Type I

Question 1

Type I: IgE Mediated - Angioedema

patho

Answer 1

• Hypersensitivity reaction to an allergen
• Involves blood vessels, all layers of skin, mucous membranes, & subcutaneous tissues
• Most common area
  > lips, face, tongue, larynx, neck
• Cause: ingested meds
  > most common ACE-I & NSAID: greatest risk w/in first 24hrs after taking first dose, reaction can occur after days, mnths, & even yrs of therapy

Question 2

Angioedema - Collaborative Care

Answer 2

• Potential for airway obstruction due to mucosal swelling
• Anxiety due to cerebral hypoxia & threat of death

Question 3

Angioedema - Interventions

Answer 3

• Interventions Focus
  > stop reaction and ensuring an adequate airway
  > reverse angioedema before laryngeal edema forms & intubation is needed
• Maintain gas exchange
  > apply O2
• Dcr swelling
  > Epinephrine
  > Corticosteroids
  > Diphenhydramine
• Laryngeal Edema Forms
  > if intubation is not possible; emergency tracheostomy
• Antigen drug still in system; continue meds

Question 4

Type I: IgE Mediated - Anaphylaxis

Answer 4

• Unanticipated severe allergic reaction with rapid onset
• Response dependent on:
  > amnt of allergen
  > amnt of mediator (trigger) released
  > sensitivity of target organ
  > route of entry
• Mild to severe; local or systemic

Question 5

Type I: IgE Mediated - Anaphylaxis

CMs

Answer 5

• Overall edema
• Laryngeal edema
• Hypotension
• Bronchospasm
• Cardiovascular collapse
• Anaphylactic shock

Question 6

Type I: IgE Mediated - Anaphylaxis

causative agents

Answer 6

• Medications
  > antibiotics
  > radiocontrast agents (iodine allergy); most serious
• Foods
• Antitoxins
• Insect stings
• Latex

Question 7

Anaphylaxis Prevention

Answer 7

• Avoidance of potential allergens
• ALWAYS check for allergies/assess risk
• Stay w/ pt when receiving new drugs especially IV antibiotics
• Teach pt use of EpiPen, wear Medical ID bracelet or necklace
• Desensitization therapy
  > body exposure to small injection of allergen, gradually increasing doses to build up immunity

Question 8

Anaphylaxis - Collaborative Management

Answer 8

• Stop drug/change IV tubing/fluid bolus
• Call Rapid Response/Code Cart
• Patent airway/oxygen
  > apply O2 100% NRB, place pt in high fowler’s
  > suction prn/ABGs prn
• Monitor VS/pulse ox
• Medication
  > SQ Epinephrine 1:1000 (0.3-0.5ml) followed by continuous UV
  > Diphenhydramine (Benadryl): blocks histamine
  > Corticosteroids: 2nd line drug
• ICU: monitor for rebound (delayed reaction) 4-8hrs after initial reactions

Question 9

Care & Use of Automative Epinphrine Injectors

Answer 9

• Practice assembly of injection training device
• Keep device with you at all times
• Use device when any symptoms of anaphylaxis is present & call 911
• When needed, inject drug into top & outside of thigh, with needle entering straight down
• Inject drug right through pants; avoid seams/pockets
• After use go to nearest hosp for monitoring (for 4-6hrs)
• Keep 2 drug-filled devices in case more than one dose is needed
• Protect device from light & avoid temp extremes