Chapter 53 Assessment and Management of Patients With Allergic Disorders pp538-541

1. Inflammation Unit II Lecture 2 Lee Resurreccion Chapter 53 Assessment and Management of Patients With Allergic Disorderspp538-541

2. Allergic Reactions • Allergy • An inappropriate, often harmful response of the immune system to normally harmless substances • Hypersensitive reaction to an allergen initiated by immunological mechanisms that is usually mediated by IgE antibodies • Allergen: the substance that causes the allergic response • Atopy: allergic reactions characterized by IgE antibody action and a genetic predisposition

3. Immunoglobulins and Allergic Response • Antibodies (IgE, IgD, IgG, IgM, and IgA) react with specific effector cells and molecules, and function to protect the body • IgE antibodies are involved in allergic disorders • IgE molecules bind to an allergen and trigger mast cells or basophils • These cells then release chemical mediators such as histamine, serotonin, kinins, SRS-A, and neutrophil factor • These chemical substances cause the reactions seen in allergic response

4. Immunoglobulins and Allergic Response (cont.) • Allergen triggers the B cell to make IgE antibody, which attaches to the mast cell; when that allergen reappears, it binds to the IgE and triggers the mast cell to release its chemicals

5. Hypersensitivity • A reflection of excessive or aberrant immune response • Sensitization: initiates the buildup of antibodies • Types of hypersensitivity reactions • Anaphylactic: type I • Cytotoxic: type II • Immune complex: type III • Delayed type: type IV

6. Type I—Anaphylactic Reaction

7. Anaphylaxis

8. Management of Patients With Allergic Disorders • History and manifestations; comprehensive allergy history • Diagnostic tests • CBC-eosinophil count • Total serum IgE • Skin tests: note precautions • Screening procedures

9. Anaphylaxis • Histamine release • Initial symptoms=edema/itching at site Systemic reaction occurs within minutes: • Shock • Bronchial constriction, airway constriction • Airway constriction • S&S: rapid weak pulse, hypotension, dilated pupils

10. Prevention and Treatment of Anaphylaxis • Screen and prevent • Treat respiratory problems; provide oxygen, intubation, and cardiopulmonary resuscitation as needed • PATENT AIRWAY • Epinephrine: 1:1,000SQ • Auto injection system: EpiPen • May follow with IV epinephrine • IV fluids

11. Self-Administration of Epinephrine

12. Allergic Rhinitis • Also called hay fever and seasonal allergic rhinitis, allergic rhinitis is a common respiratory allergy presumed to be mediated by a type I hypersensitivity • Affects 10% to 25% of the population • Symptoms include sneezing and nasal congestion; clear, watery discharge; nasal itching; itching of throat and soft palate; dry cough; hoarseness; and headache • May affect the quality of life, producing fatigue, loss of sleep, and poor concentration

13. Nursing Process—Assessment of the Patient With Allergic Rhinitis • Assess health history • Include personal and family history • Perform an allergy assessment • Subjective data includes symptoms and how the patient feels before symptoms become obvious • Note the relationship between symptoms and seasonal changes, emotional problems, and stress • Identify nature of antigens, seasonal changes in symptoms, and medication history

14. Nursing Process—Diagnosis of the Patient With Allergic Rhinitis • Ineffective breathing pattern related to allergic reaction • Deficient knowledge about allergy and the recommended modifications in lifestyle and self-care practices • Ineffective individual coping with the chronicity of the condition and the need for environmental modifications

15. Collaborative Problems/Potential Complications • Anaphylaxis • Impaired breathing • Nonadherence to therapeutic regimen

16. Nursing Process—Planning the Care of the Patient With Allergic Rhinitis • Goals may include: • Restoration of normal breathing pattern • Increased knowledge about the causes and control of allergic symptoms • Improved coping with alterations and modifications • Absence of complications

17. Improved Breathing Pattern • Modify the environment to reduce allergens • Reduce exposure to people with upper respiratory infection • Take deep breaths and cough frequently

18. Promoting Understanding/Patient Teaching • Instruction to minimize allergens • Use of medications • Desensitization procedures

19. Other Allergic Disorders • Contact dermatitis • Atopic dermatitis • Drug reactions • Urticaria • Food allergy • Latex allergy

20. Type II—Cytotoxic Reaction

21. Type III—Immune Complex Reaction

22. Type IV—Delayed or Cellular Reaction

23. Wound Healing • First intention • Second intention • Third intention

24. First-Intention Healing • Wound margins well approximated • Surgical incisions • Phases: • Initial (3-5 days)-fills w/blood, fibrin clots, erythrocytes (RBC’S), neutrophils • Granulation (5 days-3 weeks)-proliferation phase • Scar contraction and maturation-collagen fibers are further organized (7 days after injury increases over several months)

25. Second-Intention healing • Wide, irregular wound margins • Trauma • Ulceration • Infection • Wound classification • Red-granulation tissue • Yellow-presence of slough/necrotic tissue • Black-debridement

26. Wound-Red

27. Wound-Yellow

28. Wound -Black

29. Third-Intention Healing • Delayed primary intention • Delayed suturing • Infection • Larger deeper scar