Chapter034

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Timby/Smith: Introductory Medical-Surgical Nursing, 10/e

Chapter 34: Caring for Clients with Immune-Mediated Disorders


Allergic Disorders Allergic Disorders

• Hyperimmune response to weak antigens that are typically harmless

• Organs, structures primarily involved:

– Skin

– Respiratory passageways

– GI tract

– Blood, vascular system



• Pathophysiology and Etiology

– Tendency can be inherited

– Sensitization

– Hypersensitivity response

• Immediate; Delayed


QuestionQuestion

Is the following statement true or false?

There is more than one type of hypersensitivity response.


AnswerAnswer

True.

There is more than one type of hypersensitivity response. The response can be immediate or delayed.




Hypersensitivity ResponsesHypersensitivity Responses• Immediate Hypersensitivity Responses

– Type I: Atopic; Anaphylactic

• Most severe; IgE mediated

– Type II: Cytotoxic

• IgM or IgG mediated

– Type III: Immune complex

• IgG mediated

• Delayed Hypersensitivity Response: Type IV

• Allergic response suppression


Allergic Disorders Allergic Disorders • Assessment Findings: Signs and Symptoms

– Cause-and-effect relationship

• Symptom correlation

• Consistent exposure reaction to allergen

• Assessment Findings: Diagnostic Findings

– RAST

– Scratch (or prick) test

– Patch test

– Intradermal injection test


QuestionQuestionIs the following statement true or false?

Allergic reaction symptoms are unconnected to the exposure route.


AnswerAnswerFalse.

Allergic reaction symptoms typically have a cause-and-effect correlation to the route of exposure to the allergen.


Allergic Disorders Allergic Disorders • Inhalant Allergy Potential Complications

– Nasal polyps; Sinus infections; Asthma

– Secondary pulmonary infections

• Most Severe Complications of any Allergy Type

– Anaphylactic shock; Angioneurotic edema

• Medical Management

– Allergen avoidance

– Symptomatic; Drug therapy; Emergency kit

– Desensitization


Nursing ManagementNursing Management

• Diagnostic Skin Testing

• Observe for allergic reaction

• Remove the offending substance

• Notify the physician

• Anaphylactic reaction

• Removal of ring from a swelling finger

• Temporary discontinuation of some medications


Nursing ManagementNursing Management

• Desensitization

– Administer serial doses; Monitor for 30 minutes

– Sublingual-swallow immunotherapy

• Allergic rhinitis

– Client teaching

• Prescribed medications: Self-administration; Side effects

• Reduce exposure at home and work


QuestionQuestion

Is the following statement true or false?

A newer type of desensitization therapy uses sublingual-swallow immunotherapy for several types of allergic reactions.


AnswerAnswer

False.

A newer type of desensitization therapy uses sublingual-swallow immunotherapy. It is used as a desensitization treatment for allergic rhinitis.


Nursing ProcessNursing Process• Assessment

– Thorough history: Diet and family

– Record

• Allergic symptoms

• Factors that appear to increase or decrease symptoms

– Prescription or nonprescription drugs taken

– Skin rashes or eruptions

– Observation and monitoring each time a new drug is given


Nursing ProcessNursing Process• Diagnosis, Planning, and Interventions

– Altered comfort: Itching

– Impaired home maintenance

– PC: Anaphylaxis and angioedema

• Evaluation of Expected Outcomes

– Relief of itching; No evidence of rash

– Stable vital signs

– Effortless breathing

– Necessary changes made at home


Autoimmune Disorders Autoimmune Disorders • Pathophysiology and Etiology

– Unrelenting, progressive tissue damage

– Killer T cells; Autoantibodies attack “self”

– Triggering event

• Assessment Findings: Signs and Symptoms

– Acute inflammatory response

– Low-grade fever; Malaise; Weight loss

– Alternating exacerbations, remissions

• Assessment Findings: Diagnostic Findings

– Elevated circulating antibodies


Autoimmune Disorders Autoimmune Disorders • Medical Management

– Rarely cured

– Goal: Remission; Slowing destruction

– Drug therapy

• Anti-inflammatory agents; Immunosuppressive agents; Antineoplastic drugs

– Controlling side effects of drugs

– Continued medication to avoid recursive exacerbation


Nursing Process: Autoimmune DisorderNursing Process: Autoimmune Disorder

• Assessment

– Family history

– Vital signs

– Signs of localized inflammation and compromised body functions

– Client’s level of energy

– Laboratory test findings

– Client teaching


Nursing Process: Autoimmune Disorder Nursing Process: Autoimmune Disorder • Diagnosis, Planning, and Interventions

– Activity intolerance

– Risk for infection

– Disturbed personal identity

• Evaluation of Expected Outcomes

– Participation in self-care, ADLs without overwhelming fatigue

– No evidence of iatrogenic infection

– Realistic self-perception


Chronic Fatigue Syndrome Chronic Fatigue Syndrome • Profound fatigue without identifiable cause,

unrelenting for 6+ months

• Pathophysiology and Etiology

– No known cause: Possible combination of immune defects, viral assault

– Low serum cortisol levels; Impaired activation of HPA axis

• Assessment Findings: Signs and Symptoms

– Ongoing fatigue plus at least four additional signs, symptoms

– Neurologic symptoms (several)


Chronic Fatigue Syndrome Chronic Fatigue Syndrome • Assessment Findings: Diagnostic Findings

– Medical history, physical examination

• Unremarkable findings

– Blood tests

– Exhaustive medical workup

– Tilt-table test


Chronic Fatigue Syndrome Chronic Fatigue Syndrome • Medical Management

– Drug treatment: Symptomatic; Investigational

– Balanced activity, rest

– Hypotension: Increased salt, water intake

– Several adjunct and alternative therapies

• Nursing Management

– Client education: Disease process; Accommodating limitations


End of Presentation

Chapter034

Documents

medications copyright

work copyright

antibodies copyright

allergic reaction symptoms

allergic disorderscopyright

allergen assessment

types of allergic reactions

igg mediated type