Immunity Inflammation Infection Study Guide Flashcards
1st line of defense
o Skin and mucous membranes
o Sweat glands secrete lysozyme, an antimicrobial enzyme
Immunity
Provides resistance to invading organism’s.
Antigens
-Any substance capable of stimulating a response from the immune system .
-Asthma is a common allergic response disorder.
Antibodies
Also known as Immunoglobulins
Innate (natural passive) immunity
-Present at birth
-Babies are born with immunoglobulin G which can cross the placenta barrier and last about 6 months .
Acquired immunity
Developed after birth after being exposed to
Antigens through vaccine or living the good life.
-also know as an active immunity .
Leukocytes (Aka white blood cells)
Key role in immune responses to infectious organisms and other antigens .
Primary organs in immunity
Thymus
Bone marrow
Secondary organs in immunity
Adenoids
Tonsils
Lymphoid
Liver
Spleen
Appendix
Gut - peyers patches (lymphoid tissue)
2nd line of defense
-5 cardinal signs of inflammation : pain , heat , redness, swelling ,loss of function.
- inflammatory response : neutralize ,attract immune response, prevent spread of injury, prepare site for repair.
(Inflammation literally means the fire within)
Local Systemic
-rubor- redness. -Fever
-color -heat. -Headache
-tumor- swelling - -Muscle ache
-dolor- pain -Chills
Functionlaesa- loss of function -sweating
-leukocytosis
Phagocytosis
White blood cells are able to phagocytose (ingest) bacteria.
Anti inflammatory
-cortisol
-hormone produced by the adrenal cortex
-slows the release of histamine and prevents influx of the leukocytes.
- drugs such as corticosteroids mimic cortisol.
-treats inflammatory conditions
wound healing (vitamin c)
Process of wound healing
-tissue repair set in motion form the beginning of inflammatory process.
-speed depends on the type of tissue injured severity , if there is infection and health of the host.
-macrophage cells clean up inflammatory debris
-fibroblasts begin repair process by laying elastin and collagen at wound edges and migrate to base of wound.
-scab is usually formed of dried blood and fibroblasts.
-epithelial cells migrate over wound and under scab.
-sometimes wound bed is too large for granulation tissue to fill.
-wound is cleaned and debrided to enhance healing.
-when infection is no longer present its sutured closed (healing by tertiary intention)
Nursing Assessment During Antimicrobial Therapy
Nausea, vomiting, diarrhea
(big 3 adverse effects)
-determine if related to antibiotic
-determine hydration status
-report diarrhea, abd pain
secondary infection
-oral infections, lesions, itching i vaginal, anal areas.
-can produce severe life threatening diarrhea.
allergies and anaphylaxis
-mild to fatal, within 30 min after administration to days after therapy
-anaphylaxis, laryngeal edema, shock, dyspnea, skin reactions
-determine if allergies (skin rash . edema , dyspnea) or gi symptoms.
Nursing Assessment During Antimicrobial Therapy ☺ (3 of 3)
Nephrotoxicity: Increasing BUN/creatinine, decreasing urine output, changes in UA
Hepatotoxicity: Assess for preexisting hepatic disease, abnormal liver enzymes
***Ototoxicity: Damage to eighth cranial nerve, can lead to hearing loss. Manifested by dizziness, tinnitus, and progressive hearing loss
Blood dyscrasias
***Ototoxicity
Damage to eighth cranial nerve, can lead to :
1.hearing loss
2.Manifested by dizziness
3.tinnitus
4.progressive hearing loss
Implementation
-Precautions for infection transmission
-Monitor for phlebitis when given IV
-Administer on established time schedule
-Determine whether able to give with food
-Identify drug allergies
Implementation (2 of 3)
Nausea, vomiting, diarrhea: Give with food if possible, or healthcare provider can switch to parenteral
Secondary infections: Notify healthcare provider if infection develops
Allergies/anaphylaxis: Monitor patients with allergies, asthma, rhinitis, or taking multiple meds for allergic response; watch carefully for 20 to 30 minutes after administration
See treatment of allergic response
Implementation (3 of 3)
Nephrotoxicity: Monitor BUN/creatinine, I&O; report declining urine output <30 mL/hr
Hepatotoxicity: Monitor labs, observe for anorexia, nausea, vomiting, jaundice, etc.
Ototoxicity: Report hearing impairment, dizziness, or tinnitus
Blood dyscrasias: Monitor and report sore throat, fatigue, elevated temperature, skin hemorrhages, and bruises
Photosensitivity: Wear sunscreen, avoid ultraviolet light
Drug Class: Aminoglycosides ☺
Action: Inhibit protein synthesis
Use: Effective against gram-negative organisms that cause urinary infections, meningitis, wound infections, septicemia
**Serious adverse effects: Ototoxicity (damage to the 8th cranial nerve manifested by hearing loss); nephrotoxicity (damaging or destructive to the kidneys)
Do not give within 72 hours of skeletal muscle relaxants used with anesthesia
Drug Class: Glycopeptides ☺
Action: Prevent synthesis of bacterial cell walls
Uses
Dalbavancin is used in treatment of adult patients with acute bacterial skin and skin structure infections
Oritavancin, telavancin, *vancomycin
Serious adverse effects: Ototoxicity (notify for any changes in hearing) , nephrotoxicity, Q-T interval prolongation, coagulation, hepatic effects, secondary infections
Table 45.4 Glycopeptides
Drug Class: Penicillins ☺
Action: Inhibit cell wall synthesis, penicillinase-resistant penicillins
Uses: Treat middle ear infections, pneumonia, meningitis, urinary tract infections, syphilis, gonorrhea, and as prophylactic antibiotic
Common adverse effects: Diarrhea, electrolyte imbalance
Serious adverse effects: Hepatotoxicity, nephrotoxicity, hyperkalemia, or hypernatremia
Table 45.6 Penicillins
e.g. ***amoxicillin-clavulanate – take with food
Drug Class: Antitubercular Agents ☺ (1 of 4)
Drug: Ethambutol (Myambutol)
Action: Alters cellular RNA synthesis and phosphate metabolism
Use: Treatment of tuberculosis
Common adverse effects: Nausea, vomiting, anorexia, abdominal cramps
Serious adverse effects: Confusion, hallucination, blurred vision, red-green vision changes
Drug Class: Antitubercular Agents ☺ (2 of 4)
Drug: Isoniazid (INH, Nydrazid)
Action: Disrupts the cell wall and inhibits replication of tuberculosis bacteria
Use: Treats and prevents tuberculosis
Common adverse effects: Nausea, vomiting
Serious adverse effects: Hepatotoxicity, tingling, numbness of hands and feet, dizziness, ataxia
Drug Class: Antitubercular Agents (3 of 4)
Drug: Pyrazinamide (Tebrazid)
Action: Lowers the pH of environment
Use: Treatment of tuberculosis; in combination with antitubercular agents
Common adverse effects: Nausea, vomiting, anorexia, arthralgia, myalgia
Serious adverse effect: Hepatotoxicity
Drug Class: Antitubercular Agents ☺ (4 of 4)
Drug: Rifampin (Rifadin)
Action: Prevents RNA synthesis by inhibiting DNA-dependent RNA polymerase
Use: Eliminates meningococci and H. influenzae type b (Hib) from asymptomatic carriers
**Common adverse effect: Reddish-orange secretions
Serious adverse effects: Nausea, vomiting, anorexia, abdominal cramps
What important information does a nurse provide to a patient prescribed rifampin (Rifadin) to treat tuberculosis?
A. “Medication should be taken with food to reduce irritation to the stomach.”
B.“Oral contraceptives are not affected by the drug.”
C.“This medication will turn body secretions a reddish-orange color.”
D.“Any nausea and vomiting must be reported to your healthcare provider immediately.”
A large, heavy, and older adult patient has a stroke and develops an infected decubitis ulcer on the sacrum during the hospital stay. Approximately 2 weeks after the patient has gone home, the patient returns to the hospital with pneumonia. What is the distinction between these 2 infections?
The decubitis ulcer is termed a ‘health-care associated’ infection,
and pneumonia is termed a ‘community-acquired’ infection
A school nurse hosted a clean up campaign at a local elementary school, in effort to combat allergens. What is the most common allergic response disorder?
asthma
Miscellaneous Antibiotics
Aztreonam (Azactam): Inhibits cell wall synthesis, monobactams
Clindamycin (Cleocin): Inhibits protein synthesis
Daptomycin (Cubicin)
Cyclic lipopeptide, binds to bacterial membranes and causes rapid depolarization
Serious adverse effects: diarrhea, muscle pain
Which medication is in a class of antibiotics known as cyclic lipopeptide antibiotics?
Metronidazole (Flagyl)
Clindamycin (Cleocin)
Chloramphenicol (Chloromycetin)
Daptomycin (Cubicin)
Miscellaneous Antibiotics (2 of 2)
Metronidazole (Flagyl): Bactericidal, trichomonacidal, and protozoacidal
Tinidazole (Tindamax)
Similar to metronidazole
Primary therapeutic outcome: elimination of parasitic infection
Corticosteroids
Corticosteroids are hormones
Two categories: mineralocorticoids and glucocorticoids
The primary mineralocorticoid is aldosterone
Fludrocortisone is the only commercially available mineralocorticoid
Glucocorticoids (e.g. cortisone, hydrocortisone, prednisone) regulate carbohydrate, protein, and fat metabolism. Used to treat variety of disorder because of its potent anti-flammatory, antiallergenic, and immunosuppressant activity
Nursing Implications For Corticosteroid Therapy
Assessment:
Baseline weight
Blood pressure
Results of electrolyte and glucose studies
Medication use
Nursing Implications For Corticosteroid Therapy
Neurologic
Mental status
Check for orientation to date, time, and place
Assess for level of confusion, restlessness, or irritability
Status of hydration
Dehydration
Skin turgor
Oral mucous membrane
Laboratory changes
Overhydration
Edema
Nursing Implications For Corticosteroid Therapy ☺
Assessment:
-Presence of ulcer disease
**-Laboratory tests – monitor the serum potassium, PT/INR, and blood sugar if patient is taking furosemide, warfarin, and metformin.
-Nutrition
-Hyperglycemia
-Activity and exercise
Drug Class: Glucocorticoids ☺
Actions: the major glucocorticoid is cortisol.
-Uses: usually given because of their anti-inflammatory and antiallergenic properties. They do not cure disease, but they relieve symptoms of tissue inflammation.
-When used to control rheumatoid arthritis, symptom relief is noted. Joint and muscle stiffness, muscle tenderness and weakness, joint swelling, and soreness are slightly reduced.
*-Glucocorticoids are also effective for immunosuppression in the treatment of cancers, organ transplantation, autoimmune diseases *(rheumatoid arthritis), relief of allergic manifestation, and treatment of shock. Also treat nausea and vomiting secondary to chemotherapy.
**-E.g. A patient with rheumatoid arthritis is taking glucocorticoid (prednisone) will experience an improve range of motion.
Drug Class: Glucocorticoids ☺
**Examples of drugs that reduce inflammation and hinder body’s immune response are bronchodilators and corticosteroids
-Therapeutic outcomes:
Reduced pain and inflammation
Minimized shock and faster recovery
Reduced nausea and vomiting associated with chemotherapy
Table 37.1 Topical and Systemic Corticosteroid Preparation
A nurse explains that a medication, hydro-cortisone is given to a patient with severe inflammatory response mimics a hormone secreted by the adrenal cortex. To what hormone is the nurse referring?
cortisol
A nurse is discussing the body’s first and second lines of defense against infection with a community group. What does the body’s first line of defense include?
sweat
With the exposure to an antigen, a nurse explains that the initiator of the inflammatory response is the presence of histamine. What is responsible for releasing histamine?
Basophils-
Basophils are a type of white blood cell that works closely with your immune system to defend your body from allergens, pathogens and parasites. Basophils release enzymes to improve blood flow and prevent blood clots.
Physical and chemical barriers :)
Skin and mucous membranes are the first line of defense. Sweat is included as the first line of defense
- Sweat glands secrete lysozome -antimicrobial enzyme
- Sebaceous glands secrete sebum – has antimicrobial and antifungal properties.
Second line of defense is the phagocytosis and the inflammatory response
*** White blood cells – count increases during infection
- Reticuloendothelial cells are found in the blood and connective tissue
** Organs involve in immunity are liver, spleen,tonsils, bone marrow, and lymph nodes
A nurse is bathing a patient who is immunodeficient and has a cryptococcus infestation. What is the classification of this organism?
Fungus
A mosquito or a fly carries an organism that infects another living organism. What is this mode of transportation of infection?
vector
An air conditioner duct cleaning is recommended by a home health nurse. What should this precaution prevent the spread of in the parent’s home?
fungi
A school nurse cautions a group of parents about children playing barefoot on dirt. To what infectious agents can this action expose the children?
Helminthes
A community picnic is held. A number of the attendees become ill with GI symptoms after the picnic. How was the pathogen acquired?
common vehicle
A nurse caring for a patient who is immuno-suppressed is diligent about protecting the patient from infection. When visitors come in, in addition to having them put on isolation attire, what should the nurse also prohibit?
potted plants
(flowers etc)
A patient who is receiving daily steroids for the control of a condition calls the nurse to ask advice whether a small child who has been exposed to influenza should come and visit because she has not had any symptoms. What is the most appropriate response by the office nurse?
“No, the child should not visit. Infectious diseases are often most communicable in the short period before signs and symptoms appear”
A patient with the diagnosis of Clostidium difficile infection asks what has caused the diarrhea. What is the best response by the nurse?
a long term of antibiotic therapy
A patient receiving a large intramuscular dose of antibiotic was asked to please wait 20-30 minutes before checking out. What is the reason for this request?
Antibiotics are a common source of severe allergic reactions within the first few minutes after an injection
After receiving an injection of penicillin, a patient undergoes an anaphylactic reaction. What should the nurse do first?
administer oxygen
The organs involved in immunity include the tonsils, spleen, and lymph nodes. What other organ is involved in immunity?
liver
What occurrences of disease is the school nurse required to report to the health department? (SATA-3)
- rubella
- lyme disesae
- salmonella
The nurse is discharging a client who has been taking prednisone 30 mg/day for the last 14 days and is going home with an order for a taper of the medication. What is the priority client teaching that the nurse needs to cover?
The client should never stop the medication abruptly; he should follow the prescribed taper regimen to prevent adrenal insufficiency
Tapering means to reduce opioid dosage over time. Opioids can be an important part of treatment for your pain management, but they come with serious. side effects and risks. If your healthcare provider thinks the risks of opioids outweigh the benefits, they may recommend tapering.
Medications which are used to stop the growth and development of susceptible bacteria are classified as which one of the following
Antibiotics
Clients taking aminoglycosides should have the functioning of their _____ tested before and after treatment
Hearing
A client has been diagnoses with tuberculosis and has been started on rifampin along with other antitubercular medications. The nurse should notify the client to expect which common adverse effect?
All body fluids will turn reddish orange
Ketoconazole is used to treat which type of infection?
fungi
The client has been diagnosed with herpes simplex virus. The nurse expects that the medication most likely to be prescribed is acyclovir if:
the client has normal kidney function
High dose or long-term use of aspirin (ASA) can produce a variety of adverse effects that include; (SATA-3)
- gastric ulceration
- hemorrhage
- tinnitus
To decrease the risk of gastrointestinal upset when taking nonsteroidal anti-inflammatory agents, the nurse advises the client to take the medication
with food or milk
White blood cells called Granulocytes
neutrophils, eosinophils and basophils
White blood cells (leukocytes)
colorless blood cells that have the ability to phagocytose (ingest) bacteria that can cause infection when they invade the body.
There are five types of leukocytes:
neutrophils, monocytes, eosinophils, basophils, and lymphocytes.
Neutrophils
are the first to respond to infection. Neutrophils phagocytise (eat) bacteria and also destroy bacterial toxins in body fluids. They primarily destroy dissolved toxins that bacterial secretes (produce and discharge) into your body’s fluids. Neutrophils’ contain a nuclear that has 2 to 6 lobes. Neutrophils are the white blood cells that contribute to immunity. Neutrophils contribute to immunity by engulfing (completely covering) bacteria and foreign bodies (thorns, dirt, etc) a process called phagocytosis.
WBCs (neutrophils, eosinophils and basophils)
release the contents of their lysosomes onto the invader, dissolving it. When a bacterium has a capsule, it makes it hard to phagocytise, so the neutrophil requires opsonization by antibodies.
Bacteria without capsule
can be destroyed without opsonization. Antibodies can destroy the bacterium itself by popping the cell membrane. When a capsule is present, the neutrophil and antibody work best together. Neutrophils are also considered leukocytes.
Patient teaching for antibiotics
Rest, nutrition, and hydration
Infection prevention
Personal hygiene
Refrain from sexual intercourse during therapy for STIs
Common adverse effects and what to report to prescriber
Take entire course of antimicrobials t
Personal measures to control the spread of communicable diseases
proper hygiene
HAND WASHING
use of personal barriers such condoms
stay home when you have symptoms of an infectious disease so you can break the chain of infection
On a visit to administer the fifth in a series of 10 antibiotic doses, a home health nurse is told that the patient is now complaining about a bothersome vaginal discharge. The nurse communicates the problem and arranges for medication. What is the most likely cause of the vaginal discharge?
A ‘superinfection’, which is an acquired response, caused by taking antibiotic medication
know nursing interventions for anaphylactic reactions
Patients who are at risk for life-threatening (anaphylactic) reactions should wear a medical alert bracelet that identifies their allergy.
*Individuals with insect sting allergies should obtain an emergency sting kit and be taught how to self-inject epinephrine.
Cause and risk factors
Life-threatening; can quickly deteriorate into shock, coma, and death
Histamine released causes bronchospasm, vasodilation, and increased capillary permeability, which causes fluid to leave the circulation and enter the tissues, causing shock from hypovolemia
Signs and symptoms of anaphylaxis include anxiety, wheezing and difficulty breathing, cyanosis, hives, facial edema, and hypotension
Anaphylaxis is an emergency situation, and the patient’s life depends on rapid intervention
know nursing interventions for anaphylactic reactions
-medical treatment
Medical treatment
Oxygen, intravenous epinephrine, aminophylline, diphenhydramine, and corticosteroids
Dopamine to raise blood pressure; nebulized bronchodilator to relax bronchi and improve ventilation
Nursing care
Administer prescribed drugs, including oxygen, and monitor intravenous fluids
Monitor respirations, color, heart rate, and oxygen saturation until the patient is fully recovered
The best care is to prevent anaphylaxis whenever possible by obtaining a history of allergies and taking precautions to protect the patient from substances (often drugs) that may trigger this reaction.
-Common that nitrile gloves replaced latex. Allergic reactions to antiobiotics - rash or hives, which typically occur during the first days of therapy. If the reaction is severe, the client may exerpience swelling of the airway, wheezing and difficulty breathing, also known as anaphlactic reaction.
organs involved in immunity
thymus and bone marrow
Participate in the formation and maturation of immune system cells
Lymph nodes
Attack antigens and debris in the interstitial fluid and produce and circulate lymphocytes
Spleen
Filter dead cells, debris, and foreign molecules from blood
Liver
Filters blood and plays a part in the production of specific immunoglobulins and other chemicals involved in the immune response
Know what organs are involved in immunity ..
Primary lymphoid organs: These organs include the bone marrow and the thymus. They create special immune system cells called lymphocytes. Secondary lymphoid organs: These organs include the lymph nodes, the spleen, the tonsils and certain tissue in various mucous membrane layers in the body (for instance in the bowel)
The big 3 as it relates to antimicrobial agents
Nausea, vomiting, diarrhea:
“Big three”
Determine if related to antibiotic
Determine hydration status
Report diarrhea, abdominal pain
Nursing Assessment During Antimicrobial Therapy (1 of 3)
Nausea, vomiting, diarrhea: “Big three” adverse effects
Determine if related to antibiotic
Determine hydration status
Report diarrhea, abdominal pain
Secondary infection
Oral infections, lesions, or itching in vaginal, anal areas
Can produce severe life-threatening diarrhea
Nursing Assessment During Antimicrobial Therapy (2 of 3)
Allergies and anaphylaxis
Mild to fatal, within 30 minutes after administration to days after therapy
Anaphylaxis, laryngeal edema, shock, dyspnea, skin reactions
Determine if allergies (skin rash, edema, dyspnea) or GI symptoms
Nursing Assessment During Antimicrobial Therapy ☺ (3 of 3)
Nephrotoxicity: Increasing BUN/creatinine, decreasing urine output, changes in UA
Hepatotoxicity: Assess for preexisting hepatic disease, abnormal liver enzymes
Ototoxicity: Damage to eighth cranial nerve, can lead to hearing loss. Manifested by dizziness, tinnitus, and progressive hearing loss
Blood dyscrasias
Antimicrobial therapy implementation 1 of 3
Precautions for infection transmission
Monitor for phlebitis when given IV
Administer on established time schedule
Determine whether able to give with food
Identify drug allergies
Antimicrobial therapy implementation 2 of 3
Nausea, vomiting, diarrhea: Give with food if possible, or healthcare provider can switch to parenteral
Secondary infections: Notify healthcare provider if infection develops
Allergies/anaphylaxis: Monitor patients with allergies, asthma, rhinitis, or taking multiple meds for allergic response; watch carefully for 20 to 30 minutes after administration
See treatment of allergic response
Antimicrobial therapy implementation 3 of 3
Nephrotoxicity: Monitor BUN/creatinine, I&O; report declining urine output <30 mL/hr
Hepatotoxicity: Monitor labs, observe for anorexia, nausea, vomiting, jaundice, etc.
Ototoxicity: Report hearing impairment, dizziness, or tinnitus
Blood dyscrasias: Monitor and report sore throat, fatigue, elevated temperature, skin hemorrhages, and bruises
Photosensitivity: Wear sunscreen, avoid ultraviolet light
Examples of drugs that reduce inflammation and hinder body’s immune response are ?
bronchodilators and corticosteroids
RIFAMPIN
Rifampin Antitubercula agent
Actions
◦Prevents RNA synthesis by inhibiting DNA-dependent RNA polymerase
Uses
◦Eliminate meningococci and H. influenzae type b, (Hib) from asymptomatic carriers
Common adverse effects
◦Reddish-orange secretions
Serious adverse effects
◦Nausea, vomiting, anorexia, abdominal cramps
which drugs are used to treat anaphylaxis
diphenhydramine
corticosteroids
epinephrine
which drugs are used to treat anaphylaxis
diphenhydramine
corticosteroids
epinephrine
which illnesses require the use of airborne precautions
measles
tuberculosis
varicella
any items that have bee touched or cross-contaiminated by the host, such as bed linens or side rails are
Fomites
soiled hands are the main transmitter of
nosocomial infection
Localized infections
redness
swelling
pain
warmth
pus
An anti-inflammatory hormone produced by the adrenal cortex is called:
Cortisol
Three common sites for nosocomial infections include surgical wounds, the respiratory tract, and the:
Urinary tract
Isonaizid
Isoniazid - antitubercula agent
Drug: isoniazid (INH, Nydrazid)
Actions
◦Disrupts the cell wall and inhibit replication of tuberculosis bacteria
Uses
◦Treat and prevent tuberculosis
Common adverse effects
◦Nausea, vomiting
Serious adverse effects
◦Hepatotoxicity, tingling, numbness of hands and feet, dizziness, ataxia
Nursing care of patients with infections
Urge the patient to consume adequate fluids
Encourage to consume high-protein, high-vitamin diet
Isolation, if required
Laboratory tests
White blood cell count with differential; erythrocyte sedimentation rate; iron level; cultures of urine, blood, wound, sputum, and throat
Administer antibiotic drug therapy
Hyperbaric oxygen therap
CDC’s Nationally Notifiable and Reportable Diseases
Influenza, Lyme disease, Rubella,
Salmonellosis
MRS
infections become resistant to high doses of
antibiotics
transmission based isolation precaution
***Airborne infection isolation precautions
* Used with diseases that are spread through the air **(TB, varicella
(chicken pox,) rubeola (measles), SARS)
* Fitted high efficiency particulate absorption (HEPA) filter
respirators or N95 respirators
- Droplet precautions – p. 72
- Used with infections that are spread by droplets or dust particles
containing the infectious agent (Flu, Bacterial Meningitis, Mumps,
Rubellla)
** Contact precautions – p. 72
* Used when caring for patients who are infected by microorganisms that
are transmitted by direct (skin-to-skin) or indirect contact with
contaminated equipment (MRSA, C-diff, VRE)
** Dedicate the use of equipment to a single patient
Reportable to the health department
by a school nurse:
- Rubella
- Lyme disease
- Salmonella
nursing care for an immunosuppressed patient
Prevent infection
* Proper hand hygiene
* Vital signs – small increase in the body temperature is significant
* Adequate nutrition
* Flowers or plants may be prohibited
* Patient education
* A patient with neutropenia should be assign to a private room
hypersensitivity and allergen
Causes and Risk Factors
* Allergy (or hypersensitivity) describes an atypical immune
response that is activated by a foreign substance that
normally is inoffensive
* An antigen that causes a hypersensitive reaction is
called an allergen. Any substance can act as an allergen to a susceptible person, but some of the more
common ones are house dust, animal dander, pollens,molds, foods, *pharmacologic agents (antibiotics are a common source of allergic reactions w/n the first
few minutes after injection), cigarette smoke,feathers, and insect venoms.
hypersensitivity and allergen
**Asthma is the most common allergic response disorder
* Local manifestations of allergic reactions include
urticaria, pruritus, conjunctivitis, rhinitis, laryngeal
edema, bronchospasm, dysrhythmia,
gastrointestinal cramps and malabsorption, and angioedema.
Medical Treatment
* Antihistamines, bronchodilators, corticosteroids,
topical lotions, and ointments
* Antihistamines sometimes cause confusion in
older adults.
* Testing to determine specific allergens
* Desensitization
* Aimed at increasing tolerance to the offending agent and decreasing the severity of the allergicresponse
anaphylaxis
Cause and risk factors
* Life-threatening; can quickly deteriorate into shock, coma, and
death
* Histamine released causes bronchospasm, vasodilation, and
increased capillary permeability, which causes fluid to leave
the circulation and enter the tissues, causing shock from
hypovolemia
* Signs and symptoms of anaphylaxis include anxiety, wheezing
and difficulty breathing, cyanosis, hives, facial edema,
arthralgia, and hypotension
** Antimicrobials (Ex. Penicillin) – the most common cause of Anaphylaxis (Administer oxygen)
** Cephalexin should be avoided if the individual is allergic to
penicillin due to cross-sensitivity. Request the physician to
prescribe a different antibiotic
Medical treatment
* Oxygen, intravenous epinephrine, aminophylline,
diphenhydramine, and corticosteroids
* Dopamine to raise blood pressure; nebulized bronchodilator to
relax bronchi and improve ventilation
* Nursing care of the patient with allergies p. 77-78
* Administer prescribed drugs, including oxygen, and monitor
intravenous fluids
* Monitor respirations, color, heart rate, and oxygen saturation until
the patient is fully recovered
** A patient who is allergic to shellfish should not receive drugs
containing iodine because an anaphylactic reaction may result
Laboratory tests
monitor the serum potassium, PT/INR, and blood sugar if patient is taking furosemide, warfarin, and metformin
Glucocorticoids are also effective for immunosuppression in the treatment of?
cancers, organ transplantation, autoimmune diseases **(rheumatoid arthritis), relief of allergic manifestation, and treatment of shock. Also treat nausea and vomiting secondary to chemotherapy.
**E.g. A patient with rheumatoid arthritis is taking glucocorticoid (prednisone) will experience an improve range of motion.
