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 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
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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

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

Type IAnaphylactic Reaction

Anaphylaxis

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

Anaphylaxis
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
Histamine release

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
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Self-Administration of Epinephrine

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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

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Nursing ProcessAssessment 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

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Nursing ProcessDiagnosis 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
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Collaborative Problems/Potential Complications

Anaphylaxis Impaired breathing

Nonadherence to therapeutic regimen

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Nursing ProcessPlanning 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

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Improved Breathing Pattern

Modify the environment to reduce allergens Reduce exposure to people with upper respiratory infection Take deep breaths and cough frequently
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Promoting Understanding/ Patient Teaching

Instruction to minimize allergens Use of medications Desensitization procedures

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Other Allergic Disorders

Contact dermatitis Atopic dermatitis Drug reactions Urticaria Food allergy Latex allergy

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Type IICytotoxic Reaction

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Type IIIImmune Complex Reaction

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Type IVDelayed or Cellular Reaction

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Wound Healing
First intention Second intention Third intention

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First-Intention Healing
Wound margins well approximated

Surgical incisions
Phases:

Initial (3-5 days)-fills w/blood, fibrin clots, erythrocytes (RBCS), 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)
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Second-Intention healing
Wide, irregular wound margins Trauma Ulceration Infection Wound classification Red-granulation tissue Yellow-presence of slough/necrotic tissue Black-debridement

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Wound-Red

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Wound-Yellow

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Wound -Black

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Third-Intention Healing
Delayed primary intention
Delayed suturing Infection

Larger deeper scar

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