Autoimmune Disorders :Autoimmune Disorders By:
Maria Hazel T. Organo, RN
MYASTHENIA GRAVIS :MYASTHENIA GRAVIS Produces sporadic, progressive weakness and abnormal fatigue of voluntary skeletal muscles
These effects are exacerbated by exercise & repeated mov’t
Usually affects muscles of the face, lips, tongue, neck, throat – all innervated by CN
Weakness is usually irreversible
Age of onset: women (20-30), men (70-80)
Cause: UK
MYASTHENIA GRAVIS :MYASTHENIA GRAVIS S/S:
Extreme muscle weakness
Fatigue
Ptosis
Diplopia
Difficulty chewing & swallowing
Sleepy, masklike expression
Drooping jaw
Bobbing head
Arm or hand weakness
MYASTHENIA GRAVIS :MYASTHENIA GRAVIS Diagnostics:
Tensilon Test
Electromyography
Nerve conduction
Chest X-ray or CTscan
MYASTHENIA GRAVIS :MYASTHENIA GRAVIS Normally:
Motor nerve impulse travels to a motor nerve terminal
Releases acethylcholine PROBLEM
ACT diffuses across the synapse
Receptor sites in the motor & plate reacts
Depolarization of muscle fibers
Muscular contraction
MYASTHENIA GRAVIS :MYASTHENIA GRAVIS PROBLEM:
Antibodies attach to ACT
Block, dsetroy, weaken the receptor sites
Insensitive to ACT
No neuromuscular transmission
MYASTHENIA GRAVIS :MYASTHENIA GRAVIS Treatment:
Anticholinesterase drug – Neostigmine & pyridostigmine
Corticosteroids
Plasmaparesis
thymomectomy
Endotracheal intubation & mechanical ventilation
GUILLAIN BARRE SYNDROME :GUILLAIN BARRE SYNDROME Acute, rapidly progressive, potentially fatal syndrome
Associated with segmented demyelination of peripheral nerves
Also called acute demyelinating polyneuropathy
Occurs usually in both sexes, at ages between 30-50
Cause: UK – cell mediated, immunologic attack on peripheral nerves in response to a virus
Risk factors: surgery, rabies or influenza, viral illness, malignant diseases
GUILLAIN BARRE SYNDROME :GUILLAIN BARRE SYNDROME Three Phases:
acute phase
plateau phase
recovery phase
GUILLAIN BARRE SYNDROME :GUILLAIN BARRE SYNDROME S/S
Tingling & numbness
Muscle weakness, immobility & paralysis
Muscle stiffness, pain, sensory loss, loss of position sense, diminished or absent DTR
Symptom follow a ascending pattern
GUILLAIN BARRE SYNDROME :GUILLAIN BARRE SYNDROME Diagnostics:
CSF Analysis
Electromyography Electrophysiologic testing
GUILLAIN BARRE SYNDROME :GUILLAIN BARRE SYNDROME Treatment:
Supportive and may require Endotracheal intubation or tracheostomy
Atrophine – for bradycardia
Mechanical ventilation – if with respiratory difficulty
High dose of IV immune globulin & plasmaparesis
GUILLAIN BARRE SYNDROME :GUILLAIN BARRE SYNDROME UK CAUSE
Possible: surgery, influenza, viral illness, malignant illnesses
Immunologic reaction
Segemental demyelination of the peripheral nerves
Prevents N transmission of electrical impulses
Along the semsorimotor nerve roots, myelin sheath degenerates for UK cause
GUILLAIN BARRE SYNDROME :GUILLAIN BARRE SYNDROME Inflammation, swelling, patchy demyelination
Myelin sheath destroyed
Nodes of Ranvier widens
Delays & impairs impulse transmission
Dorsal nerve root ventral nerve root
Affects sensory fxn
Tingling/numbness muscle weakness, immobility, paralysis
SJOGREN’S SYNDROME :SJOGREN’S SYNDROME Autoimmune rheumatic disorder
Cause: UK – genetic & environmental factors
S/S
Dry mouth
Dry eyes
swollen salivary glands
dental cavities
dry nose, throat & lungs
dryness of the vagina
Fatigue
SJOGREN’S SYNDROME :SJOGREN’S SYNDROME Diagnostics:
Blood tests
Schirmer
Slit-lamp examinations
Lip biopsy
Salivary fxn test
Urine test
Chest xray
SJOGREN’S SYNDROME :SJOGREN’S SYNDROME Treatment
for dry mouth :
sip fluids throughout the day, use sugar free gum or candies to stimulate saliva prod’n,
to prevent dental cavities:
Have frequent dental check ups, use mouth rinses that contain fluoride, brush and floss your teeth regularly, use sugar free products
SJOGREN’S SYNDROME :SJOGREN’S SYNDROME for dry eyes
use artificial tears or eye drops, try lubricating ointments or small long acting pellets for overnight or long lasting relief, your ophthalmologist may recommend a simple operation that blocks tear drainage from your eyes
for dry skin
use moisturizing lotions for sensitive skin, avoid drafts fr air conditioners, heaters, radiators when possible, use a humidifier in your house and at work
SJOGREN’S SYNDROME :SJOGREN’S SYNDROME for vaginal dryness
use lubricants made specifically to help vaginal dryness. Do not use petroleum jelly
MEDS: aspirin & NSAIDs
SJOGREN’S SYNDROME :SJOGREN’S SYNDROME Autoimmune
Lymphycytic infiltration of exocrien glands
Tissue damage
dryness
Lupus erythematosus :Lupus erythematosus Chonic, inflammatory, autoimmune disoredr affecting the connective tissues
Two forms:
Discoid – only the skin
Causes superficial lesions – cheeks & bridge of nose- leaves scars after healing
Systemic – multiple organs & fatal
Recurrent remissions & exacerbations
Lupus erythematosus :Lupus erythematosus Risk: hormonal, genetic & viral factors
Treatment: No cure but the prognosis improve swith early detection & treatment
Prognosis is poor for patients who develop cardiovascular, reanl or neurologic complications or severe bacterial infections
Lupus erythematosus :Lupus erythematosus S/S:
Acute or insiduous onset
Fever,Anorexia,Weight loss,Malaise, Fatigue, Addm’l pain
n/v, Diarrhea, constipation, rashes & polyarthralgia (multiple joint pain)
Blood disorders: anemia, leukopenia, thrombocytopenia, elevated ESR (due to circulating antibodies)
Women: irregular menstruation or amenorrhea ( during exacerbations)
Skin eruption: rash of areas exposed to light (red areas to disc-shaped plaque)
Lupus erythematosus :Lupus erythematosus Butterfly rash – occurs in 50 %
Patchy alopecia
Cardio: chest pain (pleuritis), dyspnea(parenchymal infiltrates & pneumonitis), tachycardia, central cyanosis, hypotension (pulmo embolism)
Neuro: seizure, confusion, amotional lability, psychosis, h/a, irritability, stroke, depression
GU: infrequent urination (renal failure), painful urination, bladder spasms, UTIs
Lupus erythematosus :Lupus erythematosus Diagnostics:
CBC with differential count – reduced WBC, anemia
Serum electrophoresis – hypergammaglobulinemia
Other blood test: dec platelets, elev ESR, leukopenia, thrombocytopenia, anemia
CXR – plurisy or lupus pneumonitis
Antinuclear antibodies are elevated
Lupus erythematosus :Lupus erythematosus Autoimmunity
(prod’n of antibodies against its own cells)
Antigen-antibody complex
Suppression of the body’s normal immunity
Damage of tissue components (RBC, neutrophils, platelets, lymphocytes)
Organ failure
Lupus erythematosus :Lupus erythematosus Treatment
Drugs: mainstay
Ibuprofen – NSAIDs
Skin lesions require sun protection, topical cortocosteroid creams
Fluorinated steroids – control discoid lupus
Antimalarials – for stubborn lesions
Corticosteroids: DOC
Methotrexate – controlling the dse
Don’t screw up the best thing that ever happened to you just because :Don’t screw up the best thing that ever happened to you just because You’re a little unsure about who you are…