42A Lesson E- Immune System Disorder.pptx

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VOCN 42A

Lesson E

Immune System Disorders

Manuel Barbosa RN, MSN-Ed., CCRN,

PCCN

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Objectives

•

By the end of this lesson, the student

vocational nurse will be able to:

•

Differentiate between the immune system

disorders and formulate a nursing care

plan which addresses the physiological

and psychosocial integrity, health

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Outline

 _{Immune System} Disorders

 _{Allergic Disorders}  _{Allergic Reactions}

Anaphylaxis

 Hypersensitivity

 _{Transfusion Reactions}

 _{2. Autoimmune} Disorders

 _{3. Chronic Fatigue} Syndrome

4. White Blood Cell Disorders

1. Leukocytosis 2. Agranulocytosis 3. Pancytopenia 5. Lymphatic System Disorders

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Immune Disorders

~Allergies~

- _{Immune system mistakenly} recognizes harmless foreign particles as serious threats - _{Launches immune}

response, which causes sneezing, runny nose, and watery eyes

- _{Anti-histamines block effect} of histamines and bring

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Immunoglobulins and Allergic

Response

• Antibodies (IgE, IgD, IgG, IgM, and IgA) react with specific effector cells and molecules, and function to protect the body • IgE antibodies are involved in allergic disorders

• IgE molecules bind to an allergen and trigger mast cells or basophils

• These cells then release chemical mediators such as

histamine, serotonin, kinins, SRS-A, and neutrophil factor • These chemical substances cause the reactions seen in

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Immunoglobulins and Allergic Response

(cont.)

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Management of Patients With

Allergic Disorders

• _{History and manifestations; comprehensive allergy}

history

• _{Diagnostic tests}

– _{CBC-eosinophil count}

– _{Total serum IgE}

– _{Skin tests: note precautions}

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Nursing Process—Assessment of the Patient With Allergic Disorders

• Assess health history

• Include personal and family history • Perform an allergy assessment

• Subjective data includes symptoms and how the patient feels before symptoms become obvious

• Note the relationship between symptoms and seasonal changes, emotional problems, and stress

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Nursing Process—Diagnosis of the

Patient With Allergic Disorders

• _{Ineffective breathing pattern related to allergic}

reaction

• _{Deficient knowledge about allergy and the}

recommended modifications in lifestyle and self-care practices

• _{Ineffective individual coping with the chronicity of}

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Nursing Process—Planning the Care of the

Patient With Allergic Disorders

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Goals may include:

– _{Restoration of normal breathing pattern}

– _{Increased knowledge about the causes and control}

of allergic symptoms

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Definition of Anaphylaxis

• _{Systemic allergic reaction}

– _{Affects body as a whole}

– Multiple organ systems may be involved

• _{Onset generally acute}

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Anaphylaxis

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Anaphylaxis comes from the Greek

and means against or without

protection.

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Clinical Manifestations of Anaphylaxis

 _{Skin: Flushing, pruritus,}

urticaria, angioedema

 _{Upper respiratory:}

Congestion, rhinorrhea

 _{Lower respiratory:}

Bronchospasm, throat or chest tightness,

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Clinical Manifestations of Anaphylaxis

• _{Gastrointestinal tract:}

– Oral pruritus

– Cramps, nausea, vomiting, diarrhea

• _{Cardiovascular system:}

– Tachycardia, bradycardia, hypotension/shock,

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Treatment of Anaphylaxis

 _{Simple BLS (O2, position, etc)}  _{Anti Histamines}

 _{Benadryl (IV 25-50 mg, PO 50 mg adult, 25 mg ped)}

 _{Corticosteroids}

 _{Decadron, Solu-medrol, etc}

 _{Treat Hypotension}

 _{IV fluids}

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Treatment of Anaphylaxis

• Bronchodilators

– Albuterol MDI or Neb

• Observe for a minimum 8-12 hours

– Insure F/U with PMD,

– Benadryl for 24 hours.

• Rebound or persitent S/S

– Repeat epinephrine if Sx persist or increase after 10-15 minutes

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Screening Patients at Risk

Did you ever have a severe allergic reaction:

 _{To any food?}

 _{To any medicine?}  _{To an insect sting?}  _{To latex?}

 _{Side effect or allergic reaction?}

 _{That caused breathing trouble? Severe hives and swelling? Severe}

vomiting or diarrhea? Dizziness?

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Risk Management for

Anaphylaxis

• EDUCATE

– Teach avoidance measures

– “Accidents are never planned” – Stress importance of:

• _{Always having a current EpiPen}_{on hand}

• _{Immediate treatment}

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Delayed hypersensitivity

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Reaction occurs 24 to 72 hours after

exposure

–

Examples include:

• _{Poison ivy}

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Transfusion Reactions are

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Adverse reactions associated with the

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Transfusion reactions

• _{Non-threatening to fatal}

• Hemolytic or non-hemolytic – may or may not cause RBC destruction

• _{Acute to delayed}

– _{Acute – rapid onset}

– _{Delayed – days to weeks}

• _{Reactions may involve antigen-antibody}

interactions

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Hemolytic Transfusion

Reactions (HTR)

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Most common cause is ABO

incompatibility (clerical error)

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Red cell destruction due to

complement activation by IgM

(within 24 hours)

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As little as 10-15 mL can trigger a

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Symptoms

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Fever

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Chills

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Acute renal failure

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Early signs

– Anxiety

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Allergic Transfusion

Reactions

• _{May be caused by antibodies (recipient) to}

plasma proteins (donor)

• _{A mild transfusion reaction causes:}

– Urticarial Reaction: hives, itching

• Erythema: redness of the skin

• Dyspnea: shortness of breath

• _{An antihistamine can be given prior to transfusion}

or during transfusion

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Anaphylactic Reactions

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May be associated with anti-IgA antibodies

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Very severe & life threatening allergic reaction

although rare

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Symptoms:

– NO fever Hypotension

– Skin flushing Cardiac arrhythmia

– _Nausea _{Cardiac arrest} – Diarrhea Laryngeal edema

•

Treated with

epinephrine

(vasoconstrictor &

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Autoimmune Disorders

• _Autoimmune

– _{The development of an immune response to one’s own}

tissues

– _{Body is unable to distinguish “self” protein from}

“foreign” protein

– _{Examples of disorder: pernicious anemia; Guillain-Barré}

syndrome; scleroderma; systemic lupus erythematosus

• _{Plasmapheresis}

– _{Removal of plasma that contains components causing}

disease

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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

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Chronic Fatigue Syndrome

Assessment Findings: Diagnostic

Findings

Medical history, physical examination

Unremarkable findings

Blood tests

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Chronic Fatigue Syndrome

Medical Management

Drug treatment: Symptomatic; Investigational Balanced activity, rest

Hypotension: Increased salt, water intake Several adjunct and alternative therapies

Nursing Management

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White Blood Cell Disorders

Leukocytosis: Leukemia

Pathophysiology and Etiology

Proliferation of leukocytes: Usually immature forms; Four types Precipitating factors; Genetic correlation

Assessment Findings

Severe anemia; Bleeding; Infections; Fatigue; Easy bruising; Fever; Enlarged spleen, lymph nodes

Medical Management

Antineoplastic drugs; Transfusions

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White Blood Cell Disorders

Leukocytosis: Leukemia Assessment

History; Physical assessment Symptoms; Laboratory results

Diagnosis, Planning, and Interventions

Risks; Activity intolerance; Anxiety; Fear Evaluation of Expected Outcomes

No infection and blood loss

Adapts to changes in body image Copes with anxiety and fears

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White Blood Cell Disorders

Agranulocytosis

 Pathophysiology and Etiology Drug toxicity

 Assessment Findings

Fatigue; Fever; Chills; Headache; Opportunistic infections: Mouth, throat, nose, rectum, vagina

 Medical Management

Removal of the cause; Drug therapy  Nursing Management

History: Client; Medication

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White Blood Cell Disorders

Pancytopenia: Aplastic Anemia Pathophysiology and Etiology

Autoimmune

Exposure to toxic chemicals, radiation, and drug therapy

Assessment Findings

Weakness; Fatigue; Opportunistic infections; Unusual bleeding

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White Blood Cell Disorders

Pancytopenia: Aplastic Anemia Medical Management

Withdrawal of the causative agent

Transfusions; Antibiotics; Corticosteroids

Transplantations: Bone marrow; Autologous stem cell Nursing Management

History; Physical assessment; Symptoms Infection prevention measures

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Anatomy and Physiology

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Lymph vessels, ducts, and nodes

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Protects body from infection by filtering

bacterial and nonbacterial products

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Prevents waste products from entering

circulatory system

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Anatomy and Physiology

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Two divisions of lymph system:

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Right lymphatic duct drains lymph from

head, upper torso, and right arm

–

Left lymphatic duct

• _{Also known as thoracic duct}

• _{Rest of body drains through this duct}

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Organs related to lymph system:

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Common Diseases of the Lymphatic

System

Lymphadenitis

Inflammation of lymph glands

Symptoms:

Swelling Pain

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System

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Lymphangitis

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Swelling of lymph vessels due to

inflammation caused by strep infections

following trauma

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Characterized by red streak at bacterial

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System

Lymphangitis

Other symptoms:

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System

Lymphangitis

Treatment:

Antibiotics

Warm, moist packs

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Common Diseases of the Lymphatic

System

Lymphedema

Abnormal collection of lymph fluid in extremities

Possible causes:

Surgery or radiation treatments Pregnancy

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Clinical Signs and Symptoms of Lymphedema

• _{Edema of the dorsum of the foot or hand} • _{Decreased range of motion, flexibility and}

function

• _{Usually unilateral}

• _{Worse after prolonged dependency}

• _{No discomfort or a dull, heavy sensation; sense}

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Common Diseases of the Lymphatic

System

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Lymphedema

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Treatment:

• _Antibiotics

• _{Compression therapy}

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Types of Lymphedema

Pitting edema

Short duration edema

Finger indentation of the skin

Brawny edema

Tissue feels hard upon palpation Indicates fibrotic changes

_Weeping

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Prevention of Lymphedema

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Prevention of Lymphedema should

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Components of a Decongestive

Lymphatic Therapy Program

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Elevation

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Manual lymphatic drainage

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Compression

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Exercise

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Skin care

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Elevation

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Elevate the involved limb when

using a sequential compression

pump

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Elevate limb when sleeping, resting,

and during sedentary activities

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Compressive bandages or garment

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Manual Lymphatic Drainage

• _{Slow, very light, repetitive stroking and circular}

massage movements performed in a specific sequence, limb elevated whenever possible

• _{Proximal congestion in the trunk, groin, buttock,}

or axilla is cleared first

• _{Direction of massage is towards specific lymph}

nodes

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Exercise

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Exercises are performed in a specific

sequence, often with the limb

elevated

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Low-intensity

cardiovascular/pulmonary endurance

activities included

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Deep breathing and relaxation also

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Compression

• _{No-stretch, non-elastic or low-stretch elastic}

bandages are used

• _{Sports bandages, such as ACE wraps, are NOT}

recommended in the treatment of lymphedema

• _{Compressive garments are available}

• _{Use of a sequential, pneumatic compression}

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Skin Care and Hygiene

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Lymphedema increases risk of skin

breakdown, infection, and delayed

wound healing

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Proper skin care

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Inspection

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Reference

•

Timby, B. & Smith, N. (2010).

Introductory medical-surgical

nursing. (10

th

ed.). Philadelphia:

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