Transcript August 11, 2014 - Immune system

Immune System & Oncology
Nursing Care
PN 143 – Lecture 2
Rebecca Maier, BSN
Lecture 2
DISORDERS OF THE IMMUNE
SYSTEM
Disorders of the Immune System
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Hypersensitivity
(the thing)
response directed against
non-self antigens that are not
pathogenic
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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
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Hypersensitivity disorders Allergies
Physical assessment of the immune
system involves predominantly
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the following systems:
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Integumentary
Gastrointestinal
Respiratory
Cardiovascular
Assessment
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seasonal
Most important diagnostic tool: a
thorough history
Diagnostic Tests-Common laboratory studies:
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CBC
Skin Testing
Total serum IgE levels
Specific IgE level for a particular
allergen maybe ordered – i.e. RAST,
(radioallergosorbent test)
Other Diagnostic Tests
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ANA
Total complement,
C3 & C4
CRP
CD4 T-Cells
ELISA
ESR
HLA-DW4
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LE Prep
PCR
RBC *
RF
Total White Blood
Cell count w/
differential *
Western Blot
Medical Management
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Avoid the allergen
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And Symptom management
Immune Response
Medications
Medications
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Leukotriene Inhibitors:
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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
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Bronchodilators
Nursing Diagnosis
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For patients with hypersensitivity
disorder includes:
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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
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Patient and diagnosis specific
Avoid exposure to allergen
Tx Plan
Self care
Anaphylaxis
Anaphylaxis
Anaphylaxis
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Assessment: Early recognition
early treatment!
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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
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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
Anaphylaxis
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Nursing Interventions
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Assess:
Respiratory/ Cardiac, circulatory status
 VS, I/O, Neuro checks
 Mental status
 Skin
 GI status
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Anaphylaxis
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Nursing Diagnosis
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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
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Patient Education:
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Reassurance during procedures
Teach patient avoidance of allergens
Teach use of medic-alert identification
Teach patient preparation and
administration of epinephrine
subcutaneously
Latex Allergies
Latex Allergies
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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 648 hrs.
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Dryness, pruritis, fissuring, cracking of
skin erythema, edema, and crusting at
24 -48 hrs.
Latex Allergies
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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
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Nursing interventions
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Identification of individuals sensitive to
latex -> thorough health hx.
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Risk factors – long term exposure
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Additional risk factors: hx. of hay fever,
asthma, and food allergies
Latex Allergies
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Patient teaching: recommendations for
preventing allergic reaction to latex:
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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
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Patient Teaching cont.
 Frequently clean areas that are
contaminated with latex-containing dust
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Avoid direct contact
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Wear medic-alert bracelet; carry Epipen
Teach your patient to be proactive in their
health care
Transfusion Reactions
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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 Reactions
Transfusion Reaction
Transfusion Reaction
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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
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Reaction occurs 24-72 hrs. after
exposure
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E.g. delayed contact dermatitis after
contact with poison ivy
E.g. tissue transplant rejection
Transplant Rejection
Transplant Rejection
Immunodeficiency Disorders
Immunodeficiency Disorders
• The first evidence of
immunodeficiency disease is an
increased susceptibility to infection
Immunodeficiency Disorders
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Diseases d/t immunodeficiency
include:
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AIDS
Agammaglobulinemia
Multiple myeloma
Immunodeficiency Disorders
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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
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Primary Immunodeficiency
Immunodeficiency Disorders
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Secondary Immunodeficiency
Disorders
Immunodeficiency Disorders