Allergic Disorders (Grad)

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Allergic Disorders (Grad)
2014-11-23 00:00:29
Allergic Disorders grad

Allergic Disorders
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  1. Role/Response of Immune System
    Defends the body's tissues from invasion by pathogens and allergens

    *Production of antibodies in response to haptens

    *Coating antigens with antibodies

    *Neutralize toxins

    *Prepare antigens for disposal
  2. Nonspecific immunity present at birth (epithelial cells) with the same response every time and first line of defense
    Natural Immunity
  3. Developed immunity after birth, guided by cellular mediators like cytokines released in response to natural immunity (Vaccine)
    Acquired Immunity
  4. Destroy antigens, signals macrophages to bring any antigens to them...they digest them and clean up debris
    T Lymphocytes
  5. ____ are the factory for antibody production
    Plasma Cells
  6. In response to antigens, ____ cells stimulate even more plasma cells and more antibodies are made
    B cells (B lymphocytes)
  7. Body's Mechanisms of Defense
    Phagocytic (macrophages)

    Humoral Response

    Cellular Response
  8. Immune Cycle/Response:
    Initial contact with allergen

    Plasma cell releases IgE antibodies 

    Mast cell has memory

    Subsequent contact with allergen creates histamine and leukotrienes to release 

    Causing an allergic reaction
  9. "reflection of excessive or aberrant immune response to any type of stimulus"
  10. Type 1 Hypersensitivity
    IgE recognizes antigen, stimulates mast cell to release histamine and other immune mediators

    (Extrinsic asthma, allergic rhinitis, anaphylaxis, insect stings)
  11. Clinical Manifestations of Type 1 hypersensitivity
    • Local:
    • -vasodilation
    • -increased capillary permeability
    • -smooth muscle contraction
    • -eosinophilia
    • -urticaria

    • Systemic:
    • -laryngeal stridor
    • -angioedema
    • -hypotension
    • -bronchial
    • -GI or uterine spasm
  12. Internally, body misidentifies part of itself as foreign (cell and tissue damage)
    Type 2 Hypersensitivity (Cytotoxic)
  13. Types of Type 2 Hypersensitivity
    • MG (myasthenia gravis)
    • Transfusion reactions
    • Thrombocytopenia
  14. Antigens bind to antibodies, create immune complexes, become lodged in tissues and result in tissue injury, and vascular permeability
    Type 3 Hypersensitivity (Immune Complex)
  15. Ex of Type 3 Hypersensitivity
    • Rheumatoid Arthritis
    • Systemic Lupus Erythematosus
  16. Result of interaction of T cells at the site of antigen, tissue damage from interactions of macrophages and lysozymes
    • Type 4 Hypersensitivity
    • (delayed type, cellular hypersensitivity)
  17. Ex of Type 4 Hypersensitivity
    Hashimoto's Thyroiditis Sarcoidosis

    Graft vs Host Disease

    Contact Dermatitis
  18. Clinical manifestations of Type 4 Hypersensitivity
    Itching, Erythema
  19. Dx Hypersensitivity
    Pt assessment:

    • -patient hx (mild, mod, severe reactions)
    • -degree of discomfort
    • -time interval

    • LABS:
    • -CBC, Eosinophils, IgE levels
    • -Radioallergosorbent Test (RAST)
    • -ELISA/EIA
    • -Skin tests (Epicutaneous, Intradermal)
    • -Provacative Testing
  20. Anaphylaxis is ____ mediated (Atopic)
    IgE (on mast cells)
  21. IgE on mast cells react with antigens and release ____ (leukotrienes, prostaglandins, cell mediator activation)
  22. Anaphylaxis is usually immediate, but could be delayed for up to ____ hours
  23. Emergency Assessment for Anaphylaxis:
    Airway Breathing Circulation
  24. Anticipatory meds for anaphylaxis:
    IVF, Antihistamines, Corticosteroids, Epinephrine (1:1000), Oxygen, Breathing Treatments, IV initiation, Potential Intubation
  25. Clinical Manifestations of Anaphylaxis:
    Respiratory: laryngeal edema, bronchospasms, wheezing, cough, nasal congestion

    Cardio: hypotension, collapse, tachycardia

    Skin: periorbital swelling, facial flushing, warmth, itching
  26. Ways to promote anaphylaxis preventions/readiness
    • Avoidance therapy
    • Food labels
    • Med ID
    • Screening for allergies
    • Deployment of ApiPen autoinjector (remove cap, inject pen into lateral thigh, hold 10 sec and release...bring to med facility!!!)
  27. Allergic rhinitis is ____ mediated...leading to vasodilation and increased capillary permeability
  28. Untreated Allergic Rhinitis may lead to:
    • allergic asthma
    • chronic nasal obstruction
    • otitis media
    • hearing loss/anosomia
  29. Goals of Therapy for allergic rhinitis:
    Relief of sx

    Avoidance therapy


    Pharm therapy

    Monitor: Sx management, resp, response to meds/side effects, and open communication
  30. Pharm treatment for allergic rhinitis
    • Antihistamines
    • Intranasal corticosteroids
    • Intranasal cromolyn sodium
  31. Nursing Considerations for Pharm Treatment of allergic rhinitis
    • Rebound congestion
    • Pt with hypertension
  32. Nursing management of urticaria (hives)
    • List as allergy
    • Keep track
    • Topical corticosteroids
    • Watch for progression to anaphylaxis
  33. Clinical manifestations of contact dermatitis
    Itching, burning, erythema, lesions, edema, weeping, crusting, drying, peeling, vesicles
  34. Nursing management for contact dermatitis
    • Avoidance therapy
    • Use of antihistamines
    • Topical corticosteroids
    • Immunosuppressant therapy

    (Consider: pt self esteem, sleep, s/e)
  35. Characteristics of angioneurotic edema
    Localized edema of deep tissues of the layers of the skin, pink and vary in size/shape (especially GI tract)

    May itch/burn

    Type 1 Hypersensitivity

    Suddenly or over 1-2 hours usually one spot lasting 24-36 hours or less

    Involves lips, eyelids, cheeks, hands, feet, genitalia, tongue, GI tract, bronchi
  36. Management of Angioneurotic Edema
    Administration of corticosteroids, antihistamines, and epinephrine if invading the resp tract

    (frequently occurs in response to penicillin or ace-inhibitors; consider all medications and new prescriptions)
  37. Common food allergens
    • seafoods
    • legumes
    • seeds
    • tree nuts
    • berries
    • soy
    • buckwheat
    • milk protein
  38. Manifestation of food allergies:
    • urticara
    • wheezing
    • cough
    • itching
    • swelling
  39. Management of food allergies
    Pt/Family education

    History of severity of allergy

    Strategies to avoid
  40. People most at risk from latex allergies:
    • Healthcare workers
    • Factory workers
    • Cosmetologists
    • Mechanics
    • Police
  41. Clinical manifestation of latex allergies:
    • Erythema
    • Pruritis
    • Vesical formation
    • Papules
  42. Testing for Latex Allergies:
    Contact-Patch testing preferred

    RAST/ELIsA for latex-specific IgE antibody
  43. Nursing management of Latex Allergy
    • Avoidance
    • Armbands
    • Communication with employment and med staff
    • Carry rescue medication
    • Latex free gloves
  44. Supplies that may contain latex:
    • gloves
    • dressings
    • stethescopes
    • catheters
    • tourniquets
    • ace wraps
    • thermometer probes
    • feminine hygiene products
    • BP cuffs
    • wheelchair cushion
    • tape
    • thromboembolism hose
  45. Nursing Dx for allergies:
    • Ineffective breathing patterns
    • Ineffective airway clearance
    • Ineffective coping
    • Fatigue
    • Knowledge deficit r/t self care/lifestyle mod.
    • Ineffective therapeutic regimen management 
    • Powerlessness
  46. Nursing interventions of allergy reactions:
    • Risk Identification
    • Latex precautions
    • Airway insertion/stabilization
    • Environmental management
    • Allergy management
    • Surveillance
    • Shock prevention
    • Nutrition management
    • Emotional Support
    • V/S monitoring
    • Health system guidance
  47. Nursing Outcomes of allergy pts:
    Pt demonstrates accurate deployment of Epi

    Pt describes strategies to minimize exposure

    Pt explains how to screen ingredients for potential allergens

    Pt maintains effective airway clearance and normal breathing pattern

    Pt contacts health care professional when sx not controlled

    Pt communicates presence of allergy to employer, school and other social networks

    Pt reports manageable sx and fatigue during allergy season
  48. Allergy Pt education:
    • Lifestyle alterations
    • Dietary changes
    • Vigilant prophylaxis
    • Modify environment
    • Communication
    • Proper use of medications
    • Self-admin Epi
    • When to seek medical services
    • Follow up