Immune 2

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Immune 2
2015-10-04 22:28:24

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  1. Anaphylaxis (2nd exposure severe)
    • 400-800 deaths per a yr
    • causatuve agent same
  2. Anaphylactic Hypersensitivity
    Type 1 (second exposure severe)chec
    • most serious with systemic results
    • can be severe life threaten reaction- do something fast
    • rapid onset of symptoms
    • rapid release of igE mediated chemical mediators from antigen/antibody reaction
    • occurs in susceptible persons
  3. how the allergy works
    • look at slide
    • sensitization (IgE antibody formation)
    • second exposure in antigen
    • mast cell and basophil degranulation
    • chemical mediators release- histamine
    • three things can happen
    • smooth muscle contraction: lungs and GI
    • GI/GU: cramping, diarrehea, Nausea, urinary incontinence, vomiting
    • Resp: Bronchospasms,larygeal and peripheral edema, airway obstruction, dyspnea, hoarness, pulmonary edema, respiration arrest, stridor, wheezing (u would not give nasal cannula, high Oxygen or intubation)
    • Increase Capillary permability:
    • Fluid shift from vascular to extravascular
    • - see Respiratory
    • - hypovolemia: ECG may show ST segment and T-wave changes suggesting cononary injury and ischemia, hypotension, tachycardia
    • Vasodilation: reduced circulating blood volume- leads to hypvolemia and skin effects- angioedema, esp periorbital area, palms, soles, and mucous membrane, diffuse erythemia, prurititis, urticaria, warmth
    • all lead to neurologic effects: apprehension, dizziness, drowiness, headache, restlessness, seizures (headaches bc of vasodilation and incr prostagladins
    • 20-30 mins onset occurs
  4. Patho Histamine
    • dilation of capillaries and venules
    • contraction of nonvascular smooth muscle- tearing and rhinorrhea
    • incr cap permability
    • plasma leaks into interstitial space (decr cardiac preload, stroke volume and cardiac output)
  5. s/s anaphylaxis
    • multiple organ effects (GI, lungs, GU, heart, brain, skin)
    • mild to severe
    • - depends on degree of allergy¬† and dose
    • - chemical mediators are local and systemic
    • Epinephrine is given- b/c because you are trying close (vasocontriction) the vessels- doesn't last for long, like 5 mins
  6. s/s of anaphylaxis mild
    • onset: usually within 2 hrs
    • peripheral tingling and warmth
    • nasal congestion, pruritis, sneezing, tearing
    • periorbital swelling/edema
    • wheal/flare reaction
  7. s/s anaphylaxis moderate
    • onset: with 2 hours
    • flushing, warmth, itching
    • anxiety
    • bronchospasm and edema of airways broncho constriction
  8. s/s anaphylaxis severe
    • abrupt onset <30 mins and symptoms progress rapidly
    • bronchospasm laryngeal edema, bronchial edema can lead to airway obstruction
    • severe dyspnea
    • angioedema
    • hypotension, tachycardia, weak pulse
    • dysphagia, n/v/d, abd cramping
    • dilated pupils
    • cynnosis
    • seizures- trigger electrical activity of brain- not enough oxygen getting to the brain
    • cardiac arrest
    • think about what is happening to the organs
  9. management of anaphylaxis
    • anaphylactic reactions occur suddenly and progress rapidly
    • accurate and rapid assessment and intervention
    • Goals: recognition of symptoms
    • - prevent spread of antigen (if possible)
    • - administer medications
    • - treat shock- IV fluid NS, LR to maintain
  10. immediate management
    • epinephrine (right away)
    • - 1:1000 dilution sc repeat -10-15 mins intervals (mild)
    • - IV injection of infusion for severe reaction (pay attention to expiration date)
    • Respiratory support
    • - airway
    • - high flow oxygen via non rebreather mask or intubation
    • - mechanical ventilation
    • Cardiac support (hypovolemia shock)
    • - IV volume expanders
    • - vasopressors (IV dopamine)
    • - elevate legs
  11. management with med anaphylaxis
    • Accurate assessments- understand patho
    • IV glucocorticords- inflammation
    • IV antihistamines
    • patient/family support
  12. nursing management for anaphylaxis
    • Pt education
    • avoidance of allergens
    • screening of allergens
    • - asking pt if have hx of allergy
    • - clear identification of allergy
    • - Medic alert bracelet
    • Epipen
    • auto- injection system of pre-measured dose- sc epinephrine
    • teaching self injection techniques (1618)
    • always carry it
    • check expiration date
  13. take away msg
    anaphylaxis is an immediate systemic life threatening allergic reaction, prompt recognition and approriate drug therapy in the pre-hospital phase are crucial to patient survival
  14. Cytoxic (type II hypersensitivity)
    • Cytotoxic hypersensitivity
    • - immune system recognizes normal component of body as foriegn
    • direct binding to IgG and IgM antibodies to antigen on cell surface
    • antigen-antibody complex activate complement system--inflammatory changes- cell tissue damage
    • examples: ABO incompatibles of blood transfusions, RH hemolytic disorders of newborn, drug related hemolytic reaction
  15. Type II hypersensitivity
    • transfusion reactions
    • produced by mismatch blood types
    • - destroy foriegn rbc by complement-mediated lysis triggered by IgG
    • -- produces fever, intravascular clots, lower back pain, Hgb in urine
    • Free hgb has two fates:
    • - passes to the kidneys- hemoglobinuria
    • - breaks down to bilirubin- can be toxic

    2 different antigen- cause clumping, then it bust and it affects the kidneys
  16. nursing management for incompatible blood
    • Assessment
    • follow the facility protocol
    • -time with pt is 10-15 mins
    • - two nurses look at the blood and order
    • - blood given with NS- when blood stop u start the NS- to flush
    • - monitor the pt for itchy, SOB, pain, fever- stop and do the NS
    • know CBC prior and know after
    • listen for crackles because of overload.