Universidad de Sta.

Isabel Vincentian Learning Module

Higher Education Department
CHS College of Nursing Teacher In-Charge: Melinda P. Reyes MAN, RN

Module 3 Lesson 1 Auto-Immunity/Theories of Immunity/

Course • NCM 112 Care of Clients with Problems in Oxygenation, Fluids and
Code and Electrolytes. Infectious, Inflammatory and antibodies Immunologic Response,
Title Cellular Aberrations, Acute and Chronic.

At the end of this module, you will be able to:

Learning • Define and explain autoimmunity, autoimmune response.
Outcome
• Classify and explain the Immunodeficiency theories.

Autoimmunity

➢ Autoimmunity – is a disruption in the body’s ability to tolerate its own cells;

instead, it recognizes those cells as antigens. (a toxin or other foreign
substances which induces an immune response in the body, especially the
production of antibodies.
Autoimmune Theory. As a person ages, the ability of
the immune system to differentiate between invaders as
normal tissues diminishes.
Immune Deficiency Theory-with increasing age, the
immune system is no longer able to defend the body from
foreign invaders and detrimental changes can result.
Can’t defend itself.

➢ Autoimmune response- occur when the immune system reacts against its
own cells by forming antibodies, which then destroy its own tissue.

➢ Immune Response- how the body recognizes and defends itself against
bacteria, viruses and substances that appear foreign and harmful.
 The immune system protects the body from possibly harmful
substances by recognizing and responding to antigens. The body cells
have proteins that are antigens.
It includes a group of antigens called HLA antigens. Human
Leukocyte Antigen.
The immune system learns to see this antigen as normal and usually
does not react against them called INNATE IMMNUNITY.
Innate or nonspecific immunity is the defense system with which you
were born. It protects the body against all antigens.
It keeps harmful materials from entering the body.

➢ Three Lines of Defense

1) Barriers
2) Inflammatory Response
3) Actual Immune Response

➢ First line of defense- in the immune response

✓ Cough reflex
✓ Enzymes in tears and skin oils
✓ Mucus which traps bacteria and small particles
✓ Skin
✓ Stomach acid

➢ Acquired Immunity- is immunity that develops with exposure to various

antigens. Immune system builds a defense against that specific antigen.
How? So, if an antigen gets past these barriers, it is attacked and destroyed
by other parts of the immune system.

➢ Passive Immunity- due to antibodies that are in a body other than your
own. Infants have passive immunity because they are born with antibodies
that are transferred through the placenta from their mother. Disappears
between ages 6 and 12 months.

Also due to injection of antiserum, which contains antibodies that are

formed by another person or animal. It provides immediate
protection against an antigen, BUT DOES NOT provide long-lasting
protection against an antigen.

Examples of Passive Immunity

a. Immune Serum Globulin (given for hepatitis exposure)
b. Tetanus Antitoxin
 ➢ Once the tissue is recognized as foreign, a tissue-specific reaction, an immune
complex-mediated reaction, or a cell -mediated reaction occurs.
➢ In Tissue- specific reactions:
▪ IgG and IgM are most commonly affected.
▪ Tissue is destroyed through the action of antibodies on the cell’s
plasma membrane.
▪ Tissue destruction occurs by way of complement-mediated cell
lysis. (breaking down of cells), macrophage phagocytosis, and
▪ antibody-dependent cell-mediated cytotoxicity.
➢ In cell-mediated reactions:
▪ Antibodies and sensitized T lymphocytes mediate this type of
reaction.
▪ Cytotoxic T cells destroy the host tissue directly.
▪ Lymphokine-producing T cells have a widespread effect by
attracting phagocytic cells to the tissues.
➢ According to several theories, autoimmunity develops:
a. Due to the presence of a previously hidden antigen
b. Secondary to infectious diseases
c. As a result of alteration in suppressor T cell function

➢ Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis and scleroderma

are autoimmune disorders.
➢ The body’s tolerance to self-antigen decreases with age, so the incidence of
autoimmune diseases rises with age.
➢ Autoimmunity also appears to be familial.

Immunodeficiency states

1. Immunodeficiency states are abnormal deficits in humoral or cellular

immunity, resulting in increased susceptibility to infections.
2. Immune deficiencies can be primary (congenital) or secondary (acquired).
3. Acquired immune deficiencies can result from:
a. Nutritional deficits
b. Iatrogenic causes (e.g. drug induce)
c. Infectious or vital agents
4. Immunodeficiency is caused by a disruption of lymphocyte function.
5. If the disruption occurs at the level of the stem cell, normal lymphocyte
production will be impaired, leading to total collapse of the immune system.
6. If the defect occurs at the level of a lymphoid organ, then maturity of the
stem cells into B or T Lymphocytes may not occur.
7. If the defect occurs in the final stages of maturation, then specific groups of
antibodies may not be able to develop.
 8. Immunodeficiency also may render the two components of the immune
system unable to coordinate activities (e.g. if suppressor T -cell activity
increases because of a deficiency of helper T-cells, the immune response will
be suppressed instead of mediated).
9. Alterations in the inflammatory process, such as macrophage or complement
function, also affect the immune response.
10. AIDS is commonly occurring severe secondary immunodeficiency state.

➢ Any disease that results from such an aberrant immune response is termed an
"autoimmune disease".
➢ Prominent examples include
✓ Celiac disease
✓ Post-infectious IBS
✓ Diabetes mellitus type 1
✓ Systemic lupus erythematosus (SLE),
✓ Hashimoto's thyroiditis
✓ Graves' disease
✓ Idiopathic thrombocytopenic purpura
✓ Addison's disease
✓ Rheumatoid arthritis (RA)
✓ Ankylosing spondylitis
✓ polymyositis (PM)
✓ Dermatomyositis (DM)
✓ multiple sclerosis (MS).

Reference Further learning Autoimmunity (Autoimmune Disease)

• https://www.youtube.com/watch?v=3XszVyYWZJE
•
 Self - Assessment

Name: __________________________________________________Yr. &Sec. ____________________________

Test I. Multiple Choice. Read each question carefully and choose the best answer.

1. If you have an autoimmune disease, what happens with the immune system?
a. Your immune cells die
b. Antibodies from your immune system mistakenly attack tissues in the body
c. Your immune system makes too many immune cells
d. None of the above

2. In immune system deficiencies in which the disruption is at the level of the stem cell, which of
the following manifestations will occur?
a. Disruption of specific antibody production.
b. Total collapse of the immune system
c. Alterations in the inflammatory process
d. Maturation into B or T lymphocytes

3. Autoimmune diseases strike which group more often?

a. Children younger than 12
b. Men older than 40%
c. Women of childbearing age
d. Women older than 50

4. What tissues, organs, or body systems can be affected by autoimmune diseases?

a. Skin
b. Joints
c. Thyroid
d. All of the above

5. How does a person develop an autoimmune disease?

a. It may be triggered by a virus, such as mumps
b. It may be a complication of an existing infection, such as strep throat
c. It may be caused by exposure to an environmental agent
d. All of the above

6. Why are some autoimmune disease difficult to diagnose?

a. Symptoms may be vague
b. No specific lab test exists to confirm a diagnosis
c. Symptoms may come and go, making it hard to pinpoint the problem
d. All of the above
 7. Which of these is an autoimmune disease?
a. Type 1 Diabetes
b. Rheumatoid Arthritis
c. Psoriasis
d. AIDS
8. Which of the following accurately describes normal changes of aging of the immune system?
a. The older adult has decreased susceptibility to infections.
b. Older adults have increased tear production.
c. Older adults have increased production of saliva and gastric
d. The thymus gland decreases in size and activity with age.

9. Once the tissue is recognized as foreign, a tissue -specific reaction, an immune complex-
mediated reaction, or a cell-mediated reaction occurs. Which of the following is most commonly
affected?
a. IgG and IgM
b. IgA and IgD
c. IgE and IgD
d. All of the above

10. Which of the following is not a line of defense in the immune system?
a. Skin
b. Cough Reflex
c. Mucus
d. Blood

TEST II Essay 10 pts

1. Define and explain autoimmunity.

2. Compare and contrast autoimmune theory and immune deficiency theory.
 Universidad de Sta. Isabel Vincentian Learning Module
Higher Education Department
College of Nursing Teacher In-Charge: Melinda P. Reyes MAN, RN

Module 4: Lesson 2
Systemic Lupus Erythematosus (SLE)

At theend of this module, you will:

Learning 1. Define systemic lupus erythematosus (SLE)
Outcome 2. Discuss the pathophysiology of SLE.
3. Utilize the nursing process as a framework for planning and providing safe,
appropriate and holistic care to client’s with SLE.
4. Assess patient’s health needs and problems related to SLE.
5. Formulate a comprehensive nursing care plan based on assessed data.
6. Illustrate the rationale behind the nursing care for a patient with SLE.

• Description: An autoimmune disease,

Overview • SLE is a chronic, inflammatory, multi-system disorder characterized
by periods of remission and exacerbation.

Etiology and incidence

• The exact cause of SLE isn’t known, but several factors have been
associated with the disease.

✓ Environment. Ultraviolet rays, certain medications,

viruses, physical and emotional stress, trauma.
✓ Sex and Hormones. Affects more women than men.
Female hormone estrogen may play a role in causing SLE.
However, more research is still needed to prove this theory.

• SLE is associated with genetic predisposition to the disease as

well as a family history of other autoimmune disorders.

• It occurs most commonly in women, especially among those ages 20

to 30, incidence is higher among African Americans than whites.
 Three Types of Lupus

• Discoid Type- limited to the skin and only rarely involves other
organs.
• Systemic Lupus -more common and usually more severe than
discoid; it can affect other organs. They may be periods of remission
and flares.
• Drug Induced- drug commonly implicated in precipitating this
condition are hydralazine (Apresoline), procainamide (Pronestyl)
isoniazid (INH) chlorpromazine (Thorazine), d-penicillamine and
some seizure medications.

Symptoms usually do not present until after months or years of continued

administration. The symptoms are usually abolished when the drugs are
discontinued.

Pathophysiology

• SLE is characterized by the formation of antibodies (IgG and IgM

against the body’s nuclei acids, phospholipids, white blood cells, red
blood cells and coagulation components.
• Antigen-antibody complexes against host DNA form and deposit
in a variety of tissues, causing diffuse damage.
• Neutrophils attempt to phagocytize the antigen-antibody complexes
but are ineffective.
• Lysosomal enzymes are released, further propagating the tissue
damage.
• The glomerular basement membrane of the kidneys is
particularly susceptible to complex deposition; as a result, there is
a high incidence of renal failure secondary to SLE.
• Deposition of complexes also occurs in the brain, heart, lung, GI
tract, spleen, and skin.

The Most Common Symptoms of SLE:

• Arthralgia and arthritis, typically affecting proximal joints
• Vasculitis (Raynaud’s phenomenon)
• Appearance of a facial butterfly like rash- hallmark of SLE
• Renal dysfunction
• Anemia
 • Cardiovascular disease (e.g. pericarditis)

Other Symptoms of SLE:

• Photosensitivity
• Scaly, patchy rash
• Fever
• Myalgia
• Weight loss
• Ulceration of the mucous membranes
• Alopecia
In severe forms SLE, neurologic dysfunction such as seizures and cranial
nerves palsies may occur.

Nursing Interventions:

• Administer steroids, disease modifying anti-malarial agents,

immunosuppressive agents, and non-steroidal anti-inflammatory
agents as prescribed
• Assess severity of the disease.
• Provide supportive care for patients with target organ dysfunction.
• Vary treatment according to the stage of the illness.
• Assess skin for integrity. (maculopapular rash) The classic
“butterfly” rash may appear.
• Advise to wear maximum protection sunscreen (SPF 15 or above) in
the sun. Sunbathing is contraindicated. The sun can exacerbate a skin
rash or precipitate a disease flare.

➢ Lupus- Normally, the immune system protects the body from infection. In
lupus, however, the immune system inappropriately attacks tissues in
Key Points various parts of the body. This abnormal activity leads to tissue damage and
illness
➢ The hallmark of SLE is malar rash or butterfly rash.
➢ SLE: Goals of Therapy
✓ Control inflammation
✓ Provide emotional support
✓ Develop a life plan
➢ Corticosteroids- the single most important medication used in the
treatment of SLE.
➢ The description for Lupus Erythematosus-Systemic inflammatory connective-
tissue disorder.
 Malar rash or Butterfly rash

• Textbook of Medical-Surgical Nursing 14th ed. Vol.2 by Brunner & Suddarth,

Janice L. Hinkle, Kerry H. Cheever
References • https://www.webmd.com/lupus/arthritis-lupus
• https://content.healthwise.net/resources/12.5/en-
us/media/medical/hw/acj0222_460x300.jpg