Allergic Reaction

HYPERSENSITIVITY

REACTIONS

Result of excessive immune response to any type of

stimulus, usually does not occur with the first exposure

to an allergen. Rather, the reaction follows a

re-exposure after sensitization, or buildup of

antibodies, in a predisposed person.

re-exposure after sensitization,

buildup of antibodies

predisposed person.

HYPERSENSITIVITY REACTIONS

the reaction follows a (2) in a __

type 1 anaphylactic hypersensitivity

most severe

type 1 anaphylactic hypersensitivity

ONSET: immediate, unanticipated and often sever explosive allergic reaction

type 1 anaphylactic hypersensitivity

chracterized by:

edema in tissues (larynx), hypotension, bronchospasm and cardiovascular collapse (severe case)

type 1 anaphylactic hypersensitivity

examples:

1. anaphylaxis

2. allergic rhinitis

3. allergic asthma

4. urticaria

anaphylaxis

allergic rhinitis

allergic asthma

urticaria

type 1 anaphylactic hypersensitivity examples 4

edema in tissues (larynx), hypotension, bronchospasm and cardiovascular collapse (severe case)

type 1 anaphylactic hypersensitivity CHARACTERIZED BY (4)

TYPE II cytotoxic hypersensitivity

system mistakenly Identified a normal constituent of a body as foreign, may be the result of cross-reacting antibody, possibly leading to tissue and cell damage

TYPE II cytotoxic hypersensitivity

EXAMPLES

1. drug induced hemolytic anemia

2. good pasture syndrome

3. myasthenia gravis

1. drug induced hemolytic anemia

2. good pasture syndrome

3. myasthenia gravis

TYPE II cytotoxic hypersensitivity example 3

cross reacting antibody

TYPE II cytotoxic hypersensitivity may be a result of

cell damage

tissue damage

TYPE II cytotoxic hypersensitivity possibly leading to (2)

TYPE III immune complex hypersensitivity

increase in vascular permeability and tissue injury due to immune complexes that are formed when antigens bind to antibodies

TYPE III immune complex hypersensitivity

examples

1. Serum sickness

2. systemic Lupus erythematous

3. rheumatoid arthritis

4. acute glomerulonephritis

1. Serum sickness

2. systemic Lupus erythematous

3. rheumatoid arthritis

4. acute glomerulonephritis

TYPE III immune complex hypersensitivity examples 4

vascular permeability

tissue injury

antigens bind to antibodies

TYPE III immune complex hypersensitivity

increase in ___ and ___ due to immnue complexes that are formed when ___

TYPE VI delayed hypersensitivity

Onset: 24-72 hpurs after exposure to allergen

TYPE VI delayed hypersensitivity

Mediated by sensitized T cells and macrophages rather than antibodies

TYPE VI delayed hypersensitivity

EXAMPLES

1. contact dermatitis

2. poison IVY

3. transplant rejection

1. contact dermatitis

2. poison IVY

3. transplant rejection

TYPE VI delayed hypersensitivity examples 3

sensitized T cells

macrophages

antibodies

TYPE VI delayed hypersensitivity

mediated by ___ and __rather than __

IgE

Type 1 ANAPHYLACTIC (ig___

anaphylaxis (type 1)

An immediate immunologic reaction

between a specific antigen and an

antibody.

Anaphylactic reaction;

Anaphylactic shock

anaphylaxis (type 1) AKA 2

allergen

anaphylaxis (type 1) CAUSE: (substance that can cause an allergic reaction.)

anaphylaxis (type 1)

is a severe, whole-body allergic reaction to a chemical

that has become an allergen.

Skin allergy test

anaphylaxis DX

1. food (Peanuts, tree nuts, shellfish)

2. antibiotics

3. biologic agents

4. insect sting

5. latex

common cause 5

biologic agents

Animal serums (tetanus antitoxin,

snake venom antitoxin, rabies

antitoxin), antigens used in skin testing

1. penicillin

2. sulfa antibiotics

common antibiotic as cause of anaphylaxis (2)

Mild anaphylaxis

peripheral tingling, warmth, fullness of mouth and throat, nasal congestion. periorbital swelling, pruritus, sneezing, eye tearing

peripheral tingling, warmth, fullness of mouth and throat, nasal congestion. periorbital swelling, pruritus, sneezing, eye tearing

Mild anaphylaxis CLINICAL MANIFESTATION

Moderate anaphylaxis

mild symptom : ; flushing, warmth anxiety and itching

Moderate anaphylaxis

serious reaction:

bronchospasm and edema (airway and larynx) with dyspnea, cough and wheezing

1. FLUSHING, warmth, anxiety and itching

2. bronchospasm and edema (airway and larynx) with dyspnea, cough and wheezing

Moderate anaphylaxis CLINICAL MANIFESTATION

MILD 4

SERIOUS 5

Severe anaphylaxis

ONSET IS ABRUPT

Severe anaphylaxis

progressive rapidly to bronchospasm, laryngeal edema, sever dyspnea, cyanosis, hypotension, dysphagia, abd cramp, V/D, seizures. Cardia arrest and coma may follow

bronchospasm, laryngeal edema, sever dyspnea, cyanosis, hypotension, dysphagia, abd cramp, V/D, seizures

SEVERE anaphylaxis clinical manifestation 13

1. epinephrine

2. antihistamine and corticosteroid

3. aminophylline and corticosterois

4. IV fluids, volume expanders and vasopressor agents

5. CPR

6. educ on how to ad med and prevention of allergen

N MGT for anaphylaxis (6)

for urticaria and edema and to prevent

recurrence

Epinephrine:

1:1000 SQ/IM in the upper extremity or thigh, then followed by a

continuous IV infusion

Aminophylline and corticosteroids:

improve airway patency

IV fluids, volume expanders, and vasopressor agents:

to maintain blood pressure

and normal hemodynamic status

1. Strict avoidance of potential allergens

2. Avoid areas populated by insects, use appropriate clothing, and use insect repellants

3. Always carry an emergency kit containing epinephrine (EpiPen)

PREVENTION OF ANAPHYLAXIS 3

1. Airway compromise

2. Cardiovascular collapse

3. Neurological complications

4. Gastrointestinal and renal complications

5. Rebound (biphasic) reactions

COMPLICATIONS of anaphylaxis 5

Laryngeal edema

bronchospasm

severe respiratory distress

hypoxemia.

anaphylaxis

• Airway compromise (4)

Hypotension

shock

arrhythmias

cardiac arrest.

anaphylaxis

Cardiovascular collapse (4)

Hypoxic brain injury due to prolonged hypoxemia.

anaphylaxis

• Neurological complications

acute kidney injury, bowel ischemia.

anaphylaxis

• Gastrointestinal and renal complications 2

1–72 hours.

anaphylaxis

Rebound (biphasic) reactions (time of reoccurance)

TYPE II cytotoxic

MYASTHENIA

GRAVIS (MG)

MYASTHENIA

GRAVIS (MG)

A neuromuscular disorder characterized by failure

of transmission of nerve impulses at the myoneural

junction

nerve impulses

myoneural junction

A neuromuscular disorder characterized by failure

of transmission of __ at the __

MYASTHENIA

GRAVIS (MG)

caused by decreased functioning of

acetylcholine receptor sites. It is also associated

with autoimmune disorders

1. decrease function of acetycholine receptor sites

MYASTHENIA

GRAVIS (MG) MAY BE CAUSED BY

1. Autoimmune reaction: antibodies block or destroy acetylcholine (ACh)

receptors.

2. Thymus gland abnormalities (hyperplasia, thymoma).

3. More common in women <40 and men >60.

4. May be triggered or worsened by infection, surgery, stress, pregnancy,

certain medications (e.g., aminoglycosides).

factors influencing myasthenia gravis (1)

(hyperplasia, thymoma).

Thymus gland abnormalities (2)

aminoglycosides).

medication that may trigger MG

1. Autoimmune problem:

2. Blocked communication:

3. Less muscle stimulation:

4. Muscle weakness:

PATHOPHYSIOLOGY FOR MG

1. Muscle weakness associated with activity

   relieved by rest,

2. Eyelid droopiness

3. double vision

4. impaired speech

5. difficulty swallowing

6. changes in facial expression

7. trouble breathing

MG CLINICAL MANIFESTATION 7

•Tensilon Test (Edrophonium Test)

MG DX

Tensilon

short – acting cholinergic – treatment for MG

IB

2MG

8MG

•Tensilon Test (Edrophonium Test)

administered __ (__ first, then __mg).

muscular strength

3 -5

Positive Tensilon test is observed as improvement in ___. Muscle weakness returns

in _ to _ minutes

Atropine sulfate (anticholinergic)

antidote for cholinergic is

1. Assess swallowing and gag reflex before feeding the client to prevent aspiration

2. Administer medications 20 to 30 minutes before meals to improve ability to swallow and prevent choking

3. Administer medications at an exact time to prevent myasthenic crisis that results to respiratory distress

4. Protect the client from falls due to muscle weakness

5. Implement aspiration precaution

6. Start meal with cold beverage. To contract muscles of the throat and

improve ability to swallow

7. Promote adequate ventilation to relieve respiratory difficulty

8. Avoid infections. Infections may trigger exacerbations of MG

9. Provide adequate rest with alternating activity

MG management (9)

•Plasmapheresis

separation of

antibodies from the

plasma to inhibit

autoimmune

response

Acetylcholinesterase Inhibitors/Cholinesterase Inhibitors

MANAGEMENT

•

Pharmacotherapy

1. Prostigmin (Neostigmine)

2. Mestinon (Pyridostigmine)

3. Mytelase (Ambenomium)

Acetylcholinesterase Inhibitors/Cholinesterase Inhibitors (3)

neuromuscular impulses

acetylcholine.

These medications transmit ___ by preventing the

destruction of ___

1. Monitor improvement of muscle strength and respirations

2. Observe the client for signs and symptoms of cholinergic crisis caused by

overdosing of the drug – muscle weakness, increased salivation, sweating,

tearing, and miosis

3. Have readily available on antidote for cholinergic crisis (Atropine Sulfate)

4. Encourage the client to wear Medic-Alert bracelet that indicates the health

problem and the drug taken

5. Instruct the client to take the medication before meals for best drug

absorption

6. Observe and report possible side effects and adverse reactions:

Nursing Interventions for Acetylcholinesterase Inhibitors 6

• Nausea, vomiting, diarrhea, abdominal cramps

• Increased salivation

• Tearing

• Miosis (constriction of pupils)

• Possible hypertension

Acetylcholinesterase Inhibitors

side effects and adverse reactions:

Glucocorticoids

MEDICATION

for anti-inflammatory effects

Antacids

medication

(As protection)

To prevent gastrointestinal upset due to glucocorticoids

Thymectomy

MANAGEMENT

Surgery:

thyroidectomy

(surgical removal

of the thymus gland).

thymoma

(tumor of the thymus gland).

*25%

thymoma

5-10

Thymectomy

__ of people with MG have been found to have __. The surgery achieves

remission for _-_ years

Myasthenic Crisis

Cholinergic Crisis

The 2 major complications of MG are

MYASTHENIC CRISIS

Caused by undermedication or delayed medication

MYASTHENIC CRISIS

Clinical manifestations

Sudden marked rise in BP due to hypoxia

Increased heart rate

Severe respiratory distress and cyanosis

Absent cough and swallowing reflex

Increased secretions, increased diaphoresis, and increased lacrimation (tearing)

Restlessness, dysarthria

Bowel and bladder incontinence

1. Sudden marked rise in BP due to hypoxia

2. Increased heart rate

3. Severe respiratory distress and cyanosis

4. Absent cough and swallowing reflex

5. Increased secretions, increased diaphoresis, and increased lacrimation (tearing)

6. Restlessness, dysarthria

7. Bowel and bladder incontinence

MYASTHENIC CRISIS

Clinical manifestations 7

1. Increased doses of cholinergic as long as the client responds positively to edrophonium treatment

2. Possible mechanical ventilation of respiratory muscle paralysis is acute

Interventions for patients with Myasthenic Crisis: (2)

CHOLINERGIC CRISIS

Caused by excessive medications

CHOLINERGIC CRISIS

Clinical manifestations

Weakness with difficulty swallowing, chewing, speaking, and breathing

Apprehension, nausea and vomiting

Abdominal cramps and diarrhea

Increased salivation and secretions

Sweating, lacrimation, fasciculations, and blurred vision

1. Weakness with difficulty swallowing, chewing, speaking, and breathing

2. Apprehension, nausea and vomiting

3. Abdominal cramps and diarrhea

4. Increased salivation and secretions

5. Sweating, lacrimation, fasciculations, and blurred vision

CHOLINERGIC CRISIS

Clinical manifestations (5)

1. Discontinue all cholinergic drugs until cholinergic effects decrease

2. Provide adequate ventilator support

3. Atropine 1mg/IV may be necessary to counteract severe cholinergic reactions

Interventions for the patients with cholinergic crisis: (3)

1. Muscle relaxants

2. Barbiturates

3. Morphine sulfate

4. Tranquilizers

5. Neomycin

drugs should be avoided by the clients with MG: (5)

1. Reschedule daily task. To prevent weakness

2. Secure “handicapped” parking sticker

3. Frequent rest periods

4. Have alarm clock available – to take medications on time. This prevents myasthenic crisis

5. Patch each eye alternately for diplopia (double vision)

6. Start meal with cold beverage. To contract muscles of the throat and prevent aspiration

7. Avoid factors that affect respiratory functions

SURVIVAL GUIDE FOR CLIENTS WITH

MG (7)

1. Very hot or very cold weather

2. Aerosol, pesticides, cleaners

3. Alcohol, tonic water, cigarette smoke

factors that affect respiratory functions and may cause respiratory

infections: (3)

1. Assessment: Evaluate muscle strength, respiratory status, and the presence of symptoms.

2. Diagnosis: Identify nursing diagnoses such as impaired physical mobility, risk for aspiration, and ineffective breathing pattern.

3. Planning: Develop a care plan that includes goals for improving muscle strength, managing symptoms, and preventing complications.

4. Implementation: Provide medications, assist with ADLs, educate the patient and family, and monitor for signs of crisis.

5. Evaluation: Regularly assess the effectiveness of interventions and adjust the care plan as needed

MG (NURSING PROCESS)

• Assessment

• DX

• Planning

• Implementation

• evaluation