Med-Surg hypersensitivity

Type I hypersensitivity reaction

100

What are examples of type I

extrinsic asthma, allergy, allergic rhinitis(hay fever), latex anaphylaxis, systemic anaphylaxis, Drug hypersensitivity (dermatitis medicamentosa), Atopic Dermatitis (eczema [atopic dermatitis; skin], asthma [lungs], allergic rhinitis [hay fever; nose, sinus]), insect bites/stings

200

what is an anaphylactic reaction effects on the body (not symptoms)

vasodilation, increased capillary dilation, + eosinophils Systemic reactions ~ laryngeal stridor, angioedema, hypotension, + bronchial, GI + uterine spasms

local reactions ~ hives

300

what's the action + what should you educate + monitor for when a Pt is taking:

Nasal decongestant sprays; phenylephrine, oxymetazoline, + naphazoline

Action; blocks alpha-adrenergic receptors + vasoconstricts nasal mucosa BV, 

educate + monitor for: overuse d/t reduced sensitivity @ 3-7 days → rhinitis medicamentosa (worsening nasal congestion),

400

what's the Indication for immunotherapy;

allergic rhinitis or asthma, conjunctivitis, hx systemic reaction to Hymenoptera + IgE to Hymenoptera venom, unable/failed avoidance therapy, disagrees w/ long-term use, SE, + costs of meds, (+) skin test + allergy hx.

500

what's the Contraindications for immunotherapy;

• BB, ACEI (masks early anaphylaxis s/s), pulmonary or CVD, organ failure, inability to recognize + report systemic reaction, nonadherence to other meds, unable to monitor Pt 30min afterwards, no support (caregiver, self, equipment) for allergic reaction, pregnancy or ↑ doses after being pregnant  

Type II hypersensitivity reaction

100

What are examples of type II

Myasthenia gravis, good pasture syndrome, pernicious anemia, hemolytic (anemia) disease of NB, transfusion reaction, thrombocytopenia

200

what is cytotoxic reaction effects on the body (not symptoms)

IgG or IgM bind antigen on cells + may cause tissue/cell damage

300

Nursing mgt

Eliminate cause

Maintain IV Access & Hydration

Assessment & Monitoring ABCs, O2, VS, UO

Corticosteroids (hydrocortisone, prednisone to stop immune attack), Immunosuppressants (Rituximab or mycophenolate mofetil), Antihistamines: Diphenhydramine (Benadryl to decrease SX), Plasmapheresis: Used in severe cases to remove circulating antibodies)     

400

Is an insect bite/sting a type II reaction

No

500

what are some s/s

S/S infection w/in days-wks; fever, cutaneous rash, stomatitis, pharyngitis, pneumonia, sepsis.

Type III hypersensitivity reaction

100

What are examples of type III

SLE, Serum sickness, nephritis, RA

200

what is a type III reaction effects on the body (not symptoms)

acute inflammation + immune (immune + antigen) complex deposits, esp. in joints + kidneys

300

Does this reaction involve sensitized T cell

No

400

Does this reaction involve infiltration of PMN leukocytes

yes

500

what are some s/s

urticaria, joint pain, fever, rash, swollen nodes, polyarthralgias / polyarthritis 

Type IV hypersensitivity reaction

100

What are examples of type IV

contact dermatitis, graft vs host, Hashimoto's disease, sarcoidosis

200

what is a type IV reaction effects on the body (not symptoms)

active immune response resulting in tissue damage

300

Does this reaction involve sensitized T cell,

yes, 

400

when do s/s of delayed hypersensitivity occur

24-72 hrs

500

what are some s/s

erythema, burning, itching, skin lesions, scaling, lichenification, skin thickening + pigment changes, rash, swelling, dry/cracked skin, SJS, TEN, hives, fever

Random

100

home mgt education for hypersensitivity Pt

• Allergy home care mgt Pt states impact of environmental allergens, home environment modifications (no curtains, carpet, fabric furniture, feather pillows, tufted bedding, stuffed toys, + itchy clothes. Avoid fresh cut grass, leaves, weeds, pollen, triggers. Wear mask on windy days. Use hypoallergenic mattress, pillow covers + cosmetics, HEPA purifiers, air conditioners, daily cleaning; mask, sweep, mop, vacuum). Stress mgt, regular exercise + adequate rest. Report S/S of anaphylaxis (urticaria, itching, peripheral tingling, oral/throat fullness, flushing, difficulty swallowing, coughing, wheezing, DIB) 

200

what Pt care should you do immediately after + r/t administering epinephrine (Epi pen; adrenaline) 

monitor for delayed rebound reaction (4-8hrs)

300

what are s/s of a latex allergy

Localized itching, erythema, or local urticaria w/in 10-15 min; rhinitis, conjunctivitis, + nasal congestion. May trigger an asthma attack, severe anaphylaxis (generalized urticaria, angioedema, bronchospasm, + hypotension, CV collapse w/in min)

400

what cells are involved in latex allergies

immediate hypersensitivity type I, IgE mediated; mast cell proliferation, basophil histamine.

500

Educate what to avoid for latex allergy Pt

balloons, Condoms, diaphragms (use Polyurethane products, Durex Avanti and Reality products/female condom instead), BP cuff, brown ACE bandages, telfa, Adhesive tape/bandages/liquid, catheters, tubing, crutches/wheelchair padding, pulse ox, hygiene pads, SCD stockings, ECG pads.