M.

N PRIYADARSHANIE
Bsc in Nursing

Nursing Management of a client with

Immunological Disorders
What Are Immune System Disorders?
An immune disorder is a dysfunction of the
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
cases of immune system over activity, the body
attacks and damages its own tissues (
autoimmune diseases)

 Immune deficiency diseases decrease the

body's ability to fight invaders, causing
vulnerability to infections
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
Immune System

5
 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
• Causes of immune deficiency can include various
illnesses such as viruses, chronic illness, or
immune system illnesses
 Innate and Acquired Immunity

Innate Acquired
Ag specificity no yes
Memory no yes
 Primary immune deficiency diseases are those
caused by inherited genetic mutations

 Secondary or acquired immune deficiencies are

caused by something outside the body such as a
virus or immune suppressing drugs
eg. AIDS
 Allergies - a true allergy to a substance or food is
caused by the immune response
 Asthma - caused by an allergic reaction affecting
the airway passages
 Anaphylaxis - an extremely dangerous over-
reaction that can lead to shock
 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
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
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.
Lymphocytes

Consist of B-cells and T-cells

B lymphocytes:
Produce antibodies or immunoglobulins
 Acquired Immunity

Cells: (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,

 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
Primary immune diseases are at risk to an
increased susceptibility to, and often recurrent ear
infections, pneumonia, bronchitis, sinusitis or skin
infections
 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
 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
 Our IG services include:
 Access to IG products (IV and subcutaneous)
 Specially trained infusion nurses
 Individualized care plans
 Multiple points of care
 Immunological disorders

Hypersensitivity mediated disorders

Immunodeficiency
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
 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
An allergy is an abnormal immune reaction to a
harmless antigen
 Seasonal allergy
 Anaphylaxis
 Food allergy
 Allergic rhinitis
•
Atopic dermatitis
•
Drug Allergy
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
 Anaphylaxis
It is defined as "a serious allergic reaction that is rapid
in onset and may cause death
It typically results in a number of symptoms including
an itchy rash, throat swelling, and low blood 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
mechanisms
 The primary treatment is injection of epinephrine
 Skin Prick Test
 Type II Hypersensitivity

Cytotoxic antibodies: IgG, IgM

Clinical spectrums:
 Autoimmune Hemolytic anemia (AIHA)
 ABO Miss-matched
Stimulatory antibody: Grave’s disease
Inhibitory antibody: Myasthenia gravis (anti-Ach Rc)
 Principle treatments in Type II

ABO matching
Steroid, immunosuppressive agents, +/-
splenectomy
 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
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
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 mellitus
Immune system antibodies attack and destroy
insulin-producing cells in the pancreas
 Principle treatments in Type III

Serum sickness: Avoidance of heterogeneous

protein injection
Autoimmune diseases: SLE
 Avoidance sun exposure
 Steroid
 Immunosupressive agents


 Treatments for Autoimmune diseases
Treatments vary for specific diseases but may
include
 Hormone replacement therapy –
for autoimmune diseases damaging hormone
glands
 Enzyme replacement therapy –
for autoimmune diseases damaging enzyme-
producing glands
 Corticosteroids
 Prednisolone
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
Principle treatments in Type IV

Avoidance
Topical steroid
Systemic steroid, if severe
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
 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
 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
 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
 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
 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
 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
 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
 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
  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
 Nursing Process—Diagnosis of the
Patient With an Infectious Disease

 Risk for infection transmission

 Deficient knowledge

 Risk for ineffective thermoregulation

 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
Thank you !