Exam 4-Care of Pts with Immune Function Excess Flashcards Preview

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Flashcards in Exam 4-Care of Pts with Immune Function Excess Deck (30):
1

Hypersensitivities/Allergies

Increased/excessive response to presence of antigen exposure

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Degree of rtx:

-Uncomfortable: itchy watery eyes, sneezing
-Life threatening: allergy asthma, anaphylaxis, bronchoconstriction circulatory collapse

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TYPE I: Rapid Hypersensitivity Rtx (also an atopic allergy)

-Most common type
-some rtx occur only in areas of antigen exposure
-caused by increased production of IgE antibody class

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TYPE I: Rapid Hypersensitivity Rtx causes

Inhalation: pollens, spores, animal dander, dust

Ingestion: foods, food additives, drugs

Injection: insects (bee sting), drugs

Contraction: latex, food, environmental proteins

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TYPE I: Rapid HR -Anaphylaxis

blood vessel dilation, decreased cardiac output, bronchoconstriction

occurs very quickly

also known as anaphylactic reaction

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TYPE I: Allergic Rhinitis (Hay fever)

triggered by airborne allergens: plant pollen, molds, dust, animal dance, wool, food, air pollutants

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Allergic Rhinitis: Primary phase

allergens binds to 2 adjacent IgE molecules
Histamine is released

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Allergic Rhinitis: Secondary Phase

release of other proteins, general inflammatory reaction develops

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TYPE I PT COLLABERATIVE CARE

-Hx
-Lab assessment: increased eosinophils (normal 1%-2%), IgE, RAST
-Allergy testing: scratch testing & intradermal testing, repeat open application testing (ROAT)
-Oral food challenge

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Oral food challenge

taking away everything and introducing one food at a time

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scratch testing & intradermal testing

antihistamines & glucocorticoids discontinued for 4 wks prior to testing

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TYPE I: Environmental changes

-air conditioning, air cleaning units
-cloth drapes
-upholstered furniture
-carpeting
-change clothes when come inside to make home free of outside allergens

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TYPE I: Pet intervention

-pets that shed
-bathe pets
-no sleeping with pets

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TYPE I: Drug therapy

Decongestants
Antihistamines
Corticosteroids
Mast cell stabilizers
Leukotriene antagonists
Complementary & Alternative therapy: Aromatherapy, Unprocessed honey
Desensitization therapy (allergy shots)

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Anaphylaxis

-1st feelings of uneasiness, apprehension, weakness, impending doom
-pruitis and urticaria
-Erythema, sometimes angioedema of eyes, lips, tongue
Tx: EpiPen
-Emergency situation
-histamine causes capillary leak, bronchochonstriction, mucosal edema, excess mucus secretion

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Anaphylaxis s/s

Congestion
Rhinorrhea
Dyspnea
Increasing Respiratory Distress
with audible wheezing

-can be fatal
common cause: Drugs and dyes

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Anaphylaxis Inerventions

-EpiPen or Twinject
-Assess respiratory function; establish airway
-CPR (if needed)
-Epinephrine
-Antihistamines (for angioedema & urticaria)
-O2
-Tx bronchospasm
-IV fluids

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TYPE I: Latex

-protein found in natural latex rubber products is specific allergen
-allergen causes interaction with IgE
-Incidence of latex allergy is increasing
-can develop rtx later in life
-health care workers especially susceptible

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TYPE II Cytotoxic rtx

body makes special autoantibodies directed against self cells that have some form of foreign protein attached to them

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TYPE II: Cytotoxic ex

Hemolytic anemias
Thrombocytopenic purpura
Hemolytic transfusion rtx
Goodpasture's syndrome

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TYPE III: Immune Complex rtx

-excess antigens cause immune complexes to form in blood
-circulating complexes lodge in small blood vessels (damage of organ its going to)
-Usual sites: kidneys, skin, joints, small blood vessels
-Deposited complexes trigger inflammation, result in tissue or vessel damage

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TYPE III: Immune Complex Causes

Rheumatoid arthritis
systemic lupus erythematosus
serum sickness occur

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TYPE IV: Delayed Hypersensitivity Rtx

-Reactive cell is T-lymphocyte
-antibodies & complemnet not involved
-Local collection of lymphocytes & macrophages cause edema, induration, ischemia, tissue damage at site

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TYPE IV: Delayed Hypersensitivity Rtx Examples

-Positive purified protein:TB skin tests
-Contact dermatitis
-Posisn ivy skin rashes: exposure may not show until the next day
-Insect stings: rtx the following day
-Tissue transplant rejection
-Sarcoidosis

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TYPE V: Stimulatory Rtx

-excess stimulation of normal cell surface receptor by autoantibody
-results in continuous "turned-on" cell state
ex. Graves' disease

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Autoimmunity

-person develops inappropriate immune response
-antibodies/lymphocytes directed against healthy normal cells & tissues (autoantibodies)
-Immune system fails to recognize certain body cells/tissues as self, triggers immune rtx

Ex. SLE, scleroderma, rheumatoid arthritis

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SJOGREN'S SYNDROME

-often appears with autoimmune disorders
-insufficient tears causing inflammation/ulceration of cornea
-no cure; intensity & progression can be slowed

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SJOGREN'S SYNDROME S/S

dry eyes
dry mucous membranes of nose & mouth (xerostomia)
vaginal dryness

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GOODPASTURE'S SYNDROME

-autoantibodies made against glomerular basement membrane & neutrophils
-lungs & kidneys

Tx: High-dose corticosteroids
-may require dialysis or kidney transplant

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GOODPASTURE'S SYNDROME S/S

shortness of breath
hemoptysis
decreased urine output
weight gain
edema
hypertension
tachycardia