Immunological

disorders
 Objectives
On completion of this lecture , the learner will be
able to:
1. Describe the body’s general immune responses.
2. Discuss the stages of the immune response. 3.
3. Describe the effects of the following variables on
function of the immune system: age, gender,
nutrition, psychoneuroimmunology, concurrent
illness, cancer, medications, and radiation.
4. Use assessment parameters for determining the
status of immune function
 Introduction
• The immune system functions is the
body’s defence mechanism against
invasion.
• The term immunity refers to the
body’s specific protective response
to an invading foreign agent or
organisms.
 Introduction
Disorders of the immune system

It is excesses or deficiencies in immuno

competent cells, alterations in the function
of these cells, immunologic attack on self -
antigens, or inappropriate or exaggerated
responses to specific antigens.
 Immune System Disorder
Autoimmunity:
Normal protective immune response
paradoxically turns against or attacks the
body, leading to tissue damage.
Hypersensitivity:
Body produces inappropriate or
exaggerated responses to specific antigens
 Immune Function:
Defence and response
• There are two general types of immunity:
• Natural immunity is a nonspecific
immunity present at birth.
• Acquired or specific immunity develops
after birth, acquired responses increase in
intensity with repeated exposure to the
invading agent
 Indications of Immune
Dysfunction
Respiratory System
• Changes in respiratory rate
• Cough (dry or productive)
• Abnormal lung sounds (wheezing,
crackles, rhonchi)
• Rhinitis
• Hyperventilation
• Bronchospasm
 Indications of Immune Dysfunction

Cardiovascular System
• Hypotension
• Tachycardia
• Dysrhythmia
• Vasculitis inflammation of a blood vessel.
• Anemia
 Indications of Immune Dysfunction

Gastrointestinal System
• Hepatosplenomegaly
• Colitis inflammation of the lining of the colon.
• Vomiting
• Diarrhea
 Indications of Immune Dysfunction

Skin
• Rashes
• Lesions
• Dermatitis
• Hematomas or purpura
• Edema or urticaria
• Inflammation
• Discharge
 Indications of Immune Dysfunction

• Neurosensory System
• Cognitive dysfunction
• Hearing loss
• Visual changes
• Headaches and migraines
• Ataxia loss of full control of bodily movements
• Tetany a condition marked by intermittent
muscular spasms
 Diagnostic Evaluation
• A series of blood tests and skin tests
and a bone marrow biopsy may be
performed to evaluate the patient’s
immune competence.
• Specific laboratory and diagnostic
tests are discussed in greater detail
along with specific disease processes.
Nursing Assessment of immunity disorder
patients
• Health History
• Age is an important factor to elicit from the
patient as people at the extremes of the life
span are more likely to develop problems
related to immune system functioning than are
those in their middle years.
• Family History Assessment
• Inquire about rheumatic diseases such as
rheumatoid arthritis, ankylosing spondylitis, and
systemic lupus erythematosus SLE in other
family members in several generations.
Nursing assessment of immunity disorder
patients
• Nutrition
• The nurse assesses the patient’s nutritional
status, including caloric intake as well as the
type of calories that the patient is
consuming.
• Adequate nutrition is essential for optimal
functioning of the immune system.
• Inadequate intake of vitamins that are
essential for DNA and protein synthesis may
lead to protein - calorie deficiency and
 Nursing assessment of immunity disorder
patients
Allergy
• The patient is asked about history of any allergies,
including types of allergens (pollens, dust, plants,
cosmetics, food, medications, vaccines), the
symptoms experienced, and seasonal variations in
occurrence or severity in the symptoms.
• A history of testing and treatments that the patient
has received or is currently receiving for these
allergies and the effectiveness of the treatments is
obtained.
• All medication and food allergies are listed on an
allergy alert sticker and placed on the front of the
patient’s health record or chart to alert others to
the possibility of these allergies.
 Nursing assessment of immunity disorder
patients
Infection and Immunization
• The patient is asked about immunizations (including
those received recently and those received in childhood)
and the usual childhood diseases.
• Known past or present exposure to tuberculosis is
assessed, and the dates and results of TB tests.
• Chest x-rays are obtained.
• Recent patient exposure to any infections and the
exposure dates are elicited.
• It is important for the nurse to assess whether the
patient has been exposed to any sexually transmitted
diseases and blood borne pathogens such as hepatitis A,
Nursing assessment of immunity disorder
patients
Neoplastic Disease
• A history of cancer in the patient is obtained, along
with the type of cancer and date of diagnosis.
• Dates and results of any cancer screening tests are
also obtained.
• Immunosuppression contributes to the
development of cancers; however, cancer itself is
immunosuppressive.
 Nursing assessment of immunity disorder
patients
Neoplastic Disease cont,
• All treatments that the patient has received or is
currently receiving, such as radiation or
chemotherapy, are identified and documented in
the health history. Radiation destroys
lymphocytes and decreases the population of cells
required to replace them.
• The size or extent of the irradiated area
determines the extent of immunosuppression.
• Whole-body irradiation may leave the patient
totally immunosuppressed.
• Chemotherapy also destroys immune cells and
causes immunosuppression.
 Nursing assessment of immunity disorder
patients
Chronic Illness and Surgery
• The health assessment includes a history of chronic
illnesses, such as diabetes mellitus, renal disease, or
chronic obstructive pulmonary disease.
• The onset and severity of illnesses, as well as treatment
that the patient is receiving for the illness, are
obtained.
• Chronic illness may contribute to immune system
impairments in various ways.
• Renal failure is associated with a deficiency in
circulating lymphocytes.
• Immune defences may be altered by acidosis and uremic
 Nursing assessment of immunity disorder
patients
Chronic Illness and Surgery
• In diabetes, an increased incidence of infection has
been associated with vascular insufficiency,
neuropathy, and poor control of serum glucose levels.
• Recurrent respiratory tract infections are associated
with chronic obstructive pulmonary disease as a result
of altered inspiratory and expiratory function and
ineffective airway clearance.
• Additionally, a history of surgical removal of the spleen,
lymph nodes, or thymus or a history of organ
transplantation is noted because these conditions may
place the patient at risk for impaired immune function.
 Nursing assessment of immunity disorder
patients

SPECIAL PROBLEMS
• Conditions such as burns and other forms of injury and
infection may contribute to altered immune system function.
• Major burns or other factors cause impaired skin integrity
and compromise the body’s first line of defense.
• Loss of large amounts of serum with burn injuries depletes
the body of essential proteins, including immunoglobulins.
• The physiologic and psychological stressors associated with
surgery or injury stimulate cortisol release from the adrenal
cortex; increased serum cortisol also contributes to
suppression of normal immune responses.
Nursing assessment of immunity disorder
patients
• Medications and Blood Transfusions
• A list of past and present medications is
obtained. In large doses, antibiotics,
corticosteroids, cytotoxic agents, salicylates,
nonsteroidal anti-inflammatory drugs
(NSAIDs), and anesthetics can cause immune
suppression
Selected Medications and Effects on the Immune System

• Antibiotics (in large doses) ceftriaxone

(Rocefin)
Effect in immune system

• Bone marrow depression ,Eosinophilia,

hemolytic anemia,
hypoprothrombinemia, neutropenia,
thrombocytopeni
 Selected Medications and Effects on the Immune System

• Chloramphenicol (Chloromycetin),
fluoroquinolones (Cipro).
Effect in immune system

• Leukopenia, aplastic anemia

• Agranulocytosis, neutropenia
• Hemolytic anemia, methemoglobinemia,
eosinophilia, pancytopenia
 Selected Medications and Effects on the Immune System

• Adrenal Corticosteroids prednisone

• Antineoplastic agents (Cytotoxic Agents)
alkylating agents cyclophosphamide (Cytoxan)
mechlorethamine HCl (Mustargen) cyclosporine
• Effect in immune system
• Immunosuppression
• Leukopenia , neutropenia, agranulocytosis.
 Nursing assessment of immunity disorder
patients

A history of blood transfusions

• It is obtained because previous exposure to foreign antigens
through transfusion may be associated with abnormal immune
function. Additionally, although the risk of human
immunodeficiency virus (HIV) transmission through blood
transfusion is extremely low in patients who received a
transfusion after 1985 (the year that testing of blood for HIV was
initiated in the United States), a risk still exists.

• The patient is also asked about use of herbal agents and over the-
counter medications. Because many of these products have not
been subjected to rigorous testing, not all of their effects have
been identified.
• It is important, therefore, to ask patients about their use of these
 Nursing Management
• The nurse needs to be aware that patients
undergoing evaluation for possible immune
system disorders experience not only physical
pain and discomfort with certain types of
diagnostic procedures, but many psychological
reactions as well.

• For example, patients may fear test results

that demonstrate decreased immune function
that makes them more prone to certain
infections, cancers and other disorders.
 Nursing Management
• It is the nurse’s role to counsel, educate, and
support patients throughout the diagnostic
process.
• Further, many patients may be extremely
anxious about the results of diagnostic tests
and the possible implications of those
results for their employment, insurance,
and personal relationships.
• This is an opportune time for the nurse to
provide counseling and education should
these interventions be warranted.