IMMUNOLOGIC DISORDERS.pptx

7/24/2019 IMMUNOLOGIC DISORDERS.pptx

1/156

IMMUNOLOGIC

DISODERS

By:

Manuel L. Hermosa, EdDProfessor


2/156


3/156

I. STRUCTURES AND UNCTI!N ! THEIMMUNE S"STEM


4/156

A. un#$%ons of $&e Immune Sys$em

'. Defense a(a%ns$ )&ys%#al %n*uryand %nfe#$%on

+. Ma%n$enan#e of &omoeos$as%s, as$a$e of eu%l%-r%um of $&e %n$ernalen%ronmen$


5/156

B. !r(ans and T%ssues of $&e Immune Sys$em %n#lude$&e -one marro/ and lym)&o%d $%ssue, /&%#& #om)r%se$&e $&ymus (land, lym)& nodes, s)leen, $ons%ls, and

adeno%ds. '. Bone marro/ %s s)e#%al%0ed sof$ $%ssue 1ll%n( $&e

s)a#es %n #an#ellous -one of $&e e)%)&yses. I$ %sres)ons%-le for:

a. releas%n( ma$ure B lym)&o#y$es %n$o $&e -lood#%r#ula$%on

-. mo%n( T lym)&o#y$es from -one marro/ $o $&e$&ymus

+. T&e $&ymus %s a s%n(le un)a%red (land $&a$ %s

lo#a$ed %n $&e med%as$%num and %s $&e )r%mary #en$ral(land of $&e lym)&a$%# sys$em. I$s )r%mary fun#$%on %sallo/%n( $&e T lym)&o#y$es $o deelo) -efore m%(ra$%n($o $&e lym)& nodes and s)leen


6/156

2. Lym)& nodes and essels )erform seeral %m)or$an$fun#$%on, su#& as:

a. $rans)or$%n( lym)&

-. 1l$er%n( and )a$&o(o#y$%0%n( 3)ro#ess%n( and4%ll%n(5 an$%(ens

#. (enera$%n( lym)&o#y$es and mono#y$es

6. S)leen fun#$%ons %n#lude :

a. remo%n( /orn7ou$ ery$&ro#y$es from -lood -. s$or%n( -lood and )la$ele$s

#. 1l$er%n( and )ur%fy%n( -lood

8. T&e $ons%ls, adeno%ds, and o$&er mu#o%d lym)&a$%#

$%ssues defend $&e -ody a(a%ns$ m%#roor(an%sms 9. In $&e &ema$o)o%e$%# sys$em, -one marro/ and

lym)&a$%# $%ssue )rodu#ed -lood #ells %n#lud%n( $&ose%noled %n %mmunolo(%# defense 3%.e. leu4o#y$es5


7/156

C. Nons)e#%1# Immunolo(%# defense %sa $y)e of %mmun%$y ee#$%e a(a%ns$any &armful a(en$ en$er%n( $&e -ody.

T&e -ody;s na$ural %mmun%$y #an

d%s#r%m%na$e fr%ends from for or selffrom nonself -y #anno$ d%s$%n(u%s&-e$/een and )a$&o(ens.


8/156

Na$ural me#&an%sm %n#ludes $&e follo/%n(:

'. P&ys%#al -arr%ers. In$a#$ s4%n and mu#ous mem-rane )reen$

)a$&o(ens from (a%n%n( a##ess $o $&e -ody. C%l%a of $&e res)%ra$ory$ra#$ 1l$er and #lear )a$&o(ens from $&e u))er res)%ra$ory $ra#$

+. C&em%#al -arr%ers. A#%d%# (as$r%# *u%#es, en0ymes %n $ears and

sal%a, and se-a#eous and s/ea$ se#re$%ons a$$em)$ $o des$roy%nad%n( -a#$er%a and fun(%.

2. B%olo(%# res)onse mod%1ers. In$erferon, a %r%#%dal su-s$an#e,

#oun$er %ruses and a#$%a$es o$&er #om)onen$s of $&e %mmunesys$em

6. A#$%on of /&%$e -lood #ells

a. Neu$ro)&%ls are 1rs$ $o arr%e a$ $&e %n%ns

d. Mono#y$es or ma#ro)&a(es fun#$%on as )&a(o$o# #ells en(ulf,%n(es$ and des$roy fore%(n $o>%ns


9/156

8. In


10/156

D. S)e#%1# %mmunolo(%# defense %s a $y)e of%mmun%$y ee#$%e a(a%ns$ s)e#%1# &armful a(en$sen$er%n( $&e -ody. Immun%$y %s a normal ada)$%eres)onse des%(ned $o )ro$e#$ $&e -ody a(a%ns$)o$en$%ally &armful an$%(ens 3%.e. any su-s$an#ere#o(n%0ed as fore%(n -y $&e %mmune sys$em5

'. Ty)es of %mmun%$y

a. In-orn %mmun%$y %s an %n&er%$ed %mmun%$y ofs)e#%es 3e.(. &uman do no$ #on$ra#$ #er$a%n an%mald%seases5, ra#es, and %nd%%duals $o #er$a%n d%seases.

-. A#u%red %mmun%$y %s %mmun%$y $&a$ deelo)s

as an %nd%%dual en#oun$ers s)e#%1# &armful a(en$s.I$ may -e na$ural 3%.e. a#$%a$ed -y $&e ae#$ed%nd%%dual5 or as ar$%1#%al 3%.e. a#$%a$ed -y a##%ne5and a#$%e or )ass%e


11/156

7 A#$%e %mmun%$y %noles )rodu#$%on of an$%-od%esand

7 Memory #ells do no$ se#re$e an$%-od%es, -u$ on re7e>)osure $o $&e s)e#%1# an$%(en, $&ey deelo) %n$oan$%-ody se#re$%n( )lasma #ells.

7 Im)or$an$ a##%nes %n#lude IM $e$anus andd%)&$&er%a -oos$er %n*e#$%on /&%#& %s reu%red for adul$

a$ leas$ eery ' years, and $&e &e)a$%$%s B a##%ne,/&%#& %s reu%red for all &eal$& #are /or4ers

7 Pass%e %mmun%$y %s a $em)orary %mmun%$yreu%red -y %n$rodu#$%on of an$%-od%es or sens%$%0edlym)&o#y$es from ano$&er sour#e 3e.(. an$%-od%es

$&rou(& )la#en$al #%r#ula$%on $o a fe$us, (amma(lo-ul%n, an$% serum from -lood )lasma of a )erson/%$& a#u%red %mmun%$y5. T&e -ody dose no$ (enera$ememory #ells.


12/156

+. T&e me#&an%sm of s)e#%1# %mmun%$y are of $/o$y)es : &umoral 3B lym)&o#y$es5 and #ell med%a$ed 3Tlym)&o#y$es5 %mmun%$y. T&ese $/o $y)es of

%mmunolo(%# res)onses d%s#r%m%na$e self from nonselfand d%s$%n(u%s& $&e forma$%on of an$%-od%es -y )lasma#ells %n res)onse $o fore%(n )ro$e%ns.

7 Humoral %mmun%$y fun#$%ons )r%mar%ly %n $y)e I, $y)eII, and $y)e III &y)ersens%$%%$y rea#$%ons

7 B lym)&o#y$es 3 so named -e#ause $&ey /ere 1rs$%den$%1ed %n $&e a%an -ursa5 are %noled %n an$%-ody3%.e. %mmuno(lo-ul%n 3I(55 )rodu#$%on

7 Unsens%$%0ed B #ells )rol%fera$e and ma$ure %n$o

)lasma #ells af$er e>)osure $o an$%(en 7 Plasma #ells d%eren$%a$e %n$o memory #ells 3/&%#&

$r%((er a B7#ell res)onse on su-seuen$ e>)osure $osame an$%(en5 and an$%-od%es


13/156

7 %e $y)es of an$%-od%es are )rodu#ed -y $&e -ody:

7 I(= a#$%a$es #om)lemen$, en&an#es )&a(o#y$os%s,

#rosses )la#en$a 3%.e. )ass%e %mmun%$y5, and %s a#$%e %n

a se#ond res)onse 3re%nfe#$%on5

7 I(A %s )resen$ %n $&e -ody a#$ role %s

un#lear 7I(E %s asso#%a$ed /%$& aller(%# and &y)ersens%$%%$y

rea#$%ons and )oss%-ly &el)s %n defense a(a%ns$ )aras%$es


14/156

-. Cell med%a$ed %mmun%$y %noles a$$a#4 of m%#ro-es -y

s)e#%al 4%ller T #ells formed from lym)&o#y$es

7 Cellular %mmun%$y fun#$%ons )r%mar%ly delayed

&y)ersens%$%%$y rea#$%ons re*e#$%on of $rans)lan$s and%ral, fun(al, and #&ron%# %nfe#$%ons

7T lym)o&o#y$es 3#ells are $&ymus der%ed5, one>)osure $o an$%(en, )rol%fera$e and d%eren$%a$e %n$o oneof seeral $y)es of T #ells.

7 Hel)er T #ells 3T65 ass%s$ B7#ells %n &umoral res)onse

$o form an$%-od%es

7 Su))ressor T #ells 3T5 su))ress B7#ell syn$&es%s ofan$%-ody )rodu#$%on $&rou(& a feed-a#4 me#&an%sm

7 Memory T #ells s$ore fu$ure %mmune res)onse $osome an$%(en

7 Cy$o$o>%# T #ells d%re#ly a$$a#4 an$%(en, al$er%n( #ell

mem-rane /%$& resul$an$ #ell lys%s


15/156

2. S$a(es of s)e#%1# %mmune res)onses

a. Re#o(n%$%on. C%r#ula$%n( lym)&o#y$es

and ma#ro)&a(es re#o(n%0e fore%(nma$ernal or an$%(ens as nonself

-. Prol%fera$%on. Sens%$%0ed lym)&o#y$es)rol%fera$e, d%eren$%a$e, and ma$ure %n$oa res)e#$%e T and B #ells

#. Res)onse. An$%-ody %s )rodu#ed /%$&s)e#%1# T7#ells a#$%on

d. Ee#$or. An$%(en %s des$royed -yan$%-ody, /&%#& %s )rodu#ed -y B7#ell or#y$o$o>%# T #ell a#$%on


16/156

II. THE IMMUNES"STEM


17/156

A. Assessmen$

'. Heal$& &%s$ory

a. El%#%$ a des#r%)$%on of $&e #l%en$;s )resen$ %llness and#&%ef #om)la%n$, %n#lud%n( onse$, #ourse, dura$%on,lo#a$%on and )re#%)%$a$%n( and alle%a$%n( fa#$ors. El%#%$ ades#r%)$%on of $&e #l%en$;s oerall &eal$& s$a$us, %n#lud%n(%mmun%0a$%ons s$a$us usual #&%ld&ood d%seases, 4no/

aller(%es, and a &%s$ory of )as$ and )resen$ med%#a$%ons.Card%nal s%(ns and sym)$oms %nd%#a$%n( al$ered%mmun%$y are su-seuen$ly des#r%-ed.

7 =eneral

7 Re#urren$ %nfe#$%ons

7 Seasonal sym)$oms 7 e%(&$ loss

7 eer


18/156

7 Head

7 I$#&%n(, -urn%n(, /a$er%n( eyes %s%on )ro-lems and eye %nfe#$%ons

7 Re#urren$ ear %nfe#$%ons

7 R&%n%$%s and snee0%n( 7 Res)%ra$ory Sys$em

7 Cou(&

7 Dys)nea

7 Re#urren$ %nfe#$%on

7 Card%oas#ular sys$em

7 Pa%n

7 Reynaud;s )&enomenon 3%.e. e>$reme )allor and $&en #yanos%s ofe>$rem%$%es -rou(&$ on -y #old e>)osure5

7 =I Sys$em

7 Nausea and om%$%n(

7 D%arr&ea 7 =en%$our%nary Sys$em

7 Re#urren$ %nfe#$%ons

7 dysur%a and &ema$ur%a


19/156

7 Mus#ulos4ele$al sys$em

7 ea4ness and fa$%(ue

7 Ina-%l%$y $o )erform a#$%%$%esof da%ly l%%n( 3ADLs5

7 Neurolo(%# Sys$em

7 D%sor%en$a$%on $o name. da$e,and )la#e

7 Al$ered leel of#ons#%ousness

7 Pares$&es%as


20/156

-. E>)osure $&e #l%en$;s &eal$& &%s$oryfor r%s4 fa#$ors asso#%a$ed /%$&%mmune d%sorders, %n#lud%n( no$

4ee)%n( u) $o da$e %mmun%0a$%ons,e>)osure $o %nfe#$%on d%sease, ande>)osure $o )ollen, %nse#$s, and

aller(ens


21/156

+. P&ys%#al E>am%na$%on

a. Ins)e#$%on

7 Ins)e#$ s4%n and mu#ous mem-ranes fro ras&es, les%ons,

derma$%$%s, )ur)ura 3su-#u$aneous -leed%n(5 and any $y)e of%n


22/156

2. La-ora$ory and d%a(nos$%# s$ud%es

a. Mul$%7aller(en aller(y $es$%n( measures $&e %n#rease and uan$%$y ofaller(en s)e#%1# %mmuno(lo-ul%n 3I(5 E an$%-od%es and %s done $o %den$%fyaller(ens $o /&%#& $&e #l%en$ &as %mmed%a$e &y)ersens%$%%$y

-. T7 and B7lym)&o#y$es assays ealua$e $&e num-er of lym)&o#y$es %n$&e %mmune sys$em

#. I( assays 3I(=, I(A, I(M5 #an de$e#$ and mon%$or %mmune de1#%en#%es

d. Serum #om)lemen$ assays $es$ for C2 and C6 #om)lemen$ /&en $o$al#om)lemen$ leel %s de#reased

e. Au$an$%-ody $es$s 7 An$%nu#lear an$%-ody 3ANA5 $es$ measures and d%eren$%a$es ANAs

asso#%a$ed /%$& #er$a%n au$o%mmune d%seases su#& as sys$em%# lu)usery$&ema$osus

7 R&euma$o%d fa#$or $es$ measures for a ma#ro(lo-ul%n $y)e of an$%-odyfound %n r&euma$o%d ar$&r%$%s

f. Rad%oaller(osor-en$ $es$ %s rad%o%mmunoassay $&a$ measures aller(en7s)e#%1# I(E.

(. T&e &uman %mmunode1#%en#y %rus 3HI?5 $es$ de$erm%nes $&e )resen#eof HI? an$%-od%es, /&%#& %s $&e e$%olo(%# fa#$or reu%red %mmunode1en#ysyndrome 3AIDS5


23/156

B. Nurs%n( D%a(noses

'. Inee#$%e a%r/ay #learan#e

+. R%s4 for %nfe#$%on

2. A#u$e or #&ron%# )a%n

6. Im)a%red s4%n %n$e(r%$y

8. De1#%en$


24/156

C. Plann%n( and ou$#ome %den$%1#a$%on.T&e (oal for a #l%en$ d%a(nosed /%$&

an %mmunolo(%# d%sorder %n#lude%m)roed a%r/ay #learan#e,)reen$%on of %nfe#$%on, %n#reased

#omfor$, %m)roemen$ andma%n$enan#e of s4%n %n$e(r%$y,%n#reased 4no/led(e re(ard%n(

d%sease )reen$%on and self7#are,a-sen#e of #om)l%#a$%ons and %n*ury,and %m)roed #o)%n(.


25/156

D. Im)lemen$

'. Assess res)%ra$ory s$a$us, %n#lud%n( assessmen$ of $&elun(s, ra$e and de)$& of res)%ra$%ons, eor$ of -rea$&%n( use

of a##essory mus#les, #yanos%s, res$lessness, an>%e$y, orany #&an(e %n leel of #ons#%ousness

+. M%n%m%0e $&e r%s4 of %nfe#$%on

a. Ins$ru#$ $&e #l%en$ on /ays $o ao%d %nfe#$%on, %n#lud%n($&e %m)or$an#e of )ersonal &y(%ene and ao%dan#e of

)eo)le /%$& %nfe#$%ons and lar(e #ro/ds -. Ins$ru#$ $&e #l%en$ $o /as& $&e ae#$ed area /%$& /arm

/a$er -efore a))ly%n( $o)%#al #reams %ns$ru#$ &%m $o /as&&%s &ands -efore and af$er adm%n%s$er%n( $o)%#al #reams

2. Pro%de )a%n rel%ef. Assess $&e #l%en$;s )a%n, rule ou$ any

#om)l%#a$%ons, %m)lemen$ any non)&arma#olo(%#%n$eren$%ons 3%.e. %#e, #old, massa(e5 $o rel%ee )a%n,adm%n%s$er )a%n med%#a$%on, and ealua$e $&e ee#$%enessof %n$eren$%ons


26/156

6. Promo$e s4%n %n$e(r%$y

a. Assess $&e s4%n and mu#ous mem-ranes for any ras&es,#olor #&an(es, les%ons, )allor, )ur)ura, &ydra$%on and

%n


27/156

@. Promo$e self7#are. Ass%s$ $&e #l%en$ /%$&ADLs as needed, -u$ )romo$e %nde)enden#e.

Use any ener(y7sa%n( $e#&n%ues aa%la-le . Preen$ %n*ury. Ins$ru#$ $&e #l%en$ $o /ear

%den$%1#a$%on $a(s or -ra#ele$s #on#ern%n(aller(%es or d%sease

F. Promo$e #l%en$ and fam%ly #o)%n( a. Tea#& $&e #l%en$ and &%s fam%ly /ays $o

#o)e /%$& #&ron%# %llness, %n#lud%n(er-al%0a$%on of feel%n(s and /ays $o )reen$

e>a#er-a$%ons

-. Pro%de referrals


28/156

E. !u$#ome ealua$%ons

'. T&e #l%en$ d%s)lays no res)%ra$ory d%s$ress, as

e%den#ed -y an a-sen#e of #&es$ $%(&$ness,/&ee0%n(, #yanos%s, #ou(&, and e>a((era$ede>)%ra$ory eor$.

+. T&e #l%en$ s&o/s no sym)$oms ofo))or$un%s$%# %nfe#$%on, su#& as fa$%(ue, feer,n%(&$ s/ea$s, /e%(&$ loss and d%arr&ea

2. T&e #l%en$ er-al%0es rel%ef of *o%n$ )a%n andd%s#omfor$

6. T&e #l%en$ e>&%-%$s #lean, dry s4%n $&a$ %s freefrom ras&, %$#&%n(, -urn%n(, s#al%n(, ul#era$%onsand %nfe#$%on

8. T&e #l%en$ &as %n$a#$ s4%n and oral mu#osa


29/156

9. T&e #l%en$ ma%n$a%ns adeua$e


30/156

CATE=!RIES ! IMMUNE DIS!RDERS

A. Hy)ersens%$%%$y rea#$%ons are %mmune res)onses $oaller(ens $&a$ resul$ %n $%ssue des$ru#$%on

'. Ty)e I 3ana)&yla#$%#5 rea#$%ons are med%a$ed -y $&e

%mmuno(lo-ul%n 3I(5E an$%-ody, /&%#& )romo$es $&e release of&%s$am%ne and o$&er rea#$%e med%a$ors. T&ese -aso)&%l ormas$ #ells )rodu#e $&e #&ara#$er%s$%# sym)$oms of as$&ma or&ay feer.

+. Ty)e II 3#y$o$o>%#5 rea#$%ons 3e.(. &emoly$%# anem%a5 aremed%a$ed -y I(= and I=M an$%-od%es, /&%#& a$$a#& $o #ells3usually #%r#ula$%n( -lood elemen$s5 and #ause #ell lys%s

2. Ty)e III 3%mmune #om)le>5 rea#$%ons 3e.(. r&euma$o%dar$&r%$%s, serum s%#4ness5 are med%a$ed -y an$%(en7an$%-ody#om)le>es $&a$ de)os%$ %n $&e l%n%n( of -lood essels or on$%ssue surfa#es

6. Ty)e I? 3delayed &y)ersens%$%%$y5 rea#$%ons 3e.(. #on$a#$derma$%$%s, $rans)lan$ re*e#$%on5 are med%a$ed -y lym)&o4%nesreleased from sens%$%0ed T lym)&o#y$es


31/156

B. Aller(%# d%sorders are &y)ersens%$%eres)onses $o an aller(en $o /&%#& $&e

or(an%sm &as )re%ously -een e>)osed and$o /&%#& $&e or(an%sm &as deelo)edan$%-od%es

'. In$era#$%on -e$/een an$%(en and

an$%-ody $y)%#ally resul$s on one or moreman%fes$a$%ons of $%ssue %n*ury

+. I(E an$%-od%es are formed -y )ersonse>)er%en#%n( aller(%es /&o are (ene$%#ally

)red%s)osed. H%s$am%ne and o$&er med%a$orsare released on ree>)osure $o $&e aller(en$o /&%#& $&e )erson %s sens%$%0ed


32/156

C. Au$o%mmune d%sorders are#ond%$%ons %n /&%#& $&e -ody no

lon(er d%eren$%a$es self from nonself '. Al$era$%ons %n T #ells or B #ells

)rodu#e au$o%mmune-od%es and

au$osens%$%0ed T #ells $&e #ause$%ssue %n*ury. T&ese #&an(es may%nole one or(an or many or(an

sys$ems +. T&e #ause of au$o%mmune

d%sorders rema%ns un4no/n, -u$

many $&eor%es e>%s$


33/156

D. Immune de1#%en#y %s de1ned as a #on(en%$alor a#u%red de1#%$ %n $&e %mmune sys$em $&a$ma4es $&e )erson sus#e)$%-le $o l%fe7$&rea$en%n(o))or$un%s$%# %nfe#$%on

'. In #on(en%$al 3)r%mary5 %mmunode1#%en#y,$&e -ody )rodu#es %nadeua$e amoun$s of oneor more %mmune #ells. De1#%$s #an -e &umoralFB #ell5, #ell7 med%a$ed 3T7#ell5, or #om-%ned

+. A#u%red 3se#ondary5 %mmunode1u#%en#y %sa$$r%-u$ed $o ar%ous e$%olo(%es, %n#lud%n(:

a. %mmunos))ress%e $&era)y, su#& as#&emo$&era)eu$%# a(en$s, #or$%#os$ero%ds,nos$ero%dal an$%7%n


34/156

-. a(e7rela$ed fa#$ors, su#& asde$er%ora$%on %n $&e $&ymus (land and T

#ell fun#$%on%n( and a de#reased num-erof su))ressor T #ells and &el)er T #ells

#. d%sru)$%on of s4%n %n$e(r%$y, as o##urs/%$& -urns and $rauma

d. nu$r%$%onal de1#%$s

e. mal%(nan$ )ro#esses, su#& asleu4em%a and lym)&oma

f. %nfe#$%ous )ro#esses, su#& as se)s%sand a#u%red %mmunode1#%en#ysyndrome


35/156

TYPES OF LEUKOLCYTES

Cell Type Normal Cell Characteristics

F!ctio!

=ranulo#y$esBaso)&%lsEos%no)&%ls

Neu$ro)&%ls

8, $o',mm2

J 'K of allleu#o#y$es

+K $o 6K of allleu4o#y$es8K $o @K ofall leu#o#y$es

ormed %n-one marro/ =ranular3underm%#ros#o)e5 =ranules 1lled

/%$& &e)ar%n,&%s$am%ne Con$a%n&e)ar%n,&%s$am%ne

'+ &ourl%fes)an + $o 6&our l%fes)an/%$& %nfe#$%on

%mmed%a$eres)onse $o#ellular %n*ury Play role %n%n


36/156


37/156

TYPES OF LEUKOLCYTES

Cell Type Normal Cell Characteristics

F!ctio!

A(ran%lo#y$esLym)&o#y$es

Mono#y$es

+8K $o 22K ofall leu4o#y$es

6K $o 9K ofall leu4o#y$es

Produ#ed %nlym)&a$%#sys$em Non(ranular3underm%#ros#o)e5

Class%1ed as B#ells or T #ells

C%r#ula$e %n-lood -u$ alsose$$le %n $%ssue,/&ere $&ey are$ransformed %nma#ro)&a(es

%(&$ %nfe#$%on P&a(o#y$os%s Release oflym)&o4%nes Produ#$%on of

(amma(lo-ul%ns Cell med%a$edrea#$%ons P&a(o#y$os%s3#an %n(es$

lar(er )ar$%#les$&a$neu$ro)&%ls 1e$%mes as many%n one%n(es$%on5


38/156

T"PES ! SPECIIC IMMUNIT"

3See )a(e @5


39/156

"#CCIN#TION FOR #DULTS

$EP#TITIS # Recomme!%e% &or tra'elers (heresa!itatio! a!% hy)ie!e are !satis&actory

a!% &oe people at hi)h ris* +i,e, homose-alme!. I" %r) ser. health care perso!!el/,#%mi!istere% i! t(o %oses 0 1rst %ose. the!seco!% %ose 2 to 34 mo!ths a&ter the 1rst%ose

HEPATITIS B Re#ommended for )eo)le a$ &%(& r%s4 3%.e. &eal$&

#are )ersonnel, &emod%alys%s #l%en$s5.Adm%n%s$ered %n $&ree doses 1rs$ dose, se#onddose ' mon$& la$er, $&en $&%rd dose 8 mon$&saf$er $&e se#ond dose.

INLUENA lus&o$O

Re#ommended eery fall for )eo)le a(e 98 orolder res%den$s %n lon( $erm #are fa#%l%$%es

%nd%%dual /%$& &ear$ or lun( d%sease, d%a-e$es,4%dney d%sease or a #om)rom%sed %mmunesys$em and for $&ose /&o /or4 /%$& or l%e /%$&any of $&ese %nd%%duals


40/156

"#CCIN#TION FOR #DULTS

PNEUMOCOCC#L

Recomme!%e% 3 time &or people a)es 25 orol%er a!% &or people yo!)er tha! a)e 25

(ho ha'e certai! chro!ic ill!esses, Forpeople (ith chro!ic respiratory %isor%ers. ao!e time re'acci!atio! %ose a&ter 5 years isrecomme!%e%

TETANUSDIPTHERIA 3Td5

$e$anus s&o$O

Mus$ &ae -oos$er eery ' years af$er #&%ld&ood%mmun%0a$%ons. If none %n #&%ld&ood, mus$ &ae

$&ree s&o$s 1rs$ dose, $&en se#ond dose 'mon$& la$er, $&en $&%rd dose 9 mon$&s af$er $&ese#ond dose

?ACIRELLA Re#ommended for )eo)le /&o &ae neer &ad#&%#4en )o>. Adm%n%s$ered %n $/o doses 1rs$dose, $&en se#ond dose ' $o + mon$&s af$er $&e1rs$ dose.


41/156

$E#LT$ EDUC#TION FOR #LLERGY SYMPTOM CONTROL

Mai!tai! a %st &reee!'iro!me!t

Re%ce e-posre to polle!

Redu#e room #on$en$s $o$&e -ares$ m%n%mum -yremo%n( dra)es, #ur$a%ns,-l%nds 3use )ull s&ades%ns$ead5

as& /ood /or4 andl%noleum )osures 3e.(./%ndy days, mo/%n( yard5 Be a/are of &%(& )ollen#oun$s. Redu#e e>)osure a$$&ese $%mes and s$ay %n a%r7#ond%$%oned areas

Ensure a smo4e free


42/156

DIS!RDERS


43/156


44/156


45/156

ALLER=IC RHINITIS

A. Des#r%)$%on. Aller(%# r&%n%$%s 3%.e.

&ay feer5 %s an aller(%# rea#$%on $o%n&aled a%r-orne aller(ens#&ara#$er%0ed -y seasonal

o##urren#es. I$ %s $&e mos$ #ommonform of res)%ra$ory aller(y. Al$&ou(&%ldren and adoles#en$s &ae an

es)e#%ally &%(& %n#%den#e, %$ o##urs %nall a(e (rou)s


46/156

B. E$%olo(y. Aller(%# r&%n%$%s %s %ndu#ed-y a%r-orne )ollens. Common

seasonal )ollens %n#lude: '. $ree )ollens 3e.(. oa4, ma)le,

and -%r#&5 %n $&e s)r%n(

+. (rass )ollens 3e.(. s&ee) sorrel,and )lan$a%n5 %n $&e summer

2. /eed )ollens 3e.(. ra(/eed5 %n

$&e fall


47/156

C. Pa$&o)&ys%olo(y. Aller(%# r&%n%$%s

o##urs /&en %mmuno(lo-ul%n 3I(5Ean$%-od%es %n $&e nasal mu#osa#om-%ne /%$& %n&aled aller(ens on

$&e mu#osa surfa#e. T&e nasalmu#osa rea#$s -y slo/%n( of #%l%arya#$%on, edema forma$%on, and

leu4o#y$e %n1l$ra$%on. T%ssue edema%s a resul$ of asod%la$a$%on and%n#reased #a)%llary )ermea-%l%$y.


48/156

D. Assessmen$ 1nd%n(s

'. Asso#%a$ed 1nd%n(s may -e

%n#lude a fam%ly &%s$ory of aller(%es

+. Cl%n%#al man%fes$a$%ons

a. I$#&%n(, -urn%n( nasal mu#osa

-. Co)%ous mu#ous se#re$%ons#aus%n( runny nose

#. Red, -urn%n( $ear%n( eyes

d. Snee0%n(

e. Pale, -o((y nasal mu#osa


49/156

2. La-ora$ory and d%a(nos$%# s$udy 1nd%n(s

a. Nasal smears reeal eos%no)&%ls %n nasal

se#re$%ons -. Per%)&eral -lood #oun$ reeal a

lym)&o#y$es #oun$ a-oe $o$al ',+ml

#. To$al serum I(E de$erm%na$%on s&o/s an

elea$ed serum leel of I(E d. S4%n $es$%n( %den$%1es $&e oend%n(

aller(ens

e. Rad%oaller(osor-en$ $es$ measures

aller(en7s)e#%1# I(E. If an$%-od%es are )resen$,$&ey #om-%ne /%$& $&e rad%ola-eled aller(ens,/&%#& are #om)ared /%$& #on$rol alues


50/156

E. Nurs%n( Mana(emen$

'. Adm%n%s$er )res#r%-ed med%#a$%ons, /&%#&may %n#lude an$%&%s$am%nes, de#on(es$an$s, and$o)%#al #osr$%#os$ero%ds

+. En#oura(e $&e #l%en$ $o use sal%ne s)ray $osoo$&e mu#ous mem-ranes. Ad%se $&e #l%en$ $o-lo/ &%s nose -efore adm%n%s$er%n( nasal

med%#a$%ons

2. Pre)are #l%en$ for %mmuno$&era)y, /&%#& %s)res#r%-ed only /&en I(E &y)ersens%$%%$y $os)e#%1#, unao%da-le %n&alan$ aller(ens 3&ouse

dus$ and )ollens5 %s demons$ra$ed 6. M%n%m%0e $&e r%s4 of %nfe#$%on

8. Pro%de #l%en$ and fam%ly $ea#&%n(


51/156


52/156


53/156


54/156

ALLER=IC DERMAT!SES

A. Des#r%)$%on. Aller(%# derma$oses %sa (rou) of %n


55/156

B. E$%olo(y

'. Aller(%# #on$a#$ derma$%$%s %s )rodu#ed -ymany su-s$an#es. Common #auses %n#ludee>)osure $o )o%son %y, $o)%#al med%#a$%ons,#osme$%#s, soa)s, and %ndus$r%al #&em%#als.

+. Al$&ou(& $&e #ause of a$o)%# derma$%$%s %sun4no/n, $&e #ond%$%on a))ears $o -easso#%a$ed /%$& a fam%ly &%s$ory of aller(%#res)%ra$ory d%sorders 3e.(. aller(%# r&%n%$%s,as$&ma5. E>a#er-a$%n( fa#$ors amy %n#lude%rr%$an$s, %nfe#$%on, and #er$a%n aller(ens


56/156

C. Pa$&o)&ys%olo(y

'. Aller(%# #on$a#$ derma$%$%s %noles

delayed &y)ersens%$%%$y and reu%res a la$en$)er%od ran(%n( from seeral days 3 for s$ron(sen$%s%$%0er su#& as )o%son %y5 $o years

+. a$o)%# derma$%$%s %s $y)e I %mmed%a$e

&y)ersens%$%%$y d%sorder resul$%n( %n lar(eamoun$s of &%s$am%ne %n $&e s4%n, #&an(es %nl%)%d #on$en$ of $&e s4%n, se-a#eous (landa#$%%$y, and d%a)&ores%s. I$ mos$ #ommonly

-e(%ns %n %nfan#y or early #&%ld&ood. I$ maysu-s%de s)on$aneously $o -e follo/ed -yun)red%#$a-le e>a#er-a$%ons $&rou(&ou$ l%fe.


57/156


'. Asso#%a$ed 1nd%n(s. Cl%en$ &%s$ory may

4no/n or sus)e#$ed e>)osure $o analler(en


a. Aller(%# #on$a#$ derma$%$%s

7 Burn%n(, %$#&%n(, edema, and ery$&emaof s4%n

7 Crus$%n(, /ee)%n( les%ons

7 Dry%n( and feel%n( of $&e s4%n 7 Hemorr&a(%# -ullae, )oss%-ly /%$&

seere res)onses


58/156

-. A$o)%# derma$%$%s

7 Prur%$us

7Hy)er%rr%$a-%l%$y of $&e s4%n

7 E>#ess%e dryness of $&e s4%n

7 Redness for '8 $o 2 se#ondsaf$er s$ro4%n( follo/ed -y )allorlas$%n( ' $o 2 m%nu$es


59/156

2. La-ora$ory and d%a(nos$%# s$udy1nd%n(s

a. Aller(%# #on$a#$ derma$%$%s.Pa$#& $es$s of $&e s4%n #lar%fyd%a(nos%s /%$& oend%n( a(en$s

-e%n( %den$%1ed -. A$o)%# derma$%$%s

7 Serum %mmuno(lo-ul%n E leels

are freuen$ly elea$ed 7 S4%n -%o)sy s&o/s nons)e#%1#

e#0ema$ous #&an(es


60/156


'. Adm%n%s$ered )res#r%-ed med%#a$%ons, /&%#& may%n#lude an$%&%s$am%ne, an$%)rur%$%#s, or s$ero%dal #reams

+. M%n%m%0e $&e r%s4 of %nfe#$%on

2. Pro%de )a%n rel%ef

6. Promo$e s4%n %n$e(r%$y

8. Promo$e #l%en$ and fam%ly #o)%n(

9. Pro%de #l%en$ and fam%ly $ea#&%n(

a. Ins$ru#$ $&e #l%en$ $o /ear #o$$on fa-r%#s and /as& /%$&a m%ld de$er(en$

-. Ad%se $&e #l%en$ $o $a4e da%ly -a$&s $o &ydra$e $&e s4%n

#. En#oura(e $&e #l%en$ $o use $o)%#al s4%n mo%s$ur%0er

d. Ad%se $&e #l%en$ $o &um%d%fy dry &ea$ dur%n( /%n$er.Re#ommend $&a$ $&e #l%en$ 4ee) $&e room $em)era$ure a$9$o @ 3+$o +'.C5


61/156


62/156

ALLER=IC ASTHMA

A. Des#r%)$%on. Aller(%# as$&ma %s a

#&ron%# rea#$%e res)%ra$ory d%sorder)rodu#%n( e)%sod%#, reers%-le a%r/ayo-s$ru#$%on. T&e es$%ma$ed %n#%den#e

%s 2K $o K of $&e )o)ula$%on more$&an one &alf of #ases found %n#&%ldren youn(er $&an a(e '


63/156

B. E$%olo(y. Aller(%# as$&ma resul$sfrom an %mmunolo(%#ally med%a$ed&y)ersens%$%%$y $o %n&aled aller(ens,

su#& as a%r-orne )ollens and molds,dus$, and an%mal danders.


64/156

C. Pa$&o)&ys%olo(y. Al$&ou(& $&e )a$&olo(%#

me#&an%sms of aller(%# as$&ma rema%nsome/&a$ un#lear, $&e fundamen$al )ro#ess)resuma-ly %noles a rea#$%on of sens%$%0ed%mmuno(lo-ul%n E an$%-od%es $o an %n&aled

aller(en, /%$& su-seuen$ release of #&em%#almed%a$ors, su#& as &%s$am%ne, slo/7rea#$%n(su-s$an#e of ana)&yla>%s, and eos%no)&%ls#&emo$a#$%# fa#$or of ana)&yla>%s. !-s$ru#$%onresul$s from #ons$r%#$%on of -ron#&%al smoo$&mus#les, s/ell%n( of -ron#&%al mem-ranes,and &y)er se#re$%on of mu#us


65/156


'. Asso#%a$ed 1nd%n(s. T&e #l%en$;s &eal$& &%s$orymay reeal a fam%ly &%s$ory of aller(%# as$&ma and

e>)osure $o a 4no/n or sus)e#$ed )re#%)%$a$%n(su-s$an#es


a. C&es$ $%(&$ness

-. Prolon(ed, s$renuous e>)%ra$%ons #. &ee0%n( on e>)%ra$%ons

d. Bu##al and )er%)&eral #yanos%s

e. Cou(&, non )rodu#$%e a$ 1rs$, follo/ed -y %olen$

#ou(&%n( $&a$ )rodu#es $&%n, (ela$%nous mu#us and %srel%eed -y a -ron#&od%la$or

f. Nausea and om%$%n(

(. An>%e$y


66/156

2. La-ora$ory and d%a(nos$%# s$udy 1nd%n(s

a. Pulmonary fun#$%on s$ud%es reeal a%r/ayo-s$ru#$%on and de#reased )ea4 e>)%ra$ory am%na$%on mays&o/ &y)er%n%de 3PaC!+5 and %n#reased )H

3res)%ra$ory al4alos%s5 7 La$er %n#reased PaC!+and de#reased )H

3res)%ra$ory a#%dos%s5


67/156


'. Adm%n%s$er )res#r%-ed med%#a$%ons, /&%#& %n#ludeadrener(%#s, -ron#&od%la$ors, leu4o$r%ene re#e)$or an$a(on%s$,mas$ #ell %n&%-%$ors, and oral #ors$o#os$ero%ds

+. Pro%de nurs%n( #are dur%n( an a#u$e a$$#4

a. Adm%n%s$er adrener(%#s , /&%#& are $&e %n%$%al med%#a$%ons-e#ause $&ey d%la$e -ron#&%al smoo$& mus#les, %n#rease #%l%arymoemen$s, and de#rease $&e #&em%#al med%a$ors of ana)&yla>%s

-. Colla-ora$e /%$& res)%ra$ory $&era)y and adm%n%s$er o>y(en

as )res#r%-ed #. Elea$e $&e &ead of $&e -ed, and lean $&e #l%en$ for/ard $o

)ro%de ma>%mum lun( e>)ans%on and esae res)%ra$ory eor$

d. Mon%$or res)%ra$ory ra$e and de)$& and aus#ul$a$e lun(sounds

e. Mon%$or AB=s for #&an(es from -asel%ne f. Adm%n%s$er %e$y


68/156

2. Mon%$or for and $a4e )re#au$%ons $o )reen$#om)l%#a$%ons, su#& as )neumo$&ora>, )ulmonary&y)er$ens%on, r%(&$ &ear$ fa%lure, and res)%ra$ory

fa%lure 6. Pro%de #l%en$ and fam%ly $ea#&%n(

a. En#oura(e $&e #l%en$ $o under(o $es$%n( $o%den$%fy $&e #ause of as$&ma a$$a#4s

-. Coney $&e %m)or$an#e of s$r%#$ #om)l%an#e/%$& $&e $&era)eu$%# re(%men

#. D%s#uss $&e need for %n#reased


69/156


70/156

ANAPH"LAQIS

A. Des#r%)$%on. Ana)&yla>%s %s ana#u$e, l%fe $&rea$en%n( aller(%#

rea#$%on mar4ed -y ra)%d)ro(ress%ely ur$%#ar%a andres)%ra$ory d%s$ress $&a$ may resul$ %n

ana)&yla#$%# s&o#4.

% l & l % l f


71/156

B. E$%olo(y. Ana)&yla>%s resul$s from%n(es$%n( 3 or o$&er sys$em e>)osure5 $o

aller(en%# su-s$an#es. Poss%-le #ausa$%esu-s$an#es %n#lude:

'. Dru(s 3e.(. )en%#%ll%n and o$&eran$%-%o$%#s, a##%nes, &ormones,

sal%#yla$es, and lo#al anes$&e$%#s5 +. oods 3e.(. le(umes, nu$s, -err%es,

seafoods, and e(( al-um%n5

2. Sul1$e #on$a%n%n( food add%$%es 6. Inse#$ enom 3e.(. /as), &orne$s,

&oney-ee, #er$a%n s)%ders5

C P $& & % l


72/156

C. Pa$&o)&ys%olo(y

'. Ana)&yla#$%# rea#$%on reu%res )re%oussens%$a0a$%ons $o $&e $r%((er%n( aller(en, /%$& )rodu#$%on

of s)e#%1# %mmuno(lo-ul%n 3I(5E an$%-od%es $&a$ -%nd $omas$ #ells and -aso)&%ls

+. !n e>)osure, I(E re#a$s %mmed%a$ely /%$& $&ealler(en and $r%((ers release of )o$en$ #&em%#al med%a$ors3e.(. &%s$am%ne, eos%no)&%l #&emo$a#$%# fa#$or of

ana)&yla>%s5 from -aso)&%ls and mas$ #ells. Con#urren$ly,I(= or I(M a#$%a$es release of #om)lemen$ fra#$%ons, and$/o o$&er #&em%#al med%a$ors 3%.e. -rady4%n%n andleu4o$r%enes5 $r%((er )rofound as#ular #&an(es $&a$ #anlead $o as#ular #olla)se 3%.e. ana)&yla#$%# s&o#45

2. Ana)&yla>%s %s a med%#al emer(en#y -e#ause of $&e)oss%-%l%$y of res)%ra$ory o-s$ru#$%on and as#ular#olla)se. In seere #ases, dea$& may o##ur /%$&%n 8 $o 'm%nu$es of onse$.

B A $ 1 d%


73/156

B. Assessmen$ 1nd%n(s

'. Cl%n%#al man%fes$a$%ons de)end on /&e$&ermed%a$ors rema%n lo#al or are sys$em%#

a. Lo#al ee#$s %n#lude /&eals /%$& surround%n( red


74/156

+. La-ora$ory and d%a(nos$%# s$udy

1nd%n(s a. Serum and ur%ne &%s$am%ne %s

elea$ed for a s&or$ $%me

-. Serum $ry)$ase, a mas$ #ellen0yme mar4er for aller(%# andana)&yla#$%# rea#$%ons, elea$ed 2

$o F m%nu$es af$er rea#$%ons onse$

E Nurs%n( Mana(emen$


75/156


'. Pro%de nurs%n( #are dur%n( an ana)&yla#$%# a$$a#4

a. Es$a-l%s& a )a$en$ a%r/ay

-. Adm%n%s$er e)%ne)&r%ne, IM or su-#u$aneously, $o

#ons$r%#$ d%la$ed -lood essels, a $u-er#ul%n syr%n(e $o ensure$&e e>a#$ dosa(e and mon%$or $&e #l%en$ #losely af$eradm%n%s$ra$%on

#. Es$a-l%s& a )a$en$ I? l%ne for dru( and y(en. Hae a

$ra#&eos$omy se$ a$ $&e -eds%de

e. Mon%$or %$al fun#$%ons, ealua$%n( -lood )ressure, )ulse,res)%ra$%ons, ar$er%al -lood (as alues, ele#$ro#ard%o(ram and

ur%nary ou$)u$ f. Adm%n%s$er )res#r%-ed med%#a$%ons, /&%#& may %n#lude

an$&%s$am%nse, -ron#&od%la$ors, aso)ressors, and#or#os$ero%ds

+ Tea#& )reen$%e measures


76/156

+. Tea#& )reen$%e measures

a. En#oura(e $&e #l%en$ $o ao%d or el%m%na$e anyoend%n( aller(ens

-. Ad%se $&e #l%en$, /&o %s sens%$%e $o %nse#$ -%$es,$o #arry an$%7s$%n(O 4%$s

#. Ins$ru#$ $&e #l%en$ $o /ear %den$%1#a$%on $a(s or

-ra#ele$s

2. Ma%n$a%n safe$y )re#au$%ons a. Al/ays 4ee) $&e #l%en$ %n $&e o#e for 2

m%nu$es af$er adm%n%s$er%n( any ne/ med%#a$%on $ode$erm%ne %f aller(%# rea#$%on o##urs

-. Al/ays #&e#4 for 4no/n aller(%es -eforeadm%n%s$er%n( any )res#r%-ed or oer $&e #oun$ermed%#a$%on

6. Pro%de referrals


77/156


78/156

RHEUMAT!ID ARTHRITIS

A Des#r%)$%on. R&euma$o%d ar$&r%$%s %sa #&ron%#, )ro(ress%e d%sease%nol%n( %n


79/156

B. E$%olo(y. R&euma$o%d ar$&r%$%s %sa))aren$ly an au$o%mmune d%sorder%$s #ause %s un4no/n. E>a#er-a$%ons

may -e asso#%a$ed /%$& %n#reased)&ys%#al or emo$%onal s$ress.


80/156

C. Pa$&o)&ys%olo(y. Pa$&olo(%# #&an(es-e(%n as %n$end $o -ody or(ans and -lood

essels.

D Assessmen$ 1nd%n(s


81/156


'. Cl%n%#al man%fes$a$%ons

a. Edema$ous, /arm, $ender *o%n$s -. L%m%$ed ran(e of mo$%on %n ae#$ed *o%n$s

#. =eneral%0ed edema or nodules aroundae#$ed *o%n$s

d. Im)a%red mo-%l%$y and a-%l%$y $o )erforma#$%%$%es of da%ly l%%n( 3ADLs5

e. a$%(ue, /ea4ness, and anore>%a

f. In la$er s$a(es, /e%(&$ loss, feer, anem%a,mus#le a$ro)&y, and S*o(ren;s syndrome

+ La-ora$ory and d%a(nos$%# s$udy


82/156

+. La-ora$ory and d%a(nos$%# s$udy1nd%n(s

a. Rad%o(ra)&%# s$ud%es reeala-normal%$%es su#& as )ro(ress%e

*o%n$ dama(e

-. R&euma$o%d fa#$or %s )resen$%n more K of $&e #l%en$s

#. Ery$&ro#y$e sed%men$a$%on

ra$e %s s%(n%1#an$ly elea$ed d. Red -lood #ell #oun$ and C6

#om)lemen$ are de#reased

E Nurs%n( Mana(emen$


83/156


'. Adm%n%s$er )res#r%-ed med%#a$%ons, /&%#& may %n#ludenons$ero%dal an$% %ner#%ses are e>#ellen$ -e#ause/a$er )romo$es -uoyan#y, /&%#& eases *o%n$ moemen$

Re#ommend a /e%(&$ redu#$%on )ro(ram


84/156

. Re#ommend a /e%(&$ redu#$%on )ro(ram,%f a))ro)r%a$e

F. Colla-ora$e /%$& $&e o##u)a$%onal$&era)%s$ and )romo$e $&e use of -ra#es,s)l%n$s and ass%s$%e mo-%l%$y de%#es, %fa))ro)r%a$e

'. D%s#uss rela>a$%on $e#&n%ues, su#& as%ma(ery, elf &y)nos%s, -%ofeed-a#4,d%ers%onary a#$%%$%es,a nd d%s$ra#$%on for)a%n mana(emen$

''. D%s#uss ma%n$a%n%n( o)$%mal nu$r%$%onals$a$us

'+. Pro%de a referral


85/156


86/156


87/156

S"STEMIC LUPUS ER"THEMAT!SUS

A. Des#r%)$%on. Sys$em%# lu)usery&$ema$ous 3SLE5 %s a #&ron%#sys$em%# %n


88/156

B. E$%olo(y. SLE %s $&ou(&$ $o -eau$o%mmune d%sorder


89/156

C. Pa$&o)&ys%olo(y

'. SLE %noles mar4edly %n#reased B7#ell&y)er(amma(lo-ul%nem%a, au$oan$%-ody)rodu#$%on, and de#reased T #ell fun#$%ons.Sym)$oms resul$ from %mmune #om)le>%nas%on of -ody sys$ems. D%sease )ro(ress%on,

/&%#& %s #&ara#$er%0ed -y re#urr%n( rem%ss%onsand e>a#er-a$%ons, %s /%dely ar%a-le

+. Pro(nos%s %s (ood /%$& early de$e#$%on and$rea$men$ &o/eer, SLR #an lead $o )o$en$%ally

serous #om)l%#a$%ons, %n#lud%n( #ard%oas#ular,renal, and neurolo(%# )ro-lems and sere-a#$er%al %nfe#$%ons



90/156


'. Cl%n%#al man%fes$a$%ons may -e %ns%d%ous or a a#u$e$&e #l%en$ may rema%n under d%a(nosed for many years

#l%n%#al man%fes$a$%ons %nole mul$%)le -ody sys$ems a. Mus#ulos4ele$al sys$em

7 Ar$&ral(%as and ar$&r%$%s 3syno%$%s5

7 o%n$ edema and $enderness

7 Pa%n on moemen$ and morn%n( s$%ness

-. In$e(umen$ary sys$em

7 Su-a#u$e #u$aneous lu)us ery$&ama$ous resul$s %n a-u$$er


91/156

#. Card%oas#ular sys$em

7 Per%#ard%$%s

7 Po)ular, ery&$ema$ous, and )ur)ur%# les%ons on

1n(er $%)s, el-o/s, $oes, forearms, and &ands d. Res)%ra$ory sy$em

7 Pleural eus%on

7 Pleur%$%s

e. Neurolo(%# sys$em 7 Su-$le #&an(es %n )ersonal%$y and #o(n%$%e a-%l%$y

7 Commonly, de)ress%on and )sy#&os%s

f. !$&er sys$ems

7 Lym)&adeno)a$&y 7 %$& renal %nolemen$, $&e (lomerul% of 4%dney

are usually ae#$ed


92/156



93/156

( (

'. Adm%n%s$er )res#r%-ed med%#a$%ons, /&%#& may%n#lude #or$%#os$ero%ds, nons$ero%dal, an$%7%n


94/156

)) y ) * )s$%ness

@. Colla-ora$e /%$& $&e )&ys%#al $&era)y de)ar$men$ and

en#oura(e an a))ro)r%a$e e>er#%se )ro(ram $o &el)ma%n$a%n mo-%l%$y and s$ren($&

. Pro%de #l%en$ and fam%ly $ea#&%n(

a. En#oura(e )ro$e#$%on from $&e sun and ul$ra%ole$ l%(&$.Ad%se $&e #l%en$ $o ao%d (o%n( ou$ -e$/een ': am and

6: )m, use suns#reen /%$& a sun )ro$e#$%on fa#$or of a$leas$ 2, /ear a lar(e &a$ and $%(&$ /eae #lo$&%n(, andrefra%n from us%n( a $ann%n( -ed

-. Ad%se $&e #l%en$ $o #onsul$ a &eal$& #are )ro%der-efore re#e%%n( %mmun%0a$%ons or $a4%n( -%r$& #on$rol )%lls

or oer $&e #oun$er dru(s #. Ad%se $&e #l%en$ $o ao%d )ersons /%$& #on$a(%ous

%nfe#$%ons

F. Pro%de a referral


95/156


96/156


97/156

ACUIRED IMMUN!DEICIENC" S"NDR!ME

A. Des#r%)$%on. A#u%red %mmunode1#%en#ysyndrome 3AIDS5 %s a seere%mmunode1#%en#y #aused -y $&e &uman%mmunode1#%en#y %rus 3HI?5, /&%#& allo/s

normally -en%(n or(an%sms $o


98/156

(y

'. HI? %s $ransm%$$ed se>ually, $&rou(& d%re#$#on$a#$ /%$& -lood or -lood )rodu#$s and some -ody

se#re$%ons +. Persons a$ r%s4 for #on$ra#$%n( HI?

a. Anyone /&o en(a(es %n un)ro$e#$ed se>ual

a#$%%$y /%$& an %nfe#$ed )ar$ner.

-. Re#%)%en$s of $ransfused -lood or -lood#om)onen$s 3un#ommon s%n#e 'F8, /&en -lood

s#reen%n( /as %ns$%$u$ed5

#. I? dru( a-users

d. C&%ldren 3)er%na$ally5 of mo$&ers /%$& HI?

e. Heal$& #are /or4ers e>)osed $o HI? needle s$%#43 T&e %n#%den#e ofr &eal$& #are /or4ers e>)osed $oHI? -y needle s$%#4 %s es$%ma$ed $o -e less $&an 'K5

C. Pa$&o)&ys%olo(y. HI? %s a )ar$ of a (rou) of


99/156

) y (y ) ( )%ruses 4no/n as re$ro%ruses, /&%#& #arry(ene$%#s ma$er%al %n r%-onu#le%# a#%d ra$&er $&an

deo>yr%-onu#le%# a#%d. HI? %nfe#$s #ells /%$& CD6lym)&o#y$es 3also #alled T6 or &el)er T #ells5.

T&%s %nfe#$%on #auses #ell dea$& and a de#rease %n$&e %mmune fun#$%on, resul$%n( %n o))or$un%s$%#

%nfe#$%ons and neurolo(%# )ro-lems. HI? #an -e%sola$ed from -lood, semen, sal%a, $ears, -reas$m%l4, and #ere-ros)%nal


100/156

'. Asso#%a$ed 1nd%n(s. T&e Cl%en$ may re)or$ re#urr%n( %ral and -a#$er%al%nfe#$%ons


a. a$%(ue

-. eer and n%(&$ s/ea$

#. e%(&$ loss

d. =eneral%0ed lym)&adeno)a$&y

e. Non)rodu#$%e #ou(& and s&or$ness of -rea$&

f. S4%n les%ons, dry s4%n, and )allor

(. =I u)se$ and #&ron%# d%arr&ea

&. Edema

%. ?%sual %m)a%rmen$

*. Pa%nful oral les%ons

4. Bru%s%n( and -leed%n( $enden#%es

l. o%n$ )a%n

m. !))or$un%s$%# %nfe#$%ons, su#& as Pneumo#ys$%s #ar%n% )neumon%a,my#o-a#$er%al %nfe#$%ons, #ry)$o#o##al %nfe#$%on, $o>o)lasmos%s, &%s$o)lasmos%sand #y$ome(alo%rus %nfe#$%on

n. Ga)os%;s sar#oma and AIDS demen$%a #om)le>

). HI? /as$%n( syndrome

2. La-ora$ory and d%a(nos$%# 1nd%n(s


101/156

y ( (

a. En0yme l%n4ed %mmunosor-en$ assay 3ELISA5%nd%#a$es e>)osure $o or %nfe#$%on /%$& HI? -u$ does

no$ d%a(nose AIDS -. es$ern -lo$ assay %den$%1es HI? an$%-od%es

#. SUDS s#reen%n( $es$ %s only F8K a##ura$e -u$$&e resul$s are aa%la-le %n 2 $o 9 m%nu$es. T&%s

$es$ %s only useful /&en a &eal$& #are /or4ersus$a%ns a needle s$%#4 %n*ury, %f $&e #l%en$;s $es$#omes -a#4 )os%$%e, $&e &eal$& #are /or4ers %ss$ar$ed on )ro)&yla#$%# an$%7re$ro%ral med%#a$%ons

d. AIDS %s d%a(nosed on #l%n%#al &%s$ory, r%s4fa#$ors, )&ys%#al e>am%na$%on. La-ora$ory e%den#e

of %mmune dysfun#$%on and )os%$%e ELISA ores$ern -lo$ assay.

E. Nurs%n( Mana(emen$. No #ure or a##%ne &as -een found, and$ $ $ f % $ % % & l$& d % % % l


102/156

$rea$men$ fo#uses on ma%n$a%n%n( &eal$& and %m)ro%n( sur%al$%me.

'. Adm%n%s$er )res#r%-ed med%#a$%on, /&%#& may %n#lude dru(

$&era)y for AIDS rela$ed o))or$un%s$%# %nfe#$%ons, an$%re$ro%ral$&era)y, an$%d%arr&eals, and an$%eme$%#s

+. Promo$e )reen$%e measures rela$ed $o $&e $ransm%ss%on ofHI?. T&%s %s a )r%me #on#ern un$%l a a##%ne %s found resear#&ers&ae re)or$ed $&a$ a a##%ne %s -e%n( %nes$%(a$ed and $es$ed for)reen$%on of HI? $ransm%ss%on

a. Promo$e )u-l%# edu#a$%on re(ard%n( HI? and AIDS. Tea#l%en$ and fam%l%es $o )ra#$%#e safe se>, ao%d%n( s&ar%n( needles,and ao%d $ou#&%n( ano$&er;s -ody #. Promo$e s$andard )re#au$%ons $o )ro$e#$ &eal$& #are )ro%der

from e>)osure $o $&e #l%en$;s -lood or -ody


103/156

s#ra$#&%n( s$ron( )erfumed , soa)s, and ad&es%e $a)es follo/rou$%ne oral #are 4ee) anal area as #lean as )oss%-le. /ear/&%$e so#4s $o )reen$ foo$ )ro-lems 4ee) l%nens dry and

#lean and a))ly )ro$e#$%e -arr%ers $o $&e s4%n as ne#essary 6. Ins$ru#$ $&e #l%en$ a-ou$ $&e )romo$%on of normal -o/el

moemen$s and )reen$%on of d%arr&ea. Ins$ru#$ $&e #l%en$ $omon%$or $&e uan$%$y and olume of l%u%d s$ools and ao%d-o/el %rr%$an$s, su#& as ra/ fru%$s, e(e$a-les, s)%#y foods, and

&o$ and #old foods. 8. Promo$e %nfe#$%on )reen$%on. D%s#uss $&e %m)or$an#e of

ma%n$a%n%n( )ersonal &y(%ene, 4ee)%n( -a$&rooms and 4%$#&ens#lean, and (e$$%n( adeua$e res$ a#$%%$y and /ell -alan#e d%e$

9. Tea#& ener(y #onsera$%on $e#&n%ue su#& as s%$$%n( /&%le

do%n( morn%n( #are, us%n( a s&o/er #&a%r and arran(%n( $&e&ome %n a /ay sae $%me from /al4%n( or s$and%n(. In $&e&os)%$al, )u$ all ne#essary %$ems /%$&%n easy rea#&

@. D%s#uss /ays $&e #l%en$ and fam%ly #an ass%s$ /%$& men$al s$a$us )ro-lems.T&ese %n#ludes )u$$%n( no$es on $&e refr%(era$or or no$e -oards us%n(


104/156

T&ese %n#ludes )u$$%n( no$es on $&e refr%(era$or or no$e -oards, us%n(#alendars and #lo#4s $o or%en$ $&e #l%en$s $o $%me and )la#e, and ass%s$%n( $&e#l%en$ /%$& )ay%n( -%lls, s&o))%n( and o$&er &ouse&olds a#$%%$%es

. Tea#& me$&ods for a%r/ay #learan#e. T&ese %n#lude $urn%n(, #ou(&%n(,

and dee) -rea$&%n( %n#reas%n( y(en %f ne#essary.

F Hel) ma%n$a%n nu$r%$%onal s$a$us -y #on$roll%n( nausea and om%$%n(en#oura(%n( foods $&a$ are easy $o s/allo/ en#oura(%n( oral &y(%ene -eforeand af$er meals )romo$%n( a &%(& )ro$e%n, &%(& #alor%e d%e$ mon%$or%n(/e%(&$, %n$a4e and ou$)u$, mon%$or%n(


105/156

Classi1catio!s

I!%icatio!s

Selecte% I!ter'e!tio!s

Adrener(%#Al-u$erolE)%ne)&r%neIsoe$&ar%neIso)ro$erenolMe$a)ro$eren

ol$er-u$al%ne

Rela>smoo$&-ron#&%almus#leand d%la$ea%r/ays

Ins$ru#$ $&e #l%en$ $o %n&ale $/%#e asfollo/s %n&ale on#e, /a%$ ' m%nu$e, and%n&ale on#e more

An$%-%o$%#sAm%no(y#os%des3(en$am%#%n,

$o-ramy#%n5Amo>%#%ll%nEry$&romy#%nPen%#%ll%n$e$ra#y#l%ne

Preen$or $rea$%nfe#$%ons#aused -y)a$&o(en%#m%#roor(an%sms

Before adm%n%s$er%n( $&e 1rs$ dose,assess $&e #l%en$ for aller(%es andde$erm%ne /&e$&er #ul$ure &as -eeno-$a%ned

Af$er mul$%)le doses, assess $&e #l%en$for su)er %nfe#$%on 3$&rus&, yeas$%nfe#$%on, d%arr&ea5 no$%fy $&e &eal$are )ro%der %f $&ese o##ur Assess $&e %nser$%on s%$e for )&le-%$%s %fan$%-%o$%#s are -e%n( adm%n%s$ered I?

To assess $&e ee#$%eness of

MEDIC#TIONS FOR IMMUNE DISORDERS


106/156

Classi1catio!s I!%icatio!s Selecte% I!ter'e!tio!s

An$%d%arr&eal

A$$a)ul(%$eB%smu$&su-sal%#yla$eD%)&eno>yla$eand a$ro)%nelo)eram%de

A-sor- e>#ess

/a$er from s$ool

To assess $&e ee#$%eness

of $&e med%#a$%on, re#ord $&enum-er and #ons%s$en#y ofs$ools Mon%$or %n$a4e and ou$)u$,da%ly /e%(&$, and serumele#$roly$e leels

An$%eme$%#sBen0u%nam%deD%men&ydr%na$eTr%me$&o-en0am%deHydro#&lor%de

Prome$&a0%nes#o)olam%ne

Rel%ee nausea andom%$%n( -y%n&%-%$%n(medullary#&emore#e)$or$r%((ers dru(

#&o%#e de)ends on$&e #ause ofom%$%n(

Ad%se $&e #l%en$ $&a$ $&%smed%#a$%on may #ausedro/s%ness Be#ause $&e med%#a$%onmay #ause #&em%#al%rr%$a$%on, adm%n%s$er -y dee)

IM %n*e#$%on %n$o a lar(emus#le mass, %f a))ro)r%a$e Measure emes%s andma%n$a%n a##ura$e %n$a4e andou$)u$ mon%$or forde&ydra$%on



107/156

Classi1catio!s

I!%icatio!s Selecte% I!ter'e!tio!s

An$%&%s$am%nesCe$%r%0%neC&olor)&en%ram%ne malea$eDes#lora$ad%ne

D%)&en&ydram%nee>ofenad%neLora$%d%ne$erfenad%ne

In&%-%$ &%s$am%nerelease -y -%nd%n(sele#$%ely $o H,re#e)$ors

Tea#& $&e #l%en$ $o ao%dal#o&ol, dr%%n(, or en(a(%n( %n&a0ardous a#$%%$%es -e#ause$&e med%#a$%on may #ausedro/s%ness. 3Somean$%&%s$am%nes are nonseda$%n(.

Ma4e sure $&e #l%en$ %s4no/led(ea-le of $&emed%#a$%on;s aderse ee#$s5 En#oura(e su#4%n( on &ard#andy or %#e #&%)s fro rel%ef ofdry mou$&

An$%)rur%$%#a(en$sTo)%#als$ero%dsDeso>%me$asone

Hydro#osr$%son

Rel%ee or )reen$%$#&%n( 3may -e$o)%#al s$ero%ds oranes$&e$%#s5

Ad%se $&e #l%en$ $o /as& &%s&ands -efore and af$er

a))l%#a$%on

Ins$ru#$ $&e #l%en$ $o #lean $&e

ae#$ed area /%$& /arm /a$er

-efore a))l%#a$%on



108/156

Classi1catio!s


An$%re$ro%ralsNu#leos%de%n&%-%$orsD%danos%ne%doud%ne

No!!cleosi%ere'erseTra!scriptasei!hi6itorsDela%rd%neNe%ra)%ne

Proteasei!hi6itorsInd%na%rr%$ona%r

Su))ress syn$&es%s of %raldeo>yr%s-onu#le%# a#%dreerse $rans#r%)$ase51rs$ dru( used a(a%ns$&uman %mmunode1#%en#y%rus 3HI?5 %nfe#$%onrema%ns a ma%ns$ay of

$rea$men$Cause d%re#$ %n&%-%$%on ofHI? -y -%nd%n( $o a#$%e#en$er of reerse$rans#r%)$ase

B%nd $o $&e a#$%e s%$e ofHI? )ro$ease, $&ere-y)reen$%n( $&e en0ymeform #lea%n( HI?)oly)ro$%ens $&e %rusrema%ns %mma$ure andnon%nfe#$%ous /&en used

%n #om-%na$%on /%$&

T&e #l%en$ mus$ ad&ere#losely $o $&e )res#r%-eddos%n( s#&edule All med%#a$%ons are oral.E>#e)$ I? 0%doud%ne /&%#&mus$ -e adm%n%s$ered slo/ly

Ins$ru#$ $&e #l%en$ $o $a4e $&emed%#a$%on ' &our -efore oraf$er food or an$a#%ds Inform $&e #l%en$ $o no$%fy &%s&eal$& #are )ro%der %f a ras&o##ur

Ins$ru#$ $&e #l%en$ $o follo/)ro)er %ns$ru#$%ons /&en$a4%n( $&e med%#a$%on, somemus$ -e $a4en on an em)$ys$oma#&, and o$&ers mus$ -e$a4en /%$& food

Inform $&e #l%en$ $&a$ all



109/156

Classi1catio!s


Bron#&od%la$ors 3>an$&%neder%a$%es5$&eo)&yll%ne

Rela> -ron#&%alsmoo$& mus#le

Mon%$or serum leel of $&eo)&yll%ne

3$&era)eu$%# leel, ' $o + u(ml5

Pro%de $&e med%#a$%on a$ re(ular

%n$erals, -efore meals, and /%$& a full

(lass of /a$er

Ins$ru#$ $&e #l%en$ $o no$%fy &%s &eal$&

#are )ro%der of %rr%$a-%l%$y, res$lessness,

&eada#&e, %nsomn%a, d%00%ness,

$a#&y#ard%a, )al)%$a$%ons, or se%0ures

Do no$ #rus& sus$a%ned release

med%#a$%on

Cor$%#os$ero%dsIn&aled7%mum da%ly dose of 6 s)raysnos$r%l

Ins$ru#$ $&e #l%en$ $o r%nse &%s mou$&

af$er ea#& use $o )reen$ nasal#and%d%as%s

Ins$ru#$ $&e #l%en$ $o $a4e $&e

med%#a$%on e>a#$ly as d%re#$ed and $o

$a)er %$ ra$&er $&an s$o) %$ a-ru)$ly,

/&%#& #ould #ause ser%ous /%$&dra/al

sym)$oms lead%n( $o adrenal

%nsu#%en#y, s&o#4, and dea$&



110/156

Classi1catio!s I!%icatio!s Selecte%I!ter'e!tio!s

C!Q7+ %n&%-%$orsCele#o>%-rofe#o>%d

In&%-%$ $&eforma$%on ofsu-s$an#es $&a$#an #ause *o%n$ and#onne#$%e $%ssue)ro-lems

Ins$ru#$ #l%en$ $o$a4e med%#a$%on %n$&e een%n(/%$&ou$ food E>)la%n $&a$ $&emed%#a$%on %s no$for a#u$e as$&maa$$a#4s

Leu4o$r%enere#e)$or an$a(on%s$mon$elu4as$

Redu#e%n


111/156


Mas$ #ell %n&%-%$orCromolyn sod%um

In&%-%$ mas$ #ell,$&ere-y releas%n(#&em%#al med%a$ors$&a$ resul$ %n-ron#&od%la$%on and ade#rease %n a%r/ay%n&ale #om)le$ely,)la#e $&e mou$&)%e#e -e$/een $&e

l%)s, %n&ale dee)ly,&old $&e -rea$& for 'se#onds, and $&ene>&ale Tell $&e #l%en$ $&a$an %n&aler %s used

)ro)&yla#$%#ally-efore e>er#%se, no$%n a#u$e as$&maa$$a#4



112/156


Nono)%od anal(es%#sNons$ero%dalAn$%7%n


113/156


114/156


115/156


116/156


117/156


118/156


119/156


120/156


121/156


122/156


123/156


124/156


125/156


126/156


127/156


128/156


129/156


130/156


131/156


132/156


133/156


134/156


135/156


136/156


137/156


138/156


139/156


140/156


141/156


142/156


143/156


144/156


145/156


146/156


147/156


148/156


149/156


150/156


151/156


152/156


153/156


154/156


155/156


156/156

IMMUNOLOGIC DISORDERS.pptx

Documents

Transcript of IMMUNOLOGIC DISORDERS.pptx