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From Flashcardlet > 1229 Exam 8: Allergies, Anaphylaxis, Eczema, Asthma > Flashcards

1229 Exam 8: Allergies, Anaphylaxis, Eczema, Asthma Flashcards

1
Q

Allergies

A
  • Allergic reaction is an abnormal immune response to a substance that does not generally cause a reaction in most people
  • The job of immune system is to find foreign substances; viruses, bacteria and get rid of them
  • Normally, this response protects from disease
  • Allergies have super sensitive immune system; react to harmless substances
  • Tendency to be allergic is usually inherited
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2
Q

Allergen

A

Substance causing the allergy

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3
Q

Symptoms of Allergies

A

Mild
-Rash, itch, watery eyes, congestion
-Mild reactions do not spread to other parts of body
Moderate:
-Itchiness, difficulty breathing, hives
Severe:
-Anaphylaxis- complete closure of the airway; Some have tingling

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4
Q

Causes of Allergies

A
  • Ingestants: Substances that enter the body PO
  • Injected: Enter body through puncture; Wasp, injection
  • Inhalants: the allergen is breathed in
  • Contact allergens: ones you touch with your body (poison oak)
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5
Q

Ingestants

A 
Milk
Eggs
Wheat 
Soy
Fish and Shellfish
Peanuts, Tree nuts
-These account for about 90% of all reactions in the US
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6
Q

Allergy vs. Intolerance

A
  • Intolerance is common: Ex. Lactose, MSG; N/V, diarrhea, spitting up, headache. Intolerance symptoms occur only when someone has been exposed to too much of the substance
  • True food allergies ALWAYS occur with any exposure
  • Severe allergic reactions can occur just by smelling the allergen
  • Severe peanut allergies require a “peanut free” environment
  • Food-related anaphylaxis causes 30,000 ER visits and 150 deaths per year
  • Food is the leading cause of anaphylaxis in children
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7
Q

Ingested Drugs

A 
Penicillin
-Common cause of drug allergy
-Anaphylactic reactions cause 400 deaths/year
Sulfa-bactrum
Barbiturates
Anticonvulsants
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8
Q

Drug Allergy Symptoms

A

Mild-life threatening
-Even in people who aren’t allergic, many drugs cause irritation, such as an upset stomach. But during an allergic reaction, the release of histamine c an cause symptoms like hives, skin rash, itchy skin or eyes, congestion, and swelling, in the mouth and throat.
Severe reaction may include:
-Difficulty breathing, blueness of the skin, dizziness, fainting, anxiety, confusion, rapid pulse, nausea, diarrhea, and abdominal problems.

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9
Q

What drugs most often cause an allergic reaction?

A
  • PCN and other antibiotics can also trigger allergic reactions
  • Other drugs commonly found to cause reactions include sulfa drugs, barbiturates, anticonvulsants, insulin, and iodine (found in many x-ray contrast dyes) (injected)
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10
Q

Injected

A

Vaccines
Antibiotics
Insulin
Insect Stings
-Hornets, wasps, bees, yellow jackets, ants
-40 deaths annually in US to insect stings

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11
Q

Inhalants

A
  • Pollens (hay fever)
  • House dust mites- a big thing with carpet and older homes
  • Molds
  • Animal dander and saliva- most of the time they are allergic to the saliva, but sometimes it is the dander
  • Chemicals used in industry
  • Many that have problems with these allergies will go and have allergy testing done
  • Inhalants are the MOST important allergens for allergic asthma
  • Typically do allergy testing
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12
Q

Dust Mite

A
  • Second only to pollen
  • To control dust mites wash bedding/stuffed toys weekly in hot water of at least 130 degrees
  • Replace items that can’t be washed
  • Use filters when vacuuming and change filters regularly…HEPA
  • Encase bedding in an airtight cover…Encase or wash pillows
  • Avoid having children sleep directly on carpet
  • Clean all surfaces with a damp cloth
  • Remove carpets
  • Do not vacuum with child present
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13
Q

Contact Allergies

A
  • An allergic skin reaction from contact with a substance that is usually harmless to others
  • Metals: nickel in watches, snaps
  • Skin care products: fragrances, lanolin, soaps
  • Medication
  • Fabric softeners, dryer sheets
  • Latex: gloves, toys, balloons, elastics, foam (can’t eat bananas or avocados
  • -220 cases of anaphylaxis and 3 deaths a year
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14
Q

Aggravating Factors

A 
Weather changes
Cold
Heat
Second hand smoke 6x > ear infections
Infections
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15
Q

Conditions Aggravated by Allergies

A 
Asthma
Hay Fever
Eczema
Hives
Contact Dermatitis
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16
Q

Treatment

A

Avoidance: stay away from it
Medication: Steroid creams/shots
Allergy Shots: Immunotherapy (helps to build up immunity to some things)
Control of environment

17
Q

Anaphylaxis

A

Life threatening allergic reaction where body’s response to allergen is sudden and affects whole body. Begins with sudden itching of eyes or face and progresses to more serious symptoms including:

  • Swelling that can make breathing/swallowing difficult
  • Abdominal pain
  • Cramps
  • Hives
  • Vomiting
  • Diarrhea
  • Mental confusion or dizziness
  • LOC
  • Death
18
Q

Symptoms of Anaphylaxis

A
  • Tingling sensation
  • Itching and hives over large areas
  • Metallic taste in mouth
  • Sensation of warmth
  • Asthma symptoms
  • Swelling of throat or tongue
  • Difficulty breathing
  • Dizziness, N/V/D
  • Stomach cramps
  • Rapid fall in blood pressure
  • Shock, loss of consciousness
  • Death
19
Q

Anaphylaxis, what should you do?..

A
  • Activate emergency plan
  • Establish an airway
  • Epinephrine Sub-Q, IV, IM, Nebulizer, ET
  • -Gold standard in severe reactions
  • -Relaxes muscles in airway and constrict blood vessels; raises blood pressure
  • -Epi-pen Jr. contains 0.15 mg epinephrine
  • IV fluids to raise BP
20
Q

Nursing Measures for Anaphylaxis

A 
Unresponsive Child ABC's:
-Check for breathing
-If breathing; place on the left side
-If the child is not breathing begin rescue breathing 
Responsive Child:
-Place child who is having trouble berating in a sitting position to make breathing easier
-Administer epinephrine as ordered
-A second injection may be needed
21
Q

Epinephrine

A

Potential side-effects:

  • Palpitations
  • Rapid heart beat
  • Nausea; respiratory difficulty
22
Q

Eczema

A

A descriptive category of dermatologic diseases and not a specific etiology

23
Q

Atopic Dermatitis-(Eczema)

A

3 types depending on age and distribution of lesions

  • Associated with allergy/hereditary tendency
  • -Infantile: 2-6 months
  • -Childhood: 2-3 years of age
  • -Preadolescent and Adolescent: 12 years-early adulthood
24
Q

Infantile

A
  • Generalized, especially cheeks, scalp, trunk, and extremities
  • Erythema
  • Vesicles (fluid filled blisters)
  • Papules (small bumps or pimple)
  • Weeping
  • Oozing
  • Crusting
  • Scaling
  • Can have coin lesions- round/flat (similar to ringworm)
25
Q

Childhood

A
  • Symmetric
  • Clusters
  • Dry and hyper-pigmented
  • Lichenification (thickened skin)
  • Keratosis pilaris (follicular hyperkeratosis) where the hair gets inflamed in that area
  • -Chronic inflammation of hair follicle area
  • -Chicken bump
26
Q

Adolescent/Adult

A

-Symmetric
-Lichenification (dry, thick lesions)
Other Physical Manifestations:
-Intense itching
-Prone to cold hands
-Facial pallor; may have bluish color under eyes
-Bluish discolor beneath the eyes

27
Q

Therapeutic Management

A 
Relieve Pruritus
Colloid bath (2 cups cornstarch)
Bedtime, Benadryl, Atarax
Daytime, Allegra, Claritin
-Hydrate skin:
--Tepid bath with mild soap
--Emulsifying oil followed by emollient
--Aquaphor, cetaphil, eucerin
-Reduce inflammation:
--Topical corticosteroids
--Immunomodulator (tarcolimus & pimercrolimus)
-Prevent/Control Secondary Infection:
--Soft cotton pjs
--Short clean nails
--Antibiotic...as treated/needed
28
Q

Asthma

A
  • Increasing in the US
  • Most common chronic disease of childhood
  • Primary cause of school absences
  • Severe asthmatics should have peak flow every day
  • Chronic inflammatory disorder of airways
  • Bronchial hyper-responsiveness
  • Episodic
  • Limited airflow
29
Q

Classification 5 years and Older

A
  • Step 1: Mild, intermittent - 2x week, exacerbations may affect activity
  • Step 3: Moderate, persistent - daily sx, require daily short acting beta2adrenergic agonist, night time sx >1x a week
  • Step 4: Severe, persistent - Continued 5x and throughout the night
30
Q

What does Asthma look like?

A 
Cough:
-Hacking, paroxysmal, irritable, nonproductive
-Becomes rattling and productive
Respiratory:
-SOB, prolonged expiratory phase
-Audible wheezes, restless, lips deep dark red
Chest:
-Coarse loud breath sounds, crackles
-Wheezes through lung fields, increasingly high pitched
Chronic:
-Barrel chest, elevated shoulders
-Use of accessory muscles
31
Q

Diagnostic Evaluation

A
  • H&P and clinical manifestation
  • PFT’s- evaluate presence and degree of lung disease, response to therapy
  • PEFR (peak expiratory flow rate)- measure the max air flow forced out in 1 minute
  • Skin testing for allergies
  • RAST
  • -Identified food allergies
32
Q

Goals for Asthma

A
  • Prevent disability
  • Minimize physical/psychological morbidity
  • Allergen control:
  • -Dust mites, roaches, mice
    • < humidity 50% dust mites can’t live
  • -Skin testing
  • Drug therapy
33
Q

Drug Therapy

A
  • Most can be given PO, IV, inhaled, nebulizer
  • Long term control meds
  • Quick relief meds (rescue)
  • MDI (meter dosed inhaler) with spacer - Teach them to count to 10 while holding in so it will go to lungs, then wait a second and take a few breaths, then do the same thing again; When finished rinse mouth out
  • Corticosteroids
  • Cromolyn Sodium (NSAID)
  • Albuterol, metaproterenol, terbutaline, B adrenergic agonist
34
Q

Drug Therapy for Asthma

A
  • LT bronchodilators
  • -Inhaled 2x daily
  • Theophylline-monitor serum levels and KNOW them
  • -3rd line drug now
  • -5-15 mcg/ml - therapeutic levels
35
Q

Asthma Interventions

A
  • Exercise- exercise induced bronchospasm
  • -beta-adrenergic agents or cromolyn sodium - prior to exercise can prevent problem
  • Chest physiotherapy- breathing exercises and physical training
  • Hyposensitization
  • -NOT used for allergens that can be avoided
  • -Allergy shots
36
Q

Prognosis for Asthma

A

May grow out of it by adulthood, but usually doesn’t

-Death is rare, but teens are the most vulnerable (10-14); Don’t know why

37
Q

Status Asthmaticus

A
  • Respiratory distress continues with vigorous therapeutic measures
  • Emergency treatment-epinephrine 0.01 ml/kg (max dose 0.3 ml)
  • Concurrent infection in some cases
  • Therapeutic intervention
  • -Improve ventilation
  • -Hydrate, correct acidosis, treat concurrent infection
38
Q

Goals for Asthma Management

A
  • Avoid exacerbation
  • Avoid allergens
  • Relieve asthmatic episodes promptly
  • Relieve bronchospasm
  • Monitor function w/ peak flow meter
  • Self-management of inhalers, devices, & activity regulation

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