Discharge And Home Healthcare Guidelines

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TEACHING. Teach the patient to eat a well-balanced diet with sufficient fluids. Emphasize the value of exercise and adequate rest. Encourage the patient to develop adequate coping strategies.

FOLLOW-UP. Following an alcohol withdrawal experience, the patient may be able to accept that he or she has a problem with alcohol abuse. Discharge plans may include behavior modification programs, sometimes in conjunction with disulfiram (Antabuse) or participation in AA. Families must also be involved in the treatment planning to gain an understanding of the part that family dynamics play in people who are alcohol dependent.

^Allergic purpura is an allergic reaction that leads to acute or chronic inflammation of the vessels of the skin, joints, gastrointestinal (GI) tract, and genitourinary (GU) tract. It occurs as an acquired, abnormal immune response to a variety of agents that normally do not cause allergy, and it is manifested by bleeding into the tissues, organs, and joints, which leads to organ dysfunction, discomfort, and immobility. An acute attack of allergic purpura can last for several weeks, but usually episodes of the disease subside without treatment within 1 to 6 weeks. Patients with chronic allergic purpura can have a persistent and debilitating disease. The most severe complications are acute glomerulonephritis and renal failure. Hypertension often complicates the course, and if bleeding is excessive, the patient can develop a fluid volume deficit. On rare occasions, patients may be at risk for airway compromise from laryngeal edema.

Allergic purpura occurs in response to agents such as bacteria, drugs, food, or bee stings. The allergic reaction, probably an autoimmune response directed against the vessel walls, may be triggered by a bacterial infection. Most patients have experienced an upper respiratory infection, particularly a streptococcal infection, 1 to 3 weeks prior to the development of allergic purpura. Experts suggest that other causes, such as allergic reactions to drugs and vaccines, insect bites, and foods (wheat, eggs, chocolate, milk) may lead to the condition.

Over 20 genes have been associated with the development of allergy and mutations of these may be passed on in families. Family studies indicate that if both parents suffer from allergies, the allergy risk in their offspring is 80%. Implicated genes include the IL-4, IL-4 receptor, cytokine, INFy, p-adrenergic receptor, 5 lipoxygenase, PHF1, TARC, and leukotriene C4 synthetase genes.

Allergic purpura can occur at any age, but it is most common in children between the ages of 3 and 10; the condition is more common in males than females. In North America, the disease occurs mostly from November to January. In one-half to two-thirds of children, an upper respiratory tract infection precedes the clinical onset by 1 to 3 weeks, and children are mildly ill with a fever. Whites are more affected than blacks/African Americans.

DRG Category: 397

Mean LOS: 5.0 days

Description: MEDICAL: Coagulation Disorders

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