Allergies/Transfusion/Anaphylaxis Flashcards
What are the functions of immune response?
Defence
Homeostasis
Surveillance
What are the different types of immunity?
- Natural or innate (born with it)
- Acquired
- active *natural (infections)
* artificial (immunizations)
- passive (transfer of immunoglobulin across the placental membrane)
* *passive immunity is short lived
Central or primary lymphoid organs of immune system?
- thymus
- bone marrow
Peripheral lymphoid organs?
- lymph nodes
- spleen
- tonsils
- associated tissues
Which cells are involved with immune response?
- Mononuclear phagocytes
- B and T lymphocytes
3 TYPES OF IMMUNITY?
- humoral immunity
- cell-mediated immunity
- altered immune response
Humoral immunity?
antibodies (immunoglobulins) produced by plasma cells
produces: strong and longer lasting immunity
Cell-meidated immunity?
immune response brought on by T cell antigen recognition
produces: sensitized T cells and lymphokines
Protection from:
- viruses/some bacteria
- fungal infections
- transplant rejection
- contact hypersensitivity reactions
- tumor identity
Altered immune response (hypersensitivity)
heightened immune response against foreign antigen
produces: depends on allergen and immune response
heightened reaction to hum oral or cell mediated immunity
Altered immune response (hypersensitivity) risk factors?
- family hx of allergies or asthma
- have asthma or allergic condition
- children
Types of hypersensitivity reactions?
- anaphylactic (humoral immunity)
- cytotoxic (humoral immunity)
- immune complex (humoral immunity)
- delayed (cell mediated immunity)
Anaphylactic (humoral immunity) examples?
anaphylactic and atopic reactions like: asthma, allergic rhinitis, urticaria, angioedema
Cytotoxic (humoral immunity) examples?
- ABO incompatibility transfusion reaction
- RH incompatibility transfusion
Immune complex (humoral immunity) examples?
reactions associated with autoimmune disorders like: lupus, rheumatoid arthritis
Delayed (cell-mediated immunity) examples?
contact dermatitis hypersensitivity reactions to: bacterial, fungal, viral infections and transplant rejections
hypersensitivity reactions release histamine into the body which effects the other body systems in which ways?
- Smooth muscle contraction of the airway and GI tract
- Increased vascular permeability
- Vasodilation
- Increased secretion of mucous
- Itching
- Gastric acid secretions
Effects of anaphylactic reaction on neuro system?
headache, dizziness, parathesia, feeling of doom
Effects of anaphylactic reaction on intengumentary system?
pruritus, angioedema, erythema, urticaria
Effects of anaphylactic reaction on respiratory system?
hoarseness, coughing, narrowing of airway, wheezing, stridor, dyspnea, tachycardia, respiratory arrest
Effects of anaphylactic reaction on cardiovascular system?
systemic vasodilation & vasopermeability, hypotension, tachycardia, cardiac arrest
Effects of anaphylactic reaction on gastrointestinal system?
cramping, abdo pain, nausea, bloating, vomiting, diarrhea
Interventions for anaphylactic reaction?
- recognize S&S
- maintain airway
- administer 02 prn
- ask for help
- take vitals, 02 sat and LOC
- if reaction from insect bite, remove sting from skin
- start IV stat
- place pt in recumbent position and elevate legs
- maintain BP
- keep pt warm
EPINEPHRINE (ADRENALIN) for anaphylaxis?
Drug classes: sympathomimetic drug, cardiac stimulant, vasopressor, bronchodilator, etc.
Therapeutic actions: vasoconstriction, bronchodilation, vasodilation
Adverse effects: fear, anxiety, tenseness, restlessness, headache, nausea, pallor
Nursing: Take vital signs prior and while tx
Benadryl (diphenhydramine)
Drug classes: antihistamine, cough suppressant
Therapeutic actions: competitively blocks the effect of histamine, antipruritic and sedative effects
Adverse effects: drowsiness, sedation, dizziness, disturbed coordination
Nursing: Monitor patient’s response
Cimetedine (Tagamet)
Drug classes: histamine2 antagonist
Therapeutic actions: inhibits the action of histamine
Adverse effects: dizziness, somnolence, headache, confusion, hallucinations, diarrhea
Nursing: Monitor side effects
ON GOING MONITORING for allergic reaction?
Monitor vital signs respiratory effort O2 sat cardiac rhythm LOC Anticipate intubation or tracheostomy if severe laryngeal edema
Epipen?
Epinephrine (.3mg) to be injected by self or other in case of a severe allergic reaction. Used by or for a person that is well known to suffer from an anaphylactic allergy to a specific substance.
FOLLOW UP for anaphylaxis?
- Anaphylactic allergen is written in red on the chart of the patient
- Patient should wear a medic-alert bracelet
- Patient should carry an epipen at all times
- Should be offered immunotherapy, especially if allergen is insect bites
IMMUNOTHERAPY used when?
individuals with anaphylactic reaction to insect venom or when allergen can’t be avoided and drug therapy is not effective.
Immunotherapy goal?
- To keep high levels of “blocking” IgG levels
- To help individual develop allergen-specific T suppressor cells
immunotherapy treatment?
- sub-cutaneous injection twice or once a week
- dose of allergen increasing gradually
- takes about two years to reach the maximum therapeutic effect
- could last up to 5 years or indefinitely with severe allergies or insect stings
ATOPIC REACTIONS?
ALLERGIC RHINITIS (HAY FEVER) ASTHMA ATOPIC DERMATITIS URTICARIA (HIVES) ANGIOEDEMA
ALLERGIC RHINITIS (HAY FEVER)?
- Most common type 1 hypersensitivity reaction.
- Seasonal or year round (perennial allergic rhinitis)
- Principal causes: pollen, dust, molds, animal dander, weeds and grass
ALLERGIC RHINITIS (HAY FEVER)? S&S?
Nasal discharge Sneezing Lacrimation Mucosal swelling and airway obstruction Pruritus around eyes, nose, throat and mouth
ASTHMA?
- bronchial smooth muscle constriction
- excessive secretion of viscoid mucus
- edema of mucus membranes of bronchi
- decreased lung compliance
ASTHMA S&S?
Dyspnea Wheezing Coughing Chest tightness Thick sputum
ATOPIC DERMATITIS characteristics?
CHARACTERISTIC:
exacerbation and remission
PRESENTATION:
- skin lesions are generalized
- involve vasodilation of blood vessels
- vesicle formation
- erythema, crust and cracks
URTICARIA (HIVES)?
PRESENTATION: -transient wheals (pink, raised, edematous, pruritic areas) -is localized -develops shortly after exposure -could last minutes or hours
ANGIOEDEMA?
PRESENTATION:
- lesions similar to urticaria but deeper in the skin, and mucosa layers
- diffuse swelling; no welts; the outer skin appears normal or reddish
- swelling starts in the face and then progresses to the airway and other parts of the body
AREAS INVOLVED:
Eyelids, lips, tongue, larynx, hand, feet and GI
SENSATION:
Burns, stings, slight itch and abdominal pain
REACTION:
Swelling might occur suddenly or over a few hours and could last for 24 hrs
DELAYED HYPERSENSITIVITY REACTIONS?
SAME AS CELL-MEDIATED IMMUNE RESPONSE
Tissue damage caused by T lymphocytes and macrophages. Reaction takes between 24-48hrs
Includes:
- contact dermatitis
- hypersensitivity reactions to bacterial, fungal and viral infections and transplant rejections
CONTACT DERMATITIS?
When skin is exposed to a certain substance that becomes antigenic
over a period of 7-14 days (the memory cells from the antigen)
On subsequent exposures to the substance, a sensitized person develops eczematous skin lesions within 48 hrs.
PRESENTATION:
- skin appears erythematous and edematous
- papules, vesicles and bullae
- may burn, itch or sting
- is localized and restricted to the area exposed to allergen
CAUSES: metal compounds, rubber compounds, poison ivy, poison oak and sumac, cosmetics, some dyes
PREVENTION TO LATEX ALLERGY?
-Use non-latex gloves if not in contact with infectious material
-Use powder-free gloves
-Do not use oil-based hand cream or lotions when wearing gloves
-Wash hands with soap after removing gloves
medic-alert bracelet and Epipen if severe allergy
MICROBIAL HYPERSENSITIVITY REACTIONS?
TUBERCULOSIS IS AN EXAMPLE
PPD skin test will read positive after 48-72hrs. after injection because the initial cell-mediated reaction, memory cells remain
MULTIPLE CHEMICAL SENSITIVITIES (IDIOPATHIC ENVIRONMENTAL INTOLERANCES)?
- Linked to various chemicals and food in the environment
- Subjective symptoms related to multiple body systems: fatigue, headache, nausea, pain, dizziness, mouth irritation, disorientation and cough.
- Primarily in women
- Odour is principle trigger
TRANSPLANT REJECTIONS reactions?
Hyperacute
Acute
Chronic
IMMUNOSUPPRESSIVE THERAPY FOR LIFE
ALLERGIC RECTIONS- NURSING INTERVENTIONS?
HEALTH HISTORY Family allergies Past and present allergies Clinical manifestations and course of allergic reactions Social and environmental factors
PHYSICAL EXAMINATION
SUBJECTIVE DATA: FUNCTIONNAL HEALTH PATTERNS -health perception and health management -nutrition; elimination -activity and exercises -cognitive and perceptual (ex itching) -role and relationship (ex home-work)
OBJECTIVE DATA: RASHES EYES-EARS AND THROAT RESPIRATORY POSSIBLE FINDINGS (blood test, skin tests)
DIAGNOSTIC STUDIES?
CBC with differential
-with immunodeficieny lymph count will be lower than 1200 µ, eosinophil count is higher than normal
Immunoglobulins
- Sputum, nasal and bronchial cultures
- Pulmonary functions for asthma
- Skin testing
- Alpha-1 Antitrypsin
CHRONIC ALLERGIES?
CHARACTERISTIC:
Remission and exacerbation of symptoms
TREATMENT:
Allergen recognition and control
-decrease exposure to offending allergen
-treat the symptoms
-talk to patient of having a safer environment
-teach patient relaxing techniques and stress management
ANTIHISTAMINES (Benadryl)?
- For treatment of allergic rhinitis and urticaria
- Best results if taken as soon as allergy signs and symptoms appear
SYMPATHOMIMETIC AND DECONGESTANT DRUGS?
- Epinephrine or adrenaline
- Sudafed (orally or nasally; used for allergic rhinitis and could last hours.)
CORTICOSTEROIDS?
- nasal spray for rhinitis (Nasonex)
- oral cortisone to relieve severe discomfort of allergies
TOPICAL ANTIPRURITIC?
- Calamine lotion
- benadryl ointment
- coal tar solution (ex Tegrin shampoo)
- camphor
CYTOTOXIC REACTIONS?
Involves the direct binding of antibodies to an antigen on the cell surface
Antigen-antibody will create a reaction that will destroy cellular tissue by: -cytolysis
-phagocytosis
Target cells frequently destroyed are: erythrocytes, platelets and leucocytes
Antigen involved are ABO, Rh and drugs
HEMOLITIC TRANSFUSION REACTION?
Blood group antigens (A & B) are found only on RBCs membranes
ABO INCOMPATIBILITY
ACUTE HEMOLYTIC REACTiON?
tx = shock treatment
S&S? Chills, fever, low back pain, flushing, tachycardia, tachypnea, hypotension, vascular collapse, hemoglobinu-ria due to hemolysis of RBCs
Antibodies on the recipient’s serum react with antigens on the donor’s RBCs.
Results in agglutination of cells which can obstruct capillaries and block blood flow
Hemolysis of the RBCs releases free hemoglobin into the plasma
The hemoglobin is filtered by the kidney and may be found in urine and may obstruct the renal tubules
The clinical reactions may be mild or severe
Usually develop within the first 15 minutes of transfusion
ACUTE TRANSFUSION REACTIONS
- FEBRILE, NON-HEMOLYTIC REACTION
Most common
-due to the sensitization of the patient to the WBCs of the donor (leucocytes)
- S&S: sudden chills and fever (+1C), flushing, anxiety, muscle pain and vomiting
- Management: Stop transfusion, call md and give antipyretics
ACUTE TRANSFUSION REACTIONS
-ALLERGIC REACTIONS
- Due to patient
s sensitivity to plasma proteins of the donors blood. - Most common with patients who have hx of allergies
- S&S: mild-flushing, itching, hives
- Management: stop transfusion. If mild symptoms, give patient antihistamine (as ordered) and restart transfusion slowly. If severe, discontinue.
ACUTE TRANSFUSION REACTIONS
-CIRCULATORY OVERLOAD
-In patients with cardiac or renal insufficiency
-S&S: cough, dyspnea, pulmonary congestion,
hypertension, tachycardia, distended neck veins
-Management: stop infusion, place patient upright with feet in dependant position, give diuretics and O2 as ordered
ACUTE TRANSFUSION REACTIONS
-Sepsis
- Due to blood products becoming infected from improper handling and storage
- S&S: rapid onset of chills, high fever, vomiting, diarrhea, marked hypotension or shock
- Management: stop transfusion, obtain blood cultures and send bag with remaining blood and all tubing back to blood bank
DELAYED TRANSFUSION REACTIONS?
- Can occur 2-14 days after the administration of blood
- Include delayed hemolytic transfusion reactions (fever, mild jaundice, decreased hematocrit)
- No acute treatment is required but must be taken into consideration for further transfusions- notify MD
ADMINISTRATING BLOOD PRODUCTS?
- Use an 18 gage needle preferably
- Maximum infusing time for blood product is 4 hours
- Has to be administered within 30 min. after the product gets to the unit
- Must be given in conjunction with Normal Saline only with a Y connection
- Do not use the transfusion line to administer medications
- Use an IV line specific for blood products (has a filter integrated)
STEPS WHEN ADMINISTERING BLOOD PRODUCTS?
-When the blood product is delivered to the unit, two nurses must make positive identification of the blood donor AND the recipient
-Inspect blood or blood component (visually)
-Nurse must verify patient understanding of procedure and S&S to report as well has obtaining a signed consent
Nurse take VS before transfusion and reports abnormalities (esp. hyperthermia)
-Nurse remains at the patient’s bedside for the first 15 min. or 50ml of the transfusion for safety measure (transfusion reaction) rate 2ml/min.
-After 15 min. or 50ml of blood infusion, VS are taken again and rate of infusion is governed by the clinical condition of the patient and the product being infused
IMMEDIATE ACTIONS TO TAKE IF REACTION OCCURS-transfusion
-Stop transfusion
-Keep main IV line open with Normal Saline (different line than blood set)
-Take vital signs and monitor urine output
-Notify blood band and MD immediately- anticipate possible orders
-Check concordance of information on label, voucher and patient`s ID band
-If transfusion is discontinued, send blood bag with tubing, blood specimen and reaction report to the blood bank
Send blood for C&S in the presence of fever, chills, dyspnea or hypotension
-Inform blood bank if symptoms persist or worsen
-Document the reaction in patient’s chart in RED
