Transcript Allergy and Immune Disorders

Allergy and Immune Disorders
Med/Surg
Allergy-hypersensitivity to one or more
substances
 Acquired through exposures to substances
 Allergist-physician that specializes and treats allergies
 Immunity is based on the ability of the body to recognize foreign proteins
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and to destroy foreign matter
Antigen is a foreign protein substance and the normal reaction from the
body is to produce antibodies
Antibodies release histamine (chemical mediators) antigen-antibody
response
These mediators start a series of reactions in the body
Allergic reactions do not form during the first exposure to antigens, only
during subsequent contacts
Autoimmune disorders-body fails to recognize its own cells and destroys
them
Allergies are responsible for symptoms that range from rhinorrhea, skin
rash to asthma or anaphylaxis
Allergy-hypersensitivity to one or more
substances
 Dx tests: detailed medical history and physical exam, laboratory and skin
tests, allergy-antibody response varies with seasons, fatigue, and
hormones
 Lab tests: CBCD, eosonophil count, eosinophil smear of secretions,
blood levels of IgE (immunoglobulin E)
 *Skin tests: done to confirm disorders or determine the cause of allergic
reactions intradermally. The needle is held flat against the skin and the
bevel up.
 *Physical examination information:
 Dyspnea
 Syncope
 Nasal edema and congestion
Skin Tests
 Antigens are injected intradermally or applied to a scratch on
the skin
 After 20-30 minutes, the skin test is read, redness (erythema),
or an induration (lump, wheal, or edema) represent a positive
test
 Degree of edema (measured in mm’s) indicates the severity of
the reaction
 Physician may premedicate with antihistamines prior to these
tests
 Monitor the client closely because they could have a severe
allergic reaction (anaphylactic reaction)
Nursing Process
 Data collection
 Observe and assess (head to toe)
 Question client about pruritus, numbness, dyspnea, tingling
 Examine for rash, urticaria, rhinorrhea, sneezing, wheezing
 Document and REPORT abnormal s/s
 A person can have an allergic reaction to any medication
 *the reaction is more dramatic if the medication is administered parenterally
 Check allergies prior to administering meds
 *Immune disorders often present with fatigue, dyspnea, recurrent
infections, joint pain, rashes, slow wound healing or visual disturbances
 Ask about family Hx
Nursing Diagnosis for Allergy
 Diarrhea
 Risk for Injury
 Impaired Skin Integrity
 Disturbed Sleep Pattern
 Fatigue
 Delayed Growth and Development
 Disturbed Self-esteem
Planning and Implementation
 Client may require assistance with
 Activities of daily living
 Dealing with emotional aspects of living with chronic disorder
 Teach client, family about
 Disorder and its prognosis, treatment
Nursing Process: Evaluation
 Evaluate outcomes of care
 With client, family, other members of healthcare team
 Short and long term goals
 Symptom control
 Medication compliance
 Seriousness of disorder influences future planning for
care, rehabilitation
Allergies
 Immunogen-antigens that cause an immune response
in the body
 Allergens-antigens that cause a tissue reaction to
occur
 Sensitive or allergic reaction occurs when a person
has a tissue reaction to a specific substance
Allergies
 Allergens can enter the body via:
 inhalation-pollen, dust, mold
 ingestion-meds, foods, eggs, nuts
 injection-meds, insect bites/stings,
immunizations with animal serum, blood
transfusions
 direct contact-poison ivy, dyes, latex rubber,
wool
Allergies
 Manifestation of allergies r/t many factors
 inherited
 hormonal response
 type and concentration of allergen
 body part involved
 exposure to the allergen
 illness
 allergy response can occur at any age
 allergic reaction may include skin, respiratory, GI tract
 edema-often r/t allergy and may occur on any body part:
Monitor AIRWAY!!
Allergies with skin response
 Urticaria-erythematous areas, burning around
swollen patches of skin
 Itching (pruritis)
 Burning
 These all appear suddenly
 Disappear in a few hours or last days, weeks
 Result from food, additives, meds, infections,
stress
 Tx: identify cause and give meds: antihistamines,
epinephrine or steroids
Allergies
 Eczema
 tiny, oozing, itchy blisters
 usually located on the neck, elbows and knees
 Chronic eczema-scaly, thick skin
 Contact Dermatitis
 most common allergen is poison ivy, oak or sumac
 causes itching, swelling, redness, blisters
 Encourage client to refrain from scratching
 Use cool compresses or showers
 Light patting of the area
 Distraction
 Avoid vigorous rubbing
 soap, detergent, perfumes, cosmetics, metals in jewelry, wool,
latex, and leather are other allergens
Allergies with a respiratory response
 Allergic asthma-spasms of smooth muscles of the bronchi
Causes edema, dyspnea, mucus accumulation and
wheezing
 If severe enough, death may occur
 Bronchial asthma-common
 May be induced by exercise, meds, stress, etc.
 Sx: recurring paroxysms of dyspnea with wheezing, dyspnea, tight
chest, cough, wheezing, thick sputum, cyanosis, diaphoresis,
tachycardia, tachypnea, death in extreme situations
 Cause-narrowing of the lumen of the smaller bronchi and bronchioles
 Tx: corticosteroids, bronchodilators, antihistamines, anticholinergics
Allergic Rhinitis
 inflammed nasal passages caused by an allergen
 S/S: edema, burning, itching, watery eyes and rhinorrhea
 Allergens include pollen, molds, dust, dust mites, perfumes
 Symptoms are seasonal or perennial
Food Allergy
 Food allergens include: eggs, wheat, soybeans, fish, shellfish,
chocolate, seeds, nuts, beer, corn, citrus fruits, and some dairy
products
 S/S: n/v/d, abd. pain, tenderness; swelling of the lips and throat,
rhinoconjunctivitis, sneezing, wheezing, urticaria, migraines
 Tx: avoid those food allergens that cause these sx’s
 Latex allergies are noted in people who have hypersensitivities to
bananas, avocados, kiwis, chestnuts
Drug Allergies
 Adverse reactions: result from the antigen-antibody response,
unintended response to a drug
 S/S: depend on the drug, obtain a thorough H&P
 Serum Sickness or Serum Reaction-antiserum used for rabies may
cause a severe reaction
 Body’s immune system attacks the serum or med administered
 S/S: occur 7-14 days after receiving a drug, body has not
developed antibodies; itching at injection site, skin rash, enlarged
lymph nodes, general weakness, elevated temp
 Tx: antihistamines, corticosteroids
Allergy with Multisystem Response
 Symptoms occur in more than one body system
 S/S: itching, edema, GI or respiratory symptoms
 Ex: latex allergy which produces itching, erythema, edema,
respiratory, cardiac and GI symptoms may occur, wheezing,
dyspnea, laryngeal edema, bronchial spasm, tachycardia, and
cardiac arrest, anaphylaxis may occur
 Tx: Avoid substance
 May be difficult to identify
 If allergic to pollens, do not rake grass or mow
 If allergic to pets, avoid them
 Exercise is encouraged rather than discouraged. Instruct clients to
use their inhalers before exercise to avoid bronchospasm
Immunotherapy
 Desensitization or hyposensitization
 Give minute doses of allergens subq.
 Doses increased until client can tolerate
 May eliminate the allergy
 If receiving injections, must start them at least 3 months prior
to allergy season. Expensive and may last 1- 2 years or longer
Medication Therapy
 Given to counteract an allergy or to relieve
symptoms.
 Antihistamines-inhibit the action of histamine
(mediator in allergic response) Provide temporary
relief and must be used freq.
 Meds may cause drowsiness and should not be used
long term.
 Antihistamines may dry secretions and may make it
difficult to swallow or expectorate
Medication Therapy
 Decongestants (nasal congestion) bronchodilators and
expectorants (relieve respiratory symptoms) cortisone
(relieve itching and inflammation) epinephrine (used in
emergencies to neutralize adverse effects of histamine)
 Antihistamine inhibit the action of histamine, a major
chemical mediator involved in the allergic response.
 These medications may cause drowsiness, in clients who
have asthma, antihistamines may dry up the secretions so
much that clients cannot swallow or expectorate
Leukotrienes are chemical mediators that are 100-1000
times more potent than histamine in causing
bronchospasm
Anaphylaxis
 Severe and may result in laryngoedema, shock, vascular
collapse, and death
 s/s: see box 84-1
 Causes include: ASA, vaccines, foods, x-ray contrast medium
with iodine, antibiotics, insect venom
 Tx: IMMEDIATE d/t airway obstruction, remove cause,
administer antihistamines, if d/t injection or insect bite,
apply tourniquet and use ice to slow absorption
 OPEN AIRWAY!!!!
 SUPPORT CIRCULATION!
 ADMINISTER MEDS!!!
Immune Disorders
 Immunity-body’s adaptive state to protect itself from disease,
normal
 Infectious diseases-more virulent than immune system antibodies
 Immunosuppression-immune system is depressed d/t disease,
shock, injury, drugs,or radiation, may be congenital
(agammaglobulinemia)
 Overproduction of gamma globulins-alignant blood diseases or
infection present
 Severe immune response to an antigen that is invading (anaphylaxis)
 Rejection response-foreign substance in the body is rejected;
organs, skin grafts
Autoimmune Disorders
 Body does not recognize itself, therefore, produces antibodies against its own
healthy cells
 Called autoimmunity
 Cause unknown, believe that genetic predisposition, interaction with physical,
chemical, and biologic agents trigger abnormal immune responses, and
abnormal immune cells that lead to abnormal immune responses
 Types
 Organ-specific (localized autoimmune disease)-affects one organ
 Examples: DM-type 1, Hashimotos thyroiditis, Grave’s
 Disease, Addison’s disease, MS, Guillan Barre
 Non-organ specific (systemic autoimmune disease)-affecting one or more
organs
 Examples: Rheumatoid arthritis, SLE, scleroderma, polymyalgia rheumatica
Autoimmune Disorders
 At Risk
 Genetic predisposition
 Females (SLE)
 Abnormalities in immune cells
 Examples
 Rejection of transplanted organ-deemed foreign object by the body
and the normal immune system will reject this
 Tissue typing performed prior to transplant
 Use immunosuppressive drugs for life
 S/S: chills, fever, HTN, diaphoresis, hypotension, edema, and organ
involvement
SLE (Systemic Lupus
Erythematosus)
 Chronic systemic disorder (widespread damage to connective
tissue)
 Believed to be caused by antibodies that fight the body’s own
cells and tissues that it normally protects leading to
inflammation and tissue/organ damage
 Exacerbations caused by pregnancy and BCP use are d/t
increase in estrogen
 S/S-waxes and waning symptoms such as fatigue, fever,
weight loss, see picture
 Shift of WBC to left in a CBC-D (implies infection d/t
increased # of immature band cells)
SLE
 Diagnosis is made by 4 of 11 criteria: malar rash, discoid rash,
photosensitivity, oral ulcers, arthritis, serositis, renal disorder,
neurologic disorder, hematologic disorder (hemolytic anemia or
leukopenia), immunologic disorder (+LE cell prep) , antinuclear
antibody (+ titer)
 Damage to hematologic system, skin, heart, kidneys, brain, connective
tissue
 Note a false + syphilis test may occur in client’s with SLE d/t the
phospholipid used in the assay; chronically false + veneral disease
research laboratory or RPR tests may indicated a client has SLE
 Tx-NOT CURABLE; managed with meds and lifestyle modification such
as rest, stress management, use anti-inflammatory agents and
corticosteroids, goals of tx: decrease inflammation, suppress overactive
immune system, prevent symptom flares
SLE
 Drugs: NSAIDS, antimalarials (control rash, fatigue, fever),
corticosteroids, cytotoxic drugs (suppress the hyperactive immune
response)
 Nsg care: tx to prevent flare-ups: limit sun exposure, eat healthy,
get adequate rest, exercise, and learn to recognize signs of
impending flare-ups
Rheumatoid Arthritis
 Chronic and systemic disease
 Inflammed joints
 Swan neck deformity and ulnar deviation
 May have systemic manifestations
 Morning stiffness lasting over 1 hour, fatigue, wt. loss
 Autoimmune disorder of the musculoskeletal system
 S/S: fatigue, stiffness in am, weakness, muscle pain,
loss of appetitie, most commonly begins in the
smaller joints of the fingers, hands and wrists, joint
involvement is symmetrical
Rheumatoid Arthritis
 Progresses in 3 stages:
 Synovial lining swelling
 Rapid division and growth of cells which causes the
synovium to thicken
 Inflamed cells release enzymes that digest bone, cartilage,
which often causes the joint to lose its shape, alignment
and movement
 Tx: symptomatic use analgesics, corticosteroids
(prednisone-take same time every day), radiation to
suppress normal antigen-antibody responses, heat
and cold tx., gold salts (MONITOR for
ANAPHYLAXIS!!!)
RA
 Biologic Response Modifiers-etanercept, infliximab
 Drugs modify immune system by inhibiting proteins called
cytokines which contribute to inflammation
 Protein-A Immunoadsorption Therapy-therapy that filters
blood to remove antibodies and immune complexes that
promote inflammation
 Disease Modifying Antirheumatic Drugs (DMARDS)methotrexate-standard use of tx of RA
 Takes several weeks to work, drug adjusted for optimum
effect at lowest dose
Scleroderma
Chronic connective tissue disease (autoimmune)-exact cause unknown
Organ-specific disease!
Not contagious or cancerous; most common in middle-aged women
Not directly inherited, possibly a family hx of rheumatic diseases
S/S: chronic hardening and thickening of the skin caused by new collagen
formation, skin changes include edema and pallor, then firmness of the skin;
systemic scleroderma is due to injury to blood vessels and to fibrosis or
scarring and the
 Blood vessel injury leads to Raynauds, kidney disease, pulmonary HTN or
other manifestations
 TX: Localized scleroderma (drugs not proven in clinical trials), Plaquenil,
methotrexate (suppress immune function), prednisone, Dilantin (action
unclear), phototherapy; treatment aimed at symptoms
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Latex Allergy
 Common
 Initial sx are mild but become worse after repeated
exposure-likely to be allergic to latex if you have other
allergies
 S/S-pruritis, hives, watery eyes, scratchy throat, dyspnea,
lips and/or throat edema-this can lead to DEATH!!!
 TX-avoid contact with latex-even condoms, keep epi-pen
closeby