Nursing Care of Patients with Immune Disorders PDF

NURSING CARE OF PATIENTS WITH Chapter 19 IMMUNE DISORDERS Disorders of the Immune System ◦Hypersensitivity Reactions ◦Autoimmune Disorders ◦Immune Deficiencies Hypersensitivity Reactions ◦ The immune system can cause injury to the body with an exaggerated response ◦ Gell and Coo...

NURSING CARE OF PATIENTS WITH Chapter 19 IMMUNE DISORDERS Disorders of the Immune System ◦Hypersensitivity Reactions ◦Autoimmune Disorders ◦Immune Deficiencies Hypersensitivity Reactions ◦ The immune system can cause injury to the body with an exaggerated response ◦ Gell and Coombs classifications: ◦ Type I ◦ Ex. Allergic rhinitis, Atopic dermatitis, Anaphylaxis, Urticaria, Angioedema ◦ Type II ◦ Ex. Hemolytic Transfusion Reaction ◦ Type III ◦ Ex. Serum sickness ◦ Type IV ◦ Ex. Contact dermatitis, transplant rejection Autoimmune Disorders ◦ Antigens on normal body cells are recognized as foreign ◦ The body launches an immune response to destroy its own cells ◦ Examples: ◦ Pernicious Anemia ◦ Idiopathic Autoimmune Hemolytic Anemia ◦ Hashimoto Thyroiditis ◦ Systemic Lupus Erythematosus ◦ Ankylosing Spondylitis ◦ Immune Thrombocytopenia ◦ Multiple Sclerosis ◦ Myasthenia Gravis ◦ Rheumatoid Arthritis ◦ Ulcerative Colitis Pernicious Anemia ◦Immune system develops antibodies that destroy the stomach parietal cells and disrupt intrinsic factor production ◦Results in a vitamin B12 deficiency ◦Leads to insufficient and deformed RBCs with poor oxygen carrying capacity Pernicious Anemia ◦Symptoms ◦Diagnosis ◦ Weakness ◦ Macrocytic (enlarged cells) ◦ Loss of appetite under microscope ◦ Glossitis ◦ Low cobalamin levels ◦ Pallor ◦ Intrinsic factor and parietal cell ◦ Irritability antibodies ◦ Confusion ◦Treatment ◦ Peripheral neuropathy ◦ Corticosteroids ◦ Vitamin B12 replacement for life – don’t miss a dose! Idiopathic Autoimmune Hemolytic Anemia ◦Body produces auto-antibodies for no known reason ◦Attach to RBCs and cause them to lyse or agglutinate ◦Fragments circulate in vessels ◦Or occlusions of vessels from clumping Idiopathic Autoimmune Hemolytic Anemia ◦ Symptoms vary ◦ Diagnosis ◦ RBC count, Hgb/Hct low from mild to severe ◦ Fragmented RBCs in microscope ◦ Fatigue ◦ LDH and serum bili elevated ◦ Pallor ◦ Coombs test ◦ Determines if antibodies attached to RBCs is the ◦ Hypotension cause ◦ Dyspnea ◦ Treatment ◦ Palpitations ◦ Oxygen ◦ Folic acid to increase production of RBCs ◦ Headaches ◦ IV immunoglobulin ◦ Jaundice ◦ Immunosuppressants ◦ Difficulty concentrating ◦ Corticosteroids ◦ Erthrocytapheresis ◦ Splenectomy Hashimoto Thyroiditis ◦ Autoantibodies for thyroid stimulating hormone (TSH) form ◦ They bind with hormone receptors on the thyroid gland and stimulate the thyroid to secrete thyroid hormones ◦ The thyroid is overstimulated and enlarged (hyperthyroidism) ◦ The thyroid gets infiltrated with lymphocytes and phagocytes causing inflammation ◦ Different autoantibodies then appear and destroy the thyroid cells ◦ This slows secretion activity and causes hypothyroidism ◦ Exact cause is unknown ◦ Could be genetic, or bacterial or viral ◦ More common in middle-aged females and people with Down syndrome and Turner syndrome  Hashimoto Thyroiditis ◦ Symptoms ◦ Diagnosis ◦ Hyperthyroidism ◦ Immunofluorescent assay to detect antithyroid antibodies ◦ Restlessness, tremors, chest pain, increased appetite, diarrhea, moist ◦ TSH elevated, T3 and T4 low skin, heat intolerance, weight loss ◦ Treatment ◦ Hypothyroidism (progressed) ◦ Thyroid hormone replacement of thyroxine ◦ Goiter, fatigue, bradycardia, ◦ Levothyroxine hypotension, dyspnea, anorexia, constipation, dry skin, weight gain, ◦ Nursing care sensitivity to cold, facial puffiness, ◦ Soft diet (goiter) slowing of mental processes ◦ Daily weights, I/O ◦ Avoid foods high in iodine ◦ Take levothyroxine 4 hours after iron containing medications and antacids Systemic Lupus Erythematosus ◦Progressive, systemic inflammatory disease that can cause major organ and system failure ◦Spontaneous remissions and exacerbations ◦The body develops abnormal antibodies against itself, leading to formation of immune complexes, which affect connective tissue, vascular system, and organs ◦Leads to inflammation, damage, and possibly death SLE ◦Risk Factors ◦ Signs and Symptoms ◦ Genetic link ◦ Vary from mild to severe- table 19.6 ◦ Black, Asian, Hispanic, ◦ Can affect nearly all systems American Indian > White ◦ Characteristic reddened ◦ Women > Men butterfly rash over bridge of ◦ Ages 15-44 nose into cheeks ◦ Less than half of patients develop rash ◦ Not painful, worsens in light ◦ Some get discoid skin lesions on other parts of body ◦ Exacerbations/flares SLE ◦Diagnosis ◦Treatment ◦Biopsy skin lesions ◦ Treat symptoms ◦ NSAIDs ◦ESR ◦ Immunosuppressants ◦ANA titer (abnormal ◦ Corticosteroids antibodies) ◦ IVIG ◦ Anti-double stranded DNA ◦ Belimumab/Benlysta ◦ Decreases production of ◦ Anti-Smith antibodies autoantibodies ◦ New developing gene therapy SLE Nursing Interventions ◦ Prevent exacerbations (flares) ◦ Minimize sun exposure and UV lights, sunscreen, protective clothing ◦ Help with ADLs, rest periods ◦ Maintain range of motion ◦ Pain management ◦ Psychological support ◦ Monitor for complications ◦ Emboli, vasculitis, myocarditis, osteonecrosis, sepsis, renal failure (closely monitor labs and signs of renal impairment like peripheral edema), thrombocytopenia (monitor platelet count) Ankylosing Spondylitis ◦ Chronic progressive inflammatory disease of the spine and sacroiliac area ◦ Also affecting ribs and large limb joints ◦ Begins in lower region and progresses upward ◦ HLA B27 antigen is formed that stimulates immune response ◦ New bone is laid down to attempt to heal the inflamed area, resulting in spinal fusion and rigidity (“bamboo spine”) ◦ Familial tendencies ◦ Men > Women ◦ Diagnosed between late teens – 40 years Ankylosing Spondylitis ◦Signs and Symptoms ◦ Diagnosis ◦ Back stiffness and pain that ◦ X-rays improves with activity ◦ Lordosis and kyphosis ◦ Treatment ◦ Fatigue ◦ No cure ◦ Anorexia ◦ Pain management ◦ Weight loss ◦ Muscle relaxants ◦ Anti-inflammatories ◦ Physical therapy ◦ Anti-tumor necrosis factor TNF-a Image: https://www.uvmhealth.org/heal thwise/topic/zm6126 Immune Deficiencies ◦One or more components of the immune system are either completely absent or deficient ◦Body cannot elicit or sustain an adequate immune response to combat infectious agents ◦Ex. Hypogammaglobulinemia ◦ Congenital or acquired ◦ Deficient in one or more Igs ◦ Lack of normal antibody function increases risk for infection ◦ Treatment aimed at increasing immune function with IVIG