Chapter 34: Caring for Clients with Immune-Mediated Disorders Flashcards

1

An older adult who reports CFS should be evaluated for what?

Depression

2

characterized by a hyperimmune response to weak antigens that usually are harmless

can occur at any age, and the pattern of allergic response can vary in the same person during life

Allergic disorders

3

Types of Allergies?

Allergic rhinitis
Contact Dermatitis
Dermatitis medicamentosa
Food allergy
Urticaria
Angioedema

4

Clients with this type of allergy present w/:

sneezing
itching
nasal congestion w/ watery nasal discharge
itching/redness of the eyes

Allergic rhinitis

tx'd w/:

antihistamines
nasal decongestants
allergen avoidance
eye drops
corticosteroid nasal spray

5

Clients w/ this type of allergy present w/:

itching
burning
redness
rash on contact w/ substance

Contact dermatitis

tx'd w/:

allergen avoidance
wearing gloves
topical or oral antihistamines and corticosteroids

6

Clients w/ this type of allergy present w/;

nausea/vomiting
diarrhea
abdominal cramping
malaise
itching
wheezing
rash
cough

Food allergy

tx'd w/:

identification and avoidance of allergenic food
intubation
subq epinephrine
aminophylline in severe reactions

7

Clients w/ this type of allergy present w/:

itching
swelling
redness
wheals of the superficial skin layers

Urticaria (hives)

tx'd w/:

topical or oral antihistamines and corticosteroids

8

Clients w/ this type of allergy present w/:

itching
swelling
redness of deeper tissues and mucous membranes

Angioedema

tx'd w/:

intubation
subq epinephrine
aminophylline

9

The first exposure to an antigen doesn't cause symptoms, it causes this?

This is the process by which cellular and chemical events occur after a second or subsequent exposure to an allergen

Sensitization

10

This client presents w/:

laryngeal edema
wheezing
stridor
tachycardia; hypotension
itching
bronchospasm
angioneurotic edema

Anaphylactic shock

11

This client presents w/:

watery eyes
increased nasal and bronchial secretions
sneezing
vomiting
diarrhea
urticaria
itching
localized redness
allergic shiners: dark areas under the eyes

Localized hypersensitivity

12

These usually cause respiratory symptoms:

nasal congestion
runny nose
sneezing
coughing
dyspnea
wheezing
trigger asthma

Inhalants

13

these usually cause skin reactions such as:

urticaria
rash
localized itching

Contactants

14

These symptoms are associated w/?

diarrhea
cramping
vomiting
common allergens: milk, egg whites, wheat, soybeans, fish, shellfish, nuts, corn, strawberries

Food allergens

15

These, such as bee venom, and some other allergens can produce systemic and potentially fatal effects, including shock and airway obstruction caused by laryngeal swelling

Injectants

16

measures IgE on a scale of 0-5

if score is greater than 2, that is an indication of an allergic disorder
doesn't identify substances that a person is allergic to, but only validates that a person is potentially hypersensitive to antigenic substances

Radioallergosorbent Test (RAST)

17

involves scratching the skin and applying a small amount of the liquid test antigen to the scratch

usually done of forearm, upper arm, or back (the back is more sensitive than the arms)
each substance should be 3-5 cm apart from another
results are identifiable in as little as 20 minutes
the larger the reaction, the greater the likelihood that the test allergen is the cause of symptoms in the tested person

Scratch/Prick test

18

used to identify the offending substance in allergic dermatitis

a concentrated form of the substance is applied to the skin and is covered w/ an occlusive dressing
after 48 hours, the dressing is removed and the area is examined for erythema, edema, and vesicles

Patch test

19

performed only when the results of a scratch test are negative for allergies

a dilute solution of a substance is injected intradermally
a positive reaction is based on the size of the raised wheal with localized erythema that forms where the antigen was injected

intradermal injection test

20

Ex. of intradermal injection test

tb skin test

the area of induration (hard, raised area) is measured

21

How do you identify allergens?

meticulous record keeping of symptoms and a food diary listing all foods and beverages consumed are necessary
elimination diets to establish cause-and-effect relationships: the client completely avoids suspected foods for 1-2 weeks and then adds them back to the diet one at a time in small amounts
have client fast for 1-2 days, drinking only distilled water
introduce hypoallergenic foods one at a time
then, introduce allergenic foods (wheat, peanuts) one at a time in small quantities
observe client for allergic symptoms after introducing each new food

22

to protect against poison ivy, clients can apply what to the skin 15 minutes prior to exposure and at least q 4 hours as long as risk of exposure continues

Bentoquatam 5%

23

Medical management for clients w/ allergic disorders

drug therapy: diphenhydramine, promethazine, loratadine, fexofenadine, cetirizine, epinephrine, brompheniramine, albuterol (bronchodilator), Ipratropium (anticholinergic), montelukast
desensitization

24

form of immunotherapy in which a person receives weekly or twice-weekly injections of dilute but increasingly higher concentrations of an allergen w/o interruption

repeated exposure to the weak antigen promotes the production of IgG, this antibody blocks IgE so it cannot stimulate mast cells
after injection, client is observed for 30 minutes to assess for any reactions; epi may be administered for severe reactions
when maximum dose is achieved after 2-4 months of tx, maintenance doses are administered at longer intervals (usually q 2-4 weeks)

Desensitization

25

What is the most common site for administration of Epinephrine?

clients w/ severe allergies to bee venom are advised to carry epi in an emergency kit

lateral thigh

26

REVIEW FIGURE 34-7: SELF-INJECTION OF EPINEPHRINE TO AVOID ANAPHYLACTIC REACTION

27

Nursing management for clients w/ Allergic Disorders

be sure to ask clients about allergies
flag medical record and wristband w/ appropriate information
if a mild allergic reaction is suspected, remove/withhold offending substance and notify the healthcare provider
if there's an anaphylactic reaction, act immediately to stop exposure to allergen, summon code team, call 911, provide life support
instruct clients who are scheduled for dx skin testing to avoid taking prescribed or OTC antihistamines or cold preparations for at least 48-72 hours before testing (reduces potential for a false-negative)
advise client not to drive a car, operate machinery, or perform tasks that require alertness when taking antihistamines
advise clients to avoid nonprescription eye preparations to reduce redness, refer for ophthalmologist

28

Techniques for removing a ring from a swollen finger?

apply soap/oil to finger
if that doesn't work, wrap finger w/ twine, dental floss, or narrow elastic; once the tissue is compressed, the proximal free end of twine is slipped under and over the ring; as the twine unwinds, the ring will slip off the finger (preferred method)
cutting ring

29

REVIEW CLIENT AND FAMILY TEACHING 34-1: ALLERGIES

30

those in which killer T cells and autoantibodies attack or destroy natural cells- those that are self

Autoimmune disorders

31

Examples of autoimmune disorders

hemolytic anemia
thrombocytopenic purpura
multiple sclerosis
guillain-barre syndrome
myasthenia gravis
ulcerative colitis
glomerulonephritis
lupus
RA

32

This client presents w/:

antibodies that attack normal tissue mistakenly identified as nonself
symptoms are episodic
exacerbations alternate w/ periods of remission
during exacerbations, clients experiece: low-grade fever, malaise, fatigue
lose weight

Autoimmune disorders

33

What is the hallmark find for autoimmune disorders?

Elevated circulating antibodies

34

Medical management for clients w/ Autoimmune disorders?

rarely cured
goal is to induce a remission or slow the immune system's destructive activities
drug therapy: dexamethasone, prednisone, methylprednisolone
antineoplastic medications

35

REVIEW NURSING PROCESS FOR CLIENT WITH AN AUTOIMMUNE DISORDER

36

CLIENT AND FAMILY TEACHING 34-2: AUTOIMMUNE DISORDERS

37

a complex of s/s primary characterized by profound fatigue w/ no identifiable cause

has been unrelenting for 6 or more months
causes pain in fibrous tissues of the body (muscles, tendons, and ligaments)

Chronic Fatigue Syndrome

(mimics fibromyalgia)

38

This client presents w/:

having had a recent illness w/ flu-like symptoms or an URI
clients don't describe their initial symptoms being severe
thereafter, ongoing fatigue has lasted 6 months w/o any explanation
fatigue worsens after physical activity
interferes w/ client's ability to work
malaise that last more than 24 hours after exertional activity
sore throat
tender cervical/axillary lymph nodes
joint pain
myalgia
headaches of a different type/pattern/severity
unrefreshing sleep
short-term memory loss and concentration
digestive issues
chills and night sweats
SOB
irregular heart beat

Chronic Fatigue Syndrome

39

diagnostic test for CFS

client lies horizontally on a table whose incline is elevated to approx. 70 degrees for 45 minutes
during the test, BP and pulse are monitored
the test tends to provoke hypotension in those eventually dx'd w/ CFS

tilt-table test

40

Medical management for clients w/ CFS

relieving client's symptoms
analgesics, antidepressants, CNS stimulants
advise client to balance activity w/ rest
client may need to resign from their job or negotiate for less physically demanding position
avoid overexertion at all costs
mild pain and fever may be tx'd w/: ASA, acetaminophen, NSAIDs
advise increase in salt and water if not contraindicated
antihypotensive agents: midodrine
cognitive therapy (people learn skills to change distorted thoughts about themselves)

41

REVIEW CLIENT AND FAMILY TEACHING 34-3: CHRONIC FATIGUE SYNDROME

42

REVIEW NURSING CARE PLAN 34-1: CLIENT W/ CHRONIC FATIGUE SYNDROME

Timby's Introductory Medical-Surgical Nursing: Chapter 34: Caring for Clients with Immune-Mediated Disorders Flashcards