August 11, 2014 - Immune system
Download
Report
Transcript August 11, 2014 - Immune system
Immune System & Oncology
Nursing Care
PN 143 – Lecture 2
Rebecca Maier, BSN
Lecture 2
DISORDERS OF THE IMMUNE
SYSTEM
Disorders of the Immune System
Hypersensitivity
(the thing)
response directed against
non-self antigens that are not
pathogenic
Hypersensitivity reaction
(the action)
An inappropriate and excessive
response of the immune system to a
sensitizing antigen
Pemphigus (Vulgaris) –
look up pemphigus you need to know it
Disorders of the Immune System
Hypersensitivity disorders Allergies
Physical assessment of the immune
system involves predominantly
the following systems:
Integumentary
Gastrointestinal
Respiratory
Cardiovascular
Assessment
seasonal
Most important diagnostic tool: a
thorough history
Diagnostic Tests-Common laboratory studies:
CBC
Skin Testing
Total serum IgE levels
Specific IgE level for a particular
allergen maybe ordered – i.e. RAST,
(radioallergosorbent test)
Other Diagnostic Tests
ANA
Total complement,
C3 & C4
CRP
CD4 T-Cells
ELISA
ESR
HLA-DW4
LE Prep
PCR
RBC *
RF
Total White Blood
Cell count w/
differential *
Western Blot
Medical Management
Avoid the allergen
And Symptom management
Immune Response
Medications
Medications
Leukotriene Inhibitors:
Reduce symptoms of an allergic response
caused by leukotrienes [inflammatory cells
from mast cells and basophils.
Eg. Accolate, Singulair, Zyflo – inhibit the
production of leukotrienes
Other meds:
Corticosteroids
Bronchodilators
Nursing Diagnosis
For patients with hypersensitivity
disorder includes:
Risk for injury related to exposure to
allergen
Activity Intolerance related to malaise
Risk for infection related to
inflammation of protective mucous
membranes
Patient Teaching
Patient and diagnosis specific
Avoid exposure to allergen
Tx Plan
Self care
Anaphylaxis
Anaphylaxis
Anaphylaxis
Assessment: Early recognition
early treatment!
Pt. may have a sense of uneasiness
sense of foreboding sense of
impending death
Skin: urticaria cyanosis and pallor
Upper respiratory s/sx.: congestion and
sneezing edema of the tongue and
larynx with stridor and occlusion of the
upper airway
Anaphylaxis
Anaphylaxis – Medical Management
Immediate, aggressive treatment
At the first sign, administer 0.2-0.5ml epinephrine
(1:1000 dilution) subcutaneously for mild reaction
For severe reaction, Epinephrine 1:10,000 dilution
0.5ml IV at 5-10min intervals
Benadryl 50-100mg may be given IM or IV
Pt. may be intubated
Oxygen supplied
Place in recumbent position/keep warm
Note: all meds and frequency given per order of
physician
Call 911
Anaphylaxis
Nursing Interventions
Assess:
Respiratory/ Cardiac, circulatory status
VS, I/O, Neuro checks
Mental status
Skin
GI status
Anaphylaxis
Nursing Diagnosis
Ineffective breathing pattern r/t sudden
hypersensitivity reaction AEB edema,
bronchospasm, and increased
secretions
Decreased cardiac output r/t sudden
hypersentitivity reaction AEB increased
capillary permeability and vascular
dilation
Anaphylaxis
Patient Education:
Reassurance during procedures
Teach patient avoidance of allergens
Teach use of medic-alert identification
Teach patient preparation and
administration of epinephrine
subcutaneously
Latex Allergies
Latex Allergies
2 types of latex allergies:
Type IV (4) contact dermatitis:
Caused by the chemicals used in the
manufacturing process of latex gloves
A delayed reaction occurring within 648 hrs.
Dryness, pruritis, fissuring, cracking of
skin erythema, edema, and crusting at
24 -48 hrs.
Latex Allergies
Type I allergic reaction:
A response to the natural rubber latex
proteins
Occurs within minutes of contact with
the proteins
Reactions can range from: skin
erythema, urticaria, rhinitis,
conjunctivitis, or asthma
anaphylactic shock
Latex Allergies
Nursing interventions
Identification of individuals sensitive to
latex -> thorough health hx.
Risk factors – long term exposure
Additional risk factors: hx. of hay fever,
asthma, and food allergies
Latex Allergies
Patient teaching: recommendations for
preventing allergic reaction to latex:
Use nonlatex gloves for activities that are not
likely to involve contact with infectious
materials (eg. Food prep, housekeeping)
Use powder-free gloves with reduced protein
content
Do not use oil-based hand creams or lotion
when wearing gloves
After removing gloves, wash hands with mild
soap and dry thoroughly
Latex Allergies
Patient Teaching cont.
Frequently clean areas that are
contaminated with latex-containing dust
Avoid direct contact
Wear medic-alert bracelet; carry Epipen
Teach your patient to be proactive in their
health care
Transfusion Reactions
A hypersensitivity disorder
Prevention:
Careful type and cross-matching
Careful storage: refrigerated at specific
temperatures until ½ hr. before
administration
Blood must be administered within 4
hours of refrigeration
Blood components: must be
administered within 6 hrs of refrigeration
Transfusion Reactions
Transfusion Reactions
Transfusion Reaction
Transfusion Reaction
The best method for prevention of
transfusion reactions: autologous
transfusion- i.e. using one’s own blood
for replacement therapy
The blood can be frozen and stored
for as long as 3 years
Delayed Hypersensitivity
Reaction occurs 24-72 hrs. after
exposure
E.g. delayed contact dermatitis after
contact with poison ivy
E.g. tissue transplant rejection
Transplant Rejection
Transplant Rejection
Immunodeficiency Disorders
Immunodeficiency Disorders
• The first evidence of
immunodeficiency disease is an
increased susceptibility to infection
Immunodeficiency Disorders
Diseases d/t immunodeficiency
include:
AIDS
Agammaglobulinemia
Multiple myeloma
Immunodeficiency Disorders
Immunodeficiency disorders are
“primary” if the immune cells are
improperly developed or absent
“Secondary” if the deficiency is
caused by illnesses or treatment.
Immunodeficiency Disorders
Primary Immunodeficiency
Immunodeficiency Disorders
Secondary Immunodeficiency
Disorders
Immunodeficiency Disorders