Med-Surg: Chapter 19: Type IV Hypersensitivity Reaction

Question 1

Type IV (4) Hypersensitivity Reaction

Answer 1

-delayed-type hypersensitivity (and cell-mediated immune memory response or antibody independent)
ex: poison ivy, the Mantoux test for tuberculosis, and latex allergy
>some patients may experience a mixed type I and type IV reaction; latex allergy may be an immediate, rapid type I hypersensitivity reaction or a type IV delayed hypersensitivity reaction

Question 2

People at High-risk for developing a latex allergy

Answer 2

• healthcare workers who are routinely exposed to latex
• patients who have undergone multiple surgical procedures; spina bifida patients
• previous hx of atopic dermatitis or pre-existing hand dermatitis
• females

Question 3

Pathophysiology

Answer 3

• mediated by cells rather than antibodies
• is delayed and regulated by T lymphocytes that are damaging to cells or cytotoxic
• reaction occurs 24 to 72 hours after exposure to antigen
• sensitized T lymphocytes are the cells that attack the antigens and release cytokines and thus mediate the reaction
• the macrophages and enzymes release by macrophages are responsible for tissue destruction
• takes 24 to 48 hours for a response to occur

Question 4

Clinical Manifestations

Answer 4

• clinical manifestations of a local reaction typical of a positive TB test include a wheal and flare reaction; is a raised area containing edematous fluid surrounded by red flare
• latex allergy= may range from local contact dermatitis, rhinitis, and conjunctivitis to pharyngeal edema and severe systemic reaction such as anaphylactic shock

Question 5

Medical Management

Answer 5

• avoiding products that contain latex
• antihistamines may help with a less severe reaction
• skin creams containing steroids help with contact dermatitis
• more severe reactions that occur with repeated exposure may require a trip to the hospital to receive oxygen, epinephrine, and IV corticosteroids to reduce the inflammatory response

Question 6

Nursing Management: Assessment and Analysis

Answer 6

the clinical manifestations seen with type IV hypersensitivity latex reaction are typically due to the tissue damage caused by the inflammatory response mediated by sensitized T cells
>Mild reactions include:
-local skin reactions; on hands r/t latex gloves
-conjunctivitis
-rhinitis
>more severe reactions can include severe respiratory distress r/t pharyngeal edema and anaphylactic shock

Question 7

Nursing Interventions: Assessment

Answer 7

> Vital Signs:
-a severe latex allergy reaction may produce clinical manifestations of anaphylaxis: respiratory distress with decreased oxygenation, hypotension, and tachycardia

> Assess the Skin
-mild reactions may include rashes, on hands from latex gloves

> Assess for previous hx of latex allergy
-a secondary exposure to latex after an allergic reaction may cause a more severe anaphylactic response b/c of already sensitized T cells

> Assess for allergies for any of the following:
-avocado, chestnut, mango, papaya, passion fruit, tomato, raw potato, peach, banana, kiwi
(allergies to these may also indicate a sensitivity to latex)

> Assess for hx of repeated surgical procedures or adverse reaction or complication r/t surgery
-patients having repeated surgical procedures resulting in multiple exposures to latex are more likely to become sensitized and suffer an allergic response to latex

Question 8

Nursing Actions

Answer 8

> Administer medications

• steroid skin creams and/or IV corticosteroids to decrease inflammation
• IM epinephrine to relieve respiratory distress and increase BP

> Eliminate exposure to latex products by using nonlatex alternatives: vinyl or neoprene gloves

> Protect patients from exposure to latex by:

• covering the skin with cloth before applying BP cuff
• not allowing rubber stethoscope tubing to touch the patient
• not injecting through rubber ports on IV tubing

Question 9

Teaching

Answer 9

> Teach patient to avoid exposure to products that are commonly made of latex

• healthcare equipment: wheelchair cushions, tourniquets, airways, endotracheal tubes, masks for anesthesia, electrode pads
• office/household products: erasers, rubber balls, tires, shoe soles, rubber bands, hot water bottles, cycle grips, baby bottle nipples, carpeting

> wear a medic alert bracelet and inform health care providers of allergy

> instruct patient on use and necessity of an EpiPen

• delivers a small dose of epinephrine to counteract an allergic response
• decrease respiratory distress and increasing BP

Question 10

Evaluating Care Outcomes

Answer 10

patients can avoids the complications r/t latex allergy by maintaining heightened awareness of products in the environment that contain latex
-carrying an EpiPen and wearing a Medic Alert Bracelet are necessary in the case of an inadvertent exposure to latex