Immunity

Question 1

What are some clinical presentations of IgE-mediated reactions.

Answer 1

• Allergic rhinitis
• Angioedema
• Asthma
• Atopic dermatitis
• Urticaria (hives)

Question 2

What are neurologic findings caused by anaphylaxis?

Answer 2

• Headache
• Dizziness
• Paresthesia
• Feeling of impending doom

Question 3

What are skin findings caused by anaphylaxis?

Answer 3

• Pruritus
• Angioedema
• Erythema
• Urticaria

Question 4

What are respiratory findings caused by anaphylaxis?

Answer 4

• Hoarseness
• Coughing
• Sensation of narrowed airway
• Wheezing
• Stridor
• Dyspnea, tachypnea
• Respiratory arrest

Question 5

What are cardiovascular findings caused by anaphylaxis?

Answer 5

• Hypotention
• Dysrhythmias
• Tachycardia
• Cardiac arrest

Question 6

What are GI findings caused by anaphylaxis?

Answer 6

• Cramping, abdominal pain
• Nausea, vomiting
• Diarrhea

Question 7

Describe initial management of anaphylactic shock.

Answer 7

1. Recognize cues of an anaphylactic action
2. Maintaining a patent airway
3. Establish IV access
4. Administer drugs as ordered:
   ~ Epinephrine (IM, IV, or subcut)
   > If IM, give mid-outer thigh
   ~ High flow O2 (8-10 L/min) via facemask
   ~ Nebulized albuterol for bronchospasm
   ~ IV diphenhydramine for hives & itching
   ~ IV corticosteroids
   ~ Treating hypovolemic shock

Question 8

How do you manage hypotension resulting from anaphylactic shock?

Answer 8

• Place in recumbent position and elevate legs
• IV NS (0.9% Sodium Chloride) rapid bolus of 1-2 L
• Maintain BP w/ fluids, volume expanders, and vasopressors (dopamine)

Question 9

Describe further monitoring and treatments for anaphylactic shock.

Answer 9

• Monitor VS, respiratory effort, O2 saturation, LOC, heart rhythm, and urine output
• Anticipate intubation w/ severe respiratory distress
• Anticipate cricothyrotomy or tracheostomy w/ severe laryngeal edema

Question 10

Develop an individual teaching plan for a client with allergens causing an anaphylactic reaction.

Answer 10

• Fill Rx at once and keep at least 2 doses available
• Always keep at least 1 autoinjector w/ you
• Keep an autoinjector in a place where others can easily find it in case of an emergency
• Mark on a calendar when the autoinjector expires
• Use device if you have any cues of anaphylaxis (trouble breathing or feeling tightness in the throat, or lightheaded)
• When needed:
  ~ Inject into top of the thigh, slightly on the outside, at a 90o angle. Hold in place for 2-3 minutes.
  ~ You can inject through clothes; avoid pockets and seams
  ~ After use, call 911 and get to the nearest hospital for monitoring. Take autoinjector w/ you

Question 11

Describe clinical manifestations of Rheumatoid Arthritis (RA).

Answer 11

• Fatigue
• Anorexia
• Weight loss
• General stiffness, limited motion
• Cues of inflammation (warmth, swelling, pain)
• Joint stiffness after periods of inactivity, esp. morning stiffness
• Joints are tender, painful, and warm to the touch
• May cause irreversible deformity and disability

Question 12

Developing an individual teaching plan for a client with systemic lupus erythematosus (SLE)

Answer 12

• Increase patient involvement in self-care
  ~ Help patient understand that adherence to treatment is no guarantee against flares
• Avoid factors that increase disease activity (stress, fatigue, sun exposure, infection, certain drugs, surgery)
• Explain treatments and all diagnostic procedures
• Teach patient about drug therapy
  ~ Disease process
  ~ Using sunscreen daily
  ~ Energy conservation and activity prioritization
  ~ Up to date on immunizations
  ~ Help patient understand that abruptly stopping a drug may worsen disease activity