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

Depression

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

Types of Allergies?

• Allergic rhinitis
• Contact Dermatitis
• Dermatitis medicamentosa
• Food allergy
• Urticaria
• Angioedema

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

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

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

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

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

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

This client presents w/:

• laryngeal edema
• wheezing
• stridor
• tachycardia; hypotension
• itching
• bronchospasm
• angioneurotic edema

Anaphylactic shock

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

These usually cause respiratory symptoms:

• nasal congestion
• runny nose
• sneezing
• coughing
• dyspnea
• wheezing
• trigger asthma

Inhalants

these usually cause skin reactions such as:

• urticaria
• rash
• localized itching

Contactants

These symptoms are associated w/?

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

Food allergens

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

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)

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

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

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

Ex. of intradermal injection test

tb skin test

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

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

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%

Medical management for clients w/ allergic disorders

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

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

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

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

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

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

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

REVIEW CLIENT AND FAMILY TEACHING 34-1: ALLERGIES

REVIEW CLIENT AND FAMILY TEACHING 34-1: ALLERGIES

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

Autoimmune disorders

Examples of autoimmune disorders

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

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

What is the hallmark find for autoimmune disorders?

Elevated circulating antibodies

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

REVIEW NURSING PROCESS FOR CLIENT WITH AN AUTOIMMUNE DISORDER

REVIEW NURSING PROCESS FOR CLIENT WITH AN AUTOIMMUNE DISORDER

CLIENT AND FAMILY TEACHING 34-2: AUTOIMMUNE DISORDERS

CLIENT AND FAMILY TEACHING 34-2: AUTOIMMUNE DISORDERS

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)

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

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

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)

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

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

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

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