Transcript Autoimmune Diseases

Autoimmune
Disorders and
Diseases
AUTOIMMUNE DISORDERS
• Autoimmune: development of an
immune response to one’s own
tissues
– An “immune attack” on the self
– Failure to distinguish ‘self’ protein
from ‘foreign’ protein
• For some unknown reason,
immune cells that are normally
unresponsive (i.e. tolerant to selfantigens) are activated
AUTOIMMUNE DISORDERS
• Disorders include: pernicious anemia, GuillainBarre’ syndrome, scleroderma, rheumatic fever,
RA, myasthenia gravis, MS, autoimmune
hemolytic anemia, Type 1 diabetes,
glomerulonephritis, SLE
AUTOIMMUNE DISORDERS
• Treatment
• Plasmapheresis: the removal of plasma that
contains components causing or thought to
cause disease
• When plasma is removed, it is replaced by
substitution fluid (e.g. saline or albumin). “plasma
exchange”.
• In autoimmune disorders, the rationale is to
remove pathologic substances present in the
plasma
AUTOIMMUNE DISORDERS
• Nursing responsibilities with
plasmapheresis:
– Most common complications are
hypotension or citrate toxicity
• Hypotension is usually the result of
vasovagal reaction or transient volume
changes
• Citrate is used as an anticoagulant and may
cause hypocalcemia
Autoimmune Diseases
• Includes: rheumatoid arthritis,
systemic lupus erythematosus,
myasthenia gravis, addison’s
disease, crohn’s disease, multiple
sclerosis, etc.
Rheumatoid Arthritis (RA)
• RA is a chronic disease characterized by
joint stiffness
• Cause is unknown but seems to be a
genetic predisposition
•
• Immune complexes are formed within the
joint  inflammation, swelling and deformity
• Pattern of joint involvement is symmetrical
Rheumatoid Arthritis (RA)
• Thickening of synovial fluid leads to
calcification, joint pain, limited
mobility, and deformity
• Damage to bone begins within the first
two years of the onset of RA
• May have periods of Remissions and
Exacerbations
Med/Surg Mgmt of RA
• Medical
o Reduce inflammation, relieve pain,
maintain normal joint function, and
promote general good health
o Therapeutic regimen includes meds, rest,
hot and cold applications, and stress
management
o Diet
o Nutritious, well balanced diet w/ foods
high in iron when RBCs are low
Med/Surg Mgmt of RA
• Surgical
– Hip, knee and finger joints may be
replaced
• Pharmacological
– NSAIDS & Salicylates may relieve pain, but
do not control the disease
– Deltasone, Gold Salts, Azulfidine, Imuran,
Plaquenil, Depen or Rheumatrex may be
used
– May have serious side effects
Med/Surg Mgmt of RA
• Activity
– PT and OT are part of the therapeutic
team
– ROM, resting splints, and assistive devices
are often used
RA Nursing Process
• Nursing Management
– Encourage relaxation techniques, warm
showers, and planned rest periods
– Emphasize importance of doing ROM
several times daily
RA Assessment
• Subjective
– Client hx reveals a gradual development
of symptoms beginning initially w/ early
a.m. stiffness and pain in finger joints
– Eventually other joints involved
– Fatigue, muscle weakness, malaise and
loss of appetite develop
– Obtain information about remissions and
exacerbations
RA Nursing Process
• Objective
– Skin may show presence of ulcers and
rheumatoid nodules
– Eye tissue may be inflamed
– Reduction in tear and saliva production
can occur (Sjogren’s Syndome)
– May have weight loss and elevated
temperature
– X-rays demonstrate the amount and
degree of deformity
RA Nursing Process
• Hands may reveal the classic
deformities associated w/ RA:
•Boutonniere deformity
•Ulnar drift
•Swan-neck deformity
RA Labs
• No specific lab test confirms RA
though alterations in the following may
occur:
– RBC’s decrease as disease
progresses
– Elevation of:
•WBCs
•ESR
•ANA
•CRP
•Platelet count
SLE (Systemic Lupus
Erythematosus)
• A chronic, progressive, incurable
disease affecting multiple body organs
• Characterized by remissions and
exacerbations
• Occurs most commonly in women
during childbearing years
• 2-3 times more common in African Americans
SLE
• Abnormal B-lymphocyte cells produce
“auto-antibodies” that destroy body
cells
• Immune complexes are formed and
circulate in serum causing
inflammation in the skin, brain, kidney,
lung, heart or joints
• If 4 or more established criteria are
present, diagnosis of SLE is confirmed
SLE Medical-Surgical Management
• Medical
– Treatment aimed at decreasing
tissue inflammation and destruction
– Client can assist in controlling the
disease by:
•Stress management
•Rest
•Exercise
•Taking medications as prescribed
SLE (Systemic Lupus Erythematosus)
Medical-Surgical Management
• During acute exacerbations, plasmapheresis
may be used
• SLE clients are carefully monitored for renal,
cardiac, pulmonary, hematological and
neurological damage
• Large percentage of clients eventually have
renal failure, requiring dialysis to maintain life
SLE Medical-Surgical Management
• Pharmacological
– NSAIDs are used for joint and muscle pain
– Lowest possible doses of corticosteroid is
used to suppress immune system activity
– Higher doses may be required during
periods of exacerbations
SLE Med-Surg Management
• Pharmacological cont.
– Plaquenil sulfate is used to treat side
effects; can lead to development of
retinal toxicity
– Cytoxan or Imuran may be used for
severe SLE
SLE
Medical-Surgical Management
• Diet
– Low in sodium and glucose & high in
potassium due to effects from
corticosteroids
– Discourage excessive fluid intake
• Activity
– Sleep at least 8 hours at night, schedule
rest during the day
– Regular exercise helps prevent muscle
weakness and fatigue
SLE Nursing Process
• Nursing Management
– Teach client importance of avoiding
direct sunlight and the use of protective
clothing and sunscreen
– Encourage client to balance rest &
activity and to eat a balanced diet with
low sodium
– Emphasize signs of exacerbation and
early signs of infection
SLE Nursing Assessment
– Subjective
• Ask when disease began, what symptoms
have developed, and how they have been
treated
• Note medications and side effects, and
degree of fatigue
• Determine client’s understanding of disease
and how they are coping
• Client may describe malaise,
photosensitivity, pain in joints, irregular
menses, irritability, confusion, hallucinations
SLE - Medical-Surgical Management
• Nursing Process Assessment
– Objective Data
• Head to toe assessment
SLE
Most Common Objective Findings
– Joint swelling
and pain
– Fever
– Swollen
glands
– N/V
– Anorexia
– Hypertension
– Respiratory
and cardiac
infections
– Renal
infections
– Enlarged liver
and spleen
– Skin lesions,
especially
“butterfly
rash”
– Raynauds
phenomenon
may develop
with exposure
to cold
SLE (Systemic Lupus Erythematosus)
Medical-Surgical Management
• Labs
– Frequently reveal serum ANA and antiDNA antibodies
– LE cells are present in most cases
– Anemia, leukopenia, and
thrombocytopenia are evident
Myasthenia Gravis (MG)
• Autoimmune disease characterized
by extreme muscle weakness due to
the body’s inability to transmit nerve
impulses to voluntary muscles
Myasthenia Gravis
• It is thought that MG clients develop
antibodies that act to decrease the
number and effectiveness of
acetylcholine receptor sites at
neuromuscular junctions
• Voluntary muscles are most
commonly involved
Myasthenia Gravis (MG)
• In mild conditions known as Group I
ocular myasthenia, only the eye
muscles are involved
Myasthenia Gravis (MG)
• As severity increases, symptoms of
Group II generalized myasthenia
develop
• Facial, neck, skeletal, and respiratory
muscles become affected
• Periods of remission and
exacerbation occur
Myasthenia Gravis (MG)
• Three possible complications:
– Respiratory distress, such as dyspnea,
tachypnea, tachycardia, and diaphoresis
– Myasthenia crisis is an acute
emergency; muscle weakness, difficulty
swallowing, chewing, or talking, and
respiratory distress
– Cholinergic crisis is a result of an
overdose of anticholinesterase
medications
MG Med/Surg Management
• Medical
– Use of anticholinesterase medications
and plasmapheresis
– Used primarily for acute crisis or no
response to drug therapy or prior to a
thymectomy
MG Med/Surg Management
• Surgical
– Removal of the thymus gland has shown
the best results in young people early in
the course of the disease
MG Med/Surg Management
• Pharmacological
– Anticholinesterase medications such as
Mestinon, Prostigmin, and Mytelase are
prescribed
– Individual dosages must be determined
– Steroids also prescribed to slow down
immunological response
MG Med/Surg Management
• Diet
– Encourage clients to eat a snack before
taking anticholinesterase medications
– Diet may need adjustment with chewing
and swallowing difficulties
• independent
MG Med/Surg Management
• Activity
– Client should avoid excessive muscular
activity and rest periodically throughout
the day
– ROM exercises, braces, splints, and
walkers assist in keeping the client
MG Med/Surg Management
• Nursing Management
– Teach client airway protective
techniques
– Encourage client to change daily activity
pattern, and ROM exercises
– Emphasize need to see physician at first
sign of upper respiratory infections
MG Nursing Process
• Objective Data
• Must access level of muscle groups
affecting the eyes, face, neck, and
chest
– Look for Diplopia – double vision
– Look for ptosis – drooping upper eyelids
– Look for facial symmetry
MG Nursing Process
• Objective Data
– Note chewing or swallowing problems
– Vocal tones and breath sounds should
be assessed
– Level of weakness in arm and leg
muscles as well as breathing muscles
should all be noted
MG Nursing Process
• Objective Data cont.
– Ach receptoros antibody and LE cell
tests are often positive
– X-rays and CT scans detect enlargement
of thymus
– EMG determines extent of muscle
damage
Matching (?)
1. Crohn’s Disease
2. Graves’ Disease
3. Systemic Lupus
Erythematosus
4. Multiple Sclerosis
5. Rheumatoid
Arthritis
A.
B.
C.
D.
Skeletal System
Nervous System
Digestive System
Integumentary
Systems
E. Endocrine Gland