M.N PRIYADARSHANIE Bsc in Nursing Nursing Management of a client with Immunological Disorders
Jan 02, 2016
M.N PRIYADARSHANIE Bsc in Nursing
Nursing Management of a client with Immunological Disorders
What Are Immune System Disorders?An immune disorder is a dysfunction of the immune system
These disorders can be characterized in several different ways;
By the component(s) of the immune system affected
By whether the immune system is overactive or underactive
By whether the condition is congenital or acquired
cases of immune system over activity, the body attacks and damages its own tissues (autoimmune diseases)
Immune deficiency diseases decrease the body's ability to fight invaders, causing vulnerability to infections
What is the meaning of the Immunity ?
The body’s specific protective response to invading foreign agent or organism
Immune disorders:
• Autoimmunity• Hypersensitivity• Immune deficiencies:
primary and secondary• Infection
5
Immune System
Immune disorders• The immune system helps the body defend
against various microbes and pollutants• The immune system itself can have various
failings An impaired immune system is called immunocompromise
• Causes of immune deficiency can include various illnesses such as viruses, chronic illness, or immune system illnesses
Innate and Acquired Immunity
Innate Acquired
Ag specificity no yes
Memory no yes
Primary immune deficiency diseases are those caused by inherited genetic mutations
Secondary or acquired immune deficiencies are caused by something outside the body such as a virus or immune suppressing drugs
eg. AIDS
Allergies - a true allergy to a substance or food is caused by the immune response
Asthma - caused by an allergic reaction affecting the airway passages
Anaphylaxis - an extremely dangerous over-reaction that can lead to shock
Autoimmune diseases - a group of more than 100 diseases where the body's own immune system gets confused and starts to attack good body cells
Natural immunity: nonspecific response to any foreign invader
White blood cell action: release cell mediators such as histamine, bradykinin, and prostaglandins, and engulf (phagocytize) foreign substances
Inflammatory response
• Physical barriers, such as intact skin, chemical barriers, and acidic gastric secretions or enzymes in tears and saliva
Acquired immunity: Specific against a foreign antigen
Result of prior exposure to an antigen
Active or passive
WBC’s (leukocytes) participate in both, natural and acquired immunity
• Granulocytes (granular leukocytes) release mediators (such as histamine, bradykinin and prostaglandins) and engulf antigen
(include neutrophils, eosinophils and basophils)Neutrophils- first cells to arrive on scene
• Nongranular leukocytes Monocytes or macrophages engulf, ingest and destroy greater number of foreign bodies/toxins that granulocytes do.
Lymphocytes
Consist of B-cells and T-cellsB lymphocytes: Produce antibodies or immunoglobulins
Acquired Immunity
• Cells: (macrophages), T (CD4+, CD8+) and B lymphoctyes (plasma cells), monocytes
T cell with CD4 receptor that recognizes antigens on the surface of a virus-infected cell and secretes lymphokines that stimulate B cells and killer T cells; helper T cells are infected and killed by the AIDS virus
• Molecules: cytokines, immunoglobulins,
adhesion molecules
Primary immunodeficiency diseasePrimary immune deficiency is caused by a genetic problem in the body's defense system, called the immune systemThere are more than 150 different primary immune deficiency diseasesSome occur with great frequency (selective IgA deficiency), while others are extremely rareIf a primary immune deficiency is not treated, it can cause serious illness
Primary immune diseases are at risk to an increased susceptibility to, and often recurrent ear infections, pneumonia, bronchitis, sinusitis or skin infections
Treatment for primary immune deficiencyMany patients with primary immune deficiency will need treatment with intravenous immunoglobulin and antibiotic medications. Gamma globulin is extracted from healthy people's donation of plasma and is purified through a manufacturing process before administeringOther patients may need more invasive therapies
Immune globulin (IG) therapy
Immune globulin (IG) therapy has become an invaluable therapy for patients with autoimmune, primary immune deficiency, neurological diseases and other chronic conditions and illnesses
Our staff of nurses and pharmacists is experienced in providing IG for patients of all ages and conditions
Our IG services include:
Access to IG products (IV and subcutaneous)
Specially trained infusion nurses
Individualized care plans
Multiple points of care
Immunological disorders
• Hypersensitivity mediated disorders
• Immunodeficiency
Classification of HypersensitivityGell and Coomb’s Classification: 4 Types• Type 1 : IgE-mediated • Type 2 : Cytotoxic antibodies• Type 3 : Ag-Ab Immune complexes• Type 4 : Delayed-type, cell-mediated
hypersensitivity
Type I Hypersensitivity• Allergen exposure, sensitization and re-
exposure• IgE antibody, mast cells/ basophils and its’
mediators• Target organ immediate reactions• Clinical allergy: atopic diseases, drug allergy,
insect allergy and anaphylaxis
An allergy is an abnormal immune reaction to a harmless antigen
Seasonal allergy
Anaphylaxis
Food allergy
Allergic rhinitis• Atopic dermatitis• Drug Allergy
Allergies result from the immune system's overreaction to a non-threatening foreign substanceFoods and inhaled particles like pollen and pet dander are the most common allergens(substances causing allergic reactions)When the immune system senses an allergen, it stimulates the release of chemicals such as histamine
Anaphylaxis
It is defined as "a serious allergic reaction that is rapid in onset and may cause death
It typically results in a number of symptoms including an itchy rash, throat swelling, and low blood pressure
Common causes include insect bites, foods, and medications.
Anaphylaxis is caused by the release of mediators from certain types of white blood cells triggered either by immunologic or non-immunologic mechanisms
The primary treatment is injection of epinephrine
Skin Prick Test
Type II Hypersensitivity
• Cytotoxic antibodies: IgG, IgM• Clinical spectrums:
– Autoimmune Hemolytic anemia (AIHA)– ABO Miss-matched
• Stimulatory antibody: Grave’s disease
• Inhibitory antibody: Myasthenia gravis (anti-Ach Rc)
Principle treatments in Type II
• ABO matching• Steroid, immunosuppressive agents, +/-
splenectomy
Type III Hypersensitivity
• Mechanisms: Ag (protein, drugs) + Ab (IgG, IgM) --> Immune complex --> deposit at subendothelial basement membrane --> fix complement
• Immune complex diseases:– Serum sickness– Autoimmune diseases: SLE
Autoimmune DiseasesIn response to an unknown trigger, the immune system may begin producing antibodies that instead of fighting infections, attack the body's own tissuesTreatment for autoimmune diseases generally focuses on reducing immune system activity
Eg.Rheumatoid arthritis The immune system produces antibodies that attach to the linings of joints Immune system cells then attack the joints, causing inflammation, swelling, and painIf untreated, gradually causes permanent joint damagefor rheumatoid arthritis can include various oral or injectable medications
Systemic lupus erythematosus (lupus) People with lupus develop autoimmune antibodies that can attach to tissues throughout the bodyThe joints, lungs, blood cells, nerves, and kidneys are commonly affected in lupusTreatment often requires daily oral prednisolone, a steroid that reduces immune system function
Type 1 diabetes mellitus
Immune system antibodies attack and destroy insulin-producing cells in the pancreas
Principle treatments in Type III
• Serum sickness: Avoidance of heterogeneous protein injection
• Autoimmune diseases: SLE– Avoidance sun exposure– Steroid– Immunosupressive agents
Treatments for Autoimmune diseases Treatments vary for specific diseases but may include Hormone replacement therapy – for autoimmune diseases damaging hormone glands Enzyme replacement therapy – for autoimmune diseases damaging enzyme-producing glands Corticosteroids
Prednisolone
Type IV Hypersensitivity
• Delayed-type cell-mediated reaction• Mechanism: Antigen (contactants) -->
sensitized T-lymphoctyes --> re-exposure --> T cells activation --> cytokines
• Clinical disorder: Atopic contact dermatitis
Principle treatments in Type IV
• Avoidance• Topical steroid• Systemic steroid, if severe
Nursing care for a patient with Immunological Disease
Assessment for Immune Dysfunction Health History Taking System wise Assessment
Nursing Care Management of a patient with Immuno deficienciesAssessmentPatient teachingSupportive Care
Continuously Monitoring for laboratory Values
Vital signs Treating for infections Reducing Patient’s risk for infections Assessment for patient’s nutritional
status, stress level, and drug usage and hygienic practices
Attention for strict aseptic techniques Identify early signs of infection and
treat to processing conditions
Factors affects for attract an infectious disease
Age and gender
Nutrition
Presence of conditions and disorders: cancer/neoplasm, chronic illness, autoimmune disorders, surgery/traumaAllergiesHistory of infection and immunizationGenetic factorsLifestyleMedications and transfusionsPyschoneuroimmunologic factor
Usually seen in infants and young children
Manifestations: vary according to type; severe or recurrent infections; failure to thrive or poor growth; and positive family history
Potential complications: recurrent, severe, potentially fatal infections; related blood dyscrasias and malignancies
Treatment: varies by type; treatment of infection; pooled plasma or immunoglobulin; GM-CSF or GCSF; thymus graft, stem cell, or bone marrow transplant
Monitor for signs and symtoms of infections Symptoms of inflammatory response may be
blunted Monitor lab values Promote good nutrition Address anxiety, stress, and coping Strategies to reduce risk of infection
Handwashing and strict aseptic technique Patient protection and hygiene measures: skin
care, promote normal bowel and bladder function, and pulmonary hygiene
Signs and symptoms of infection
Medication teaching
Prevention of infection
Handwashing
Avoid crowds and persons with infections
Hygiene and cleaning
Nutrition and diet
Lifestyle modifications to reduce risk
Follow-up care
Guidelines to prevent the transmission of microorganisms in hospitals
Standard precautions used for all patients
The primary strategy for preventing HAIs
Transmission-based precautions are for patients with known infectious diseases spread by airborne, droplet, or contact rout
Isolation PrecautionsGuidelines to prevent the transmission of microorganisms in hospitals
Standard precautions used for all patients
The primary strategy for preventing HAIs
Transmission-based precautions are for patients with known infectious diseases spread by airborne, droplet, or contact rout
Elements of Standard Precautions
Guidelines to prevent the transmission of microorganisms in hospitals
Standard precautions used for all patients
The primary strategy for preventing HAIs
Transmission-based precautions are for patients with known infectious diseases spread by airborne, droplet, or contact routes
Nursing Process—Assessment of the Patient With an Infectious Disease
Health history: investigate the likelihood and probable source of infection, associated pathology, and symptoms
Administer a physical exam
Vital Signs
Nursing Process—Diagnosis of the Patient With an Infectious Disease
Risk for infection transmission
Deficient knowledge
Risk for ineffective thermoregulation
Interventions Prevent the spread of infection
Perform handwashing
Exercise Standard Precautions
Recognize mode of transmission and establish Transmission-Based Precautions as indicated
Teach about infectious process and the prevention of the spread of infections
Assess and treat fever
Increases metabolic rate by 7% each 1 degree above normal
Thank you !