ANAPHYLAXIS

Definition Anaphylactic shock; An abrupt, fatal allergic response that is caused by a systemic antigen- antibody immune response to a foreign substance (antigen)introduced into the body

Risk Factors
People with atopic diseases such as asthma, eczema, or allergic rhinitis are at high risk of anaphylaxis from food, latex, and radiocontrast but not from injectable medications or stings]One study in children found that 60% had a history of previous atopic diseases, and of those who die from anaphylaxis more than 90% have asthma. Those with mastocytosis

Pathophysiology
Previous sensitization or exposure to the specific allergen

RE-EXPOSURE

Antigen binds to adjacent IgE antibodies or cross-linked IgE receptors

Cellular reactions that trigger mast cells degranulation Release of powerful chemical mediators Entry of IgM and IgG in the reaction and activation of complement cascade

Smooth muscle spasm, bronchospasm, mucosal edema and inflammation, and increased capillary permeability result

Decreased peripheral resistance and plasma leakage from circulation to the extravascular tissues

Reduction of blood volume Clinical ManifestationS

Abdominal pain Abnormal (high-pitched) breathing sounds Anxiety Chest discomfort or tightness Cough Diarrhea Difficulty breathing Difficulty swallowing Dizziness or light-headedness Hives, itchiness Nasal congestion Nausea or vomiting Palpitations Skin redness Slurred speech Swelling of the face, eyes, or tongue Unconsciousness Wheezing

Diagnostic

No specific exam Skin test showing hypersensitivity to a specific allergen Elevated serum IgE levels

Medical Management
Epinephrine Diphenhydramine Corticosteroids Vassopressors Oxygen therapy Aminophylline

 Nursing Management

Assess the patient for signs and symptoms of anaphylaxis Keep intubation equipment available for immediate use Observed for signs and symptoms of increasing edema and respiratory distress Advise the patient to avoid allergens that trigger their allergic reactions

Mastitis
Definition
Inflammation of the breast tissues Mastitis usually affects lactating women - women who are breastfeeding, producing milk

Risk factors
Exact cause unknown Familial history Early menarche, late menopause, nulliparous or first child after age 34 High-fat diet Hormonal contraceptive use

Etiology

Mastitis may occur with or without infection. Infectious mastitis and breast abscess are usually caused by bacteria colonizing the skin. Cases due to Staphylococcus aureusare by far the most common,

followed by those due to coagulase-negative staphylococci. The majority of S aureus isolates are now resistant to methicillin.

Pathophysiology
Two types of mastitis Non-infectious mastitis - this is usually caused by breast milk staying within the breast tissue - milk stasis - because of a blocked milk duct or a breastfeeding problem. If left untreated, the milk left in the breast tissue can become infected, leading to infectious mastitis.

Infectious mastitis - this is caused by bacterial infection. It is important to receive treatment immediately to prevent complications, such as an abscess in the breast.

Clinical Manifestations

A nontender lump, usually in an upper outer quadrant Axillary lymphadenopathy (late) Fixed nodular breast mass (late) Pain (late) a red, swollen area on your breast that may feel hot and painful to touch an area of hardness on your breast a burning pain in your breast that may be continuous or may only occur when you are breastfeeding nipple discharge - which may be white or may contain streaks of blood

Over half of women with mastitis may also experience flu-like symptoms such as:

aches high temperature (fever) of 38C (100.4F) or above shivering and chills tiredness

Diagnostic Exams

Cultures may be taken, either of breast milk or of material aspirated (taken out through a syringe) from an abscess, to determine the type of organism causing the infection. This information can help your doctor decide what kind of antibiotic to use Mammogram Breast biopsy

Medical Management
Chemotherapy Radiation therapy Mastectomy

For simple Mastitis Cephalexin Dicloxacillin Erythromycin Pain Relievers

Nursing Management
Give analgesics as indicated Provide comfort measures such as a warm soaks Use meticulous hand-washing Regularly measure the patients temperature and assess the effectiveness of antipyretic agents. Inspect the patients breast daily for signs of impaired skin integrity, such as cracks and fissures. Advise the patient to take antibiotics as ordered. Stress the need to take the entire prescribed amount even if symptoms improve in the meantime.

Reassure the patient that breast-feeding during mastitis wont harm her infant because the infant is the source of the infection. If only one breast is affected, instruct the patient to offer the infant his breast first to promote complete emptying and prevent clogged ducts. Suggest applying a warm, wet towel to the affected breast or taking a warm shower to relax and improve her ability to breastfed.