20 terms

Serum Sickness

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Overview
Immune system response to a variety of factors, such as medications, injected proteins used to treat immune conditions, and antiserums derived from animals
Type III hypersensitivity reaction
Overview-Pathophysiology
The clear plasma fluid of blood contains proteins and antibodies, which are formed as part of the immune system to protect against infection.
Antiserum produced from plasma protects the body against infection. It gives the body immediate but temporary protection until the body develops an active immune response.
In serum sickness, the immune system mistakes the protein antiserum as a potentially harmful substance known as an antigen. Antigen-antibody complexes forms and are deposited in the tissues or form there directly.
An inflammatory response ensues.
Overview-Causes
Injectable proteins (such as antithymocyte globulin and rituximab)
Allergen extracts
Blood products
Hormones
Hymenopteran venom
Infectious agents
Vaccines
Antibiotics, such as cephalosporins, penicillins, sulfonamides, and tetracyclines
Monoclonal antibodies, such as infliximab, omalizumab, and rituximab
Overview-Risk Factors
People with a genetic predisposition to produce excessive amounts of immunoglobulin (Ig) E are more susceptible.
Overview-Incidence
Decreasing in the United States because of the use of vaccinations
Overview-Complications
Vasculitis
Neuropathy
Acute kidney injury
Anaphylaxis
Shock
Death
Assessment-History
Fever
Skin rash
Pain
Joint and muscle aches, malaise
Chest pain
Shortness of breath
Abdominal pain, nausea, vomiting, and diarrhea
Assessment-Physical Findings
Fever
Lymphadenopathy
Edema
Rash, typically urticarial, beginning on the anterior lower trunk or area around the umbilicus or axillae and spreading to the back, upper trunk, and extremities.
Friction rub
Neurologic changes
Tachypnea
Diagnostic Test Results-Laboratory
Complete blood count and differential reveal leukocytosis or leucopenia.
Erythrocyte sedimentation rate is elevated.
Serum protein electrophoresis reveals hypergammaglobulinemia.
Urinalysis may reveal protein, hematuria, or both.
Complement levels (C3, C4) may be reduced
Treatment-General
Supportive therapy focusing on relief of signs and symptoms
Cessation of medications that may have contributed to the problem
Identification of triggers to help prevent further exposure
Treatment-Diet
Elimination of all suspected food allergens, including dairy, wheat (gluten), soy, corn, preservatives, and chemical food additives (with possible food allergy testing to determine specific allergens)
Treatment-Activity
As tolerated
Treatment-Medications
Antihistamines, such as diphenhydramine, to block the release of histamine that causes the allergic reaction
Antipyretics, such as aspirin, to relieve fever and joint and muscle pain
Corticosteroids, such as predniSONE, which contain anti-inflammatory and salt-retaining properties
Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen, for joint pain relief
Nursing Considerations-Nursing Diagnoses
Acute pain
Ineffective breathing pattern
Ineffective health maintenance
Risk for activity intolerance
Risk for infection
Risk for injury
Nursing Considerations-Expected Outcomes
remain free from pain
maintain adequate oxygen levels
verbalize information about the disease process and self-care
verbalize the importance of balancing activity, as tolerated, with rest
remain free from infection
remain free from injury.
Nursing Considerations-Nursing Interventions
Provide supplemental oxygen, as ordered, if the patient is experiencing shortness of breath; use pulse oximetry to evaluate oxygen saturation levels.
Elevate the head of the bed to 45 degrees to ease the work of breathing and maximize chest expansion.
Provide humidified air.
Provide periods of rest to promote sleep and decrease fatigue.
Organize patient care and activities to provide uninterrupted rest.
Perform hand hygiene.
Maintain adequate nutrition and adequate rest.
Provide a safe environment.
Assess and provide pain management interventions. Administer analgesics, as ordered.
Provide comfort measures, if needed, to help relieve itching.
Nursing Considerations-Monitoring
Respiratory pattern
Oxygen saturation
Energy level; activity tolerance
Temperature
Intake and output
Signs of anaphylaxis
Response to pain management interventions
Nursing Considerations-Associated Nursing Procedures
12- or 24-hour timed urine collection
Health history interview and physical assessment
Humidifier therapy, bedside
Intake and output assessment
Nutritional screening
Oral drug administration
Oxygen administration
Pain management
Pulse oximetry
Respiration assessment
Temperature assessment
Venipuncture
Patient Teaching-General
avoidance of agents that contribute to the development of serum sickness
drug dosages, adverse reactions, and signs of toxicity
dietary restrictions, including appropriate food choices that are low in fat and calories
energy conservation measures, including the need to plan for rest periods
daily weights, including the importance of notifying the practitioner of significant weight gain
signs and symptoms associated with corticosteroid therapy, such as weight gain and moon face.
signs and symptoms of anaphylaxis and the need to notify the practitioner immediately.
need to adhere to prescribed corticosteroid therapy, emphasizing the need for a gradual tapering of the dosage and to avoid abruptly stopping the drug.
Importance of adhering to scheduled follow-up medical care.
Patient Teaching-Discharge Planning
Refer the patient to appropriate support groups.
Contact social services to ensure that the patient is not exposed to allergens after discharge.