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Critical Care Nursing > Allergies > Flashcards

Allergies Flashcards

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1
Q

What causes an allergic response?

A

B cells become hyperactive and increased amounts of immunoglobulins are produced causing a hypersensitivity

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2
Q

Hypersensitivity

A

an amplified or inappropriate response to an antigen leading to inflammation and destruction of healthy tissue

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3
Q

What are the two types of allergic reactions?

A

Atopic (local) and nonatopic disorders

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4
Q

Atopic disorders are characterized by what?

A

hereditary predisposition and production of local reaction to IgE antibodies

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5
Q

What are the 3 types of Atopic disorders?

A
  • allergic rhinitis
  • asthma
  • atopic dermatitis/eczema
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6
Q

Nonatopic Reaction Examples

A
  • tetanus vaccine
  • insect venom
  • airborne allergy
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7
Q

Nonatopic reactions lack what?

A

the genetic component and organ specificity of atopic disorders

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8
Q

A true latex allergy is considered to be what type of reaction?

A

type I hypersensitivity reaction

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9
Q

Contact dermatitis is considered to be what type of reaction?

A

type IV hypersensitivity reaction

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10
Q

Anaphylaxis

A

severe allergic reaction that is rapid onset and can cause various systemic reactions including death

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11
Q

Anaphylaxis is a clinical response to what type of reaction?

A

An immediate (type I hypersensitivity) immunologic reaction b/t specific antigen and an antibody

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12
Q

When does anaphylaxis occur?

A

when the body’s immune system produces specific IgE antibodies toward a substance that is normally nontoxic

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13
Q

When the body is re-exposed to the stimulating substance again it produces excess amounts of what protein?

A

histamine

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14
Q

Large amounts of histamine released in the body causes what?

A
  • flushing
  • urticaria
  • angioedema
  • hypotension
  • bronchoconstriction
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15
Q

What are some common causes of Anaphylaxis?

A
  • food
  • medications
  • other pharmaceutical/biologic agents
  • insect stings
  • latex
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16
Q

The severity of an anaphylactic reaction depends on what?

A

degree of allergy and dose of allergen

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17
Q

What are the three patterns of Anaphylactic reactions?

A
  • uniphasic
  • biphasic
  • protracted
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18
Q

Uniphasic Reactions

A

occur as an exclusive incident where the patient develops symptoms w/in 30 minutes of exposure and resolve spontaneously w/in 1-2 hrs w/ or w/o meds

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19
Q

Biphasic Response

A

patient will have an initial reaction followed by subsequent symptoms up to 8 hours after

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20
Q

Biphasic response patients should be managed where?

A

emergency room

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21
Q

Protracted Response

A

may last for long period of time, up to 32 hours, and may include cardiogenic or septic shock and respiratory distress despite treatment

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22
Q

Mild systemic reactions consist of what symptoms?

A
  • peripheral tingling
  • sensation of warmth
  • sensation of fullness in mouth/throat
  • nasal congestion
  • periorbital swelling
  • pruritis
  • sneezing
  • tearing of eyes
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23
Q

Moderate systemic reactions may have what symptoms?

A
  • flushing/warmth
  • anxiety
  • itching
  • any of the milder symptoms
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24
Q

With more severe reactions you may see what?

A
  • bronchospasm
  • edema
  • dyspnea
  • cough
  • wheezing
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25
Q

Mild and moderate reactions begin how long of exposure?

A

2 hours

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26
Q

Severe Systemic Reaction S/S

A
  • abrupt onset w/ previous s/s
  • bronchospasm
  • larygeal edema
  • severe dyspnea
  • cyanosis
  • hypotension
  • dysphagia
  • abdominal cramping
  • n/v
  • diarrhea
  • seizures
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27
Q

What events may follow a severe systemic reaction?

A

cardiac arrest and coma

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28
Q

If the client is unable to avoid exposure to allergens they should be instructed to carry what?

A

Epinephrine

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29
Q

What route for medication administration is associated w/ the most severe anaphylactic reaction?

A

Parenteral

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30
Q

Insulin-allergic patients w/ diabetes and those allergic to penicillin may require what?

A

Desensitization

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31
Q

Desensitization

A

based on controlled anaphylaxis with a gradual release of mediators

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32
Q

What is the first line treatment of anaphylaxis?

A

Epinephrine

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33
Q

Why is Epinephrine the first line treatment?

A

it is the only medication that may halt cardiac or respiratory arrest

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34
Q

Cardiac or Respiratory Arrest typically occurs how long after exposure to allergen?

A

5-30 minutes

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35
Q

How is epinephrine given?

A

Sub q in the upper extremity or thigh

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36
Q

What other medications may be administered to prevent reoccurrence and to treat urticaria and angioedema?

A

Antihistamines and corticosteroids

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37
Q

Antihistamines take how long to suppress histamine levels by 50%?

A

80 minutes

38
Q

If hypotension is unresponsive to vasopressors the nurse may administer what?

A

Glucagon

39
Q

Rebound reactions typically occur how long after the initial reaction?

A

4-10 hours

40
Q

How long are patients w/ severe reactions monitored in emergency unit?

A

12-14 hours

41
Q

What emergency measures are taken to reduce severity of reaction and restore cardiovascular function?

A
  • call provider
  • intubation
  • emergency meds
  • IV lines
  • fluids
  • oxygen
42
Q

Why may ET intubation be difficult or impossible w/ an acute allergic reaction?

A

b/c it can result in increased laryngeal edema, bleeding, and further narrowing of glottic opening

43
Q

What type of intubation may be needed for Acute Allergic Reaction?

A
  • fiberoptic ET intubation
  • needle cricothyrotomy followed by trach
  • cricothyrotomy
44
Q

Allergic Rhinitis (Hay Fever/seasonal allergies)

A
  • type I hypersensitivity reactions
  • most common chronic respiratory allergic disease
  • most common reason to visit doctor
  • more common in children but rising in adults
45
Q

Allergic Rhinitis often occurs w/ what other conditions?

A
  • allergic conjunctivitis
  • sinusitis
  • asthma
46
Q

If Allergic Rhinitis is left untreated what may occur?

A
  • allergic asthma
  • chronic nasal obstruction
  • chronic otitis media w/ hearing loss
  • anosmia
  • orofacial dental deformities in children
47
Q

Allergic Rhinitis is induced by what?

A

airborne pollens or molds

48
Q

S/S of Allergic Rhinitis

A
  • sneezing/nasal congestion
  • clear,watery nasal discharge
  • itchy eyes/nose
  • lacrimation
  • postnasal drip
  • headache/pain over paranasal sinuses
49
Q

Postnasal drip result in multiple attempts to clear airway causing what?

A
  • dry cough
  • hoarseness
  • scratchy throat
50
Q

Chronic Allergic Rhinitis can affect quality of life by causing what?

A
  • fatigue
  • loss of sleep
  • poor concentration
  • interference w/ physical activity
51
Q

The greatest fear w/ allergic rhinitis is the development of what?

A
  • persistent asthma
  • chronic otitis media
  • obstructive sleep apnea
  • airway inflammation
52
Q

What to see during physical exam diagnosis of patient for Allergic Rhinitis?

A
  • allergic shiners
  • puffy eyes
  • clear/cloudy fluid arounf tympanic membrane
  • rhinorrhea/congestion
  • enlarged lymph nodes
  • sinus tenderness
53
Q

Diagnostic tests for Allergic Rhinitis

A
  • nasal smears
  • peripheral blood counts
  • total serum IgE
  • epicutaneous and intradermal tests
  • RAST
54
Q

What is the goal of therapy for Allergic Rhinitis?

A

provide relief of symptoms and encourage adherence to therapeutic regimens

55
Q

Avoidance Therapy

A

every attempt is made to remove allergens that act as precipitating factors

56
Q

What is the safest and most effective means of treating symptoms for Allergic Rhinitis?

A

Avoidance Therapy

57
Q

When are oral antihistamines most effective?

A

when given at the first occurrence of symptoms b/c thet prevent development of new symptoms

58
Q

Examples of Antihistamines

A
  • benadryl
  • claritin
  • zyrtec
  • xyzal
  • clarinex
  • allegra
59
Q

Effectiveness of Antihistamines are limited to what patients?

A
  • hay fever
  • vasomotor rhinitis
  • urticaria
  • mild asthma
60
Q

How do Adrenergic Agents help relieve severity of symptoms?

A

narrowing blood vessels in nasal passages therefor decreasing congestion

61
Q

Adrenergic Agents will not treat what?

A

underlying cause

62
Q

What is the most common oral Adrenergic Agent used?

A

Sudafed (pseudo-ephedrine hydrochloride)

63
Q

When are Mast Cell Stabilizers used?

A

prophylactically to prevent onset of symptoms and treat symptoms once they occur

64
Q

What is the most effective maintenance therapy for Chronic allergic rhinitis?

A

intranasal corticosteroids

65
Q

Recommended use of ICS is limited to how long?

A

30 days

66
Q

Immunotherapy

A

administration of gradually increasing quantities of specific allergens to patient until a dose is reached that is effective in reducing disease severity from natural exposure

67
Q

Immunotherapy is treatment in the form of what?

A

vaccine therapy or sublingual meds

68
Q

Allergy control by immunotherapy usually requires treatment for how long?

A

3-5 years

69
Q

Therapeutic failure for Immunotherapy is evident when a patient doesn’t experience decrease in symptoms after how long?

A

12-24 months

70
Q

Contact Dermatitis

A
  • type IV delayed hypersensitivity reaction
  • acute or chronic
  • results from direct skin contact w/ chemicals or allergens
71
Q

What are the 4 types of Contact Dermatitis?

A
  • allergic
  • irritant
  • phototoxic
  • photoallergic
72
Q

S/S of Contact Dermatitis

A
  • itching
  • burning
  • erythema
  • skin lesions
  • edema
  • weeping, crusting, drying, and peeling of skin
  • hemorrhagic bullae if severe
73
Q

Atopic Dermatitis

A

type I immediate hypersensitivity disorder characterized by inflammation and hyperreactivity of skin often causing pruritus

74
Q

What are the most consistent features of Atopic dermatitis?

A

pruritus and hyperiritability of skin most commonly in flexural folds

75
Q

Atopic dermatitis is often the first step in the process that leads to what?

A

asthma and allergic rhinitis

“Allergic/Atopic Triad”

76
Q

Guidelines for treating Atopic Dermatitis

A
  • wear cotton fabrics
  • washing with mild detergents
  • humidifying dry heat
  • using antihistamines
  • avoiding allergens
77
Q

What is the main treatment for Atopic Dermatitis?

A

keeping skin moisturized w/ daily baths and use of topical skin ointments

78
Q

Dermatitis Medicamentosa (Drug Reactions)

A

type I hypersensitivity disorder applied to skin rashes associated w/ certain medications

79
Q

S/S of Dermatitis Medicamentosa

A
  • appear suddenly
  • vivid color
  • disappear rapidly after medication is withdrawn
80
Q

What is Urticaria?

A

Hives

81
Q

Urticaria

A

type I hypersensitive reaction characterized by sudden appearance of pinkish edematous elevations that cause itching/discomfort

82
Q

How long do hives last?

A

remain for a few minutes to several hours

83
Q

How long does do the hives have to come and go before a patient is diagnosed with Chronic Urticaria?

A

6 weeks

84
Q

Angioneurotic Edema

A

involves deeper levels of the skin, resulting in more diffuse swelling rather than discrete lesions

85
Q

S/S of Angioneurotic Edema

A
  • no pitting
  • skin may appear normal w/ reddish hue
  • itching/burning sensations
  • sudden swelling
  • lips, eyelids, cheeks, hands, feet, genitalia, tongue
86
Q

How does swelling appear with Angioneurotic Edema?

A

suddenly in a few seconds or minutes or slowly in 1-2 hours

87
Q

Food allergies are thought to occur in who?

A

people w/ a genetic predisposition combined w/ exposure to allergen early in life

88
Q

Most common food allergies are?

A
  • seafood
  • legumes (nuts)
  • seeds
  • berries
  • egg whites
  • buck wheat
  • milk
  • chocolate
89
Q

S/S of Food Allergy

A
  • urticaria
  • dermatitis
  • wheezing
  • cough
  • laryngeal/angio edema
  • abdominal pain/cramps
  • n/v
  • diarrhea
90
Q

Latex Allergy

A

allergic reaction to natural rubber proteins

91
Q

Who is at most risk for Latex Allergy?

A
  • health care workers
  • patients w/ atopic allergies/multiple surgeries
  • factory workers
  • females
  • spina bifida patients/SCI
92
Q

Routes of exposure to latex are?

A
  • cutaneous
  • purcutaneous
  • mucosal
  • parenteral
  • aerosol

Critical Care Nursing (14 decks)

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