Understanding Medical Surgical Nursing Ch 53
Terms
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- anaphylaxis
-
severe systemic type I hypersensitivy reaction
IgE antibodies produced from prior exposure to antigens attach to mast cells
because mast cells exist system wide, allergic reaction caused by exposure to antigen is system wide
S/S: generalalized smooth muscle spasms - bronchial narrowing - stridor - wheezing - dyspnea - laryngeal edema - respiratory arrest- cramps - diarrhea - nausea - vomiting - increased capillary permeability - hypotension - tachycardia - histamine
- substance released from mast cells that causes vasodilation, changes in vascular permeability, increase in mucus production, & contraction of various mooth muscles
- uriticaria
-
AKA hives
IgE antibodies cause release of mast cell contents, especially histamine
S/S: raide, pruritic, nontender lesions on skin - concentrated on trunk & proximal extremities - angioedema
-
a form of uriticaria
patho same as uriticaria EXCEPT angioedema affects submucosal & subcutaneous tissue (not skin)
S/S: dermal erythematous & subcutatneous eruptiosn - skin & mucous membrane edema - eruptions may last longer than with uriticaria - allergic rhinitis
-
result of antigen-antibody reaction
ciliary action decreases & mucus secretions increase
vasodilation & local tissue edema occur
S/S: sneezing - nasal itching, runny nose - red eyes - dark circles under eyes - venous congestion in maxillary sinuses - atopic dermatitis
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AKA eczema
inflammatory skin response BUT specific antigen is not usually identified as cause
S/S: pruritus - edema - extremely dry skin - blisters - dermatitis - Type I Reactions
-
an immediately occuring reaction when exposure to specific antigen occurs
MUST have had previous exposure to antigen
- allergic rhinitis
- atopic dermatitis
- anaphylaxis
- urticaria
- angioedema - Type II Reactions
-
involves destruction of a cell or substance that has an antigen attached to its cell membrane
IgG or IgM determines cell/substance is a foreign antigen, antibodies attach to it, and it's destroyed
- hemolytic transfusion reaction - hemolytic transfusion reaction
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RBcs w/antigens foreign to the individual are rapidly lysed
rapid RBC lysis ends in massive amount of cellular debris that occludes blood vessels & causes ischemia/negrosis
S/S: sudden low back/chest pain - Type III Reaction
-
patient is sensitized w/an initial exposure to antigen & on subsequent exposure the reaction occurs
reaction localized & evolves over several hours
- serum sickness - serum sickness
-
involves formation of antigen-antibody complexes within blood vessels as antigen is absorbed through vessel wall
in past, occurred after innocculation of equine antiserum for tetanus, diphtheria, etc.
now seen occasionally after administration of w/penicillin & sulfonamide
S/S: severe urticaria - angioedema - fever - malaise - arthralgia - Type IV Reaction
-
AKA delayed reaction
occurs when sensitized T lymphocyte comes in contact w/particular antigen to which it's sensitized
- contact dermatitis
- transplant rejection - contact dermatitis
-
substance or chemical comes in contact w/skin
it's absorbed into skin & binds w/haptens (skin proteins)
T memory cells formed in 7-10 days
S/S: area of contact becomes reddened - fragile vesicles - secondary infections possible - transplant rejection
-
any transplanted living tissue seen as foreign material by immune system
with lymphocytes sensitized during induction phase immediately after tissue transplant
sensitized lymphocytes invade transplanted tissue & destroy it via release of chemicals & macrophage activity
S/S: depends on tissue & severity of reaction - s/s reflect failure of organ or tissue - autoimmune disorders
-
immune system no longer recognizes body's normal cells as self & not foreign
instead the antigens on normal body cells are recognized as foregin & an immune response to destroy them is launched - pernicious anemia
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antibodies against gastric parietal cells & intrinsic factor lead to destruction of cells & decrease secretion & function of intrinsic factor
intrinsic factor needed for vit B12 absorption in small bowel so deficiency results in decreased number of RBCs
S/S: mild fatigue - pallor - severe hypotension - dyspnea - palpitations - jaundice - Hashimoto's thyroiditis
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autoantibodies for TSH form but, instead of inactivating TSH, they bind w/hormone receptors on thyroid & cause hyperthyroidism
thryoid infiltrated w/lymphocytes & phagocytes causing inflammation
different autoantibodies appear & destroy thyroid cells resulting in hypothyroidism
S/S: HYPER - restlessness - tremors - diarrhea - heat intolerance - weight loss HYPO - fatigue - bradycardia - hypotension - dyspnea - constipation - weight gain - slowing mental process - ankylosing spondylitis
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AKA rheumatoid spondylitis
chronic progressive inflammatory disease of sacroiliac, costovertebral, & large peripheral joints
begins in lower back & progresses upward
histocompatibility antigen (antigen that identifies self), human leukocyte antigen (HLA) B27, formed that stimulates immune response
S/S: lower back stiffness & pain (worse in a.m.) - back muscle spasms - curvature of lower back flattens (lordosis) - curvature of upper back increases (kyphosis) - immune deficiencies
- occur when one or more components of immune system are either completely absent or deficient in quantities sufficient to elicit or sustain an adequate immune response to combat an infectious agent
- hypogammaglobulinemia
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absence/deficiency of one or more of five classes of immunoglobulins (IgG, IgM, IgA, IgD, & IgE) from defective B-cell function
leaves patient prone to infections
S/S: infant asymptomatic up to 6 months when maternal immunoglobulins are gone
many recurrent infections begin (especially Staph & Strep) -
The nurse is contributing to the plan of care for a patient with allergic rhinitis. Which of the following interventions should the nurse anticipate will be included in the treatment plan?
a. Epinephrine
b. Gold salts
c. Anticholinergic me - d. Avoiding environmental stimuli
- A patient who has an allergy to penicillin is receiving preoperative meds, which include ranitidine (Zantac), metoclopramide (Reglan), and cefazolin (Ancef) intravenously. Fifteen minutes after the cefazolini is started, the pt reports an uneasy feeling,
- b. Anaphylaxis
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The nurse is contributing to the plan of care for a pt w/ankylosing spondylitis. Which of the following interventions would be appropriate for the nurse to suggest?
a. Avoid massage
b. Use interferon injections
c. Avoid one position for pr - c. Avoid one position for prolonged periods
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The nurse is contributing to the plan of care for a pt w/an immune system deficiency. Which of the following complications should the nurse consider is most likely to occur when recommending prevention interventions?
a. Overwhelming infection
b - a. Overwhelming infection
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A pt is admitted w/an autoimmune disease & asks the nurse what autoimmune means. which of the following would be the appropriate response by the nurse?
a. "Immune cells produce too many antibodies."
b. "Immune cells grow and - d. "Immune cells are unable to distinguish between 'self' and 'not self'."
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Inflammation of the tongue.
SLITSISGO - GLOSSITIS
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Medication that counteracts the action of histamine
MANESHIITTAIN - ANTIHISTAMINES
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Another term for hives.
URICTARAI - URTICARIA
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The first drug of choice in anaphylaxis.
PEPNINEHIRE - EPINEPHRINE
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Medications to reduce inflammation.
DOICSSTORTOICER - CORTICOSTEROIDS
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Complication of atopic dermatitis.
IFNETCOIN - INFECTION
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Types of medications used to prevent transplant rejection.
IMPRESSIONUSUMPNO - IMMUNOSUPPRESSION
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A defect in the production of the plasma cells occurs in pernicious anemia.
TRUE or FALSE -
FALSE
A defect in the production of the RED BLOOD CELLS occurs in pernicious anemia. -
A common cause for contact dermatitis is poison ivy.
TRUE or FALSE - TRUE
-
Allergic shiners are the dark circles under the eyes of a patient who has allergic rhinitis.
TRUE or FALSE - TRUE
-
IgM triggers mast cells to burst and release their contents of histamine.
TRUE or FALSE -
FALSE
IgE triggers mast cells to burst and release their contents of histamine. -
With anaphylactic reactions, there is usually a previous exposure to the antigen.
TRUE or FALSE - TRUE