AUTOIMMUNE

AUTOIMMUNE
DISORDERS
AUTOIMMUNE DISORDERS
Quick Facts:
 condition arising from an abnormal immune response
to a normal body part.
 can affect one or many different types of body tissue
 can cause abnormal organ growth and changes in
organ fxn
 fluctuates from periods of remission and flare-ups
 Treatment – focused on relieving sx
 Runs in the family; 75% affected are women (AARDA)
 African Americans, Hispanics, and Native Americans
also have an increased risk of developing an
autoimmune disease.
COMMON AIDs
1. MS
2. MG
3. Guillain-Barre Syndrome [GBS]
4. RA
5. SLE
6. Inflam. Bowel Dse. [IBD]
7. DM typeI
8. PSORIASIS
9. GRAVE’S DSE
10. HASHIMOTO’S THYROIDITIS
COMMON AIDs
11. Chronic Inflam. Demyelinating Polyneuropathy
12. Vasculitis
13. Celiac Sprue
14. Pernicius Anemia
15. Vetiligo
16. Scleroderma
17. Addison’s Dse
18. Sjogren’s Syndrome
COMMON AIDs
1. MS
- immune-mediated progressive demyelinating
dse of the CNS that results in impaired
transmission of nerve impluses
Etiology: Unknown
Predisposing factors:
- Geoghraphic prevalence [Europe, NZ, Southern
Australia, Northern US, Southern Canada
 Environmental exposure
 Genetic predisposition
COMMON AIDs
1. MS
Primary sx: fatigue, weakness, numbness, difficulty in
coordination, loss of balance and pain.
Visual disturbances due to lesions in the optic nerves
or their connection may include: blurring of vision,
diplopia, patchy blindness[scotoma], and total
blindness
Secondary comp: UTI, consti, pressure ulcers,
contracture deformities, pedal edema, pneumonia,
reactive depression, osteoporosis
COMMON AIDs
1. MS
DX: MRI - multiple plagues in the CNS
Mgt: No cure; tx is indicated for the relief of sx
Goal of tx:
1. delay progression
2. manage chronic sx
3. treat acute exacerbations
Nursing Process: Assessment
a. mobility and balance is observed to detemine the risk
of falling
b. assessment of fxn: weakness, spacity , visual
impairment, incontinence & disorders in swallowing or
speech
COMMON AIDs
1. MS
Nursing Process: Diagnosis
a. Impaired bed and physical mobility RT weakness,
muscle paresis, spasticity
b. Risk for injury related to sensory and visual
impairment
Nursing Process: Planning and Goals
Major Goals:
1. Promotion of physical mobility
2. Avoidance of injury
3. achievement of B/B continence
COMMON AIDs
1. MS
Nursing Process: Planning and Goals
Major Goals:
4. Promotion of speech and swallowing mechanism
5. Improvement in cognitive function
6. development of coping strengths
7. improved home maintenance management
8. Adaptation to sexual dysfunction
COMMON AIDs
1. MS
Nursing Process: Nursing Intervention
-an individualized program of PT, Rehab and Educ is
combined with emotional support
2. Promoting physical mobility
3. Preventing Injury
4. Enhancing B/B control
5. Enhancing communication and managing
swallowing difficulties
6. Improving sensory and cognitive fxn
7. Improving home management
8. Promoting sexual fxning
COMMON AIDs
1. MS
Nursing Process: Evaluation
Expected patient outcomes:
2. Improves physical mobility
3. Free of Injury
4. Attains/ maintains B/B control
5. Participate in strategies to improve speech
6. Compensate for altered thought process
7. Demonstrates effective coping strategies
8. Adheres to plan for home maintenance mgt
9. Adopts to changes in sexual function
COMMON AIDs
1. MG
 An autoimmune disorder affecting myoneural
junction
 Characterized by varying degrees of weakness
of the voluntary muscles
 Antibodies directed at the acetylcholine
receptor sites impair transmission of impulses
across the myoneural junction
 Purely a MOTOR disorder with no effect on
sensation and coordination
COMMON AIDs
2. MG
Clinical Manifestations:
Initial: involves the ocular muscles – diplopia,
ptosis
 Facial muscle weakness and the throat
[dysphonia, risk for choking/aspiratiob]
 Generalized weakness affects all extremities
and the intercostal muscles resulting in dec
vital capacity and respiratory failure
COMMON AIDs
2. MG
Assessment & Dxtic Findings:
TEST: Acetylcholinesterase inhibitor test
- stops the breakdown of Ach, thereby
increasing availability at the neuromuscular
junction
Tensilon – IV ; 30 sec p, stat improvement of
muscle strength (+)
MRI Scan – enlarged thumus gland [site for Ach
receptor antibody production]
COMMON AIDs
2. MG
Medical Mgt:
Directed at improving fxn and reducing & removing
circulating antibodies
1. Anticholinesterase medication &
immunosuppressive therapy
2. Plasmapheresis
3. Thymectomy
Pharmacologic therapy:
1. Mestinon – 1st line of therapy
2. Cortecosteroids – immunosuppressant
3. Cytotoxic medications – if no response to steroids
COMMON AIDs
2. MG
Medical Mgt:
NOTE: A number of medications are C/I for
patients with MG : antibiotics, CArdioV meds
etc including OTC meds
Complications:
1. Respiratory Failure
COMMON AIDs
2. MG
Nursing Mgt:
Focus: Patient & Family Teaching
Includes: Medication mgt –IMPT
- energy conservation
- prevent/minimize risk for aspiration
- strategies to help with ocular manifestations
- prevention & mgt of complications
COMMON AIDs
 An autoimmune attack on the peripheral nerve
myelin that results in acute, rapid, segmental
demyelination of peripheral nerve and some
cranial nerves, producing ascending weakness
with dyskinesia (inability to execute voluntary
movement), hyporeflexia and paresthesis
(numbness).
 Precipitating factor: Viral infection
Annual Incidence: 1-2 cases/100,000
Common in males 16-25; 45-60 yo
60-75% recover completely
COMMON AIDs
 Is the result of the cell-mediated and humoral
immune attack on peripheral nerve myelin
proteins that causes inflam. demyelination
 Molecular Mimicry - best accepted theory of
cause : infectious organism contains an amino
acid that mimics the peripheral nerve myelin
protein… the IS cant distinguish between the 2
CHONs and attacks and destroys peripheral
myelin
COMMON AIDs
Clinical Manifestations
1. Muscle weakness and diminished reflexes of the
lower extremeties
2. Hyporeflexia and weakness may progress to
tetraplegia
3. Neuromuscular Respiratory failure
4. Sensory sx: paresthesias of the hands & feet, pain
COMMON AIDs
 pt. presents with symmetric weakness ,
diminished reflexes and upward progression of
motor weakness
 A hx of a viral illness in the previous 2 weeks
suggests the dx
CSF Evaluation: elevated CHON levels
COMMON AIDs
Medical Mgt:
Note: medical emergency
- bec of the possibility of rapid progression and
neuromuscular respiratory failure, requires mgt
in an ICU
1. Respi therapy or Mech vent to support
pulmonary fxn and adequate oxygenation
2. Elective intubation before onset of extreme respi
muscle fatigue
3. Other interventions: aimed at preventing
complications and immobility
COMMON AIDs
Medical Mgt:
4. Plasmapheresis & IVIg (intravenous
ImmunoGlobulin)
5. Continuous ECG monitoring – prevent
cardiovascular risk
6. Meds like alpha-adrenergic blocking agents – to
treat tachycardia and htn
7. Inc IVF admin – to manage hypotension
COMMON AIDs
Nursing Process:
1. Assessment – ongoing assess for dse progression
- pt is monitored for life-threatening comp
2. Diagnosis
a. Ineffective breathing pattern and Impaired gas
exchange RT rapidly progressive weakness and
impending resp failure
b. Impaired bed and physical mobility RT
paralysis
COMMON AIDs
Planning andGoals:
Major goal : improved respi fxn
increased mobility
improved nutritional status
effective communication
decreased fear and anxiety
absence of complications
COMMON AIDs
Nursing Interventions:
1. Maintaining Respiratory fxn
2. Enhancing physical mobility
3. Providing adequate nutrition
4. Improving cmmunication
5. Decreasing fear and anxiety
6. Monitoring and managing potential
complications
COMMON AIDs
Evaluation:
1. Maintain effective respiration & airway clearance
2. Shows increasing mobility
3. Receives adequate nutrition and hydration
4. Demonstrates recovery of speech
5. Shows lessening fear and anxiety
6. Absence of complications
COMMON AIDs
4. RA
- The immune system produces antibodies that attach
to the linings of joints.
- Immune system cells then attack the joints,
causing inflammation, swelling, and pain.
- If untreated, RA gradually causes permanent joint
damage.
Treatment: can include various oral or injectable
medications that reduce immune system over activity.
COMMON AIDs
5. SLE
- a chronic inflam disorder of the connective tissue
- affects multiple organ systems and can be fatal
- 8x as many women than men; most prevalent among
asians and blacks
CAUSE: unknown; interrelated immunologic,
environmental, hormonal and genetic factors
Risk: genetic predisposition, stress, strep or viral
infection, exposure to sunlight or UV light,
immunization, pregnancy, abnormal estrogen
metabolism
COMMON AIDs
5. SLE
Characteristic sx: facial erythema, arthritis,
photosensitivity
Others: systemic signs like aching, malaise, fatigue,
low-grade or spiking fever, chills, anorexia, weight loss,
lymph node enlargement, abdominal apin, N/V, D/C
and irregular menses or amenorrhea
Treatment: often requires daily oral PREDNISONE
a steroid that reduces immune system function.
COMMON AIDs
5. SLE
Interventions:
1. Watch for s/s as joint pains or stiffness, weakness,
fever, fatigue, chills
2. Observe for dyspnea, chest pain and edema on the
arms and legs
3. Note the size, type and location of the lesion
4. Check the urine for blood
5. Inspect the scalp for hair loss and check skin and
mucus membrane for petechiae, bleeding, ulcers,
pallor and bruising
COMMON AIDs
5. SLE
Interventions:
6. provide balanced diet. A patient with renal
involvement may require an low-Na , low-CHON
diet
7. Apply heat packs to relieve joint pain and stiffness.
Encourage regular exercise to maintain full ROM and
prevent contractures
8. Monitor V/S, InO, weight and lab findings
9. Evaluate the pt
COMMON AIDs
1. The immune system attacks the lining of the
intestines, causing episodes of diarrhea, rectal
bleeding, urgent bowel movements, abdminal pain,
fever, and weight loss.
2. Ulcerative colitis and Crohn's disease are the two
major forms of IBD.
3. Oral and injected immune-suppressing medicines
can treat IBD.
COMMON AIDs
Ulcerative colitis
- is a disease that causes inflammation and sores
(ulcers) in the lining of the large intestine
-It usually affects the lower section (sigmoid colon)
and the rectum. But it can affect the entire colon.
Crohn's disease
- is a chronic inflammatory disease of the digestive
tract.
COMMON AIDs
7. DM typeI
- Immune system antibodies attack and destroy
insulin-producing cells in the pancreas.
- By young adulthood, people with type 1 diabetes
require insulin injections to survive.
COMMON AIDs
8. PSORIASIS
- overactive immune system blood cells called T-
cells collect in the skin.
- The immune system activity stimulates skin cells
to reproduce rapidly, producing silvery, scaly
plaques on the skin.
COMMON AIDs
9. GRAVE’S DSE
- The immune system produces antibodies that
stimulate the thyroid gland to release excess amounts
of thyroid hormone into the blood (hyperthyroidism).
- Symptoms fo Graves' disease can include bulging
eyes as well as weight loss, nervousness, irritability,
rapid heart rate, weakness, and brittle hair.
- Destruction or removal of the thyroidgland, using
medicines or surgery, is usually required to treat
Graves' disease.
COMMON AIDs
10. HASHIMOTO’S THYROIDITIS
-Antibodies produced by the immune system attack
the thyroid gland, slowly destroying the cells that
produce thyroid hormone.
- Low levels of thyroid hormone develop (
hypothyroidism), usually over months to years.
Symptoms: fatigue, constipation, weight gain,
depression, dry skin, and sensitivity to cold.
Tx: Taking a daily oral synthetic thyroid hormone pill
restores normal body functions.
COMMON AIDs
11. Chronic Inflam. Demyelinating
Polyneuropathy
- Similar to Guillian-Barre, but symptoms last much
longer.
- About 30% of patients can become confined to a
wheelchair if not diagnosed and treated early.
- Treatment for CIDP and GBS are essentially the
same.
COMMON AIDs
12. Vasculitis
- can affect any organ, so symptoms vary widely and
can occur almost anywhere in the body.
Treatment: Includes reducing immune system activity,

usually with prednisone or another corticosteroid.
COMMON AIDs
13. Celiac Sprue
= is a condition caused by damage to the lining of the
small intestine.
= this damage comes from a reaction to eating gluten.
This is a substance that is found in wheat, rye, barley,
and possibly oats.
= When people with celiac disease eat foods with
gluten, their immune system reacts by damaging the villi.
= Because of the damage, the villi are unable to properly
absorb iron, vitamins, and other nutrients.
= As a result, a number of symptoms and health
problems may occur.
COMMON AIDs
- decrease in red blood cells caused by inability to
absorb vitamin B-12
- The body needs vitamin B12 to make red blood cells.
You get this vitamin from eating foods such as meat,
poultry, shellfish, eggs, and dairy products.
- A special protein, called intrinsic factor (IF), helps
your intestines absorb vitamin B12. This protein is
released by cells in the stomach. When the stomach
does not make enough intrinsic factor, the intestine
cannot properly absorb vitamin B12.
COMMON AIDs
Common causes of pernicious anemia include:

Weakened stomach lining (atrophic gastritis)
An autoimmune condition in which the body's
immune system attacks the actual intrinsic factor
protein or the cells in the lining of your stomach that
make it.
COMMON AIDs
The goal of treatment is to increase your vitamin
B12 level:
Treatment involves a shot of vitamin B12 once a
month. People with severely low levels of B12 may
need more shots in the beginning.
vitamin B12 supplements by mouth.
A certain type of vitamin B12 may be given through the
nose.
eating a variety of foods.
COMMON AIDs
15. Vitiligo
 causes white patches on the skin.
 It can also affect the eyes, mouth, and nose.
 It occurs when the cells that give the skin its color are
destroyed.
 It is more common in people with autoimmune
diseases
 Genetics play a role
COMMON AIDs
15. Vitiligo
 The white patches are more common where the skin
is exposed to the sun.
 In some cases, the patches spread.
Treatment - steroids
COMMON AIDs
16. Scleroderma
- is a group of rare diseases that involve the
hardening and tightening of the skin and connective
tissues — the fibers that provide the framework and
support for your body.
- is a disease of the connective tissue featuring
thickened skin that can involve scarring, blood vessel
problems, varying degrees of inflammation and pain,
and is associated with an overactive immune system.
COMMON AIDs
16. Scleroderma
In some people, scleroderma affects only the skin.
But in many people, scleroderma also harms
structures beyond the skin — such as blood vessels,
internal organs and the digestive tract.
Signs and symptoms vary, depending on which
structures are affected.
Cause:
- exposures to environmental factors
- virus
COMMON AIDs
16. Scleroderma
Signs And Symptoms
Skin - hardening and tightening of patches of skin
- shaped like ovals or straight lines, or cover wide
areas of the trunk and limbs.
- Skin can appear shiny [it's so tight], and
movement of the affected area may be restricted.
Fingers or toes - earliest sign is an exaggerated
response to cold temperatures or emotional distress,
which can cause inumbness, pain or color changes
[called Raynaud's disease, this condition also occurs in
people who don't have scleroderma]
COMMON AIDs
16. Scleroderma
Signs And Symptoms
Digestive system - acid reflux, which can damage the
section of esophagus nearest the stomach
- some may also have problems absorbing nutrients
if their intestinal muscles aren't moving food properly
through the intestines.
Heart, lungs or kidneys - affect the function of the
heart, lungs or kidneys to varying degrees. These
problems, if left untreated, can become life-
threatening.
16. Scleroderma
ETIOLOGY:
 Autoimmune
 symptoms may be triggered by exposure to
certain types of pesticides, epoxy resins or
solvents.
COMMON AIDs
17. Addison’s Dse
called primary adrenal insufficiency, the adrenal
glands don't make enough of a hormone called cortisol
Cortisol's most important function is to help the body
respond to stress.
also helps regulate your body's use of protein,
carbohydrates, and fat;
helps maintain blood pressure and cardiovascular
function;
and controls inflammation.
COMMON AIDs
17. Addison’s Dse
Aldosterone helps the kidneys regulate the amount of
salt and water in the body -- the main way you
regulate blood volume and keep the blood pressure
under control.
When aldosterone levels drop too low, the kidneys
cannot keep the salt and water levels in balance. This
makes the blood pressure drop.
COMMON AIDs
 Sjögren's syndrome is an autoimmune disease of
salivary and tear glands.
 destroys the glands that produce tears and saliva
causing dry eyes and mouth; may affect kidneys
and lungs
Sjögren's syndrome can be complicated by
infections of the eyes, breathingpassages, and
mouth.
Sjögren's syndrome is typically associated with
antibodies against a variety of body tissues
(autoantibodies).
COMMON AIDs
  Treatment of patients with Sjögren's
syndrome is directed toward relieving symptoms
and complications in the particular areas of the
body that are involved, such as the eyes & mouth.
TISSUE TRANSPLANT
Human cells and tissues for transplantation can save lives or
restore essential functions.
 the transplantation of haematopoietic stem cells can cure

congenital or acquired diseases including some
--leukaemias - stem cells can be collected from living
donors [Bone marrow, collected as cord blood drawn from
the placenta during or after delivery.)
 human heart valve transplantation often constitutes the
best replacement situation and recipient patients do not
require long term anti-coagulation therapy.
TISSUE TRANSPLANT
Human cells and tissues for transplantation can save
lives or restore essential functions.
 Risks: disease transmission

 WHO : held several global consultations on human
cells and tissues for transplantation
 Transparency and the openness to scrutiny in these
activities are essential to ensure public support and
understanding.
TISSUE TRANSPLANT
Human cells and tissues for transplantation can save
lives or restore essential functions.
Robust bidirectional Donor-Recipient traceability is a

prerequisite to achieve effective vigilance and
surveillance worldwide.
Resolution WHA63.22 encourages the implementation
of globally consistent coding systems.
BONE MARROW TRANSPLANT
Tx alternative for a variety of dse
A. Malignancies including several types of Leukemias
B. Blood disorders including severe aplastic anemia,
thalassemia
C. Solid tumors such as breast Ca and brain tumor
D. Other conditions including malignant infantile
osteoporosis, some inherited metabolic disorders
Types
A. Autologous: client transplant with own harvested
marrow
B. Syngeneic: transplant between identical twin
C. Allogeneic: transplant from a genetically non
identical donor
1. Most common transplant type
2. Sibling most common donor
 Procedure
A. Donor suitability determined through tissue antigen
typing; includes human leukocyte antigen(HLA) and
mixed leukocyte culture (MLC) typing
B. Donor bone marrow is aspirated from multiple sites
along the iliac crest under Gen. Anesthesia
C. Donor marrow is infused IV into the recipient
 Early evidence of enlargement seen during
the 2nd week post-transplant; hematologic
reconstitution takes 4-6weeks;
immunologic reconstitution takes months
Hospitalization of 2-3 mos required
Prognosis is highly variable depending on
indication for use
 Complications:
1. Failure of engraftment
2. Infection: 1st 3-4weeks
3. Pneumonia: nonbacterial or interstitial
pneum are principal cause of death during
1st 3months post transplant
 Complications:
4. Graft VS. Host Disease (GVHD): principal
complication caused by immunologic rxn
of engrafted lymphoid cells against the
tissues of the recipient
a. Acute GVHD: develops 1st 100days post
transplant and affects skin, gut, liver, marrow and
lymphoid tissue
b. Chronic GVHD: 100-400days post-transplant
manifested by multi-organ involvement
 Complications:
5. Recurrent malignancy
6. Late complications such as cataracts,
endocrine abnormalities
 Nursing Care: Pre-transplant
1. Recipient immunosuppression attained
with total body irradiation (TBI) and
chemotherapy to eradicate existing dse and
create space in host marrow to allow
transplanted cells to grow
2. Provide protected environment
A. ct. should be in a laminar airflow room or on strict
reverse isolation; surveillance cultures done 2x/week
B. Objects must be sterilized before being brought into
the room
C. When working with children, introduce new people
where they can be seen, but outside childs room so
child can see what they look like without isolation
garb
3. Monitor central lines frequently; check patency
and observe for signs of infection
(fever, redness around site)
4. Provide care for ct receiving chemo and radiation
therapy to induce immunosuppression
a. Administer chemo as ordered, assist with radiation therapy if
required
b. Monitor side effects and keep client as comfy as possible
c. Monitor carefully for potential complications
d. ct. will become very ill; prepare ct and family
 Nursing Care: Post-transplant
1. Prevent infection
a. Maintain protective environment
b. Administer Antibiotics as ordered
c. Assess all mucus membrane, wounds, catheter sites for
swelling, redness, tenderness, pain
d. Monitor V/S frequently
e. Collect specimen for cultures as needed (2x/wk)
f. Change IV set ups q24H
2. Provide mouth care for stomatitis and mucositis
(develops about 5 days after irradiation)
a. note tissue sloughing, bleeding, changes in color
b. Provide mouth rinses, viscous lidocaine and
antibiotic rinses
c. Do not use lemon or glycerin swabs
d. administer parenteral narcotics as ordered if
necessary to control pain
e. provide care q2H or as needed
3. Provide skin care: skin breakdown may result from profuse
diarrhea from the TBI (total body irradiation)
4. Monitor carefully for bleeding
a. check for occult blood in emesis and stools
b. observe for easy bruising, petechiae on skin, mucus
membrane
c. monitor changes in V/S
d. check paltelet count daily
e. replace blood products as ordered (all blood products
should be irradiated)
5. Maintain fluid and electrolyte balance and promote
nutrition
a. measure InO carefully
b. provide adequate fluid, CHON and caloric intake
c. weigh daily
d. administered fluid replacement as ordered
e. monitor hydration status: check skin turgor, moisture of
mucus membranes, urine output
f. check electrolyte daily
g. check urine for glucose, ketones, protein
h. admin. Antidiarrheal agents as needed
6. Provide client teaching and discharge planning
concerning:
a. Home environment (cleaning, pets, visitors)
b. diet modifications
c. medication regimen: schedule, dosages, effects and
side effects
d. communicable diseases and immunization
e. daily hygiene and skin care
f. fever
g. activity

AUTOIMMUNE

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AUTOIMMUNE

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AUTOIMMUNE

Treatment: Includes reducing immune system activity,

Common causes of pernicious anemia include:

 the transplantation of haematopoietic stem cells can cure

 Risks: disease transmission

Robust bidirectional Donor-Recipient traceability is a

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