This document discusses altered immune response and related topics. It begins by defining immunity and describing the two main types: innate and adaptive immunity. It then discusses specific topics in depth, including:
- The four types of hypersensitivity reactions (immediate, antibody-mediated, immune complex-mediated, cell-mediated)
- Common allergic disorders like anaphylaxis, allergic rhinitis, contact dermatitis, and their symptoms and treatments
- Autoimmune diseases like rheumatoid arthritis and systemic lupus erythematosus, how they are assessed and managed
It provides details on immune system function, complications of altered immune response, and the nursing management of patients with these conditions.
Dr. ihsan edan abdulkareem alsaimary
PROFESSOR IN MEDICAL MICROBIOLOGY AND MOLECULAR IMMUNOLOGY
ihsanalsaimary@gmail.com
mobile : 009647801410838
university of basrah - college of medicine - basrah -IRAQ
Allergies and autoimmune diseases are examples of unfavourable immune system-induced reactions that are referred to as hypersensitivity. These reactions, which are frequently referred to as immune system overreactions, can be harmful and painful. A drug, your body's immune system, and viruses all interact in a complex way to induce hypersensitivity syndrome. Over time, it tends to get narrower. Antihistamines, NSAIDs, corticosteroids, and epinephrine are all supportive treatments for acute type I hypersensitivity reactions.
Purpose:
The purpose of this interactive webinar is to raise awareness about Hypersensitivity reaction and the approaches to timely control this reaction.
I need an article not copied on the internet talks about allergic .pdfmohdjakirfb
I need an article not copied on the internet talks about \"allergic reaction\"
Solution
allergic reactions
allergic reaction : it is a the body\'s method for reacting to an \"intruder.\" When the body detects
an outside substance, called an antigen, the insusceptible framework is activated. The immune
framework typically shields the body from destructive operators, for example, microscopic
organisms and poisons. Its overcompensation to a safe substance (an allergen) is known as a
touchiness response, or a hypersensitive reaction.
Responses may happen in one spot, for example, a little restricted skin rash, bothersome eyes,
confront knocks, or all over, as in an entire body rash, for example, hives.
Most hypersensitive responses are minor, for example, a rash from toxic substance ivy, mosquito
or other bug chomps, or sniffling from feed fever.The kind of response relies on upon the
individual\'s insusceptible framework reaction, which is some of the time eccentric. In
uncommon cases, a hypersensitive response can be life-undermining (known as
hypersensitivity).
The Asthma and Allergy Foundation of America (AAFA) gauges that no less than one in 50
Americans (1.6%), and upwards of one in 20 (5.1%), have had hypersensitivity happen, bringing
about a normal of 186-225 passings for each year. The AAFA states that hypersensitivities
influence 50 million Americans, are the fifth driving unending malady in the U.S., and the third
driving interminable ailment among kids under 18 years old. More than 40 million individuals
have indoor/open air sensitivities as their essential hypersensitivity. In 2012, more than 11
million individuals in the U.S. gone to their specialist for unfavorably susceptible rhinitis, and
hypersensitivities to nourishment represent 200,000 visits to the crisis room and 10,000
hospitalizations every year.
Practically anything can trigger an allergic reaction.The body\'s safe framework includes the
white platelets, which deliver antibodies. At the point when the body is presented to an antigen
(an outside body, for example, dust that can trigger an invulnerable reaction), a perplexing
arrangement of responses starts.
The white platelets deliver a neutralizer particular to that antigen. This is called
\"\"sensitization.\" The employment of the antibodies is to white platelets recognize and crush
substances that cause malady and disorder. In unfavorably susceptible responses, the counter
acting agent has a place with the class of immunoglobulins known as immunoglobulin E or IgE.
This neutralizer sort advances creation and arrival of chemicals and hormones called
\"mediators.\"
Mediators have impacts on neighborhood tissue and organs notwithstanding initiating more
white platelet safeguards. It is these impacts that cause the side effects of the response.
Histamine is one of the better-known hypersensitivity , mediators delivered by the body.
In the event that the arrival of the mediators is sudden or broad, the unfavorably susceptibl.
Obsessive-Compulsive Disorder (OCD) is a common, chronic, and long-lasting disorder in which a person has uncontrollable, reoccurring thoughts (obsessions) and/or behaviors (compulsions) that he or she feels the urge to repeat over and over.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Unit IV
1. UNIT IV
ALTERED IMMUNE RESPONSE
Submitted To
Mrs. Jisha Surendrakurup
Principal,
St. Catherine Hospital
& School of Nursing
Submitted By
Mr. Earnest Lamuel
Nursing Tutor,
St. Catherine Hospital
& School of Nursing
2. IMMUNITY
Immunity is the state of having sufficient
biological defenses to avoid infection, disease,
or other biological invasion. It is the capability
of the body to resist harmful microorganisms
or viruses from entering it.
4. INNATE IMMUNITY
Innate immunity or non specific immunity is
the natural resistances with which a person is
born. It provides a resistance through several
physical, chemical, and cellular approaches.
5. ADAPTIVE IMMUNITY
The adaptive immune system, also known as
the acquired immune system or, more rarely,
as the specific immune system, is a subsystem
of the overall immune system that is
composed of highly specialized, systemic cells
and processes that eliminate pathogens or
prevent their growth.
6. ADAPTIVE IMMUNITY
Adaptive immunity is often sub divided into two
major types-
Natural- Natural acquired immunity occurs
through contact with a disease causing agent
when the contact was not deliberate.
Artificial- Artificial acquired immunity develops
only through deliberate action such as vaccination.
7. NATURAL IMMUNITY
Natural immunity is often sub divided into two major
types-
Active Immunity- The immunity which results from
the production of antibodies by the immune system
in response to the presence of an antigen.
Passive Immunity- The short term immunity which
results from the introduction of antibodies from
another person.
8. ALTERED IMMUNE RESPONSE
The immune response is how our body recognizes and defends
against bacteria, viruses, and substances that appear foreign and
harmful.
The Immune system protects the body from possibly harmful
substances by recognizing and responding to antigens. Antigens
are substances on the surface of the cells, viruses, fungi, or bacteria.
Nonliving substances such as toxins, chemicals, drugs, and foreign
particles can also be antigens. The immune system recognizes and
destroys substances that contain antigens.
9. COMPLICATIONS
Complications due to an altered immune response-
Allergy or hypersensitivity
Anaphylaxis
Autoimmune disorders
Graft versus host disease
Immunodeficiency disorder
Transplant rejection
10. HYPERSENSITIVITY
Hypersensitivity (also called hypersensitivity reaction or intolerance) refers
to undesirable reactions produced by the normal immune system, including
allergies and autoimmunity. They are usually referred to as an over-reaction
of the immune system and these reactions may be damaging,
uncomfortable, or occasionally fatal.
Hypersensitivity reactions require a pre-sensitized (immune) state of the
host. They are classified in four groups after the proposal of P. G. H.
Gell and Robin Coombs in 1963.
Hypersensitivity describes an abnormal or pathologic immune reaction that
is caused by an immune response to repeated exposure to an antigen.
12. (TYPE 1) IMMEDIATE
Immediate hypersensitivity is a rapid IgE and mast
cell mediated vascular and smooth muscle occurs in
genetically susceptible individuals upon exposure to
certain environmental antigens to which they have
been previously exposed.
These reactions are also known as allergies, and the
antigens that instigate these reactions are commonly
called allergens.
13. (TYPE II) ANTIBODY-MEDIATED
Type II Hypersensitivity results when antibodies
are directed against antigens on the surface of
cells or other tissue components.
These reactive antigens may be intrinsic, naturally
occurring antigens or the reactive antigen may be
an exogenous substance such as drug metabolite
that has absorbed to a cell surface.
14. (TYPE III) IMMUNE COMPLEX MEDIATE
Type III hypersensitivity diseases are some of the most
common immune-mediated diseases. In these diseases,
complexes of antibodies and antigens in circulation deposit
in the vascular walls of blood vessels leading to
inflammation.
Alternatively, the complexes may form “in situ” at locations
where the antigen or antibody has been initially deposited.
The antigens in these complexes may be exogenous or
endogenous.
15. (TYPE IV) CELL MEDIATED
Type IV hypersensitivity reactions are inappropriate
or excessive immune reactions that are mediated by a
specific subsets of CD4+ helper T cells or by CD8+
cytotoxic T cells.
These reactions form the basis of many common
diseases ranging in severity from contact dermatitis to
diseases such as type I diabetes and viral hepatitis.
16. ALLERGY
Allergies occur when the immune system
reacts to a foreign bodies such as pollen, bee
venom, or pet dander.
The immune system produce substances
known as antibodies. Some antibodies protect
us from unwanted invaders that could make
us sick or cause infection.
26. ASSESSMENT OF IMMUNE SYSTEM
The Agency for Toxic Substances and Disease Registry (ATSDR) basic panel of
immune function tests consists of a group of assessments that are performed
with serum and several other substances that are performed on whole blood.
Assays of serum include the following:
C Reactive Protein (CRP) – A marker of acute-phase reactions and a sensitive
indicator of tissue damage from a variety of causes
Immunoglobulins (Ig) G and M - Indicators of humoral immune status
IgA - An indicator of mucosal humoral immunity
Antinuclear antibody - An indicator of autoantibodies
Total protein - Used to correct the concentration of immunoglobulins for
concentration of blood proteins.
28. ANAPHYLAXIS
Anaphylaxis is a serious allergic reaction that is rapid in onset and may
cause death. It typically causes more than one of the following: an itchy
rash, throat or tongue swelling, shortness of breath, vomiting, light
headedness, and low blood pressure. These symptoms typically come on
over minutes to hours.
Common causes include insect bites and stings, foods, and
medications. Other causes include latex exposure and exercise. Additionally,
cases may occur without an obvious reason. The mechanism involves the
release of mediators from certain types of white blood cells triggered by
either immunologic or non-immunologic mechanisms. Diagnosis is based
on the presenting symptoms and signs after exposure to a
potential allergen.
29.
30.
31. ALLERGIC RHINITIS
Allergic Rhinitis, also known as hay fever, is a type of inflammation in the
nose which occurs when the immune system overreacts to allergens in the
air. Signs and symptoms include a runny or stuffy nose, sneezing, red, itchy,
and watery eyes, and swelling around the eyes. The fluid from the nose is
usually clear. Symptom onset is often within minutes following exposure
and they can affect sleep, the ability to work, and the ability to concentrate
at school. Those whose symptoms are due to pollen typically develop
symptoms during specific times of the year. Many people with allergic
rhinitis also have asthma, allergic conjunctivitis, or atopic dermatitis.
32.
33. POLLEN GRAINS FROM A VARIETY OF PLANTS, ENLARGED
500 TIMES AND ABOUT 0.4 MM WIDE
34. CONTACT DERMATITIS
Contact Dermatitis is a red, itchy rash caused by
direct contact with a substance or an allergic reaction to it.
The rash isn't contagious or life-threatening, but it can be
very uncomfortable. Many substances can cause such
reactions, including soaps, cosmetics, fragrances, jewellery
and plants.
35.
36.
37. ATOPIC DERMATITIS
Atopic Dermatitis (eczema) is a condition that
makes your skin red and itchy. It's common in
children but can occur at any age. It is long lasting
(chronic) and tends to flare periodically. It may be
accompanied by asthma or hay fever. No cure has
been found.
38.
39.
40. DRUG REACTIONS
Adverse Drug Reaction (ADR, or adverse drug effect) is a
broad term referring to unwanted, uncomfortable, or
dangerous effects that a drug may have.
Adverse drug reactions can be considered a form of toxicity;
however, toxicity is most commonly applied to effects of over
ingestion(accidental or intentional) or to elevated blood levels
or enhanced drug effects that occur during appropriate use
(e.g., when drug metabolism is temporarily inhibited by a
disorder or another drug).
41.
42.
43. FOOD ALLERGY
Food Allergy is an immune system reaction that
occurs soon after eating a certain food. Even a tiny
amount of the allergy-causing food can trigger
signs and symptoms such as digestive problems,
hives or swollen airways.
44.
45.
46. SERUM SICKNESS
Serum Sickness is an allergic reaction to an injection of serum, typically
mild and characterized by skin rashes, joint stiffness, and fever.
Serum sickness in humans is a reaction to proteins in antiserum derived
from a non-human animal source, occurring 5–10 days after exposure. It
is a type of hypersensitivity, specifically immune complex
hypersensitivity (type III). The term serum sickness–like reaction (SSLR) is
occasionally used to refer to similar illnesses that arise from the
introduction of certain non-protein substances, such as penicillin. It was
first characterized by Clemens von Pirquet and Béla Schick in 1906.
47.
48.
49. LATEX ALLERGY
Latex Allergy symptoms may include hives, itching,
stuffy or runny nose. Symptoms begin within minutes
after exposure to latex containing products. The most
severe latex allergy can result in anaphylaxis, a
serious allergic reaction involving severe breathing
difficulty and/or fall in blood pressure (shock).
50.
51.
52. APPROACHES TO TREAT
ALLERGIC DISEASES
Allergen Avoidance
Allergen Immunotherapy
Medications to reduce symptoms
Emergency Epinephrine
53. ALLERGEN AVOIDANCE
Careful Allergen Avoidance of the specific allergens responsible for
allergic disease should always be the first consideration in managing
patients with allergies. This is the primary form of treatment for food
allergies and some stinging insect allergies, as avoidance can be a
very effective strategy if patients are well educated about
precautionary measures. For example, a person allergic to jumper-ant
venom can minimise the chances of being stung by wearing shoes
and long-sleeved shirts when outdoors and gloves when gardening.
Accurate diagnosis of food allergies can enable patients to minimise
the disruption to their lives caused by an unnecessarily restrictive diet.
54. ALLERGEN IMMUNOTHERAPY
Allergen-specific Immunotherapy involves administration of
increasing doses of allergen to a patient to achieve clinical and
immunological tolerance over time.
Allergen injection immunotherapy induces T cell tolerance by several
methods, including decreased allergen-induced proliferation,
alteration of secreted cytokines, stimulation of apoptosis, and the
production of T regulatory cells.
This results in a reduction in inflammatory cells and mediators in the
affected tissues, the production of blocking antibodies, and the
suppression of IgE.
55. NURSING MANAGEMENT
OF THE CLIENT WITH THE
ALTERED IMMUNE RESPONSE
Avoidance of stress
Environmental control - air conditioned room, damp dusting
daily, hypoallergenic covers, mask outdoors
Monitor for side effects
Evaluate the progress of the client
Encourage self care
Maintain close supervision
Educate the attender about the follow up care
56. AUTO IMMUNE DISEASES
An Autoimmune Disease is a condition arising from an abnormal immune
response to a normal body part. There are at least 80 types of autoimmune
diseases. Nearly any body part can be involved. Common symptoms include
low grade fever and feeling tired. Often symptoms come and go.
The cause is generally unknown. Some autoimmune diseases such as lupus run
in families, and certain cases may be triggered by infections or other
environmental factors. Some common diseases that are generally considered
autoimmune include celiac disease, diabetes mellitus type 1, Graves'
disease, inflammatory bowel disease, multiple sclerosis, psoriasis, rheumatoid
arthritis, and systemic lupus erythematosus. The diagnosis can be difficult to
determine.
58. RHEUMATOID ARTHRITIS
Rheumatoid Arthritis is a systemic disorder in which
immune cells attack and inflame the membrane around
joints. It can affect the heart, lungs and the eyes as well.
It is an inflammatory disorder of unknown origin that
primarily involves the synovial membrane of the joints.
59. CLINICAL FEATURES
• Joint Pain
• Swelling
• Warmth
• Erythema
• Lack of basic functions of the extremities.
60. ASSESSMENT &
DIAGNOSTIC METHODS
Several factors contribute to an RA diagnosis
• Rheumatoid Nodules
• Joint Inflammation
• Laboratory Findings
• Extra articular Changes
RBC Count & C4 Compliment are decreased
Erythrocyte Sedimentation Rate is elevated
C Reactive Protein and Anti Nuclear Antibody Test results may be positive
Arthrocentesis and X Rays
64. SYSTEMIC LUPUS ERYTHEMATOUS
Systemic Lupus Erythematous is an inflammation of the
connective tissues, which can afflict every organ system. It is up
to nine times more common in women than men and strikes
black women three times as often as white women. The
condition is aggravated by sunlight.
It is a chronic inflammatory autoimmune disease of unknown
aetiology that commonly affects women of child bearing age.
Lethargy and fatigue are described as the most disabling of
lupus symptoms.
70. ANKYLOSING SPONDYLITIS
Ankylosing Spondylitis (AS) is a type of arthritis that affects
your spine. It can cause pain, stiffness, and inflammation from your
neck to your lower back. When you have this condition, the vertebrae
in your spine can fuse together. This makes your spine less flexible
and might lead to a hunched-over posture and trouble breathing.
Early diagnosis and treatment can control the condition and prevent
these and other problems.
71. SYMPTOMS
• Pain and stiffness
• Bony fusion
• Pain in ligaments and
tendons
• Bent posture
• Breathing problems
• Heart trouble
• Eye problems
• Inflammatory bowel
disease
• Psoriasis
• Fatigue
• Dactylitis
• Fever
72. RISK FACTORS
Age - It tends to start between in teens and 30s.
Gender - Men are two to three times more likely to get
the disease than women.
Genetics - One can inherit it from parents. One gene,
called HLA-B27, is common in people with AS.
Ethnicity - AS appears more often among native tribes in
the U.S. and Canada, especially Alaskan Eskimos.
76. NURSING CONSIDERATIONS
Exercise daily - Moving helps in staying flexible. It can help ease back
pain and stiffness. A physical therapist can teach how to exercise safely.
Work out in a warm pool to make movement easier.
Practice posture - Sitting and standing up straight may help with pain
and stiffness.
Heat and cold therapy - Using moist heat pads or taking hot showers can
ease the stiffness, sore back. Cold packs can lower swelling in inflamed
joints.
Healthy lifestyle and food choices - Keep a healthy body weight or ask
the doctor how you can lose weight if you need to. Extra pounds stress
the back and other joints. Smoking makes AS worse.
77. NURSING CONSIDERATIONS
Follow the treatment plan - Take medications as prescribed,
don’t smoke, and exercise daily to help ease inflammation and
prevent spine fusion or organ damage.
Watch for signs of inflammation in other areas - Talk to the
doctor if pain or redness in eyes, pain in your stomach, or a
patchy rash on your skin persists.
Get support - It’s helpful to talk to others who have AS. The
Spondylitis Association of America has support groups in many
areas as well as online communities.
78. GRAFT VERSUS HOST DISEASE
Graft Versus Host Disease is a process in which donor T-cells
attack by the host cell, manifesting primarily in skin, liver and
gastrointestinal complication. Graft-versus-host disease (GvHD) is
a medical complication following the receipt of transplanted tissue
from a genetically different person. GvHD is commonly associated
with stem cell transplants such as those that occur with bone
marrow transplants. GvHD also applies to other forms of
transplanted tissues such as solid organ transplants.
80. PATHOPHYSIOLOGY
Acute GVHD occurs in several steps
High dose conditioning regimen causes cell
injury and inflammation in the host cells,
leading to a release of cytokines.
Host Antigen Presenting Cells (APCs) cause
activation of the donor T cells.
Cell Injury and death is induced by cytokines
and donor T cells.
83. ACUTE GVHD
The onset of Acute GVHD develops with
conventional allogenic transplant between 14-35
days after infusion, but typically can occur up to
100 days or longer.
Reduced intensity transplant recipients can
develop acute GVHD weeks to months after the
transplant.
84. CHARACTERISTICS
Acute GVHD graded using one of two
scales. The Glucksberg scale was
developed over 30 years ago and is still
used in many institutions.
85. SKIN
Skin GVHD is graded according to the percentage
of body surface area involved.
Must differentiate from drug reaction and skin
infection.
Biopsy can help in differentiation.
86. LIVER
Liver GVHD graded according to the bilirubin level.
Liver biopsy can clarify.
87. GUT
Gut GVHD is graded according to the volume of stool
daily.
Typically presents nausea, anorexia, abdominal pain and
watery diarrhea which can be liters per day.
Severe cases may experience bloody diarrhea.
88. OTHER ORGANS
Some feel that GVHD can also affect the lung,
causing problems such as alveolar hemorrhage,
interstitial pneumonitis, bronchiolitis and other lung
conditions.
89. CHRONIC GVHD
Chronic GVHD typically occurs 60-400
days after transplant and can last from
months to years after. The median time to
develop chronic GVHD with an unrelated
donor is 133 days and 201 days.
90. CHARACTERISTICS
Chronic GVHD resembles autoimmune
disorders, such as lupus, Sjogren’s
syndrome and scleroderma. The skin, oral
mucosa, liver and lacrimal glands are the
most frequently involved areas.
91. SKIN
Skin changes can vary greatly ranging from
erythematous or purple maculopapular rash and
scaling to pigmentation changes and fibrosis.
Skin can become fibrotic, immobile and fixed to tissue
below it.
Hair may be brittle, thin, fall out.
Sweat gland can be damaged.
92. EYES
Chronic GVHD causes fibrosis of the
lacrimal glands.
Patient reports dry or burning eyes,
photophobia or sensation of something
under eyelid.
93. ORAL
Damaged to salivary gland results in
decreased saliva production, dry mouth,
irritation and dental decay.
Ulceration and white plaques can
develop in the oral mucosa.
94. LIVER
Damages bile duct epithelium and can
cause cholestasis.
Elevation in bilirubin, alkaline and
phosphate is common.
95. OTHER SITES
GI Tract – Esophageal Fibrosis
Lungs – Cough, Wheezing & Dyspnea
Immune Suppression – Bone Marrow
Suppression
Musculoskeletal, Vulvar and Vaginal, Cardiac
and Kidney Changes can occur.
96. TREATMENT
Corticosteroids - Destroy T cells and suppress
cytokine production via anti-inflammatory
effects.
Cyclosporine - Immunosuppressant.
Tacrolimus - Immunosuppressant.
Methotrexate - Chemotherapy agent
Anti-thymocyte Globulin
97. NURSING CONSIDERATIONS
Skin
• Topical steroid creams may be used.
• Maintain skin integrity with lotions, creams and or moisture barriers.
• Wound care blistering or open areas.
• Burn care for severe cutaneous involvement.
Liver
• Education about liver biopsy.
• Cautious use of hepatotoxic medication.
98. NURSING CONSIDERATIONS
Gut
• Maintain input and output chart.
• Rectal care consisting of cleansing after each bowel movement
and moisture barrier cream.
• Monitor for GI bleeding, test emesis and stool for occult blood.
• Monitor hemoglobin, hematocrit and platelet counts.
• Management of fecal incontinence.
• NPO Diet.