cimetidine (Tagamet)

Diphenhydramine (Benadryl) Explanation: Certain medications are categorized by their action at these receptors. Diphenhydramine (Benadryl) is an example of an antihistamine, a medication that displays an affinity for H1 receptors. Cimetidine (Tagamet) and ranitidine (Zantac) target H2 receptors to inhibit gastric secretions in peptic ulcer disease.

A client comes to the clinic reporting nasal congestion and states, "I've been using an over-the-counter nasal spray that seemed to help at first, but then I got even more congested than before I started the medication. I continued the nasal spray, but it seems to be worse." The nurse suspects which of the following? Tolerance to the medication Drug overdose Development of a new allergy Rhinitis medicamentosa

Rhinitis medicamentosa * a condition of rebound nasal congestion suspected to be brought on by extended use of topical decongestants

The nurse teaches the patient with allergies about anaphylaxis including which of the following statements? Anaphylactoid (anaphylaxis-like) reactions are commonly fatal. The most common cause of anaphylaxis is penicillin. The most common food item causing anaphylaxis is chocolate. Systemic reactions include urticaria and angioedema.

The most common cause of anaphylaxis is penicillin.

A nurse is preparing a discharge teaching plan for a client with atopic dermatitis. Which instruction should the nurse include in her teaching plan? Keep the thermostat above 75° F (23.9° C). Wear only synthetic fabrics. Bathe only three times per week. Use a topical skin moisturizer daily.

Use a topical skin moisturizer daily. Explanation: 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).

hypersensitivity refers to allergic reactions

false, it includes allergic reactions, but also is an excessive or aberrant immune response to ANY type of stimulus

substance in the body that causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle

histamine:

anaphylactoid response may occur with:

medications, food, exercise, or cytotoxic antibody transfusions.

The methods of skin testing include (3)

prick skin tests, scratch tests, and intradermal skin testing

unsaturated fatty acids that have a wide assortment of biologic activity

prostaglandins

atopy

refers to IgE-mediated diseases, such as allergic rhinitis, that have a genetic component.

After topical application of the medication, a rebound period occurs in which the nasal mucous membranes become more edematous and congested than they were before the medication was used. Such a reaction encourages the use of more medication, and a cyclic pattern results.

rhinitis medicamentosa

In ________________, the rebound reaction from the overuse of sympathomimetic nose drops or sprays worsens the congestion, causing the patient to use more of the medication and thus leads to more nasal congestion. This condition should not be confused with a patient developing tolerance to the drug.

rhinitis medicamentosa

The patient must be aware of the effects caused by overuse of the sympathomimetic agents in nose drops or sprays, because a condition referred to as _____________________ may result.

rhinitis medicamentosa

Immediate hypersensitivity, a type I allergic reaction, is mediated by the IgE mast cell system. Symptoms can include:

rhinitis, conjunctivitis, asthma, and anaphylaxis.

In cases of doubt about the validity of the skin tests, a _______________ test or a provocative challenge test may be performed.

serum-specific IgE

The _______________________, formerly known as RAST, is an automated test performed on blood samples by a pathology laboratory. As the name suggests, it detects free antigen-specific IgE in serum as opposed to antigen-specific IgE bound to mast cells in the skin

serum-specific IgE test

Correlation of a positive ________ test with a positive allergy ________ is an indication for immunotherapy if the allergen cannot be avoided.

skin history

Delayed hypersensitivity to latex is characterized by

symptoms of contact dermatitis, including vesicular skin lesions, papules, pruritus, edema, erythema, and crusting and thickening of the skin. *These symptoms usually appear on the back of the hands.

Prostaglandins are primary chemical mediators that respond to astimulus by contracting smooth muscle and increasing capillarypermeability. This response causes ________

the pain and fever seen with inflammatory responses

Corticosteroids and antihistamines, including over-the-counter allergy medications should be stop 48 to 96 hours before testing. Why?

this drugs suppress skin test reactivity

All patients with any form of cold urticaria should carry an auto-injectable epinephrine device for emergency use because hives can progress to anaphylaxis.

true

Decongestants can cause an increase in blood pressure; therefore, patients with a history of hypertension should be cautioned about long-term use of any medication that contains decongestants

true

In the event of signs and symptoms suggestive of anaphylaxis, emergency medications and equipment must be available for immediate use.

true

One of the dangers of food allergens is that they may be hidden in other foods and not apparent to people who are susceptible to the allergen.

true

in Immunotherapy, because the injection of an allergen may induce systemic reactions, such injections are given only in a setting where epinephrine is immediately available (i.e., primary provider's office, clinic).

true

there is insufficient evidence that maternal diet during pregnancy or lactation affects the development of food allergies later in life

true

Anaphylactic reactions produce a clinical syndrome that affects multiple organ systems. Reactions may be categorized as mild, moderate, or severe. The time from the exposure to the antigen to the onset of symptoms is a good indicator of the severity of the reaction. Why?

—the faster the onset, the more severe the reaction.

An office worker takes a cupcake that contains peanut butter. He begins wheezing, with an inspiratory stridor and air hunger and the occupational health nurse is called to the office. The nurse should recognize that the worker is likely suffering from which type of hypersensitivity? A) Anaphylactic (type 1) B) Cytotoxic (type II) C) Immune complex (type III) D) Delayed-type (type IV)

A) Anaphylactic (type 1) anaphylaxis is characterized by edema in many tissues, including the larynx, and is often accompanied by hypotension, bronchospasm, and cardiovascular collapse in severe cases.

A nurse is caring for a teenage girl who has had an anaphylactic reaction after a bee sting. The nurse is providing patient teaching prior to the patients discharge. In the event of an anaphylactic reaction, the nurse informs the patient that she should self-administer epinephrine in what site? A) Forearm B) Thigh C) Deltoid muscle D) Abdomen

B) Thigh

A client with an allergic disorder calls the nurse and asks what treatment is available for allergic disorders. The nurse explains to the client that there is more than one treatment available. What treatments would the nurse tell the client about? Sublingual-swallow immunotherapy (SLIT) Desensitization Sublingual-topical immunotherapy (STIT) Resensitization

Desensitization Explanation: Desensitization is another option. Desensitization is a form of immunotherapy in which a person receives weekly or twice-weekly injections of dilute but increasingly higher concentrations of an allergen without interruption. SLIT is a form of desensitization therapy. Options C and D are distractors for this question.

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? 3% to 4% 5% to 10% 15% to 40% 1% to 3%

15% to 40%

A patient with severe environmental allergies is scheduled for an immunotherapy injection. What should be included in teaching the patient about this treatment? A) The patient will be given a low dose of epinephrine before the treatment. B) The patient will remain in the clinic to be monitored for 30 minutes following the injection. C) Therapeutic failure occurs if the symptoms to the allergen do not decrease after 3 months. D) The allergen will be administered by the peripheral intravenous route.

B) The patient will remain in the clinic to be monitored for 30 minutes following the injection.

Which of the following is the most frequent route of exposure to a latex allergy? a)Parenteral b)Inhalation c)Cutaneous d)Mucosal

Cutaneous Explanation: Routes of exposure to latex products can be cutaneous, percutaneous, mucosal, parenteral, or aerosol. Allergic reactions are more likely with parenteral or mucous membrane exposure but can also occur with cutaneous contact or inhalation. The most frequent source of exposure is cutaneous, which usually involves the wearing of natural latex gloves.

A patient who is scheduled for a skin test informs the nurse that he has been taking corticosteroids to help control his allergy symptoms. What nursing intervention should the nurse implement? A) The patient should take his corticosteroids regularly prior to testing. B) The patient should only be tested for grass, mold, and dust initially. C) The nurse should have an emergency cart available in case of anaphylaxis during the test. D) The patients test should be cancelled until he is off his corticosteroids.

D) The patients test should be cancelled until he is off his corticosteroids.

The nurse is evaluating a patient's complete blood cell count and differential (CBC and diff) along with the serum immunoglobulin E (IgE) level. Which of the following results might indicate that the patient has an allergic disorder? a)Low white blood cells b) Low eosinophil level c) High neutrophils d) High IgE level

High IgE level Explanation: High total IgE levels and/or a high percentage of eosinophils may indicate an allergic disorder. However, normal IgE levels do not exclude the diagnosis of an allergic disorder. The level of neutrophils and white blood cell counts are not impacted by allergic disorders.

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? Intradermal test Provocative testing RAST Scratch test

RAST Explanation: 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.

A client has been taking a decongestant for allergic rhinitis. During a follow-up visit, which finding suggests that the decongestant has been effective? a)Increased tearing b)Headache c)Reduced sneezing d)Increased salivation

Reduced sneezing Explanation: Decongestants relieve congestion and sneezing and reduce labored respirations. When effective, decongestants dry the mucous membranes; therefore, the client shouldn't experience increased salivation or tearing. Because decongestants alleviate congestion, they also relieve headaches, which may be caused by congestion.

Antibodies formed by lymphocytes and plasma cells in response to animmunogenic stimulus are called ____ a family of closely related proteins capable of acting as antibodies

immunoglobulins

Antibodies that are formed by lymphocytes and plasma cells in response to an immunogenic stimulus constitute a group of serum proteins called _________

immunoglobulins

a family of closely related proteins capable of acting as antibodies

immunoglobulins

A client reports to a physician's office for intradermal allergy testing. Before testing, the nurse provides client teaching. Which client statement indicates a need for further education? "I'll go directly to the pharmacy with my EpiPen prescription." "The test may be mildly uncomfortable." "If I notice tingling in my lips or mouth, gargling may help the symptoms." "I may experience itching and irritation at the site of the testing."

"If I notice tingling in my lips or mouth, gargling may help the symptoms."

A client presents at the clinic with an allergic disorder. The client asks the nurse what an "allergic disorder" means. What would be the nurse's best response? "It means you are very sensitive to something inside of yourself." "It is a harmless reaction to something in the environment." "It is a muted response to something in the environment." "It is a hyperimmune response to something in the environment that is usually harmless."

"It is a hyperimmune response to something in the environment that is usually harmless."

Antibodies react with antigens in a variety of ways (3)

(1) by coating the antigens' surfaces if they are particular substances (2) by neutralizing the antigens if they are toxins, (3) by precipitating the antigens out of solution if they are dissolved.

SIT immunotherapy instruction for patient

- remain in the primary provider's office for at least 30 minutes after the injection, so that emergency treatment can be given if the patient has a reaction - avoiding rubbing or scratching the injection site - continuing with the series for the period of time required. * patient and family are instructed about emergency treatment of severe allergic symptoms.

Immunotherapy Indications

- Allergic rhinitis, conjunctivitis, or allergic asthma - History of a systemic reaction to Hymenoptera and specific immunoglobulin E antibodies to Hymenoptera venom - Desire to avoid the long-term use, potential adverse effects, or costs of medications - Lack of control of symptoms by avoidance measures or the use of medications

allergic dermatitis treatment

- Avoidance of offending material - Aluminum acetate (Burow Solution, Domeboro Powder) or cool water compress - Systemic corticosteroids (prednisone) for 7-10 days - Topical corticosteroids for mild cases - Oral antihistamines to relieve pruritus

Epicutaneous Immunotherapy

- Because the epidermis is less vascular, there is reduced risk of systemic allergic side effects due to inadvertent intravascular allergen delivery

Because allergic rhinitis is induced by airborne pollens or molds, it is characterized by the following seasonal occurrences

- Early spring—tree pollen (oak, elm, poplar) - Early summer—grass pollen (Timothy, Redtop) - Early fall—weed pollen (ragweed)

irritant dermatitis treatment

- Identification and removal of source of irritation - Application of hydrophilic cream or petrolatum to soothe and protect - Topical corticosteroids and compresses for weeping lesions - Antibiotics for infection and oral antihistamines for pruritus

Irritant contact dermatitis treatment

- Referral for diagnostic testing - Avoidance of exposure to irritant - Thorough washing and drying of hands - Use of powder-free gloves with more frequent changes of gloves - Changing glove types - Use of water- or silicone-based moisturizing creams, lotions, or topical barrier agents - Avoidance of oil- or petroleum-based skin agents with latex products, because they cause breakdown of the latex product

Hereditary angioedema clinical manifestations

- swelling usually is diffuse - does not itch - is not accompanied by urticaria. - Gastrointestinal edema may cause abdominal pain severe enough to be incapacitating. - attacks last 2 to 4 days and resolve without intervention - can cause respiratory obstruction and asphyxiation

Interpretation of Skin Test Results - A positive reaction:

- urticarial wheal - localized erythema -pseudopodia (irregular projection at the end of a wheal) with associated erythema * is considered indicative of sensitivity to the corresponding antigen.

Second-Generation H1 Antihistamines (Nonsedating)

-Cetirizine (Zyrtec) -Desloratadine (Clarinex) -Loratadine (Alavert, Claritin) -Fexofenadine (Allegra) -Levocetirizine (Xyzal)

Primary Chemical Mediators

-Histamine -Eosinophil chemotactic factor of anaphylaxis -Platelet-activating factor -Prostaglandins

most common food to cause allergies

-seafood (lobster, shrimp, crab, clams, fish) - peanuts, tree nuts - berries - eggs - wheat - milk - chocolate

Patients should be advised that a "rebound" anaphylactic reaction canoccur ________ hours after an initial attack, even when epinephrinehas been given.

4 to 10

Eosinophils, which are granular leukocytes, normally make up 2% to 5% of the total number of WBCs. They can be found in blood, sputum, and nasal secretions. A level greater than___ to ____ is considered abnormal and may be found in patients with allergic disorders

5% to 10%

Atopic allergic disorders are characterized by which of the following? a)An IgA-mediated reaction b)A hereditary predisposition c)Production of a systemic reaction d)A response to physiologic allergens

A hereditary predisposition Explanation: Atopic allergic disorders are characterized by a hereditary predisposition and production of a local reaction to IgE antibodies produced in response to common environmental allergens. Atopic and nonatopic allergic disorders are IgE-mediated allergic reactions

The nurse practitioner treating a patient with allergic rhinitis decides pharmacologic therapy would be helpful. Which of the following is she most likely to prescribe? Rhinocort Sudafed Allegra Afrin

Allegra

what is the most common form of respiratory allergy, which is presumed to be mediated by an immediate (type I hypersensitivity) immunologic reaction.

Allergic rhinitis (hay fever, seasonal allergic rhinitis)

A patient was seen in the clinic for hypertension and received a prescription for a new antihypertensive medication. The patient arrived in the emergency department a few hours after taking the medication with severe angioedema. What medication prescribed may be responsible for the reaction? Beta blocker Vasodilator Angiotensin-converting enzyme (ACE) inhibitor Angiotensin receptor blocker

Angiotensin-converting enzyme (ACE) inhibitor

A nurse knows of several patients who have achieved adequate control of their allergy symptoms using over-the-counter antihistamines. Antihistamines would be contraindicated in the care of which patient? A) A patient who has previously been treated for tuberculosis B) A pregnant woman at 30 weeks gestation C) A patient who is on estrogen-replacement therapy D) A patient with a severe allergy to eggs

B) A pregnant woman at 30 weeks gestation

A nurse comes to the employee health center for evaluation and is diagnosed with allergic contact dermatitis related to latex. Which of the following would the nurse most likely exhibit? Rhinitis Angioedema Blistering Laryngeal edema

Blistering

_________ and ______________ agents cause the most serious anaphylactic reactions.

Antibiotics and radiocontrast

The best treatment for latex allergy includes which of the following? Emergency kit with epinephrine Antihistamines Avoidance of latex-based products Corticosteroids

Avoidance of latex-based products

lymphocyte cells that are important in producing circulating antibodies

B cells

A child has been transported to the emergency department (ED) after a severe allergic reaction. The ED nurse is evaluating the patients respiratory status. How should the nurse evaluate the patients respiratory status? Select all that apply. A) Facilitate lung function testing. B) Assess breath sounds. C) Measure the childs oxygen saturation by oximeter. D) Monitor the childs respiratory pattern. E) Assess the childs respiratory rate.

B) Assess breath sounds. C) Measure the childs oxygen saturation by oximeter. D) Monitor the childs respiratory pattern. E) Assess the childs respiratory rate.

A patient is receiving a transfusion of packed red blood cells. Shortly after initiation of the transfusion, the patient begins to exhibit signs and symptoms of a transfusion reaction. The patient is suffering from which type of hypersensitivity? A) Anaphylactic (type 1) B) Cytotoxic (type II) C) Immunecomplex (type III) D) Delayed type (type IV)

B) Cytotoxic (type II) occurs when the system mistakenly identifies a normal constituent of the body as foreign. This reaction may be the result of a cross-reacting antibody, possibly leading to cell and tissue damage.

A patient has a documented history of allergies presents to the clinic. She states that she is frustrated by her chronic nasal congestion, anosmia (inability to smell) and inability to concentrate. The nurse should identify which of the following nursing diagnoses? A) Deficient Knowledge of Self-Care Practices Related to Allergies B) Ineffective Individual Coping with Chronicity of Condition and Need for Environmental Modification C) Acute Confusion Related to Cognitive Effects of Allergic Rhinitis D) Disturbed Body Image Related to Sequelae of Allergic Rhinitis

B) Ineffective Individual Coping with Chronicity of Condition and Need for Environmental Modification

A nurse is aware of the need to assess patients risks for anaphylaxis. What health care procedure constitutes the highest risk for anaphylaxis? A) Administration of the measles-mumps-rubella (MMR) vaccine B) Rapid administration of intravenous fluids C) Computed tomography with contrast solution D) Administration of nebulized bronchodilators

C) Computed tomography with contrast solution

A child is undergoing testing for food allergies after experiencing unexplained signs and symptoms of hypersensitivity. What food items would the nurse inform the parents are common allergens? A) Citrus fruits and rice B) Root vegetables and tomatoes C) Eggs and wheat D) Hard cheeses and vegetable oils

C) Eggs and wheat

The nurse is administering a sympathomimetic drug to a patient. What areas of concern does the nurse have when administering this drug? (Select all that apply.) Constricts integumentary smooth muscle Causes laryngospasm Causes bronchoconstriction Dilates the muscular vasculature Causes bronchodilation

Causes bronchodilation Constricts integumentary smooth muscle Dilates the muscular vasculature

The nurse is preparing to administer a medication that has an affinityfor H1 receptors. Which medication would the nurse administer? a. Diphenhydramine b. Omeprazole c. Cimetidine d. Ranitidine

Diphenhydramine

An adolescent patients history of skin hyperreactivity and inflammation has been attributed to atopic dermatitis. The nurse should recognize that this patient consequently faces an increased risk of what health problem? A) Bronchitis B) Systemic lupus erythematosus (SLE) C) Rheumatoid arthritis D) Asthma

D) Asthma

A nurse is preparing a patient for allergy skin testing. Which of the following precautionary steps is most important for the nurse to follow? A) The patient must not have received an immunization within 7 days. B) The nurse should administer albuterol 30 to 45 minutes prior to the test. C) Prophylactic epinephrine should be administered before the test. D) Emergency equipment should be readily available.

D) Emergency equipment should be readily available -before skin testing with allergens is performed: * Testing is not performed during periods of bronchospasm. * Epicutaneous tests (scratch or prick tests) are performed before other testing methods, in an effort to minimize the risk of systemic reaction. * Emergency equipment must be readily available to treat anaphylaxis.

The nurse is creating a care plan for a patient suffering from allergic rhinitis. Which of the following outcomes should the nurse identify? A) Appropriate use of prophylactic antibiotics B) Safe injection of corticosteroids C) Improved skin integrity D) Improved coping with lifestyle modifications

D) Improved coping with lifestyle modifications

A patient has developed severe contact dermatitis with burning, itching, cracking, and peeling of the skin on her hands. What should the nurse teach the patient to do? A) Wear powdered latex gloves when in public. B) Wash her hands with antibacterial soap every few hours. C) Maintain room temperature at 75F to 80F whenever possible. D) Keep her hands well-moisturized at all times.

D) Keep her hands well-moisturized at all times.

The nurse is providing care for a patient who has a diagnosis of hereditary angioedema. When planning this patients care, what nursing diagnosis should be prioritized? A) Risk for Infection Related to Skin Sloughing B) Risk for Acute Pain Related to Loss of Skin Integrity C) Risk for Impaired Skin Integrity Related to Cutaneous Lesions D) Risk for Impaired Gas Exchange Related to Airway Obstruction

D) Risk for Impaired Gas Exchange Related to Airway Obstruction

When assessing the skin of a client with allergic contact dermatitis, the nurse would most likley expect to find irritation at which area? Plantar aspects of the feet Lower arms Ankles Dorsal aspect of the hand

Dorsal aspect of the hand

When a patient experiences an allergic reaction, the nurse should initially assess for:

Dyspnea, bronchospasm, and/or laryngeal edema. Explanation: Initial nursing assessment and intervention needs to be directed toward evaluating breathing and maintaining an open airway.

Injected allergens are used for "hyposensitization" and may produce systemic reactions that can be harmful. Which of the following medications should be on hand in case of an adverse reaction? Epinephrine Pyribenzamine Phenergan hydrochloride Dramamine

Epinephrine Explanation: Although severe systemic reactions occur in less than 1% of patients, the risk for potentially fatal anaphylaxis exists. It tends to occur at the beginning of the treatment cycle. Because of this risk, epinephrine should be immediately available.

How is epinephrine administered?

Epinephrine, in a 1:1000 dilution, is given subcutaneously in the upper extremity or thigh and may be followed by a continuous intravenous infusion.

__________ is the major mediator of allergic reactions in the nasal mucosa.

Histamine

patient receiving subcutaneous Immunotherapy must remain in the clinic for at least 30 minutes after the injection and is observed for possible systemic symptoms. What happens if a large, local swelling develops?

If a large, local swelling develops at the injection site, the next dose should not be increased, because this may be a warning sign of a possible systemic reaction

A client develops a facial rash and urticaria after receiving penicillin. Which laboratory value does the nurse expect to be elevated? a)IgG b)IgE c)IgA d)IgB

IgE Explanation: 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

______________ allergy, a type I hypersensitivity reaction, occurs in about 2% of the adult population; it is thought to occur in people who have a genetic predisposition combined with exposure to allergens early in life through the gastrointestinal or respiratory tract or nasal mucosa.

IgE-mediated food

There are several types of reactions to latex. The nurse knows to be most concerned about laryngeal edema with the following reaction: Allergic contact. IgG antibodies. Irritant contact. IgE-mediated hypersensitivity.

IgE-mediated hypersensitivity.

__________ , also referred to as allergy vaccine therapy, involves the administration of gradually increasing quantities of specific allergens to the patient until a dose is reached that is effective in reducing disease severity from natural exposure.

Immunotherapy

The clinic nurse is caring for a client with an allergic disorder who has received the first sensitizing dose of a new drug. Now, the client is given a second dose. What nursing action is most important at this stage of transition? a)Assess the client for reduced urine output. b)Monitor the client for reactions. c)Assess the client for reduced appetite. d)Monitor the client for increased heart rate.

Monitor the client for reactions. Explanation: Monitoring the client is necessary when a second dose of a new drug is administered because reactions may follow the first sensitizing dose. Although it is important to ensure the client's comfort, it is not essential to assess the client for changes in urine output, appetite, or heart rate.

most common medications to cause dermatitis medicamentosa?

Penicillin, cephalosporin, and sulfonamide antibiotics are most commonly implicated

This type of testing is helpful in identifying clinically significant allergens in patients who have a large number of positive tests.

Provocative Testing

A client being treated for an allergy has been prescribed antihistamines. The Kardex of this client reads as follows: Age: 32; Profession: Carpenter; Lifestyle & diet: Lives alone, average smoker, nonalcoholic, no food preferences, practices yoga; Medical history: Suffers from hay fever, recent urinary tract infection that has been treated successfully. What information from the Kardex is likely to have the greatest implication in educating the client about antihistamine administration? The client's age The client's medical history The client's smoking habit The client's profession

The client's profession

first line of defense against microbial invaders?

The epithelial cells that coat the skin and make up the lining of the respiratory, gastrointestinal, and genitourinary tracts

The nurse is conducting a community education program on allergies and anaphylactic reactions. The nurse determines that the participants understand the education when they make which of the following statements about anaphylaxis? Systemic reactions include urticaria and angioedema. Anaphylactoid (anaphylaxislike) reactions are commonly fatal. The most common food item causing anaphylaxis is chocolate. The most common cause of anaphylaxis is penicillin.

The most common cause of anaphylaxis is penicillin.

What education should the nurse provide to the patient taking long-term corticosteroids? Corticosteroids are relatively safe drugs with very few side effects. The patient should take the medication only as needed and not take it unnecessarily. The patient should not stop taking the medication abruptly and should be weaned off of the medication. The patient should discontinue using the drug immediately if weight gain is observed.

The patient should not stop taking the medication abruptly and should be weaned off of the medication.

Which of the following statements describes the clinical manifestations of a delayed hypersensitivity (type IV) allergic reaction to latex? They occur within minutes after exposure to latex. They may worsen when hand lotion is applied before donning latex gloves. They can be eliminated by changing glove brands or using powder-free gloves. They are localized to the area of exposure, usually the back of the hands.

They are localized to the area of exposure, usually the back of the hands.

An _________ reaction is a manifestation of tissue injury resulting from interaction between an antigen and an antibody.

allergic

In _______________, the body encounters allergens that are types of antigens, usually proteins that the body's defenses recognize as foreign, and a series of events occurs in an attempt to render the invaders harmless, destroy them, and remove them from the body.

allergic reactions

four types of contact dermatitis

allergic, irritant, phototoxic, and photo allergic

inappropriate and often harmful immune system response to substances that are normally harmless

allergy

whats an allergy?

an inappropriate and often harmful response of the immune system to normally harmless substances, called allergens (dust, weeds, pollen, dander)

Nurses should be aware that atopic dermatitis is often linked in a process called the _____________ that often leads to asthma, allergic rhinitis, or food allergy.

atopic march

The ___________ is the most suitable area of the body for skin testing because it permits the performance of many tests.

back

angioneurotic edema:

condition characterized by urticaria and diffuse swelling of the deeper layers of the skin (i.e., angioedema)

Two examples of a type IV hypersensitivity reaction (occurs 24 to 72hours after exposure)

contact dermatitis, latex allergy

Allergen desensitization

exposure to pollen, dust, dander to develop tolerance *is primarily used to treat IgE-mediated diseases by injections of allergen extracts.

angioneurotic edema

involves the deeper layers of the skin, resulting in more diffuse swelling rather than the discrete lesions characteristic of hives. It is manifested by non-pruritic, brawny, non-pitting edema with well-defined margins and erythema similar to urticaria

IgE-producing cells are found in:

located in the respiratory and intestinal mucosa.

connective tissue cells that contain heparin and histamine in their granules

mast cells

Two or more IgE molecules bind together to an allergen and trigger ____________ or _____________ to release chemical mediators, such as histamine, serotonin, kinins, slow-reacting substances of anaphylaxis, and the neutrophil factor, which produces allergic skin reactions, asthma, and hay fever.

mast cells or basophils

A patient was seen in the clinic for hypertension and received aprescription for a new antihypertensive medication. The patientarrived in the emergency department a few hours after taking themedication with severe angioedema. What medication prescribed maybe responsible for the reaction? a. Beta blocker b. Angiotensin-converting enzyme (ACE) inhibitor c. Angiotensin receptor blocker d. Vasodilator

Angiotensin-converting enzyme (ACE) inhibitor

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? a)Maintains pressure on the auto-injector for about 30 seconds after insertion b)Jabs the autoinjector into the outer thigh at a 90-degree angle c) Avoids massaging the injection site after administration d)Pushes down on the grey release cap to administer the medication

Jabs the autoinjector into the outer thigh at a 90-degree angle Explanation: 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 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"? a)Use the medication every 4 hours to prevent congestion from recurring. b)Drink plenty of fluids. c)Be sure to use the Afrin for at least 10 days to ensure the stuffiness is gone. d)Only use the Afrin for 3 to 4 days once every 12 hours.

Only use the Afrin for 3 to 4 days once every 12 hours. Explanation: 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.

The nurse is evaluating the plan of care for a client with an allergic disorder who has a nursing diagnosis of deficient knowledge related to measures for allergy control. Which of the following would indicate to the nurse that the outcome has been met? Client demonstrates appropriate coping strategies for dealing with a chronic disorder. Client identifies methods for reducing exposure risk to allergens. Client states the need for coughing and deep breathing. Client reports an absence of symptoms associated with the allergy.

Client identifies methods for reducing exposure risk to allergens. Explanation: For the nursing diagnosis of deficient knowledge, the client's ability to identify methods for reducing the risk of allergen exposure indicates that the outcome has been met. The statment about coughing and deep breathing and an absence of symptoms would be appropriate for evaluating the nursing diagnosis of ineffective breathing pattern. Positive coping strategies would be an appropriate outcome for a nursing diagnosis of ineffective coping.

A patients decline in respiratory and renal function has been attributed to Goodpasture syndrome, which is a type II hypersensitivity reaction. What pathologic process underlies the patients health problem? A) Antigens have bound to antibodies and formed inappropriate immune complexes. B) The patients body has mistakenly identified a normal constituent of the body as foreign. C) Sensitized T cells have caused cell and tissue damage. D) Mast cells have released histamines that directly cause cell lysis.

B) The patients body has mistakenly identified a normal constituent of the body as foreign. - In Goodpasture syndrome, it generates antibodies against lung and renal tissue, producing lung damage and kidney injury

A nurse is reviewing the dietary history of a client who has experienced anaphylaxis. Which of the following would the nurse identify as a common cause of anaplhylaxis? Select all that apply? Shrimp Chicken Beef Eggs Milk

Milk Eggs Shrimp

A nurse is preparing a presentation to a local commununity group about allergic disorders. Which medication would the nurse include as the most common cause of anaphylaxis? a)Penicillin b)Iodine contrast agent c) Morphine d) Aspirin

Penicillin Explanation: Although aspirin, morphine (an opioid) and radiocontrast agents such as iodine can cause anaphylaxis, penicillin is the most comon cause of anaphylaxis, accounting for about 75% of fatal anaphylactic reactions in the United States each year.

this test involves the direct administration of the suspected allergen to the sensitive tissue, such as the conjunctiva, nasal or bronchial mucosa, or gastrointestinal tract (by ingestion of the allergen), with observation of target organ response.

Provocative Testing

most consistent features of atopic dermatitis?

Pruritus and hyperirritability of the skin are the most consistent features of atopic dermatitis and are related to large amounts of histamine in the skin.

instruction for a patient taking antihistamine

- Because antihistamines may produce drowsiness, the patient is cautioned about this and other side effects applicable to the medication. - Operating machinery, driving a car, and performing activities that require intense concentration should be postponed. - The patient is also informed about the dangers of drinking alcohol when taking antihistamines, because they tend to exaggerate the effects of alcohol.

The nurse is administering a sympathomimetic drug to a patient. Whatareas of concern does the nurse have when administering this drug?(Select all that apply.) a. Causes bronchodilation b. Constricts integumentary smooth muscle c. Dilates the muscular vasculature d. Causes bronchoconstrictione. Causes laryngospasm

- Causes bronchodilationb. - Constricts integumentary smooth musclec. - Dilates the muscular vasculature

Irritant contact dermatitis

- Damage to skin because of irritation and loss of epidermoid skin layer - not an allergic reaction. - caused by excessive use of soaps and cleansers, repeated handwashing, inadequate hand drying, mechanical irritation (e.g., sweating, rubbing inside powdered gloves), exposure to chemicals added during the manufacturing of gloves, and alkaline pH of powdered gloves. * benign, and is not life-threatening.

Latex allergy

- Type I IgE-mediated immediate -hypersensitivity to plant proteins in natural rubber latex -Severe reactions usually occur shortly after parenteral or mucous membrane exposure. - risk for anaphylaxis - Local swelling, redness, edema, itching, and systemic reactions, including anaphylaxis, occur within minutes after exposure.

Patients need to understand the difference between rescue medications for allergy exacerbation and seasonal flares (e.g., ______________) and medications used for allergy control throughout the year (e.g., _______________, __________).

- antihistamines - inhaled corticosteroids, leukotriene modifiers

Familial atypical cold urticaria (FACU)

- autosomal dominant condition - inherited from one affected parent -symptoms usually begin at birth within the first 6 months of life

four major signs and symptoms of allergic rhinitis include

- copious amounts of serous - nasal discharge - nasal congestion - sneezing - nose and throat itching.

allergic dermatitis

Results from contact of skin and allergenic substance; has a sensitization period of 10-14 days

irritant dermatitis

Results from contact with a substance that chemically or physically damages the skin on a nonimmunologic basis; occurs after first exposure to irritant or repeated exposures to milder irritants over an extended time