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Hypersensitivity

y abnormal heightened reaction to a stimulus of any

kindy a state of altered reactivity in which the body reacts

with an exaggerated immune response to what isperceived as a foreign substance.

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Assessment

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. Health History

CONFIDENTIAL MEDICAL INFORMATION/FAX COMPLETED FORM TO 647-4768 FOR EVALUATION

The University of Michigan Occupational Health and Safety ProgramFor Personnel Working with AnimalsRisk Assessment Form and Health Surveillance QuestionnaireFirst Name: _____________________ MI: ______ Last Name: _________________________________Gender: M F D.O.B.: ___/___/___ Social Security # _____/____/_________Primary Language: Email:Home Address: Home phone: / /

City: State: Zip:

Student Temporary Faculty Staff Primary Investigator:Projected Duration of project/duties involving animals:Non-Human Primate Contact1) Requires TB testing at MWorks Occupational Health Clinic.

Contact Donna Capron @ dcapron@umich.edu if you need more information.2) Requires proof of immunity for RUBEOLA (Measles):

- Live-virus vaccine dates. First Second(First dose received after first birthday and second dose at least one month later.)

- Laboratory evidence of immunity date.- Adult born before 1957 can be considered immune.

What other species of animals will you be exposed to?

[This includes direct contact with animals, animal tissues and/or wastes, and animal enclosures.]What kind of contact will you have? [Check all that apply.]Direct contact with animalsDirect contact with non-fixed or non-sterilized animal tissues, fluids, or wastesDirect contact with non-sanitized animal caging or enclosures

Service support to animal equipment, devices, and/or facilities

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Do you have contact with animals outside of work? Yes NoIf yes, please list the species

Allergy HistoryList any allergies to medications:

Do you have any of the following? (Check all that apply)Chronic cough Hay fever Skin rash AsthmaChronic allergies (food, pollens, dust) Allergic rhinitis (runny nose due to allergy)

Allergic conjunctivitis (itchy, watery eye from allergy)A natural parent or sibling with allergies to animals or their substancesAre you allergic to?Dog Cat Farm Animals Bird (feathers) Sheep (wool) PrimatesRabbit Swine Rats or mice Guinea Pigs Alfalfa Weeds

Latex Grasses Trees Wood Chemicals OtherDo you have any of the following symptoms that you feel are caused by, or made worse, because of

your work with laboratory animals? Watery, burning, or itchy eyes Runny nose Sneezing Shortness of breathCough Chest tightness Wheezing Hives RashPlease list any concerns or other information the provider should know:

I verify that all information is accurate and that I have referred to and read all pertinentinformation relatedto the animals that I come in contact with. I have reviewed all of the risk related documentsposted on theOSEH web site that refer to my current work status.Signature: Date:Print Name: Dept: __________________________

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Nursing Responsibilities in diagnostic

evaluation/ tests

y skin testing entails intradermal injection orsuperficial application of solutions.

Three Methods:y Scratch test/prick test

- performed when contact dermatitis is suspected.

- uninvolved skin such as the upper back are used for

testing- skin is superficially scratched/ pricked with anallergen for an immediate reaction. Wheal formationmeans [+] result.

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y NSG. Responsibilities:

- Shave the hair of the area to be tested.

- Resuscitation equipment at bedside or within reach

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Patch testy delayed hypersensitivity reaction develops in 48-96 hrs

y the allergens are applied under occlusive tape patches.

Removed after 2 days after rxn is noted.y NSG. Responsibilities

- Test site must dry, free from moisture and oils.

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Intradermal Testingy Injecting a small amount of antigen into the ID layer of the

skin.

y Most accurate but severe reaction could occur.

y [-] result: ab have not formed to this antigen. Antigen

deposited in the subcutaneous layer. Immunosuppressed.y NSG. Responsibilities:

- Ask for allergic history

- Apply cold compress topical steroids for minor

itchiness.

- Keep injection site clean and dry if ulceration

occurs.

- Prepare O2, epinephrine, antihistamine IV prn as

ordered.

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Food Allergy Testingy a. Food Challenges

- suspected foods are given to the client in

progressively larger doses until reaction occurs.

- manifestation: erythema, itching, rash, vomitingand diarrhea.

y b. Elimination Diet

- foods are eliminated from diet one by one untilthe manifestation are relieved.

- this ma indicate allergies to food additives or the

food themselves

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Nu

rsing Management

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DISEASE /

CLASSIFICATION

CAUSE MODE OF

ENTRY/EXIT

MODE OF

TRANSMISSION

SIGNS AND

SYMPTOMS

NSG MANAGEMENT

ALLERGY (HYPER-SENSITIVITY)1.Anaphylaxis

Antigen-antibodyresponsethatprecipitatethe releaseof

vasoactivesubstances(histaminecausingprofoundvasodilation& increasecapillarypermeability

Respiratory,integumentary,GIT absorbingthe bloodstream

Antigen,allergen,contagious

1.Hypotension tovascular collapse2.Urticaria,diffuseerythema,periorbital edema3.Hoarseness,wheezing

4.Bronchospasmto respiratoryfailure5.Vomiting6.Generalizedburning/itching7.Sense ofimpending doom

1.Impaired gasexchange R/Tbronchoconstriction2.Anxiety r/t difficulty ofbreathing3.Fluid volume deficitr/t increased capillary

permeability4.Decreased cardiacoutput r/t hypovolemia5.Assess clientshx,skin test medicationbefore administration6.Position comfortably7.Maintain adequateventilation & patent

airway.8.Carefully titrate fluidwith v/s9.Monitor carefully asfluid begins to shiftback into the vascularutilization of airwayadjuncts(airways & ET.Intubation)

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DISEASE /

CLASSIFICATION

CAUSE MODE OF

ENTRY/EXT

MODE OF

TRANSMISSION

SIGNS AND

SYMPTOMS

NSG MANAGEMENT

2. TransplantRejection

Graft/organincompatiblewith recipientand recognizedas non-self .

1.Necrosis,inflammation andbleeding at thesite of transplant.2.Unstable V/S inmajor organtransplant.

1.monitoring of V/S,site for inflammation,necrosis and bleeding

3. Contact Dermatitis 1.poison ivyand poison oak2.fabric, wool,polyester

3.cosmetics4.detergents,soap, hair dye5.paints, dyes,

insecticides,rubbercompounds( sskin reaction ,usually a

delayedhypersensitivityreaction )

due to anantigen)

skin Non-communicable

1.pruritusespecially whenexposed under

the sun.2.hive-likepapules &plaques3.edema

4.sharplycircumscribedareas withoccasionalvesicle formation

1.health education toavoid contact withspecific allergen.

2.Provide cool, tepidbath, trim fingernails &utilize measures tocontrol itching3.Avoid irritating the

affected area, removebulky clothing

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4. Hay fever(allergicrhinitis Pollinosis)

Airbornepollens(seasonal)

nose 1.edematousclosed nostrils2.nasal mucous

membranes itch,burn & secrete thinirritating discharge3.sneezing-violentparoxysms4.eyes-red,

burning,lacrimating

1.advise pt to considermoving to an areawhere pollen count is

low, howeverimpractical2.remove irritatingsubstances(pets,stufftoys, feather pillows)3.avoid outside

allergens by remainingindoor as much aspossible, using airconditioning.

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DISEASE /

CLASSIFICATION

CAUSE MODE OF

ENTRY/EXIT

MODE OF

TRANSMISSION

SIGNS AND

SYMPTOMS

NSG MANAGEMENT

6. Bronchial Asthma-a hyperresponsivestate of the bronchi,

which may beantigen-mediated(allergic)

AllergensPrecipitating-

1.streptococcusrespiratory

infection2.intolerance to aspirin,indomethacin3.cold &

suddenbarometricchanges4.exercise

5.emotionalupset6.airpollutants-industrial

chemicals

respiratory Non-communicable

Early episodes:drycough, mild chesttightness

Severe episodes-wheezing,coughing, SOB,

laborious &prolongedexpiration thaninspirationDyspnea becomesapparent,

inspiratorywheezing & use ofaccessorymuscles(bronchos

pasm)Weak pulse,sweating, coughbecomesproductive

Anxiety,restlessness &apprehensionFatigues stato mayfollow leading torespiratory failure

with hypercapnia,respiratoryacidosis &

hypoxemia

1.never overusebronchodilators toavoid excessive drying

of tracheo-bronchialtree & cardiacarrhythmias2.elevate head of bed.

3.Regulate temp.&humidity to comfortablelevels4.Increase oral fluid5.Chest physiotherapy

6.Act calmly, reassurept during attack7.Stay with pt untilattack subsides.8.Avoid crowds &

sources of infections.9.Reduce number ofallergens @home(dust, pets,

plants, etc.)10.Promote goodnutrition adequate rest11.Avoid otudoors onhigh humidity days12.Avoid cigarette

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7. Stinging insectallergy

Sting of aninsect is aforeignprotein thatstimulates

immuneresponse,thus

inflammation occurs.

Skin andmucousmembrane

Bite of an insect. 1.Skin rashes2.Macule3.Redness/heat4.Itciness5.Bronchospasm

followed byshortness ofbreath and

cyanosis in severecases.

1.monitor V/S closelyincluding level ofconsciousness2.prepare O2 andintubation set at

bedside3.prepare forvenoclysis.

4.Position patient onmoderate high backrest for airwayclearance.

8. Blood TransfusionReaction

ABO/Rhincompatibility. An

antigen-antibodyreaction.

Blood stream Transfusion 1.generalized skinrashes (flare)2.urticaria

3.heat4.Shortness ofbreath andcyanosis in severecases.

1.same as above2.stop/discontinuetransfusion

immediately.

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Type I ( immediate, Ig E-antibodies involved)

y Person sensitized by prior exposure to a particular antigen.

y When same antigen reappears, it interacts with the IgE whichinitiates mast cell degranulation. The mast cell degranulationactivates the release of chemical mediators, primarilyhistamines.

y Histamine major chemical mediator.y spasm of bronchial muscles.y Capillary vasodilationy Increased capillary permeabilityy Decreased blood pressurey Increased nasal stuffiness and bronchial secretionsy Peak effect in 1 2 minutes and last for about 10 minutesy Disorders associated with Type 1.y Anaphylaxis( most severe)y Atopic reactions ( most common)y allergic rhinitisy urticaria

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Type II ( cytotoxic, IgG and IgM-antibodies involved)

y complementary system is activated causing

cytotoxic effects against the bodys own cells.y The normal process of phagocytosis begins to

damage normal body tissue.

y Disorders associated with Type II.

y hemolytic disease of the newborny myasthenia gravis

y acute graft rejections

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y Type II hypersensitivity Type II hypersensitivity reactions arecaused by antibody-mediated cell damage or lysis. The actualmechanisms underlying cell destruction are multiple:

y (i) complement-dependent red blood cell lysis occurs forexample in haemolytic transfusion reactions (HTR) caused byABO incompatibility and in other forms of haemolyticanemias.

y (ii) antibody-dependent red blood cell degradation occurs,

for example. as the result of binding of antibodies to the redcell membrane which fail to activate complement butpromote macrophage uptake and catabolism. This occurs forexample in the haemolytic disease of the newborn (HDN)caused by Rh incompatibility.

y (iii) antibody-dependent cell-mediated cytotoxicity (ADCC)occurs when cytotoxic antibodies become fixed on the surfaceof cytotoxic T cells and subsequent antigen binding induceperforin-dependent cell lysis of the cell bearing the antigen

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Type III (immune complex, IgG and IgM antibodies

involved)

y circulating immune complexes (antibody/antigen complex) aredeposited in the body tissue.

y When the immune complex is deposited in the body tissue, thecomplement factors may be activated. This causes local tissueinflammation and cell wall damage.

y Categories of immune complex formation

y persistent infections ( streptococcal infections) combined with a poorantibody response may lead to the formation of immune complex thateventually deposits in an affected organ.

y endocarditisy acute glomerulonephritisy serum sickness (injection with foreign serum)

y the body produces antibodies that attack the bodys own cells (autoantibodies)

y rheumatoid arthritisy systemic lupus erythematosusy repeated inhalation of allergens causes immune complex formation to

be deposited in the lungs and on other body surfaces.

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Type IV ( cell mediated , delayed

hypersensitivity)

y The T-cells are sensitized to an antigen from aprevious exposure.

y The sensitized T-cells initiate the inflammatoryresponse leading to cellular damage and damage tothe surrounding tissue.

y Disorders associated with Type IV.y tuberculosisy contact dermatitisy graft vs hosty transplant rejection

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Nursing Management of

patients with Rheumatic

Disorders

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Rheumatic Disease

y - is a group of conditions where there is damage

caused to thejoints of the body. Arthritis is the leadingcause of disability in people over the age of 55.

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Diffuse Connective Tissue DiseasesyA chronic syndrome characterized by nonspecific,

usually symmetric inflammation of the peripheral

joints, potentially resulting in progressive destructionof articular and periarticular structures; generalizedmanifestations may also be present

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Degenerative Joint Disease(osteoarthritis)

Spondyloarthopaties

y is a condition in which low-grade inflammationresults in pain in the joints, caused by wearing of

the cartilage that covers and acts as a cushioninside joints. As the bone surfaces become less wellprotected by cartilage, the patient experiences painupon weight bearing, including walking and

standing. Due to decreased movement because ofthe pain, regional muscles mayatrophy, andligaments may become more lax. OA is the mostcommon form ofarthritis

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Fibromyalgiay is a chronic syndrome (constellation ofsigns and

symptoms) characterized by diffuse or specific muscle,joint, or bone pain, fatigue, and a wide range of other

symptoms. It is not contagious, and recent studiessuggest that people with fibromyalgia may begeneticallypredisposed.[1] It affects more females thanmales, with a ratio of 9:1 by ACR (American College ofRheumatology

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Arthritis Associated with Infectious

Organismsy Some inflammation of the joints and tendons is

directly related to infections caused by bacteria, virusor fungi.Bacterial arthritis is the most rapidlydestructive form of infectious arthritis

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Assessment

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Assessment:

y past & present symptomsy fatigue

y weakness

y pain

y stiffnessy fever

y anorexia

y effects to patients lifestyle and self image.

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y Psychological, and mental status and social supportsystems re assessed

y

Ability to participate in daily activitiesy Comply with the treatment regimen and managed

self care.y assess

y patient understandingy motivationy knowledgey coping abilityy past experiencesy

fearsy effects of the disease on the patients self concepty Assist patient in managing stress and lifestyle modification

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Nursing Diagnoses

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y Acute and chronic pain r/t inflammation and increase

disease activity, tissue damage, fatigue or loweredtolerance level.

y Fatigue r/t increased disease activity, pain, inadequatesleep/rest, deconditioning, inadequate nutrition,emotional stress/ depression

y Self care deficit r/t contractures, fatigue, or loss ofmotion

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Planning and Goalsy relief of pain and discomfort

y increase mobility

y

maintenance of self carey effective coping

y absence of complications

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Nursing Interventionsa. Relieving pain and discomforty medications

y weight reduction program

y warm bath

y canes and crutchesy muscle relaxation technique

b. Decrease fatigue

y rest periods

y

napsy gradual progression of activities

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c. Increase mobility

y

proper body positioningy active ROM exercises, if not possible: passive ROM

d. Facilitating self care

- adaptive equipment

e. Monitoring & managing potential complicationsy avoid medication-induced complications

- teach patient with correct administration

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Evaluationy Experiences relief of pain or improved comfort level

y Experiences reduction in fatigue

yImprove sleep pattern

y Increase mobility

y Maintain self care

y Experiences absence of complications

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Thats all for today!