Nursing of Adult Patients with Medical & Surgical Conditions

1. Nursing of Adult Patientswith Medical & Surgical Conditions Care of the Patient with an Immune Disorder

2. Nature of Immunity • Three Main Functions • Protect the body’s internal environment against invading organisms • Maintain homeostasis by removing damaged cells from the circulation • Serve as a surveillance network for recognizing and guarding against the development and growth of abnormal cells

3. Organization of the Immune System

4. Nature of Immunity • Inappropriate Responses of the Immune System • Hyperactive responses against environmental antigens (allergy) • Inability to protect the body, as in immunodeficiency disorders (AIDS) • Failure to recognize the body as self, as in autoimmune disorders (systemic lupus erythmatosus) • Attacks on beneficial foreign tissue (organ transplant rejection or transfusion reaction)

5. Nature of Immunity • Innate (Natural) Immunity • First line of defense • Provides physical and chemical barriers to invading pathogens and protects against the external environment • Composed of the skin, mucous membranes, cilia, stomach acid, tears, saliva, sebaceous glands, and secretions and flora of the intestine and vagina • Non-specific immunity

6. Nature of Immunity • Adaptive (Acquired) Immunity • Second line of defense • Provides a specific reaction to each invading antigen • Protects the internal environment • Composed of thymus, spleen, bone marrow, blood, and lymph • Produces antibodies in the cells after an infection or vaccination

7. Nature of Immunity • Macrophages (phagocytes) • Engulf and destroy microorganisms that pass the skin and mucous membrane. • Carries antigen to the lymphocytes

8. Nature of Immunity • Lymphocytes • T Cells • 70 - 80 % of lymphocytes • Releases lymphokine to attract macrophages to the site of infection or inflammation • Responsible for cell-mediated immunity • Provide the body with protection against viruses, fungi, and parasites. • B Cells • 20 - 30% of lymphocytes • Cause the production of antibodies • Provide protection against bacteria, viruses, and soluble antigens

9. Types of Adaptive Immunity • Humoral Immunity • Responds to antigens such as bacteria and foreign tissue • Result of the development and continuing presence of circulating antibodies in the plasma • Active Immunity • antibodies are produced by one’s own body (vaccines) • Passive Immunity • antibodies formed by another in response to a specific antigen and administered to an individual (HBIG) • Cellular Immunity • Defense against intracellular organisms • Involved in resistance to infectious disease caused by viruses and some bacteria

10. Immune Response • Immunization • A controlled exposure to a disease-producing pathogen which develops antibody production and prevents disease • Provides protection for months to years

11. Immune Response • Immunotherapy • Treatment of allergic responses that administers increasingly large doses of the offending allergens to gradually develop immunity • Preseasonal, coseasonal, or perennial • Severe side effect: Anaphylaxis

12. Hypersensitivity • Hypersensitivity • an abnormal condition characterized by an excessive reaction to a particular stimulus • Hypersensitivity Reaction • an inappropriate and excessive response of the immune system to a sensitizing antigen • Hypersensitivity Disorders • Harmless substances such as pollens, danders, foods, and chemicals are recognized as foreign

13. Hypersensitivity • CAUSE: • Genetic defect that allows increased production of Immunoglobulin E (IgE) • Exposures may occur by inhalation, ingestion, injection, or touch

14. Hypersensitivity • Diagnostic Tests • History • onset, nature, and progression of symptoms • aggravating and alleviating factors • frequency and duration of signs and symptoms • Physical Exam • Assessment of skin, middle ear, conjunctiva, nasooropharynx, and lungs • Laboratory Studies • CBC, skin testing, total serum IgE levels

15. Hypersensitivity • Medical Management • Symptom management with medications • Antihistimines--pseudoephedrine(Actifed), diphenhydramine(Benadryl), chlorpheniramine(Chloir-Trimeton), brompheniramine(Dimetapp), cetirizine(Zyrtec), loratidine(Claritin), and fexofenadine(Allegra) • Environmental control • Avoidance of the offending allergen • Immunotherapy • Allergy specific injections

16. Anaphylaxis • Etiology/Pathophysiology • System reaction to allergens • Venoms • Drugs - penicillin • Contrast media dyes • Insect stings • Foods

17. Anaphylaxis • Signs and Symptoms • Feelings of uneasiness to impending death • Urticaria(hives) and pruritus • Cyanosis and pallor • Congestion and sneezing • Edema of the tongue and larynx with stidor • Bronchospasm, wheezing, and dyspnea • Nausea and vomiting • Diarrhea and involuntary stools • Tachycardia and hypotension • Coronary insufficiency, vascular collapse, dysrhythmias, shock, cardiac arrest, respiratory failure, and death

18. Anaphylaxis • Treatment • Epinephrine 1:1000 0.5 ml SQ (may repeat at 15 minute intervals) • Benadryl 50 to 100mg IM or IV • IV access • Oxygen (as ordered by physician) • Aminophylline ( as ordered)

19. Anaphylaxis • Nursing Interventions • Assessment: • Respiratory status • Circulatory status • Vital signs • Intake and output • Mental status • Skin status • GI status status • Teaching • Avoid allergen • Use Medic-Alert ID • Administration of epinephrine

20. Transfusion Reactions • Etiology/Pathophysiology • Reactions that occur with mismatched blood

21. Transfusion Reactions Signs and Symptoms

22. Transfusion Reactions • Treatment • Mild • Stop transfusion • Administer saline • Administer steroids, diuretics, and antihistimines as ordered • Physician may order transfusion continued at a slower rate.

23. Transfusion Reaction • Treatment • Moderate • Stop transfusion • Administer saline • Administer antihistamines and epinephrine as ordered

24. Transfusion Reaction • Treatment • Severe • Stop transfusion • Administer saline • Administer antihistamines and epinephrine as ordered • Return blood or blood product to lab for testing • Obtain urine specimen

25. Delayed Hypersensitivity • Reaction occurs 24 to 72 hours after exposure • Examples include: • Poison Ivy • Tissue transplant rejection

26. Transplant Rejection • Autograft • Transplantation of tissue from one site to another on an individual • Isograft • Transfer of tissue between genetically identical individuals (identical twins) • Allograft (homograft) • Transplantation of tissue between members of the same species • Heterograft • Transplantation of tissue from another species such as a pig or cow

27. Transplant Rejection • Antigenetic determinants on the cells lead to graft rejection via the immune process • 7-10 days after vascularization, lymphocytes appear in sufficient numbers for sloughing to occur

28. Transplant Rejection • Immunosuppressives • Administration of agents that interfere with the ability of immune system to respond to antigenic stimulation • Corticosteroids • Cyclosporine (Neoral, Sandimmune) • Azathioprine (Imuran)

29. Immunodeficiency • An abnormal condition of the immune system in which cellular or humoral immunity is inadequate and resistance to infection is decreased • May cause recurrent infections, chronic infections, severe infections, and/or incomplete clearing of infections • Can be induced (chemotherapy)

30. Autoimmune Disorders • The development of an immune response to one’s own tissues • Body is unable to distinguish “self” protein from “foreign” protein • Examples of disorder: • pernicious anemia • Guillain-Barr’e • Scleroderma • Systemic lupus erthematosus