Unexpected Response to Therapies (Nursing)

00:01 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.

00:42 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.

01:00 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.

01:28 They bind to IgE, which is an immunoglobulin found in your body.

01:34 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.

01:54 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.

02:08 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.

02:58 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.

03:12 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.

03:29 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.

04:37 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.

04:53 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.

05:15 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.

05:40 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.

05:55 They can have additional seizures, and sometimes they can even throw up. This is from the pressure that's put on the brain.

06:02 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.

06:15 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.