Question

You are caring for a patient experiencing a Type I allergic reaction.

• Based on the pathophysiology of this disease, what clinical manifestations would you expect?
• Correlate three nursing interventions with the chosen diagnosis.

Answer 1

Type 1 reaction 9i.e - immediate hypersensitivity reaction ) involve immunoglobin E ( IgE ) - mediated release of histamine and other mediators from the mast cells and basophils for example includes ;- anaphylaxis

PATHOPHYSIOLOGY

Allergens ( or antigens ) are presented to T- cells by Antigen presenting cells (APCs) during the sensitization phase of Type I hypersensitivity .T - cells then signal for stimulation of B- cells to produce IgE antibodies , which bind to the Fc receptors on themast cells ans basophils .Subsequently , the   free antigen induces the crosslinking of these mast cell and basophil bound IgE antibodies .This results in the degranulation of teh cells and the release of histamine , proteolytic enzymes and other mediators (i.e , prostaglandin , cytokines , leukotrienes , platelet - activating factors , macrophage inflammatory proteins , trypatase , etc ) As a result thers is increased vascular permeability , peripheral vasodilation and smooth muscle contraction which can manifest to increased mucous secretions , bronchospasm , abdominal cramping , rhinitis and potentially hypovolemia or hypoxia .Pulmonary edema or general edema can also occur due to fluid shifting into interstitial space . individual can experience pruritis and local response of asthma or a systemic response of anaphylaxis .

CLINICAL MANIFESTATION

Pruritis concentrated around the head , neck and ears or it may involve other areas suchas the ventral abdomen , caudal thigh, forelegs or lateral thorax .

Urticaria (hives)

Angioedema is similar to urticaria but involves the deeper subcutaneous tissues around teh head and extrimities , without producing pain or pruritis .

possible inspiratory stridor from laryngeal edemal

Localized or generalized subdermal wheals

salivation

hypotensive shock

tachypnea

vomiting , diarrhea

dizziness and lead to fainting

collapse andd even death

NURSING INTERVENTION

Monitor client's airway ;- assess the client for the sensation of a narrowed airway

Monitor the   oxygenation status ;- Monitor oxygen saturation and arterial blood gas values

Focus breathing ;- Instruct the client to breathe slowly and deeply

Positioning ;- position the client upright as this position provides oxygenation by promoting maximum chest expansion and is the position of choice during respiratory distress.

Activity ;- Encourage adequate rest and limit activities to within client's tolerance

Hemodynamic parameters ;- Monitor the client's central venous pressure (CVP) , pulmonary artery diastolic pressure (PADP) and pulmonary capillary wedge pressure and cardiac output / cardiac index .

Monitor urine output;- The renal system compensates for low blood pressure by retaining water , and oliguria is a classic sign of inadequate renal perfusion .