Chapter 33 med-surge
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What is SLE?
Systemic Lupus Erythematosus (SLE)--an autoimmune disease in which the immune system losesits ability to recognize itself and mounts an immune response against its ownproteins.
How is SLE diagnosed?
- no one test confirms SLE, rather dx is based ona constellation of symptoms the pt is experiencing. Sx come and go.
Signs and Symptoms a SLE pt may present with
- Fatigue, malaise, fever, anorexia, nausea, and weight loss
- Characteristic rash (butterfly-shaped across the bridge of nose and cheeks, can extend to neck, arms, and upper trunk)
- Photosensitivity with exposure to sunlight
- Muscle pain and/or joint pain. Joints often swollen, stiff, tender, pain at movement.
- Inflammation of the heart, lungs, and kidneys resulting in organ failure
- Sudden-onset blindness caused by inflammation of the retina
What to TEACH pt’s about SLE
- (No cure for SLE. The goal is quality of life)
- Know the names, dosages, schedule, and side effects of your medications.
- Avoid prolonged exposure to the sun and use sunscreen SPF 15 or higher
- Encourage pt’s to ask questions and talk about their feelings - this helps in coping with a chronic illness.
- Additional information is available from the Lupus Foundation of America
what the normal Neutro-phil count should
Neutro-phils fight bacterial infections andare the most numerous of the WBC (approx 60%)- bone marrow capable of producinghuge numbers of neutro-phils.
what an increase or a decrease of neutro-phils wouldmean
Increased count (or shift to the left) means that the bone marrow has been stimulated to produce more neutro-phils to fight an infection Decreased count (or shift to the right) indicates that only a small percentage of WBC’s are neutro-phils. This could be due to two issues: either the body is overwhelmed with an infection, exhausting the supply of neutro-phils or the bone marrow isn’t producing enough neuts
nursing interventions that we may need to incorporate as a priority on an immune deficient pt.
- Private room
- Visitors must washhands before entering room
- Vitals q2-4h
- minimise invasive prosedures
- cough deep breath q4h
- no raw foods
- minimise time in common areas by coordinating scan/test times
- Pt weasr a mask while outside of room
- Pt should not handle plants
- no standing water humidifiers
Active vs. passive immunuty
- acquired immunity occurs when a person synthesizes his or her own antibodies in Active response to a pathogen. A person is exhibiting active immunity when he or she manufactures antibodies in response to an infection or vaccination. Active acquired immunity is permanent.
- Passive acquired immunity occurs when and antibody produced by one person or animal is transferred to another person. An example of this is antibodies passed in breast milk to a baby or gamma globulin given to a person exposed to hepatitis. Passive immunity lasts only 1 to 2 months after the antibodies have been received.
marrow biopsy and what it is used for
If blood tests show abnormalities, the MD may performan bone marrow biopsy to see how well the blood cells are being made in thebone marrow
types of bone marrow transplants
- Allogenic bone marrow transplant: high doses of chemo and radiation therapy given to destroy all the cancerous bone marrow. Then bone marrow from a matched donor (usually a sibling) is infused. This type of transplant has been done the longest amount of time but for many isn’t possible to find a donor match
- Autologous bone marrow transplant: pt’s own bone marrow is harvested before chemo
- and radiation therapy. After therapy, pt’s bone marrow is returned. This type is best for pt’s with solid tumors that have not metastasized to the bone marrow - pt’s with lymphoma. Not usually an option for leukemia pt’s or pt’s that their cancer has metastasized to the bone marrow.
- Peripheral blood stem cell transplant: colony-stimulating factors are administered to the pt to stimulate the bone marrow to produce large numbers of WBCs. Then apheresis is performed to collect the pt’s peripheral stem cells. The WBC stem cells are removed and stored. When enough WBC stem cells have been stored (other WBCs, RBCs, plasma is returned), the pt is treated with chemo. When therapy is complete, the peripheral blood stem cells are returned to pt. These stem cells reengraft more quickly than bone marrow, reducing the risk of infection. This treatment has been so successful, it is quickly becoming the most common type of transplant.
what autoimmune disorders are
Autoimmune disorders happen when the immune system inappropriatelyidentifies its own proteins as foreign and mounts a response to destroythese self-proteins
- Idiopathic thrombocytopenic purpura (ITP)
- Thrombotic thrombocytopenic purpura (TTP)
- Acute rheumatic fever
- Type 1 diabetes mellitus
- Systemic lupus erythematosus (SLE)
- Rheumatoid arthritis
- Multiple sclerosis
- Graves disease
- Hashimoto thyroditis
B lymphocytes (B cells) manufacture antigen-bindingproteins called Ig’s on their cell membrane. When the B cell Igbinds with a particular antigen, the B cell is stimulated to produce plasmacells and memory B cells. Plasma cells are antibody factories (producelots of Ig) and Memory B cells “hibernate”until needed
· Immunoglobulin is IgE. It signals basophils to release histamine, which increases the blood flow to the site of infection, quickly bringing WBCs to the site.
Function of Bone Marrow
Function of Thymous
WBC's migrate to the Thymus and mature into T-cells.
function of Lymph, Lymphatics, and Lymph Nodes
collects plasma left behind intissues and returns it to the venous system
function of liver
Liver: filters microorganisms from the blood so that macrophages can destroy them
function of the spleen
Spleen: filters microorganisms from the blood and WBC’s that reside in the spleen destroy them. The spleen may need to be removed: trauma from MVC or pt’s with Hodgkin disease, a form of cancer in the lymph nodes. Anyone without a spleen is at increased risk for pneumococcal infections.
lymphoid tissue found where the small intestinetransitions into the large intestine. Macrophages and both B and T cellsare found in this tissue- attack microorganisms that attempt to enter thebloodstream
- A spleen scan is used to evaluate the size andfunction of the spleen
- A radioactive dye is injected into a vein. The amountof dye taken up by the spleen is measured by a machine 20-60 minutes afterthe dye is injected.
- Pt preparation: explain purpose and procedure. Ask pt about any allergies to contrast media (dye). No fasting is necessary. An I.V. is put in place to inject the dye but can be taken out after the injection. Procedure takes approx. 60 minutes.
signs and symptoms of TTP
- TTP - thrombotic thrombocytopenia purpura
- TTP is an exaggerated immunologic response to vessel injury that results in extensive clot formation and decrease blood flow to the site. Pt’s become critically ill developing:
- Thrombocytopenia (a low platelet count)
- Hemolytic Anemia
- Renal impairment
- Neurologic symptoms
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