CHA 2 Exam 1 Questions and Answers

CHA 2 Exam 1 Questions and Answers What is another name for a type 1 hypersensitivity reaction? Atopic Allergy What is the most common hypersensitivity reaction? Type 1 During a type I hypersensitivity reaction, what antibodies are released? IgE What do IgE antibodies release? Histamine & other vasoactive agents How can allergens be taken in to the body? Inhaled, ingested, injected Patients with allergies to shellfish may also react to? Propodone Iodine Patients with allergies to avocados, bananas, strawberries, and other topical fruit may also be allergic to? Latex Patients with allergies to egg, soy, or peanut may also be allergic to? Propofol Patients with an allergy to penicillin may also be allergic to? Bee venom What is the difference between the 1st and 2nd allergic response exposure? 2nd exposure has a primary AND secondary phase What is the most common vasoactive amine? Histamine (short acting biochemical) Where is angioedema most common during a dermatologic reaction? Lips, face, tongue, larynx, and neck During what type of reaction does angioedema occur? Severe type I hypersensitivity reaction What are signs and symptoms of intestinal angioedema? Severe pain, cramping, nausea, vomiting What are the most common meds to cause an angioedema reaction? ACE inhibitors and NSAIDs When are patients most at risk for an allergic reaction with ACE inhibitors? 1st 24hrs after 1st dose (but it can happen later) Angioedema s/s? Possible laryngeal edema. Deep firm swelling of the eyes, face, lips, tongue, and neck. Difficulty speaking or drinking. Distortion of the face. Swollen nasal passages. Hives. What s/s of angioedema require immediate intervention? Strider, unable to swallow, lump in their throat (give O2, steroids, etc.) How quickly does anaphylaxis occur? Seconds to minutes What is the #1 reason patients die during an anaphylactic reaction? Delay of Epinephrine S/S of anaphylaxis? Feeling of apprehension, anxiety, swollen tongue, hives, feeling of doom, overall weakness, congestion, rhinorrhea, dyspnea, increased respiratory distress with wheezing and stridor, hypotension What is actively working in the body during an anaphylactic reaction? Histamine and other mediators What is the nurse's priority during an anaphylactic reaction? Assess & stabilize (be ready to incubate or perform emergency tracheotomy) What meds are used to treat an anaphylactic reaction? Epi & corticosteroids What is rhinosinusitis? Hay fever (reaction or airborne allergens) What part of the body does rhinosinusitis impact? Superficial layers What are s/s of hay fever? Pain over cheek/teeth, tender sinuses, referred pain to temple or back of head, general facial pain What treatment options are available for allergies? Allergy medications, epi, desensitization with allergy shots What is an allergy shot? A small amount of the allergen is injected on a regular basis to desensitize the patient What diagnostic procedures are used for type I hypersensitivity reactions? CBC w/differential, RAAS, sputum/nasal/bronchial samples, PFT, skin test (intradermal) What is type 2 hypersensitivity? cytotoxic What is occurring in a type 2 hypersensitivity reaction? The body is making antibodies directed against self-cells with foreign proteins attached. Complement is activated and self cells are destroyed. What do nurses need to do first during a cytotoxic reaction? D/c the offending drug or blood product What are examples of a type II hypersensitivity reaction? Immune hemolytic paperia, hemolytic transfusion reaction (wrong blood type), drug induced hemolytic anemia, and erythroblastosis fetalis (incompatible Rh between mom & baby) What is a type III hypersensitivity reaction? immune complex reaction What happens on a cellular level in the body during a type III hypersensitivity reaction? Excess antigens cause immune complexes that damage tissues and vessels Autoimmune disorders are what type of hypersensitivity? Type III (immune complex) What are examples of type III hypersensitivities? Rheumatoid arthritis, serum sickness, vasculitis, system lupus erythmatosus What type of reaction is a type IV hypersensitivity reaction? Delayed reaction aka cell mediated immune response What cells are working in a type IV hypersensitivity reaction? T cells are reactive (sensitive from previous exposure) When does a type IV hypersensitivity reaction occur? Hours to days after exposure What are s/s of a type IV hypersensitivity reaction? Edema, induration, ischemia, tissue damage to the site What are examples of type IV hypersensitivity reactions? PPD test for TB, contact dermatitis, poison ivy, skin rashes, local response to insect sting, tissue transplant rejections, and sarcoidosis How long do type IV hypersensitivity reactions usually last for? 5-7 days What can you do to treat/prevent type IV hypersensitivity reactions? Corticosteroids and avoid the source of the reaction What should you immediately do as a nurse if your patient is showing signs of an allergic reaction? Call a rapid response If a patient is having an allergic reaction to an IV drug or solution what should you do? D/C the solution AND tubing and hang a bag of normal saline with NEW tubing (if patient doesn't have an IV, start one) What is the most common AIDS related malignancy? Kaposi's sarcoma What is the risk with kaposi's sarcoma and AIDS? Risk is related to do-infection with herpes S/s of Kaposi's sarcoma? Small purplish/brown raised lesions on skin and mucous membranes (usually not painful or itchy. May also see lesions in lymph nodes, mouth, throat, intestinal tract, and lungs) How do you diagnose kaposi's sarcoma? Biopsy of a lesion What is important about mucositis and AIDS? Sores occur in mucous membranes especially the mouth and GI tract (check mouth regularly for sores) What can help prevent mucositis? Cryotherapy (ice water or chips) What medications work against opportunistic infections in HIV? Antiretroviral Do antiretrovirals kill the infections? No, they only inhibit viral replication Why is mono-therapy dangerous for patients with HIV? It promotes drug resistance What therapy is standard for HIV/AIDS? Combination antiretroviral therapy (cART) What is important to teach about cART therapy? Patients must take it 90% of the time & as prescribed Is it possible to determine if an HIV strain has developed drug resistance? Yes What happens when a strain of HIV becomes resistant to a specific drug? Once resistant it's stored forever (archived) What are examples of cART drug therapy? -Nucleotide Reverse Transcriptase Inhibitors (NRTIs) -Abacavir (Ziagen) -Didanoise (Videx EC) -Emtricitabine (Emtriva) -Lamivudine (Epivir) -Stavudine (Zerit) -Tenofovir (Viread) -Zidovudine (Retrovir) (Review chart 19-6) What is candidiasis? Thrush (yeast infection) What nursing implications should be implemented for HIV patients with candidiasis? Check mouth for sores to prevent opportunistic infections