Caring for Clients With ImmuneMediated Disorders

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Caring for Clients With Immune-Mediated Disorders
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Allergic Disorders

• A hyper-immune response to weak antigens that
  usually are harmless
• Allergensantigens that can cause an allergic
  response (Table 42-1) p. 560

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Types of Allergies(how allergens enter the body)

• Skin
• Respiratory
• GI
• Blood
• Vascular system
• (Table 42-1) p. 560

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Definitions

• Gastroenteropathy - gastrointeritis
• Symptoms of eosinophilic gastroenteritis depend
  on which layer of the wall of the GI tract is
  involved. Involvement of the inner lining can
  cause pain, nausea, vomiting, diarrhea, weight
  loss and malabsorption. Muscle layer involvement
  can cause obstruction.
• Urticariahives
• Angioedemaacute swelling p. 562
• Serum sickness--Serum sickness is a
  hypersensitivity reaction similar to an allergy.
  The immune system misidentifies a protein in the
  antiserum as a potentially harmful substance
  (antigen ), and it develops an immune response
  against the antiserum. Because it takes time for
  the body to produce antibodies to a new antigen,
  symptoms do not develop until 7 - 21 days after
  initial exposure to the antiserum. Patients may
  develop symptoms in 1 - 3 days if they have
  previously been exposed to the offending agent.
• Exposure to certain medications (particularly
  penicillin) can cause a similar process. Unlike
  other drug allergies, which occur very soon after
  receiving the medication for the second (or
  subsequent) time, serum sickness can develop 7 -
  21 days after the first exposure to a medication.
  Blood products may also induce serum sickness.
• Allergic asthma is triggered by year-round
  allergens in the air.
• Hypersensitivity pneumonitis (HP), also called
  extrinsic allergic alveolitis, is a complex
  syndrome of varying intensity. HP is caused by
  sensitization to repeated inhalation of dusts
  containing organic antigens, such as dairy and
  grain products, animal dander and protein, wood
  bark, and water reservoir vaporizers

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Pathophysiologh Etiology

• 10-15 develop allergies
• Inherited tendency
• Sensitization- exposure to allergens triggers an
  immune system response
• Anaphylaxis-a rapid profound allergic response,
  charachterized by shock, laryngeal edema,
  wheezing, stridor, tachycardia, and generalized
  itching.

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Pathophysiologh Etiology cont

• Mast cells and basophilsrelease granuels of
  heparin, serotonin, bradykinin, and antihistamine
  in response to subsequent exposure to allergens
• Localized reactions (Fig. 42-10 P.562)
• Delayed hypersensitivity responseover several
  hours or days.
• Reactions to blood transfusions, transplant
  rejection, reaction to TB skin test.

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Assessment Findings

• S/S
• ID of substance causing symptoms and how it
  entered the body.
• Respiratory symptoms
• Skin reactions
• GI upset
• Systemic reactions/anaphylaxix
• Airway obtruction

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Diagnostic Findings

• Blood tests
• Skin tests
• ID of food allergens (Nursing Guidelines 42-1)
  p. 563

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Medical Management

• Avoid allergens
• Symptomatic relief
• Drug therapy (Table 42-1) p. 565
• Emergency kits (Epipen) p. 566
• Desensitizationimmunotherapy
• Repeated exposure to the weak antigen.

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Nursing Management

• Client teaching for S/S of allergic reactions
• Avoiding allergens
• Client teaching for prep for skin tests
• Administration of meds/teaching/ documentation of
  effects reactions
• Teaching box 42-1, p. 566

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Autoimmune Disorders

• Killer T cells and autoantiboidies (antibodies
  against self-antigens)immuniglobulins

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Pathophysiology Etiology

• The immune system fails to recognize
  histocompatible cells causing an immune response
  which damages/destroys cells, tissues, organs.
• Theories--Table 42-3
• More than one mechanism
• Triggered events
• Genetic predisposition

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Assessment Findings

• S/S
• Various depending on the tissues and organs
  effected
• Alternating unpredictable periods of
  exacerbation/remission
• Diagnostic Findings
• Variousdepending on the disorder
• Overall elevated circulating antibodies

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Medical Management

• Goalinduce remission of slow distruction
• Drug therapy
• Anti-inflamatory/immunosupressive agents
• Anti-neoplastic drugs
• Drug Therapy 42-2

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Chronic Fatigue Syndrome(CFS)

• A complex of symptoms characterized by fatigue
  with no indetifiable cause
• Duration 6 or more months
• Associated with fibromyalgia

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Pathophysiology/Etiology

• Unknown
• Immune system deregulation

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Assessment Findings

• S/S
• Recent illness with flulike symptoms
• Debilitating fatigue lasting 6 months
• Plus 4 or more symptomsp. 572
• Diagnostic Findings
• Unremarkable for specific dx
• Tilt table test p. 573

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Medical Management

• Relief of symptoms
• Client teaching for balance between rest and
  activity
• Meds for pain/fever relief
• Increase in salt and water intake for hypotension
• Holistic tx

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Nursing Management

• Client ed. 42-3, p. 573