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Role/Response of Immune System
Defends the body's tissues from invasion by pathogens and allergens
*Production of antibodies in response to haptens
*Coating antigens with antibodies
*Neutralize toxins
*Prepare antigens for disposal
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Nonspecific immunity present at birth (epithelial cells) with the same response every time and first line of defense
Natural Immunity
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Developed immunity after birth, guided by cellular mediators like cytokines released in response to natural immunity (Vaccine)
Acquired Immunity
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Destroy antigens, signals macrophages to bring any antigens to them...they digest them and clean up debris
T Lymphocytes
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____ are the factory for antibody production
Plasma Cells
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In response to antigens, ____ cells stimulate even more plasma cells and more antibodies are made
B cells (B lymphocytes)
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Body's Mechanisms of Defense
Phagocytic (macrophages)
Humoral Response
Cellular Response
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Immune Cycle/Response:
Initial contact with allergen
Plasma cell releases IgE antibodies
Mast cell has memory
Subsequent contact with allergen creates histamine and leukotrienes to release
Causing an allergic reaction
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"reflection of excessive or aberrant immune response to any type of stimulus"
Hypersensitivity
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Type 1 Hypersensitivity
IgE recognizes antigen, stimulates mast cell to release histamine and other immune mediators
(Extrinsic asthma, allergic rhinitis, anaphylaxis, insect stings)
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Clinical Manifestations of Type 1 hypersensitivity
- Local:
- -vasodilation
- -increased capillary permeability
- -smooth muscle contraction
- -eosinophilia
- -urticaria
- Systemic:
- -laryngeal stridor
- -angioedema
- -hypotension
- -bronchial
- -GI or uterine spasm
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Internally, body misidentifies part of itself as foreign (cell and tissue damage)
Type 2 Hypersensitivity (Cytotoxic)
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Types of Type 2 Hypersensitivity
- MG (myasthenia gravis)
- Transfusion reactions
- Thrombocytopenia
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Antigens bind to antibodies, create immune complexes, become lodged in tissues and result in tissue injury, and vascular permeability
Type 3 Hypersensitivity (Immune Complex)
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Ex of Type 3 Hypersensitivity
- Rheumatoid Arthritis
- Systemic Lupus Erythematosus
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Result of interaction of T cells at the site of antigen, tissue damage from interactions of macrophages and lysozymes
- Type 4 Hypersensitivity
- (delayed type, cellular hypersensitivity)
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Ex of Type 4 Hypersensitivity
Hashimoto's Thyroiditis Sarcoidosis
Graft vs Host Disease
Contact Dermatitis
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Clinical manifestations of Type 4 Hypersensitivity
Itching, Erythema
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Dx Hypersensitivity
Pt assessment:
- -patient hx (mild, mod, severe reactions)
- -degree of discomfort
- -time interval
- LABS:
- -CBC, Eosinophils, IgE levels
- -Radioallergosorbent Test (RAST)
- -ELISA/EIA
- -Skin tests (Epicutaneous, Intradermal)
- -Provacative Testing
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Anaphylaxis is ____ mediated (Atopic)
IgE (on mast cells)
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IgE on mast cells react with antigens and release ____ (leukotrienes, prostaglandins, cell mediator activation)
Histamine
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Anaphylaxis is usually immediate, but could be delayed for up to ____ hours
24
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Emergency Assessment for Anaphylaxis:
Airway Breathing Circulation
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Anticipatory meds for anaphylaxis:
IVF, Antihistamines, Corticosteroids, Epinephrine (1:1000), Oxygen, Breathing Treatments, IV initiation, Potential Intubation
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Clinical Manifestations of Anaphylaxis:
Respiratory: laryngeal edema, bronchospasms, wheezing, cough, nasal congestion
Cardio: hypotension, collapse, tachycardia
Skin: periorbital swelling, facial flushing, warmth, itching
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Ways to promote anaphylaxis preventions/readiness
- Avoidance therapy
- Food labels
- Med ID
- Screening for allergies
- Deployment of ApiPen autoinjector (remove cap, inject pen into lateral thigh, hold 10 sec and release...bring to med facility!!!)
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Allergic rhinitis is ____ mediated...leading to vasodilation and increased capillary permeability
Histamine
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Untreated Allergic Rhinitis may lead to:
- allergic asthma
- chronic nasal obstruction
- otitis media
- hearing loss/anosomia
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Goals of Therapy for allergic rhinitis:
Relief of sx
Avoidance therapy
Immunotherapy
Pharm therapy
Monitor: Sx management, resp, response to meds/side effects, and open communication
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Pharm treatment for allergic rhinitis
- Antihistamines
- Intranasal corticosteroids
- Intranasal cromolyn sodium
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Nursing Considerations for Pharm Treatment of allergic rhinitis
- Rebound congestion
- Pt with hypertension
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Nursing management of urticaria (hives)
- List as allergy
- Keep track
- Topical corticosteroids
- Watch for progression to anaphylaxis
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Clinical manifestations of contact dermatitis
Itching, burning, erythema, lesions, edema, weeping, crusting, drying, peeling, vesicles
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Nursing management for contact dermatitis
- Avoidance therapy
- Use of antihistamines
- Topical corticosteroids
- Immunosuppressant therapy
(Consider: pt self esteem, sleep, s/e)
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Characteristics of angioneurotic edema
Localized edema of deep tissues of the layers of the skin, pink and vary in size/shape (especially GI tract)
May itch/burn
Type 1 Hypersensitivity
Suddenly or over 1-2 hours usually one spot lasting 24-36 hours or less
Involves lips, eyelids, cheeks, hands, feet, genitalia, tongue, GI tract, bronchi
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Management of Angioneurotic Edema
Administration of corticosteroids, antihistamines, and epinephrine if invading the resp tract
(frequently occurs in response to penicillin or ace-inhibitors; consider all medications and new prescriptions)
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Common food allergens
- seafoods
- legumes
- seeds
- tree nuts
- berries
- soy
- buckwheat
- milk protein
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Manifestation of food allergies:
- urticara
- wheezing
- cough
- itching
- swelling
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Management of food allergies
Pt/Family education
History of severity of allergy
Strategies to avoid
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People most at risk from latex allergies:
- Healthcare workers
- Factory workers
- Cosmetologists
- Mechanics
- Police
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Clinical manifestation of latex allergies:
- Erythema
- Pruritis
- Vesical formation
- Papules
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Testing for Latex Allergies:
Contact-Patch testing preferred
RAST/ELIsA for latex-specific IgE antibody
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Nursing management of Latex Allergy
- Avoidance
- Armbands
- Communication with employment and med staff
- Carry rescue medication
- Latex free gloves
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Supplies that may contain latex:
- gloves
- dressings
- stethescopes
- catheters
- tourniquets
- ace wraps
- thermometer probes
- feminine hygiene products
- BP cuffs
- wheelchair cushion
- tape
- thromboembolism hose
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Nursing Dx for allergies:
- Ineffective breathing patterns
- Ineffective airway clearance
- Ineffective coping
- Fatigue
- Knowledge deficit r/t self care/lifestyle mod.
- Ineffective therapeutic regimen management
- Powerlessness
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Nursing interventions of allergy reactions:
- Risk Identification
- Latex precautions
- Airway insertion/stabilization
- Environmental management
- Allergy management
- Surveillance
- Shock prevention
- Nutrition management
- Emotional Support
- V/S monitoring
- Health system guidance
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Nursing Outcomes of allergy pts:
Pt demonstrates accurate deployment of Epi
Pt describes strategies to minimize exposure
Pt explains how to screen ingredients for potential allergens
Pt maintains effective airway clearance and normal breathing pattern
Pt contacts health care professional when sx not controlled
Pt communicates presence of allergy to employer, school and other social networks
Pt reports manageable sx and fatigue during allergy season
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Allergy Pt education:
- Lifestyle alterations
- Dietary changes
- Vigilant prophylaxis
- Modify environment
- Communication
- Proper use of medications
- Self-admin Epi
- When to seek medical services
- Follow up
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