Nursing of Adult Patients with Medical & Surgical Conditions Care of the Patient with an Immune Disorder

Nature of Immunity Three Main 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 the development and growth of abnormal cells

Organization of the Immune System

Nature of Immunity Inappropriate Responses of the Immune System –Hyperactive responses against environmental antigens (allergy) –Inability to protect the body, as in immunodeficiency disorders (AIDS) –Failure to recognize the body as self, as in autoimmune disorders (systemic lupus erythmatosus) –Attacks on beneficial foreign tissue (organ transplant rejection or transfusion reaction)

Nature of Immunity Innate (Natural) Immunity –First line of defense –Provides physical and chemical barriers to invading pathogens and protects against the external environment –Composed of the skin, mucous membranes, cilia, stomach acid, tears, saliva, sebaceous glands, and secretions and flora of the intestine and vagina –Non-specific immunity

Nature of Immunity Adaptive (Acquired) Immunity –Second line of defense –Provides a specific reaction to each invading antigen –Protects the internal environment –Composed of thymus, spleen, bone marrow, blood, and lymph –Produces antibodies in the cells after an infection or vaccination

Nature of Immunity –Macrophages (phagocytes) Engulf and destroy microorganisms that pass the skin and mucous membrane. Carries antigen to the lymphocytes

Nature of Immunity –Lymphocytes T Cells – % of lymphocytes –Releases lymphokine to attract macrophages to the site of infection or inflammation –Responsible for cell-mediated immunity –Provide the body with protection against viruses, fungi, and parasites. B Cells – % of lymphocytes –Cause the production of antibodies –Provide protection against bacteria, viruses, and soluble antigens

Types of Adaptive Immunity Humoral Immunity –Responds to antigens such as bacteria and foreign tissue –Result of the development and continuing presence of circulating antibodies in the plasma –Active Immunity antibodies are produced by one’s own body (vaccines) –Passive Immunity antibodies formed by another in response to a specific antigen and administered to an individual (HBIG) Cellular Immunity –Defense against intracellular organisms –Involved in resistance to infectious disease caused by viruses and some bacteria

Immune Response Immunization –A controlled exposure to a disease- producing pathogen which develops antibody production and prevents disease –Provides protection for months to years

Immune Response Immunotherapy –Treatment of allergic responses that administers increasingly large doses of the offending allergens to gradually develop immunity –Preseasonal, coseasonal, or perennial –Severe side effect: Anaphylaxis

Hypersensitivity –an abnormal condition characterized by an excessive reaction to a particular stimulus Hypersensitivity Reaction –an inappropriate and excessive response of the immune system to a sensitizing antigen Hypersensitivity Disorders –Harmless substances such as pollens, danders, foods, and chemicals are recognized as foreign

Hypersensitivity CAUSE: –Genetic defect that allows increased production of Immunoglobulin E (IgE) –Exposures may occur by inhalation, ingestion, injection, or touch

Hypersensitivity Diagnostic Tests –History onset, nature, and progression of symptoms aggravating and alleviating factors frequency and duration of signs and symptoms –Physical Exam Assessment of skin, middle ear, conjunctiva, nasooropharynx, and lungs –Laboratory Studies CBC, skin testing, total serum IgE levels

Hypersensitivity Medical Management –Symptom management with medications Antihistimines--pseudoephedrine(Actifed), diphenhydramine(Benadryl), chlorpheniramine(Chloir-Trimeton), brompheniramine(Dimetapp), cetirizine(Zyrtec), loratidine(Claritin), and fexofenadine(Allegra) –Environmental control Avoidance of the offending allergen –Immunotherapy Allergy specific injections

Anaphylaxis Etiology/Pathophysiology –System reaction to allergens Venoms Drugs - penicillin Contrast media dyes Insect stings Foods

Anaphylaxis Signs and Symptoms –Feelings of uneasiness to impending death –Urticaria(hives) and pruritus –Cyanosis and pallor –Congestion and sneezing –Edema of the tongue and larynx with stidor –Bronchospasm, wheezing, and dyspnea –Nausea and vomiting –Diarrhea and involuntary stools –Tachycardia and hypotension –Coronary insufficiency, vascular collapse, dysrhythmias, shock, cardiac arrest, respiratory failure, and death

Anaphylaxis Treatment –Epinephrine 1: ml SQ (may repeat at 15 minute intervals) –Benadryl 50 to 100mg IM or IV –IV access –Oxygen (as ordered by physician) –Aminophylline ( as ordered)

Anaphylaxis Nursing Interventions –Assessment: Respiratory status Circulatory status Vital signs Intake and output Mental status Skin status GI status status –Teaching Avoid allergen Use Medic-Alert ID Administration of epinephrine

Transfusion Reactions Etiology/Pathophysiology –Reactions that occur with mismatched blood

Transfusion Reactions Signs and Symptoms

Transfusion Reactions Treatment –Mild Stop transfusion Administer saline Administer steroids, diuretics, and antihistimines as ordered Physician may order transfusion continued at a slower rate.

Transfusion Reaction Treatment –Moderate Stop transfusion Administer saline Administer antihistamines and epinephrine as ordered

Transfusion Reaction Treatment –Severe Stop transfusion Administer saline Administer antihistamines and epinephrine as ordered Return blood or blood product to lab for testing Obtain urine specimen

Delayed Hypersensitivity Reaction occurs 24 to 72 hours after exposure Examples include: –Poison Ivy –Tissue transplant rejection

Transplant Rejection Autograft –Transplantation of tissue from one site to another on an individual Isograft –Transfer of tissue between genetically identical individuals (identical twins) Allograft (homograft) –Transplantation of tissue between members of the same species Heterograft –Transplantation of tissue from another species such as a pig or cow

Transplant Rejection Antigenetic determinants on the cells lead to graft rejection via the immune process 7-10 days after vascularization, lymphocytes appear in sufficient numbers for sloughing to occur

Transplant Rejection Immunosuppressives –Administration of agents that interfere with the ability of immune system to respond to antigenic stimulation Corticosteroids Cyclosporine (Neoral, Sandimmune) Azathioprine (Imuran)

Immunodeficiency An abnormal condition of the immune system in which cellular or humoral immunity is inadequate and resistance to infection is decreased May cause recurrent infections, chronic infections, severe infections, and/or incomplete clearing of infections Can be induced (chemotherapy)

Autoimmune Disorders 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-Barr’e –Scleroderma –Systemic lupus erthematosus