Seasonal Allergies

By Janella Schroeder RN

It is spring time! Oh the glory! Time to head outside and mow the grass plant your garden, water the flowers, go to the baseball games, and go for a long evening walk after being cooped up all winter long…but what if you have seasonal allergies? This beautiful and magnificent time of year can be miserable for your patients with chronic allergies, 1 in 6 patients to be exact. The multiple symptoms that are associated with allergies such as sneezing, nasal congestion, wheezing and watering of the eyes and dermatitis and/or eczema are the second most reported medical complaint (WOOTEN, 2000).

Do you know what allergies are and how to help?
What are allergies?
Seasonal allergies are an abnormal or over exaggerated response to a substance (dust, mites, pets, mold, pollens, grass…) that most others tolerate without difficulty. When an allergen enters the body the immediate hypersensitivity reaction happens on the surface of mast cells reacting with IgE causing histamine to be released. Histamine causes spasms of smooth muscle, dilation of blood vessels, and increased production of mucus leading to the cascade of allergy symptoms. (WOOTEN, 2000)

How are allergies diagnosed?
• History: The Who, what, what, when, where and how.
WHO: Who all has these symptoms?
WHAT: What causes the symptoms and what are the symptoms?
WHEN: When are the symptoms the worst?
WHERE: Where are the symptoms the worst?
WHY: Why are they seeking treatment now, are they worse?
HOW: How long have they had these symptoms?

• Physical Exam: A complete physical exam should be performed with special attention to eyes, ears, nose, mouth, throat, and chest.

Common Symptoms: allergic shiners (dark circles under eyes), allergic salute (constant wiping of the nose as if saluting), chronic sniffling, halitosis, postnasal drip, lingering colds, sinusitis, cough, asthma, chronic throat clearing, nasal congestion, snoring, fatigue, rhinitis (Pickett, Hamel, Weaver, & Timmons, 2003). Sneezing, runny nose, watering eyes, itchy eyes, ears, nose (Lillis, 2007).

• RAST Testing: (Radioallergosobent Teasting) A blood allergy test that measures IgE in the patients serum.
• Skin Testing: There are two types of skin tests, the prick and intradermal where very diluted concentrations of allergens are injected into the patient to see if there is a reaction inflected. A patient is considered to be allergic to the allergen if there is a 3mm or larger red wheal on the skin as a reaction (WOOTEN, 2000).

How can I help my patients manage the symptoms?
Environmental Control:
o Watch the weather and pay attention to pollen, grass, weed and mold levels before going outside (hot, dry, windy weather equals more allergens)
o Limit time outside, especially gardening or mowing-wear a mask if you must do these
o Keep windows and doors to house and car closed
o Install an air purifier and a heap-filter on the heater and air conditioner
o Shower and wash clothes daily to remove allergens from clothing and hair
o Vacuum carpet, curtains, and upholstery often
o Wash bedding often and in the warmest water setting on washer

Provide education of medications:
• Antihistamines- can block the effects of the histamine release. Best when taken before exposure to allergen. Available both over the counter and prescription.
• Bronchodilators-given for asthma symptoms associated with allergies, can alleviate bronchospasms.
• Corticosteroids- can be used topically or as a nasal spray to relieve inflammation. Available both over the counter and prescription.
• Decongestants – can reduce congestion in the nasal airway by vasoconstriction. Available both over the counter and prescription.
• Allergy Shots- can help decrease histamine and IgE over time by actually giving small doses of allergen

References:
Lillis, K. (2007, January). Surviving Seasonal Allergies. Advance for Nurses .
Pickett, ,. A., Hamel, ,. V., Weaver, ,. J., & Timmons, C. (2003). Pediatric Allergies. Advance for Nurses , 5 (1), 29.
WOOTEN, L. (2000, October). Diagnosis & Management of Environmental Allergies. Advance for Nurses ,11.

NOTE: This blog post reflects the work of Janella Schroeder, RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.

Whose afraid of Hepatitis C?

By Kathleen Jacobs-McLoyd RN


ONE INSTANT AND YOUR LIFE CAN BE CHANGED. Do you know to protect yourself? “HEPA”-means liver….”IT IS” means inflammation.
In July 1988, Massachusetts Nurses Association president Karen Daley, MPH, RN, went from being an emergency room department nurse to being a lifelong patient. Karen got stuck with a needle. Six months after being stuck and after reporting the accident she learned that she had been infected with HIV and Hepatitis C. She states “the moment I reached my gloved hand over a needle box to dispose of the needle I had used to draw blood-has drastically changed my life”.
Approximately 170 million people worldwide are infected with the hepatitis C virus; at least four million reside in the United States. The CDC (Centers for Disease Control) predicts that in the next 10 years the hepatitis C death toll will triple, eclipsing that of AIDS. Although the rate of HCV infection is declining, those infected decades ago now face complications. Hepatitis C is one of the many types of hepatitis caused by a virus that damages the liver. It’s mainly a blood borne virus, which means that it’s passed from person to person when infected blood comes into contact with non infected blood. It’s also possible to contact hepatitis C from infected body fluids such as IVDU past or present, tattooing, body piercing, needle sticks, dialysis equipment, and transmission from mother to child, and sexual activity that involves contact with infected body fluids. In 10 out of 100 cases of hepatitis C, the risk factor is unknown.
Hepatitis C can be either acute or chronic. Acute infection (1st stage liver is inflamed) typically remains asymptomatic or produces mild symptoms 60%-70% have no discernible symptoms. The most common symptom is fatigue, some people have muscle and joint pain, fever, nausea, vomiting, loss of appetite or stomach pains….this sounds like the flu. Sometimes, the liver is able to get rid of the virus and go back to normal. A person infected with hepatitis C can carry the virus 20 years or more and not have symptoms. Chronic infection in up to 85% of hepatitis C cases doesn’t go away when that happens it’s called chronic or long lasting. If liver damage caused by the virus is left untreated, it can sometimes lead to cirrhosis- a serious condition in which normal cells are replaced by scar tissue.
Treatments for HCV are improving medications used to treat hepatitis C. The treatment is a combination of two antivirals- interferon and ribavirin. About 40% of patients with HCV who undergo this therapy become clear of the virus. Self care for patients would include:Inform anyone who may come into contact with your blood that you have hepatitis C. Don’t share any personal hygiene items i.e. razors, nail files, tooth brushes . Carefully toss any items that may contain your blood or body fluids. Clean cuts and wounds with disinfectants and cover with bandages. Avoid sexual practices that may cause contact with blood.
Handle contaminated needles with care, ensure the safety of sharps disposal containers, wear protective equipment, demand hypoallergenic gloves if you’re allergic to latex, consider all human blood as a source of infection, demand safer devices in your workplace.

References:Who’s Afraid of Hepatitis C? American Journal of Nursing Volume 100 (5) May 2000, pp26-32
www.liverfoundation.orgwww.cdc.gov/hepatitis
www.hepc-connection.org

NOTE: This blog post reflects the work of Kathleen Jacobs-McLoyd RN with minor editing by Shirley Comer RN and was completed as a class assignment. The content of this blog is for informational purposes only. Before beginning or changing a treatment or lifestyle regime you should consult your primary health care provider.