Chapter 21
CARE OF CLIENTS
WITHIMMUNOLOGIC DISORDERS
ntroduction
The immune system is the body's protecion against invading foreign
Animmune system that is impaired is unable to protect the body from a widebodies.
variety
diseases ranging from severe infecion, allergies, to immune diseases
This Chapter aims to assist you, nursing students to develop the essential
nowledge, skills and attitudes to provide quality, compassionate and humane care
among clients with immunologic disorders.
Learning Outcomes
At the end of this Chapter, the leamer will be able to.
1. Assess the client for clinical manifestations of immunologic disorders.
2. Discuss the risk factors, basic pathophysiology and clinical manifestations
associated with common immunologic disorders.
3. Develop plans of care for the preventionimmunologic of injury, collaborative
disorders.
management and rehabilitation of clients with
quality of life for clients with
4. Implement interventions that optimize the
immunologic disorders.
Evaluate efectiveness of management of cients with immunologic
5. in the planning phase of
disorders based on outcome criteria developed
care.
which elicit an immune response and are also
Antigens are forejan substances immune system.
the
apable of combining with products of
funcions:
nmune response serves three infection.
Defense -involves resisting component's'
wom out "selfdestruction
Homeostasis - involves removing
and of mutantcells.
identfication
Surveillance- deals with the
The unique characteristics of the immune Sy_term are as follows:
1. Self- or Non - Self Recognition -nomally recognizes host
antigenic and responds only to foreign and potentially harmful cells
or non - living as antigens.
2. Antibody Production - produces specific antibodies for specific
agents, iving
3.
destruction.
Memory remembers antigens that have invaded the body in anigens
for
allowing a quicker response. the past
monitors its Own perfomance,
antigens invade and tuming itself off when infecion is tuming
4. Self - Regulation - itself on
eradicated When
*in Autoimmune Response, there is a breakdown in this
Because of the damage in the immune system due to pathologic
an autoimmune response may occur in response to
protein resulting in the production of autoantibodies.
disincion,.
certain body'chasnges
Five Classes of Antibodies (lmmunoglobulins):
1. lgG
The most abundant antibodies.
Can cross the placenta, responsible for immunity in the newbom.
Neutralizes toxins and viruses.
2. lgA
Located in the saliva, tears, colostrum and mucus of the respiratory
digestive and urinary tracts.
Adds protection against enteric viruses in the breastfed infant.
3. lgM
The largest of the immunoglobulins in molecular size.
/Second most abundant antibodies.
V First to appear in fetal life.
First to form during viral or bacterial infection.
4. lgE
Responsible for some allergic responses, triggers release of histamine.
5. lgD
/Minute amounts.
Possibly a regulatory antibody, acts as an antigen receptor of Bceis.
Types of Antigen - Antibody Reactions
1. Agglutination -
2. Precipitation - clumping
antibodiestogether.
react with soluble antigens resulting in an insoluble
complex which then precipitates.
3. Neutralization -
antibodies
4. Lysis- antibodies attack allcombine with all the toxin
5. Opsonization- antibodies membrane andand
coat bacteria cause cell rupture.
increase their susceptibilty to
phagocytosis.
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murnization - process of
gpeciic
charmtul substances.
DiagnosticTests
rendering an organism immune to the
Bone Marrow Aspiration effects of
4
WBC indicates
bone marow
(1500 depression.
Tcell (cellular deficiency) 3000/cu mm) indicates
2 Cell function can be
screened by delayed defecive celular immunity
skin testing to common
h DNCB -
antigen
PPD-Purified Protein Derivative hypersensitivity.
Bcell(humoral Dinitrochlorcbenzene
deficiency)
Flectrophoresi
electrical field. s
- the
movement of colloid (protein) paricles in an
Identifies immunogloblins igG, lgA, lgM in a
It assesses the serum.
detects effectiveness of
chemotherapy or radiation
hypogammaglobulinemias
diagnoses paraproteinemias.
4 Quantitative
Immunoglobulin Test
and therapy,
hypergammaglobulinemias and
lgG 600--1600mg/100mi.
mg/100mi.
lgA 20-500
/ lgM ’
V 60-200
lgE-4 presernt in mg/100ml.
lgD’ present in amounts too small to measure
amount too
5. small to measure
Specific
a. Antigen- Antibody Test
Radioimmunoassay Test (RIA) consists of the
antibody followed by incubation. unknown antigen to the
b.
Immunoflourescence
antibodies
Test -
and then mixing withconsists
the
of attaching
flourescein dye to
C.
Agglutination Test - determines theantigen to beof tested.
Surfaces of RB's or on presence antigens located on the
by clumping of cells. microorganisms, the antigen and antibody react
a. Complement Fixation Test - a
to a mixture of an antigen and itsstandard amount of complement is added
ELISA (enzyme-linked immunosorbentcorresponding
assay)
antibody.
- designed to screen blood or
plasma for the presence of antibodies of HTLV3
vinus 3) (human -T lymphocytes
I. Allergy Test
a. Intradermal skin test
1. Tine test
2. Mantoux test
9. Patch and Scratch allergy test
Patch test
The test is read 20- 30 minutes after thepatch is removed.
+ = erythema only;, doubtful reaction; negative or anergic
> tt =erythema and papules; weak (nonvesicular) reaction
= erythema, papules and small vesicles; strong
(edematous or vesicular) reaction
> ttt+ = all of the above plus bullae or ulceration; extreme
reaction
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Scratch Test skin with
scratching the patient's a special
o Involve allergens into the
and introducing theexamined30- 40 scratched area.
minutes
Test sites are later and
the control site.
edema indicates a positive
o Erythema or of test extract is instilled in
Conjunctival Test-1 drop
reacion COmpare
the eye
8. within5-15 minutes.
tearing wll appear
Test- cosmetics fabics Tednes
substances such asfoods,eliminated froor to
9. Use allergic are from use and
is suspected of being th
schedule.
individually according to set
Immunologic Disorders
Immunodeficiencies - deficiencies in the proper expression of
response system.
a.TwoPrimary
types: Immunodeficiencies
Deficiencies resulting from the improper
immunosuppressive cells and tissues.
Mainly genetic disorders seen in
children. developmernt o
b. Secondary Immunodeficiencies
Any condition that can interfere with the nommal growth Or
of the immune response system. expres ic
Primary Immunodeficiencies
1. T-cell Deficiency: Di-George's Syndrome (Thymic Hypoplasial)
o Absence of thymus in the neonate.
o Hypocalcemia and tetany - secondary to hypoparathyroidisn.
2. B-cel Deficiency: (Bruton's agammaglobulinemia)
o Infantile seX linked agammaglobulinemia wherein
immunoglobulines are depressed
o Found only in boys.
3. Common Vaiable Immunodeficiency (CVID)
Becomes evidet when the person beComes an aut
deficiencies are primarily lgA and lgM.
4. Severe Combined Immunodeficiency Disease
o Complete absence of both cellular and humoral immunity.
5. Phagocytic Defect-Chronic Granulomatous Disease (CGD)
o Sex - linked recessive disease in males producing a
destruction of phagocytized organisms and partices.
incudetiy
Collaborative Management For Primary Immunodeficiencies
following:
A. Replacement Therapy:
1. Gamma globulin (B cell
deficiency) areincluded)
2. Plasma therapy-(all iImmunoglobulins
3. Transfer factor -(T cell
4. Bone -mediated deficiency)
marrow transplantation -(T cell deficiency)
5. Thymus transplant- (DiGeorge syndrome)
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SoondaryImmunodeficiencies (acquired)
Protein-Caloic Malnutrition
1.
Induced Immunosuppression
Antigen administration
Antibody administratior
Antilymphocyte serum
Iradiation
Drug immunosuppression
Corticosteroids
Cytotoxic drug
> Cyclosporine
Surgical excision of lymphoid tissue
3. AIDS(Acquired Immune Deficiency Syndrome)
Gammopathies or Hypergammaglobulinemias
I production of
antibodies
Abnomal
/ a MonoclonalGammopathy
Single B cell clone
"blood dyscrasias"
1. Multiple Myeloma characterized by widespread bone
destruction, anemia, hypercalcemia and hyperuicemia.
overproducion of lgM.
2. Macroglobulinemia - involves the
b. Polyclonal Gammopathies
synthesis as a result of
Refer to a difuse increase in antibody
inappropriate antigen stimuation.
Hypersensitivity Reacions
tissue damaging overreaction to the
/An inappropriate response manifested as
antigen.
Allergens -the antigenic stimulants invoking the reaction.
Types of Allergerns
1. Inhalants -pollen, dust
2. Ingestants - food, drugs
3. Contactants - soaps, plants
4. Injectants- serum
5. Bacteria
6. Self-allergens/ autologous antigens
Y General Etiologic Factors
1. Hereditary - runs in the family
placental
ongenital - allergens can be passed to the fetus via
3.circulation.
Contact - between the patient and the allergens
V
Factors Related to the Degree of Allergic Response
Kesponsiveness of the host to the allergen
2. Amount
3. Nature ofof allergen
4. Route of allergen
5.
Timing entrance
of exposureto allergen
8. Site of the
allergen
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/ Classifiçation of Hypersensitivities
1. Imediate (Humoral) /B-cell Mediated
Type I(Anaphylactic)
Systemic Anaphylaxis
Urticaria (Hive)
Angioedema
> Deep, large wheals involving subcutaneous tissues
Atopic Allergy
Are not antigens for the remainder of the population
Less severe form of Type I
Common Allergens
Seasonal inhalants- tree, grass inhalants
Environmental inhalants - house dust,
animal
feathers or fungal spores
o Management
danders
1. Recumbent position
2. Epinephrine 1:1,00 solution
3. Antihistamine (diphenhydramine HCI)
4. Corticosteroids (hydrocortisone)
5. IV fluids
Type ll(Cytotoxic)
ABO incompatibility
Drug- induced hemolytic Anemia
Type ll(Immune Complex)
Serum sickness
Develops 1-3 weeks after administration of horse serum
o Systemic Lupus Erythematosus
o Acute Glomerulonephritis
2. Delayed (Cellular) / T-cellMediated
Type IV Hypersensitivity Reaction
Contact Dermatitis
Transplant Rejection (Graft Versus Host Disease/ GVHD)
Tuberculosis
Autoimmune Diseases
Immunologic attack on self - antigens.
V SLE, Rheumatic Fever,
Glumerulonephritis, `Sjogren's synai
Fibromyalgia Syndrome, Vasculitis, Scleroderma,
been discussed in the different Chapters Reiter's
according disease
to the organ etc,System
l
involved.
