Nursing of Adult Patients with Medical

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Nursing of Adult Patientswith Medical
Surgical Conditions

• Care of the Patient
• with an
• Immune Disorder

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Nature of Immunity

• Three Main Functions
• Protect the bodys internal environment against
  invading organisms
• Maintain homeostasis by removing damaged cells
  from the circulation
• Serve as a surveillance network for recognizing
  and guarding against the development and growth
  of abnormal cells

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Organization of the Immune System
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Nature of Immunity

• Inappropriate Responses of the Immune System
• Hyperactive responses against environmental
  antigens (allergy)
• Inability to protect the body, as in
  immunodeficiency disorders (AIDS)
• Failure to recognize the body as self, as in
  autoimmune disorders (systemic lupus
  erythmatosus)
• Attacks on beneficial foreign tissue (organ
  transplant rejection or transfusion reaction)

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Nature of Immunity

• Innate (Natural) Immunity
• First line of defense
• Provides physical and chemical barriers to
  invading pathogens and protects against the
  external environment
• Composed of the skin, mucous membranes, cilia,
  stomach acid, tears, saliva, sebaceous glands,
  and secretions and flora of the intestine and
  vagina
• Non-specific immunity

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Nature of Immunity

• Adaptive (Acquired) Immunity
• Second line of defense
• Provides a specific reaction to each invading
  antigen
• Protects the internal environment
• Composed of thymus, spleen, bone marrow, blood,
  and lymph
• Produces antibodies in the cells after an
  infection or vaccination

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Nature of Immunity

• Macrophages (phagocytes)
• Engulf and destroy microorganisms that pass the
  skin and mucous membrane.
• Carries antigen to the lymphocytes

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Nature of Immunity

• Lymphocytes
• T Cells
• 70 - 80 of lymphocytes
• Releases lymphokine to attract macrophages to the
  site of infection or inflammation
• Responsible for cell-mediated immunity
• Provide the body with protection against viruses,
  fungi, and parasites.
• B Cells
• 20 - 30 of lymphocytes
• Cause the production of antibodies
• Provide protection against bacteria, viruses, and
  soluble antigens

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Types of Adaptive Immunity

• Humoral Immunity
• Responds to antigens such as bacteria and foreign
  tissue
• Result of the development and continuing presence
  of circulating antibodies in the plasma
• Active Immunity
• antibodies are produced by ones own body
  (vaccines)
• Passive Immunity
• antibodies formed by another in response to a
  specific antigen and administered to an
  individual (HBIG)
• Cellular Immunity
• Defense against intracellular organisms
• Involved in resistance to infectious disease
  caused by viruses and some bacteria

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Immune Response

• Immunization
• A controlled exposure to a disease-producing
  pathogen which develops antibody production and
  prevents disease
• Provides protection for months to years

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Immune Response

• Immunotherapy
• Treatment of allergic responses that administers
  increasingly large doses of the offending
  allergens to gradually develop immunity
• Preseasonal, coseasonal, or perennial
• Severe side effect Anaphylaxis

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Hypersensitivity

• Hypersensitivity
• an abnormal condition characterized by an
  excessive reaction to a particular stimulus
• Hypersensitivity Reaction
• an inappropriate and excessive response of the
  immune system to a sensitizing antigen
• Hypersensitivity Disorders
• Harmless substances such as pollens, danders,
  foods, and chemicals are recognized as foreign

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Hypersensitivity

• CAUSE
• Genetic defect that allows increased production
  of Immunoglobulin E (IgE)
• Exposures may occur by inhalation, ingestion,
  injection, or touch

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Hypersensitivity

• Diagnostic Tests
• History
• onset, nature, and progression of symptoms
• aggravating and alleviating factors
• frequency and duration of signs and symptoms
• Physical Exam
• Assessment of skin, middle ear, conjunctiva,
  nasooropharynx, and lungs
• Laboratory Studies
• CBC, skin testing, total serum IgE levels

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Hypersensitivity

• Medical Management
• Symptom management with medications
• Antihistimines--pseudoephedrine(Actifed),
  diphenhydramine(Benadryl), chlorpheniramine(Chloir
  -Trimeton), brompheniramine(Dimetapp),
  cetirizine(Zyrtec), loratidine(Claritin), and
  fexofenadine(Allegra)
• Environmental control
• Avoidance of the offending allergen
• Immunotherapy
• Allergy specific injections

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Anaphylaxis

• Etiology/Pathophysiology
• System reaction to allergens
• Venoms
• Drugs - penicillin
• Contrast media dyes
• Insect stings
• Foods

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Anaphylaxis

• Signs and Symptoms
• Feelings of uneasiness to impending death
• Urticaria(hives) and pruritus
• Cyanosis and pallor
• Congestion and sneezing
• Edema of the tongue and larynx with stidor
• Bronchospasm, wheezing, and dyspnea
• Nausea and vomiting
• Diarrhea and involuntary stools
• Tachycardia and hypotension
• Coronary insufficiency, vascular collapse,
  dysrhythmias, shock, cardiac arrest, respiratory
  failure, and death

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Anaphylaxis

• Treatment
• Epinephrine 11000 0.5 ml SQ (may
  repeat at 15 minute intervals)
• Benadryl 50 to 100mg IM or IV
• IV access
• Oxygen (as ordered by physician)
• Aminophylline ( as ordered)

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Anaphylaxis

• Nursing Interventions
• Assessment
• Respiratory status
• Circulatory status
• Vital signs
• Intake and output
• Mental status
• Skin status
• GI status status
• Teaching
• Avoid allergen
• Use Medic-Alert ID
• Administration of epinephrine

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Transfusion Reactions

• Etiology/Pathophysiology
• Reactions that occur with mismatched blood

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Transfusion Reactions
Signs and Symptoms
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Transfusion Reactions

• Treatment
• Mild
• Stop transfusion
• Administer saline
• Administer steroids, diuretics, and
  antihistimines as ordered
• Physician may order transfusion continued at a
  slower rate.

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Transfusion Reaction

• Treatment
• Moderate
• Stop transfusion
• Administer saline
• Administer antihistamines and epinephrine as
  ordered

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Transfusion Reaction

• Treatment
• Severe
• Stop transfusion
• Administer saline
• Administer antihistamines and epinephrine as
  ordered
• Return blood or blood product to lab for testing
• Obtain urine specimen

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Delayed Hypersensitivity

• Reaction occurs 24 to 72 hours after exposure
• Examples include
• Poison Ivy
• Tissue transplant rejection

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Transplant Rejection

• Autograft
• Transplantation of tissue from one site to
  another on an individual
• Isograft
• Transfer of tissue between genetically identical
  individuals (identical twins)
• Allograft (homograft)
• Transplantation of tissue between members of the
  same species
• Heterograft
• Transplantation of tissue from another species
  such as a pig or cow

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Transplant Rejection

• Antigenetic determinants on the cells lead to
  graft rejection via the immune process
• 7-10 days after vascularization, lymphocytes
  appear in sufficient numbers for sloughing to
  occur

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Transplant Rejection

• Immunosuppressives
• Administration of agents that interfere with the
  ability of immune system to respond to antigenic
  stimulation
• Corticosteroids
• Cyclosporine (Neoral, Sandimmune)
• Azathioprine (Imuran)

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Immunodeficiency

• An abnormal condition of the immune system in
  which cellular or humoral immunity is inadequate
  and resistance to infection is decreased
• May cause recurrent infections, chronic
  infections, severe infections, and/or incomplete
  clearing of infections
• Can be induced (chemotherapy)

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Autoimmune Disorders

• The development of an immune response to ones
  own tissues
• Body is unable to distinguish self protein from
  foreign protein
• Examples of disorder
• pernicious anemia
• Guillain-Barre
• Scleroderma
• Systemic lupus erthematosus