1. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Chapter 19 Nursing Care of Patients with Immune Disorders

2. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Disorders of the Immune System  Three Categories  Hypersensitivity Reactions  Autoimmune Disorders  Immune Deficiencies

3. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Disorders of the Immune System (cont ’ d)  Hypersensitivity Reactions  Anaphylaxis  Hemolytic Transfusion Reactions  Measles  Transplant Rejections

4. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Disorders of the Immune System (cont ’ d)  Autoimmune Disorders  Rheumatoid Arthritis  Ulcerative Colitis  Multiple Sclerosis

5. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Disorders of the Immune System (cont ’ d)  Immune Deficiencies  Hypogammaglobulinemia  Acquired Immunodeficiency Syndrome

6. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hypersensitivity Reactions  Injury to Body Due to Exaggerated Response  Classified by Way Tissue is Injured  Type I, II, III, IV

7. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Type I  Anaphylactic Reaction  Immediately  Mild to Severe, Life-threatening

8. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Type I (cont ’ d)

9. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Allergic Rhinitis  Most Common Form of Allergy  Sneezing, Nasal Itching, Runny Nose, Itchy Red Eyes

10. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Atopic Dermatitis  Eczema  Inflammatory Skin Response  Pruritus, Edema, Extremely Dry Skin, Blisters, Crusts, Scales

11. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anaphylaxis  Severe Systemic Hypersensitivity Reaction  Widespread Histamine Release  Bronchial Narrowing: Stridor, Wheezing, Respiratory Arrest  Hypotension, Tachycardia, Cardiac Arrest

12. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anaphylaxis (cont ’ d)  Immediate Treatment Guided by Symptoms  Oxygen  Epinephrine  Antihistamines  Corticosteroids  Vasopressors  Mechanical Ventilation

13. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Anaphylaxis (cont ’ d)  Nursing Care  Early Recognition  Maintain Airway  Emotional Support  Education

14. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Urticaria (Hives)  Release of Histamine  Raised, Pruritic, Non-tender, Erythematous Wheals on Skin

15. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Urticaria (Hives) (cont ’ d)  Therapeutic Interventions  Epinephrine  Corticosteroids  Antihistamines  Histamine H 2 Blockers

16. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Angioedema  Form of Urticaria  Affects Submucosal/Subcutaneous Tissue Rather Than Skin  Painless, Dermal Erythematous/ Subcutaneous Eruptions, Skin/Mucous Membrane Edema

17. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Type I Nursing Diagnoses  Impaired Gas Exchange  Anxiety  Risk for Impaired Skin Integrity  Ineffective Health Maintenance

18. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Type I Nursing Care  Monitor Respiratory Status  Monitor Level of Consciousness  Stay with Patient  Provide Information  Note and Document Skin and Lesions  Teach Rubbing or Pressure, Not Scratching

19. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Type I Nursing Care (cont ’ d)  Teach Patient to Wear Medical Alert Identification  Discuss Methods of Avoiding Allergen

20. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Type II  Destruction of Substance with Antigen  May Be Beneficial (Bacteria)  Not Beneficial When RBC Sensed as Foreign

21. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Type II (cont ’ d)

22. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hemolytic Transfusion Reaction  RBCs with Foreign Antigens Rapidly Lysed  Occludes Blood Vessels  Ischemia, Necrosis  Life-threatening

23. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hemolytic Transfusion Reaction (cont’d)  Prevention is Key!  Rhogam: Rh o (D) Negative Patients  Careful Blood Transfusion Administration

24. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hemolytic Transfusion Reaction (cont ’ d)  Therapeutic Interventions  Antihistamines  Corticosteroids  Sympathomimetics

25. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hemolytic Transfusion Reaction (cont ’ d)  Nursing Diagnoses  Hyperthermia  Ineffective Tissue Perfusion  Impaired Gas Exchange  Ineffective Breathing Pattern

26. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hemolytic Transfusion Reaction (cont ’ d)  Nursing Care  Prevention  Careful Transfusion Monitoring  If Reaction, Stop Blood, Follow Policy  Education

27. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Type III  Immune Complexes Formed by Antigens and Antibodies  Antigen-antibody Complexes Within Blood Vessels  Enzymes Lead to Blood Vessel Damage  Red Edematous Lesion, Bleeding, Necrosis

28. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Type III (cont ’ d)

29. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Serum Sickness  Antigen-antibody Complexes Cause Symptoms of Inflammation  7 to 10 Days After Penicillin/Sulfonamide  Severe Urticaria and Angioedema  Brief and Self-limiting Condition

30. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Serum Sickness (cont ’ d)  Nursing Diagnoses  Anxiety/Fear  Pain  Risk for Deficient Fluid Volume  Risk for Impaired Skin Integrity

31. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Serum Sickness (cont ’ d)  Nursing Care  Monitor Symptoms  Evaluation Medication Effects  Education

32. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Type IV  Delayed Reaction  Sensitized T Lymphocyte Contacts Antigen  Cell-mediated Immune Response  Necrosis

33. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Type IV (cont ’ d)

34. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Contact Dermatitis  Chemical Comes in Contact with Skin  On Second Exposure, T Cells Secrete Chemicals  Poison Ivy, Poison Oak, Latex Rubber  Reddened, Pruritic, Fragile Vesicles

35. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Contact Dermatitis (cont ’ d)  Therapeutic Interventions  Antihistamines, Topical Drying Agents, Corticosteroids  Tepid Baking Soda Baths or Aveeno Baths  Wash with Brown Soap (Fels-naptha)  Avoid Scratching Skin

36. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Transplant Rejection  Transplanted Living Tissue Sensed as Foreign  Lymphocytes Sensitized Immediately  Invade Transplanted Tissue and Destroy it  Failure of Organ or Tissue  Infection Can Result in Death

37. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Transplant Rejection (cont ’ d)  Prevention  Immunosuppression Therapy

38. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Autoimmune Disorders  Immune System Recognizes Body ’ s Own Cells as Foreign  Immune Response Destroys Cells

39. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pernicious Anemia  Antibodies Against Gastric Parietal Cells and Intrinsic Factor  Vitamin B 12 Deficiency  RBC Production Decreased  Also Caused by Gastric or Small Bowel Resections

40. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Pernicious Anemia (cont ’ d)  Therapeutic Interventions  Corticosteroids  Lifelong Vitamin B 12

41. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Idiopathic Autoimmune Hemolytic Anemia  Autoantibodies Attach to RBCs  Lyse or Agglutinate

42. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Idiopathic Autoimmune Hemolytic Anemia (cont ’ d)  Signs and Symptoms  Mild Fatigue  Pallor  Hypotension  Dyspnea  Jaundice

43. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Idiopathic Autoimmune Hemolytic Anemia (cont ’ d)  Therapeutic Interventions  Immunosuppressive Medications  Oxygen  Corticosteroids  Folic Acid  Transfusion

44. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Idiopathic Autoimmune Hemolytic Anemia (cont ’ d)  Therapeutic Interventions (cont’d)  Erythrocytapheresis  Splenectomy

45. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hashimoto ’ s Thyroiditis  Autoantibodies for Thyroid-stimulating Hormone, Thyroid Gland Overstimulation  Then Autoantibodies Destroy Thyroid, Hypothyroidism  Lifelong Thyroxine

46. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Lupus Erythematosus  Three Types  Discoid (DLE)  Skin Lesions  Drug-induced Systemic Lupus Erythematosus  After Certain Medication Use  Systemic Lupus Erythematosus  Chronic, Inflammatory, Multisystem Disorder

47. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Lupus Erythematosus (cont ’ d)  Etiology  Young Women of Child-bearing Years  First-degree Relatives of Lupus Patients  African American/Hispanic Population More Frequently

48. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Lupus Erythematosus Signs and Symptoms  Discoid  Patchy, Crusty, Sharply Defined Skin Plaques  Occur on Face/Sun-exposed Areas

49. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Systemic Lupus Erythematosus Signs and Symptoms  Drug-Induced  Pleuropericardial Inflammation  Fever  Rash  Arthritis

50. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Systemic Lupus Erythematosus Signs and Symptoms (cont ’ d)  Early Symptoms Vague: Fatigue, Fever  Dermatologic: Butterfly Rash, Bruising Photosensitivity, Alopecia, Pain, Pruritis  Musculoskeletal: Arthralgia, Arthritis

51. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Systemic Lupus Erythematosus Signs and Symptoms (cont ’ d)  Hematologic: Anemia, Leukocytopenia, Thrombocytopenia  Cardiopulmonary: Pericarditis, Myocarditis, Myocardial Infarction, Vasculitis, Pleurisy, Valvular Disease

52. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Systemic Lupus Erythematosus Signs and Symptoms (cont ’ d)  Renal: Kidney Disease, Urinary Tract Infections, Fluid and Electrolyte Imbalances  CNS: Cranial Neuropathies, Seizures, Cognitive Impairment

53. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Systemic Lupus Erythematosus Signs and Symptoms (cont ’ d)  Gastrointestinal: Anorexia, Ascites, Pancreatitis, Intestinal Vasculitis  Ophthalmologic: Conjunctivitis, Dry Eyes, Glaucoma, Cataracts, Retinal Pigmentation

54. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Systemic Lupus Erythematosus Therapeutic Interventions  Symptomatic Management  Nonsteroidal Anti-inflammatory Drugs  Immunosuppressants  Corticosteroids  Antimalarials  Intravenous Immunoglobulin

55. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Systemic Lupus Erythematosus  Complications  Osteonecrosis  Kidney Disease  Thrombocytopenia  Emboli  Myocarditis

56. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Systemic Lupus Erythematosus (cont’d)  Complications (cont’d)  Vasculitis  Mesenteric or Intestinal Vasculitis  Sepsis

57. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Systemic Lupus Erythematosus Nursing Diagnoses  Acute Pain  Chronic Sorrow  Disturbed Body Image  Fatigue  Powerlessness

58. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Systemic Lupus Erythematosus Nursing Diagnoses (cont ’ d)  Ineffective Health Maintenance  Risk for Impaired Skin Integrity  Spiritual Distress  Deficient Knowledge

59. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Ankylosing Spondylitis  Chronic Progressive Inflammatory Disease  Sacroiliac, Costovertebral, Large Peripheral Joints

60. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Ankylosing Spondylitis Signs and Symptoms  Lower Back Stiffness  Pain  Lordosis, Kyphosis  Spasms  Fatigue  Anorexia, Weight Loss

61. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Ankylosing Spondylitis (cont ’ d)  No Cure, Supportive Care, Surgery  Education: ROM Frequently

62. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Ankylosing Spondylitis (cont ’ d)  Nursing Diagnoses  Chronic Pain  Powerlessness  Fatigue  Self-Care Deficit  Impaired Physical Mobility

63. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Immune Deficiencies One or More Components of Immune System Completely Absent or Deficient

64. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hypogammaglobulinemia Absence/Deficiency of One or More of Five Immunoglobulins from Defective B Cell Function

65. Copyright © 2011. F.A. Davis Company Linda S. Williams / Paula D. Hopper Understanding Medical Surgical Nursing, 4th Edition Hypogammaglobulinemia (cont ’ d)  Prone to Infections  Therapeutic Interventions  Minimizing Infections  IgG Injections  Fresh Frozen Plasma