Exam 4-Care of Pts with Immune Function Excess Flashcards
Hypersensitivities/Allergies
Increased/excessive response to presence of antigen exposure
Degree of rtx:
- Uncomfortable: itchy watery eyes, sneezing
- Life threatening: allergy asthma, anaphylaxis, bronchoconstriction circulatory collapse
TYPE I: Rapid Hypersensitivity Rtx (also an atopic allergy)
- Most common type
- some rtx occur only in areas of antigen exposure
- caused by increased production of IgE antibody class
TYPE I: Rapid Hypersensitivity Rtx causes
Inhalation: pollens, spores, animal dander, dust
Ingestion: foods, food additives, drugs
Injection: insects (bee sting), drugs
Contraction: latex, food, environmental proteins
TYPE I: Rapid HR -Anaphylaxis
blood vessel dilation, decreased cardiac output, bronchoconstriction
occurs very quickly
also known as anaphylactic reaction
TYPE I: Allergic Rhinitis (Hay fever)
triggered by airborne allergens: plant pollen, molds, dust, animal dance, wool, food, air pollutants
Allergic Rhinitis: Primary phase
allergens binds to 2 adjacent IgE molecules
Histamine is released
Allergic Rhinitis: Secondary Phase
release of other proteins, general inflammatory reaction develops
TYPE I PT COLLABERATIVE CARE
- Hx
- Lab assessment: increased eosinophils (normal 1%-2%), IgE, RAST
- Allergy testing: scratch testing & intradermal testing, repeat open application testing (ROAT)
- Oral food challenge
Oral food challenge
taking away everything and introducing one food at a time
scratch testing & intradermal testing
antihistamines & glucocorticoids discontinued for 4 wks prior to testing
TYPE I: Environmental changes
- air conditioning, air cleaning units
- cloth drapes
- upholstered furniture
- carpeting
- change clothes when come inside to make home free of outside allergens
TYPE I: Pet intervention
- pets that shed
- bathe pets
- no sleeping with pets
TYPE I: Drug therapy
Decongestants Antihistamines Corticosteroids Mast cell stabilizers Leukotriene antagonists Complementary & Alternative therapy: Aromatherapy, Unprocessed honey Desensitization therapy (allergy shots)
Anaphylaxis
-1st feelings of uneasiness, apprehension, weakness, impending doom
-pruitis and urticaria
-Erythema, sometimes angioedema of eyes, lips, tongue
Tx: EpiPen
-Emergency situation
-histamine causes capillary leak, bronchochonstriction, mucosal edema, excess mucus secretion
Anaphylaxis s/s
Congestion Rhinorrhea Dyspnea Increasing Respiratory Distress with audible wheezing
-can be fatal
common cause: Drugs and dyes
Anaphylaxis Inerventions
- EpiPen or Twinject
- Assess respiratory function; establish airway
- CPR (if needed)
- Epinephrine
- Antihistamines (for angioedema & urticaria)
- O2
- Tx bronchospasm
- IV fluids
TYPE I: Latex
- protein found in natural latex rubber products is specific allergen
- allergen causes interaction with IgE
- Incidence of latex allergy is increasing
- can develop rtx later in life
- health care workers especially susceptible
TYPE II Cytotoxic rtx
body makes special autoantibodies directed against self cells that have some form of foreign protein attached to them
TYPE II: Cytotoxic ex
Hemolytic anemias
Thrombocytopenic purpura
Hemolytic transfusion rtx
Goodpasture’s syndrome
TYPE III: Immune Complex rtx
- excess antigens cause immune complexes to form in blood
- circulating complexes lodge in small blood vessels (damage of organ its going to)
- Usual sites: kidneys, skin, joints, small blood vessels
- Deposited complexes trigger inflammation, result in tissue or vessel damage
TYPE III: Immune Complex Causes
Rheumatoid arthritis
systemic lupus erythematosus
serum sickness occur
TYPE IV: Delayed Hypersensitivity Rtx
- Reactive cell is T-lymphocyte
- antibodies & complemnet not involved
- Local collection of lymphocytes & macrophages cause edema, induration, ischemia, tissue damage at site
TYPE IV: Delayed Hypersensitivity Rtx Examples
- Positive purified protein:TB skin tests
- Contact dermatitis
- Posisn ivy skin rashes: exposure may not show until the next day
- Insect stings: rtx the following day
- Tissue transplant rejection
- Sarcoidosis
TYPE V: Stimulatory Rtx
- excess stimulation of normal cell surface receptor by autoantibody
- results in continuous “turned-on” cell state
ex. Graves’ disease
Autoimmunity
- person develops inappropriate immune response
- antibodies/lymphocytes directed against healthy normal cells & tissues (autoantibodies)
- Immune system fails to recognize certain body cells/tissues as self, triggers immune rtx
Ex. SLE, scleroderma, rheumatoid arthritis
SJOGREN’S SYNDROME
- often appears with autoimmune disorders
- insufficient tears causing inflammation/ulceration of cornea
- no cure; intensity & progression can be slowed
SJOGREN’S SYNDROME S/S
dry eyes
dry mucous membranes of nose & mouth (xerostomia)
vaginal dryness
GOODPASTURE’S SYNDROME
- autoantibodies made against glomerular basement membrane & neutrophils
- lungs & kidneys
Tx: High-dose corticosteroids
-may require dialysis or kidney transplant
GOODPASTURE’S SYNDROME S/S
shortness of breath hemoptysis decreased urine output weight gain edema hypertension tachycardia
