Download - Immunological Disorders
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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.
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immune disorders
Presenter: Ms Shahina Amiry
Acknowledge: Ms. Saima Sohail
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By the end of this session, students will be able to:
Review the anatomy & physiology of the immune system Discuss the definitions related to immunological disorders.
Define the term “hypersensitivity” (allergy)
Understand the types of hypersensitivity reactions with its examples
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OBJECTIVES cont’d----Discuss the Definition, Causes, Pathophysiology, Clinical manifestations of the following allergic disorders
•Describe the diagnostic, medical and surgical management of the below mentioned disorders.
•Apply nursing process including assessment, diagnosis, implementation and evaluation of care provided to the client with the following allergic disorders;
Allergic rhinitis Atopic dermatitisAnaphylaxisSerum sickness
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Definition:“It is an abnormal, heightened reaction to any type of stimuli”.
(Smeltzer, et al, 2004)
“Immune response that results in tissue injury or other physiological changes are called hypersensitivity (allergic)
reactions”. (Mellors, 1999).
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Hypersensitivity reactions are classified into four types: Type I: anaphylactic hypersensitivity
Type II: cytotoxic hypersensitivity
Type III: immune complex hypersensitivity
Type IV: cell mediated hypersensitivity
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Type I: Anaphylactic hypersensitivity:
It is an immediate reaction beginning within minutes of exposure to an antigen.
It is mediated by I.e. antibodies.
It requires previous exposure to specific antigen.
It usually affects on skin, lungs and gastrointestinal tract.
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Anaphylactic (type I) Hypersensitivity
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Examples:
◦Asthma◦Allergic rhinitis◦Systemic anaphylaxis.◦Atopic dermatitis
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Type II: cytotoxic hypersensitivity
It occurs when the system mistakenly identifies a normal constituent of the body as foreign.
This reaction may be a result of cross-reacting antibody, possibly leading to cell and tissue damage
It involves activation of complement by IgG or IgM antibody binding to an antigenic cell.
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Examples: Myasthenia gravis
Blood Transfusion reaction
Thrombocytopenia
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Type III: Immune complex hypersensitivity It involves in the formation of immune complexes
when antigen binds to antibodies.
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.
The joints and kidneys are particularly susceptible.
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Examples: Systemic lupus erythematous
Rheumatoid arthritis
Serum sickness
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Type IV: Cell mediated hypersensitivity
Also known as cellular hypersensitivity
It occurs 24-72 hrs after exposure to an allergen
The reaction is mediated by sensitized T cells and macrophages.
The reaction results In tissue damage by releasing lymphokines, macrophages and lysozymes.
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Examples:
Contact dermatitis
Tuberculin test.
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It is also called as Hay Fever
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Definition:“It is an inflammation of the nasal mucosa by an
allergen”. (Smeltzer, 2004).
Incidence:It affects about 8-10% of U.S. population.
(Smeltzer, 2004).
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Perennial Seasonal Year-round with allergic
triggers
Early spring, early fall, early summer
Sneezing, itching, watery discharge from nose and eyes
Intense symptoms triggered by air-borne pollens, house dust and animal feather.
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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).
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Clinical manifestations: ALLERGIC RHINITIS
• Nasal congestion
• Clear to greenish rhinorrhea
• Intermittent sneezing and nasal itching
• Headache
• Pain over Para nasal sinuses
• Epistaxis
• Fatigue, loss of sleep and poor coordination.
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Diagnostic tests:• Nasal smears (nasal eosinophilia)
• Total serum IgE
Medical management:• Oral anti histamines (blocks the action of histamine)
• Adrenergic nasal decongestant
• Mast cell stabilizers.
• Analgesics and antipyretics.
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Nursing management:
Assessment• Examination (Assess symptoms) • History of patient (Allergy assessment)
Diagnosis• Ineffective breathing pattern related to allergic
reactions• Knowledge deficit related to allergy and the
recommended modifications in life style and self-care practices
• Ineffective individual coping with condition and need for environmental modification.
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Nursing interventions:
1. Patient is instructed to modify the environment to reduce the severity.
2. Encourage for deep breathing and cough frequently for adequate gas exchange.
3. Encourage for steam inhalation
4. Promote rest.
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It is a type I immediate hypersensitivityDefinition:
Inflammation of the skin
Incidences/Causes:• Familial tendency
• It is highest in infants and children
• 1% population is suffering from this disease
• Aggravated in low humidity and in winter. (smeltzer, 2004)
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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
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Clinical manifestations: Atopic dermatitis
• Red oozing crusting rash (in childhood)
• Dry thick brownish – grey and scaly skin (later stage)
• Pruritis
• Lesion are mostly found on hand, foot, back of the knees, neck, face, eyelids and elbow bands.
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Medical Management: Atopic dermatitis
• Moisturizers• Topical and
systemic steroids• Antibiotics• Antihistamines• Perform allergen
test
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Nursing management: Atopic dermatitis
• Assess and maintain hygiene (daily bath)
• Determine dietary and other allergen (cow milk, egg, Soya, wheat, nut, fish)
• Teach to avoid allergen
• Keep wound area moist
• Teach proper use of medicines
• Avoid scratching (wear cotton fabrics, washing with mild detergent)
• Prevent from secondary infection
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AnaphylaxisDefinition:
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.
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Causes: Anaphylaxis
• Food ( peanuts, fish, milk, eggs, wheat and chocolate).
• Medications (penicillin, NSAID’s)
• Insects stings (bees, ants)
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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.
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Clinical manifestations: Anaphylaxis
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
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Medical management: Anaphylaxis
1. If cardiac arrest then cardiopulmonary resuscitation initiated.
2. Antihistamine to prevent recurrence reaction3. Start intravenous fluids to maintain hemodynamics.4. Give aminophylline for bronchospasm
Nursing management: Anaphylaxis
1. Assess for signs of anaphylaxis.2. Restore effective breathing 3. Reduce anxiety by reassuring the patient4. Provide oxygen, and maintain airway5. Monitor vital signs.
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It is a type III hypersensitivity reaction.
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
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Localized:Inflammatory reaction at the site of injection.
Generalized:Skin rashes Tenderness and swelling of joints vasculitis mostly in kidneys results in proteinuriaGlomerulonephritisPeripheral neuritis leads to temporary paralysisFever
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Medical management:AntihistaminesCorticosteroids
Nursing management:Encourage for ROM exercises, provide DVT stockings (a deep
vein thrombosis and pulmonary embolism are treats to these patients.
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Carpenito-Moyet, L. J. (2003). Nursing Care Plans & Documentation: Nursing Diagnosis And Collaorative Problems. (4th ed.). Philadelphia: Lippincott Williams and Wilkins
Jevon, H. (April, 2000). Anaphylaxis: Emergency Treatment. Nursing Times, 96(14), 39-40.
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.
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
Smeltzer, S. C., Bare, B. (2004). Medical and surgical nursing. (10th ed.). Philadelphia: Lippincott Williams & Wilkins
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