Immunologic disorder

A. Immunopathology Type 4 – delayed and cell mediated

> refers to the study of diseases that result from
dysfunctions within the immune system
> excesses or deficiencies of immunocompetent
cells, alterations in the function of these cells,
immunologic attack on self- antigens, or
inappropriate or exaggerated responses to
specific antigens
Hypersensitivity
- is an excessive or aberrant immune response
to any type of stimulus
- usually does not occur with the first exposure
to an allergen. Rather, the reaction follows a re-
exposure after sensitization, or buildup of
antibodies, in a predisposed person
>delayed reaction.
Type I Hypersensitivity: Anaphylaxis
- Mediated by IgE antibody
- it is an immediate reaction beginning within
minutes of exposure to an antigen
- most severe hypersensitivity reaction is
anaphylaxis characterized by edema in many
tissues, including the larynx, and is often
accompanied by hypotension, bronchospasm,
and cardiovascular collapse in severe cases
- Antibiotics and radiocontrast agents cause the
most serious anaphylactic reactions
- Type I hypersensitivity reactions may include
both local and systemic anaphylaxis

Characterized by edema, bronchospasm that

may cause difficulty of breathing.

- Most allergic reactions are either type I or type

IV hypersensitivity reactions
type I – anaphylaxis
allergic asthma- allergy to dust, paint, smell can
trigger, odors can trigger
Hay Fever –
Skin reaction – bitten by tics, spiders, bee stings
can cause anaphylactic shock
Type II – IgG / IgM
Im its is immune it can be thrombocytopenia
Reactions under type 2 is very fatal that can kill
the patients may cause hemolisis (death of
blood cells or bleeding)

Type 3 – immune complex (are antigen comes

from antibody microphage that eats the virus)
mediator is the genes.
Vasculitis – attacks the veins
Serum sickness immune disease
 - > 200 KU/L

Serologin test (?) Skin testing

- the intradermal injection of solutions at
Bronchodilators – steroids, antihistamine several sites
Trichiostomy (?) - Positive (wheal-and-flare) reactions are
clinically
Nursing Implications of Anaphylactic (Type I) significant when correlated with the history,
Hypersensitivity physical findings, and results of other laboratory
tests -Skin testing is considered the most
Assessment: accurate confirmation of allergy.
- comprehensive allergy history and a thorough
physical examination -degree of difficulty and
discomfort experienced by the patient because
of allergic symptoms
- degree of improvement in those symptoms
with and without
treatment are assessed and documented

erethema

Sugar doesn’t help in allergic reaction

Type I Hypersensitivity: Nursing Implications

Diagnostic Evaluation : Erethema - allergic reaction during skin testing

Complete Blood Count With Differential

- WBC count is usually normal except with
infection and inflammation
Eosinophil Count
- greater than 5% to 10%
Total Serum Immunoglobulin E Levels
- High total serum IgE levels support the
diagnosis of allergic disease
Prevention: - instructs the patient and family in the use of
- Strict avoidance of potential allergens prescribed Epi-pen and has the patient and
- auto-injector system for epinephrine will be family demonstrate correct administration
prescribed to the pt
- Screening for allergies before a medication is 2. Cytotoxic (Type II) Hypersensitivity
prescribed
- history of any sensitivity to suspected antigens
must be obtained before administering any
medication, particularly in parenteral form,
because this route is associated with the most
severe anaphylaxis in pts
- instruct pt to wear medical identification such
as a bracelet or necklace, which names allergies
to medications, food, and other substances
- venom immunotherapy, which is used as a
control measure and not a cure for people who
are allergic to insect venom
- Desensitization to insulin-allergic patients with
diabetes and those who are allergic to penicillin

Medical management

- If the patient is in cardiac arrest,

cardiopulmonary resuscitation (CPR)
- if the patient is cyanotic, dyspneic, or
wheezing. We inject Epinephrine
- Antihistamines and corticosteroids are given as
adjunct therapy
- Intravenous fluids (e.g., normal saline
solution), volume expanders, and vasopressor
agents are given to maintain blood pressure and
normal hemodynamic status

Nursing Management

- assesses the patient for signs and symptoms of

anaphylaxis. Airway, breathing pattern, and vital
signs if there is vasoconstriction we give
vasodilation.
- observed for signs of increasing edema and
respiratory distress
- Prompt notification of the rapid response
team, the provider, or both are required -
document the interventions used and the
patient’s vital signs and response to treatment
- instructed pt about antigens that should be
avoided and about other strategies to prevent
recurrence of anaphylaxis