Download Autoimmune disorders

February 2013 Vol. 11, No. 2
Autoimmune disorders
The term “autoimmune disorder” may describe any one
of over 80 disorders that occur when the body ­produces an
abnormal immune response in which the immune ­system
attacks its own cells, tissues, and/or organs, ­leading to the
development of disorders within the body.
Autoimmune disorders vary greatly in severity and
symptoms, depending on what part of the body is ­targeted.
Therefore, these conditions create unique challenges for
CNAs. ­Residents may not be admitted to a facility specifically because of an ­autoimmune disorder, but the disorder
may call for attention nonetheless.
In this lesson, you will learn the basic ­functions of
the immune system and the autoimmune ­response,
as well as contributing factors and ­common symptoms of autoimmune disorders. We will also cover the
differences between localized autoimmune disorders and systemic autoimmune disorders, with a
closer look at conditions including multiple sclerosis,
Crohn’s disease, rheumatoid ­arthritis, and systemic
lupus erythematosus.
Have a good day of training, and stay tuned for next
month’s issue of CNA Training Advisor on food
­allergies and intolerances.
Program Prep
Program time
Approximately 30 minutes
Learning objectives
Participants in this activity will learn:
➤➤ How to define autoimmune disorders
➤➤ How to identify the common symptoms of autoimmune
disorders
➤➤ How to provide effective care to residents based on specific
autoimmune disorders
Preparation
➤➤ Review the material on pp. 2–4
➤➤ Duplicate the CNA Professor insert for participants
➤➤ Gather equipment for participants (e.g., an attendance sheet,
pencils, etc.)
Method
1. Place a copy of CNA Professor and a pencil at each
­participant’s seat
2. Conduct the questionnaire as a pretest or, if participants’
reading skills are limited, as an oral posttest
3. Present the program material
4. Review the questionnaire
5. Discuss the answers
Your shortcut to compliant
documentation
A focus on pain management
The Long-Term Care Clinical Assessment and Docu-
Regardless of the autoimmune disorders residents may face, the
mentation Cheat Sheets is the ultimate blueprint
symptoms may cause pain, discomfort, and/or embarrassment
for how to provide resident-centered care. This
for the residents. As a group, brainstorm ways that your staff
electronic-only resource provides nurses with a
can ­maintain a special focus on these residents to help ease their
­thorough list of what to check and what to docu-
pain and discomfort. Are these tactics you can implement for all
ment during every shift, based on the specific circumstances of
residents?
a ­given resident. Best of all, the new electronic format of this
content ­enables long-term care clinicians to easily search for the
condition they need to treat and access the appropriate checklist
Quiz answer key
within seconds.
1. a
3. d
5. a
7. a
9. b
2. c
4. b
6. c
8. d
10. d
For more information or to order, call 800-650-6787 or visit
www.hcmarketplace.com/prod-9750.
CNA Training Advisor Page 2
February 2013
autoimmune disorders
Autoimmune disorders are a group of over 80 disorders that
­occur when the body produces an abnormal immune response,
Autoimmune disorders
An essential function of the immune system is its ability to differ-
leading antibodies to attack the body’s own cells, tissues, and/or or-
entiate between the molecules that make up the body (“self”) and
gans. This response will lead to the ­development of disorders within
foreign molecules (“nonself”). Self molecules contain ­markers that indi-
the body.
cate to antibodies that they are safe, and these molecules normally coexist peacefully with antibodies.
The immune system
However, in an autoimmune reaction, the immune response mal-
To understand autoimmune disorders, you must first understand
functions, and antibodies attach to the self molecules by mistake, sig-
how the immune system works. The immune system, also called the
naling the body to attack them. The damage to the body as a result of
lymphatic system, is the network of cells, tissues, and organs that
these ­attacks leads to an autoimmune disorder.
­defend the body from infection and disease. This is done in part by
Autoimmune disorders can affect almost any part of the body, but
production of white blood cells or leukocytes. This system includes the
commonly affected areas include the following:
bone marrow, spleen, tonsils, thymus, lymph nodes, and lymphatic
➤➤ Heart
vessels.
➤➤ Brain
The immune system can be viewed as having two parts:
➤➤ Inborn immune system. Also known as the innate immune
➤➤ Nerves
➤➤ Muscles
­system, this part of the system creates the initial immune response
➤➤ Skin
that alerts the body to danger when it senses the presence of a
➤➤ Eyes
­foreign body or antigen.
➤➤ Joints
➤➤ Adaptive immune system. Also known as the acquired immune
➤➤ Lungs
system, this system develops as a person ages. As the body comes
➤➤ Kidneys
in contact with different invaders, it remembers them in an effort
➤➤ Glands
to combat them better if they return.
➤➤ The digestive tract
➤➤ Blood vessels
When the immune system is working properly, the presence of an
antigen prompts the body to produce antibodies and specific types of
Autoimmune disorders are grouped into two main categories:
white blood cells as a defense measure. These antibodies attach to the
­localized autoimmune disorders and systemic autoimmune disorders.
­antigen in an effort to destroy it.
The classic sign of an autoimmune disorder is inflammation,
which can cause redness, heat, pain, and swelling. However, how an
Relocating? Taking a new job?
If you’re relocating or taking a new job
­autoimmune disorder affects a person depends on what part of the
body is targeted.
Although various autoimmune disorders can produce ­vastly
and would like to continue receiving CNA
different ­symptoms, a common thread is that the body reacts
Training Advisor, you are eligible for a free
­differently than it does with normal diseases and disorders. In nor-
trial subscription. Contact customer serv­ice with
mal ­disorders, the body is reacting to an outside influence that
your moving information at 800-650-6787.
­initiates the ­disorder. In autoimmune disorders, the body is ­reacting
to ­something within the body itself, with no outside ­influences. The
Editorial Board
Project Director: Elizabeth Petersen
Editor:
© 2013 HCPro, Inc.
Casey Pickering
[email protected]
CNA Training Advisor (ISSN: 1545-7028 [print]; 1937-7487 [online]) is published monthly by HCPro, Inc.,
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CNA Training Advisor February 2013
Page 3
autoimmune disorders
cause for this reaction is ­unknown; however, it is suggested that
­Physical and occupational therapy may also help. The most com-
certain factors may contribute to the development of autoimmune
mon ­symptoms of MS include:
disorders. These factors may include:
–– Numbness of the face, extremities, or other body parts.
➤➤ External stressors. While outside influences, such as viruses,
–– Dizziness.
are not the cause of an autoimmune attack, these stressors may
–– Bladder problems or dysfunctions.
cause the autoimmune disorder to develop faster than it normally
–– Mobility problems, including extremity weakness, spasticity,
would. For example, if a person with an underlying autoimmune
­disorder develops a strep throat infection, that infection may set off
the ­disorder and the patient may begin showing symptoms of the
­balance problems, and decreased sensation.
–– Visual problems, including optic neuritis, uncontrolled eye
­movement, and double vision.
–– Speech problems, including slurring of words.
­disorder faster.
➤➤ Specific genes. Research shows that some people may be born
–– Difficulty swallowing (dysphagia), which can occur at any time
with a specific gene that may cause certain autoimmune disorders,
but more frequently occurs in advanced MS. MS residents
such as lupus.
who have speech disorders are more likely to have difficulty
➤➤ Sex. The sex of the patient may also influence the development of
autoimmune disorders. According to the Centers for Disease Control and Prevention, approximately 77.8% of those with autoimmune disorders are female.
swallowing.
–– Cognitive disorders, including decreased ability to reason, concentrate, or remember. About half of all MS residents will develop some cognitive disorders.
➤➤ Crohn’s disease is a condition of chronic inflammation in the
Localized autoimmune disorders
­gastrointestinal (GI) tract. Crohn’s may impact any location of
Disorders that fall into this group are those where only a single or-
the GI tract, but it frequently affects the end of the small ­bowel
gan or tissue is directly damaged by the ­autoimmune ­response. While
and the beginning of the large bowel. All layers of the intestine
only specific areas of the body may be directly ­impacted by these disor-
may be involved, and there can be normal healthy bowel be-
ders, damage may spread to other areas of the body indirectly. The fol-
tween patches of diseased bowel. Treatment may include medi-
lowing are some examples of localized ­autoimmune ­disorders residents
cation, ­nutritional supplements, and/or surgery. Symptoms of
may face:
this ­condition include:
➤➤ Multiple sclerosis (MS) is a disorder that affects the central
–– Persistent diarrhea (loose, watery, or frequent bowel
­nervous system. According to the National Institutes of Health, it
movements)
is thought that 250,000–350,000 people in the United States have
–– Cramping abdominal pain
been diagnosed with the disorder—accounting for 118,000 hos-
–– Fever
pitalizations per year. MS symptoms are not predictable and ­often
–– Rectal bleeding
reduce the resident’s ability to perform ADLs. The symptoms of
MS are caused by damage to the myelin sheath, which protects
–– Loss of appetite and weight loss
➤➤ Graves’ disease is the most common cause of ­hyperthyroidism,
the nerve ­fibers and allows them to conduct electrical impulses to
or overactive thyroid. It is caused by an abnormal immune
and from the brain for feeling and movement. The damaged ar-
­system ­response that causes the thyroid gland to produce too
eas, known as plaques or lesions, prevent normal ­transmissions of
much ­thyroid hormone. There are three treatment options for
nerve impulses. There is no cure for MS, but medicines may slow
this ­condition: radioiodine therapy, medication, and thyroid sur-
the progression of the disorder and help control its symptoms.
gery. Symptoms of this condition may include:
Questions? Comments? Ideas?
Contact Editor
Casey Pickering
Email [email protected]
Phone 781-639-1872, Ext. 3911
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CNA Training Advisor Page 4
February 2013
autoimmune disorders
–– Anxiety and difficulty concentrating
exercise, education, and possibly surgery. Symptoms of this condi-
–– Double vision
tion include:
–– Eyeballs that stick out (exophthalmos)
–– Pain or stiffness of joints, particularly in the morning or after
–– Fatigue or muscle weakness
–– Frequent bowel movements
–– Increased appetite
­periods of rest
–– Swelling and redness around joints (usually the same joints on
both sides of the body)
–– Nodules or bumps under the skin
–– Insomnia
–– Irregular heartbeat
–– Shortness of breath with activity
➤➤ Raynaud’s phenomenon is a disorder that affects blood ves-
➤➤ Systemic lupus erythematosus (SLE) is the most common
form of lupus—the Lupus Foundation of America estimates that
1.5 ­million Americans have a form of lupus, and SLE ­accounts for
sels, mostly in the fingers and toes. It causes the blood vessels
approximately 70% of all cases. There is no cure for the condi-
to narrow when a person is cold or experiencing stress. The
tion, but medication and some lifestyle changes can help control
body saves heat when it is cold by slowing the supply of blood
flare-ups. Lupus has many symptoms. Some common ones are:
to the skin; it does this by making blood vessels narrower. During
–– Joint pain or swelling
an attack, the fingers and toes can change colors—from white
–– Muscle pain
to blue to red. They may also feel cold and numb. As the attack
–– Fever with no known cause
ends and the cold parts of the body warm up, the fingers or toes
–– Red rashes, often on the face (known as the butterfly rash)
can throb and tingle as normal blood flow gradually returns.
There is no cure for this condition, but lifestyle changes to protect the body from the cold or to reduce stress may help limit or
avoid attacks.
The CNA’s role
While the role of the CNA will vary depending on the type and severity of the ­disorder a resident is experiencing, a CNA’s duties may
include:
Systemic autoimmune disorders
Disorders that fall into this group are those that damage many or-
➤➤ Assisting with personal cares. Provide assistance based on the
resident’s assignment sheet. Allow the resident to assist as much as
gans or entire systems within the body. The following are some exam-
possible, and notify the supervisor if the resident appears to need
ples of systemic autoimmune disorders residents may face:
additional help.
➤➤ Rheumatoid arthritis (RA) is an inflammatory ­disorder which
➤➤ Assisting with exercises. Follow the assignment or therapy
affects multiple joints of the body. The ­inflammatory process pri-
­instruction sheet carefully. Time the exercises so that the resident
marily affects the lining of the joints (synovial membrane), but can
is not overly tired. Do not force range of motion in joints that are
also affect other organs. The inflamed synovium leads to erosions
spastic. Move the joints slowly and in a relaxed manner.
of the cartilage and bone and sometimes joint ­deformity. RA usually
➤➤ Assisting with ambulation and transfers. Encourage the use
requires lifelong treatment, including medication, physical therapy,
of assistive devices, and be aware of any visual symptoms or balance
problems that might interfere with ambulation.
Need guidance on advanced
restorative skills?
➤➤ Learning resident-specific communication. Do not ask several
questions in rapid succession; provide sufficient time for the resident
to answer questions. If the resident’s speech is slurred, do not assume that you understand what he or she has said.
In The Long-Term Care Nursing Assistant’s Guide to Advanced
➤➤ Promoting lifestyle changes. Remind the resident of specific
Restorative Skills is written specifically for RNAs or nursing assis-
­activities to engage in or avoid in regard to his or her condition, and
tants to help them provide quality restorative care. Author Bar-
give the resident the resources and education to follow though with
bara Acello, MS, RN, offers detailed nursing procedures that do
not fall under therapy treatment and must be provided by your
nursing staff.
any requested changes.
➤➤ Observation and reporting. It is important for CNAs to keep an
eye out for any new signs and symptoms of a resident’s disorder and,
if any are observed, to report them to the supervisor.
For more information, visit www.hcmarketplace.com/prod8344/The-LongTerm-Care-Nursing-Assistants-Guide-to-AdvancedRestorative-Skills.html.
Find ways to allow residents affected by autoimmune disorders to live
as independently and pain-free as they can during periods of relapse.
­Design care and activities to prevent further decline. n
© 2013 HCPro, Inc.
For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at www.copyright.com or 978-750-8400.
February 2013 Vol. 11, No. 2
AutoImmune disorders
Mark the correct response.
Name:
1.
Date:
In an autoimmune reaction, the immune system will
produce _________ that attack its own cells, tissues,
and/or organs.
6.
Multiple sclerosis is a disorder that affects the
_________ system.
a. respiratory
a. antibodies
b. skeletal
b. autoantibodies
c. central nervous
c. antigens
d. digestive
d. viruses
7.
2.
The immune system is also called the _________ system.
Females are more likely than males to develop an
­autoimmune disorder.
a. lymph node
a. True
b. leukocytic
b. False
c. lymphatic
d. defense
3.
8.
Which autoimmune disorder causes the blood vessels
to narrow when a person feels cold or experiences
stress?
An essential function of the immune system is its
­ability to differentiate between _________.
a. Crohn’s disease
a. autoantibodies and antibodies
b. Rheumatoid arthritis
b. antigens and white blood cells
c. Systemic lupus erythematosus
c. tissues and organs
d. Raynaud’s phenomenon
d. self and nonself
9.
4.
5.
The red facial rash characteristic of systemic lupus
­erythematosus is known as what?
The adaptive immune system creates the initial
immune response that alerts the body to danger when
it senses the presence of a foreign body or antigen.
b. Butterfly rash
a. True
c. Fire rash
b. False
d. Acne
_________ autoimmune disorders are characterized
as those where only a single organ or tissue is directly
damaged by the autoimmune response.
a. Localized
b. Systemic
c. Inborn
d. Adaptive
a. Spider rash
10. Which of the following is a symptom of Grave’s
­disease?
a. Eyeballs that stick out (exophthalmos)
b. Fatigue or muscle weakness
c. Increased appetite
d. All of the above
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