Chapter 15 Care of the Patient with an Immune Disorder Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc.

Care of the Patient with an Immune Disorder In response to attack, the body exhibits a wide array of adaptations designed to provide a defense and protect the body from external and internal harmful agents The immune system has three functions: – Protect the body’s internal environment against invading organisms – Maintain homeostasis by removing damaged cells from the circulation – Serve as a surveillance network for recognizing and guarding against development and growth of abnormal cells

Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Immunity Quality of being insusceptible to or unaffected by a particular disease or condition – Innate (natural) – body’s first line of defense provides physical and chemical barriers to invading pathogens and protects against the external environment – Adaptive (acquired) – body’s second line of defense provides a specific reaction to each invading antigen and can remember the antigen causing the attack

Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Effects of Aging on the Immune System Decline in the immune system High incidence of tumors in older adults Greater susceptibility to infections such as influenza and pneumonia Bone marrow is relatively unaffected Delayed hypersensitivity response is frequently decreased or absent, results in an increased risk of cancer mortality

Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Immune Response There are two ways of assisting the body to develop immunity: – Immunization – controlled exposure to a disease-producing pathogen develops antibody production while preventing disease – Immunotherapy – a special treatment of allergic responses that administers increasingly large doses of the offending allergens to gradually develop immunity

Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Origin and Processing of B & T Cells (Figure 15-3)

Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Failure of the Immune Response Severity of altered immune response disorders range from mild to chronic to life threatening: – I – Hypersensitivity disorder – involves allergic response and tissue rejection – II – Immunodeficiency disease – involves altered and failed immune response – III – Autoimmune disease – involves extensive tissue damage resulting from an immune system that seemingly reverses its function to one of self-destruction

Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Hypersensitivity Disorder Hypersensitivity disorder – involves allergic response and tissue rejection – Treatment: Symptom management with medications Environmental control Immunotherapy – Nursing Diagnosis Risk for injury, related to exposure to allergen Activity intolerance, related to malaise Risk for infection, related to inflammation of protective mucous membrane

Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Hypersensitivity Disorder Anaphylaxis or Systemic Reaction – Most severe allergic reaction - reaction may be fatal very rapidly within seconds to a few minutes Transfusion reaction – Hypersensitivity to mismatched blood Delayed Hypersensitivity – Reactions may occur 24 – 72 hours after exposure Transplant Rejection – Immune response to foreign protein

Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Immunodeficiency Disease Immunodeficiency disease – involves altered and failed immune response – Primary immunodeficiency – Phagocytic B cell deficiency T cell deficiency Combined b cell and t cell deficiency – Secondary immunodeficieny Drug – induced (most common) treatment for prevention of transplant rejection Stress, hypofunctional state, malnutrition, radiation, Hodgkin’s

Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Autoimmune Disease Autoimmune disease – involves extensive tissue damage resulting from an immune system that seemingly reverses its function to one of self-destruction – Unknown reasons – immune cells that are normally unresponsive (tolerant to self- antigens) are activated – Rheumatoid arthritis

Mosby, Inc. items and derived items copyright © 2003, 1999, 1995, 1991 Mosby, Inc. Nursing Diagnoses Risk for injury, related to exposure to allergen Activity intolerance, related to malaise Risk for infection, related to inflammation of protective mucous membranes Breathing patterns, ineffective, related to edema, bronchospasm and increase secretions Cardiac output, decreased, related to increased capillary permeability and vascular dilation