ISPN Review Drug Allergy 药物变态反应
A drug allergy occurs when the body forms antibodies to a particular drug, causing an immune response when the person is re-exposed to the drug. A patient cannot be allergic to a drug that has never been taken, although patients can have cross-allergies to drugs within the same drug class as one formerly taken. Many people state that they have a drug allergy because of the effects of a drug. For example, one patient stated that she was allergic to the diuretic furosemide (Lasix).
On further questioning, the nurse discovered that the patient was “allergic” to the drug because it made her urinate frequently — the desired drug effect, but one that the patient thought was a reaction to the drug. Ask additional questions of patients who state that they have a drug “allergy” to ascertain the exact nature of the response and whether or not it is a true drug allergy. Many patients do not receive needed treatment because the response to the drug is not understood.
Drug allergies fall into four main classifications: anaphylactic reactions, cytotoxic reactions, serum sickness, and delayed reactions. The nurse, as the primary caregiver involved in administering drugs, must constantly assess for potential drug allergies and must be prepared to intervene appropriately.
Anaphylactic Reaction 过敏反应
This allergy involves an antibody that reacts with specific sites in the body to cause the release of chemicals, including histamine, that produce immediate reactions (mucous membrane swelling and constricting bronchi) that can lead to respiratory distress and even respiratory arrest.
Cytotoxic Reaction 细胞毒性反应
This allergy involves antibodies that circulate in the blood and attack antigens (the drug) on cell sites, causing death of that cell. This reaction is not immediate but may be seen over a few days.
Serum Sickness Reaction 血清病反应
This allergy involves antibodies that circulate in the blood and cause damage to various tissues by depositing in blood vessels. This reaction may occur up to 1 week or more after exposure to the drug.
该反应指,循环于血液中的抗体沉积于血管,引起多种组织破坏。该反应可在接触药物一周后出现。
Delayed Allergic Reaction 迟发性变态反应
This reaction occurs several hours after exposure and involves antibodies that are bound to specific white blood cells.
Cytotoxic reaction -- Complete blood count showing damage to blood-forming cells (decreased hematocrit, white blood cell count, and platelets); liver function tests show elevated liver enzymes; renal function test shows decreased renal function.
Test 1. As a knowledgeable nurse, you know that the following are part of the five rights except:
A. Right dose
B. Right route
C. Right drug
D. Right room 2. When performing an assessment about medication, the drug history should include:
A. Complete vital signs
B. Client’s goal of therapy
C. Reason for medication
D. Administration of OTC medications
本期ISPN Review答案: 1. D. Right room. Right room is not one of the five rights.The five rights are right client, route, dose, drug, and time. 2.D. Administration of OTC medications. The nurse should determine if the client is taking any other medications, especially OTC medications because their effects are often minimized. Other choices are important part of assessment, but choice D is the most accurate answer.