Nursing Care of Patients with Immune Disorders Chapter 19
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Questions and Answers

What is the main categorization of immune disorders?

  • Infectious diseases, inflammatory reactions, and degenerative disorders
  • Hypersensitivity reactions, autoimmune disorders, and immune deficiencies (correct)
  • Neurological disorders, cardiovascular disorders, and musculoskeletal disorders
  • Cancer, genetic disorders, and hormonal imbalances

    • What is anaphylaxis classified as?

  • Infectious disease
  • Autoimmune disorder
  • Hypersensitivity reaction (correct)
  • Immune deficiency

    • What type of reaction involves immune complexes?

  • Cell-mediated reaction
  • Autoimmune reaction
  • Anaphylactic reaction (correct)
  • Delayed reaction

    • What is an example of an inhalant allergen?

    <p>Pollen</p> Signup and view all the answers

    What type of reaction occurs immediately after exposure to an antigen?

    <p>Anaphylactic reaction</p> Signup and view all the answers

    What is required for an anaphylactic reaction to occur?

    <p>Previous exposure to the antigen</p> Signup and view all the answers

    What is an example of an ingestant allergen?

    <p>Food</p> Signup and view all the answers

    How many categories of allergens are listed?

    <p>4</p> Signup and view all the answers

    What is the preferred route for administering an Epi-pen?

    <p>Intramuscularly in the anterior thigh or deltoid</p> Signup and view all the answers

    What is the primary function of dopamine in the treatment of anaphylaxis?

    <p>Increase cardiac output and contractility</p> Signup and view all the answers

    What is the role of antihistamines in the treatment of anaphylaxis?

    <p>Relieve symptoms of an allergic reaction</p> Signup and view all the answers

    What is the primary goal of immediate treatment for anaphylaxis?

    <p>Guided by symptoms</p> Signup and view all the answers

    What should be done after using an Epi-pen?

    <p>Seek medical attention</p> Signup and view all the answers

    How often should the expiration dates of Epi-pens be checked?

    <p>Often</p> Signup and view all the answers

    What is the primary role of corticosteroids in anaphylaxis?

    <p>Decrease severity and recurrence of symptoms</p> Signup and view all the answers

    What patient statement demonstrates effective teaching on the use of an Epi-pen?

    <p>I will seek medical attention immediately after using the Epi-pen.</p> Signup and view all the answers

    What is the typical duration of a severe urticaria and angioedema condition?

    <p>Brief and self-limiting</p> Signup and view all the answers

    What is the type of immune response involved in Type IV reactions?

    <p>Cell-mediated immune response</p> Signup and view all the answers

    What happens during the first exposure to a chemical in contact dermatitis?

    <p>No symptoms occur, but memory cells are formed</p> Signup and view all the answers

    What is the purpose of topical immunomodulators in treating contact dermatitis?

    <p>To reduce the activity of T-lymphocytes</p> Signup and view all the answers

    Why do lymphocytes invade transplanted tissue in transplant rejection?

    <p>Because the transplanted tissue is sensed as foreign</p> Signup and view all the answers

    What is the purpose of immunosuppression therapy in transplant rejection?

    <p>To prevent rejection of the transplanted tissue</p> Signup and view all the answers

    What is the common symptom of severe urticaria and angioedema?

    <p>All of the above</p> Signup and view all the answers

    What is the recommended treatment for contact dermatitis?

    <p>Antihistamines, topical drying agents, and corticosteroids</p> Signup and view all the answers

    What is the primary concern for patients who have undergone a spleenectomy?

    <p>Increased risk of infection</p> Signup and view all the answers

    What is the primary cause of Multiple Organ Dysfunction Syndrome (MODS)?

    <p>Sepsis</p> Signup and view all the answers

    Which patient report requires immediate assessment and intervention by the nurse?

    <p>I noticed that I have developed tiny reddish-purple lesions all over my arms</p> Signup and view all the answers

    What is the term for bleeding under the skin?

    <p>Petechiae</p> Signup and view all the answers

    What lab result should the nurse review prior to the administration of etanercept to a patient with psoriatic arthritis?

    <p>Tuberculin skin test</p> Signup and view all the answers

    What is the primary reason for reviewing the white blood cell count before administering etanercept?

    <p>To monitor for infection</p> Signup and view all the answers

    What is the term for purple spots on the skin?

    <p>Purpura</p> Signup and view all the answers

    What is the primary purpose of educating patients who have undergone a spleenectomy?

    <p>To teach them how to prevent OPSS</p> Signup and view all the answers

    What is the result of infection in autoimmune disorders?

    <p>The immune system destroys healthy cells</p> Signup and view all the answers

    What is the purpose of checking WBC and platelets before giving immunosuppressants?

    <p>To report WBC &lt; 4000</p> Signup and view all the answers

    What is the cause of pernicious anemia?

    <p>Antibodies against gastric parietal cells</p> Signup and view all the answers

    What is the treatment for idiopathic autoimmune hemolytic anemia?

    <p>Immunosuppressive medications and corticosteroids</p> Signup and view all the answers

    What is the characteristic rash of lupus?

    <p>Butterfly rash on the face</p> Signup and view all the answers

    What is the goal of nursing care for patients with lupus?

    <p>To decrease inflammation and prevent organ damage</p> Signup and view all the answers

    What is the purpose of minimizing UV light in lupus treatment?

    <p>To prevent exacerbation of lupus symptoms</p> Signup and view all the answers

    What is the treatment for ankylosing spondylitis?

    <p>Analgesics, anti-inflammatory, and physical therapy</p> Signup and view all the answers

    What is the purpose of administering IgG injections in immune deficiencies?

    <p>To replace deficient immunoglobulins</p> Signup and view all the answers

    What is a potential complication of spleen trauma?

    <p>All of the above</p> Signup and view all the answers

    What is a common symptom of GERD?

    <p>Weight loss</p> Signup and view all the answers

    What should a patient with GERD avoid consuming?

    <p>Alcohol, chocolate, and spicy foods</p> Signup and view all the answers

    What is the purpose of placing a T-tube in the common bile duct?

    <p>To drain bile</p> Signup and view all the answers

    What is the recommended time to take PPIs?

    <p>Late at night</p> Signup and view all the answers

    What is the purpose of fundoplication?

    <p>To prevent acid backup and hiatal hernia</p> Signup and view all the answers

    What is a potential complication of cirrhosis?

    <p>Ascites</p> Signup and view all the answers

    What is the purpose of giving vitamin K to a patient with esophageal varices?

    <p>To reduce bleeding</p> Signup and view all the answers

    What is the normal color of a stoma?

    <p>Pink to beefy red</p> Signup and view all the answers

    What is a characteristic of Asterixis?

    <p>Flapping of hands when arms are extended</p> Signup and view all the answers

    What is the recommended treatment for dumping syndrome?

    <p>Avoid fluids 1 hour before and 2 hours after eating</p> Signup and view all the answers

    What is the purpose of monitoring CBC and liver enzymes?

    <p>To detect any adverse effects of medications</p> Signup and view all the answers

    What is the purpose of giving cytoprotective drugs?

    <p>To protect the stomach lining</p> Signup and view all the answers

    What is the normal progression of a stoma over time?

    <p>It shrinks</p> Signup and view all the answers

    What is the primary assessment for GI perforation?

    <p>Hard rigid board-like abdomen</p> Signup and view all the answers

    What is the treatment for a ruptured appendix?

    <p>IV and antibiotic therapy for 8 hours, followed by surgery</p> Signup and view all the answers

    What is the characteristic of a healthy stoma in an ileostomy or colostomy?

    <p>Pink and moist</p> Signup and view all the answers

    What is the purpose of a t-tube in gallstone surgery?

    <p>To drain the bile duct</p> Signup and view all the answers

    What is the primary concern for patients with an ileostomy or colostomy?

    <p>All of the above</p> Signup and view all the answers

    What is the purpose of encouraging early ambulation in post-operative patients?

    <p>To prevent atelectasis</p> Signup and view all the answers

    What is a common symptom of peptic ulcer disease?

    <p>Heartburn</p> Signup and view all the answers

    What is the primary goal of treatment for peptic ulcer disease?

    <p>Reduce acid production</p> Signup and view all the answers

    What is the term for the inflammation of the GI tract?

    <p>Gastroenteritis</p> Signup and view all the answers

    What is the recommended dietary approach for managing peptic ulcer disease?

    <p>Eat small, frequent meals</p> Signup and view all the answers

    What is the cause of pernicious anemia?

    <p>Vitamin B12 deficiency</p> Signup and view all the answers

    What is the purpose of giving antacids with acute pain?

    <p>To neutralize stomach acid</p> Signup and view all the answers

    Study Notes

    Disorders of Immune System

    • Three categories of immune disorders:
      • Hypersensitivity reactions
      • Autoimmune disorders
      • Immune deficiencies

    Hypersensitivity Reactions

    • Injury to body resulting from its exaggerated response
    • Classified by way tissue injured
    • Four types of hypersensitivity reactions:
      • Anaphylactic reaction
      • Destruction of cell that antigen attached to
      • Involves immune complexes
      • Delayed reaction

    Categories of Allergens

    • Inhalants:
      • Pollens
      • Molds
      • Spores
      • Animal Dander
      • House Dust
      • Mites
    • Contactants:
      • Plants
      • Drugs
      • Metals
      • Cosmetics
      • Dyes
      • Fibers
      • Chemicals
    • Ingestants:
      • Food
      • Food Additives
      • Drugs
    • Injectables:
      • Drugs/Dyes
      • Vaccines
      • Insect Stings

    Anaphylaxis

    • Immediate treatment guided by symptoms
      • IV access is priority
      • Fluids to increase blood pressure
      • Oxygen
      • Epinephrine- IV
      • Antihistamines
      • Corticosteroids
      • Vasopressors- dopamine- IV
      • Mechanical ventilation- respiratory distress

    EpiPen

    • Outer thigh at 90-degree angle at onset of symptoms
    • Hold in place for at least 10 seconds
    • Seek immediate medical attention after use
    • Repeat every 5-15 minutes until symptoms resolve
    • Store in dark place at room temperature
    • Check expiration dates often

    Anaphylaxis Nursing Care

    • Early recognition
    • Emotional support
    • Education
      • Insect repellent
      • Medical alert bracelet
      • Epinephrine pen- can be given SQ or IM

    Type IV Delayed Reaction

    • Delayed reaction- ie. Poison ivy
    • Sensitized T lymphocyte contacts antigen
    • Cell-mediated immune response
    • Necrosis

    Contact Dermatitis

    • Chemical comes in contact with skin
    • First exposure, no symptoms- memory cells formed
    • On second exposure, T cells secrete chemical reaction (histamine→cytokine) that causes itchy rash
    • Poison ivy, poison oak, latex rubber
    • Reddened, pruritic, fragile vesicles

    Contact Dermatitis Treatment

    • Antihistamines
    • Topical drying agents
    • Corticosteroids
    • Tacrolimus (Protopic) and pimecrolimus (Abreva)- topical immunomodulators
    • Tepid baking soda baths or Aveeno baths
    • Wash with brown soap (fels-naptha)
    • Avoid scratching skin

    Transplant Rejection

    • Transplanted living tissue sensed as foreign
    • Lymphocytes sensitized immediately after transplant
    • Sensitized lymphocytes invade transplanted tissue and destroy it
    • Symptoms: Failure of organ or tissue
    • Prevention: Immunosuppression therapy

    Autoimmune Disorders

    • Immune system recognizes body's own cells as foreign
    • Immune response destroys them

    Immunosuppressants

    • Before giving: Check WBC and Platelets
    • Report WBC < 4000
    • Monitor for bleeding- teach soft toothbrush, razors
    • No pregnant patients
    • Use contraception
    • Educate to avoid crowds
    • While on drugs suppressing immunity- no live vaccines – MMR, nasal influenza, ZOSTAVAX--- not Shingrex (inactivated)
    • Flu and pneumovac are okay

    Pernicious Anemia

    • Antibodies against gastric parietal cells lead to decreased production of intrinsic factor
    • Vitamin B12 deficiency
    • RBC production decreased, macrocytic RBC’s
    • Also caused by gastric or small bowel resections
    • DX: Schilling Test- radioactive B 12 given and 24 hour urine measurements done
    • Symptoms: numbness, tingling, weakness, glossitis
    • Treatment: Corticosteroids
    • Lifelong Vitamin B12 IM

    Idiopathic Autoimmune Hemolytic Anemia

    • Autoantibodies attach to RBC’s lyse/clump
    • Unknown reason why it happens
    • Symptoms: Mild fatigue, pallor, severe hypotension, dyspnea, palpitations, jaundice
    • Treatment: Immunosuppressive medications, corticosteroids, folic acid, oxygen, blood transfusions, erythrocytapheresis (remove abnormal RBC- replace with normal RBC), spleenectomy
    • Nursing: Safety issues, cluster care, blood products

    Hashimoto’s Thyroiditis

    • Autoantibodies for thyroid-stimulating hormone, thyroid gland overstimulation
    • Then autoantibodies destroy thyroid, hypothyroidism
    • Thyroid becomes filled with lymphocytes/phagocytes
    • Unknown cause
    • Symptoms: 1st hyper then hypothyroid Symptoms
    • Treatment: Lifelong thyroxine
    • Nursing: rest periods, daily weights, check fluid retention, medication education

    Lupus (SLE)

    • Tend to occur in families, highest in child-bearing females
    • African Americans, Hispanics, Asians, Native Americans
    • Cause is unknown
    • Autoimmune disease- effects Connective Tissue
    • Spontaneous remissions and exacerbations
    • Mild to severe symptoms
    • Butterfly rash over bridge of nose and cheeks- worsens with sun
    • Joint or chest pain, anemia, fatigue, hematuria, etc
    • Can affect joints, skin, kidneys, blood, brain, heart, kidneys
    • Nursing: disturbed body image
    • Treatment focuses on decreasing inflammation and preventing organ damage
    • NSAIDS
    • Antimalarials
    • Corticosteroids
    • Immunosuppressants- hydroxychloroquine
    • Human Monoclonal Antibody- decrease B lymphocytes

    Ankylosing Spondylitis

    • Chronic progressive inflammatory disease of sacroiliac, costovertebral, large peripheral joints
    • Lower back stiffness, pain, lordosis, kyphosis, spasms, fatigue, anorexia, weight loss
    • Treatment: No cure, analgesics, anti-inflammatory, physical therapy, surgery
    • Education: ROM frequently, position changes
    • Nursing: pain mgmt, rest periods, ADL assist

    Immune Deficiencies

    • One or more components of immune system completely absent or deficient
    • Hypogammaglobulinemia
    • Absence or deficiency of one or more of 5 immunoglobulins r/t defective B cell function
    • Prone to infections
    • Treatment:
      • Minimizing infections
      • IgG injections
      • Fresh frozen plasma

    Spleen Trauma

    • Past - trauma to spleen- spleenectomy
    • Now - watch and attempt to let spleen heal - last resort
    • Spleenectomy
    • The spleen is a blood filter, so it is very bloody if traumatized

    Side effects after total spleenectomy

    • Sepsis
    • Pulmonary Complications
    • Thrombocytosis
    • Excessive Bleeding during Surgery

    Nursing Care/ Spleen Trauma

    • IV access, fluids, and vital signs
    • Monitor Blood loss- S/S Shock
    • Check for Peritonitis
    • Cullen’s Sign (ecchymosis around umbilicus)
    • Follow up CT Scans
    • Activity limitations
    • Teach how to assess for bleeding
    • After 6 months without complications, then the spleen is considered healed.

    OPSS

    • Overwhelming Post spleenectomy Sepsis Syndrome
    • High risk for infection after having spleen removed
    • Life-long risk of infection, especially in children
    • Risk for infection the highest in the first year after spleenectomy
    • Patients need lots of teaching in order to prevent OPSS
    • Flu/Pneumonia shots
    • Limit exposure to large crowds, etc…

    MODS

    • Multiple Organ Dysfunction Syndrome
    • Cascade of events that leads to organ failure
    • Many times due to
      • Sepsis
      • Trauma

    GERD (Gastroesophageal Reflux Disease)

    • Symptoms: dyspepsia (burning/heartburn), worsened pain while lying down, weight loss, regurgitation, dysphagia, bleeding, and loss of tooth enamel
    • Patient teaching: avoid bedtime snacks, eat small frequent meals, avoid caffeine, milk products, spicy foods, and citrus
    • Treatment: antacids, H2 blockers (e.g. tidine), and PPI (Prazole)
    • Lifestyle modifications: drink fluids between meals, avoid lying down after eating, and elevate the head of the bed (HOB) 4-6 inches

    Cholecystectomy (Gallbladder Removal)

    • Surgical procedure: laparoscopy and T-tube placement in the common bile duct
    • Post-operative care: monitor drainage (yellowish-brown color), keep tube under the surgical site, and turn off suction to assess bowel sounds
    • Patient teaching: avoid atelectasis by taking deep breaths and coughing only when medicated, and encourage early ambulation
    • Complications: impaired gas exchange and fluid deficit

    Cirrhosis

    • Symptoms: RUQ pain, fatigue, and ascites (fluid accumulation in the abdomen)
    • Patient teaching: limit activity, rest, and decrease fluid intake
    • Treatment: diuretics (e.g. Lasix) to reduce abdominal swelling, and paracentesis for ascites
    • Complications: encephalopathy ( Asterixis, confusion, and increased ammonia levels)

    Liver Biopsy

    • Procedure: left side lying position during biopsy, and right side lying position post-operatively
    • Complications: bleeding and encephalopathy

    Esophageal Varices

    • Treatment: vasoconstrictors (e.g. Propranolol) to decrease varices, and vitamin K for clotting
    • Patient care: protect airway, monitor vital signs, and maintain a side-lying position

    GI Perforation

    • Assessment: hard, rigid board-like abdomen, abdominal pain radiating to the shoulder, restlessness, and apprehension
    • Treatment: avoid applying heat, and consider surgical intervention

    Appendicitis

    • Symptoms: located in the RLQ, positive McBurney's point (pain in RLQ when touched), Rovsig's point (pain in LLQ when RLQ palpated), rebound tenderness, and radiating pain
    • Treatment: IV and antibiotic therapy, and surgical intervention
    • Complications: perforation and peritonitis

    Gallstones

    • Symptoms: same as cholecystectomy
    • Treatment: laparoscopy and T-tube placement in the common bile duct
    • Patient teaching: same as cholecystectomy

    Ileal Conduit/Colostomy

    • Procedure: removal of the colon, and creation of an ileostomy or colostomy
    • Stoma care: monitor for pink, moist, and healthy stoma, and check for discoloration and abnormalities every 8 hours
    • Diet: eat small, frequent meals, and avoid fatty foods, seeds, and broccoli
    • Complications: impaired gas exchange and fluid deficit

    Gastroenteritis

    • Definition: inflammation of the GI tract
    • Types: autoimmune (Chronic Type A) and PUD (Chronic Type B)
    • Symptoms: heartburn, belching, sour taste, nausea, and vomiting
    • Treatment: PPI and 2 antibiotics

    Peptic Ulcer Disease (PUD)

    • Symptoms: gut pain 1-2 hours after meals, radiating to the shoulder area, and weight loss
    • Treatment: PPI and 2 antibiotics
    • Complications: perforation, hard, rigid abdomen, and bleeding

    Medication Classification and Patient Teaching

    • Antacids: neutralize stomach acid, take 1 hour before or after meals, and not with other medications
    • H2 blockers (e.g. tidine): decrease acid production, take 30 minutes before meals, and can cause confusion
    • PPI (e.g. Prazole): prevents final transportation of hydrogen ions, take in the morning, and can cause bone breakdown
    • Cytoprotective drugs (e.g. pepto-bismol, sucralfate): used as a bandaid, take on an empty stomach, and can cause constipation and abdominal discomfort

    Ostomy Assessments

    • Vital signs: monitor for pink, moist, and healthy stoma
    • Skin around the stomach: monitor for irritation
    • Stoma shrinks over time, which is normal

    Dumping Syndrome

    • Definition: rapid entry of food into the jejunum
    • Symptoms: dizziness, increased heart rate, sweating, nausea, abdominal cramps, and diarrhea
    • Treatment: avoid fluids 1 hour before and 2 hours after eating

    Fundoplication

    • Procedure: wraps the upper part of the stomach around the esophagus to form a collar-like structure
    • Goal: prevent acid back-up and air hiatal hernia
    • Post-operative care: elevate the head of the bed (HOB) 6-10 days, and monitor for dysphagia

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    Description

    This quiz covers the nursing care of patients with immune disorders, including hypersensitivity reactions, autoimmune disorders, and immune deficiencies.

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