OM VERMA ASSISTANT PROFESSOR RELIANCE INSTITUTE OF NURSING

1. PRESENTED BY-
OM VERMA
ASSISTANT PROFESSOR
RELIANCE INSTITUTE OF NURSING

2. ALLERGY
Definition :-
1) “An abnormally high sensitivity to certain substances, such as
pollens, foods, or microorganisms. Common indications of allergy may include
sneezing, itching, and skin rashes.”
- www.medicinenet.com
2) “Allergy is an inappropriate & often harmful
response of the immune system to normally harmless substances.These
substances is termed an allergen.”
- Brunner & Suddarth’s
Types :-
The types of Allergic Disorders mentioned in various sources includes :-
1) Asthma
2) Eczema
3) Contact dermatitis
4) Allergies
a) Hay fever
b) Allergic rhinitis
c) Airborne allergies
d) Food allergies
e) Drug Allergies
f) Insect sting allergies
g) pollen allergies
h) Dust allergies
i) Animal allergies
5) Anaphylaxis

3. Asthma
definition :-
1) “Asthma is a lung condition that causes a person to have
difficulty breathing.”
- kidshealth.org
2) “Asthma is an inflammatory disorder of the airways, which
causes attacks of wheezing, shortness of breath, chest tightness, and
coughing.”
- health.nytimes.com
3) “ Asthma is a common inflammatory condition of the airways which is
characterized by bronchospasm,severe dyspnea,wheezing & chest
tightness.The airway are hyperresponsive as a result of inflammation & narrow
easily in response to a wide range of provoking stimuli.”
- Usha Ravindran Nair
Etiology :-
1. Airborne allergens, such as pollen,animal dander,mold,cockroaches and dust
mites.
2. Respiratory infections such as the common cold.
3. Physical activity (exercise-induced asthma)
4. Cold air
5. Air pollutants and irritants such as smoke.
6. Certain medications including beta blockers,aspirin and other nons-teroidal
anti- inflammatory drugs.
7. Strong emotions and stress.
8. Preservatives added to some types of foods and beverages.
9. Gastro-esophageal reflux disease (GERD),a condition in which stomach acids
back up into your throat.
10. Menstrual cycle in some women.
11. Allergic reactions to some foods such as peanuts or shellfish.
12. Tobacco smoke.

4. Types :-
1) EXTRINSIC ASTHMA:- Hypersensitivity reaction to
inhalant allergens.(dustmites, pollen, animal
dander)
2) INTRINSIC ASTHMA:- Infection, environmental
stimuli.
3) MIXED ASTHMA:- Immediate type I reactivity
appears to be combined with intrinsic factor.
4) ASPIRIN INDUCED ASTHMA:- Induced by ingestion
of aspirin & related compounds.
5) EXERCISE INDUCED ASTHMA:- Symptoms vary from
slight chest tightness & cough to severe
wheezing,cough & shortness of breath that usually
occur after 5 to 20 min. of sustained exercise.
6) OCCUPATIONAL ASTHMA:- due to inhalation of
industrial of industrial fumes, dust, allergens &
gases.

5. Pathophysiology :-
Causative agent
Ige stimulation
Mast cell degeneration
Release chemical mediators
Histamine Prostaglandin Bradikinase
Inflammation
Increase mucous production
Blockage in lumen
Atelectasis Bronchospasm Emphysema

6. Clinical manifestation :-
1) Shortness of breath
2) Chest tightness
3) Cough with or without symptoms
4) Trubble sleeping caused by shortness of breath
5) Wheezing
Assessment & diagnostic findings :-
 Blood tests to measure eosinophil count & IgE,because eosinophil count high
in any allergic condition.
 Chest x-ray : which can evaluate the presence of other condition such as
pneumonia,bronchitis etc
 Pulmonary function tests : To confirm the diagnosis & determine the severity
of the disease.This include :
- Peak flow measurements :- A peak flow meter is a simple device that
measures how hard you can breathe out.
- Spirometry :- This test measures the narrowing of your bronchial
tubes by checking how much air you can exhale after a deep breath
and how fast you can breathe out.
MANAGEMENT
Medical Management :-
 The goal of treatment is to avoid the substances that trigger your symptoms
and to control airway inflammation.
 There are two basic kinds of medication for the treatment of asthma :-
1. Long-acting medications to prevent attacks
2. Quick-relief medications for use during attacks.
1) Long-acting medications :-
Long-term control medications are used on a
regular basis to prevent attacks, not to treat them. Such medicines include:
Inhaled corticosteroids such as Azmacort,Vanceril,Aerobid,Flovent prevent
inflammation.
Leukotriene inhibitors such as Singulair and Accolate.
Long-acting bronchodilators such as Serevent, help open airways.

7. Cromolyn sodium.
Aminophylline or theophylline.
Sometimes a single medication that combines steroids and bronchodilators are
used.
2) Quick-relief medications :-
Quick relief, or rescue, medications are used to
relieve symptoms during an attack.These include:
Short-acting bronchodilators (inhalers) such as Proventil,Ventolin,Xopenex,
and others.
Corticosteroids such as methylprednisolone may be given directly into a vein
(intravenously) during a severe attack along with other inhaled medications.
Nursing management :-
 A specific, customized plan for monitoring and managing symptoms should be
created.
 The nurse obtain a history of allergic reaction to medications before
administering medication.
 Monitor vital sign’s,breath sounds,peak flow,pulse oximetry,skin colour,degree
of restlessness,which may indicate hypoxia.
 Provide medication & oxygen therapy as prescribed.
 Monitor airway functioning through pulmonary function test.
 Encourage intake of fluids to liquefy secretion.
 Provide semi-fowler’s position,to facilitate breathing.
 Use chest physiotherapy or postural drainage,to mobilize secretion,if ordered.
 Daily peak flow monitoring is recommended.peak flow meter measures the
highest airflow during a forced expiration.
 The patient is instructed in the proper technique.
 The Green (80-100 % of personal best),Yellow (60-80 %) & Red (less than 60 %)
zones are determined.
 Fluid may be administered if patient is dehydrated.

8. Complication :-
1. Asphyxia or asphyxiation
is a condition of deficient supply of oxygen to the body that
arises from abnormal breathing. An example of asphyxia is
choking. Asphyxia causes generalized hypoxia, which affects
primarily the tissues and organs.
2. respiratory failure
is caused by inadequate alveolar ventilation; both oxygen and
carbon dioxide are affected. Defined as the buildup of carbon
dioxide levels (PaCO2) that has been generated by the body but
cannot be eliminated.
3. Status asthmaticus
is an older, less precise term for what's now more commonly
known as acute severe asthma or a severe asthma
exacerbation. It refers to an asthma attack that doesn't improve
with traditional treatments, such as inhaled bronchodilators.
These attacks can last for several minutes or even hours.
4. Atelectasis
is a complete or partial collapse of the entire lung or area (lobe)
of the lung. It occurs when the tiny air sacs (alveoli) within the
lung become deflated or possibly filled with alveolar
fluid. Atelectasis is one of the most common breathing
(respiratory) complications after surgery

9. Eczema
definition :-
1) “ Eczema is a group of skin conditions that cause skin
to become red, irritated, itchy, and sometimes develop small, fluid-filled
bumps that become moist and ooze.”
- kidshealth.org
2) “Eczema is a particular type of inflammatory reaction
of the skin in which there are typically vesicles (tiny blister-like raised areas) in
the first stage followed by erythema(reddening),edema (swelling)
papules(bumps) & crusting of the skin.”
- www.medterms.com
Types :-
The common types of eczema are following :-
1) Atopic eczema or dermatitis :-It is a chronic skin disease characterized
by itchy, inflamed skin.
2) Contact eczema or Dermatitis :-It is a localized reaction that includes
redness,itching & burning where the skin has come into contact with
an allergen or with an irritant such as an acid,a cleaning agent or other
chemicals.
3) Seborheic eczema :- It is a form of skin inflammation of unknown cause
that presents as yellowish,oily,scaly patches of skin on the scalp,face &
occasionally other parts of the body.
4) Nummular eczema :-It is a coin-shaped patches of irritated skin,most
commonly on the arms,back,buttocks & lower legs.
5) Neuro dermatitis :-It is a scaly patches of skin on the head,lower
legs,wrists or forearms caused by a localized itch (such as an insect bite).
6) Statis dermatitis :-It is a skin irritation on the lower legs, generally related
to circulatory problems.

10. Etiology :-
1) Eczema is commonly found in families with a history of allergies.
2) Harsh soaps & deergents
3) Solvents
4) Lotions
5) Low humidity
6) Rough wool clothing
7) Sweating
8) Rubbing
9) Occlusive rubber or plastic gloves
10)Repeated handling & drying of the skin
Clinical manifestation :-
1) Usually,the first symptom of eczema is intense itching.
2) Rashs appears later and is red colour.
3) Rash itches or burns.
4) Scratched, it may ooze and become crusty.
5) Chronic rubbing produces thickened plaques of skin.
6) Painful cracks can develop over time.
7) The rash can be located anywhere on the body,most often found on the neck,
flexures of the arms (opposite the elbow) and flexures of legs (opposite the
knee).
8) It interferes with sleep.
Diagnostic findings :-
 History taking :-A detail medical history is most important for diagnosis.A
physician ask the question focusing on when the rash appears,where it appears
& How often it does it does so.They also ask about itching,any food or inhaled
allergen,temp. changes etc.
 Blood test such as eosinophilia count & IgE because eosinophilia count &
serum IgE levels are raised.
 Skin biopsy :- A doctor first numbs the skin and then removes one or more
small pieces of skin.A pathologist then examines the skin sample under a
microscope.

11. Management :-
The objectives of management are to rest the
involved skin & protect it from further damage.
1. Corticosteroides such as
Hydrocortisone,Betamethasone(Betnovate), Prednisolone.They do
not cure eczema,but are highly effective in controlling or suppressing
symptoms in most cases.
2. Skin barrier emulsions such as Epiemulsion is a non-steroidal,made
up of ceramides,free fatty acids & cholesterols,hich helps repair the
damaged skin.
3. Topical immunomodulators like pimecrolimus & tacrolimus were
developed after corticosteroid treatments.
4. Antibiotic such as Ceftriaxone should be given.
5. immunosuppressants such as methotrexate should be given.
6. Anti-itch drug often antihistamine such as promethazine(Phenergan)
or diphenhydramine(Benadryl)should be given.
7. Cool,wet dressing also are applied over small areas of vesicular
dermatitis.
Prevention :-
 Avoidance of over bathing.
 Applying moisturizer frequently,especially after bathing.
 Bathing in warm,not hot water and using a mild soap.
 Limiting or avoiding contact with known irritants like
soaps,perfumes, detergents,jewelry,environmental irritants etc.
 wearing loose-fitting clothing (cotton clothing may be less irritating
for many people than wool or synthetic fibers).
 The use of cool compresses to help control itching.
 Exercise,meditation or other stress management techniques can help
those for whom stress is a trigger.
 Wearing protective gloves for activities that require frequent
submersion of the hands in water.
 Avoiding activities that make you hot and sweaty as well as abrupt
changes in temperature and humidity.