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

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2. Allergic Reactions. AllergyAn 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 antibodiesAllergen: the substance that causes the allergic resp
Chapter 53 Assessment and Management of Patients With Aller...

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1. 1 Chapter 53 Assessment and Management of Patients With Allergic Disorders pp538-541

2. 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. 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. 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. 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. 6 Type I?Anaphylactic Reaction

7. 7 Anaphylaxis

8. 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. 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. 10 Prevention and Treatment of Anaphylaxis Screen and prevent Treat respiratory problems; provide oxygen, intubation, and cardiopulmonary resuscitation as needed PATENT AIRWAY Epinephrine: 1:1,000 SQ Auto injection system: EpiPen May follow with IV epinephrine IV fluids

11. 11 Self-Administration of Epinephrine

12. 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. 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. 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. 15 Collaborative Problems/Potential Complications Anaphylaxis Impaired breathing Nonadherence to therapeutic regimen

16. 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. 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. 18 Promoting Understanding/ Patient Teaching Instruction to minimize allergens Use of medications Desensitization procedures

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

20. 20 Type II?Cytotoxic Reaction

21. 21 Type III?Immune Complex Reaction

22. 22 Type IV?Delayed or Cellular Reaction

23. 23 Wound Healing First intention Second intention Third intention

24. 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. 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. 26 Wound-Red

27. 27 Wound-Yellow

28. 28 Wound -Black

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

30. 30


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