Allergic Disorders

Adult Health exam 2

What is a type 1 hypersensitivity reaction?

An immediate allergic reaction mediated by IgE antibodies

Exposure to an allergen triggers mast cells and basophils to release histamine and other inflammatory mediators

Can cause itching, hives, swelling, bronchoconstriction, and anaphylaxis

What are common signs of a mild allergic reaction?

Itching or pruritus

Urticaria

Sneezing and watery eyes

Localized redness or swelling

Nasal congestion or runny nose

What is anaphylaxis?

A severe, rapidly developing, potentially life-threatening systems allergic reaction

Can cause airway swelling, bronchospasm, hypotension, and cardiovascular collapse

Requires immediate treatment

What are common triggers of anaphylaxis?

Foods duch as peanuts, tree nuts, shellfish, milk, and eggs

Medications, including antibiotics

Insect stings or bites

latex

Certain contrast agents and other allergens

What are the early signs and symptoms of anaphylaxis?

Hives, flushing, and itching

Swelling of the lips, tongue, or throat

Wheezing, coughing, or difficulty breathing

Abdominal cramping, vomiting, or diarrhea

Dizziness, tachycardia, and hypotension

What is the priority nursing action when anaphylaxis is suspected?

Recognize the reaction and administer IM epinephrine immediately

Activate the emergency response system

Assess airway, breathing, and circulation

Do not delay epinephrine while waiting for IV access or other medications

What medication is first line for anaphylaxis?

Epinephrine (IM)

Administer into the mid-outer thigh

It reduces airway swelling, causes vasoconstriction, improves blood pressure, and relaxes bronchial smooth muscle

May be repeated every 5-15 minutes if symptoms persist, according to emergency protocols

What positioning is appropriate for a patient experiencing anaphylaxis?

Place the parting supine with legs elevated if tolerated

If breathing is severely difficult, positioning may need to be adjusted to support breathing

Pregnant patients should generally be positioned on their left side

never allow the patient to suddenly stand or walk, because this can worsen cardiovascular collapse

What additional interventions are needed during anaphylaxis?

Maintain and protect the airway

Administer high-flow oxygen as indicated

Establish IV access

Administer prescribed isotonic IV fluids for hypotension

Prepare for advancer airway management if swelling progresses

Continuously monitor vital signs, oxygen saturation, and cardiac rhythm

What medications may be given in addition to epinephrine for anaphylaxis?

Antihistamines: help relieve itching and hives

Corticosteroids: may help reduce prolonged inflammation but have delayed effects

Inhaled beta-agonists, such as albuterol: help relieve persistent bronchospasm

IV fluids: help trat hypotension

Important: Antihistamines and corticosteroids do not replace epinephrine

What are the common side effects of epinephrine?

Tachycardia

Palpitations

Tremors

Anxiety or restlessness

Headache

Elevated blood pressure

What is a biphasic anaphylactic reaction?

A second phase of anaphylaxis that occurs after the initial symptoms have been resolved

Symptom can return without another allergen exposure

patients require appropriate observation after treatment because symptoms may recur

What should a patient with a history of anaphylaxis be taught?

Carry two epinephrine auto injectors if prescribed

Know how and when to administer epinephjrine

Use epinephrine immediately when anaphylaxis is suspected

Call emergency serviced after using the auto injector

Wear medical identification

Avoid known triggers and read food labels carefully

What is angioedema?

Rapid selling beneath the skin or mucous membranes

Commonly affects the lips, tongue, face, and throat

Can become life-threatening if the airway is involved

What are the priority assessment findings in a patient with angioedema?

Swelling of the tongue, lips, or throat

Difficulty swallowing

Hoarseness or voice changes

Stridor

Difficulty breathing

Drooling or inability to handle secretions

What is the priority nursing intervention for angioedema involving the airway?

Assess and maintain airway patency

Activate emergency response

Prepare for possible intubation or emergency airway intervention

Administer oxygen as indicated

If the reaction is histamine-mediated or part of anaphylaxis, administer IM epinephrine promptly

What is the difference between histamine-mediated and bradykinin-mediated angioedema?

Histamine-mediated: often associated with hives, itching, and allergic reactions; may respond to epinephrine and antihistamines

Bradykinin-mediated: often associated with ACE inhibitor use or hereditary angioedema; usually occurs without hives or itching

Bradykinin-mediated angioedema generally does not respond to typical allergy medications

Airway protection and provider-directed treatment are priorities

What should the nurse do if a patient develops angioedema while taking an Ace inhibitor?

Treat airway involvement as an emergency

Notify the provider immediately

Prepare for airway intervention if swelling progresses

The ACE inhibitor should be discontinued under provider direction

Recognize that antihistamines, corticosteroids, and epinephrine may not be effective for bradykinin-mediated angioedema

What is allergic rhinitis?

An inflammatory response of the nasal mucosa caused by exposure to allergens

Common triggers include pollen, dust mites, mold, and animal dander

What are common manifestations of allergic rhinitis?

Sneezing

Clear, watery nasal drainage

Nasal congestion

Itchy nose, throat, or eyes

Watery eyes

Postnasal drip

What are priority nursing interventions for allergic rhinitis?

Identify and reduce exposure to allergens

Encourage saline nasal rinses as appropriate

Administer prescribed antihistamines or intranasal corticosteroids

Encourage keeping windows closed during high-pollen periods

Reduce dust and other indoor allergens

What is the purpose of antihistamines in allergic rhinitis?

Block histamine receptors

Reduce sneezing, itching, watery eyes, and runny nose

Examples include cetirizine, loratadine, and diphenhydramine

What are important nursing considerations for antihistamines?

First-generation antihistamines, such as diphenhydramine, can cause significant drowsiness

They may cause dry mouth, urinary retention, and constipation

Use caution in older adults because of confusion, sedation, and fall risk

Second-generation antihistamines generally cause less sedation

What is the purpose of intranasal corticosteroids?

Reduce inflammation in the nasal passages

Decrease congestion, sneezing, and nasal drainage

Examples include fluticasone and budesonide

The work best when used consistently as directed

What is an important safety concern with topical nasal decongestants such as oxymetazoline?

Prolonged use can cause rebound congestion (Rhinitis medicamentosa)

Limit use to approximately 3 days unless otherwise directed

What should patients know about oral decongestants such as pseudoephedrine?

They can increase blood pressure and heart rate

May cause insomnia, nervousness, and palpitations

Patients with hypertension or cardiovascular conditions should consult their healthcare provider before use

What is contact dematitis?

Skin inflammation caused by direct exposure to an irritating or allergenic substance

Can cause redness, itching, swelling, and sometimes blisters

What is the difference between irritant and allergic contact dermatitis?

Irritant: caused by direct damage to the skin from substances such as detergents, chemicals, or frequent handwashing

Allergic: immune-mediated reaction after exposure to an allergen, such as nickel, fragrances, or poison ivy

What are priority nursing interventions for contact dermatitis?

Identify and remove the offending substance

Wash the affected area to remove remaining irritant or allergen

Apply cool wet compresses as appropriate

Administer prescribed topical corticosteroids

Prevent scratching and monitor for secondary infection

What patient education is important for contact dermatitis?

Avoid the substance causing the reaction

Wear protective gloves when handling irritants

Use gentle, fragrance-free skin products

Keep the skin clean and moisturized

Avoid scratching affected areas

What is a food allergy?

An immune system reaction to a specific food protein

Can cause mild symptoms such as itching or hives or severe symptoms such as anaphylaxis

What are common food allergens?

Milk

Eggs

Peanuts

Tree nuts

Soy

Wheat

Fish

Shellfish

Sesame

What are important patient education points for food allergies?

Read ingredient labels every time

Avoid foods containing the identified allergen

Prevent cross-contact during food preparation

Inform restaurants and food handlers about the allergy

Carry prescribed epinephrine

Have an emergency action plan

What is cross-contact in food allergies?

When an allergen unintentionally transfers from one food surface to another

Examples include shared cooking utensils, cutting boards, fryers, or preparation surfaces

Even small amounts can trigger a reaction in highly sensitive individuals

What diagnostic tests may be used to identify allergies?

Skin-prick testing

Serum allergen-specific IgE testing

Patch testing for delayed contact allergies

Supervised oral food challenges when indicated

What is an important nursing consideration during skin-prick allergy testing?

Monitor for signs of systemic allergic reaction

Keep emergency medications and equipment available

Follow instructions about medications that may interfere with test results, particularly antihistamines

What is patch testing primarily used to identify?

Allergic contact dermatitis

Small amounts of suspected allergens are placed on the skin under patches

Reactions are assessed over time, often at multiple intervals

What is the priority nursing concern when a patient reports that throat tightness after eating is a suspected allergen?

possible airway compromise and anaphylaxis

Immediately assess airway and breathing

Administer IM epinephrine if anaphylaxis is suspected

Activate emergency response and prepare for advanced airway support

What findings suggest that an allergic reaction is progressing toward anaphylaxis?

Increasing swelling of the lips, tongue, or throat

Wheezing or stridor

Difficulty breathing

Hypotension

Dizziness or fainting

Rapid progression of symptoms involving multiple body systems

What is the most important nursing principle when caring for a patient with a severe allergic reaction?

Prioritize airway, breathing, and circulation

Administer IM epinephrine promptly for anaphylaxis

Do not delay emergency treatment while waiting for diagnostic confirmation

Continuously reassess for worsening symptoms or recurrence