Chapter 33 outline.pdf

lOMoARcPSD|46511380 Chapter 33-Assessment and Management of Patients with Allergic Disorders Allergic Response  Allergy o Inappropriate response of the immune system to normally harmless substances called allergens  Antigen...

lOMoARcPSD|46511380 Chapter 33-Assessment and Management of Patients with Allergic Disorders Allergic Response  Allergy o Inappropriate response of the immune system to normally harmless substances called allergens  Antigens = substance that causes the allergy  Antibody = produced when body responds to the antigen  Role of B cells and T cells  Chemical Mediators: o Primary=Histamine, Prostaglandins, Platelet activating factor o Secondary=Leukotrienes, Bradykinin, Serotonin Hypersensitivity  Type I – Anaphylactic Hypersensitivity o Full blown anaphylaxis o Don’t always know what will cause it until it happens o Latex is a popular example  Need to wait for latex free equipment EVEN IN AN EMERGENCY SITUATION  Type II – Cytotoxic Hypersensitivity o Auto Immune  Type III: Immune Complex Hypersensitivity o Typical immune response but NOT an autoimmune response  Type IV: Delayed Hypersensitivity o No reaction at 昀椀rst but reaction happens after the second or third time of contact Diagnostic Evaluation of Allergic Disorders o IgE test – hospital world  Labs that are done after someone has a suspected allergy  IgE shows there WAS a reaction but not what the reaction originated from o Skin test  Most speci昀椀c to 昀椀gure out speci昀椀c allergies  This gives exactly what the individual is allergic to and to what degree Anaphylaxis  Severe medical emergency! Type of distributive shock  A clinical response to an immediate reaction between a speci昀椀c antigen and antibody o Rapid release of IgE mediated chemicals  Many common causes Downloaded by vea de leon ([email protected])  lOMoARcPSD|46511380  Symptoms may be mild or moderate, but can progress rapidly to severe  PREVENTION IS KEY  This is systemic! We have a breathing, airway, AND circulation issue. Concern for Anaphylaxis?  A – changes in voice, drooling, stridor, changes in breathing pattern  B – wheezing, dyspnea, diminished air sounds, NO SOUNDS – everything has closed o昀昀 (YIKES)  C – hypotension, syncope, hypoperfusion, everything is closing o昀昀, blood isn’t getting back to where it should  D (Disability) – angioedema, hives  E (Exposure) – remove patient from stimulus that created the reaction  Oxygen treatment when available  Epinephrine (adrenaline) o 1:1000 solution o 0.5 mL IM  Fluids  Benadryl, Albuterol (open bronchioles), and Corticosteroids (stop the in昀氀ammation)  Stop med/infusion  Assessment of systems  Prioritize based on what you see in that moment Anaphylaxis—Nursing Management  Assess for ABC’s  Observe for S/S of increasing edema or respiratory distress  Prepare for intubation, IV access, and IVF administration  Monitor VS  PATIENT (and family) EDUCATION!  Prescriptions Allergic Rhinitis  A form of Type I hypersensitivity  The most common form of respiratory allergy  May interfere with sleep, leisure, school, and quality of life  4 major S/S o Post nasal drip o Cough o Itchy eyes o Fatigue  Allergic Rhinitis-Medical Management-Avoidance Therapy  Avoidance Therapy o Avoid allergic triggers such as dust, tobacco smoke, and pollen  Humidi昀椀ers  Saline nasal sprays Allergic Rhinitis-Medical Management-Pharmacologics  Antihistamines (H1 receptor agonists) Downloaded by vea de leon ([email protected])  lOMoARcPSD|46511380 o Prevent the action of histamine o Major side e昀昀ects o First generation vs second generation  1st Gen – Benadryl WILL MAKE YOU DROWSY  2nd Gen – Zyrtec and Allegra  Education – do not operate heavy machinery until you know how you react to this medicine  Adrenergic Agents  Vasoconstrictors  Major side e昀昀ects o Dries everything out o Hypertension o Arrhythmias o CNS stimulation o Irritability o Tremor o Tachyphylaxis  Mast Cell Stabilizers o Reduce the release of histamine o Nasal Spray o Do not use for long periods of time due to rebound congestion  Corticosteroids o Intranasal o Indicated for more severe cases o Limited use of 30 days  Leukotriene Modi昀椀ers o Have e昀昀ects on the immune system o For long term use  Immunosuppressive Allergic Rhinitis-Medical Management-Immunotherapy  Also known as allergic desensitization or allergic vaccine therapy o Administration of allergens until disease severity is reduced  Requires long term administration before allergy disease course is altered  Can be given subcutaneously, sublingual, or epicutaneous  Patient needs to be o昀昀 allergy regime for 2 weeks during this time  Long term maintenance therapy  Takes some time to build up a therapeutic e昀昀ect Downloaded by vea de leon ([email protected])  lOMoARcPSD|46511380 Allergic Rhinitis—Nursing Management  Improve Breathing Patterns o Reduce exposure to individuals with URI’s  Promote understanding of allergy and allergy control o Modify the environment to reduce allergens o Medication use  Coping with a chronic disorder  Monitoring and Managing Complications o Anaphylaxis and Impaired breathing o Nonadherence to therapeutic regimen  Educate patients about self-care Contact Dermatitis  A type IV hypersensitivity caused by contact with an external substance that elicits an allergic response  4 basic types o Allergic, irritant, phototoxic, photo allergic  Stop using whatever is causing the allergy o Detergent, jewelry, perfumes, etc. Atopic Dermatitis  A chronic type I hypersensitivity characterized by in昀氀ammation and hyper reactivity of the skin with recurrent remissions and exacerbations  Also known as Atopic eczema  Pruritus, Hyperirritability, papules, and excessive dryness  Can lead to asthma, allergic rhinitis, and food allergies Dermatitis Medicamentosa  A type I hypersensitivity  Skin rashes associated with medications  Leading cause of death from anaphylaxis  Sudden appearance of rash sometime associated with other systemic symptoms  Can cause infection if it slofts o昀昀  Keep a look out for reactions when it’s the 昀椀rst time a patient is getting a medication Urticaria (Hives)  Type I hypersensitive allergic reaction of the skin  Sudden appearance of edematous pink or red wheals that vary in size and can remain for minutes to hours o Can also take this long to appear  May involve any part of the body  Common causes Angioedema  Neurotic edema (Angioedema) o More di昀昀use swelling of the deeper layers of the skin o Non-pruritic edema and erythema Downloaded by vea de leon ([email protected])  lOMoARcPSD|46511380  Only swelling o Appears suddenly and goes away within a day o Can be caused by stress  Hereditary Angioedema o Not an immunologic disorder o Autosomal dominant disorder with similar presentation to allergic angioedema Food Allergy  A type I hypersensitivity reaction  Thought to occur in patients with genetic predispositions combined with exposure to allergies early in life  More than 170 foods have been associated with allergic reactions  Classic allergic symptoms combined with GI symptoms Latex Allergy  Hypersensitivity (Type 1 or Type 4) to latex containing products o Type 4 – can become sensitive to latex w/ continuous exposure to the material  8-17% of healthcare workers are at risk  Many di昀昀erent types of reactions can occur o Localized itching, erythema, or local urticaria are typically 昀椀rst S/S  Diagnosis based on history and skin patch testing  Management o Avoid all latex products if pt has allergy o If medical emergency, wait for latex free equipment to show up  Spina bi昀椀da patients have latex allergies Downloaded by vea de leon ([email protected])