Unit 9 Chapter 18 Allergies Flashcards
What is an Allergy
Hypersensitivity (also known as allergy ) is overactive immunity with excessive inflammation occurring in response to the presence of an antigen to which the patient usually has been previously exposed.
How many types of allergic reactions are there?
A. 1
B. 2
C. 3
D. 4
D. 4
What does type 1 allergy consist of?
A. Hemolytic transfusion reaction
B. Anaphylactic reaction
C. Systemic Lupus Erthymaous
D. Poison Invy
B. Anaphylactic shock
Type 1 Allergic reacgtion info
most common
Type I: Immediate Hypersensitivity (Anaphylactic Reaction) – most
common
rapid and immediate
Cause:
* Your body makes too much antibody Immunoglobulin E (IgE)
* Release of histamine in response to an antigen such as pollen
- Examples of reactions: angioedema, anaphylaxis
S/s of Allergic reaction
Some reactions occur just in the areas exposed to the antigen such as the mucous membranes of the nose and eyes, causing symptoms of rhinorrhea, sneezing, and itchy, red, watery eyes.
Other examples of Type 1 Allergic reaction
- Examples of reactions: angioedema, anaphylaxis
- Allergic asthma
- Hay fever
- Allergic rhinosinusitis (caused by dust from ceiling or curtains)
How can an individual be induced to have an allergic reaction type 1?
A. Contact to allergen
B. Proximity to persons with same allergen sensitivity
C. Family history
D. Self process of allergen
A. Contact to allergen
hypersensitivity to allergen can be induced by…
- inhalation
- ingestion
- contact
-injection
Contacted by:
* Inhaled – plant, pollens, dander, house dust, grass,
ragweed
* Ingested – foods, additives, drugs
* Injected – bees, venom, drugs, contrast dyes
* Skin or mucous membranes – latex, pollens, foods
What are some subtances that can induce Allergic reaction type 1
Substances
* Latex
* Bee venom
* Peanuts
* Iodine shellfish
* Drugs: like penicillin, codeine, iodine contrast
What does the Serum immunoglobulin E test?
Elevated concentrations of IgE are generally thought of in the context of allergic disease.
What is the best patient teaching for clients with type 1 Allergic reactions?
A. It is best to get a vaccine if you are allergic to latex or penicillin
B. Stay as far away from triggers to your allergen
C. If you are allergic to dust it is best to keep curtains on all windows.
D. Anaphylactic shock can be reversed with Albuterol.
B. Stay as far away from triggers to your allergen
Is Anaphylaxis shock a medical emergency?
A. No
B. Yes
B. Yes
NOTIFY RAPID RESPONSE TEAM ASAP AND STAY WITH CLIENT
- Rapid, systemic, life threatening * Varies in severity
What are signs and symptoms of Anaphlaxis reaction?
- hives
-Angioedema: of lips, tongue, and eyes
Intestinal angioedema: severe abdominal pain, cramping, nausea, and vomiting.
-dyspnea**
-itchiness
-flushing of skin
-Hypotension
-tachycardia
Uneasiness,
apprehension,
weakness
, impending doom
bronchospasms
,wheezing,
stridor,
hypoxia,
cyanosis
What drug can cause angioedema?
A. Prednisione
B. Diphenhydramine
C. Epinephrine
D. Lisinopril
D. Lisinopril
Exposure to any ingested drug or chemical can cause the problem. The most common drugs associated with angioedema are angiotensin- converting enzyme inhibitors (ACEIs) used for hypertension
About 0.7% of adults taking ACEIs develop angioedema from the drug. These reactions are responsible for at least 40,000 emergency department visits in the United States annually (Banerji et al., 2017). This high incidence reflects how commonly these drugs are prescribed.
Although the greatest risk for angioedema from ACEIs is within the first 24 hours after taking the first dose of an offending drug, the reaction can occur after days, weeks, and months of therapy
Patient teaching for Angiodema
Black adults, especially African Americans, have a higher incidence of angioedema and laryngeal edema from ACEIs, about five times higher than in whites (Hirschy et al., 2018; Nguyen, 2018). Any ACEI should be used cautiously in black patients. Be sure to observe the patient carefully for any signs and symptoms of angioedema and laryngeal edema after the first dose.
Teach black patients taking an ACEI about the indications of angioedema and the need to go to an emergency department or to call 911 immediately if symptoms appear.
Your client was admitted due to being stung by a bee and reports illness and trouble breathing. On assessment he has inspiratory wheezing. After administering Epinephrine IM you notice there is a high-pitched noise instead of wheezing and no breath sounds. What is the nurse priority action?
A. Call HCP for an emergency tracheostomy
B. Administer norepinephrine PO
C. Keep the client’s head of bed flat
D. Anticipate endotracheal intubation with mechanical ventilator
A. Call HCP for an emergency tracheostomy
When stridor is present
** priority is to establish airway**
UTILIZE NONREBREATHER MASK
What is the #1 tx for Anaphylactic reaction?
A. Prednisone
B. Albuterol
C. Epinephrine
D. Alprazolam
C. Epinephrine
the most useful drugs are corticosteroids and epinephrine. Indications for intubation are the presence of stridor and the inability of the patient to swallow.
How many times should epinephrine be administered?
A. 10 times in one minute cycles
B. Until symptoms resolve every 5-15 minutes
C. Every 20 minutes
D. Once Intravenously
B. Until symptoms resolve every 5-15 minutes
- Be prepared to administer epinephrine IM.
Repeat drug as needed every 5 to 15 minutes until the patient responds.
Most deaths from anaphylaxis are related to delay in epinephrine administration.
Intervention for Anaphylaxis Shock
Asses first: Immediately assess respiratory status
* Call rapid response
* Stop IV med if the reaction occurs upon administration
* Infuse 0.9% NS: to flush out med
* PRIORITY: Prepare Epi, death occurs due to a delay in administration of epinephrine
* middle thigh, through clothes if necessary * Elevate HOB if BP is normal
* If hypotension occurs Raise feet/legs
Stay with pt at all times
Reassure pt that interventions to help them are taking place* keep client calm
Emergency care for client with Anaphylaxis reaction
- Immediately assess the respiratory status, airway, and oxygen saturation of patients who show any symptom of an allergic reaction.
- Call the Rapid Response Team.
- Ensure that intubation and tracheotomy equipment is ready.
- Apply oxygen using a high-flow, nonrebreather mask at 90% to 100%.
- Immediately discontinue the IV drug or infusing solution of a patient having an anaphylactic reaction to that drug or solution. Do not discontinue the IV, but change the IV tubing and hang normal saline.
- If the patient does not have an IV, start one immediately and infuse normal saline.
- Be prepared to administer epinephrine IM.
Repeat drug as needed every 5 to 15 minutes until the patient responds. - Keep the head of the bed elevated about 10 degrees if hypotension is present; if blood pressure is normal, elevate the head of the bed to 45 degrees or higher to improve ventilation.
Care for Epi Pens
- Practice assembly of injection device with a non–drug-containing training device provided through the injection device manufacturer.
- Keep the device with you at all times.
- When needed, inject the drug into the top of your thigh, slightly to the outside, holding the device so the needle enters straight down.
- You can inject the drug right through your pants; just avoid seams and pockets where the fabric is thicker.
- Use the device when any symptom of anaphylaxis is present and before you call 911 (Hayden, 2019). It is be er to use the drug when it is not needed than to not use it when it is needed!!!
- Whenever you need to use the device, get to the nearest hospital for monitoring for at least the next 4 to 6 hours.
- Have at least two drug-filled devices on hand in case more than one dose is needed.
- Protect the device from light and avoid temperature extremes.
- Carry the device in the case provided by the manufacturer.
- Keep safety cap in place until you are ready to use the device.
- Check the device for:
Expiration date—If the date is close to expiring or has expired, obtain a replacement device.
Drug clarity—If the drug is discolored, obtain a replacement device.
Security of cap—If the cap is loose or comes off accidently, obtain a replacement device.
Which of the following is an example of Type 2 Allergic reaction?
A. Poison Ivy
B.Myastenia Gravis
C. Systemic Lupus Erythematosus
D. Amyotrophic lateral sclerosis
B.Myastenia Gravis
Type 2 Allergic reaction(cytotoxic) info
Destruction of self cells - antibodies are directed against antigens on self cells
for example
autoimmune diseases like:
-gullian barre and
-myasthenia gravis
-Hemolytic anemia
- Immune thrombocytopenia purpura
-Hemolytic transfusion reaction
-Goodpasture’s syndrome
-Drug induced hemolytic anemia
Examples of Type 2 cytotoxic reactions continued
- Hemolytic anemias - the abnormal breakdown of red blood cells
(RBCs) - **Immune thrombocytopenia purpura - decreased number of circulating platelets (thrombocytopenia) (see the image below)
manifests as a bleeding tendency, easy bruising (purpura) ** - Hemolytic transfusion reactions - red blood cells that were given during the transfusion are destroyed by the person’s immune system
- Goodpasture’s syndrome - immune system mistakenly attacks and destroys healthy body tissue
- Drug induced hemolytic anemia - medicine triggers the body’s
defense (immune) system to attack its own red blood cells
What is the typical treatment for Type 2 cytotoxic reactions?
A. Epinephrine
B. Plasmapharesis
C. Pyrigdostagmine
D. Aceytocholine
B. Plasmapharesis
-Plasmapharesis reduces bad antibodies in the blood stream
What is an example of Type 3 (connective tissue allergic reaction?
A. Fibromyalgia
B. Hemolytic transfusion reaction
C. Poison ivy
D. Rheumatoid arthritis
D. Rheumatoid arthritis
classical sign inflamation
Type 3 (connective tissue allergic reaction) info
Type III hypersensitivity excess antigens cause immune complexes to form in the blood. The circulating complexes lodge in small blood vessels of kidney, skin, and joints – cause inflammation – tissue or vessel damage occurs.
OTHER EXAMPLES
- Rheumatoid Arthritis - complexes in joints, scarring and fibrotic damage
* Systemic Lupus – complexes lodge in blood vessels, glomeruli,
and joints
* Serum sickness – receiving certain drugs. Penicillin, animal serum-based drugs
Tx for Type 3 (connective tissue allergic reaction) info
A. Epinephrine
B. Plasmapharesis
C. Pyrigdostagmine
D. Prednisone
D. Prednisone
What is an example of Type 4 ( Delayed Hypersensitivity Reactions?
A. Fibromyalgia
B. Hemolytic transfusion reaction
C. Organ rejection
D. Rheumatoid arthritis
C. Organ rejection
Reaction of T-lymphocyte cells. Antibodies are not involved. Sensitized T-cells from previous exposure. Triggers macrophages to destroy the antigen.
Other Examples
* Positive reaction to PPD
* Contact dermatitis - poison ivy, local response to insect stings
* Transplant rejections,
* Sarcoidosis - abnormal collection of inflammatory cells that
form aggregates in the lungs, skin or lymph nodes
* THE REACTION CAN GO AWAY IN 5-7 days
s/s of Type 4 ( Delayed Hypersensitivity Reactions?
. A type IV response typically occurs hours to days after exposure. It consists of edema, induration, ischemia, and tissue damage at the site of the exposure.
Tx for ( Delayed Hypersensitivity Reactions?
A. Diphenhydramine
B. Plasmapharesis
C. Pyrigdostagmine
D. Prednisone
Treatment – corticosteroids to reduce discomfort
D. Prednisone
