Immunological Disorders

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Immunological Disorders

  1. 1. 06/07/09 immune disorders 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.
  2. 2. Presenter: Ms Shahina Amiry Acknowledge: Ms. Saima Sohail 06/07/09 immune disorders
  3. 3. <ul><li>By the end of this session, students will be able to: </li></ul><ul><li>Review the anatomy & physiology of the immune system </li></ul><ul><li>Discuss the definitions related to immunological disorders. </li></ul><ul><li>Define the term “hypersensitivity” (allergy) </li></ul><ul><li>Understand the types of hypersensitivity reactions with its examples </li></ul>06/07/09 immune disorders
  4. 4. <ul><li>                        </li></ul>OBJECTIVES cont’d---- <ul><li>Discuss the Definition, Causes, Pathophysiology, Clinical manifestations of the following allergic disorders </li></ul><ul><li>Describe the diagnostic, medical and surgical management of the below mentioned disorders. </li></ul><ul><li>Apply nursing process including assessment, diagnosis, implementation and evaluation of care provided to the client with the following allergic disorders; </li></ul><ul><ul><ul><li>Allergic rhinitis </li></ul></ul></ul><ul><ul><ul><li>Atopic dermatitis </li></ul></ul></ul><ul><ul><ul><li>Anaphylaxis </li></ul></ul></ul><ul><ul><ul><li>Serum sickness </li></ul></ul></ul><ul><li>Summarization </li></ul>06/07/09 immune disorders
  5. 5. 06/07/09 immune disorders
  6. 6. <ul><li>Definition: </li></ul><ul><li>“ It is an abnormal, heightened reaction to any type of stimuli”. </li></ul><ul><li>                                  (Smeltzer, et al, 2004) </li></ul><ul><li>“ Immune response that results in tissue injury or other physiological changes are called hypersensitivity (allergic) reactions”.  </li></ul><ul><li>(Mellors, 1999). </li></ul>06/07/09 immune disorders
  7. 7. <ul><li>Hypersensitivity reactions are classified into four types: </li></ul><ul><li>Type I: anaphylactic hypersensitivity </li></ul><ul><li>Type II: cytotoxic hypersensitivity </li></ul><ul><li>Type III: immune complex hypersensitivity </li></ul><ul><li>Type IV: cell mediated hypersensitivity </li></ul>06/07/09 immune disorders
  8. 8. <ul><li>Type I: Anaphylactic hypersensitivity: </li></ul><ul><li>It is an immediate reaction beginning within minutes of exposure to an antigen. </li></ul><ul><li>It is mediated by I.e. antibodies. </li></ul><ul><li>It requires previous exposure to specific antigen. </li></ul><ul><li>It usually affects on skin, lungs and gastrointestinal tract. </li></ul>06/07/09 immune disorders
  9. 9. Anaphylactic (type I) Hypersensitivity 06/07/09 immune disorders
  10. 10. <ul><li>Examples: </li></ul><ul><ul><li>Asthma </li></ul></ul><ul><ul><li>Allergic rhinitis </li></ul></ul><ul><ul><li>Systemic anaphylaxis. </li></ul></ul><ul><ul><li>Atopic dermatitis </li></ul></ul>06/07/09 immune disorders
  11. 11. <ul><li>Type II: cytotoxic hypersensitivity </li></ul><ul><li>It occurs when the system mistakenly identifies a normal constituent of the body as foreign. </li></ul><ul><li>This reaction may be a result of cross-reacting antibody, possibly leading to cell and tissue damage </li></ul><ul><li>It involves activation of complement by IgG or IgM antibody binding to an antigenic cell. </li></ul>06/07/09 immune disorders
  12. 12. 06/07/09 immune disorders
  13. 13. <ul><li>Examples: </li></ul><ul><li>Myasthenia gravis </li></ul><ul><li>Blood Transfusion reaction </li></ul><ul><li>Thrombocytopenia </li></ul>06/07/09 immune disorders
  14. 14. <ul><li>Type III: Immune complex hypersensitivity </li></ul><ul><li>It involves in the formation of immune complexes when antigen binds to antibodies. </li></ul><ul><li>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. </li></ul><ul><li>The joints and kidneys are particularly susceptible. </li></ul>06/07/09 immune disorders
  15. 15. 06/07/09 immune disorders
  16. 16. <ul><li>Examples: </li></ul><ul><li>Systemic lupus erythematous </li></ul><ul><li>Rheumatoid arthritis </li></ul><ul><li>Serum sickness </li></ul>06/07/09 immune disorders
  17. 17. <ul><li>Type IV: Cell mediated hypersensitivity </li></ul><ul><li>Also known as cellular hypersensitivity </li></ul><ul><li>It occurs 24-72 hrs after exposure to an allergen </li></ul><ul><li>The reaction is mediated by sensitized T cells and macrophages. </li></ul><ul><li>The reaction results In tissue damage by releasing lymphokines, macrophages and lysozymes. </li></ul>06/07/09 immune disorders
  18. 18. 06/07/09 immune disorders
  19. 19. <ul><li>Examples: </li></ul><ul><li>Contact dermatitis </li></ul><ul><li>Tuberculin test. </li></ul>06/07/09 immune disorders
  20. 20. <ul><li>It is also called as Hay Fever </li></ul>06/07/09 immune disorders
  21. 21. <ul><li>Definition: </li></ul><ul><li>“ It is an inflammation of the nasal mucosa by an allergen”. </li></ul><ul><li>(Smeltzer, 2004). </li></ul><ul><li>Incidence: </li></ul><ul><li>It affects about 8-10% of U.S. population. </li></ul><ul><li>(Smeltzer, 2004). </li></ul>06/07/09 immune disorders
  22. 22. 06/07/09 immune disorders Perennial Seasonal <ul><li>Year-round with allergic triggers </li></ul><ul><li>Early spring, early fall, early summer </li></ul><ul><li>Sneezing, itching, watery discharge from nose and eyes </li></ul><ul><li>Intense symptoms triggered by air-borne pollens, house dust and animal feather. </li></ul>
  23. 23. 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). 06/07/09 immune disorders
  24. 24. <ul><li>Clinical manifestations: ALLERGIC RHINITIS </li></ul><ul><li>Nasal congestion </li></ul><ul><li>Clear to greenish rhinorrhea </li></ul><ul><li>Intermittent sneezing and nasal itching </li></ul><ul><li>Headache </li></ul><ul><li>Pain over Para nasal sinuses </li></ul><ul><li>Epistaxis </li></ul><ul><li>Fatigue, loss of sleep and poor coordination. </li></ul>06/07/09 immune disorders
  25. 25. <ul><li>Diagnostic tests: </li></ul><ul><li>Nasal smears (nasal eosinophilia) </li></ul><ul><li>Total serum IgE </li></ul><ul><li>Medical management: </li></ul><ul><li>Oral anti histamines (blocks the action of histamine) </li></ul><ul><li>Adrenergic nasal decongestant </li></ul><ul><li>Mast cell stabilizers. </li></ul><ul><li>Analgesics and antipyretics. </li></ul>06/07/09 immune disorders
  26. 26. <ul><li>Nursing management: </li></ul><ul><li>Assessment </li></ul><ul><ul><li>Examination (Assess symptoms) </li></ul></ul><ul><ul><li>History of patient (Allergy assessment) </li></ul></ul><ul><ul><li>Diagnosis </li></ul></ul><ul><ul><li>Ineffective breathing pattern related to allergic reactions </li></ul></ul><ul><ul><li>Knowledge deficit related to allergy and the recommended modifications in life style and self-care practices </li></ul></ul><ul><ul><li>Ineffective individual coping with condition and need for environmental modification. </li></ul></ul>06/07/09 immune disorders
  27. 27. <ul><ul><ul><ul><ul><li>Nursing interventions: </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Patient is instructed to modify the environment to reduce the severity. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Encourage for deep breathing and cough frequently for adequate gas exchange. </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Encourage for steam inhalation </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>4. Promote rest. </li></ul></ul></ul></ul></ul>06/07/09 immune disorders
  28. 28. <ul><li>It is a type I immediate hypersensitivity </li></ul><ul><li>Definition: </li></ul><ul><li>Inflammation of the skin </li></ul><ul><li>Incidences/Causes: </li></ul><ul><ul><li>Familial tendency </li></ul></ul><ul><ul><li>It is highest in infants and children </li></ul></ul><ul><ul><li>1% population is suffering from this disease </li></ul></ul><ul><ul><li>Aggravated in low humidity and in winter. (smeltzer, 2004) </li></ul></ul>06/07/09 immune disorders
  29. 29. 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 06/07/09 immune disorders
  30. 30. <ul><li>Clinical manifestations: Atopic dermatitis </li></ul><ul><ul><li>Red oozing crusting rash (in childhood) </li></ul></ul><ul><ul><li>Dry thick brownish – grey and scaly skin (later stage) </li></ul></ul><ul><ul><li>Pruritis </li></ul></ul><ul><ul><li>Lesion are mostly found on hand, foot, back of the knees, neck, face, eyelids and elbow bands. </li></ul></ul>06/07/09 immune disorders
  31. 31. <ul><li>Medical Management: Atopic dermatitis </li></ul><ul><ul><ul><li>Moisturizers </li></ul></ul></ul><ul><ul><ul><li>Topical and systemic steroids </li></ul></ul></ul><ul><ul><ul><li>Antibiotics </li></ul></ul></ul><ul><ul><ul><li>Antihistamines </li></ul></ul></ul><ul><ul><ul><li>Perform allergen test </li></ul></ul></ul>06/07/09 immune disorders
  32. 32. <ul><li>Nursing management: Atopic dermatitis </li></ul><ul><ul><ul><ul><li>Assess and maintain hygiene (daily bath) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Determine dietary and other allergen (cow milk, egg, Soya, wheat, nut, fish) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Teach to avoid allergen </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Keep wound area moist </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Teach proper use of medicines </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Avoid scratching (wear cotton fabrics, washing with mild detergent) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Prevent from secondary infection </li></ul></ul></ul></ul>06/07/09 immune disorders
  33. 33. Anaphylaxis Definition: 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. . 06/07/09 immune disorders
  34. 34. <ul><li>Causes: Anaphylaxis </li></ul><ul><li>Food ( peanuts, fish, milk, eggs, wheat and chocolate). </li></ul><ul><li>Medications (penicillin, NSAID’s) </li></ul><ul><li>Insects stings (bees, ants) </li></ul>06/07/09 immune disorders
  35. 35. 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. 06/07/09 immune disorders
  36. 36. Clinical manifestations: Anaphylaxis 06/07/09 immune disorders 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   Sneezing wheezing  
  37. 37. <ul><li>Medical management: Anaphylaxis </li></ul><ul><li>If cardiac arrest then cardiopulmonary resuscitation initiated. </li></ul><ul><li>Antihistamine to prevent recurrence reaction </li></ul><ul><li>Start intravenous fluids to maintain hemodynamics. </li></ul><ul><li>Give aminophylline for bronchospasm </li></ul><ul><li>Nursing management: Anaphylaxis </li></ul><ul><li>Assess for signs of anaphylaxis. </li></ul><ul><li>Restore effective breathing </li></ul><ul><li>Reduce anxiety by reassuring the patient </li></ul><ul><li>Provide oxygen, and maintain airway </li></ul><ul><li>Monitor vital signs. </li></ul>06/07/09 immune disorders
  38. 38. <ul><li>It is a type III hypersensitivity reaction. </li></ul><ul><li>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 </li></ul>06/07/09 immune disorders
  39. 39. <ul><li>Localized: </li></ul><ul><ul><ul><li>Inflammatory reaction at the site of injection. </li></ul></ul></ul><ul><li>Generalized: </li></ul><ul><ul><ul><li>Skin rashes </li></ul></ul></ul><ul><ul><ul><li>Tenderness and swelling of joints </li></ul></ul></ul><ul><ul><ul><li>vasculitis mostly in kidneys results in proteinuria </li></ul></ul></ul><ul><ul><ul><li>Glomerulonephritis </li></ul></ul></ul><ul><ul><ul><li>Peripheral neuritis leads to temporary paralysis </li></ul></ul></ul><ul><ul><ul><li>Fever </li></ul></ul></ul>06/07/09 immune disorders
  40. 40. <ul><li>Medical management: </li></ul><ul><ul><ul><li>Antihistamines </li></ul></ul></ul><ul><ul><ul><li>Corticosteroids </li></ul></ul></ul><ul><li>Nursing management: </li></ul><ul><ul><ul><li>Encourage for ROM exercises, provide DVT stockings (a deep vein thrombosis and pulmonary embolism are treats to these patients. </li></ul></ul></ul>06/07/09 immune disorders
  41. 41. 06/07/09 immune disorders
  42. 42. <ul><li>Carpenito-Moyet, L. J. (2003). Nursing Care Plans & Documentation : Nursing Diagnosis And Collaorative Problems. (4th ed.). Philadelphia: Lippincott Williams and Wilkins </li></ul><ul><li>Jevon, H. (April, 2000). Anaphylaxis: Emergency Treatment. Nursing Times, 96(14), 39-40. </li></ul><ul><li>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. </li></ul><ul><li>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 </li></ul><ul><li>Smeltzer, S. C., Bare, B. (2004). Medical and surgical nursing. (10th ed.). </li></ul><ul><li>Philadelphia: Lippincott Williams & Wilkins </li></ul>06/07/09 immune disorders
  43. 43. 06/07/09 immune disorders
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