Burgess Nursing Care Chapter 19: Immune Disorders

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Questions and Answers

Which of the following best describes an example of a Type IV hypersensitivity reaction?

Hemolytic transfusion reaction

Anaphylaxis

Urticaria

Contact dermatitis (correct)

What is a likely result of pernicious anemia due to immune system action?

Increased vitamin B12 absorption

Destruction of stomach parietal cells (correct)

Excessive red blood cell production

Normal intrinsic factor levels

Which autoimmune disorder is characterized by the immune system attacking the body's own thyroid tissue?

Multiple Sclerosis

Rheumatoid Arthritis

Systemic Lupus Erythematosus

Hashimoto Thyroiditis (correct)

Which of the following antibodies is typically detected for diagnosing pernicious anemia?

Intrinsic factor antibodies (C) Signup and view all the answers

What is a common symptom associated with pernicious anemia?

Confusion (D) Signup and view all the answers

What differentiates Hashimoto Thyroiditis from other autoimmune diseases?

It causes both hyperthyroidism and hypothyroidism. (B) Signup and view all the answers

Which of the following lab findings would most likely indicate Idiopathic Autoimmune Hemolytic Anemia?

Elevated LDH and serum bilirubin levels. (A) Signup and view all the answers

Which symptom is commonly associated with Systemic Lupus Erythematosus?

Butterfly rash. (C) Signup and view all the answers

What is the primary goal of the treatment for Ankylosing Spondylitis?

Management of pain and inflammation. (B) Signup and view all the answers

What significant change in the immune response occurs in Immune Deficiencies?

There is an absence or deficiency in immune components. (C) Signup and view all the answers

Which treatment option is used for managing symptoms in Systemic Lupus Erythematosus?

Corticosteroids. (C) Signup and view all the answers

Which population group is most affected by Hashimoto Thyroiditis?

Middle-aged females. (D) Signup and view all the answers

In which way does the immune response manifest in Systemic Lupus Erythematosus?

Through excessive antibody production that leads to immune complex formation. (D) Signup and view all the answers

What effect does the presence of the HLA B27 antigen have in Ankylosing Spondylitis?

It stimulates an immune response leading to inflammation of the spine. (D) Signup and view all the answers

What is a common nursing intervention for patients experiencing flares in Systemic Lupus Erythematosus?

Limiting activity and advocating rest. (A) Signup and view all the answers

What is the role of Coombs test in diagnosing Idiopathic Autoimmune Hemolytic Anemia?

To determine if antibodies are attached to RBCs. (B) Signup and view all the answers

Which dietary precaution should be taken by patients with Hashimoto Thyroiditis?

Reduce iodine intake. (C) Signup and view all the answers

Which of the following is a characteristic feature of back pain associated with Ankylosing Spondylitis?

Pain that improves with rest. (B) Signup and view all the answers

Which of the following treatments is aimed at increasing RBC production in patients with Idiopathic Autoimmune Hemolytic Anemia?

Folic acid supplementation. (D) Signup and view all the answers

What is the primary cause of vitamin B12 deficiency in pernicious anemia?

Destruction of stomach parietal cells by antibodies (B) Signup and view all the answers

Which type of hypersensitivity reaction is characterized by an immune response involving antibodies directing against cellular antigens?

Type II (C) Signup and view all the answers

Which of the following is NOT a symptom of pernicious anemia?

Excessive bruising (D) Signup and view all the answers

In the context of autoimmune disorders, which of the following statements is true regarding the immune response?

Normal body antigens may be misidentified as foreign, triggering an immune response. (B) Signup and view all the answers

Which of the following autoimmune disorders involves an immune response resulting in damage to the myelin sheath surrounding nerves?

Multiple Sclerosis (D) Signup and view all the answers

What process is primarily responsible for the symptoms experienced in Idiopathic Autoimmune Hemolytic Anemia?

Destruction of red blood cells by auto-antibodies (A) Signup and view all the answers

Which lab finding is indicative of Hashimoto Thyroiditis?

Presence of antithyroid antibodies (A) Signup and view all the answers

How does Systemic Lupus Erythematosus primarily affect the body?

It causes organ damage through immune complex formation. (A) Signup and view all the answers

Which treatment for Ankylosing Spondylitis focuses on pain management?

Muscle relaxants (C) Signup and view all the answers

What contributes to the transformation from hyperthyroidism to hypothyroidism in Hashimoto Thyroiditis?

Destruction of thyroid cells by autoantibodies (B) Signup and view all the answers

Which symptom is least commonly associated with Systemic Lupus Erythematosus?

Bacterial infections (A) Signup and view all the answers

What is the primary role of the Coombs test in diagnosing Idiopathic Autoimmune Hemolytic Anemia?

To detect the presence of auto-antibodies on red blood cells (B) Signup and view all the answers

What characteristic symptom of Ankylosing Spondylitis improves with activity?

Back stiffness and pain (A) Signup and view all the answers

Which of the following is a recommended nursing intervention for patients with Systemic Lupus Erythematosus?

Minimize sun exposure with protective measures (A) Signup and view all the answers

Which condition is characterized by an abnormal immune response leading to inflammation and damage to connective tissues?

Systemic Lupus Erythematosus (C) Signup and view all the answers

What complication is associated with Idiopathic Autoimmune Hemolytic Anemia due to vessel occlusions?

Ischemic stroke (B) Signup and view all the answers

Which parameter is commonly chosen for the diagnosis of Hashimoto Thyroiditis?

Immunofluorescent assay results (B) Signup and view all the answers

How is the immune response altered in Immune Deficiencies?

It is unable to combat infectious agents effectively. (A) Signup and view all the answers

What is a typical clinical presentation in patients with Hashimoto Thyroiditis?

Fatigue and weight gain (C) Signup and view all the answers

Which type of hypersensitivity reaction is associated with the anaphylactic response?

Type I (C) Signup and view all the answers

Which autoimmune disorder is primarily characterized by the destruction of the stomach's parietal cells?

Pernicious Anemia (A) Signup and view all the answers

What is a common laboratory finding in patients diagnosed with pernicious anemia?

Macrocytic red blood cells (C) Signup and view all the answers

In autoimmune disorders, what mechanism leads to the recognition of self-antigens as foreign?

Failure of self-tolerance (B) Signup and view all the answers

Which of the following conditions is classified under Type III hypersensitivity reactions?

Serum Sickness (C) Signup and view all the answers

What is a characteristic symptom of Idiopathic Autoimmune Hemolytic Anemia?

Hypotension (B) Signup and view all the answers

Which immunological response is primarily responsible for the symptoms of Systemic Lupus Erythematosus?

Development of abnormal autoantibodies (C) Signup and view all the answers

What laboratory test is used to confirm Hashimoto Thyroiditis?

Immunofluorescent assay (A) Signup and view all the answers

In Ankylosing Spondylitis, which part of the body is primarily affected?

Sacrum and lower back (D) Signup and view all the answers

Which treatment option is often employed for managing symptoms of Systemic Lupus Erythematosus?

Corticosteroids (A) Signup and view all the answers

What is the main goal of nutrition management in patients with Hashimoto Thyroiditis?

Avoid foods high in iodine (D) Signup and view all the answers

Which symptom is associated with the progression to hypothyroidism in Hashimoto Thyroiditis?

Facial puffiness (B) Signup and view all the answers

What type of anemia is characterized by fragments of RBCs in circulation?

Idiopathic Autoimmune Hemolytic Anemia (A) Signup and view all the answers

Which of the following is a common complication to monitor in patients with Systemic Lupus Erythematosus?

Acute kidney injury (B) Signup and view all the answers

What is a common characteristic of the pain associated with Ankylosing Spondylitis?

Improves with activity (D) Signup and view all the answers

Which of the following is a potential environmental trigger for Hashimoto Thyroiditis?

Bacterial or viral infections (A) Signup and view all the answers

Which intervention is critical for nursing care in patients with Systemic Lupus Erythematosus?

Monitoring for signs of renal failure (A) Signup and view all the answers

In the context of Idiopathic Autoimmune Hemolytic Anemia, what is the result of vessel occlusions?

Potential organ damage (C) Signup and view all the answers

Study Notes

Nursing Care of Patients with Immune Disorders

This chapter (19) covers nursing care for patients with immune system disorders.
Immune system disorders are categorized into hypersensitivity reactions, autoimmune disorders, and immune deficiencies.

Disorders of the Immune System

Hypersensitivity Reactions: The immune system reacts excessively, causing injury to the body.
- Gell and Coombs classifications are used to categorize these reactions.
  - Type I: Allergic rhinitis, atopic dermatitis, anaphylaxis, urticaria, angioedema
  - Type II: Hemolytic transfusion reaction
  - Type III: Serum sickness
  - Type IV: Contact dermatitis, transplant rejection
Autoimmune Disorders: Body's immune system mistakenly attacks its own cells.
- Examples include: Pernicious Anemia, Idiopathic Autoimmune Hemolytic Anemia, Systemic Lupus Erythematosus, Hashimoto Thyroiditis, Ankylosing Spondylitis, Immune Thrombocytopenia, Multiple Sclerosis, Myasthenia Gravis, Rheumatoid Arthritis, and Ulcerative Colitis.
Immune Deficiencies: One or more components of the immune system are absent or deficient.
- The body cannot effectively combat infections.
- Examples include hypogammaglobulinemia, which can be congenital or acquired and is characterized by a deficiency in one or more immunoglobulins (Igs).

Pernicious Anemia

Immune system attacks stomach parietal cells.
Disrupts intrinsic factor production.
Leads to vitamin B12 deficiency and insufficient/deformed red blood cells (RBCs) with poor oxygen-carrying capacity.
Symptoms: Weakness, loss of appetite, glossitis, pallor, irritability, confusion, peripheral neuropathy.
Diagnosis: Macrocytic (enlarged) cells under a microscope, low cobalamin levels, intrinsic factor and parietal cell antibodies.
Treatment: Corticosteroids, vitamin B12 replacement for life.

Idiopathic Autoimmune Hemolytic Anemia

Body produces auto-antibodies for no known reason, attacking red blood cells (RBCs).
RBCs are lysed (broken) or clumped, leading to circulating fragments in vessels or vessel occlusions.
Symptoms vary from mild to severe, including fatigue, pallor, hypotension, dyspnea, palpitations, headaches, jaundice, and difficulty concentrating.
Diagnosis: Low RBC count, hemoglobin/hematocrit, fragmented RBCs, elevated LDH and serum bilirubin, Coombs test to identify antibodies attached to RBCs.
Treatment: Oxygen, folic acid, intravenous immunoglobulin (IVIG), immunosuppressants, corticosteroids, erythrocytapheresis, and splenectomy.

Hashimoto Thyroiditis

Autoantibodies form against thyroid-stimulating hormone (TSH) receptors.
Binding to receptors stimulates the thyroid gland, leading to hyperthyroidism.
Inflammation in the thyroid gland caused by lymphocytes and phagocytes.
Later, different autoantibodies destroy thyroid cells, resulting in hypothyroidism which slows secretion activity.
Common in middle-aged females and people with Down or Turner syndromes.
Symptoms: hyperthyroidism - restlessness, tremors, chest pain, increased appetite, diarrhea; hypothyroidism in progression- goiter, fatigue, bradycardia, hypotension, dyspnea, anorexia, constipation, dry skin, weight gain, sensitivity to cold, facial puffiness, slowed mental processes.
Diagnosis: Immunofluorescent assay for antithyroid antibodies, elevated TSH, low T3 and T4.
Treatment: Thyroid hormone (thyroxine) replacement (levothyroxine).
Nursing care involves soft diet, daily weights/I/O, limiting foods high in iodine, and taking levothyroxine 4 hours after iron-containing medications or antacids.

Systemic Lupus Erythematosus (SLE)

Chronic systemic inflammatory disease.
Spontaneous remissions and exacerbations.
Body makes antibodies against itself, causing immune complex formation affecting connective tissues, vascular system, and organs. Leads to inflammation, damage, and possibly death.
Risk factors include genetic link, ethnicity (Black, Asian, Hispanic, American Indian) and females more than men, ages 15-44.
Symptoms: mild to severe, affects nearly all systems, butterfly rash over nose and cheeks (less than half of patients), discoid skin lesions, exacerbations/flares triggered by hormones, stress, or infection.
Diagnosis: Biopsy of skin lesions, elevated ESR, abnormal ANA titers (antibody tests), anti-double stranded DNA, anti-Smith antibodies.
Treatment: Treat symptoms (NSAIDs), immunosuppressants, corticosteroids, IVIG, belimumab/Benlysta (decreases autoantibody production), new developing gene therapy.
Nursing interventions to prevent exacerbations include sun protection, ADLs assistance, pain management, and monitoring for complications (emboli, vasculitis).

Ankylosing Spondylitis

Chronic progressive inflammatory disease impacting the spine and sacroiliac area, ribs, and large limb joints.
Begins in lower spine and progresses upward.
HLA B27 antigen stimulates an immune response, creating new bone formation at the inflamed area (bamboo spine).
Common in men more than women.
Diagnosed between late teens and 40s.
Symptoms: Back stiffness, pain improved with activity, lordosis and kyphosis, fatigue, anorexia, and weight loss.
Diagnosis: X-rays.
Treatment: No cure, pain management, muscle relaxants, anti-inflammatories, physical therapy, anti-tumor necrosis factor (TNF-α).

Immune Deficiencies

One or more components of the immune system are completely absent or deficient.
Body cannot elicit or sustain an adequate immune response, making the patient susceptible to infections.
Hypogammaglobulinemia (congenital or acquired): Deficient in one or more immunoglobulins (Igs), increasing the risk of infection.
Treatment involves increasing immune function with IVIG (intravenous immunoglobulin).

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This quiz focuses on the nursing care required for patients with immune system disorders, as outlined in Chapter 19. It encompasses hypersensitivity reactions, autoimmune disorders, and immune deficiencies, providing a comprehensive overview of patient care for these conditions.