1. M.N PRIYADARSHANIE Bsc in Nursing Nursing Management of a client with Immunological Disorders

2. What Are Immune System Disorders?  An immune disorder is a dysfunction of the immune system immune system  These disorders can be characterized in several different ways;  By the component(s) of the immune system affected  By whether the immune system is overactive or underactive  By whether the condition is congenital or acquired

3.  cases of immune system over activity, the body attacks and damages its own tissues (autoimmune diseases)autoimmune diseases  Immune deficiency diseases decrease the body's ability to fight invaders, causing vulnerability to infections

4. What is the meaning of the Immunity ? The body’s specific protective response to invading foreign agent or organism Immune disorders: Autoimmunity Hypersensitivity Immune deficiencies: primary and secondary Infection

5. 5 Immune System

6. Immune disorders The immune system helps the body defend against various microbes and pollutants The immune system itself can have various failings An impaired immune system is called immunocompromise immunocompromise Causes of immune deficiency can include various illnesses such as viruses, chronic illness, or immune system illnesses

7. Innate and Acquired Immunity Innate Acquired Ag specificity noyes Memorynoyes

8.  Primary immune deficiency diseases are those caused by inherited genetic mutations Primary immune deficiency diseases  Secondary or acquired immune deficiencies are caused by something outside the body such as a virus or immune suppressing drugs virus eg. AIDSAIDS

9.  Allergies - a true allergy to a substance or food is caused by the immune response Allergies  Asthma - caused by an allergic reaction affecting the airway passages Asthma  Anaphylaxis - an extremely dangerous over- reaction that can lead to shock Anaphylaxisshock  Autoimmune diseases - a group of more than 100 diseases where the body's own immune system gets confused and starts to attack good body cells Autoimmune diseases

10. Natural immunity: nonspecific response to any foreign invader White blood cell action: release cell mediators such as histamine, bradykinin, and prostaglandins, and engulf (phagocytize) foreign substances Inflammatory response Physical barriers, such as intact skin, chemical barriers, and acidic gastric secretions or enzymes in tears and saliva Acquired immunity: Specific against a foreign antigen Result of prior exposure to an antigen Active or passive

11. WBC’s (leukocytes) participate in both, natural and acquired immunity Granulocytes (granular leukocytes) release mediators (such as histamine, bradykinin and prostaglandins) and engulf antigen (include neutrophils, eosinophils and basophils) Neutrophils- first cells to arrive on scene Nongranular leukocytes Monocytes or macrophages engulf, ingest and destroy greater number of foreign bodies/toxins that granulocytes do.

12. Lymphocytes Consist of B-cells and T-cells B lymphocytes: Produce antibodies or immunoglobulins

13. Acquired Immunity Acquired Immunity Cells: (macrophages), T (CD4+, CD8+) and B lymphoctyes (plasma cells), monocytesCells: (macrophages), T (CD4+, CD8+) and B lymphoctyes (plasma cells), monocytes  T cell with CD4 receptor that recognizes antigens on the surface of a virus-infected cell and secretes lymphokines that stimulate B cells and killer T cells; helper T cells are infected and killed by the AIDS virus Molecules: cytokines, immunoglobulins, adhesion moleculesMolecules: cytokines, immunoglobulins, adhesion molecules

14. Primary immunodeficiency disease  Primary immune deficiency is caused by a genetic problem in the body's defense system, called the immune system  There are more than 150 different primary immune deficiency diseases  Some occur with great frequency (selective IgA deficiency), while others are extremely rare  If a primary immune deficiency is not treated, it can cause serious illness

15.  Primary immune diseases are at risk to an increased susceptibility to, and often recurrent ear infections, pneumonia, bronchitis, sinusitis or skin infectionspneumoniabronchitissinusitis

16. Treatment for primary immune deficiency  Many patients with primary immune deficiency will need treatment with intravenous immunoglobulin and antibiotic medications.  Gamma globulin is extracted from healthy people's donation of plasma and is purified through a manufacturing process before administering  Other patients may need more invasive therapies

17. Immune globulin (IG) therapy  Immune globulin (IG) therapy has become an invaluable therapy for patients with autoimmune, primary immune deficiency, neurological diseases and other chronic conditions and illnesses  Our staff of nurses and pharmacists is experienced in providing IG for patients of all ages and conditions

18.  Our IG services include:  Access to IG products (IV and subcutaneous)  Specially trained infusion nurses  Individualized care plans  Multiple points of care

19. Immunological disorders Hypersensitivity mediated disorders Immunodeficiency

20. Classification of Hypersensitivity Gell and Coomb’s Classification: 4 Types Type 1 : IgE-mediated Type 2 : Cytotoxic antibodies Type 3 : Ag-Ab Immune complexes Type 4 : Delayed-type, cell-mediated hypersensitivity

21. Type I Hypersensitivity Allergen exposure, sensitization and re- exposure IgE antibody, mast cells/ basophils and its’ mediators Target organ immediate reactions Clinical allergy: atopic diseases, drug allergy, insect allergy and anaphylaxis

22.  An allergy is an abnormal immune reaction to a harmless antigen  Seasonal allergy Seasonal allergy  Anaphylaxis Anaphylaxis  Food allergy Food allergy  Allergic rhinitis Allergic rhinitis Atopic dermatitis Drug Allergy Drug Allergy

23.  Allergies result from the immune system's overreaction to a non-threatening foreign substance  Foods and inhaled particles like pollen and pet dander are the most common allergens(substances causing allergic reactions)  When the immune system senses an allergen, it stimulates the release of chemicals such as histamine

24. Anaphylaxis  It is defined as "a serious allergic reaction that is rapid in onset and may cause deathallergic reaction  It typically results in a number of symptoms including an itchy rash, throat swelling, and low blood pressureblood pressure Common causes include insect bites, foods, and medications.  Anaphylaxis is caused by the release of mediators from certain types of white blood cells triggered either by immunologic or non-immunologic mechanismswhite blood cellsimmunologic  The primary treatment is injection of epinephrineepinephrine

25.  Skin Prick Test

26. Type II Hypersensitivity Cytotoxic antibodies: IgG, IgMCytotoxic antibodies: IgG, IgM Clinical spectrums:Clinical spectrums: –Autoimmune Hemolytic anemia (AIHA) –ABO Miss-matched Stimulatory antibody: Grave’s diseaseStimulatory antibody: Grave’s disease Inhibitory antibody: Myasthenia gravis (anti-Ach Rc)Inhibitory antibody: Myasthenia gravis (anti-Ach Rc)

27. Principle treatments in Type II ABO matching Steroid, immunosuppressive agents, +/- splenectomy

28. Type III Hypersensitivity Mechanisms: Ag (protein, drugs) + Ab (IgG, IgM) --> Immune complex --> deposit at subendothelial basement membrane --> fix complement Immune complex diseases: –Serum sickness –Autoimmune diseases: SLE

29. Autoimmune Diseases  In response to an unknown trigger, the immune system may begin producing antibodies that instead of fighting infections, attack the body's own tissues  Treatment for autoimmune diseases generally focuses on reducing immune system activity Eg.Rheumatoid arthritis  The immune system produces antibodies that attach to the linings of joints  Immune system cells then attack the joints, causing inflammation, swelling, and pain  If untreated, gradually causes permanent joint damage  for rheumatoid arthritis can include various oral or injectable medications

30. Systemic lupus erythematosus (lupus)  People with lupus develop autoimmune antibodies that can attach to tissues throughout the body  The joints, lungs, blood cells, nerves, and kidneys are commonly affected in lupus  Treatment often requires daily oral prednisolone, a steroid that reduces immune system function Type 1 diabetes Type 1 diabetes mellitus Immune system antibodies attack and destroy insulin- producing cells in the pancreas

31. Principle treatments in Type III Serum sickness: Avoidance of heterogeneous protein injection Autoimmune diseases: SLE –Avoidance sun exposure –Steroid –Immunosupressive agents 

32. Treatments for Autoimmune diseases Treatments vary for specific diseases but may include  Hormone replacement therapy – Hormone replacement therapy for autoimmune diseases damaging hormone glands  Enzyme replacement therapy – Enzyme replacement therapy for autoimmune diseases damaging enzyme- producing glands  Corticosteroids Corticosteroids  Prednisolone Prednisolone

33. Type IV Hypersensitivity Delayed-type cell-mediated reaction Mechanism: Antigen (contactants) --> sensitized T-lymphoctyes --> re- exposure --> T cells activation --> cytokines Clinical disorder: Atopic contact dermatitis

34. Principle treatments in Type IV Avoidance Topical steroid Systemic steroid, if severe

35. Nursing care for a patient with Immunological Disease Assessment for Immune Dysfunction  Health History Taking  System wise Assessment Nursing Care Management of a patient with Immuno deficiencies Assessment Patient teaching Supportive Care

36.  Continuously Monitoring for laboratory Values  Vital signs  Treating for infections  Reducing Patient’s risk for infections  Assessment for patient’s nutritional status, stress level, and drug usage and hygienic practices  Attention for strict aseptic techniques  Identify early signs of infection and treat to processing conditions

37. Factors affects for attract an infectious disease Age and gender Nutrition Presence of conditions and disorders: cancer/neoplasm, chronic illness, autoimmune disorders, surgery/trauma Allergies History of infection and immunization Genetic factors Lifestyle Medications and transfusions Pyschoneuroimmunologic factor

38.  Usually seen in infants and young children  Manifestations: vary according to type; severe or recurrent infections; failure to thrive or poor growth; and positive family history  Potential complications: recurrent, severe, potentially fatal infections; related blood dyscrasias and malignancies  Treatment: varies by type; treatment of infection; pooled plasma or immunoglobulin; GM-CSF or GCSF; thymus graft, stem cell, or bone marrow transplant

39.  Monitor for signs and symtoms of infections  Symptoms of inflammatory response may be blunted  Monitor lab values  Promote good nutrition  Address anxiety, stress, and coping  Strategies to reduce risk of infection  Handwashing and strict aseptic technique  Patient protection and hygiene measures: skin care, promote normal bowel and bladder function, and pulmonary hygiene

40.  Signs and symptoms of infection  Medication teaching  Prevention of infection  Handwashing  Avoid crowds and persons with infections  Hygiene and cleaning  Nutrition and diet  Lifestyle modifications to reduce risk  Follow-up care

41.  Guidelines to prevent the transmission of microorganisms in hospitals  Standard precautions used for all patients  The primary strategy for preventing HAIs  Transmission-based precautions are for patients with known infectious diseases spread by airborne, droplet, or contact rout

42. Isolation Precautions Guidelines to prevent the transmission of microorganisms in hospitals Standard precautions used for all patients The primary strategy for preventing HAIs Transmission-based precautions are for patients with known infectious diseases spread by airborne, droplet, or contact rout

43. Elements of Standard Precautions  Guidelines to prevent the transmission of microorganisms in hospitals  Standard precautions used for all patients  The primary strategy for preventing HAIs  Transmission-based precautions are for patients with known infectious diseases spread by airborne, droplet, or contact routes

44.  Nursing Process—Assessment of the Patient With an Infectious Disease  Health history: investigate the likelihood and probable source of infection, associated pathology, and symptoms  Administer a physical exam  Vital Signs

45.  Nursing Process—Diagnosis of the Patient With an Infectious Disease  Risk for infection transmission  Deficient knowledge  Risk for ineffective thermoregulation

46. Interventions  Prevent the spread of infection  Perform handwashing  Exercise Standard Precautions  Recognize mode of transmission and establish Transmission-Based Precautions as indicated  Teach about infectious process and the prevention of the spread of infections  Assess and treat fever  Increases metabolic rate by 7% each 1 degree above normal

47. Thank you !