Nursing Management of Clients with Stressors of Immune Function

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Nursing Management of Clients withStressors of
Immune Function

• NUR133 Lecture 7
• K. Burger, MSEd, MSN, RN, CNE

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Immune Response

• FUNCTIONS
• Defense against invading pathogens
• Removal of worn-out cells
• Immune surveillance

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Immune Response

• COMPONENTS
• LEUKOCYTES
• Neutrophils
• Eosinophils
• Basophils
• Lymphocytes B-lymphocytes/ T-lymphocytes
• Monocytes

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Immune Response

• COMPONENTS
• OTHER
• Bone marrow / stem cells
• Lymph nodes
• Spleen
• Thymus
• Tonsils/adenoids
• Appendix
• GALT

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Immune Response

• Innate
• Non-specific
• First line of defense
• Immediate
• Inflammatory process

• Adaptive
• Specific
• Sustained
• Antibody mediated
• or
• Cell mediated

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Adaptive Immune SystemAcquired Immunity

• Antibody Mediated
• B-Lymphocytes react to extracellular antigens
• Sensitization occurs
• Division into Plasma and Memory Cell
• Antibody response
• Immediate
• and
• Long-term

• Cell Mediated
• T-Lymphocytes react to intracellular antigens
• Sensitization occurs
• Proliferation of T-cell subsets
• Cytotoxic
• Helper
• Suppressor

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Classifications ofAdaptive Immunity

• Adaptive immunity
• Natural active most effective/ longest lasting
• Artificial active vaccination / immunization
• Natural passive maternal/fetus transmission
• Artificial passive injection of antibodies

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Immune Function Excess

• Auto-immune Disease
• Failure of body to recognize its own HLA
• Antibody production against self
• SLE, Rheumatoid arthritis, Scleroderma
• Hypersensitivity / Allergic Response
• Excessive response to an antigen
• Type I Type V

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Hypersensitivity / Allergic Response

• Type I Immediate atopic reaction
  rhinitis/ anaphylaxis
  
• Type II Cytotoxic transfusion reaction
• Type III Mediated Immune complex
  Rheumatoid arthritis
• Type IV Delayed Poison ivy, PPD
• Type V Stimulated Graves disease

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Type I Immediate Hypersensitivity

• Triggered by allergens
• Pollen, mold, dust, certain foods or meds etc.
• B cells synthesize IgE antibodies to allergen
• IgE antibodies attach to mast cells/basophils
• Result retained sensitivity
• Localized and/or systemic (anaphylactic)

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HypersensitivityAssessment

• History family hx, exposures, symptoms
• Physical headache, rhinorrhea, tearing eyes
• Labs elevated eosinophils
• elevated ESR
• Skin testing scratch / intradermal
• Food challenge

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HypersensitivityNursing Diagnoses

• Ineffective health maintenance r/t deficient
  knowledge regarding allergies
• Latex allergy r/t hypersensitivity to natural
  rubber latex
• Risk for latex allergy r/t repeated exposure to
  products containing latex

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HypersensitivityInterventions

• Avoidance therapy
• Desensitization therapy
• Drug therapy
• Decongestants
• Antihistamines
• Corticosteroids
• Mast Cell Stabilizers
• Leukotriene Antagonists

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Anaphylaxis Emergency Interventions

• Establish and maintain open airway
• O2 _at_ high flow ( 4-6 L/min)
• Establish IV access with NS or RL
• Epinephrine 11000 0.3 0.5 ml sc
• Benadryl 25-100 mg IV
• Suction prn
• Elevate HOB ( unless severe hypotension)
• Theophylline, Beta agonists, Corticosteroidsto
  stabilize

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Immunodeficiency

• Absence or inadequate production of immune bodies
• Primary ( congenital )
• Secondary ( acquired)
• Induced ( related to external stressors )

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Acquired ImmunodeficiencyAIDS

• Pathophysiology
• HIV virus docks with CD4 (helper T-cells)
• Enters CD4 cells DNA
• Creates more virus
• Virus buds off original host CD4 to attack more
  cells
• CD4 cell no longer working as immune cell

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Acquired ImmunodeficiencyAIDS

• Classifications
• A HIV positive
• B - Infected with HIV
• C AIDs
• Progression
• Months Years
• Dependent on
• Means of acquisition
• Personal factors

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Acquired ImmunodeficiencyHIV / AIDSAssessment

• History
• Physical exam
• Testing
• ELISA
• Western Blot
• Viral load
• CBC with differential
• CD4 / CD8 count

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Additional ResourceTesting Guidelines

• NYS DEPARTMENT OF HEALTH
• HIV / AIDS Web Resource
• http//www.health.state.ny.us/diseases/aids/index.
  htm

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Stages of HIV Infection

• Stage I 3wks-3mos prior to seroconversion.
  Mild illness S/S or asymptomatic
• Stage II 1-10 yrs after seroconversion Low
  rate of replication CD4 normal
• Stage III Persistent lymphadenopathy
• Stage IV Rapid replication of HIV virus
  Multiple opportunistic infections
  Very low CD4 counts
• Stage V Full Blown AIDS CD4 very low

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HIV / AIDS Clinical Manifestations

• Opportunistic Infections
• Protozoal - Pneumocystis carinii (PCP)
• Fungal - Candida albicans
• Bacterial - Mycobacterium avium (MAC)
  Mycobacterium tuberculosis
• Viral - Cytomegalovirus (CMV)
  Herpes simplex (HSV)
• Malignancies
• Kaposis Sarcoma

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HIV / AIDsClinical Manifestations (cont)

• Endocrine complications
• Aids Dementia Complex
• Wasting Syndrome
• Skin Changes

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HIV / AIDSNursing Diagnoses

• Risk for infection
• Impaired skin integrity
• Diarrhea
• Imbalanced nutrition
• Acute/ Chronic pain
• Impaired gas exchange
• Disturbed thought processes
• Social isolation

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AIDS/ HIV Interventions

• Prevention and early detection of infection
• Maintenance of adequate respiratory function
• Pain management
• Maintenance of skin integrity
• Promotion of nutrition and IBW maintenance
• Maintenance of self-esteem
• Maintenance of orientation

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AIDS / HIV InterventionsDrug Therapy

• Anti-retroviral agents in cocktail
• HAART ( Highly active anti-retroviral therapy)
• Nucleoside Reverse Transcriptase Inhibitors
  Retrovir AZT
• Non-nucleoside RTI Viramune
• Protease Inhibitors Invirase
• Fusion Inhibitors Fuzeon
• Immune enhancers BRMs
• Antibiotics Bactrim, Pentam, Flagyl
• Antituberculars INH