1. NURSING MANAGEMENT OF CLIENTS WITH IMMUNE AND INFLAMMATORY DISORDER

2. Physiology of Immune System CORE TERM DETAILSDESCRIPTION ROLES RECOGNIZE NEUTRALIZE FORMS OWN CELLS FROM OTHER PRESENCE OF ANTIGEN ANTIBODY FORMATION FUNCTIONS DEFENSE HOMESTASIS SURVEILLANCE AGAINST INFECTION REMOVING OLD CELLS CIRCULATING CELLS

3. Types of Immune Responses CORE TERM DETAILSDESCRIPTION Immunity Natural Genetic Acquired Natural - exposure Artificial – vaccine Passive Natural – maternal Ig Artificial – serum Ig

4. Characteristics of Immune Response CORE TERM DETAILSDESCRIPTION Specificity One antibody to one antigen Chicken pox antibodies not protect measles Memory Remember antigen Continued resistance to the disease Recognition Without self- injury Results to autoimmune disorder

5. Components of Immune Response CORE TERM DETAILSDESCRIPTION Organs Cell Type Granulocyte Eosinophils Basophils Neutrophils Allergy & parasites Anaphylaxis & allergy Phagocytosis Cell Type Agranulocyte Monocytes Lymphocytes Macrophages B-cell & T-cells

6. Immune Response Classification CORE TERM DETAILSDESCRIPTION Cellular Mediated Immunity T-cells Persists over years Function: transplant rejection, delayed hypersensitivity & surveillance Humoral Mediated Immunity B-cells Produces circulating Ig Functions: phagocytosis and lysis

7. Lines of Defense CORE TERM DETAILSDESCRIPTION Intact Skin Skin is the primary line Inflammatory Response Inflammation is the first sign of healing Dolor (pain) Calor (heat) Rubor (rubor) Tumor (swelling) Functio laesa (loss) Immune Response Release of immune serum Release of Immunoglobulins

8. Types of Immunoglobulins CORE TERM DETAILSDESCRIPTION IgG 85% of all Ig All body fluids Bacterial and viral response IgA 15% of all Ig Lining of the lungs, saliva, tear Natural response IgM 13% of all Ig Present in blood and lymph Immediate response IgE 0.002% of all Ig Skin, lungs and mucous Allergic response IgD 0.2% of all Ig Present in blood Delayed response

9. Types of Hypersensitivity CORE TERM DETAILSDESCRIPTION Type I Reactant IgE Antigen formed Soluble antigen Activator Bind to mast cells Example Local and systemic

10. Types of Hypersensitivity CORE TERM DETAILSDESCRIPTION Type II Reactant IgG & IgM Antigen formed Cell-bound Activator Binds to cellular antigen Example RBC destruction

11. Types of Hypersensitivity CORE TERM DETAILSDESCRIPTION Type III Reactant IgG & IgM Antigen formed Soluble antigen Activator Antigen antibody complexes Example Post-strep infection, RA, SLE

12. Types of Hypersensitivity CORE TERM DETAILSDESCRIPTION Type IV Reactant T-cells Antigen formed Soluble or cell bound Activator Macrophage & cytotoxic cells Example Contact dermatitis, Type 1 DM, MS

13. Factors Affecting Immune Response CORE TERM DETAILSDESCRIPTION Age Newborn Elderly Less immunity Metabolism Hormone deficient Thyroid & adrenal deficiency decreases immune response Emotional Stress Decrease production of immune cells Hormones Women vs Men Women have more immune disease than men Environment Unsanitary living condition Nutrition Poor Decreases immune response

14. HIV / AIDS CORE TERM DETAILSDESCRIPTION Etiology HIV Virus that causes the infection Attack & destroy CD4 count AIDS State of severe decrease in immune function due to HIV Incidence 2008 - 1 2010 - 4 2012 - 9 2014 - 17 2016 - 26 2018 - 31 Incidence is increasing

15. Stages of HIV Infection CORE TERM DETAILSDESCRIPTION Stage 1 Acute Infection 2-4 weeks after exposure CD4 count is decreasing Stage 2 Clinical latency or Inactivity 2-3 weeks window period 5-10 years after the window period Drastic drop in CD4 count Stage 3 End Stage Disease / AIDS 3 years survival rate CD4 count is below 200/mm3

16. HIV 1 vs HIV 2 CORE TERM DETAILSDESCRIPTION HIV 1 Location Worldwide Hetero- sexual 3-6 fold higher Perinatal 15-45% Time to AIDS 7-10 years

17. HIV 1 vs HIV 2 CORE TERM DETAILSDESCRIPTION HIV 1 Location West Africa Hetero- sexual 3-6 fold lower Perinatal 0-5% Time to AIDS 10-25 years

18. Major & Minor Signs & Symptoms CORE TERM DETAILSDESCRIPTION Major Local to Systemic Chronic Fever Chills Rash Night sweats Muscle aches Sore throat Fatigue Swollen lymph nodes Mouth ulcers

19. Major & Minor Signs & Symptoms CORE TERM DETAILSDESCRIPTION Minor Systemic Rapid weight loss Recurring fever Profuse night sweats Extreme and unexplained tiredness Prolonged swelling of the lymph glands Chronic Diarrhea Sores of the mouth, anus, or genitals Opportunistic infections and cancers

20. Mode of Transmission CORE TERM DETAILSDESCRIPTION Sexual intercourse Vaginal Oral Anal The most common transmission Blood Transfusion HIV infected blood is transfused to others Injection Sharing of needles Without sterilization Engage in tattoo Mother-Baby Utero- placental related Before, during, postpartum

21. Body Fluids as Mode of Transmission CORE TERM DETAILSDESCRIPTION Blood 3-5% Blood is has lesser transmission risks Semen 70-80% The highest transmission of HIV is due to sexual intercourse Pre-seminal Vaginal Rectal Breast milk 5-10% Milk carries the virus

22. Susceptible Sex for HIV CORE TERM DETAILSDESCRIPTION MSM 77-86% Men having sex with men MSW 14-23% Heterosexual intercourse Fetus 0-3% Mother to fetus during pregnancy Children 0-3% Mother to child after birth

23. Complication of HIV/AIDS CORE TERM DETAILSDESCRIPTION Encephalopathy HIV AIDS HIV encephalopathy AIDS dementia Cancer Kaposi’s Sarcoma Skin related cancer Most common cancer Pneumonia Pneumocystis Carinii Most common infection

24. Diagnostic Evaluation CORE TERM DETAILSDESCRIPTION HIV-1 Antibody Test ELIZA Screening test Usually false positive Western Blot Confirmatory Antigen Test Early detection Detects the virus after 2 weeks

25. Medical Management CORE TERM DETAILSDESCRIPTION Nucleoside Reverse Transcriptase inhibitors AZT (Zidovudine) Anti-retroviral Non-Nucleoside Transcriptase inhibitors Viramune (Nevirapine) Anti-retroviral Protease inhibitors Norvir (Ritonavir) Anti-retroviral Medications Treat the opportunistic infection

26. Nursing Management CORE TERM DETAILSDESCRIPTION Transmission Patient Education Focus on prevention Safe sex condom use Perinatal transmission No recapping needles No donation of blood, plasma, body organs, semen HIV positive women should not breastfeed Supportive Care Positive patient Assist client to access services

27. HIV Prevention CORE TERM DETAILSDESCRIPTION A- Abstinence The most important B- Be faithful One partner only C- Consistent use of condom Most common method D- Do early screening & testing Testing is done to all E- Early awareness and education Teaching is the most important prevention

28. ARTHRITIS CORE TERM DETAILSDESCRIPTION Osteoarthritis Primary Idiopathic, no cause Secondary Due to previous injury Inflammatory Rheumatoid Chronic inflammation of synovium (multiple joints) Psoriatic Associated with psoriasis (multiple joints) Gout Caused by monohydrate crystals Pseudogout Calcium related Septic Life and limb threatening

29. ARTHRITIS CORE TERM DETAILSDESCRIPTION Osteoarthritis Prevalence Most common Signs/ symptoms Joint pain & stiffness Swollen joints Cause Wear and tear in joints Injuries and overuse of joints Being overweight Family history of disease

30. ARTHRITIS CORE TERM DETAILSDESCRIPTION Rheumatoid Prevalence Most disabling type Signs/ symptoms Morning stiffness for hour Swelling of 3 or more joints Bilateral joints are affected Tenderness, warmth Cause Unknown Fault in immune function Family history

31. ARTHRITIS CORE TERM DETAILSDESCRIPTION Gout Prevalence Most common in men Signs/ symptoms Stiff backbone Low back pain Joint area is red or purple Attack lasts hours or days Cause Build up of uric acid crystals Body treat the crystal as foreign Undergoes inflammation

32. Diagnosis CORE TERM DETAILSDESCRIPTION X-ray First test Show cartilage loss CT Confirmation test Visualizes bones & joints MRI More detailed test UTZ Includes soft tissues & fluid containing structure

33. Medical Management CORE TERM DETAILSDESCRIPTION Medications Analgesics Acetaminophen, Tramadol, Hydrocodone NSAIDS Ibuprofen (Advil, Motrin), Naproxen sodium Counterirritants Creams and ointments Biologics Etanercept (Enbrel) Corticosteroids Prednison, Cortisone

34. Medical Management CORE TERM DETAILSDESCRIPTION Non-pharma Psychologic related Meditation Guided imagery Breathing techniques PT/OT Joint functions Prevents contractures of joints Assistive Aid Cane Crutches Walker Wheel chair Least stable aid An aid for total stiffness Most stable aid An aid for nonfunctional Weight loss Diet & Food Follow diet recommended Surgery Last resort Joint replacement surgery

35. Nursing Management CORE TERM DETAILS Be organized keep track of symptoms Manage pain & fatigue Learning to manage fatigue Staying active exercise is beneficial Balancing activity with rest rest is equally important when your disease is active. Eating a healthful diet achieve a healthy weight and control inflammation Improving sleep poor sleep can aggravate arthritis pain and fatigue Caring for joints using several joints to spread the weight of an object

36. SYSTEMIC LUPUS ERYTHEMATOSUS CORE TERM DETAILSDESCRIPTION Etiology autoimmune Mistakenly attacked own cells Affect the skin, joints, kidneys, brain, and other organs Causes Genetic Inherit a diseased genes Environmental Destroys immune function Hormonal Deficiency and excess Medicines Destroys immune function

37. SYSTEMIC LUPUS ERYTHEMATOSUS CORE TERM DETAILSDESCRIPTION Signs / Symptoms Chest pain When taking a deep breath Fatigue Immune destruction Fever No other cause Discomfort Felling ill or malaise Hair loss Skin related Weight loss Anorexia related Mouth sores Immune destruction Skin rash Butterfly rash Swollen lymph Due to antibody attack

38. SYSTEMIC LUPUS ERYTHEMATOSUS CORE TERM DETAILSDESCRIPTION Signs / Symptoms Brain Numbness, headache & seizures GIT Pain, nausea and vomiting Heart Valve problems Lung Build-up of fluids Skin Patchy skin colors Kidney Swelling in legs

39. Diagnostic Evaluation CORE TERMDESCRIPTION ANA Anti-nuclear antibody Confirmatory test CBC With differential X-ray Visualizes affected organs and tissues Creatinine Determines kidney function Urinalysis Determines the kidneys ability to excrete waste Skin biopsy Presence of inflamed cells confirms

40. Medical Management CORE TERMDESCRIPTION No Cure Goal of treatment is control symptoms Mild SLE NSAIDS Corticosteroids Biologic Medicine Severe SLE High Dose corticosteroids Immunosuppressant's Blood thinners

41. NURSING INTERVENTION CORE TERMDESCRIPTION DRUGS Topical cortisone Plaquenil Corticosteroids Immunosuppressive drugs Cytoxan Cyclophosphamide Plasmapheresis Removes antibodies in the blood Sun Exposure Minimized to limit exacerbations Surgery Renal transplant if kidney is involve

42. MYASTHENIA GRAVIS CORE TERMDESCRIPTION DEFINITION Autoimmune neuromuscular disorder CAUSE Antibodies attack acetylcholine AREA Neuromuscular junction is affected PERIODS Remissions & exacerbation INCIDENCE Between ages 10 & 65 years old PEAK Peak at 20 th – 30 th RATIO Common in females

43. ASSESSMENT CORE TERMDESCRIPTION HALLMARK Weakness that increase with activity OTHER SIGNS Ptosis Diplopia Dysphagia Respiratory difficulty Speech difficulty

44. DIAGNOSTICS CORE TERMDESCRIPTION DEFINITIVE Tensilon test (Edrophonium) Retards breakdown of Ach Antidote is Atropine sulfate Provides short term improvement OTHER TESTS Complete history & PA Thyroid function test Serum protein electrophoresis Ach receptor antibody test CT scan Positive response to cholinergic EMG

45. NURSING INTERVENTION CORE TERMDESCRIPTION ASSESS Respiratory difficulty Dysphagia MAINTAIN Emergency breathing equipment SUCTION PRN CPT PRN DIET High calorie (frequent) POSITION Upright 30-60 min after meals REST Frequent & in between activities SPEECH Ask yes or no questions Work with language pathologist

46. NURSING INTERVENTION CORE TERMDESCRIPTION ARTIFICIAL TEAR Prevent corneal lacerations EYE PROTECTION During bedtime MEDICATIONS Cholinesterase inhibitor Pyridostigmine (Mestinon) OVERMEDICATE Monitor Cholinergic Crisis Signs (nausea, vomiting, abd pain) UNDERMEDICATE Monitor Myasthenic Crisis Signs (tachycardia, hypertension) OTHER DRUG Immunosuppressive drugs Prednisone, cyclophosphamide

47. NURSING INTERVENTION CORE TERMDESCRIPTION PLASMAPHERESIS Removes antibodies from plasma 6 exchanges in 14 days SURGERY Thymectomy most effective Performed within 2 years after signs

48. GUILLAIN-BARRÉ SYNDROME CORE TERMDESCRIPTION AKA Idiopathic polyneuritis Polyradiculoneuropathy INCIDENCE Uncommon, acute, rapid, fatal LOCATION Destroys the myelin sheath CAUSE Unknown (idiopathic) Cell mediated immune reaction Associated with history of illness RATIO More in women Ages 30-50 COMPLICATION Respiratory failure

49. ASSESSMENT CORE TERMDESCRIPTION HALLMARK Bilateral ascending weakness OTHER SIGNS Paresthesia Paralysis Decreased muscle tone Decreased DTR Hypertension Bradycardia Orthostatic hypotension Absent bowel function Difficulty communicating

50. DIAGNOSTICS CORE TERMDESCRIPTION DEFINITIVE EMG OTHER TEST CSF analysis Nerve conduction studies Respiratory function tests Complete history & PA

51. MANAGEMENT CORE TERMDESCRIPTION AIRWAY Promote exchange of O2 ABG Monitor frequently INTUBATION Standby emergency equipment SUCTIONING PRN CPT PRN ANALGESICS As prescribed COMMUNICATION Implement interventions SUPPORT Emotional support system MOBILITY Prevent complications PLASMAPHERESIS As appropriate Ig Administration as required

52. MULTIPLE SCLEROSIS CORE TERMDESCRIPTION Autoimmune degenerative disorder INCIDENCE 20-40 years old PERIODS Remissions & exacerbations ETIOLOGY Unknown but viral RATIO More women than men CLIMATE Cold weather EXACERBATION Fatigue Overexertion Extreme temperature Stress

53. ASSESSMENT CORE TERMDESCRIPTION HALLMARK Extreme fatigue experience OTHER SIGNS Stiffness of legs Hyperactive DTR + Babinski reflex Clonus Intention tremor Dysmetria (limit movement) Dysdiadochokinesia (inability to stop) Lack coordination Tinnitus, vertigo, hearing loss Speech difficulty

54. DIAGNOSTICS CORE TERMDESCRIPTION NONE No specific tests OTHER TESTS CSF analysis MRI Complete history & PA

55. NURSING INTERVENTIONS CORE TERMDESCRIPTION ACUTE Bed rest MOBILITY Prevent complications TRIGGERS Instruct methods of avoidance PROMOTION Avoid illness, fatigue & extreme temp DIET Balanced diet MEDICINES Anticholinergics for spasticity Cholinergics for urine retention SUPPORT Emotional support is needed STEROIDS Administer during exacerbations RELAXANT For spasticity of muscles AMPYRA Improves walking