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NRSG 102: Med Surg 1 > Exam 3: Chapter 37: Assessment and Management of Patietns with Allergic Disorders > Flashcards

Exam 3: Chapter 37: Assessment and Management of Patietns with Allergic Disorders Flashcards

1
Q

What is a Allergy?

A

Inappropriate often harmful response in the immune system to a usually harmless item

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2
Q

What is a Allergen?

A

Substance that causes manifestations of allergy. The substance that causes the allergy response

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3
Q

What is a Atopy?

A

Genetic component of what we are allergic to. This includes peanuts, nuts, mushrooms. The chemical mediator is released due to this exposure

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4
Q

What is an Allergic Reaction?

A

Manifestation of tissue injury due to interaction between antigen and antibody. This causes the inflammatory response. Body defenses recognize these as foreign and the body attempts to remove these objects from the body

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5
Q

What lymphocytes respond to the antigen, what is produced?

A

Antibodies

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6
Q

What is the key and what is the lock in the specificity example?

A

ANtigens are the keys, and they fit only certain antibodies

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7
Q

Immunoglobulins can be found where?

A

In the lymph nodes, tonsils, appendix, and Peyer patches of the intestinal tract or circulating in the blood and lymph

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8
Q

Antibodies that are formed by lymphocytes and plasma cells are known as what?

A

Immunoglobulins

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9
Q

IgE antibodies are involved with

A

allergic disorders.

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10
Q

If performed a blood test after allergic reaction, what should be present?

A

Eosinophils and Basophils

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11
Q

IgE producing cells are located in the

A

respiratory and intestinal mucosa

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12
Q

Two or more IgE molecules bind together to an allergic and trigger

A

mast cells or basophils to release chemical mediators, such as histamine. This produces a allergic skin reaction, astha, and hay fever

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13
Q

When IgE molecules bind, what chemical mediators do they release?

A

Histamine, Serotonin, Kinins, SRS-A (Slow Reactions Substances of Anaphylaxis) and Neutrophil Factor

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14
Q

Histamine released in a allergic reaction produces what type fo response?

A

Eyes/Nose Watering and the individual sneezing

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15
Q

B Cells are programmed to

A

produce one specific antibody.

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16
Q

When encountering a specific antigen

A

B Cells stimulate production of plasma cells

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17
Q

T Cells assist the

A

B cells

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18
Q

T Cells secrete

A

substances that direct te flow of cell activity, destroy target cells, and stimulate the macrophages. Macrophages present the antigens to the T Cell

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19
Q

Example of Complete Protein Antigens?

A

Animal dander, pollen, and horse serum, stimulate a complete humoral response

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20
Q

What plays a major role in IgE-mediated immediate hypersensitivity?

A

Mast cells. Allergen triggers B Cell to make IgE antibody. When allergen reappears, it binds to the IgE and triggers the mast cell to release its chemicals

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21
Q

In Allergic Response, where are Histamine 1 and 2 Located?

A

1 located in Bronchail and 2 located in the gastric area

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22
Q

Two types of chemical mediators?

A

Primary and SEcondary

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23
Q

Primary MEdiators are

A

preformed and found in mast cells of basophils

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24
Q

Secondary Mediators

A

inactive precursors that are formed or released in response to primary mediators

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25
Q

Examples of Primary Chemical Mediators

A

Histamine,
Eosinophils
Prostaglandins
Platelet-Activating Factors

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26
Q

Examples of Secondary Chemical Medidators

A

Bradykinin
Serotonin
Leukotrienes
Heparin

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27
Q

What does Histamine do (Found in Mast Cell)

A

Vasodilation
Smooth Muscle Contraction, Increased Vascular Permeability
Increased Mucus Secretions

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28
Q

What does Eosinophil Chemotactic Factors of Anaphylaxis (Performed in Mast Cell) do?

A

Attracts Eosinophils

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29
Q

What does Platelet-Activating Factor (requires synthesis by mast cells) do?

A

Smooth muscle contraction

Incites platelets to aggregate and release serotonin and histamine

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30
Q

What does Prostaglandins (requires synthesis by cells) do?

A

D + F Series = Bronchoconstriction
E SEries = Bronchodilation
D, E, and F Series = Vasodilation

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31
Q

What does Basophil (Performed in mast cell) do?

A

Freees bradykinin, which causees bronchcontrction, vasodilation, and nerve stimulation

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32
Q

What does Bradykinin do?

A

Smooth muscle contraction, increased vascular permeability, stimultes pain receptors

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33
Q

What does SErotonin do?

A

Smooth muscle cotnraction, increased vascular permeability

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34
Q

What does Heparin do?

A

Anticoagulant

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35
Q

What does Leukoktrienes do?

A

Smooth musclle contraction, increased vascular permeability

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36
Q

Histamine is released by ___ and is the ____

A

mast cells, and is the first chemical mediator to be releasd in immune and inflammatory responses

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37
Q

Hypersensitivity is

A

an excessive or aberrant immune response to any type of stimulus. REaction that follows re-exposure after an immune reseponse to any type of stimulus.

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38
Q

Allergic reactions Types

A

Type I: Anaphylactic (Most Severe)
Type II: Cytoxic
Type III: Immune Complex
Type IV: Delayed Type

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39
Q

Type I is an

A

anaphylactic reaction that is characterized by vasodilation, increased capillary permeability, smooth muscle contraction, and eosinophilia

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40
Q

Type I: When vasodilating, the blood…

A

just pools there. It sits and you do not have the contraction to get it back to the heart as easily

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41
Q

Type I: Increased capillary permability means

A

that fluid is leaking out (Sodium and Albumin too)

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42
Q

Type I: If smooth muscle contractions, you cannot

A

breathe

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43
Q

Type I: Systemic Reactions involve

A

laryngeal stridor, angioedema (Swelling around throat and tongue), hypotension, and bronchial, BI, or Uterine Spasm

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44
Q

Type I: Location reactiosn characterized by

A

Hives. This could have been done by a bee sting.

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45
Q

Type I: Examples included

A

Extrinsic Asthma
Allergic Rhinitis
Systemic Anaphylaxis
Reactions to Insect Stings

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46
Q

Type II (Cytotoxic): Occurs when

A

the system mistakenly identifies a normal constituent of the body as foreign

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47
Q

Type II (Cytotoxic): Reaction MAY BE the result of

A

cross-reacting antibody, possibly leading to cell and tissues damage

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48
Q

Type II (Cytotoxic): This involves binding

A

either the IgG or IgM antibody to a cell-bound antigen, which may lead to eventual cell and tissue damage

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49
Q

Type II (Cytotoxic): Examples

A 
Masthenia Gravis, Goodposture Syndrome
Pernicious Anemia
Hemolytic Disease of the Newborn
TRansfusion Reaction
Thrombocytopenia
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50
Q

Type II (Cytotoxic): What happens in Myasthenia GRavis

A

The body mistakenly generates antibodies against normal nerve ending greceptors

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51
Q

Type II (Cytotoxic): What happens in Goodpasure syndrome

A

Generates antibodies against lung and renal tissue, producing lung damage and kidney injury

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52
Q

Type III (Immune Complex): What is this?

A

Hypersensitivity involves immune complexes that are formed when antigens bind to antigens . This is marked by acute inflammation resulting from formation and deposition of immune complexes

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53
Q

Type III (Immune Complex): If this is deposited in tissues or vascular endothemium, what happens.

A

The increased amount of circulating complexes and the presence of vasoactive amines contribute to injury. As a result, there is increase in vascular permeability and tissue injury

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54
Q

Type III (Immune Complex): Who is easily susceptible to this?

A

Joints and Kidneys.

This is associated with systemic lupus, erythematosus, serum sickness, nephritis, and rheumatoid arthritis

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55
Q

Type III (Immune Complex): Some signs and symptoms?

A

Urticaria, Joint Pain, Fever, Rash, and Adenopathy (Swolllen Glands)

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56
Q

Type IV (Delayed Type): What is this?

A

A delayed or ceullar reactions that occurs 1-3 days after exposure to an antigen

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57
Q

Type IV (Delayed Type): Reaction

A

Results in tissue damage and involves activity by lymphokines, macrophages, and lysozymes

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58
Q

Type IV (Delayed Type): What type of reaction is common?

A

Erythea amd itching.

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59
Q

Type IV (Delayed Type): Examples?

A

Contact Dermatitis (Poison Ivy, Laundry Soap, and Latex)
Graft-Versus-Host Disease
Hashimotos Thyroiditis
Sarcoidosis

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60
Q

Common diagnostic tests?

A

Blood Tests, Smears of Body Secretions, Skin Tests, and Serum-Specific IgE Test

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61
Q

WBC count is usually normalexcept with

A

infection and inflammation.

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62
Q

WBC range that is considered abnormal?

A

A range greater than 5-10% is considered abnormal and may be found in patients with allergic disorders

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63
Q

An increase in Eosinophil indicates

A

an active allergic response

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64
Q

What are some specific diagnostic tests?

A

CBC: Eosinophil Count
Total Serum IgE
Skin Tests: Prick, Scratch, and Intradermal

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65
Q

High IgE levels indicate

A

that an allergic disease is present.

66
Q

Positive (Wheal-And-Flare) reactions are clinically

A

significant when correlated with the history, physical findings, and results of other laboratory result

67
Q

Methods of skin testing include

A

prick skin tests, scratch tests, and intradermal skin testing

68
Q

Most suitable place to perform a intradermal skin test?

A

The back, because it permits the performance of many tests

69
Q

What does a positive reaction mean on a skin test?

A

This is evidenced by a urticarial wheal (round, reddened skin elevation), diffused redness or irregular projection at the end of the wheal.

70
Q

Skin tests are used most frequently with

A

the diagnosis of allergic rhinitis

71
Q

Negative test results are helpful in

A

ruling out food allergy

72
Q

Positive skin tests correlate

A

highly with food alergy

73
Q

Provocative testing involves the

A

direct administration of the suspected allergen to the sensitive tissue, such as teh conjunctiva, nasal, or bronchial mucosa, with observation of target organ response

74
Q

Serum specific igE test formerly known as a

A

RAST

75
Q

What are the two types of IgE-mediated allergic reactions

A

Atopic and Nonatopic disorders

76
Q

Atophy is defined as

A

the genetic predisposition to mount an IgE response to inhaled or ingested innocuous proteins

77
Q

Atopic diseases consist of

A

asthma, allergic rhinitis, and atopic dermatitis.

78
Q

Nonatopic is more about

A

contact. Something that the person themselves makes, such as latex. They lack the genetic component and organ specificity of the atopic disorders

79
Q

First thing to do in the case of allergic reaction?

A

Administer oxygen. Supplemental oxygen is important when they themselves are not receiving it.

80
Q

After administering epinephrine, what should be given?

A

Intravenous fluids (normal saline solution), volume expanders, and vasopressor given to maintain blood pressure and normal hemodynamic status

81
Q

In patients with bronchospasm or a history of bronchial asthma or chronic obstructive pulmonar disease, what should be given?

A

Aminophylline and corticosteroids may also be given to improve airway patency and function

82
Q

Where should an epipen be administered?

A

Upper extremity or thigh

83
Q

Some side effects after taking an epipen?

A

Fast heart rate and vasoconstriction

84
Q

After getting an epipen, what should the person do?

A

They should immediately drive themselves to the hospital because of the risk of rebound. Should also wait 30 minutes after injection because people may have a delayed response

85
Q

What do you give if you want to stop histamine production?

A

Antihistamine

86
Q

What does administering corticosteroids do?

A

Decreases inflammatory response

87
Q

What is Anaphylaxis?

A

A clincal response to an immediate immunologic reaction between a specific antigen and an antibody. Reaction results from a rapid release of igE mediated chemicals, which can induce a severe life-threatening reaction

88
Q

What type is Anaphylaxis considered to be?

A

A Type I IgE allergic reaction to an antigen, a foreign substance that has entered the body

89
Q

Anaphylaxis is caused by

A

the cross-links of allergen with allergen -specific IgE antibodies found on the surface membrane of mast cells and basophils, leading to cellular degranulation

90
Q

What do you do first in Anaphylaxis?

A

ABC. Protect the Airway, Breathing, and Constriction

91
Q

You should always tell your doctor about any sort of reaction you have because

A

the reaction may not be the same the next time you have an allergic reaction

92
Q

Closely resembling anaphylaxis is

A

an anaphylactoid reaction

93
Q

an anaphylactoid reaction caused by

A

the release of mast cell and basophil meditors trigger by non IgE mediated events

94
Q

an anaphylactoid reaction may occur with

A

medications, food, exercise, or cytotoxxic antibody transfusions.

95
Q

Local reactions usually involv

A

urticaria and angioedema at the site of antigen exposure

96
Q

Systemic reactions occur within

A

30 minutes after exposure and involve cardiovascular, respiratory, GI, and integumentary organ systems

97
Q

Some symptoms of Anaphylaxis?

A 
Flushing
Urticaria
Angioedema
Hypotension
Bronchoconstriction
98
Q

Common foods that cause anaphylaxis

A

Peanuts, Tree Nuts, Shellfish, Fish, Milk, Eggs, Soy, Wheat

99
Q

Medications that cause Anaphylaxis

A

Antibiotics, especially penicillin and sulfa antibiotics

100
Q

Other pharmacentucal / Biological Agents that cause Anaphylaxis

A

Animal Serums (Tetanus Antitoxin, Snake Venom Antitoxin) Antigens used in skin testing

101
Q

Insect Stings that cause Anaphylaxis

A

Bees, Wasps, Hornets, Yellow Jackets, Ants

102
Q

Latex: Common Causes of Anaphylaxis

A

Medical and Nomedical Productions Containing Latex

103
Q

Mild systemic reactions consist of

A

peripheral tingling and a sensation of warmth, possibly accompanied by a sensation of fullness in the mouth adn throat. Nasal congestion, periorbital swealling, pruritus, sneezing, and tearing can also be expected

104
Q

Moderate systemic reactions include

A

flushing, warmth, anxiety, and itchng in addition to any of the milder symptoms

105
Q

More serious systemic reactions include

A

bronchospasm and edema of the airways or larynx with dyspnea, cough, adn wheezing

106
Q

Severe systemic reactions have an

A

abrupt onset with same signs and symptoms as more serious systemic reactions. Symptoms progress to bronchspasm, laryngeal edema, severe dyspnea, cyanosis, and hypotension

107
Q

The most common serious allergic reactions to insect stings are from what family?

A

Hymenoptera, which includes bees, ants, wasps, and yellow jackets

108
Q

Epinephrine has what type of dilution?

A

1:1000

109
Q

Allergic Rhinitis (Hay Fever, Seasonal Allergic Rhinitis) is the most

A

common form of respiratory allergy, which is mediated by an immediate (Type I) reaction. Affects about 12% of the population

110
Q

Rhinitis is considered to be

A

the alergic form of the symtoms if they are caused by an allergen-specific Ig-mediated immunologic response

111
Q

Allergic Rhinitis in Early Spring?

A

Tree Pollen (Oak, Elm, Poplar)

112
Q

Allergic Rhinitis in Early Summer?

A

Grass Pollen

113
Q

Allergic Rhinitis in Early Fall?

A

Weed Pollen

114
Q

Four major signs and symptoms of allergic rhinitis included

A

copious amounts of serous nasal discharge, nasal congestion, sneezing, as well as nose and throat itching

115
Q

Diagnosis of seasonal allergic rhinitis is based on

A

history, physical examination and diagnostic tesst results

116
Q

Allergic Rhinitis: Diagnostic tests include

A

Nasal Smears, Peripheral Blood COunts, Total Serum IgE, Intradermal Testing, and Nasal PRovocation

117
Q

Allergic Rhinitis: Results indicative of allergy as the cause of rhinitis include

A

increased igE and Eosinophil levels and positive reactions on allergen testing

118
Q

Allergic Rhinitis: Therapy may include

A

Avoidance Therapy
Pharmacologic Therapy
Immunotherapy

119
Q

Allergic Rhinitis: Diagnosis

A

Pain
Inneffective Airway
Ineffective Breathing Problems
DEficient Knowledge about Allergy

120
Q

How do Antihistamines work?

A

H1 blockers bind selectively to H1 receptors, preventing the actions of histamines t these sites. Best if taken right away

121
Q

What are Adrenergic Agents?

A

Vasoconstrictors of mucosal vessels and are used topically in nasal and ophthalmic forultions

122
Q

What do Adrenergi Agents do?

A

They reduce the local blood flow fluid exudation, and mucosal edema.

123
Q

What does NasalCrom do?

A

Stablizes the mast cell membrane, thus reducing the release of histamine and other mediators of the allergic response. It also inhibits macrophages, eosinophihls, monocytes, and platelets involved in the immune response

124
Q

Goals of Immunotherapy include

A

reducing the level of circulating IgE, and reducing mediator cell sensitivity.

125
Q

Immunotherapy has been most effective for

A

treatment of grass, tree pollen, cat dander, and house dust mite.

126
Q

Allergic Rhinitis: Most common treatmetn is SIT (Subcutaneous Immunotherapy) , which consists of

A

the serial injection of one or more antigens that are selected in each particular case ont he basis of skin testing

127
Q

Allergic Rhinitis: Diagnosis Examples

A

Ineffective breathing pattern related to allergic reaction
Deficient knowledge about allergy and recommended modifications in lifestyle and self-care practices
Ineffective coping with chronic of condition and need for environmental modification

128
Q

Contact Dermatitis is

A

a type IV delayed hypersensitivity reaction, that can be acute or chronic caused by contact with an exogenous substance that elicits an alergic response

129
Q

Four types of Contact Dermatitis

A

Allergic, Irritant, Phototoxic, and Photo Allergic

130
Q

Contact Dermatitis: Symptoms include

A

Itching, burning, erythema, skin lesions, and edema , followed by skin thickening, hardening and scaling

131
Q

Contact Dermatitis: Assessment should include

A

the date of onset, and any identifiable relationship to work environment and skin care products

132
Q

Simple total definition of Contact Dermatitis

A

Type IV delayed reaction. Exposed to ingenious substances, or something on the outside. Can be irritants such as soap, detergent, and can be for short or long exposure. Can have rash or itching, skin lesions, swelling, edema

133
Q

Atopic Dermatitis is a

A

Type I immediate hypersensitivity disorder characterized by inflammation and hyper reactivity of the skin

134
Q

Atopic Dermatitis: Most patients have elevated

A

IgE levels and peripheral eosinophilia. Eosinophil count may be increased depending on concomitant respiratory allergies

135
Q

Atopic Dermatitis: What are the most consistent feautres of this?

A

Pruritus and Hyperirritability of the skin and are related to large amounts of histamine in the skin

136
Q

Atopic Dermatitis is often linked in a process called atopic march that often leads to

A

asthma, allergic rhinitis, or food allergy

137
Q

Atopic Dermatitis: Itching can be decrease dby

A

wearing cotton fabrics; washing with mild detergent; humidifying dry heat in winter; maintaining normal room temperature; using antihistamines and avoiding animals, dust, sprays, and perfumes

138
Q

Atopic Dermatitis: What should be use to inhibit T Cells and mast cells involved in atopic dermatitis

A

Immunosuppressive agents such as cyclosporine, tacrolimus, and pimecrolimus

139
Q

Dermatitis Medicamentosa: This is a

A

type I hypersensitivity disorder, and is the term that is applied to skin rashes associated with certain medications

140
Q

Urticaria: What is this?

A

Hives, and this is a Type I hypersensitive allergic reaction of the skin that is characterized by the sudden appearance of edemtous,. pink, or red wheals of variable sizes

141
Q

Urticaria: Most commonly instigated by

A

infections, allergic reaction to food, insect stings, and medications

142
Q

Urticaria: Management includes

A

Removing the food
Avoiding NSAIDs
Minimizing Aggravators
Short Course of Corticosteroids

143
Q

Angioneurotic Edema: Involves

A

Deeper layer of the skin resulting in more diffuse swelling than the discrete lesions characteristicss of hives

144
Q

Angioneurotic Edema: Region most often involved is

A

Lips, Eyelids, Cheeks, Hands, Feet, Genitalia, and Tongue

145
Q

Hereditary Angioedema: Symptoms caused by

A

Edema to the skin, the respiratory tract, or the digestive tract

146
Q

Cold Utricaria: What happens to someone with this?

A

They break ot in hives when exposed to cold. Urticaria may be prompted by exposure to cold weather.

147
Q

Cold Utricaria: Symptoms include

A

Fever, Chills, Conjuctive, Infection, Sweating, Headache, and Arthralgia

148
Q

Cold Utricaria: During the attack patient may develop

A

Leukocytosis, an increas e in the erthrocyte sedimentation rate, and raised C-Reactive protein levels

149
Q

Cold Utricaria: Diagnosed by

A

physical testing. Ice cube provocation testing involves placing cube on skin for 1-5 minutes.

150
Q

Food Allergy: Most common offenders include

A

Seafood, Peanuts, Tree Nuts, Berries, Eggs, Wheat, Milk, and Chocolate

151
Q

Food Allergy: Clinical Symptoms are

A

Urticaria, Dermatitis, Wheezing, Cough, Laryngeal Edema, Angioedema and GI Symptoms

152
Q

Food Allergy: Medication Therapy

A

This includes use of H1 blockers, antihistamines, adrenergic agents, corticosteroids, ad cromolyn sodium

153
Q

Latex Allergy: Has been implicated in

A

rhinitis, conjunctivits, contact dermatitis, urticaria, asthma, and anaphylaxis

154
Q

Latex Allergy: Those at risk include

A 
8-17% of health care workers, 
Patients with atopic allergies or multiple surgerie
People working in latex factories
females
67% patients with Spina Bifida
155
Q

Latex Allergy: Allergic reaction to

A

natural rubber proteins

156
Q

Latex Allergy: Irritant Contact DErmatitis, a Nonummunologic response, may be caused by

A

mechanical skin irritation or alkaline pH associated with latex gloves

157
Q

Latex Allergy: Common symptoms of irritant dermatitis include

A

erythema and pruritus. Can be eliminated by changing the brand of gloves

158
Q

Latex Allergy: The use of hand lotion before donning latex gloves can

A

worsen the symptoms, because lotions may leach latex proteins from the gloves

159
Q

Latex Allergy: Delayed hypersensitivty to latex (Type IV reaction), is localized

A

to the area of exposure and is characterized by symptoms of contact dermatitis

160
Q

Latex Allergy: Immediate ypersensitivity (Type I) is mediated by

A

the IgE mast cell system.

161
Q

Latex Allergy: Symptoms of Immediate Hypersensitivy include

A

rhinitis, conjunctivitis, asthma, anaphylaxis

162
Q

Latex Allergy: Clinical Manifestations of Immediate Hypersensitivity include

A

having a raipid onset and can include urticaria, wheezing ,dyspnea, laryngeal edma, bronchospasm, tachycardia, angioedema, hypotension, and cardiac arrest

NRSG 102: Med Surg 1 (52 decks)

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