Question

1. A patient has been brought to the emergency room complaining of dyspnea after sustaining a bee sting to the right arm.

a). Describe the types of hypersensitivity

b). What measures are taken to manage anaphylaxis?

2. The nurse is teaching a patient how to use an EpiPen in the event of an anaphylactic reaction.

a). What are the priority management concerns of the patient with the allergic disorder?

b)What are the key measures for the use of an EpiPen in the management of anaphylaxis?

Answer 1

1.[a].Ans. Types of hypersensitivity reactions are as follows;

• Type I: Immediate:
• These allergic reactions are systemic or localized reactions.As they result of an antigen cross linking with membrane -bound IgE antibody of a mast cell or basophil. histamine,serotonin,bradykinin and lipid mediators (e.g.,platelet activating factor,prostaglandins,leukotienes) are released during this anaphylactic reaction which can cause tissue damage.
• e.g.,Hives,erythma reactions.
• Type II: Cytotoxic Reaction (antibody dependent):
• In this  antibody reacts directly with the antigen that is bound to the cell membrane to induce cell lysis through complement activation.these reactions mediated by IgE and IgM .
• e.g.,Rh incompatibility of a newborn,blood transfusion reactions,autoimmune diseases like bullous pemphigoid,autoimmune hemolytic anemia.
• Type III; Immune complex reaction:
• IgG and IgM bind antigen forms antigen -antibody(immune )complexs.which results in PMN chemotoxis and activation.PMNs releases tissue damaging engymes.
• e.g.,systemic lupus erythmatous ,leprosy.
• TypeIV: Cell mediated ( Delayed hyprsensitivity reactions):
• these are initiated by T-lymphocytes and mediated by effector T -cells and macrophges.Sensitized lymphocytes can produce cytokines,which are biologically active substances aaffects the other cells
• .e.g,tuberculosis,fungal infections.

1.(b):Ans. Anaphylaxis is serious life threatening allergic reaction,The most common anaphylactic reactions are foods,insect stings,medications and latex.The measures to be taken to manage anaphylaxis as follows:

• a blood test measures the certain engyme i.e. tryptase that can be elevated upto three hours after anaphylaxis.
• tests related to allergies with skin may determine the anaphylaxis type like skin prick tests,
• many conditions those having signs and symptoms similar to those of anaphyalaxis like runny nose,skin rash,hives or swelling,vomiting,abdominal pain,hoarse voice,dizzinss,fainting,low blood pressure,feeling of doom,rapid heart beat,diarrhea,tightness of throat,wheezing,uterine cramps,in children behavioural changes observed,
• facing trouble in managing sudden onset of symptoms as mention above.

2.(a)Ans. priority management concerns in  anaphylaxis ,following measures to be taken as early as possible:

  

• If a person underwent with anaphylaxis reaction ask the patient whether they are carrying an adrenaline autoinjector i.e. EpiPen to treat allergic reaction.
• If the person uses EpiPen should inject that by pressing autoinjector against the thigh.
• call for help after administering epinephrine.
• have the person lie still on his back position.
• do not give the person anything to drink.
• loosen his clothes and cover with a blanket or bedsheet.
• if vomiting turn him on his side to prevent choking.
• if there is no signs of coughing, breathing start CPR,about 100 times a minute until paramedic arrive.
• in case of cardiovascular or pulmonary reactions immediate supply of oxygen is recommended .

2.(b).Ans. following are the key measures in use of EpiPen in anaphylaxis:

• Epipen should only be injected into the antero lateral aspect of the thigh.Do not inject intravenously,into buttock,or into digits,hands.or feet.
• Instruct the care giver to hold the leg of children firmely to minimize the risk of injury related to injection.
• do not inject more than 2 injections right after each other,as too much epinephrine can cause dangerously high blood pressure,stroke,or death in some cases.signs of overdose include irregular heart beat,difficulty in breathing caused by build up of fluid in lungs.
• advice patients to take medical care or help if they develop infections such as redness,warmth,swelling,tenderness at the injection site.
• EpiPen should be used in caution in cardiac patients because it may aggravate angina pectoris and produces ventricular arrythmias.
• patients with thyroid disorders,diabetes,hypertension may be at greater risk of developing adverse reactions.So they should take proper medical care while taking EpiPen.