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Chapter 19

Chapter 19. Nursing Care of Patients w ith Immune Disorders. Disorders of the Immune System. Three Categories Hypersensitivity Reactions Autoimmune Disorders Immune Deficiencies. Disorders of the Immune System (cont ’ d). Hypersensitivity Reactions Anaphylaxis

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Chapter 19

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  1. Chapter 19 Nursing Care of Patients with Immune Disorders

  2. Disorders ofthe Immune System • Three Categories • Hypersensitivity Reactions • Autoimmune Disorders • Immune Deficiencies

  3. Disorders of the Immune System (cont’d) • Hypersensitivity Reactions • Anaphylaxis • Hemolytic Transfusion Reactions • Measles • Transplant Rejections

  4. Disorders of the Immune System (cont’d) • Autoimmune Disorders • Rheumatoid Arthritis • Ulcerative Colitis • Multiple Sclerosis

  5. Disorders of the Immune System (cont’d) • Immune Deficiencies • Hypogammaglobulinemia • Acquired Immunodeficiency Syndrome

  6. Hypersensitivity Reactions • Injury to Body Due to Exaggerated Response • Classified by Way Tissue is Injured • Type I, II, III, IV

  7. Type I • Anaphylactic Reaction • Immediately • Mild to Severe, Life-threatening

  8. Type I (cont’d)

  9. Allergic Rhinitis • Most Common Form of Allergy • Sneezing, Nasal Itching, Runny Nose, Itchy Red Eyes

  10. Atopic Dermatitis • Eczema • Inflammatory Skin Response • Pruritus, Edema, Extremely Dry Skin, Blisters, Crusts, Scales

  11. Anaphylaxis • Severe Systemic Hypersensitivity Reaction • Widespread Histamine Release • Bronchial Narrowing: Stridor, Wheezing, Respiratory Arrest • Hypotension, Tachycardia, Cardiac Arrest

  12. Anaphylaxis (cont’d) • Immediate Treatment Guided by Symptoms • Oxygen • Epinephrine • Antihistamines • Corticosteroids • Vasopressors • Mechanical Ventilation

  13. Anaphylaxis (cont’d) • Nursing Care • Early Recognition • Maintain Airway • Emotional Support • Education

  14. Urticaria(Hives) • Release of Histamine • Raised, Pruritic, Non-tender, Erythematous Wheals on Skin

  15. Urticaria(Hives)(cont’d) • Therapeutic Interventions • Epinephrine • Corticosteroids • Antihistamines • Histamine H2 Blockers

  16. Angioedema • Form of Urticaria • Affects Submucosal/Subcutaneous Tissue Rather Than Skin • Painless, Dermal Erythematous/ Subcutaneous Eruptions, Skin/Mucous Membrane Edema

  17. Type I Nursing Diagnoses • Impaired Gas Exchange • Anxiety • Risk for Impaired Skin Integrity • Ineffective Health Maintenance

  18. Type I Nursing Care • Monitor Respiratory Status • Monitor Level of Consciousness • Stay with Patient • Provide Information • Note and Document Skin and Lesions • Teach Rubbing or Pressure, Not Scratching

  19. Type I Nursing Care (cont’d) • Teach Patient to Wear Medical Alert Identification • Discuss Methods of Avoiding Allergen

  20. Type II • Destruction of Substance with Antigen • May Be Beneficial (Bacteria) • Not Beneficial When RBC Sensed as Foreign

  21. Type II (cont’d)

  22. Hemolytic Transfusion Reaction • RBCs with Foreign Antigens Rapidly Lysed • Occludes Blood Vessels • Ischemia, Necrosis • Life-threatening

  23. Hemolytic Transfusion Reaction (cont’d) • Prevention is Key! • Rhogam: Rho (D) Negative Patients • Careful Blood Transfusion Administration

  24. Hemolytic Transfusion Reaction (cont’d) • Therapeutic Interventions • Antihistamines • Corticosteroids • Sympathomimetics

  25. Hemolytic Transfusion Reaction (cont’d) • Nursing Diagnoses • Hyperthermia • Ineffective Tissue Perfusion • Impaired Gas Exchange • Ineffective Breathing Pattern

  26. Hemolytic Transfusion Reaction (cont’d) • Nursing Care • Prevention • Careful Transfusion Monitoring • If Reaction, Stop Blood, Follow Policy • Education

  27. Type III • Immune Complexes Formed by Antigens and Antibodies • Antigen-antibody Complexes Within Blood Vessels • Enzymes Lead to Blood Vessel Damage • Red Edematous Lesion, Bleeding, Necrosis

  28. Type III (cont’d)

  29. Serum Sickness • Antigen-antibody Complexes Cause Symptoms of Inflammation • 7 to 10 Days After Penicillin/Sulfonamide • Severe Urticaria and Angioedema • Brief and Self-limiting Condition

  30. Serum Sickness (cont’d) • Nursing Diagnoses • Anxiety/Fear • Pain • Risk for Deficient Fluid Volume • Risk for Impaired Skin Integrity

  31. Serum Sickness (cont’d) • Nursing Care • Monitor Symptoms • Evaluation Medication Effects • Education

  32. Type IV • Delayed Reaction • Sensitized T Lymphocyte Contacts Antigen • Cell-mediated Immune Response • Necrosis

  33. Type IV (cont’d)

  34. Contact Dermatitis • Chemical Comes in Contact with Skin • On Second Exposure, T Cells Secrete Chemicals • Poison Ivy, Poison Oak, Latex Rubber • Reddened, Pruritic, Fragile Vesicles

  35. Contact Dermatitis (cont’d) • Therapeutic Interventions • Antihistamines, Topical Drying Agents, Corticosteroids • Tepid Baking Soda Baths or Aveeno Baths • Wash with Brown Soap (Fels-naptha) • Avoid Scratching Skin

  36. Transplant Rejection • Transplanted Living Tissue Sensed as Foreign • Lymphocytes Sensitized Immediately • Invade Transplanted Tissue and Destroy it • Failure of Organ or Tissue • Infection Can Result in Death

  37. Transplant Rejection (cont’d) • Prevention • ImmunosuppressionTherapy

  38. Autoimmune Disorders • Immune System Recognizes Body’s Own Cells as Foreign • Immune Response Destroys Cells

  39. Pernicious Anemia • Antibodies Against Gastric Parietal Cells and Intrinsic Factor • Vitamin B12 Deficiency • RBC Production Decreased • Also Caused by Gastric or Small Bowel Resections

  40. Pernicious Anemia (cont’d) • Therapeutic Interventions • Corticosteroids • Lifelong Vitamin B12

  41. Idiopathic Autoimmune Hemolytic Anemia • Autoantibodies Attach to RBCs • Lyse or Agglutinate

  42. Idiopathic Autoimmune Hemolytic Anemia (cont’d) • Signs and Symptoms • Mild Fatigue • Pallor • Hypotension • Dyspnea • Jaundice

  43. Idiopathic Autoimmune Hemolytic Anemia (cont’d) • Therapeutic Interventions • Immunosuppressive Medications • Oxygen • Corticosteroids • Folic Acid • Transfusion

  44. Idiopathic Autoimmune Hemolytic Anemia (cont’d) • Therapeutic Interventions (cont’d) • Erythrocytapheresis • Splenectomy

  45. Hashimoto’s Thyroiditis • Autoantibodies for Thyroid-stimulating Hormone, Thyroid Gland Overstimulation • Then Autoantibodies Destroy Thyroid, Hypothyroidism • Lifelong Thyroxine

  46. Lupus Erythematosus • Three Types • Discoid (DLE) • Skin Lesions • Drug-induced Systemic Lupus Erythematosus • After Certain Medication Use • Systemic Lupus Erythematosus • Chronic, Inflammatory, Multisystem Disorder

  47. Lupus Erythematosus (cont’d) • Etiology • Young Women of Child-bearing Years • First-degree Relatives of Lupus Patients • African American/Hispanic Population More Frequently

  48. Lupus Erythematosus Signs and Symptoms • Discoid • Patchy, Crusty, Sharply Defined Skin Plaques • Occur on Face/Sun-exposed Areas

  49. Systemic Lupus Erythematosus Signs and Symptoms • Drug-Induced • Pleuropericardial Inflammation • Fever • Rash • Arthritis

  50. Systemic Lupus Erythematosus Signs and Symptoms (cont’d) • Early Symptoms Vague: Fatigue, Fever • Dermatologic: Butterfly Rash, Bruising Photosensitivity, Alopecia, Pain, Pruritis • Musculoskeletal: Arthralgia, Arthritis

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