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 Disorders pp538-541 . Allergic Reactions. Allergy An inappropriate, often harmful response of the immune system to normally harmless substances

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allergic reactions
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
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
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
management of patients with allergic disorders
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
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
allergic rhinitis
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
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
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
Collaborative Problems/Potential Complications
  • Anaphylaxis
  • Impaired breathing
  • Nonadherence to therapeutic regimen
nursing process planning the care of the patient with allergic rhinitis
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
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
Promoting Understanding/Patient Teaching
  • Instruction to minimize allergens
  • Use of medications
  • Desensitization procedures
other allergic disorders
Other Allergic Disorders
  • Contact dermatitis
  • Atopic dermatitis
  • Drug reactions
  • Urticaria
  • Food allergy
  • Latex allergy
wound healing
Wound Healing
  • First intention
  • Second intention
  • Third intention
first intention healing
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
Second-Intention healing
  • Wide, irregular wound margins
    • Trauma
    • Ulceration
    • Infection
  • Wound classification
    • Red-granulation tissue
    • Yellow-presence of slough/necrotic tissue
    • Black-debridement
third intention healing
Third-Intention Healing
  • Delayed primary intention
    • Delayed suturing
    • Infection
  • Larger deeper scar