NUR 195 Ch 38: Nursing Management
for Patients with Allergic Disorders
Anaphylaxis - correct answer ✔✔- Anaphylaxis: clinical response to an immediate (type 1
hypersensitivity) immunologic reaction b/w specific antigen & antibody
- Reaction results from rapid release of IgE-mediated chemicals, which induce severe, life-threatening
allergic reaction
Anaphylaxis: Pathophysiology
(Box 38-1 & Box 38-2) - correct answer ✔✔- Anaphylaxis occurs when body's immune system produces
specific IgE antibodies toward a substance that is normally nontoxic (e.g. foods)
- Antibodies are produced for that specific substance, & those antibodies are stored in the immune
system for future re-exposure; If the substance is ingested again, the body releases excess amounts of
the protein histamine--Large amounts of histamine released into the body may cause flushing, urticaria,
angioedema, hypotension, & bronchoconstriction
- These systemic changes characteristically produce clinical manifestations within seconds or minutes
after antigen exposure; In severe cases, these symptoms may cause shock & If no medical intervention is
sought, death may ensue
-Substances that most commonly cause anaphylaxis are foods, meds, insect stings, & latex
- The dx of risk of anaphylaxis is determined by prick & intradermal skin testing
-The severity of previous reactions does not determine severity of subsequent reactions, which could be
the same, more, or less severe--Severity depends on degree of allergy & the dose of allergen
Anaphylaxis: Clinical Manifestation & Assessment
(Table 38-1) - correct answer ✔✔- Mild systemic reactions: peripheral tingling & sensation of warmth,
sensation of fullness in mouth & throat, nasal congestion, periorbital swelling, pruritus, sneezing, &
tearing of eyes
- Moderate systemic reactions: bronchospasm & edema of airways/ larynx w/ dyspnea, cough, &
wheezing
- Both mild& moderate reactions being within 2 hrs of exposure
, - Severe systemic reactions: abrupt onset; s/s same as described above & they progress rapidly to
bronchospasm, laryngeal edema, severe dyspnea, cyanosis, & hypotension; dysphagia, abdominal
cramping, vomiting, diarrhea, & seizures can also occur'; Cardian & coma may follow
- Monitoring pt w/ anaphylaxis: continual assessment of pt's resp. rate & pattern, O2 sat, assess
breathing difficulties/ abnormal lung sounds, & monitor for hemodynamic stability (pulse rate/rhythm, &
BP)
Anaphylaxis: Prevention
(Box 38-3) - correct answer ✔✔- Strict avoidance of potent allergens is important prevention for pt at
risk for anaphylaxis
- If avoidance of allergen is impossible, pt should be instructed to carry & administer epinephrine to
prevent anaphylactic reaction in event of exposure to the allergen
- EpiPen: commercially available 1st-aids device that delivers remeasured doses of 0.3mg (Epipen) or
0.15mg (EpiPen Jr.); an auto injection system that requires no prep, & self-admin technique is
uncomplicated (pt must be given opportunity to demonstrate correct technique for use); verbal &
written info about emergency kit & strategies to avoid exposure to allergens must be provided
- Screening for allergies before a med is prescribed or administered is important preventative measure;
Careful hx of any sensitivity to suspected antigens must be obtained before administering any med,
particularly in parenteral form, b/c this route is associated w/ most severe anaphylaxis; Nurses caring for
pts in any setting must assess pts'' risks for anaphylactic reactions (Pts are asked about previous
exposure to contrast agents used for diagnostic tests & any allergic reactions, as well as reactions to any
meds, foods, insect stings, & latex)
- People who are predisposed to anaphylaxis should wear some form of ID, like medical alert bracelet,
which names allergies to meds, food, & other substances
- People who are allergic to insect venom may require venom immunotherapy (used as a control
measure, not a cure); Immunotherapy administered after an insect sting is very effective in reducing risk
of anaphylaxis from future stings
- Insulin-allergic pts w/ diabetes & those who are allergic to penicillin may require desensitization;
Desensitization is based on controlled anaphylaxis, w/ gradual release of mediators; Pts who undergo
desensitization are cautioned that there should
Anaphylaxis: Medical Management - correct answer ✔✔- Management depends on severity of reaction;
Initially, respiratory & cardiovascular functions are evaluated
- If pt is in cardiac arrest: CPR initiate; O2 is provided in high concentrations during CPR or if pt is
cyanotic, dyspneic, or wheezing; Epinepherine (in 1:1000 dilution), is given subQ in upper extremity to
thigh & may be followed by continuous IV infusion
