Understanding Hypersensitivity and Systemic Lupus Erythematosus PDF

Understanding Hypersensitivity and Systemic Lupus Erythematosus Study online at https://quizlet.com/_g5bm4o Overreaction of immune system to for- Hypersensitivity eign...

Understanding Hypersensitivity and Systemic Lupus Erythematosus Study online at https://quizlet.com/_g5bm4o Overreaction of immune system to for- Hypersensitivity eign agents. Chronic autoimmune disease affecting Systemic Lupus Erythematosus (SLE) multiple body systems. Immunocompromised Ineffective Immune System Immune system attacks the body's own Autoimmune Disorders tissues. Incompetent immune system unable to Immunodeficiency respond effectively. Immediate allergic reaction mediated by IgE antibodies. localized or systemic Type I Hypersensitivity Antibodies bind to cells releases substances inflammation Asthma, allergic rhinitis, food allergies Cytotoxic reaction targeting specific tis- sues. : tissue-specific reaction Type II Hypersensitivity Antibodies activates system that caus- es tissue damage Transfusion reaction, hemolytic disease of newborn, ABO incompatibility Immune complex-mediated inflamma- tion in tissues. Immune-complex-mediated reaction Type III Hypersensitivity Immune complexes deposited in tis- sues - inflammatory reaction Serum sickness, acute glomeru- lonephritis Delayed cell-mediated immune re- sponse to antigens. Delayed reactions Type IV Hypersensitivity Cell-mediated immune response Antigen stimulates T-cells Contact dermatitis, TB test, GVH 1/9  Understanding Hypersensitivity and Systemic Lupus Erythematosus Study online at https://quizlet.com/_g5bm4o Common hypersensitivity reactions Triggered when allergen interacts with free IgE IgE binds to mast cells and basophils - release histamines Allergens can be ingested in foods, in- Type I Hypersensitivity Etiology and jected, inhaled, absorbed Pathophysiology -Anaphylaxis: acute systemic response Histamine and other mediators released -Localized response is more common Hay fever, Asthma, Atopic dermatitis (eczema), bee stings, food allergies Pharmacotherapy: Non-steroidal anti-inflammatory Antihistamines block histamine recep- tors Steroids impair inflammatory response Theophylline OR Epinephrine keeps mast cells intact reducing Type I Hypersensitivity Treatment: signs/symptoms of bronchospasm Immunotherapy Desensitization (Goal to create hypo-sensitization) Repeated injections of allergen to re- duce the allergic response Allergy injections -swelling, redness, itching skin sensitivity -runny nose Hypersensitivity Type I Signs/Symptoms: -bronchi constrict and spasm -wheezing/crackles May outgrow certain allergies as client ages HS Type I Lifespan and Cultural Consid- -Uncommon to outgrow peanut allergy erations Individuals who develop allergies in adulthood typically have them for rest of their lives 2/9  Understanding Hypersensitivity and Systemic Lupus Erythematosus Study online at https://quizlet.com/_g5bm4o Client will avoid known substances that provoke hypersensitivity response Planning Client will describe self-care to reduce symptoms of seasonal allergies Patient exhibits decreased symptoms Evaluation and decreased frequency of hypersensi- tivity responses -Binding of IgG- or IgM-type with antigen activates a complex cascade of a hyper- sensitivity response Type II Hypersensitivity Etiology and -Destruction of target cell Pathophysiology -Stimulated by antigen Blood transfusion ABO blood types immunosuppressive medications like systemic glucocorticoids Prevention of Transfusion Reaction Prior to blood administration blood is checked by 2 RN's Blood transfusion reaction Type II Hypersensitivity Treatment Stop transfusion of ABO incompatible blood will stop hemolysis Keep IV infusing with NS Call Provider if mild reaction -Rash/itching »Antihistamine Call Rapid Response if major reaction - Bloody urine/pain Results from formation of antibody-anti- gen immune complexes in circulatory system - IgG or IgM Type III Hypersensitivity Etiology and Deposited in capillaries or joints Pathophysiology Antibody-Antigen immune complexes are deposited in organs, activate com- plement cascade, and cause inflamma- 3/9  Understanding Hypersensitivity and Systemic Lupus Erythematosus Study online at https://quizlet.com/_g5bm4o tory damage. Immune complex deposited in small blood vessels of organs and tissues Serum sickness - response to some medications Immune complex deposited in small blood vessels of organs and tissues Type III HS Systemic: Serum sickness - response to some medications Deposited in joints = Arthritis. TYPE III Immune Complex Disease, Lo- Deposited in kidneys = Glomeru- calized disease lonephritis Deposit in connective tissue = SLE -Chronic, inflammatory connective tissue disease -Affects almost all body systems -Manifestations (signs and symptoms) vary widely Systemic lupus erythematosus (SLE) -Autoantibodies created -Caused by deposition of autoanti- body-antigen complexes in connective tissues - Damages cells and tissues Antibodies produced by B cells that mis- takenly attack and destroy "self" cells Autoantibodies belonging to the patient; autoantibodies are the pathophysiologic agent of most autoimmune disorders -Immune system loses ability to distin- guish self from others autoimmune disorders/diseases charac- -Attacks own body teristics -Results from hyper-activity of B cells -Most cases diagnosed in teen, early adult years 4/9  Understanding Hypersensitivity and Systemic Lupus Erythematosus Study online at https://quizlet.com/_g5bm4o autoantibodies react with corresponding antigen -Form immune complexes -Deposited into connective tissue Systemic lupus erythematosus (SLE) -Deposits trigger inflammatory response Pathophysiology and Etiology -Local tissues damaged -Sites of deposition kidney, musculoskeletal system, brain, heart, spleen, lung, GI tract, skin, peri- toneum Women of childbearing age -90% of diagnoses More common: SLE Risk Factors: -African American -Hispanic -Native Americans -Asians -Mild in most patients -Periods of remission and exacerbation -Number, severity of exacerbations tend to decrease with time Early manifestations SLE Clinical Manifestations: -joint pain (mimic those of Rheumatoid Arthritis) Red butterfly rash across cheeks, bridge of nose Diffuse, maculopapular rash on skin ex- posed to sun Anti-DNA antibody testing - specific indi- cator of SLE: antibodies are rarely found in any other disorder Erythrocyte sedimentation rate (ESR)- increased due to inflammation 100 SLE Diagnostic Tests: mm/hr -(normal range15 - 30 mm/hr) CBC - anemia and/or leukopenia Urinalysis - Proteinuria during exacer- bation of SLE when kidneys are involved 5/9  Understanding Hypersensitivity and Systemic Lupus Erythematosus Study online at https://quizlet.com/_g5bm4o Skin, arthritic manifestations -Antimalarial drugs (Hydroxychloro- quine) -treats rash -Corticosteroids SLE Drug Therapy: Severe, life-threatening manifestations -High-dose corticosteroid therapy Initially 40-60 mg/day prednisone Tapered as soon as clinically possibly Immunosuppressive agents -Cyclophosphamide or azathioprine Alone or in combination with corticos- teroids SLE Immunosuppressive Agents: -Increased risk for: Infection Malignancy Bone marrow depression Avoid large crowds, exposure to infec- tion Report signs of infection to physician Plan pregnancy for best outcome (moth- er and infant) Women may not experience menstrua- Teaching Point for SLE patients on Im- tion while taking cyclophosphamide munosuppressants: Consult with healthcare provider prior to receiving immunizations - immunosup- pressive medications Consult healthcare provider before adding herb, vitamin, or supplement to diet Avoid sun exposure: Use sunscreen Nutritional status Skin Respiratory assessment Musculoskeletal SLE Nursing Assessment Neurological assessment GI assessment Psychosocial assessment Pain 6/9  Understanding Hypersensitivity and Systemic Lupus Erythematosus Study online at https://quizlet.com/_g5bm4o Risk for Infection Risk for Ineffective Tissue Perfusion Chronic Pain SLE Nursing Diagnoses: Risk for Activity Intolerance Risk for Disturbed Body Image Compromised Family Coping Promote Skin Integrity Provide patient education Include possible effects on skin Discuss the relationship between sun exposure, disease activity SLE Nursing Implementation: Teach strategies to limit sun exposure Promote Rest and Comfort Encourage frequent rest periods Physical therapist program to encourage mobility, increase muscle strength Patient maintains weight within stan- dardized range Patient maintains healthy skin Patient maintains balance of rest and SLE Nursing Evaluation: activity to promote health Patient maintains medication regimen to promote health, prevent side effects Patient develops or maintains positive body image -Cell-mediated immune responses. Does not involve antibodies -Results from exaggerated interaction between antigen and T-cells Type IV Hypersensitivity Etiology and -Purified Protein Derivative/PPD/ TB skin Pathophysiology test Administer subdermal Read in 48 - 72 hours 10mm swelling = positive 7/9  Understanding Hypersensitivity and Systemic Lupus Erythematosus Study online at https://quizlet.com/_g5bm4o Response is from: -macrophages causing inflammation and tissue damage -Continued macrophage activation can Type IV Hypersensitivity Etiology cause chronic inflammation resulting in tissue lesions, scarring, and granuloma formation Delayed response arise 48-72 hours af- ter exposure rather than within minutes Acute systemic allergic reaction requir- Anaphylaxis ing immediate treatment. Immunoglobulins involved in allergic re- IgE Antibodies actions. Chemical released during allergic reac- Histamines tions causing inflammation. Chronic respiratory condition causing Asthma wheezing and difficulty breathing. Inflammation of nasal mucous mem- Allergic Rhinitis branes due to allergens. Immunotherapy to reduce allergic re- Desensitization sponses over time. Type III reaction from immune complex Serum Sickness deposition. Test measuring inflammation; normal Erythrocyte Sedimentation Rate (ESR) range 15-30 mm/hr. Anti-DNA Antibodies Specific markers for diagnosing SLE. Medications used to reduce inflamma- Corticosteroids tion in SLE. Immunosuppressive agent used in se- Cyclophosphamide vere SLE cases. Skin rash characterized by red spots and Maculopapular Rash bumps. Distinctive rash across cheeks in SLE Butterfly Rash patients. 8/9 Understanding Hypersensitivity and Systemic Lupus Erythematosus Study online at https://quizlet.com/_g5bm4o Common early symptom of SLE resem- Joint Pain bling rheumatoid arthritis. Presence of protein in urine during SLE Proteinuria exacerbation. Higher prevalence in women, especially Risk Factors for SLE minorities. Response occurring 48-72 hours after Delayed Type IV Reaction antigen exposure. Cells involved in inflammation and tissue Macrophages damage. Strategy for managing allergies, espe- Action Plan for Allergies cially in children. Assessment of dietary needs in SLE Nutritional Status management. Long-lasting pain often experienced by Chronic Pain SLE patients. 9/9