Immune / Connective Tissue Disorders

Medication-induced immunosuppression pathophysiology

Occurs when drugs intentionally / unintentionally suppress the body’s normal immune response

-Meds interfere with he production, function, or activation of white blood cells, reducing the body’s ability to recognize and fight infections, abnormal cells, and foreign substances

Examples of secondary immune dysfunction

-Chemo: cytotoxic effects on cells, inadvertently, which results in a decrease in lympho/phagocytes. Causes general immunosuppression, because the remaining lymphocytes are unable to properly facilitate an immune response

-Corticosteroids: Used to treat autoimmune disorders + prevent transplant rejection, interfere with cell-mediated immunity or production of antibodies. Suppression of cell-mediated immunity and luymphopenia + decrease in inflammatory response

Neutropenia

The body has too few neutrophils, making it especially difficult to fight bacterial / fungal infections

-Causes: chemo / radiation / bone marrow disorders / meds / surgery / burns, etc.

-Rx: Patients with severe neutropenia = higher risk for life-threatening infections, requiring close monitoring and preventative care

Medication Induced Neutropenia

Abnormally low count of neutrophils due to medication side effects

-Most common is chemotherapy

ANC levels for neutropenia (ranking)

Normal level is: 1,500-7,700 cells / microliter

-Mild: 1000-1500

-Moderate: 500-1000

Severe: <500

Neutropenia nursing management

-Vitals: monitor for early signs of infection such as fever / tachycardia / hypotension

-Skin and mucous membranes: Assess for redness, swelling, lesions, especially in the oral cavity and IV sites

-Labs: CBCs to track ANC

-Symptoms: Signs like chills, sore throat, cough, nasal congestion, rhinorrhea, urinary symptoms, all which may indicate an infection

Low bacteria diet-patient education for neutropenia

Avoid raw or undercooked meat, poultry, seafood, and eggs

-Unpasteurized dairy products / juices

-Wash fruits and veggies thoroughly / cook

-Avoid raw nuts and seeds

-Proper food handling, storage, and preparation to minimize contamination

HIV (Human Immunodeficiency Virus)

A virus tt attacks the immune system, specifically targeting CD4 cells (T cells), which help the body fight off infections

-Over time, if untreated, HIV can destroy so many of these cells that the body cannot defend against infections / diseases

AIDS (Acquired Immunodeficiency Syndrome)

The most advanced stage of HIV infection, characterized by a severely weakened immune system

-Makes individuals vulnerable to opportunistic infections and certain cancers

-Not everyone with HIV develops AIDS

Opportunistic infections resulting from HIV / AIDS

Tuberculosis, fungal infections, bacterial infections, cancers

HIV / AIDS epidemiological and etiological risk factors

Spread through infected body fluid contact

-Blood, semen, rectal / vaginal fluids, breastmilk

-Is a worldwide epidemic. Populations at risk are: sexual activities, sharing drug needles, use of drugs / alcohol, incarceration

HIV / AIDS impact on overall health

Weakened IS, opportunistic infections / cancers, psychosocial challenges, health promotion / preventions, considerations for aging

HIV / AIDS clinical presentation

Initially asymptomatic

-Symptomatic: fever, headache, rash, sore throat

-With progression: swollen lymph nodes, weight loss, fever, diarrhea, cough

Stages of infection / diagnostics

-Stages: acute (flu-like within 2-4 weeks)→ chronic (decades) → AIDS (When a blood count is below 200)

-Labs: HIV testing, viral load testing, CD4 counts, antigen/antibody testing, related conditions testing

Lupus

Autoimmune chronic inflammatory disorder of the connective tissue that produces antinuclear antibodies

-Causes widespread inflammation and tissue damage of most major body systems

-Splits into two types

Systemic Lupus Erythematosus (SLE)

Most common form of lupus that affects tissues of multiple organs

-Signs: Butterly rash over cheeks, photosensitivity, erythematous rash to areas exposed to sunlight, lupus nephritis, proteinuria, hematuria, weight loss, fever / infection, arthritis, emotional lability, hematologic/neuro disorders

-Associated: Raynaud’s / Pericarditis / Vascular Inflammation

Discoid Lupus Erythematosus (DLE)

Affects skin, can progress to systemic lupus

Lupus epidemiological and etiological risk factors

Occurs mostly in females

-Inflammatory effects: kidney-nephritis, CNS (memory loss / confusion / HA / fever / stroke / seizures), CV (CAD / MI / Stroke), Serositis (lungs / digestive system)

-Triggers: hormones, genetics, infection, stress, meds, toxins, Epstein-Barr virus, UV light, silica dust

Lupus Diagnosis

-A diagnosis is made if the patient meets at least 4 of the following criteria:

-Antinuclear Antibody test: most will be positive = presence of autoantibodies

-Anti-dsDNA and Anti-Smith Antibodies: More specific for SLE, presence can help confirm the diagnosis

-CBC: Can cause anemia, Europe is, and thrombocytopenia

-Urinalysis: Checks for protein and blood n the urine, which may indicate kidney involvement

-Complement levels (C3/4): Proteins are low in active SLE bc the immune system uses them up during inflammation

Lupus role of the nurse

Monitor for complications (renal failure), identify factors contributing to fatigue, diet (high vitamin and high iron, high protein if no evidence of kidney disease

Lupus patient teaching

-Recognizing early signs of flare, rest and energy conservation, when to seek help

-Preventing flares (sun protection), stress management, balanced diet, regular exercise, medication adherence

-Infection prevention: Handwashing, mask, avoid crowds, sick people, stay up to date on vaccines

-Skin: clean with mild soap

Gout

Occurs when uric acid levels become elevated (hyperuricemia), causing urate crystals to deposit in joints (tophi)/ organs (kidneys) and surrounding tissues. Will cause major organ dysfunction

-S/sx: excruciating joint pain, erythema, swelling, tophi in great toe, low-grade fever, malaise, headache, pruritus, renal stones from elevated acid levels

Phases of gout

-Acute: acute onset of pain, redness and swelling

-Intercortical: asymptomatic period between attacks

-Chronic: repeat attack over many years causing the formation of tophi in the joints causing destruction

Gout rx factors

-Non-modifiable: male, older age, family hx of gout, genetic predisposition

-Medical conditions: CKD, hypertension, obesity, metabolic syndrome, T2DM, HF, psoriasis

-Dietary and lifestyle: HIgh-purine diet (red meat, organ meats, shellfish), alcohol, sugary drinks, dehydration, rapid weight loss or fasting

-Med-related: diuretics, low-dose aspirin, cyclosporine and tacrolimus, some chemotherapy meds

Gout diagnostics + txt

-Diagnostics: uric acid levels become, synovial fluid exam + urate crystals, x-ray, CT scan

-Medical management: allopurinol (chronic) / colchicine (acute)

-Dietary management limit alcohol, splint affected joint, monitor for kidney stones

Gout management

-Assessments: <ROM, intense joint pain / tenderness/swelling/warmth to affected joint, presence of tophi

-Interventions: Ice pack, NSAIDS (Indocin), glucocorticoid therapy (prednisone)

-Increase urinary pH above 6 bu eating alkaline foods (green beans /broccoli), high fluid intake of 2000 mL/day to prevent stones, COLD TO THE AFFECTED JOINT

Rheumatoid Arthritis

A chronic inflammatory disorder affecting joints, characterized by synovitis, pain, swelling, and potential joint deformity

-Can be split into active / passive immune response

RA epidemiological and etiological risk factors

Age, genetics, female, obesity, smoking, stress, immune dysfunction

RA effects on overall health

Heart disease, blood clots, sleep apnea

-Medication side effects, psychosocial impact

RA clinical presentation

Fever, malaise, pain, weakness, joint stiffness + swelling, nodules

-Labs: serology + imaging

RA role of the nurse

Minimize fall risks, assistive devices, client education