M.N PRIYADARSHANIE Bsc in Nursing

Nursing Management of a client with Immunological Disorders

What Are Immune System Disorders?An immune disorder is a dysfunction of the immune system

These disorders can be characterized in several different ways;

By the component(s) of the immune system affected

By whether the immune system is overactive or underactive

By whether the condition is congenital or acquired

cases of immune system over activity, the body attacks and damages its own tissues (autoimmune diseases)

Immune deficiency diseases decrease the body's ability to fight invaders, causing vulnerability to infections

What is the meaning of the Immunity ?

The body’s specific protective response to invading foreign agent or organism

Immune disorders:

• Autoimmunity• Hypersensitivity• Immune deficiencies:

primary and secondary• Infection

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Immune System

Immune disorders• The immune system helps the body defend

against various microbes and pollutants• The immune system itself can have various

failings An impaired immune system is called immunocompromise

• Causes of immune deficiency can include various illnesses such as viruses, chronic illness, or immune system illnesses

Innate and Acquired Immunity

Innate Acquired

Ag specificity no yes

Memory no yes

Primary immune deficiency diseases are those caused by inherited genetic mutations

Secondary or acquired immune deficiencies are caused by something outside the body such as a virus or immune suppressing drugs

eg. AIDS

Allergies - a true allergy to a substance or food is caused by the immune response

Asthma - caused by an allergic reaction affecting the airway passages

Anaphylaxis - an extremely dangerous over-reaction that can lead to shock

Autoimmune diseases - a group of more than 100 diseases where the body's own immune system gets confused and starts to attack good body cells

Natural immunity: nonspecific response to any foreign invader

White blood cell action: release cell mediators such as histamine, bradykinin, and prostaglandins, and engulf (phagocytize) foreign substances

Inflammatory response

• Physical barriers, such as intact skin, chemical barriers, and acidic gastric secretions or enzymes in tears and saliva

Acquired immunity: Specific against a foreign antigen

Result of prior exposure to an antigen

Active or passive

WBC’s (leukocytes) participate in both, natural and acquired immunity

• Granulocytes (granular leukocytes) release mediators (such as histamine, bradykinin and prostaglandins) and engulf antigen

(include neutrophils, eosinophils and basophils)Neutrophils- first cells to arrive on scene

• Nongranular leukocytes Monocytes or macrophages engulf, ingest and destroy greater number of foreign bodies/toxins that granulocytes do.

Lymphocytes

Consist of B-cells and T-cellsB lymphocytes: Produce antibodies or immunoglobulins

Acquired Immunity

• Cells: (macrophages), T (CD4+, CD8+) and B lymphoctyes (plasma cells), monocytes

T cell with CD4 receptor that recognizes antigens on the surface of a virus-infected cell and secretes lymphokines that stimulate B cells and killer T cells; helper T cells are infected and killed by the AIDS virus

• Molecules: cytokines, immunoglobulins,

adhesion molecules

Primary immunodeficiency diseasePrimary immune deficiency is caused by a genetic problem in the body's defense system, called the immune systemThere are more than 150 different primary immune deficiency diseasesSome occur with great frequency (selective IgA deficiency), while others are extremely rareIf a primary immune deficiency is not treated, it can cause serious illness

Primary immune diseases are at risk to an increased susceptibility to, and often recurrent ear infections, pneumonia, bronchitis, sinusitis or skin infections

Treatment for primary immune deficiencyMany patients with primary immune deficiency will need treatment with intravenous immunoglobulin and antibiotic medications. Gamma globulin is extracted from healthy people's donation of plasma and is purified through a manufacturing process before administeringOther patients may need more invasive therapies

Immune globulin (IG) therapy

Immune globulin (IG) therapy has become an invaluable therapy for patients with autoimmune, primary immune deficiency, neurological diseases and other chronic conditions and illnesses

Our staff of nurses and pharmacists is experienced in providing IG for patients of all ages and conditions

Our IG services include:

Access to IG products (IV and subcutaneous)

Specially trained infusion nurses

Individualized care plans

Multiple points of care

Immunological disorders

• Hypersensitivity mediated disorders

• Immunodeficiency

Classification of HypersensitivityGell and Coomb’s Classification: 4 Types• Type 1 : IgE-mediated • Type 2 : Cytotoxic antibodies• Type 3 : Ag-Ab Immune complexes• Type 4 : Delayed-type, cell-mediated

hypersensitivity

Type I Hypersensitivity• Allergen exposure, sensitization and re-

exposure• IgE antibody, mast cells/ basophils and its’

mediators• Target organ immediate reactions• Clinical allergy: atopic diseases, drug allergy,

insect allergy and anaphylaxis

An allergy is an abnormal immune reaction to a harmless antigen

Seasonal allergy

Anaphylaxis

Food allergy

Allergic rhinitis• Atopic dermatitis• Drug Allergy

Allergies result from the immune system's overreaction to a non-threatening foreign substanceFoods and inhaled particles like pollen and pet dander are the most common allergens(substances causing allergic reactions)When the immune system senses an allergen, it stimulates the release of chemicals such as histamine

Anaphylaxis

It is defined as "a serious allergic reaction that is rapid in onset and may cause death

It typically results in a number of symptoms including an itchy rash, throat swelling, and low blood pressure

Common causes include insect bites, foods, and medications.

Anaphylaxis is caused by the release of mediators from certain types of white blood cells triggered either by immunologic or non-immunologic mechanisms

The primary treatment is injection of epinephrine

Skin Prick Test

Type II Hypersensitivity

• Cytotoxic antibodies: IgG, IgM• Clinical spectrums:

– Autoimmune Hemolytic anemia (AIHA)– ABO Miss-matched

• Stimulatory antibody: Grave’s disease

• Inhibitory antibody: Myasthenia gravis (anti-Ach Rc)

Principle treatments in Type II

• ABO matching• Steroid, immunosuppressive agents, +/-

splenectomy

Type III Hypersensitivity

• Mechanisms: Ag (protein, drugs) + Ab (IgG, IgM) --> Immune complex --> deposit at subendothelial basement membrane --> fix complement

• Immune complex diseases:– Serum sickness– Autoimmune diseases: SLE

Autoimmune DiseasesIn response to an unknown trigger, the immune system may begin producing antibodies that instead of fighting infections, attack the body's own tissuesTreatment for autoimmune diseases generally focuses on reducing immune system activity

Eg.Rheumatoid arthritis The immune system produces antibodies that attach to the linings of joints Immune system cells then attack the joints, causing inflammation, swelling, and painIf untreated, gradually causes permanent joint damagefor rheumatoid arthritis can include various oral or injectable medications

Systemic lupus erythematosus (lupus) People with lupus develop autoimmune antibodies that can attach to tissues throughout the bodyThe joints, lungs, blood cells, nerves, and kidneys are commonly affected in lupusTreatment often requires daily oral prednisolone, a steroid that reduces immune system function

Type 1 diabetes mellitus

Immune system antibodies attack and destroy insulin-producing cells in the pancreas

Principle treatments in Type III

• Serum sickness: Avoidance of heterogeneous protein injection

• Autoimmune diseases: SLE– Avoidance sun exposure– Steroid– Immunosupressive agents

Treatments for Autoimmune diseases Treatments vary for specific diseases but may include Hormone replacement therapy – for autoimmune diseases damaging hormone glands Enzyme replacement therapy – for autoimmune diseases damaging enzyme-producing glands Corticosteroids

Prednisolone

Type IV Hypersensitivity

• Delayed-type cell-mediated reaction• Mechanism: Antigen (contactants) -->

sensitized T-lymphoctyes --> re-exposure --> T cells activation --> cytokines

• Clinical disorder: Atopic contact dermatitis

Principle treatments in Type IV

• Avoidance• Topical steroid• Systemic steroid, if severe

Nursing care for a patient with Immunological Disease

Assessment for Immune Dysfunction Health History Taking System wise Assessment

Nursing Care Management of a patient with Immuno deficienciesAssessmentPatient teachingSupportive Care

Continuously Monitoring for laboratory Values

Vital signs Treating for infections Reducing Patient’s risk for infections Assessment for patient’s nutritional

status, stress level, and drug usage and hygienic practices

Attention for strict aseptic techniques Identify early signs of infection and

treat to processing conditions

Factors affects for attract an infectious disease

Age and gender

Nutrition

Presence of conditions and disorders: cancer/neoplasm, chronic illness, autoimmune disorders, surgery/traumaAllergiesHistory of infection and immunizationGenetic factorsLifestyleMedications and transfusionsPyschoneuroimmunologic factor

Usually seen in infants and young children

Manifestations: vary according to type; severe or recurrent infections; failure to thrive or poor growth; and positive family history

Potential complications: recurrent, severe, potentially fatal infections; related blood dyscrasias and malignancies

Treatment: varies by type; treatment of infection; pooled plasma or immunoglobulin; GM-CSF or GCSF; thymus graft, stem cell, or bone marrow transplant

Monitor for signs and symtoms of infections Symptoms of inflammatory response may be

blunted Monitor lab values Promote good nutrition Address anxiety, stress, and coping Strategies to reduce risk of infection

Handwashing and strict aseptic technique Patient protection and hygiene measures: skin

care, promote normal bowel and bladder function, and pulmonary hygiene

Signs and symptoms of infection

Medication teaching

Prevention of infection

Handwashing

Avoid crowds and persons with infections

Hygiene and cleaning

Nutrition and diet

Lifestyle modifications to reduce risk

Follow-up care

Guidelines to prevent the transmission of microorganisms in hospitals

Standard precautions used for all patients

The primary strategy for preventing HAIs

Transmission-based precautions are for patients with known infectious diseases spread by airborne, droplet, or contact rout

Isolation PrecautionsGuidelines to prevent the transmission of microorganisms in hospitals

Standard precautions used for all patients

The primary strategy for preventing HAIs

Transmission-based precautions are for patients with known infectious diseases spread by airborne, droplet, or contact rout

Elements of Standard Precautions

Guidelines to prevent the transmission of microorganisms in hospitals

Standard precautions used for all patients

The primary strategy for preventing HAIs

Transmission-based precautions are for patients with known infectious diseases spread by airborne, droplet, or contact routes

Nursing Process—Assessment of the Patient With an Infectious Disease

Health history: investigate the likelihood and probable source of infection, associated pathology, and symptoms

Administer a physical exam

Vital Signs

Nursing Process—Diagnosis of the Patient With an Infectious Disease

Risk for infection transmission

Deficient knowledge

Risk for ineffective thermoregulation

Interventions Prevent the spread of infection

Perform handwashing

Exercise Standard Precautions

Recognize mode of transmission and establish Transmission-Based Precautions as indicated

Teach about infectious process and the prevention of the spread of infections

Assess and treat fever

Increases metabolic rate by 7% each 1 degree above normal

Thank you !