It's about hypersensitivity and immunology

1. Immunological Disorders
Presented by
Rabeeya Ameen

2. Objectives
• Discuss Immunologic disorders
• Discuss the diagnostic, medical and surgical
and nursing management of the below
mentioned disorders
– HIV/ AIDS
– Hypersensitivity and autoimmunity disorders

3. Introduction
• Immune system: the collection of organs,
cells, tissues, and molecules that mediate the
immune response
• Immunity: the body’s specific protective
response to a foreign agent or organism
• Immunopathology: study of diseases resulting
in dysfunctions within the immune system

4. Cont…
• Antibody: a protein substance developed by
the body in response to and interacting with a
specific antigen
• Antigen: substance that induces the
production of antibodies

5. Immune system
• It distinguishes self from non-self & eliminate
possibly harmful non-self molecules & cells
from body
• Disorders of the immune system may stem
from
– Excesses or deficiencies of immunocompetent cells
– Alterations in the functions of these cells
immunologic attack on self –antigen
– Or inappropriate or exaggerated responses to
specific antigens

6. Immunodeficiency disorders

7. Immunodeficiency disorders
• A state in which the immune system’s ability to flight
infectious disease is compromised or entirely absent
• Immunodeficiency disorders may be caused by a defect
in or a deficiency of phagocytic cells, B lymphocytes, T
lymphocytes, or the complement system.
• The specific symptoms and their severity, age at onset,
and prognosis depend on the immune system
components affected and their degree of functional
impairment.

8. Cont….
• Regardless of the underlying cause, the cardinal
symptoms of immunodeficiency include chronic or
recurrent and severe infections, infections caused by
unusual organisms or by organisms that are normal
body flora, poor response to standard treatment for
infections, and chronic diarrhea.
• Immunodeficiencies may be acquired spontaneously or
as a consequence of medical treatment.
• These disorders can be classified as either primary or
secondary

9. Cont….
• Primary immunodeficiency:
– Primary immunodeficiency diseases are genetic in
origin and result from intrinsic defects in the cells
of the immune system.
– Primary immunodeficiencies represent inborn
errors of immune function that predispose people
to frequent, severe infections; autoimmunity; and
cancer.

10. Cont…

11. Cont….
• Secondary immunodeficiencies:
– Secondary immunodeficiencies result from
external factors such as infection
– Secondary immunodeficiencies are more common
than primary immunodeficiencies and frequently
occur as a result of underlying disease processes
or the treatment of certain disease or other
stressor

12. Cont…

13. 13
What is HIV?
• Human: Infecting human beings
• Immunodeficiency: Decrease or weakness in
the body’s ability to fight off infections and
illnesses
• Virus: A pathogen having the ability to
replicate only inside a living cell

14. 14
Structure of HIV
Envelope
Core p24
RNA
Reverse
Transcriptase

15. What is AIDS?
• Acquired: To come into possession of something
new
• Immune Deficiency: Decrease or weakness in the
body’s ability to fight off infections and illnesses
• Syndrome: A group of signs and symptoms that
occur together and characterize a particular
abnormality
AIDS is the final stage of the disease caused by
infection with a type of virus called HIV.

16. HIV Life Cycle
1. Attachment
2. Uncoating
3. DNA synthesis
4. Integration
5. Transcription
6. Translation
7. Cleavage
8. Budding

18. Cont….
The HIV life cycle is complex and consists of the
following steps (Porth & Matfin, 2009):
1. Attachment: In this first step, the GP120 and
GP41 glycoproteins of HIV bind with the host’s
uninfected CD4+ receptor and chemokine
coreceptors, usually CCR5, which results in
fusion of HIV with the CD4+T-cell membrane.
2. Uncoating: Only the contents of HIV’s viral core
(two single strands of viral RNA and three viral
enzymes: reverse transcriptase, integrase, and
protease) are emptied into the CD4+ T cell.

19. Cont….
3. DNA synthesis: HIV changes its genetic material
from RNA to DNA through action of reverse
transcriptase, resulting in double-stranded DNA
that carries instruction for viral replication.
4. Integration: New viral DNA enters the nucleus of
the CD4+ T cell and through action of integrase
is blended with the DNA of the CD4+ T cell,
resulting in permanent, lifelong infection. Prior
to this, the uninfected person has been only
exposed to, not infected with, HIV. With this
step, HIV infection is permanent

20. Cont….
5. Transcription: When the CD4+ T cell is
activated, the double-stranded DNA forms
single-stranded messenger RNA (mRNA),
which builds new viruses
6. Translation: The mRNA creates chains of new
proteins and enzymes (polyproteins) that
contain the components needed in the
construction of new viruses.

21. Cont….
7. Cleavage: The HIV enzyme protease cuts the
polyprotein chain into the individual proteins
that make up the new virus.
8. Budding: New proteins and viral RNA migrate
to the membrane of the infected CD4+ T cell,
exit from the cell, and start the process all
over.

22. Transmission of HIV
 Transmitted by body fluids containing HIV
or infected CD4 lymphocytes
 The three highest risks for becoming
infected with HIV include
 Having unprotected sex with an HIV-positive person
 Sharing needles and syringes with an HIV-
infected person
 Maternal-fetal exposure (vertical and by breast milk)
 Other possible risks are tattoos, body
piercings, and blood products

23. How you DON’T get HIV
 You CANNOT get HIV by hugging,
touching, living with or caring for
someone with HIV, shaking
hands or kissing.
 You CANNOT get HIV from eating
out of the same plate or cup or
utensils that an HIV positive
person uses.

24. Risks Associated With HIV
Infections

25. Stages of HIV Disease
Primary infection
HIV asymptomatic
HIV symptomatic
AIDS

26. Primary Infection
Acute HIV infection or acute HIV syndrome
Symptoms: none to flulike syndrome
Window period: lack of HIV antibodies, test
negative, but highly contagious
Period of rapid viral replication and
dissemination through the body

27. 27
Window Period
• Time from initial infection with HIV until
antibodies are detected by a single test
• Usually 3-8 weeks before antibodies are detected
• May test false-negative for HIV antibodies during
this time period
• Can still pass the virus to others during this
period
• Viral set point: balance between amount of HIV
and the immune response

28. HIV Asymptomatic
More than 500 CD4+ T lymphocytes/mm3
Upon reaching the viral set point, chronic
asymptomatic state begins
Body has sufficient immune response to
defend against pathogens
Up to 10 years

29. HIV Symptomatic
200–499 CD4+ lymphocytes/mm3
CD4 T cells gradually fall
The patient develops symptoms or conditions
related to the HIV infection,

30. AIDS
Less than 200 CD4+ lymphocytes/mm3
As levels drop below 100 cell/mm3 the
immune system is significantly impaired.

31. WHO HIV/AIDS Classification System
Stage I
Asymptomatic
Stage II
Minor Symptoms
Stage III
Moderate
Symptoms
Stage IV
AIDS

32. 32
Disease Progression
• Severity of illness is determined by amount of
virus in the body (increasing viral load) and
the degree of immune suppression
(decreasing CD4+ counts)
• As the CD4 count declines, the immune
function decreases.

33. Clinical Manifestations of HIV/AIDS:
Respiratory
 Pneumocystic carinii pneumonia (PCP):
 Most common life-threatening infection
 Initial symptoms may be nonspecific and may include
nonproductive cough, fever chills, dyspnea, and chest
pain
 If untreated, progresses to pulmonary impairment and
respiratory failure
 Treatment: TMP-SMZ( trimethoprine salfamethoxazole
or pentamidine, prophylactic TMP-SMZ
 Mycobacterium avium complex (MAC)
 Opportunistic
 Tuberculosis

34. Clinical Manifestations of HIV/AIDS:
GI
 Oral candidiasis
 May progress to esophagus and stomach
 Treatment with Mycelex troches or nystatin,
ketoconazole
 Diarrhea related to HIV infection or enteric pathogens
 Octreotide acetate for severe chronic diarrhea
 Wasting syndrome
 10% weight loss and chronic diarrhea or chronic
weakness and fever with absence of other cause
 Protein energy malnutrition
 Anorexia, diarrhea, GI malabsorption, and lack of
nutrition may contribute

35. Clinical Manifestations of HIV/AIDS:
Oncologic
 Kaposi's sarcoma
 Cutaneous lesions but may involve multiple
organ systems
 Lesions cause discomfort,
disfigurement, ulceration, and potential
for infection
 B-cell lymphomas

36. Lesions of Kaposi’s Sarcoma

37. Manifestations of HIV/AIDS:
Neurologic
 Peripheral neuropathy
 HIV encephalopathy
 Progressive cognitive, behavioral, and motor decline
 Probably directly related to the HIV infection
 Cryptococcus neoformans
 Crypococal meningitis and cryptococossis
 Progressive multifocal leukoencephalopathy
 Viral damage of white matter on multiple locations
 Depression

38. Opportunistic
Infections
 Viral infections
 Herpes simplex virus type 1 and
type 2
 Varicella zoster virus
 Cytomegalovirus
 Hepatitis
 Bacterial infections
 Mycobacterium tuberculosis
 Mycobacterium avium complex

39. Cont….
 Fungal infections
 Cryptococcosis
 Histoplasmosis
 Coccidiomycosis
 Candidiasis
 Pneumocystis jiroveci
 Parasitic infections
 Toxoplasmosis
 Cryptosporidiosis

42. Lab Tests for Diagnosing and
Tracking

43. Treatment and protocols are continually evolving
Antiretroviral agents
 Nucleoside reverse transcriptase inhibitors (NRTIs)
 Non-nucleoside reverse transcriptase inhibitors
(NNRTIs)
 Protease inhibitors (PIs)
 Integrate inhibitors
 Use of combination therapy
Management also focuses upon the treatment of
specific manifestations and conditions related to
the disease.
Medical Management

44. Nursing management

45. Nursing Process: The Care of the
Patient With HIV/AIDS—Assessment
Identify potential risk factors: IV drug abuse, risky
sexual practices
Immune system function
Nutritional status
Skin integrity
Respiratory status and neurologic status
Fluid and electrolyte balance
Knowledge level

46. Nursing Process: The Care of the
Patient With HIV/AIDS—Diagnosis
Impaired skin
integrity
Diarrhea
Risk for infection
Activity intolerance
Disturbed thought
processes
Ineffective airway
clearance
Pain
Imbalanced nutrition
Social isolation
Anticipatory grieving
Deficient knowledge

47. Nursing Process: The Care of the
Patient With HIV/AIDS—Planning
Goals may include
 Achievement and maintenance of skin integrity
 Resumption of usual bowel patterns
 Absence of infection
 Improved activity tolerance
 Improved thought processes
 Improved airway clearance
 Increased comfort, improved nutritional status
 Increased socialization
 Expression of grief
 Increased knowledge regarding disease prevention and
self-care
 Absence of complications

48. Planning
Prevent secondary bacterial, viral, and fungal
infections
Prevent wasting due to malnutrition
Maintain or improve the present level of
immune function
Maintain adequate social functioning
Maintain or improve current mental status

49. Implementation
Standard Precautions
Patient teaching
 Compromised immunity
 Infection control in the home
Wasting syndrome and nutrition

50. Nursing Process: The Care of the
Patient With HIV/AIDS—
Interventions: Skin
Frequent routine assessment of skin and mucosa
Encourage patient to maintain balance between
rest and activity
Reposition at least every 2 hours and as needed
Pressure reduction devices
Instruct patient to avoid scratching
Use gentle, nondrying soaps or cleansers
Avoid adhesive tape
Perianal skin care

51. Nursing Process: The Care of the
Patient With HIV/AIDS—
Interventions: Bowels
Assess bowel pattern and factors that may
exacerbate diarrhea
Avoid foods that act as bowel irritants, such as raw
fruits and vegetables, carbonated beverages, spicy
foods, and foods of extreme temperatures
Small, frequent meals
Administer medications as prescribed
Assess and promote self-care strategies to control
diarrhea

52. Nursing Process: The Care of the
Patient With HIV/AIDS—
Interventions: Activity
Maintain balance between activity and rest
Instruction regarding energy conservation
techniques
Relaxation measures
Collaboration with other members of the
health care team

53. Nursing Process: The Care of the
Patient With HIV/AIDS—
Interventions: Thoughts
Assess mental and neurologic status
Use clear, simple language if mental status is
altered
Establish and maintain a daily routine
Ensure patient safety and protect from injury
Instruct and involve family in communication
and care

54. Nursing Process: The Care of the
Patient With HIV/AIDS—
Interventions: Nutrition
Monitor weight, I&O, dietary intake, and
factors that interfere with nutrition
Dietary consult
Control of nausea with antiemetics
Oral hygiene
Treatment of oral discomfort
Dietary supplements
May require enteral feedings or parenteral
nutrition

55. Nursing Process: The Care of the
Patient With HIV/AIDS— Interventions:
Isolation
Promote an atmosphere of acceptance and
understanding
Assess social interactions and monitor
behaviors
Allow patient to express feelings
Address psychosocial issues
Provide information related to the spread of
infection
Educate ancillary personnel, family, and partners

56. Nursing Process: The Care of the
Patient With HIV/AIDS—
Interventions: Other
Improving airway clearance
 Position in semi-Fowler's or high Fowler’s position
 Pulmonary therapy; coughing and deep breathing,
postural drainage, percussion, and vibration
 Ensure adequate rest
Pain
 Medications as prescribed

57. Prevention
Standard precautions
Safer sex practices and safer behaviors
 Abstain from sharing sexual fluids
 Reduce the number of sexual partners to one
 Always use condoms
Do not share drug injection equipment
Blood screening and treatment of blood
products

58. Prevention for Health Care
Providers
Hand hygiene
Personal protective equipment (PPE)
Soiled patient care equipment handling
Textiles and laundry
Needles and other sharps
Patient resuscitation

60. HIV vs. AIDS
• HIV is the virus that causes AIDS
• Not everyone who is infected with HIV has
AIDS
• Everyone with AIDS is infected with HIV
• AIDS is result of the progression of HIV
Infection
• Anyone infected with HIV, although healthy,
can still transmit the virus to another person

61. Hypersensitivity

63. Cont….
• Hypersensitivity is a reflection of excessive or
aberrant immune response to any type of
stimulus (Abbas & Lichtman, 2011)
• Hypersensitivity : body produces
inappropriate or exaggerated responses to
specific antigens

66. Cont…
• Antigen combine with IgE antibodies
• IgE binds to mast cells and basophils, causing
them to undergo degranulation and release
several mediators
– Histamine: dilates and increases permeability of
blood vessels( swelling and redness), increases
mucus secretion (runny nose) , smooth muscle
contraction( bronchi).

67. Cont…
–Prostaglandins: contraction of smooth
muscle of respiratory system and increased
mucus secretion
–Leukotrienes: bronchial spams

80. Diagnostic test
• History and physical examination
• Antibodies
Anti-DNA antibody
Antinuclear antibody (ANA)
• Complete blood cell count
• Urinalysis
• X-ray of affected joints
• Chest X-ray
• ECG

81. Treatment
Treatment may vary depending on the type of
hypersensitivity but in general treatment may
include
Rest and exercise
Physical therapy for muscle weakness
Avoiding sun exposure
Medications:
– Anti-inflammatory drugs, such as aspirin for
symptomatic relief
– Corticosteriods such as prednisolone for
inflammation
– Immunosuppressive and cytotoxic drugs

82. Nursing care
• Minimize and observe for pain, fatigue, dyspnea,
chest pain and edema
• Note size, type & location of skin lesions
• Maintain weight, input & output at optimal range
• Teach the patient to recognize fever & sign and
symptoms of infection
• Assist patient in adjusting to physical & lifestyle
changes
• Recognize the sign and symptoms of depression
& initiate a plan of care accordingly

83. Summarization

84. Autoimmune diseases

85. Autoimmune diseases
• Normal protective immune response paradoxically
turns against or attacks the body, leading to tissue
damage
• Loss of self-tolerance leads to production of
antibodies or T cells that react against one’s own
antigens
• Immune system response to self antigens causes
damage to organs
• Three types of autoimmune disorders
– Cytotoxic ( type II reactions)
– Immune complex (type III reaction)
– Cell-mediated ( type IV reaction)

86. Cont….
• Type II (cytotoxic ) autoimmune reactions
– Grave’s disease
– Myasthenia gravis
• Type III (immune complex) autoimmune
reactions
– Systemic lupus erythematous ( SLE)
– Rheumatoid arthritis
• Type IV (cell mediated) autoimmune reactions
– Insulin-dependent (Type I or Juvenile) diabetes
mellitus

87. References
• Hinkle, J. L., & Cheever, K. H. (2014). Brunner & Suddarth’s
textbook of medical-surgical nursing (13th ed.)
• Immunological disease. (2015, August 18). Retrieved
fromhttps://www.slideshare.net/DeepakKumarGu pta2/im
munological-disease
• Immunological Disorders. (2009, January 3). Retrieved
fromhttps://www.slideshare.net/razia0000/immun ological-
disorders-presentation?next_slideshow=1