Med Surg Chapter 20 Coordinating care for patients w/immune disorders

The nurse understands information related to which of the following is a priority in the teaching plan about the management of anaphylactic response to a bee sting?

Epipens

The nurse correlates low levels of IgG with which disorder

HIGM syndrome

Immune System

Immune system provides defense against microorganisms Prevents proliferation of cancer cells Initiates healing Immune disorders Due to deficiency or overactivity Anaphylaxis and autoimmune disorders May involve one or more immune system components

Excessive immune response

Occurs when the immune system is inappropriately initiated OR overreacts Autoimmunity is when the body initiates an immune response against self; antibodies are formed that respond to normal healthy cells and tissue. The body fails to recognize these normal cells as self and causes an immune reaction to occur against the perceived antigen, the healthy cell. A hypersensitivity reaction is when the immune response is overreactive to a foreign antigen. An antigen is a foreign protein that stimulates an immune response in a susceptible individual.

Hypersensitivity: Type 2

One of the most severe is erythroblastosis fetalis, which is due to Rh sensitization. Three subtypes: 1. Complement and antibody-mediated cell destruction 2. Complement and antibody receptor-mediated inflammation 3. Antibody-mediated cellular dysfunction All produce cell destruction

The nurse is screening patients for the risk of developing agammaglobulinemia. The nurse should consider which patient at greatest risk?

a 7 month old male with recurrent infections

Subtype 2: Complement-and Antibody-Mediated Inflammation

cause inflammation rather than destruction. An example of this type is Goodpasture's syndrome, also known as antiglomerular basement antibody disease.

2ndary immune dysfunction: therapy induced deficiencies

caused by a variety of factors such as medication-induced immunosuppression, radiation, and surgery. The most common is medication-induced immunosuppression. Pathophysiology Chemotherapeutic medications used to treat cancer are cytotoxic, which means they target rapidly dividing cancer cells. Medical and nursing management Management of patients with secondary immune dysfunction is primarily preventive. Good hand washing is the first step. Avoiding contact with people who have obvious infections such as a cough or cold is recommended.

Primary immune dysfunction: T lymphocytes: DiGeorge's syndrome

congenital thymic hypoplasia, is an autosomal dominant genetic condition that arises from the 22nd chromosome. Pathophysiology DiGeorge's syndrome arises from a disturbance of a normal embryological development of the pharyngeal pouches occurring between the sixth and 10th weeks of gestation. Clinical manifestations Immune dysfunction caused by T-cell deficiencies results in recurrent infections. There are variations in type and severity of dysfunction as a result of the extent of the body systems affected.

The nurse understands which action of epinephrine helps alleviate symptoms of anaphylaxis

dilates bronchioles, constricts blood vessels, improves cardiac contraction

Subtype 1: Complement and Antibody-Mediated cell destruction hypersensitivity

hypersensitivity reaction is cytotoxic and antibody dependent. The antibodies involved in this hypersensitivity reaction are immunoglobulin M (IgM) and immunoglobulin G (IgG).

The nurse monitors for which clinical manifestation in the patient diagnosed with a severe anaphylactic reaction

hypotension

Subtype 3: Antibody-Mediated Cellular Dysfunction

Antibodies bind to cell surface receptors autoantibodies either block the action of acetylcholine or mediate the destruction of receptors Management treatment of type II reactions requires removal of the medication or blood product that is causing the reaction. May be life threatening Renal function may be completely lost in a matter of days, a condition known as rapidly progressive glomerulonephritis. Lung damage, occurring as rapidly as the renal damage, may cause severe impairment of oxygenation requiring artificial ventilation

Primary immune dysfunction: B cell deficiencies

B cells are involved in producing a humoral immune response, which is the antibody response. An antibody, or immunoglobulin, is produced in response to a foreign substance known as an antigen. B-cell deficiencies involve a lack of differentiation of B-cell precursors into mature B cells or from a lack of differentiation of B cells into plasma cells. Patho: gene located on the X chromosome Clinical s/s: ear/lung/skin/conjunctiva/CNS infections Recurrent bacterial infections of the respiratory tract is the 1st indicator of this disease •Treatment: includes giving IV immune globulin (IVIG) to provide short-term passive immunity. • IV immune globulin is a sterilized solution made from human plasma. •Children with this disorder are prone to many different complications. •Approximately 60% of individuals with XLA develop a severe, life-threatening bacterial infection such as pneumonia, empyema, meningitis, sepsis, cellulitis, or septic arthritis.

Immune dysfunction

Primary immune dysfunction defects: occurs in persons w/an immune system that is deficient or limited T lymphocytes B lymphocytes Natural killer cells Phagocytic cells Complement system Secondary immune dysfunction: occurs when there is damage caused by something external Secondary to other disease process Exposure to medications or chemicals

Hypersensitivities: Type-1

The most severe form is anaphylaxis, a systemic reaction. There can be a local (atopic) reaction or a systemic reaction. A genetic predisposition exists for the development of allergic diseases. If both parents have allergies, there is an 80% chance the child will have allergies. If the mother is allergic, the child is likely to also have allergies. Approximately 20% of the population is atopic, which means having an inherited tendency to become sensitive to environmental allergens, the substances that cause an allergic response. The primary mediator of type I hypersensitivity reactions is immunoglobulin E (IgE). The first time a patient is exposed to an allergen, IgE is produced. The IgE antibodies attach to mast cells. The next time the patient is exposed to that specific allergen, it binds to the IgE antibodies that are attached to the mast cells. Anaphylaxis is the most severe form of type I hypersensitivity reaction that exhibits the extremes of the symptoms. Clinical S/S nasal discharge sneezing Pruritus(itching)/edema of the upper airways.

Primary immune dysfunction: T lymphocytes: cytotoxic T cells

They are responsible for the cell-mediated immune response that protects against fungal, protozoan, viral, and intracellular bacterial infections. They are also responsible for controlling malignant cell proliferation and coordination of the immune response. T-cell deficiencies lead to infections and other problems that are more severe than B-cell deficiencies.

Type 3 hypersensitivity reaction: immune complex disease

This is the only hypersensitivity reaction that involves the formation of an immune complex with the resulting response due to the body's inability to rid itself of antigen-antibody immune complexes. Management Removal of the offending agent Epinephrine: used for symptom relief of serum sickness, urticaria, angioedema Corticosteroids (prednisone): reduce inflammation associated w/serum sickness

What is the desired therapeutic effect of calcium supplements for the patient with DiGeorge's syndrome

prevention of tetany

The nurse monitors for which clinical manifestations in the patient diagnosed with XLA

recurrent respiratory infection

The nurse is caring for a patient with DiGeorge's syndrome. Precautions are taken for decreased levels or which of the following

serum calcium