immune system/allergies

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immune system/allergies
2010-03-30 19:18:32
immune system allergies

immune system/allergies
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  1. visible signs that the immune system is working
    • healing wounds
    • inflammation-increases blood flow to the site
    • recovery from illness
    • healthy or absence of disease

    • the body's mechanism to eliminate organisms is through N/V
    • hydrochloric acid is a natural barrier
  2. allergies
    allergies occur when the immune system works incorrectly or unexpectedly

    adverse reactions to certain stimuli that other people do not react to at all

    sx vary and can be mild/local to severe/life-threatening
  3. contrast local from systemic adverse reaction
    • local:
    • uticaria (itching), wheals, and angioedema occur at the site of exposure
    • may be severe but rarely fatal

    • systemic:
    • involve multiple organsystems and can result in respiratory cardiovascular collapse, cardiopulmonary collapse
  4. inhaled allergens
    allergic rhinitis
    • airborne pollens or molds
    • sneezing
    • nasal congestion and drainage
    • itching nose, throat, and ears
    • headaches and epistaxis
  5. ingested allergens
    • frequent foods that cause adverse allergic reactions include peanuts, shellfish, milk, eggs, soy and wheat
    • medications-ATBs, NSAIDs, opioids, especially PCN
  6. injected allergens
    • IV anesthetics
    • contrast media
    • antibiotics
    • vaccines
    • insect and bee stings
    • serum sickness-for black widow bites, snake venom, rabies-serum conteracts, ex. use to use horse serum
    • PCN is responsible for 75% of anaphylactic death
  7. contact allergens
    • perfume
    • lotions
    • cosmetics
    • jewelry
    • poison ivy
    • latex-pts susceptible are those with spina bifida, multiple surgeries, and nurses
    • soap

    can be mild/local to severe/systemic
  8. diagnostic data
    • H&P with sx
    • CBC with Eosinophil count
    • -elevated levels bten 5-15 is not specific, but higer numbers indicate an allergy (15-45), some may be at risk for leukemia if above 45
    • radioallergosorbent test (RAST)-2 or more is significant, advantages-no systemic response or a decreased risk, doesn't react with histamines so it doesn't affect test results
    • serum immunoglobulin E (IgE)
    • provocative testing-come in contact with allergen, good for people with multiple allergies, put to skin surface or mucosa, test one atigen at a time, target response
  9. skin testing
    advantages-can test for multiple allergens, look for wheals
  10. preparation for skin testing
    • usually not performed during periods of wheezing
    • scratch tests are usually performed before other methods to prevent risk of systemic reaction
    • epinepherine/emergency equipment and trained personel must be available
    • withold antihistamines, steroids and over the counter allergy meds for one week to prevent false negative results
  11. medical interventions
    • avoid allergens
    • allergy shots (immunotherapy)
    • medications
    • continue allergy medications

    • may need to be desensitized
    • hepa filters
    • wash bed linens in hot water
    • windows rolled up
    • outside-wear mask
    • wash air b/f bed
    • remove carpet, upolstery, drapery
    • immune therapy-may take 3-5 yrs to be effective, avoid lapses btwn tx, given in small does over a period of time on a regular basis
  12. medications
    • antihistamines block the effects of histamine at the H1 receptoer sites
    • they do not block the release of histamine

    antihistamines produce anitcholinergic effects that may cause sedation, constipation, dry eyes, and blurred vision

    • ex. Zertec, Claritin
    • take when symptomatic
  13. adrenergic agents
    dec nasal congestion and mucosal edema

    examples include Afrin, Neo-Synephrine and Sudafed

    assess for s/e of HTN, dysrhythmias, irritability, and tremors
  14. mast cell stabilizers
    • reduce the release of histamine
    • may be used prohylactically to prevent sx b/f and after exposure to antigens
    • may take one week b/f relief of sx
    • Comolyn effects include mild local stinging and burning
  15. steriods
    • dec inflammation
    • may be administered intranasally, orally, or by injection
    • intranasal meds may take 2 wks b/f relief is obtained
    • examples include-Flonase, Beconase, or dexamethoasone (Decadron)
    • severe sx may be treated with injections of steriods followed by a Medrol dose pack
    • S/E-HTN, gastric irritation, glucose intolerance, wt gain, and adrenal suppression
  16. anaphylaxis
    • a life-threatening reaction in which sx develop rapidly, often w/i seconds or minutes
    • 3.3-43 million Americans are at risk for the development of anaphylaxis in the USA

    • LATEX
  17. clinical manifestations of anaphylaxis
    • fullness or tight feeling in the throat
    • bronchospasm
    • laryngeal edema-quickly need to intubate b/c it may be too difficult later
    • severe dyspnea
    • seizures
    • cardiac arrest
  18. medical interventions for anaphylaxis
    • ariw, breathing, and VS
    • Epinephrine 1:1000 SQ upper arm or thich
    • steriods and antihistamines
    • IV fluids and vasopressors to support BP
    • Aminophylline to improve airway
    • hospitalize to avoid rebound reaction 4-10 hrs after initial reaction
  19. client teaching for anaphylaxis
    • sef-administration of Epinephrine
    • carry EPI at all times
    • medic alert bracelet
    • avoidance of antigens
    • immunotherapy