Hypersensitivity Reaction

HYPERSENSITIVITY REACTION

This study will let us explore the factors that will contribute on the incidence of  Hypersensitivity Reaction. We have chosen this case to make us future nurses aware of the risk factors, management, and treatment of this disease. This study will help us in caring for patients with Hypersensitivity reaction,of course our nursing management will depend on our level of knowledge on this kind of disease.

PATIENT’S PROFILE Name: Mrs. CAP Address: Laguna Age: 83 yrs old Status: Widow Religion: Catholic Attending Physician: Dr Azcarate Chief Complain: Cough, High

BP Admitting Diagnosis: HPN St II,

CAP

HISTORY OF PRESENT ILLNESS: 3 days prior to admission

(+)cough (-) Fever Few hours prior to admission

(+) Headache, (+) cough, (+) Shortness of Breath

Final Diagnosis:Hypersensitivity reactionDislipidemia

PHYSICAL ASSESSMENT

Area to assess findings

Integument:Skin HairNails

-skin is -some hair are black and some are white-with white complexion-nails are properly kept

Head:Skull and face Eyes and visionEars and hearingsNose and sinusesMouth and oropharynx

-symmetrical in shape-pupils are equally round and reactive to light-symmetrical,-no inflammation and secretions.-moisted

Neck:Neck musclesLymph nodes of the neck

-smooth in movement with no discomfort-(-) palpable lymph nodes

Thorax and lungs :Chest shape and size

-chest symmetric- (+) cough (non productive on the first day)-(+) cough (productive on the second and succeeding days)-(+) crackles in the left lower lobe during the second day

Breast and axillae:Breast size, symmetry and contour or shape

-symmetrical

Abdomen :Abdominal contour, symmetry

-flat in appearance

Neurologic:Mental status

-conscious and coherent

GORDON’S FUNCTIONAL ASSESMENT

1. HEALTH PERCEPTION-HEALTH MANAGEMENT PATTERN Based on the patient, she is aware on

her current condition. And she is also aware in the ways to make her healthy

She also said that when there is something wrong with her, she immediately go to seek medical consultation

2. NUTRITION-METABOLIC PATTERN The patient said that she follows

strict diet to be healthy. She stated that she usually eats 3 times a day and with snacks. She also stated that she usually eats fish vegetables and fruits.

3. ELIMINATION PATTERN She stated that she voids 5-8 times a

day. And she defecates everyday. She also stated that she doesn’t have any difficulty in defecating

4. SLEEP AND REST PATTERN She verbalized that she usually

sleep late at night because she is watching news at the television. And usually wakes up early because she need to manage her meat store.

5. ACTIVITY AND EXERCISE PATTERN The pt verbalizes that she is walking

and jogging as form of her exercise.

6. COGNITIVE AND PERCEPTAL PATTERN The patient stated that she doen’t have

any difficulty in hearing, tasting, sensing, and vision. She is conscoius and coherent, oriented to person, time, and place.

7. ROLE RELATIONSHIP PATTERN The patient stated that she have 12

children 7 sons and 5 daughters. She stated that her husband died in the year 1995. She also stated that she live only with her dogs and cats but her sons and daughter live only near in her house.

8. COPING AND STRESS PATTERN The patient stated that she usually

solves the problemright away to prevent it from getting bigger.

9. VALUE AND BELIEF PATTERN The patient stated that she is a catholic

and usually goes to mass every Sunday and when she have free time.

DIAGNOSTIC TEST

Name of test: Glucose, Lipid Profile

Glucose 84 mg/dL 78-106

Cholesterol 250 97-201

Triglycerides 80 0-150

Direct HDLC 64 40-60

VLDL 16 0-35

LDL 169 160

Chol/ dHDL 3.89

Name of test: Complete Blood Count

WBC 5.89 4-10 10^3U/L

Hgb 145 140-180 g/L

Hct .44 .42-.54

Plt Adequate 150-450 10^3U/L

Neut .60 .5-.7

Lymph .26 .2-.4

Mono .11 0-.14

Baso .00 01-.03

Eo .03 0-.01

Name of test: CreatinineCrea .7 .7-1.2

Chest X-ray- Fibrotic koch’s residuals, both apices

ANATOMY AND PHYSIOLOGY

IMMUNE SYSTEM The immune system is the body's defense

against infectious organisms and other invaders. Through a series of steps called the immune response, the immune system attacks organisms and substances that invade body systems and cause disease.

The immune system is made up of a network of cells, tissues, and organs that work together to protect the body.

The cells involved are white blood cells, or leukocytes, which come in two basic types that combine to seek out and destroy disease-causing organisms or substances.

LEUKOCYTES are produced or stored in many locations in

the body, including the thymus, spleen, and bone marrow. For this reason, they're called the lymphoid organs.

There are also clumps of lymphoid tissue throughout the body, primarily as lymph nodes, that house the leukocytes.

circulate through the body between the organs and nodes via lymphatic vessels and blood vessels. In this way, the immune system works in a coordinated manner to monitor the body for germs or substances that might cause problems.

THE BASIC TYPES OF LEUKOCYTES ARE: Neutrophil- main target: Bacteria,

Fungi Eosinophil- main target: larger

parasites, modulate allergic inflammatory responses

Basophil- main target: release histamine for inflammatory responses

Monocyte- ingest foreign or dangerous substances and present antigens to other cells of the immune system

Macrophage- they act as garbage collectors, antigen presenting cells, or ferocious killers depending on the signals they receive.

Dendritic cells- Main function is as an antigen-presenting cell (APC) that activates T lymphocytes.

lymphocytes, cells that allow the body to remember and recognize previous invaders and help the body destroy themB lymphocytes are like the body's military

intelligence system, seeking out their targets and sending defenses to lock onto them.

T cells are like the soldiers, destroying the invaders that the intelligence system has identified.

PATHOPHYSIOLOGY

HYPERSENSITIVITY REACTION

refers to excessive, undesirable (damaging, discomfort-producing and sometimes fatal) reactions produced by the normal immune system.

require a pre-sensitized (immune) state of the host.

can be divided into four types: type I, type II, type III and type IV, based on the mechanisms involved.

HYPERSENSITIVITY REACTION

Type I reactions (ie, immediate hypersensitivity reactions) involve immunoglobulin E (IgE)–mediated release of histamine and other mediators from mast cells and basophils.

Type II reactions (ie, cytotoxic hypersensitivity reactions) involve immunoglobulin G or immunoglobulin M antibodies bound to cell surface antigens, with subsequent complement fixation.

Type III reactions (ie, immune-complex reactions) involve circulating antigen-antibody immune complexes that deposit in postcapillary venules, with subsequent complement fixation.

Type IV reactions (ie, delayed hypersensitivity reactions, cell-mediated immunity) are mediated by T cells rather than by antibodies.

HYPERSENSITIVITY REACTION Causes

FoodsHymenopteraAnaphylactoid reactionsDrugsAllergens

DRUG STUDY

Brand Name Indication Special Precaution

Contraindication Adverse Reaction

Nursing Responsibility

Amoclav Lower resp tract infections, otitis media, sinusitis, skin & soft tissue infections, UTI, pre & post-surgical procedures, bone & joint, O & G infections, dental infections.

Superinfections involving Pseudomonas or candida. Pregnancy & lactation

History of penicillin hypersensitivity

Diarrhea, nausea, skin rashes & urticaria, vaginitis, abdominal discomfort, flatulence & headache.

-Check for sensitivity to the drug-Must be taken with full stomach-Monitor V/s-Check Liver and Kindey function

Generic Name

Co Amoxiclav

Classification

Penicillins

Brand Name Indication Special Precaution

Contraindication Adverse Reaction

Nursing Responsibility

Clariget Treatment of upper & lower resp tract infections, acute otitis media & skin & soft tissue infections.

Impaired hepatic function & moderate to severe renal impairment.

Concomitant therapy w/ terfenadine in patients w/ preexisting cardiac abnormalities or electrolyte disturbances. Pregnancy & lactation.

Nausea, dyspepsia, abdominal pain, vomiting & diarrhea. Headache, taste perversion, transient elevation of liver enzymes.

-Check for sensitivity to the drug-Must be taken with full stomach-Monitor V/s-Check Liver and Kindey function-Advise pt to increase fluid intake

Generic Name

Clarithtromycin

Classification

Macrolides

Brand Name Indication Special Precaution

Contraindication

Adverse Reaction

Nursing Responsibility

Catapres Tab/Amp Hypertension of any etiology, except the pheochromocytoma form.

Diseases affecting rhythmic & AV conduction system of the heart; renal failure. Impairment of ability to drive or operate machinery. Sudden discontinuance.

Sick sinus syndrome.

Dizziness, headache, paraesthesia, sedation, fatigue, malaise,

-Check BP before and after administration-Advise patient to have bed rest-Instruct patient to avoid activities-Advise pt to increase fluid intake

Generic Name

Clonidine HCl

Classification

Antihypertensive

Brand Name Indication Special Precaution Contraindication Adverse Reaction Nursing Responsibility

Pulmonary & extrapulmonary TB. Leprosy in association w/ other antileprotic agents.

Alcoholics. Impaired liver function.

Hypersensitivity. Jaundice.

Flu-like syndrome; hematopoietic reactions; cutaneous, GI & hepatic reactions; shortness of breath; shock & renal failure. Hypersensitivity reactions.

-Teach the client to take orally on an empty stomach 1hr before meals or 2 hours after meals-Teach the client to eliminate the use of alcohol to reduce the risk of hepatotoxicity-Tell to the patient that there will be discoloration of the body fluids-Instruct patient to comply with the treatment-Advise pt to increase fluid intake

Generic Name

Rifampicin

Classification

Anti-TB agents

Brand Name Indication Special Precaution

Contraindication

Adverse Reaction

Nursing Responsibility

Maintenance phase treatment of all forms of pulmonary & extrapulmonary TB.

Liver dysfunction. Periodic ophth exam w/ INH. Pregnancy & lactation.

Hypersensitivity to rifamycins or to INH. Previous INH-associated hepatic injury or other severe adverse reactions to INH eg, drug fever, chills, arthritis & acute liver disease of any etiology.

Disturbances of hepatic function; convulsions, optic neuritis & atrophy, memory impairment & toxic psychosis.

-Teach the client to take orally on an empty stomach 1hr before meals or 2 hours after meals-Teach the client to eliminate the use of alcohol to reduce the risk of hepatotoxicity-Instruct patient to comply with the treatment-Advise pt to increase fluid intake

Generic Name

Isoniazid

Classification

Anti TB agents

Brand Name Indication Special Precaution Contraindication Adverse Reaction Nursing Responsibility

Tuberculosis. Impaired pre-treatment visual acuity, elderly, children. Perform liver, kidney and visual acuity tests regularly. Caution when assessing visual acuity in patients with cataracts, DM, recurrent eye inflammation to make sure that changes are not due to the underlying causes.

Hypersensitivity; optic neuritis. Lactation.

Retrobulbar neuritis with a reduction in visual acuity, constriction of visual field, central or peripheral scotoma and green-red colour blindness nausea, vomiting, abdominal pain, anorexia; rash, headache, dizziness, confusion, hallucinations, malaise, jaundice; thrombocytopenia; pulmonary infiltrates.

-Instruct patient to comply with the treatment-Advise pt to increase fluid intake-Advise the pt to report any adverse reaction-Advise pt to report any visual disturbances

Generic Name

Ethambutol

Classification

Anti TB agents

Brand Name Indication Special Precaution

Contraindication

Adverse Reaction

Nursing Responsibility

MobicRA, painful osteoarthritis, ankylosing spondylitis & similar conditions requiring anti-inflammatory treatment.

History of GI disease, dehydration, CHF, liver cirrhosis, nephrotic syndrome, overt renal disease, recent major surgical procedures. W/draw if peptic ulceration or GI bleeding occurs. Concomitant anticoagulant or diuretic treatment. Elderly.

Active peptic ulceration, overt GI bleeding; recent cerebrovascular bleeding or other bleeding disorders; severe uncontrolled heart failure; severe hepatic insufficiency

Dyspepsia, nausea, vomiting, abdominal pain, constipation, flatulence, diarrhoea, anaemia, pruritus, rash, lightheadedness, headache, oedema.

-Must be taken w8 full stomach

-Increase fluid intake

-Assess for level of pain before and after administration

-Advise patient to have bed rest

-Check for blood test result

Generic Name

Meloxicam

Classification

NSAID

Brand Name Indication Special Precaution

Contraindication

Adverse Reaction

Nursing Responsibility

AvastatTreatment of hypercholesterolemias particularly in Type IIa & IIb hyperlipoproteinemias. Prophylactic in hypercholesterolemic patients w/ ischemic heart disease.

Liver function should be assessed prior to initial treatment & should be monitored periodically until 1 yr after the last dosage treatment. Severe renal impairment.

Patients w/ acute liver disease or unexplained persistently raised serum-aminotransferase concentrations. Pregnancy.

GI disturbances. Headache, skin rashes, dizziness, blurred vision, insomnia & dysgeusia. Hypersensitivity syndrome (manifested by angio-edema), hepatitis, pancreatitis.

-Assess for liver function

-Increase fluid intake

Advise pt to have bed rest

-Advise pt to report any allergic reaction

Generic Name

Simvastatin

Classification

Dyslipidaemic Agents

NURSING CARE PLAN

DAY 1

Assesment Diagnosis Planning Intervention Rationale Evaluation

Subjective: “ Inuubo pa rin

ako pero d na katulad ng dati” as verbalized by the patient

Objective: Recieved lying on

bed conscious and coherent

With IVF of PNSS 1lx 24 hrs hooked @ left basilic vein

No swelling, no pain and no edema in the IVF site

(+) minimal cough (non Productive)

(+) pain during coughing (tolerable)

(-) headache, Dizziness, Shortness of breath

With o2 inhalation of 2 L/min

Discomfort related to cough

After 8 hrs of nursing intervention the pt will experince lesser episodes of cough and more comfortable

Nurse Initiated1. Establish rapport

2. Monitor Vital signs

3. Encourage pt to increase fluid intake

4. Encourage patient to do depp breathing and coughing exercise5. Advise pt to have bed rest

6. Encourage patient to determine and avoid things that will aggreviate the cough7. Monitor for signs of hypoxia

8. Assess the cough for any dischargesDoctor Initiated1. Reglate IVF2. Administer Medications

1. To gain the trust and cooperation of the patient2. To establish baseline data and to monitor current status of the pt3. To maintain fluid balance and to replace the insensible fluid loss4. to promote lung activity

5. To regain strength of the pt and to decrease the O2 demand6. To lessen the episodes of cough

7. cough can decrease the O2 supply of the patient

After 8 hrs of nursing intervention the pt was able to experince lesser episodes of cough and more comfortable

DAY 2

Assesment Diagnosis Planning Intervention Rationale Evaluation

Subjective: “ Inuubo pa rin

ako at may nalabas na plema” as verbalized by the patient

Objective: Recieved lying on

bed conscious and coherent

With IVF of PNSS 1lx 24 hrs hooked @ left basilic vein

No swelling, no pain and no edema in the IVF site

(+) minimal cough (Productive, clear)

(+) pain during coughing (tolerable)

(-) headache, Dizziness, Shortness of breath

(+) crackles left lower lobe of the lungs

With o2 inhalation of 2 L/min

Ineffective airway clearance related to retain secretions

After 8 hrs of nursing intervention the pt will able to expectorate secretion, demonstrate intervention such as deep breathing exercise and will maintain patent airways

Nurse Initiated1. Establish rapport2. Monitor Vital signs3. Encourage pt to increase fluid intake4. Encourage patient to do deep breathing and coughing exercise5. Advise pt to have bed rest6. Monitor for signs of hypoxia7. Assess the cough for any dischargesDoctor Initiated1. Reglate IVF2. Administer Medications

1. To gain the trust and cooperation of the patient2. To establish baseline data and to monitor current status of the pt3. To maintain fluid balance , to replace the insensible fluid loss and to liquefy secretions4. to promote lung activity5. To regain strength of the pt and to decrease the O2 demand6. cough can decrease the O2 supply of the patient

After 8 hrs of nursing intervention the pt was able to expectorate secretion, demonstrate intervention such as deep breathing exercise and will maintain patent airways

DISCHARGE PLANNING

Instruct the patient to comply with the treatmet regimen

Advise the patient to increase fluid intake

Advise the patient to have plenty of rest and eat balanced meal

Advise the patient to avoid crowded places

Advise the persons who have been exposedd to the patient to recieve tuberculin test and/ or chest x-ray

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