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Inflammation Unit II Lecture 2 Lee Resurreccion. Chapter 53 Assessment and Management of Patients With Allergic Disorders pp538-541 . Allergic Reactions. Allergy An inappropriate, often harmful response of the immune system to normally harmless substances

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

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Inflammation Unit II Lecture 2

Lee Resurreccion

Chapter 53 Assessment and Management of Patients With Allergic Disorderspp538-541

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

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

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


  • 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

Type I—Anaphylactic Reaction


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


  • 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

  • Prevention and Treatment of Anaphylaxis

    • Screen and prevent

    • Treat respiratory problems; provide oxygen, intubation, and cardiopulmonary resuscitation as needed


    • Epinephrine: 1:1,000SQ

    • Auto injection system: EpiPen

    • May follow with IV epinephrine

    • IV fluids

    Self-Administration of Epinephrine

    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

    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

    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

    Collaborative Problems/Potential Complications

    • Anaphylaxis

    • Impaired breathing

    • Nonadherence to therapeutic regimen

    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

    Improved Breathing Pattern

    • Modify the environment to reduce allergens

    • Reduce exposure to people with upper respiratory infection

    • Take deep breaths and cough frequently

    Promoting Understanding/Patient Teaching

    • Instruction to minimize allergens

    • Use of medications

    • Desensitization procedures

    Other Allergic Disorders

    • Contact dermatitis

    • Atopic dermatitis

    • Drug reactions

    • Urticaria

    • Food allergy

    • Latex allergy

    Type II—Cytotoxic Reaction

    Type III—Immune Complex Reaction

    Type IV—Delayed or Cellular Reaction

    Wound Healing

    • First intention

    • Second intention

    • Third intention

    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)

    Second-Intention healing

    • Wide, irregular wound margins

      • Trauma

      • Ulceration

      • Infection

    • Wound classification

      • Red-granulation tissue

      • Yellow-presence of slough/necrotic tissue

      • Black-debridement



    Wound -Black

    Third-Intention Healing

    • Delayed primary intention

      • Delayed suturing

      • Infection

    • Larger deeper scar

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