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

2. DISORDERS OF THE IMMUNE SYSTEM Lecture 2

3. 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

7. Disorders of the Immune System  Hypersensitivity disorders - Allergies

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

9. Assessment  seasonal

10. Most important diagnostic tool: a thorough history

11. 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)

12. 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

13. Medical Management  Avoid the allergen  And Symptom management

14. Immune Response

15. Medications

16.  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

17. Other meds: Corticosteroids Bronchodilators

18. 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

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

20. Anaphylaxis

22.  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

23. Anaphylaxis

24. Anaphylaxis – Medical Management  Immediate, aggressive treatment  At the first sign, administer 0.2-0.5ml epinephrine (1:1000 dilution) subcutaneously for mild reaction  For severe reaction, Epinephrine 1:10,000 dilution 0.5ml IV at 5-10min intervals  Benadryl 50-100mg 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

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

26. 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

27. 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

28. Latex Allergies

29.  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 6- 48 hrs.  Dryness, pruritis, fissuring, cracking of skin  erythema, edema, and crusting at 24 -48 hrs.

30. 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

31. 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

32. 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

33. 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

34. 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

35. Transfusion Reactions

37. Transfusion Reaction

38.  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

39. Delayed Hypersensitivity  Reaction occurs 24-72 hrs. after exposure E.g. delayed contact dermatitis after contact with poison ivy E.g. tissue transplant rejection

40. Transplant Rejection

42. Immunodeficiency Disorders

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

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

45. 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.

46. Immunodeficiency Disorders  Primary Immunodeficiency

47. Immunodeficiency Disorders  Secondary Immunodeficiency Disorders

48. Immunodeficiency Disorders