Immune System & Oncology Nursing Care PN 143 – Lecture 2 Rebecca Maier, BSN

DISORDERS OF THE IMMUNE SYSTEM Lecture 2

Disorders of the Immune System  Hypersensitivity (the thing) response directed against non-self antigens that are not pathogenic  Hypersensitivity reaction (the action) An inappropriate and excessive response of the immune system to a sensitizing antigen Pemphigus (Vulgaris) – look up pemphigus you need to know it

Disorders of the Immune System  Hypersensitivity disorders - Allergies

Physical assessment of the immune system involves predominantly  the following systems: Integumentary Gastrointestinal Respiratory Cardiovascular

Assessment  seasonal

Most important diagnostic tool: a thorough history

Diagnostic Tests- Common laboratory studies: CBC Skin Testing Total serum IgE levels Specific IgE level for a particular allergen maybe ordered – i.e. RAST, (radioallergosorbent test)

Other Diagnostic Tests  ANA  Total complement, C3 & C4  CRP  CD4 T-Cells  ELISA  ESR  HLA-DW4  LE Prep  PCR  RBC *  RF  Total White Blood Cell count w/ differential *  Western Blot

Medical Management  Avoid the allergen  And Symptom management

Immune Response

Medications

 Leukotriene Inhibitors : Reduce symptoms of an allergic response caused by leukotrienes [inflammatory cells from mast cells and basophils. Eg. Accolate, Singulair, Zyflo – inhibit the production of leukotrienes

Other meds: Corticosteroids Bronchodilators

Nursing Diagnosis  For patients with hypersensitivity disorder includes: Risk for injury related to exposure to allergen Activity Intolerance related to malaise Risk for infection related to inflammation of protective mucous membranes

Patient Teaching  Patient and diagnosis specific  Avoid exposure to allergen  Tx Plan  Self care

Anaphylaxis

 Assessment: Early recognition  early treatment! Pt. may have a sense of uneasiness  sense of foreboding  sense of impending death Skin: urticaria  cyanosis and pallor Upper respiratory s/sx.: congestion and sneezing  edema of the tongue and larynx with stridor and occlusion of the upper airway

Anaphylaxis

Anaphylaxis – Medical Management  Immediate, aggressive treatment  At the first sign, administer ml epinephrine (1:1000 dilution) subcutaneously for mild reaction  For severe reaction, Epinephrine 1:10,000 dilution 0.5ml IV at 5-10min intervals  Benadryl mg may be given IM or IV  Pt. may be intubated  Oxygen supplied  Place in recumbent position/keep warm  Note: all meds and frequency given per order of physician  Call 911

Anaphylaxis  Nursing Interventions Assess:  Respiratory/ Cardiac, circulatory status  VS, I/O, Neuro checks  Mental status  Skin  GI status

Anaphylaxis  Nursing Diagnosis Ineffective breathing pattern r/t sudden hypersensitivity reaction AEB edema, bronchospasm, and increased secretions Decreased cardiac output r/t sudden hypersentitivity reaction AEB increased capillary permeability and vascular dilation

Anaphylaxis  Patient Education: Reassurance during procedures Teach patient avoidance of allergens Teach use of medic-alert identification Teach patient preparation and administration of epinephrine subcutaneously

Latex Allergies

 2 types of latex allergies: Type IV (4) contact dermatitis:  Caused by the chemicals used in the manufacturing process of latex gloves A delayed reaction occurring within hrs.  Dryness, pruritis, fissuring, cracking of skin  erythema, edema, and crusting at hrs.

Latex Allergies  Type I allergic reaction:  A response to the natural rubber latex proteins Occurs within minutes of contact with the proteins Reactions can range from: skin erythema, urticaria, rhinitis, conjunctivitis, or asthma  anaphylactic shock

Latex Allergies  Nursing interventions Identification of individuals sensitive to latex -> thorough health hx. Risk factors – long term exposure Additional risk factors: hx. of hay fever, asthma, and food allergies

Latex Allergies  Patient teaching: recommendations for preventing allergic reaction to latex: Use nonlatex gloves for activities that are not likely to involve contact with infectious materials (eg. Food prep, housekeeping) Use powder-free gloves with reduced protein content Do not use oil-based hand creams or lotion when wearing gloves After removing gloves, wash hands with mild soap and dry thoroughly

Latex Allergies  Patient Teaching cont. Frequently clean areas that are contaminated with latex-containing dust Avoid direct contact Wear medic-alert bracelet; carry Epipen  Teach your patient to be proactive in their health care

Transfusion Reactions  A hypersensitivity disorder  Prevention: Careful type and cross-matching Careful storage: refrigerated at specific temperatures until ½ hr. before administration Blood must be administered within 4 hours of refrigeration Blood components: must be administered within 6 hrs of refrigeration

Transfusion Reactions

Transfusion Reaction

 The best method for prevention of transfusion reactions: autologous transfusion- i.e. using one’s own blood for replacement therapy  The blood can be frozen and stored for as long as 3 years

Delayed Hypersensitivity  Reaction occurs hrs. after exposure E.g. delayed contact dermatitis after contact with poison ivy E.g. tissue transplant rejection

Transplant Rejection

Immunodeficiency Disorders

The first evidence of immunodeficiency disease is an increased susceptibility to infection

Immunodeficiency Disorders  Diseases d/t immunodeficiency include: AIDS Agammaglobulinemia Multiple myeloma

Immunodeficiency Disorders  Immunodeficiency disorders are “primary” if the immune cells are improperly developed or absent  “Secondary” if the deficiency is caused by illnesses or treatment.

Immunodeficiency Disorders  Primary Immunodeficiency

Immunodeficiency Disorders  Secondary Immunodeficiency Disorders

Immunodeficiency Disorders