Hi, my name is Jill Beavers-Kirby and
today we’re going to be talking about
Unexpected Results to Therapies. So, what
are some common unexpected results to
therapy? Probably one of the most common
result you’re going to see is an allergy, or
hemorrhage, which is bleeding, or increased intracranial
pressure in certain settings. So first we’ll
talk about allergies. An allergy is simply
an immune response by the body to a
substance. An allergy can come from
environmental or from medications, and
you’re more likely to develop an allergy
after repeated exposures to something.
Don’t confuse a medication allergy with
an adverse reaction. So if a patient
tells you, “I’m allergic to Aspirin. It causes
my stomach to be upset.” That’s not
an allergy, that’s an adverse reaction. If
someone says, “I’m allergic to Aspirin.
It causes my throat to swell shut.” That’s a
true allergy. So what is the pathology of
an allergy? So there's actually four
different types of allergies that we’re
going to review. A Type I Allergy is the
most serious. So remember, Type I, “Yay
you’re number one,” is the most serious.
So this is when an allergen triggers mast
cells and basophils, these are part of your white
blood cells that run around in your body.
They bind to IgE, which is an
immunoglobulin found in your body.
This causes histamine, prostaglandin and
platelet activating factors to be
released. So basically that means that
your circulatory system vasodilates or
certain areas of the body will
vasoconstrict, such as the throat.
An example of a Type I Allergy in a small release
is allergic rhinitis. So, “Ach-oo!” Allergic
rhinitis. Or anaphylaxis, which is on the
other end of the Type I Allergy response.
This is when a lot of histamine
is released, a lot of
prostaglandins are released. Anaphylaxis can be life
threatening. These types of allergies you'll usually
see develop acutely, within an hour.
A Type II Allergy is the result of the
release of natural killer cells, also called
NK cells. This leads to tissue and
cell damage. So you’ll see this in
certain disease types, such as
Hashimoto’s thyroiditis. This affects the
thyroid gland. Or somebody who has Coomb’s
positive hemolytic anemia, that’s when
your body breaks down red blood cells
at a very fast rate. Or when somebody gets
an organ transplant like a liver,
and the body will acutely reject that liver.
That is also a type of allergy.
So remember, an allergy is a body’s response to
something. A Type III Allergy deals
with the complement system, leads to a certain
release of some types of immune cells.
You’ll see this with autoimmune disorders
such as systemic lupus or in
rheumatoid arthritis. Even though they’re
autoimmune, they are considered an
allergy, because remember, an allergy is the
body’s response to something.
And then, probably most common is the Type
IV Allergy. This is hypersensitivity
to a T-cell mediated response. T-cells come
from the thymus gland. So, you’ll
see these type of allergies, poison ivy,
contact dermatitis, poison oak, or
that’s the true medication allergies.
So what are symptoms of an allergy?
Hopefully you haven’t had to experience
these, but if you are, you do know what
I’m talking about. Red watery eyes. Throat
tightening. You might get a rash or ‘hives’,
which are small, red, itchy wheals that
can occur all over the body. Even eczema
that goes back to that type of autoimmune
type of response. Another type of
unexpected result to therapy is hemorrhage.
This is simply profuse
bleeding. It can occur with injury, trauma,
surgeries, pregnancies. Even some
medications, if they’re given in the
wrong amounts, can cause hemorrhage.
Nursing actions. One, stop the bleeding.
You might have to do this with manual
pressure, or sometimes you might have to
give an antidote. For example, if it’s
Coumadin, you might have an
antidote Vitamin K or fresh frozen
plasma to the patient to
stop the bleeding.
You have to notify the physician and
provide supportive care, which might
include blood transfusions or fluid
resuscitation. Increased intracranial
pressure is usually seen in the intensive
care setting, and is usually a
result of traumas such as car accidents
or seizures. This is simply a rise in the
pressure in the brain.
If you think that the skull is an enclosed
cavity and the brain if it
needs to swell, it doesn’t have anywhere to
go. So this causes an increase build-up
in the pressure inside the brain. As I
said, this can occur from trauma such as
a car accident, or disease such as
seizures. So what are symptoms of
increased intracranial pressure? The patient
might have mental status change.
Anything that’s going to affect the
brain functioning. So they might become
drowsy, they might lose consciousness, or
they might kind of wake up and go to
sleep, wake up and go to sleep. They might
have a really, really bad headache.
They can have additional seizures, and sometimes they can even throw up.
This is from the pressure that's put on the brain.
Nursing actions. Increased ICP can be life threatening,
so you'd want to notify the
physician right away, monitor the physical
exam changes, provide supportive care.
And the physician will come up with a way to
reduce the pressure. This is sometimes a
surgical intervention, or simply some
types of medications can also reduce
these pressures. Thank you! This has been Jill Beavers-Kirby
discussing Unexpected Results to Therapies.