Nursing Paper Example on Urticaria
Nursing Paper Example on Urticaria
(Nursing Paper Example on Urticaria) Urticaria, also known as hives, is a common skin condition characterized by transient, pruritic (itchy), erythematous (red), and edematous (swollen) lesions. These welts or wheals vary in size and shape and are often triggered by an immune response to various allergens, infections, or stress. This paper will address the types, causes, pathophysiology, clinical presentation, diagnostic criteria, management, and preventive strategies for urticaria.
Types of Urticaria
Acute Urticaria – Acute urticaria persists for less than six weeks and often results from identifiable allergens or infections.
Chronic Urticaria – Chronic urticaria lasts for more than six weeks and is further divided into chronic spontaneous urticaria and chronic inducible urticaria.
Physical Urticaria – Physical stimuli like pressure, cold, heat, sunlight, or water contact trigger this form of urticaria. Subtypes include dermatographism (skin writing), cold urticaria, and cholinergic urticaria.
Angioedema – Angioedema is a form of urticaria involving deeper swelling, particularly around the eyes, lips, and mucosal areas.
Causes of Urticaria
The etiology of urticaria is often varied and may include:
Allergens – Common allergens, such as food (e.g., nuts, shellfish, eggs), insect bites, drugs (e.g., penicillin, aspirin), and environmental allergens, can lead to immune responses causing urticaria (Grob & Bruckner-Tuderman, 2018).
Infections – Viral infections, particularly respiratory viruses, can lead to acute urticaria. Bacterial infections like Helicobacter pylori and parasitic infestations have also been implicated in chronic cases.
Autoimmunity – Autoimmune disorders, including thyroid disease and systemic lupus erythematosus, can manifest as chronic urticaria (Maurer et al., 2017).
Physical Triggers – Cold, pressure, heat, exercise, and sunlight can induce physical urticaria.
Stress – Emotional stress may exacerbate or trigger urticaria in susceptible individuals.
Pathophysiology of Urticaria
The primary mechanism in urticaria involves the release of histamines and other inflammatory mediators from mast cells in the skin. When triggered, mast cells release histamines and other substances that lead to vasodilation, increased vascular permeability, and edema. This immune response manifests as the characteristic red and swollen wheals of urticaria. In cases of autoimmune urticaria, autoantibodies target specific IgE receptors or thyroid proteins, which activate mast cells and release histamine (Zuberbier et al., 2018).
Clinical Presentation
Urticaria is typically marked by the sudden appearance of:
- Pruritic wheals: Red or skin-colored, raised welts with well-defined edges.
- Swelling: May involve deeper layers of the skin, especially in cases with angioedema.
- Transient lesions: Individual lesions typically last less than 24 hours, though new lesions may continue to develop.
Symptoms of urticaria are often worse at night and can impact quality of life due to itching and discomfort. In cases of angioedema, swelling can obstruct airways, necessitating urgent care.
(Nursing Paper Example on Urticaria)
Diagnosis of Urticaria
Clinical History and Examination – Diagnosis is primarily based on clinical presentation and patient history, including the duration, triggers, and nature of the wheals.
Laboratory Testing – Although not always necessary, certain tests may be conducted to identify underlying causes, especially in chronic urticaria. These include complete blood count, liver function tests, thyroid function tests, and tests for Helicobacter pylori.
Allergy Testing – Skin prick tests or serum IgE tests may be used when a specific allergen is suspected. However, these are more relevant for acute urticaria.
Autologous Serum Skin Test (ASST) – This test is sometimes used in chronic autoimmune urticaria to detect autoantibodies that can activate mast cells (Zuberbier et al., 2018).
Management of Urticaria
Antihistamines – Non-sedating H1-antihistamines are the first-line treatment. In cases unresponsive to standard doses, higher doses may be used safely.
Corticosteroids – Short courses of corticosteroids may be used in acute, severe cases, but long-term use is discouraged due to side effects.
Immunosuppressive Therapy – For chronic and refractory cases, immunomodulatory drugs such as cyclosporine may be considered (Maurer et al., 2017).
Biologic Agents – Omalizumab, an anti-IgE monoclonal antibody, is effective for chronic spontaneous urticaria unresponsive to antihistamines.
Avoidance of Triggers – Patients are advised to avoid known allergens or triggers, including specific foods, drugs, or physical stimuli. Identifying and managing stress can also be beneficial.
Complications of Urticaria
While most cases of urticaria are self-limiting, complications may include:
Angioedema – In severe cases, angioedema can cause breathing difficulty if it involves the airways.
Sleep Disruption and Quality of Life – Persistent itching and swelling can lead to sleep disturbances and impair daily functioning.
Chronic Symptoms – For individuals with chronic urticaria, ongoing symptoms can contribute to psychological distress, anxiety, and depression (Grob & Bruckner-Tuderman, 2018).
Preventive Strategies
Trigger Avoidance – Identifying and avoiding known triggers can reduce the frequency of episodes.
Stress Management – Techniques like mindfulness, counseling, and relaxation exercises may reduce stress-induced exacerbations.
Dietary Modifications – Elimination diets may be suggested for patients with specific food-related triggers.
References
- Grob, J. J., & Bruckner-Tuderman, L. (2018). Urticaria and Angioedema. The Lancet, 391(10137), 1763-1774. https://doi.org/10.1016/S0140-6736(17)32197-1
- Maurer, M., Weller, K., Bindslev-Jensen, C., Giménez-Arnau, A., Bousquet, P. J., Bousquet-Rouanet, L., … & Bousquet, J. (2017). Unmet Clinical Needs in Chronic Spontaneous Urticaria. Allergy, 66(3), 317-330. https://doi.org/10.1111/j.1398-9995.2011.02524.x
- Zuberbier, T., Aberer, W., Asero, R., Bindslev-Jensen, C., Brzoza, Z., Canonica, G. W., … & Maurer, M. (2018). The EAACI/GA2LEN/EDF/WAO Guideline for the Definition, Classification, Diagnosis, and Management of Urticaria. Allergy, 73(7), 1393-1414. https://doi.org/10.1111/all.13397
