Urticaria: Nursing

Definitions & Key takeaways

Urticaria, commonly referred to as hives, is a kind of skin rash notable for pale red, raised, itchy bumps, which can cause a burning or stinging sensation. Lesions are frequently caused by allergic reactions; however, there are many nonallergic causes, such as autoimmune disorders like thyroid disease. Most cases of hives lasting less than six weeks (acute urticaria) are the result of an allergic trigger. Chronic urticaria (hives lasting longer than six weeks) is rarely due to an allergy.

Treatment for urticaria typically involves identifying and avoiding triggers, as well as taking medication to relieve symptoms. Antihistamines are often prescribed to block the release of histamine and reduce itching and swelling. In severe cases, oral or injectable corticosteroids may be prescribed. Nursing management and care focuses on helping to eliminate or reduce the triggering factors, manage symptoms, and monitor for complications. Client and family education focuses on prevention and symptom management.

Chapters:

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Introduction0:00–0:15

Urticaria, also commonly known as hives, is a skin reaction characterized by wheals, which are raised, pruritic areas that are erythematous or red with central pallor and clearly defined borders.Now, let’s quickly review the physiology of skin reactions.

Physiology0:15–0:49

The skin is the outer barrier that protects the body from any external threat like pathogens or antigens. To do this, the skin has a thick outer layer called epidermis, which in turn consists of multiple cell layers.
Below the epidermis, there’s a deeper layer called the dermis, which is mostly made of connective tissue, and contains structures like hair follicles, nerve endings, and blood vessels.
Within the dermis, there’s also a special type of immune cell called mast cells, which serve as a first line of defense to trigger an immune response when they sense an external threat.Now, urticaria is typically caused by exposure to allergens, such as pollen, pet dander, dust, bee stings, latex, and food like shellfish and nuts, as well as certain medications like antibiotics or NSAIDs.

Causes & risk factors0:49–1:37

Other common causes include viral, bacterial, or parasitic infections.Less frequently, urticaria can be caused by stress, exercise, sweat, exposure to extreme temperatures or sunlight, as well as vibration, friction, or pressure against the skin.
Finally, urticaria can also be idiopathic, meaning that the cause is unknown. Risk factors for developing urticaria include having allergies or a family history of allergies or urticaria; as well as frequent infections, stress, cold or heat exposure, taking certain medications, and having an autoimmune disease like lupus.Okay, the underlying pathology of urticaria is a type I hypersensitivity reaction.

Pathology1:37–2:20

So, the first time a client is exposed to an allergen, the immune system reacts by producing allergen-specific IgE antibodies, which in turn bind to the surface of mast cells in the skin and mucosa.
If the client is exposed to that same antigen again, the IgEs allow mast cells to quickly recognize that antigen. As a result, mast cells become activated and release a large amount of inflammatory mediators, such as histamine, leukotrienes and bradykinin, causing the nearby blood vessels to dilate and increase their permeability, which allows leakage of fluid and attracts more immune cells locally.Typically, the clinical manifestations of urticaria begin within two to three hours after allergen exposure.

Clinical manifestations2:20–3:04

Clients generally develop slightly raised, well-defined wheals that are usually red, and blanch with pressure. In addition, these wheals are often very itchy and warm to the touch.
Occasionally, urticaria can be accompanied by angioedema, which is characterized by local vasodilation at the subcutaneous and submucosal tissue, leading to increased vascular permeability and tissue swelling; this is most common on the face, like around the eyes, but can also involve the lips, tongue, which can progress down to the throat, closing off the airway.
In severe cases, urticaria or angioedema can worsen and cause anaphylaxis.Diagnosis of urticaria begins with the client’s history and physical assessment.

Diagnosis3:04–3:25

Additional tests can help identify the triggering allergen. This includes blood tests for allergen-specific IgEs; as well as skin prick tests, where small drops of up to 40 allergens are pricked into the skin on the forearm or upper back, and evaluated for signs of urticaria.Initial treatment typically involves removing or avoiding the triggering factor.

Treatment3:25–3:49

Most often, urticaria fades on its own within 24 hours, but clients may benefit from symptomatic treatment, which can include antihistamines like cetirizine or topical corticosteroids for milder cases, as well as systemic corticosteroids like prednisone for persistent cases or accompanied by angioedema.Okay, let’s look at the nursing care you’ll provide for a client with urticaria.

Management and care3:49–4:37

Your priority nursing goals are to help eliminate or reduce the triggering factors, as well as manage your client’s symptoms, and monitor for complications.
To begin, assess the affected area, making note of the size, location, and characteristics of the lesions; as well as for any areas of broken skin.
Be sure to discontinue any triggering medications or remove the factor causing the urticaria. Then, administer the prescribed medications, and apply cool compresses to the affected areas in order to provide comfort.
Report to the healthcare provider if you notice any swelling around the eyes, lips, tongue; as well as difficulty speaking or breathing; and be prepared to assist with airway management and administer emergency medications, as ordered.Now, moving on to client and family education.

General client and family teaching4:37–5:46

First, explain how certain factors can cause urticaria, and encourage your client to avoid them. Then, teach your client about their prescribed medications, and how to administer them.
For the duration of their treatment, be sure to encourage your client to avoid overexertion, alcohol consumption, sun exposure, and temperature extremes; and prompt them to wear protective clothing to limit their contact with the triggering factor.For symptom management at home, advise your client to bathe with mild soap, use a humidifier, and drink plenty of fluids.
Also, explain to them that a cool environment at night can help reduce itching and improve sleep quality. Emphasize the importance of not touching or scratching the affected area, and keeping fingernails short and clean.
Lastly, instruct your client to notify their healthcare provider if they develop any indications of an infection, like redness, swelling, warmth, and tenderness of the affected area.
Also, instruct them to seek medical care right away if the urticaria worsens, or if they develop new symptoms, such as shortness of breath or swelling of their eyes, lips, tongue, or throat.

Review5:46–7:05

##Summary Okay, as a quick recap… Urticaria, also known as hives, is a skin reaction typically caused by exposure to a triggering factor, including allergens like pollen, pet dander, dust, bee stings, latex, and food like shellfish and nuts, as well as certain medications.
The underlying pathology of urticaria is a type I hypersensitivity reaction mediated by allergen-specific IgEs that attach to the surface of mast cells; so when the client is exposed to the allergen, mast cells quickly recognize it and release inflammatory mediators to attract immune cells locally.
Clients usually present with wheals, which are often very itchy, and can be accompanied by angioedema, while severe cases can progress into anaphylaxis.
Diagnosis is made by history and physical assessment, as well as tests to identify the triggering factor, such as blood tests for allergen-specific IgEs and skin prick tests.
Urticaria usually resolves on its own within 24 hours, but clients may benefit from symptomatic treatment with antihistamines or corticosteroids.
Nursing management and care focuses on helping to eliminate or reduce the triggering factors, manage symptoms, and monitor for complications.
Client and family education focuses on prevention, symptom management, and when to contact the healthcare provider.