IMMUNOLOGIC
DISORDERS
NCM 112
PREPARED BY:
Mary Vhinne Anne V. Colandog, RN
LEARNING OBJECTIVES:
At the end of the lesson, the students would be able to:
• Identify different immunologic disorders according
to their signs and symptoms
• Identify proper nursing management for clients
with immunologic disorders.
• Determine diagnostic tests used in each disorder.
DISORDERS TO BE DISCUSSED
Diabetes Mellitus (Type 1)
Multiple Sclerosis
Hypersensitivity
Rheumatoid Arthritis
Transplant Rejection
PANCREAS
Pancreatic islets
• Alpha cells – glucagon
• Beta cells – insulin
• Delta cells – somatostatin
GLUCOSE TRANSPORT GLYCOGEN
2 HOURS
Excess glucose
G G
G G G Hypoglycemia GLUCAGON
G (Glycogenolysis)
G G G G
G G
G G G G G G G
GLUCOSE
Normal: 80-120 mg/dl
DIABETES MELLITUS
• A metabolic disease
characterized by increased
levels of glucose in the blood.
• It is characterized by the
destruction of the pancreatic
beta cells.
RISK FACTORS: Family history, Obesity, Race,
Age, Hypertension, Cholesterol levels, GDM
CLASSIFICATION
Type 1 DM Type 2 DM
• Young onset • Late onset
• Thin at diagnosis • Obese at diagnosis
• Genetic • Obesity, heredity,
• No insulin environmental
• Insulin resistance
Complication:
Diabetic Ketoacidosis Complication:
Hyperglycemic
hyperosmolar syndrome
PATHOPHYSIOLOGY
Glucose does not go into
the cell.
PATHOPHYSIOLOGY FLUID VOLUME EXCESS
Total Dehydration
Intracellular Dehydration POLYDIPSIA ↑ Blood
↑ Heart Rate
Extracellular Dehydration Pressure
↑ GFR
Glycosuria
↑ Glucose ↑ Viscosity ↑ Osmolarity
G G G
G G Osmotic
G
G G G G Diuresis
G G POLYURIA
G G G G G G G
Osmosis:
Movement of water from lower to higher concentration.
PATHOPHYSIOLOGY
PRIMARY COMPENSATION
Cellular Starvation Profound Weakness Hunger
POLYPHAGIA
SC Insulin
X
30 mins to 3h
SEONDARY COMPENSATION
Glucocorticoids
(Gluconeogenesis)
G G G
G G
G
G G G G
G G
G G G G G G G
Protein: Glucose
Fats: Glucose & Ketones
Acidosis
SIGNS AND SYMPTOMS • Fatigue
• Weakness
P Polyuria • Sudden vision
changes
• Numbness, tingling
P Polydipsia • Dry skin, skin
lesions or wounds
that are slow to heal
P Polyphagia • Vaginitis: adolescent
• Abdominal pain
(DKA)
DIAGNOSTIC FINDINGS
• Fasting plasma glucose: NPO (8 hours)
• Random plasma glucose
• 2-hour post-prandial blood sugar: Initial
blood sugar is taken then 400 calories is
given. After 2 hours, blood sugar is taken
again. If the blood sugar is beyond normal,
suspect DM.
• Urine dipstick: To detect ketonuria
• HbA1c: Most accurate indicator for DM.
Glycosylated hemoglobin (HbA1c)
• Reflection of how well blood glucose levels have been
controlled for the past 3 to 4 months.
• Glucose molecules attach to hemoglobin in red blood
cells.
< 5.7% Normal
5.7% to 6.4% Prediabetes
6.5% Diabetes
MEDICAL MANAGEMENT
Diet
• Low caloric, high fiber
• Complex carbohydrates for
suspended release
• Prudent diet: 50% carbohydrates,
20% protein, 30% fats
• Caloric counting
• Caloric substitution
• Inverted pyramid
• Moderate alcohol consumption
MEDICAL MANAGEMENT
Activity
• Calorie burn
• Enhances glucose uptake by the cells
• Decreases insulin requirements
• Done one to two hours post meal
• Extra food needs to be consumed for
increased activity, usually 10 to 15 g of
carbohydrates for every 30 to 45
minutes of activity
MEDICAL MANAGEMENT
Medications
• Insulin and Oral Hypoglycemic Agent
• Illness, infection, and stress increase
the need for insulin, and insulin would
not be withheld. Hyperglycemia and
ketoacidosis can result.
• It is given for life.
• Mode of Delivery: Insulin pen, jet
injector, insulin pump
MEDICAL MANAGEMENT
MEDICAL MANAGEMENT
• Rapid-acting insulin: produces a more rapid effect that is of
shorter duration. Instruct patient to eat no more than 5 to 15
minutes after injection.
• Short-acting insulin: also called regular insulin. It is given 15
minutes before a meal. It can be given IV.
• Intermediate-acting insulin: appears white and cloudy. Instruct
patient to eat some food around onset and peak.
• Long-acting insulin: absorbed very slowly over 24 hours and
given once a day.
COMPLICATIONS OF INSULIN THERAPY
Local Allergic Reaction
• Redness, swelling, tenderness, induration or wheal
Systemic Allergic Reaction
• Generalized urticaria
• Generalized edema or anaphylaxis
Insulin Lipodystrophy
• Localized reaction (lipoatrophy or lipohypertrophy)
• Avoid injecting insulin in these areas
Resistance to Injected Insulin
• May require large insulin doses
COMPLICATIONS OF INSULIN THERAPY
Morning Hyperglycemia
• Dawn phenomenon: nocturnal surges in growth hormone
secretion which creates a greater need for insulin in the early
morning hours in patients with type 1 diabetes.
• Insulin waning: progressive rise in blood glucose from bed to
morning
• Somogyi effect: nocturnal hypoglycemia followed by rebound
hyperglycemia
NURSING MANAGEMENT
• Insulin must be administered subcutaneously. However, in
times of DKA, it must be given IV (regular).
• Rotate injection sites: abdomen, upper arms, thighs, hips.
Administer each injection 0.5 to 1in away from the previous
injection.
• Refrigerate unused insulin.
• Never shake the vials.
Can we mix
insulin?
Oral Hypoglycemic Agents
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
NURSING MANAGEMENT
Foot Care
• Inspect feet daily
• Wash feet with warm water and soap.
• Wear comfortable shoes
• Use white cotton socks
• Break in new pair of shoes
• Avoid going barefooted and trim toenails laterally.
• Apply lotion on feet except on interdigital spaces.
• Exercise or massage feet.
• Consult podiatrist
COLLEGE OF NURSING
Calayan Educational Foundation, Inc.
NURSING MANAGEMENT
COMPLICATIONS
• Hypoglycemia
• DKA
• Increased blood pressure
• Atherosclerosis
• Nephropathy
• Foot ulcers
• Impotence
• Neuropathy
• Retinopathy
Observe for signs of hypoglycemia
G – Gait problems
U – Unusual sweatiness
T – Tachycardia
O – Obvious tremors
M – Moodiness/ irritability
