Immunological Disorders

04/08/23www.health-nurses-doctors.blogspot.com

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Message of the day

When it rains all birds occupy shelter

but eagle is the only bird that avoids the rain

by flying above the clouds……

Problems are common to all but

attitude makes the difference.


immune disorders

Presenter: Ms Shahina Amiry

Acknowledge: Ms. Saima Sohail

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By the end of this session, students will be able to:

Review the anatomy & physiology of the immune system Discuss the definitions related to immunological disorders.

Define the term “hypersensitivity” (allergy)

Understand the types of hypersensitivity reactions with its examples



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OBJECTIVES cont’d----Discuss the Definition, Causes, Pathophysiology, Clinical manifestations of the following allergic disorders

•Describe the diagnostic, medical and surgical management of the below mentioned disorders.

•Apply nursing process including assessment, diagnosis, implementation and evaluation of care provided to the client with the following allergic disorders;

Allergic rhinitis Atopic dermatitisAnaphylaxisSerum sickness

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Definition:“It is an abnormal, heightened reaction to any type of stimuli”.

(Smeltzer, et al, 2004)

“Immune response that results in tissue injury or other physiological changes are called hypersensitivity (allergic)

reactions”. (Mellors, 1999).



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Hypersensitivity reactions are classified into four types: Type I: anaphylactic hypersensitivity

Type II: cytotoxic hypersensitivity

Type III: immune complex hypersensitivity

Type IV: cell mediated hypersensitivity



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Type I: Anaphylactic hypersensitivity:

It is an immediate reaction beginning within minutes of exposure to an antigen.

It is mediated by I.e. antibodies.

It requires previous exposure to specific antigen.

It usually affects on skin, lungs and gastrointestinal tract.



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Anaphylactic (type I) Hypersensitivity



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Examples:

◦Asthma◦Allergic rhinitis◦Systemic anaphylaxis.◦Atopic dermatitis



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Type II: cytotoxic hypersensitivity

It occurs when the system mistakenly identifies a normal constituent of the body as foreign.

This reaction may be a result of cross-reacting antibody, possibly leading to cell and tissue damage

It involves activation of complement by IgG or IgM antibody binding to an antigenic cell.



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Examples: Myasthenia gravis

Blood Transfusion reaction

Thrombocytopenia



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Type III: Immune complex hypersensitivity It involves in the formation of immune complexes

when antigen binds to antibodies.

These type III complexes deposit in tissues or vascular endothelium and leads to injury with the help of vasoactive amines and the increase number of circulating complexes.

The joints and kidneys are particularly susceptible.



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Examples: Systemic lupus erythematous

Rheumatoid arthritis

Serum sickness



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Type IV: Cell mediated hypersensitivity

Also known as cellular hypersensitivity

It occurs 24-72 hrs after exposure to an allergen

The reaction is mediated by sensitized T cells and macrophages.

The reaction results In tissue damage by releasing lymphokines, macrophages and lysozymes.



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Examples:

Contact dermatitis

Tuberculin test.



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It is also called as Hay Fever



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Definition:“It is an inflammation of the nasal mucosa by an

allergen”. (Smeltzer, 2004).

Incidence:It affects about 8-10% of U.S. population.

(Smeltzer, 2004).


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immune disorders04/08/23

Perennial Seasonal Year-round with allergic

triggers

Early spring, early fall, early summer

Sneezing, itching, watery discharge from nose and eyes

Intense symptoms triggered by air-borne pollens, house dust and animal feather.




Inhalation of an antigen (sensitization)

Re-exposure

Nasal mucosa reacts (histamine is mediator)

Slowing of ciliary action, edema formation and leukocyte infiltration

Tissue edema and increase capillary permeability (vasodilatation).




Clinical manifestations: ALLERGIC RHINITIS

• Nasal congestion

• Clear to greenish rhinorrhea

• Intermittent sneezing and nasal itching

• Headache

• Pain over Para nasal sinuses

• Epistaxis

• Fatigue, loss of sleep and poor coordination.




Diagnostic tests:• Nasal smears (nasal eosinophilia)

• Total serum IgE

Medical management:• Oral anti histamines (blocks the action of histamine)

• Adrenergic nasal decongestant

• Mast cell stabilizers.

• Analgesics and antipyretics.




Nursing management:

Assessment• Examination (Assess symptoms) • History of patient (Allergy assessment)

Diagnosis• Ineffective breathing pattern related to allergic

reactions• Knowledge deficit related to allergy and the

recommended modifications in life style and self-care practices

• Ineffective individual coping with condition and need for environmental modification.




Nursing interventions:

1. Patient is instructed to modify the environment to reduce the severity.

2. Encourage for deep breathing and cough frequently for adequate gas exchange.

3. Encourage for steam inhalation

4. Promote rest.




It is a type I immediate hypersensitivityDefinition:

Inflammation of the skin

Incidences/Causes:• Familial tendency

• It is highest in infants and children

• 1% population is suffering from this disease

• Aggravated in low humidity and in winter. (smeltzer, 2004)




Allergen /Sensitizing antigen

Effect the skin (changes in lipid content, sebaceous gland activity and sweating)

Skin reduced water-binding capacity in the skin

Higher trans epidermal water loss and decreased water content

Dry skin

Itching, rubbing leads to infection




Clinical manifestations: Atopic dermatitis

• Red oozing crusting rash (in childhood)

• Dry thick brownish – grey and scaly skin (later stage)

• Pruritis

• Lesion are mostly found on hand, foot, back of the knees, neck, face, eyelids and elbow bands.




Medical Management: Atopic dermatitis

• Moisturizers• Topical and

systemic steroids• Antibiotics• Antihistamines• Perform allergen

test




Nursing management: Atopic dermatitis

• Assess and maintain hygiene (daily bath)

• Determine dietary and other allergen (cow milk, egg, Soya, wheat, nut, fish)

• Teach to avoid allergen

• Keep wound area moist

• Teach proper use of medicines

• Avoid scratching (wear cotton fabrics, washing with mild detergent)

• Prevent from secondary infection




AnaphylaxisDefinition:

It is an immediate life threatening systemic reaction that can occur on exposure to particular substances

It is an immediate (type I hypersensitivity) immunologic reaction, results from IgE antibody

This reaction affects many tissues and organs. Death may occur due to respiratory tract spasm and constriction or collapse.

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Causes: Anaphylaxis

• Food ( peanuts, fish, milk, eggs, wheat and chocolate).

• Medications (penicillin, NSAID’s)

• Insects stings (bees, ants)




Pathophysiology: Anaphylaxis

Interaction of foreign antigen with IgE antibodies

Release of histamine

Activation of platelets, eosinophils and neutrophils

smooth muscle spasm, bronchospasm, mucosal edema and inflammation.




Clinical manifestations: Anaphylaxis

Mild Moderate Severe

Occurs within first 2hrs of exposure

Same Same

Peripheral tingling Flushing Broncospasm

Sensation of warmth

Itching Laryngeal edema

Fullness in mouth and throat

bronchospasm Severe Dyspnea, cyanosis

Nasal congestion Edema of larynx Hypotension

Periorbital swelling

Dyspnea Cardiac arrest and coma may follow.

Pruiritis Cough

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Medical management: Anaphylaxis

1. If cardiac arrest then cardiopulmonary resuscitation initiated.

2. Antihistamine to prevent recurrence reaction3. Start intravenous fluids to maintain hemodynamics.4. Give aminophylline for bronchospasm

Nursing management: Anaphylaxis

1. Assess for signs of anaphylaxis.2. Restore effective breathing 3. Reduce anxiety by reassuring the patient4. Provide oxygen, and maintain airway5. Monitor vital signs.



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It is a type III hypersensitivity reaction.

The reaction result from administration of therapeutic Anti-Sera taken from animal source for the treatment and prevention of infectious diseases like tetanus, rabies, diphtheria



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Localized:Inflammatory reaction at the site of injection.

Generalized:Skin rashes Tenderness and swelling of joints vasculitis mostly in kidneys results in proteinuriaGlomerulonephritisPeripheral neuritis leads to temporary paralysisFever



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Medical management:AntihistaminesCorticosteroids

Nursing management:Encourage for ROM exercises, provide DVT stockings (a deep

vein thrombosis and pulmonary embolism are treats to these patients.



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Carpenito-Moyet, L. J. (2003). Nursing Care Plans & Documentation: Nursing Diagnosis And Collaorative Problems. (4th ed.). Philadelphia: Lippincott Williams and Wilkins

Jevon, H. (April, 2000). Anaphylaxis: Emergency Treatment. Nursing Times, 96(14), 39-40.

Kemppainen, J. K., Brien, L. O., and Corpuz, B. (1998). The behavior of AIDS patients towards their nurses. International journal of nursing studies, (35), 330-338.

Phipps, W. J., Monahan, F. D., Sands, J.K., Marek, J.F., and Neibirs, M. (2003).Medical –Surgical Nursing: Health and Illness Perspectives. (7th ed.). St. Louis: Mosby

Smeltzer, S. C., Bare, B. (2004). Medical and surgical nursing. (10th ed.). Philadelphia: Lippincott Williams & Wilkins


Immunological Disorders

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