Chapter 19-Immune disorders

Chapter 19: Nursing Care of Patients With Immune Disorders

Overview of Immune Disorders

  • Categories of Immune Disorders

    • Hypersensitivity Reactions

    • Autoimmune Disorders

    • Immune Deficiencies

Hypersensitivity Reactions

  • Definition: Injury to the body due to an exaggerated immune response.

  • Classification: By the method of tissue injury.

    • Type 1: Immediate hypersensitivity

    • Type 2: Cytotoxic hypersensitivity

    • Type 3: Immune complex-mediated hypersensitivity

    • Type 4: Delayed-type hypersensitivity

Type 1 Hypersensitivity Reaction

  • Mechanism: Involves immunoglobulin E (IgE) antibodies against soluble antigens, leading to mast cell degranulation.

  • Histamine Release: Occurs immediately; can range from mild to life-threatening.

  • Examples:

    • Food Intolerances

Common Conditions

  • Allergic Rhinitis

    • Symptoms: Sneezing, nasal itching, runny nose, itchy red eyes.

  • Atopic Dermatitis (Eczema)

    • Symptoms: Inflammation of skin leading to pruritus (itching), edema, dry skin, blisters.

Atopic Dermatitis Management

  • Care:

    • Ensure administration of prescribed antipruritics (medications to reduce itching).

    • Offer lukewarm soaks followed by emollient topical cream.

  • Rationale: Antipruritics help to reduce the itch-scratch cycle, while emollients alleviate dryness contributing to itching.

Anaphylaxis

  • Definition: Severe systemic type 1 reaction; widespread histamine release leading to:

    • Bronchial narrowing (stridor, wheezing, potential respiratory arrest)

    • Hypotension, tachycardia, risk of cardiac arrest

Anaphylaxis Treatment

  • Immediate Treatments:

    • Oxygen

    • Epinephrine

    • Antihistamines

    • Corticosteroids

    • Vasopressors

    • Mechanical Ventilation (if necessary)

  • Nursing Care:

    • Early recognition and maintenance of airway

    • Provide emotional support and education to patient

Urticaria (Hives)

  • Mechanism: Histamine release causes pruritic, raised, erythematous wheals on skin.

  • Therapeutic Interventions:

    • Epinephrine

    • Antihistamines

    • Corticosteroids

    • Histamine H2 Blockers

Angioedema

  • Definition: Swelling in submucosal/subcutaneous tissue due to increased vascular permeability.

  • Causes: Allergic reactions, ACE inhibitors, idiopathic causes, hereditary and acquired forms.

  • Symptoms: Painless, nonpruritic swelling that can be an emergency if it involves the airway.

Nursing Care for Type 1 Hypersensitivity Disorders

  • Monitoring:

    • Respiratory status and level of consciousness.

    • Stay with patient and provide information on their condition.

    • Document skin and lesions.

  • Education:

    • Importance of avoiding scratching; recommend applying pressure or rubbing rather than scratching.

    • Discuss need for medical alert identification and methods to avoid allergens.

Type 2 Hypersensitivity Reaction

  • Definition: Destruction of a substance containing an antigen.

  • Clinical Relevance: Beneficial in fighting pathogens but detrimental if incompatible red blood cells (RBCs) are detected as foreign.

  • Blood Typing:

    • Types: A, B, AB, O; Rh−, Rh+

    • O: Universal donor

    • AB: Universal recipient

Hemolytic Transfusion Reaction

  • Mechanism: When RBCs with foreign antigens are lysed rapidly, occluding blood vessels and causing ischemia and necrosis.

  • Risk: Life-threatening; prevention is critical.

  • Prevention Strategies:

    • Administer RhoGAM to Rh(D) negative patients exposed to Rh+ blood.

    • Careful administration of blood transfusions.

Nursing Care for Hemolytic Transfusion Reaction

  • Monitoring:

    • Monitor transfusion closely; if reaction symptoms occur, stop blood immediately.

    • Infuse normal saline with new tubing and follow agency reaction policy.

    • Return any unused blood and tubing to the blood bank.

  • Education:

    • Inform the patient about recognition of transfusion reactions.

Type 3 Hypersensitivity Reaction

  • Definition: Result from initial sensitization to an antigen, with reactions upon later exposures.

  • Manifestations:

    • Red edematous lesions, bleeding, and necrosis due to immune complexes formed by antigens and antibodies.

    • These complexes can lead to injuries within blood vessels when enzymes damage their walls.

Serum Sickness

  • Description: A rare type III hypersensitivity reaction where antigen-antibody complexes develop from exposure to nonhuman proteins (e.g., anti-venoms, rabies vaccines).

  • Onset Symptoms: Typically appear 7 to 21 days after exposure; brief and self-limiting if antigen exposure ceases.

  • Prognosis: Generally good.

  • Treatment: Based on symptoms and may include:

    • Antipyretics

    • Analgesics

    • Anti-inflammatories

    • Antihistamines

    • Corticosteroids

Group Activity

  • Objective: Compare and contrast the differential diagnosis of Serum Sickness vs Immediate Allergic Reaction considering

    • Type of Hypersensitivity

    • Causes

    • Symptoms

    • Pathophysiology

    • Treatments

Type 4 Hypersensitivity Reaction

  • Characteristics: Known as delayed-type hypersensitivity.

  • Example:

    • Contact Dermatitis: Occurs when chemicals contact the skin, leading T cells to secrete chemicals upon second exposure.

  • Common Triggers: Poison ivy, poison oak, and latex.

  • Symptoms: Reddened, pruritic areas with fragile vesicles.

Contact Dermatitis Management

  • Therapeutic Interventions:

    • Use antihistamines, topical drying agents, corticosteroids, topical immunomodulators for itching.

    • Consider tepid baths with baking soda or Aveeno, and wash skin with appropriate soap (Fels-Naptha).

    • Implement latex allergy protocols.

Autoimmune Disorders

  • Definition: Conditions in which the immune system fails to adequately recognize the body’s own cells, mistakenly targeting them as foreign and destroying them.

Pernicious Anemia

  • Mechanism: Antibodies against gastric parietal cells hinder the production of intrinsic factor, causing a vitamin B12 deficiency.

  • Consequences:

    • Red blood cells (RBCs) become deformed, leading to decreased production.

  • Symptoms: Weakness, anorexia, glossitis, pallor, and peripheral neuropathy.

Diagnostic Tests

  • Schilling Test: Used to evaluate vitamin B12 absorption.

  • Therapeutic Interventions:

    • Corticosteroids

    • Lifelong vitamin B12 supplementation

  • Nursing Care:

    • Education about vitamin B12 needs and care considerations due to fatigue.

Systemic Lupus Erythematosus (SLE)

  • Definition: An autoimmune disorder where the immune system attacks its own tissues and organs.

  • Subtypes:

    • Discoid Lupus Erythematosus (DLE): Primarily skin lesions.

    • Drug-Induced Systemic Lupus Erythematosus (DILE): Occurs after certain medications.

  • Presentation:

    • Chronic, inflammatory multisystem disorder characterized by various symptoms.

Population at Risk

  • Common Demographics: Young women, individuals with first-degree relatives with lupus, and higher prevalence in Black, Asian, Hispanic, and American Indian populations.

Signs and Symptoms of SLE

  • Vague Early Symptoms: Fatigue, fever.

  • Dermatological:

    • Butterfly rash, bruising, photosensitivity, alopecia, pain, pruritis.

  • Musculoskeletal:

    • Arthralgia (joint pain), arthritis.

  • Hematological:

    • Anemia, leukocytopenia, thrombocytopenia.

  • Cardiopulmonary:

    • Pericarditis, myocarditis, myocardial infarction, vasculitis, pleurisy, valvular disease.

Therapeutic Interventions for SLE

  • Management Strategies:

    • NSAIDs for pain and inflammation

    • Immunosuppressants

    • Corticosteroids for controlling flares

    • Antimalarial medications

    • Immunoglobulin therapy as needed.