Adult Health Nursing 2 - Theory Level 6, Academic Year (AY) 1442—1443 H Care of Clients with D isturbances in Immunologic Function Part ( 1) 1 Anatomic and Physiologic Overview ﻧظرة ﻋﺎﻣﺔ ﺗﺷرﯾﺣﯾﺔ وﻓﺳﯾوﻟوﺟﯾﺔ ▶ The immune system is composed of an integrated collection of various cell types, each with a designated function in defending against infection and invasion by other organisms. ﻟﻛل ﻣﻧﮭﺎ وظﯾﻔﺔ ﻣﺣددة ﻓﻲ اﻟدﻓﺎع ﺿد اﻟﻌدوى واﻟﻐزو ﻣن، ﯾﺗﻛون اﻟﺟﮭﺎز اﻟﻣﻧﺎﻋﻲ ﻣن ﻣﺟﻣوﻋﺔ ﻣﺗﻛﺎﻣﻠﺔ ﻣن أﻧواع ﻣﺧﺗﻠﻔﺔ ﻣن اﻟﺧﻼﯾﺎ .ﻗﺑل اﻟﻛﺎﺋﻧﺎت اﻟﺣﯾﺔ اﻷﺧرى ▶ Supporting this system are molecules that are responsible for the interactions, modulations, and regulation of the system. ﯾدﻋم ھذا اﻟﻧظﺎم ﺟزﯾﺋﺎت ﻣﺳؤوﻟﺔ ﻋن اﻟﺗﻔﺎﻋﻼت واﻟﺗﻌدﯾﻼت وﺗﻧظﯾم اﻟﺟﮭﺎز ▶ These molecules and cells participate in specific interactions with immunogenic epitopes (antigenic determinants) present on foreign materials, initiating a series of actions in a host, including the inflammatory response, the lysis of microbial agents, and the disposal of foreign toxins. وﺗﺑدأ ﺳﻠﺳﻠﺔ، ﺗﺷﺎرك ھذه اﻟﺟزﯾﺋﺎت واﻟﺧﻼﯾﺎ ﻓﻲ ﺗﻔﺎﻋﻼت ﻣﺣددة ﻣﻊ اﻟﺣواﺗم اﻟﻣﻧﺎﻋﯾﺔ )ﻣﺣددات اﻟﻣﺳﺗﺿدات( اﻟﻣوﺟودة ﻋﻠﻰ اﻟﻣواد اﻟﻐرﯾﺑﺔ واﻟﺗﺧﻠص ﻣن اﻟﺳﻣوم اﻟﻐرﯾﺑﮫ، وﺗﺣﻠل اﻟﻌواﻣل اﻟﻣﯾﻛروﺑﯾﺔ، ﺑﻣﺎ ﻓﻲ ذﻟك اﻻﺳﺗﺟﺎﺑﺔ اﻻﻟﺗﮭﺎﺑﯾﺔ، ﻣن اﻹﺟراءات ﻓﻲ اﻟﻣﺿﯾف ▶ The major components of the immune system include central and peripheral organs, tissues, and cells (see Fig. 35-1) 35 ﺗﺷﻣل اﻟﻣﻛوﻧﺎت اﻟرﺋﯾﺳﯾﺔ ﻟﺟﮭﺎز اﻟﻣﻧﺎﻋﺔ اﻷﻋﺿﺎء اﻟﻣرﻛزﯾﺔ واﻟﻣﺣﯾطﯾﺔ واﻷﻧﺳﺟﺔ واﻟﺧﻼﯾﺎ )اﻧظر اﻟﺷﻛل The basic function of the immune system is to remove foreign antigens such as viruses and bacteria to maintain homeostasis. ا ﻟ و ظ ﯾ ﻔ ﺔ ا ﻻ ﺳ ﺎ ﺳ ﯾ ﮫ ﻟ ﺟ ﮭ ﺎ ز ا ﻟ ﻣ ﻧ ﺎ ﻋ ﮫ ھ ﻲ ا ز ا ﻟ ﺔ ا ي ا ﺟ ﺳ ﺎ م ﻏ ر ﯾ ﺑﮫ ﻣ ﺛ ل ا ﻟ ﻔ ﯾ ر و ﺳ ﺎ ت و ا ا ﻟ ﺑ ﻛ ﺗ ر ﯾ ﺎ ﻟ ﻠ ﺣ ﻔ ﺎ ظ ﻋ ﻠ ﻲ ﺗ و ا ز ن ا ﻟ ﺑ ﯾ ﺋ ﺔ ا ﻟ د ا ﺧ ﻠ ﯾ ﮫ و ﺛﺑﺎ ﺗﮭ ﺎ ▶ ▶ There are two general types of immunity: natural (innate) and acquired (adaptive). ا ﻟ ﻣ ﻧﺎ ﻋ ﮫ ا ﻟ ط ﺑﯾﻌ ﯾﺔ و ا ﻟ ﻣ ﻧﺎ ﻋ ﮫ ا ﻟ ﻣ ﻛ ﺗﺳ ﺑﺔ: ھ ﻧ ﺎ ك ﻧو ﻋ ﯾن ا ﺳ ﺎ ﺳ ﯾن ﻣ ن ا ﻟ ﻣ ﻧﺎ ﻋ ﮫ ▶ Natural immunity or nonspecific immunity is present at birth. Acquired or specific immunity develops after birth. ا ﻟ ﻣ ﻧ ﺎ ﻋ ﺔ ا ﻟ ط ﺑ ﯾ ﻌ ﯾ ﮫ ا و ا ﻟ ﻣ ﻧ ﺎ ﻋ ﮫ ا ﻟ ﻐ ﯾ ر ﺧ ﺎ ﺻ ﺔ ﺗ و ﺟ د ﻋ ﻧ د ا ﻟ و ﻻ د ة ا ﻧ ﻣ ﺎ ا ﻟ ﻣ ﻧ ﺎ ﻋ ﺔ ا ﻟ ﻣ ﻛ ﺗ ﺳ ﺑ ﺔ ا و ا ﻟ ﻣ ﻧ ﺎ ﻋ ﺔ ا ﻟ ﺧ ﺎ ﺻ ﺔ ﺗ ﺗط و ر ﺑ ﻌ د ا ﻟ و ﻻ د ة ▶ Each type of immunity has a distinct role in defending the body against harmful invaders, but the various components are usually interdependent ﻟ ﻛ ن ا ﻟ ﻣ ﻛ و ﻧ ﺎ ت ا ﻟ ﻣ ﺧ ﺗﻠ ﻔ ﺔ ﻋ ﺎ د ة ﻣ ﺎ ﺗﻛ و ن، ﻟ ﻛ ل ﻧو ع ﻣ ن أ ﻧو ا ع ا ﻟ ﻣ ﻧ ﺎ ﻋ ﺔ د و ر ﻣ ﻣ ﯾز ﻓ ﻲ ا ﻟ د ﻓ ﺎ ع ﻋ ن ا ﻟ ﺟ ﺳ م ﺿ د ا ﻟ ﻐ ز ا ة ا ﻟ ﺿ ﺎ ر ﯾن ﻣ ﺗر ا ﺑط ﺔ ▶ The human immune system is complex and multidimensional. It works to protect against invasion by foreign substances, protect against the proliferation of neoplastic cells, and plays a key role in inflammation and healing. Patients with primary or secondary immune system disorders require care from nurses who are knowledgeable about the pathophysiology, diagnostic procedures, and interventions that are used in the management of these disorders و ﯾﺣ ﻣ ﻲ ﻣ ن ﺗﻛ ﺎ ﺛر، ﯾﻌ ﻣ ل ﻋ ﻠ ﻲ ﺣ ﻣ ﺎ ﯾﺔ ا ﻟ ﺟ ﺳ م ﻣ ن ﻏ ز و ا ﻟ ﻣ و ا د ا ﻟ ﻐ ر ﯾﺑﺔ. ﻧظ ﺎ م ا ﻟ ﻣ ﻧﺎ ﻋ ﺔ ا ﻟ ﺑﺷ ر ي ﻣ ﻌ ﻘ د و ﻣ ﺗﻌ د د ا ﻷ ﺑﻌ ﺎ د ﯾﺣﺗﺎج اﻟﻣرﺿ ﻰ اﻟذﯾن ﯾﻌﺎﻧون ﻣن اﺿ ط راﺑﺎت. وﯾﻠﻌب دوًرا رﺋﯾﺳﯾًﺎ ﻓﻲ اﻻﻟﺗﮭﺎب واﻟﺷﻔﺎء، اﻟﺧﻼﯾﺎ اﻟﺳرط ﺎﻧﯾﺔ أ و ﻟ ﯾﺔ أ و ﺛﺎ ﻧو ﯾﺔ ﻓ ﻲ ا ﻟ ﺟ ﮭ ﺎ ز ا ﻟ ﻣ ﻧﺎ ﻋ ﻲ إ ﻟ ﻰ ر ﻋ ﺎ ﯾﺔ ﻣ ن ﻣ ﻣ ر ﺿ ﺎ ت ﻋ ﻠ ﻰ د ر ا ﯾﺔ ﺑﺎ ﻟ ﻔ ﯾز ﯾو ﻟ و ﺟ ﯾﺎ ا ﻟ ﻣ ر ﺿ ﯾﺔ و إ ﺟ ر ا ء ا ت ا ﻟ ﺗﺷ ﺧ ﯾص و ا ﻟ ﺗد ﺧ ﻼ ت ا ﻟ ﻣ ﺳ ﺗﺧ د ﻣ ﺔ ﻓ ﻲ إ د ا ر ة ھ ذ ه ا ﻻ ﺿ ط ر ا ﺑﺎ ت ▶Human Immunodeficiency Virus (Acute Immunodeficiency Syndrome) ﻓﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﺑﺷرﯾﺔ )ﻣﺗﻼزﻣﺔ ﻧﻘص (اﻟﻣﻧﺎﻋﺔ اﻟﺣﺎد ▶ Anaphylaxis اﻟﺣﺳﺎﺳﯾﮫ اﻟﻣﻔرطﺔ ▶ Atopic Dermatitis اﻻﻟﺗﮭﺎب اﻟﺟﻠدي اﻟﺗﺣﺳﺳﻲ ▶ Rheumatic Disorder اﻻﺿ طراﺑﺎت اﻟروﻣﺎﺗﯾزﻣﯾﺔ ▶ Systemic Lupus Erythematosus اﻟذﺋﺑﺔ اﻟﺣﻣﺎﻣﯾﺔ اﻟﺟﮭﺎزﯾﺔ Human Immunodeficiency Virus (Acute Immunodeficiency Syndrome ﻓﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﺑﺷرﯾﺔ )ﻣﺗﻼزﻣﺔ ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﺣﺎد HIV (human immunodeficiency virus) is a virus that attacks the body's immune system. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). Learning the basics about HIV can keep you healthy and prevent HIV transmission ﻓ ﯾر و س ﻧﻘ ص ا ﻟ ﻣ ﻧﺎ ﻋ ﺔ ا ﻟ ﺑﺷ ر ﯾﺔ ) ﻓ ﯾر و س ﻧﻘ ص ا ﻟ ﻣ ﻧﺎ ﻋ ﺔ ا ﻟ ﺑﺷ ر ﯾﺔ ( ھ و ﻓ ﯾر و س ﯾﮭ ﺎ ﺟ م ﺟ ﮭ ﺎ ز ا ﻟ ﻣ ﻧﺎ ﻋ ﺔ ﻓ ﻲ ا ﻟ ﺟ ﺳ م .إ ذ ا ﻟ م ﯾﺗم ﻋ ﻼ ج ﻓ ﯾر و س ﻧﻘ ص ا ﻟ ﻣ ﻧ ﺎ ﻋ ﺔ ا ﻟ ﺑﺷ ر ﯾﺔ ،ﯾﻣ ﻛ ن أ ن ﯾؤ د ي إ ﻟ ﻰ ا ﻹ ﯾد ز ) ﻣ ﺗﻼ ز ﻣ ﺔ ﻧﻘ ص ا ﻟ ﻣ ﻧ ﺎ ﻋ ﺔ ا ﻟ ﻣ ﻛ ﺗﺳ ب ( .ﺗﻌ ﻠ م أ ﺳ ﺎ ﺳ ﯾﺎ ت ﻓ ﯾر و س ﻧﻘ ص ا ﻟ ﻣ ﻧﺎ ﻋ ﺔ ا ﻟ ﺑﺷ ر ﯾﺔ ﯾﻣ ﻛ ن أ ن ﯾﺣ ﺎ ﻓ ظ ﻋ ﻠ ﻰ ﺻ ﺣ ﺗك و ﯾﻣ ﻧﻊ ا ﻧﺗﻘ ﺎ ل ﻓ ﯾر و س ﻧﻘ ص ا ﻟ ﻣ ﻧﺎ ﻋ ﺔ ا ﻟ ﺑﺷ ر ﯾﺔ ▶ Epidemiology of HIV ?Who can get HIV ﻣ ن ﯾ ﻣ ﻛ ﻧ ﮫ اﻹ ﺻ ﺎ ﺑﺔ ﺑ ﻔ ﯾ ر و س ﻧ ﻘ ص اﻟﻣ ﻧ ﺎ ﻋ ﺔ اﻟﺑﺷ ر ﯾﺔ ؟ Anyone can get HIV if they are exposed to the virus. Through ▶ ﯾ ﻣ ﻛ ن ﻷ ي ﺷ ﺧ ص أ ن ﯾ ﺻ ﺎ ب ﺑﻔ ﯾر و س ﻧﻘ ص ا ﻟ ﻣ ﻧ ﺎ ﻋ ﺔ ا ﻟ ﺑ ﺷ ر ﯾ ﺔ إ ذ ا ﺗ ﻌ ر ض ﻟ ﻠ ﻔ ﯾ ر و س .ﺧ ﻼ ل ؛ ; Have sex with many partners (men or women). ▶ ﻣ ﺎ ر س ا ﻟ ﺟ ﻧس ﻣ ﻊ ا ﻟ ﻌ د ﯾد ﻣ ن ا ﻟ ﺷ ر ﻛ ﺎ ء ) ر ﺟ ﺎ ل أ و ﻧﺳ ﺎ ء ( . Have unsafe sex with an infected person. ▶ ﻣ ﺎ ر ﺳ ﻲ ا ﻟ ﺟ ﻧس ﻏ ﯾر ا ﻵ ﻣ ن ﻣ ﻊ ﺷ ﺧ ص ﻣ ﺻ ﺎ ب Share needles to take drugs or steroids. ▶ ﻣ ﺷ ﺎ ر ﻛ ﺔ ا ﻹ ﺑر ﻓ ﻲ ﺗﻧﺎ و ل ا ﻷ د و ﯾﺔ أ و ا ﻟ ﻣ ﻧﺷ ط ﺎ ت Have unprotected sex for drugs or money. ▶ ﺗﻣ ﺎ ر س ا ﻟ ﺟ ﻧس ﺑد و ن و ﻗ ﺎ ﯾﺔ ﻣ ن أ ﺟ ل ا ﻟ ﻣ ﺧ د ر ا ت أ و ا ﻟ ﻣ ﺎ ل Have another sexually transmitted infection (STI). ﺗﻣ ﺎ ر س ا ﻟ ﺟ ﻧس ﺑد و ن و ﻗ ﺎ ﯾﺔ ﻣ ن أ ﺟ ل ا ﻟ ﻣ ﺧ د ر ا ت أ و ا ﻟ ﻣ ﺎ ل . ▶ ▶ ﺗﻌ ﺎ ﻧﯾن ﻣ ن ﻋ د و ى أ ﺧ ر ى ﺗﻧﺗﻘ ل ﻋ ن STI).ط رﯾق اﻻﺗﺻ ﺎل اﻟﺟﻧﺳﻲ ) اﻋراض ﻓﯾروس ﻧﻘص Symptoms of HIV اﻟﻣﻧﺎﻋﮫ اﻟﻣﻛﺗﺳﺑﺔ Some people have flu-like symptoms within 2 to 4 weeks after infection (called acute HIV infection). ﺗظ ﮭ ر ﻋ ﻠ ﻰ ﺑ ﻌ ض ا ﻷ ﺷ ﺧ ﺎ ص أ ﻋ ر ا ض ﺗﺷ ﺑﮫ أ ﻋ ر ا ض ا ﻷ ﻧ ﻔ ﻠ و ﻧ ز ا ﻓ ﻲ ﻏ ﺿ و ن 2 إ ﻟ ﻰ 4أ ﺳ ﺎ ﺑﯾﻊ ﺑ ﻌ د ا ﻹ ﺻ ﺎ ﺑﺔ ) ﺗﺳ ﻣ ﻰ ﻋ د و ى ﻓ ﯾر و س ﻧﻘ ص ا ﻟ ﻣ ﻧ ﺎ ﻋ ﺔ ا ﻟ ﺑ ﺷ ر ﯾ ﺔ اﻟﺣ ﺎد ة ( . These symptoms may last for a few days or several weeks. Possible symptoms include ﻗ د ﺗﺳ ﺗﻣ ر ھ ذ ه ا ﻷ ﻋ ر ا ض ﻟ ﺑﺿ ﻌ ﺔ أ ﯾﺎ م أ و ﻋ د ة أ ﺳ ﺎ ﺑﯾﻊ .ﺗﺷ ﻣ ل ا ﻷ ﻋ ر ا ض ا ﻟ ﻣ ﺣ ﺗﻣ ﻠ ﺔ اﻟﺣﻣﻲ Fever, ﻗﺷﻌرﯾره Chills, طﻔﺢ ﺟﻠدي Rash, ﺗﻌرق ﻟﯾﻠﻲ Night sweats, اﻻم ﻓﻲ Muscle aches, اﻟﻌ ﺿ ﻼ ت اﻻم ﻓﻲ اﻟﺣﻠق Sore throat, ﺗﻌب Fatigue, ورم Swollen lymph nodes, and Mouth ulcers.ﻓﻲ اﻟﻐدد اﻟﻠﯾﻣﻔﺎوﯾﺔ و ﺗﻘرﺣﺎت اﻟﻔم Human Immunodeficiency Virus – Stages of Infection ﻓﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﺑﺷرﯾﺔ -ﻣراﺣل اﻟﻌدوى اﻧﺗﻘﺎل اﻟﻔﯾروس Viral Transmission اﻟﻌﻼﻗﮫ اﻟزوﺟﯾﮫ )اﻟﺟﻣﺎع( ،اﻟﺗﻌرض ﻟدم ﻣﻠوث او اﻧﺗﻘﺎل اﻟﻌدوي ﻓﻲ ﻓﺗره Sexual intercourse, exposure to contaminated blood, or perinatal transmission اﻟوﻻده ▶ ﻓﻲ اﻟوﻻﯾﺎت اﻟﻣﺗﺣدة ٪50 ،ﻣن اﻟﺣﺎﻻت ﻧﺎﺗﺟﺔ ﻋن اﻧﺗﻘﺎل اﻟﻌدوى ﻣن ذﻛر إﻟﻰ ذﻛرIn U.S., 50% of cases due to male-to-male transmission. ▶ Worldwide, 70-80% caused by vaginal sex, perinatal transmission is 5-10%, and IV drug use is 5-10%. ▶ ﻓﻲ ﺟﻣﯾﻊ أﻧﺣﺎء اﻟﻌﺎﻟم ٪80-70 ،ﻧﺎﺗﺞ ﻋن اﻟﺟﻧس اﻟﻣﮭﺑﻠﻲ ،واﻧﺗﻘﺎل اﻟﻔﺗرة اﻟﻣﺣﯾطﺔ ﺑﺎﻟوﻻدة ھو Acute HIV Infection immune response. ، ٪10-5 وﺗﻌﺎطﻲ اﻟﻣﺧدرات اﻟورﯾدﯾﺔ ھو .٪10-5ﻋدوى ﻓﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﺑﺷرﯾﺔ اﻟﺣﺎدة اﺳﺗﺟﺎﺑﺔ ﻣﻧﺎﻋﯾﺔ ▶ .ﺗﺣدث ﻓﻲ ٪90-40ﻣن ﺣﺎﻻت اﻟﻌدوى اﻟﺟدﯾدة ﺑﻔﯾروس اﻟﻌوز اﻟﻣﻧﺎﻋﻲ اﻟﺑﺷرOccurs in 40-90% of new HIV infections ▶ ﺗظﮭر اﻻﻋراض ﻋﺎدة ﻓﻲ ﻏﺿون أﯾﺎم إﻟﻰ أﺳﺎﺑﯾﻊ ﺑﻌد اﻹﺻﺎﺑﺔ اﻷوﻟﯾﺔSymptoms usually develop in days to weeks after initial infection ▶ ﺗﺷﻣل اﻟﺣﻣﻰ ،ﺗﺿﺧم اﻟﻌﻘد اﻟﻠﻣﻔﯾﺔ ،اﻟطﻔﺢ اﻟﺟﻠدي ،اﻟﺗﮭﺎب اﻟﺑﻠﻌوم Include fever, lymphadenopathy, rash, pharyngitis, headache (aseptic meningitis) ، اﻟﺻداع )اﻟﺗﮭﺎب اﻟﺳﺣﺎﯾﺎ اﻟﻌﻘﯾم( ▶ HIV antibody will be negative at this point – need to check HIV viral load or p24 antigen level , (The core protein of the human immunodeficiency virus (HIV). The presence of p24 antigen in the blood is a marker ﺳﺗﻛون اﻷﺟﺳﺎم اﻟﻣﺿﺎدة ﻟﻔﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﺑﺷرﯾﺔ ﺳﻠﺑﯾﺔ ﻓﻲ ھذه اﻟﻣرﺣﻠﺔ -ﺗﺣﺗﺎج إﻟﻰ ﻓﺣص اﻟﺣﻣل اﻟﻔﯾروﺳﻲ ﻟﻔﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ of uncontrolled HIV replication. اﻟﺑروﺗﯾن اﻷﺳﺎﺳﻲ ﻟﻔﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ (p24 ،اﻟﺑﺷرﯾﺔ أو ﻣﺳﺗوى ﻣﺳﺗﺿد .ﯾﻌد وﺟود اﻻﻧﺗﯾﺟﯾن ﻓﻲ اﻟدم ﻋﻼﻣﮫ ﻋﻠﻲ ﺗﻛﺎﺛر اﻟﻔﯾروس اﻟﻐﯾر ﻣﺗﺣﻛم ﻓﯾﮫ HIV).اﻟﺑﺷرﯾﺔ ) ▶ Seroconversion ▶ اﻟﻣرﯾض ﻟدﯾﮫ اﺧﺗﺑﺎر اﻷﺟﺳﺎم اﻟﻣﺿﺎدة ﻟﻔﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﺑﺷرﯾﺔ إﯾﺟﺎﺑﻲ ﯾﺣدث ﻋﺎدة ﺑﻌد 4إﻟﻰ 10أﺳﺎﺑﯾﻊ ﻣن اﻹﺻﺎﺑﺔPatient has positive HIV antibody test. ▶ Usually occurs 4 to 10 weeks after infection. ▶ ▶ ﻣرض اﻹﯾدز اﻟﻣزﻣن /اﻟﻛﺎﻣن Chronic/Latent HIV disease ▶ ﻗوه اﻟﻔﯾروس و ﺗﺣﻣﯾﻠﮫ ﺗزﯾد ﺑﺑطﻲ ﺷدﯾد و اﻟﻧوع ﺳﻲ دي Viral load tends to increase slowly, CD4(type of lymphocyte cell,WBC ) count decreases slowly ﻓور ھو ﻧوع ﻣن أﻧواع ﺧﻼﯾﺎ اﻟﻠﯾﻣﻔوﺳﺎﯾت اﻟﻣوﺟوده ﻓﻲ ﻛرات اﻟدم اﻟﺑﯾﺿﺎء و أﯾﺿﺎ ﺗﻘل ﺑﺑطﺊ ▶ اﻟﻌدوي اﻟﻣزﻣﻧﺔ ﻏﯾر اﻟﻣﺗطوره ﺗﻣﯾل اﻧﮭﺎ ﻻ ﺗﻌطﻲ ﻧﻘص ان ﺗﻌطﻲ ﻧﻘص ﺿﺋﯾل ﺟدا ﻓﻲ “Chronic non-progressors” tend to have little/no decrease in CD4 count ﻋدد ﺳﻲ دي ﻓور اﻋراض ﻣﺑﻛره ﻓﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﻣﻛﺗﺳﺑﺔ ▶ Early Symptomatic HIV Infection اﻻﯾدز ▶ AIDS ▶ ▶ WHO stages of HIV infection ﻣراﺣل ﻣﻧظﻣﺔ اﻟﺻﺣﺔ اﻟﻌﺎﻟﻣﯾﺔ ﻣن اﻹﺻﺎﺑﺔ ﺑﻔﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﺑﺷرﯾﺔ 1 (HIV infection): The CD4+ cell count is at least 500 cells per microliter. ▶ Stage اﻟﻣرﺣﻠﺔ ) 1ﻋدوى ﻓﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ (:ﺳﻲ دي ﻓور+ﻋدد اﻟﺧﻼﯾﺎ ﻋﻠﻲ اﻷﻗل ٥٠٠ﺧﻠﯾﺔ اﻛل ﻣﯾﻛروﻣﯾﺗر Stage 2 (HIV infection): The CD4+ cell count is 350 to 499. ▶ اﻟﻣرﺣﻠﺔ ٢ﻣن ﻋدوي ﻧﻘص اﻟﻣﻧﺎﻋﮫ :ﺳﻲ دي ﻓور +ﻋدد اﻟﺧﻼﯾﺎ اﻛون ﻣن ٣٥٠اﻟﻲ ٤٩٩ Stage 3 (advanced HIV disease, or AHD): The CD4+ cell count is 200 to 349. ▶ اﻟﻣرﺣﻠﺔ : ٣ﻣرﺣﻠﮫ ﻣﺗطورة ﻣن اﻻﺻ ﺎﺑﮫ ﺑﻔﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ :ﺳﻲ دي ﻓور +ﻋدد اﻟﺧﻼﯾﺎ ﯾﻛون ﻣن ٢٠٠اﻟﻲ ٣٤٩ ▶ Stage 4 (AIDS): The CD4+ cell count is less than 200 or the percent of CD4+ cells is less than 15% of all lymphocytes. اﻟﻣرﺣﻠﺔ : ٤اﻟﺳﻲ دي ﻓور +ﻋدد اﻟﺧﻼﯾﺎ ﺗﻛون اﻗل ﻣن ٢٠٠او ان ﻧﺳﺑﮫ ﺳﻲ دي ﻓور +ﻋدد اﻟﺧﻼﯾﺎ اﻗل ﻣن ٪١٥ﻣن ﻛل ﺧﻼﯾﺎ اﻟﻠﯾﻣﻔوﺳﯾت HIV- Early Symptomatic Infection ﻓﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﺑﺷرﯾﺔ -اﻟﻌدوى اﻟﻣﺑﻛرة اﻷﻋراض ﺗﺷﻣل ▶ Includes: ▶ Thrush ﻋدوى ﻓﻲ اﻟﻔم واﻟﺣﻠق ﺑﻔطرﯾﺎت ﺗﺷﺑﮫ اﻟﺧﻣﯾرة ﻣﺳﺑﺑﺔ ﺑﻘﻊ ﺑﯾﺿﺎء)(Fungal infection ﻛﺎﻧدﯾدا )ﻋدوي ﻓطرﯾﮫ ( ﻣﮭﺑﻠﯾﺔ ﻣﺳﺗﻣره ▶ Persistent vaginal candidiasis اﻟﺣﻣﻲ ▶ Fever اﻻﺳﮭﺎل ▶ Diarrhea ) ﻣرض اﻟﮭﯾرﺑس ﻋﺑﺎره ﻋن ﺑﻘﻊ ﺑﯾﺿﺎء ﻋﻠﻲ ▶ Oral Hairy Leukoplakia(Herpes Zoster ا ﻻﻏ ﺷ ﯾﺔ ا ﻟ ﻣﺧ ﺎ ط ﯾﺔ ورم ﻋﺻوي ▶ Bacillary Angiomatosis ﻧﻣو ﺳرطﺎﻧﻲ ﻓﻲ اﻟﻌﻧق )ﺑﯾﻛون اﻟﺳرطﺎن ﻓﻲ Ø Cervical dysplasia/carcinoma in situ ا ﻟ ﻣو ﻗ ﻊ و ﻻ ﯾ ﻧ ﺗ ﺷ ر ﻓ ﻲ ا ﻟ ﺟ ﺳ م اﻻم اﻻﻋﺻﺎب اﻟطرﯾﻘﮫ ▶ Peripheral neuropathy ﻣرض اﻟﺗﮭﺎب اﻟﺣوض اﻟﻣزﻣن ▶ Pelvic inflammatory Disease Thrush- Candidiasis This condition is caused by Candida fungus. It can happen in the skin, nails and mucous membranes throughout the body ﯾﻤﻜﻦ أن ﯾﺤﺪث ﻓﻲ اﻟﺠﻠﺪ واﻷظﺎﻓﺮ واﻷﻏﺸﯿﺔ اﻟﻤﺨﺎطﯿﺔ.داء اﻟﻤﺒﯿﻀﺎت ھﺬه اﻟﺤﺎﻟﺔ ﻧﺎﺗﺠﺔ ﻋﻦ ﻓﻄﺮ اﻟﻤﺒﯿﻀﺎت ﻓﻲ ﺟﻤﯿﻊ أﻧﺤﺎء اﻟﺠﺴﻢ Oral Hairy Leukoplakia ▶ Is a condition triggered by the Epstein-Barr virus (EBV). It causes white patches on tongue. Sometimes the patches happen in other parts of mouth. The patches may look hairy ﻗد ﺗﺑدو. ﺗﺣدث اﻟﺑﻘﻊ أﺣﯾﺎﻧًﺎ ﻓﻲ أﺟزاء أﺧرى ﻣن اﻟﻔم. ﯾﺳﺑب ﺑﻘﻊ ﺑﯾﺿﺎء ﻋﻠﻰ اﻟﻠﺳﺎن. ھﻲ ﺣﺎﻟﺔ ﯾﺳﺑﺑﮭﺎ ﻓﯾروس إﺑﺷﺗﺎﯾن ﺑﺎر اﻟﺑﻘﻊ ﻣﺷﻌرة ▶ Does not rub off. ﻻ ﺗﻛﺷطﮭﺎ Is skin infection caused by the gram-negative bacteria Bartonella henselae orB. quintana. ﻋدوي ﺟﻠدﯾﮫ ﺗﺣدث ﻋن طرﯾق اﻟﺑﻛﺗرﯾﺎ اﻟﺳﺎﻟﺑﺔ ﻣﺛل اﻟﺑﺎرﺗوﻧﯾﻼ ھﯾﻧﺳﯾﻠﻲ او اﻟﺑﯾﺗﺎ .ﻛوﯾﻧﺗﺎﻧﺎ Reddish ,berry like lesions on the skin ,often surrounded by a collar of scale ﺗﺷﺑﺔ ﺷﻛل اﻟﺗوت ﻋﻠﻲ اﻟﺟﻠد و ﻣﺣﺎطﺔ ﺑﮭﺎﻟﮫ ﻣن اﻟﻘﺷور، ﻟوﻧﮭﺎ اﺣﻣر Herpes Zosterھرﺑس زوﺳﺗر Is an acute, cutaneous viral infection ھﻲ ﻋدوي ﻓﯾروﺳﯾﺔ ﺣﺎدة “Shingles” ▶ Caused by Varicella ﺗﺣدث ﺑواﺳطﮫ ﭬﺎرﯾﺳﯾﻼ ▶ ﺗﺷﺧﯾص ﻓﯾروس ﻧﻘص Diagnosis of HIV اﻟﻣﻧﺎﻋﮫ اﻟﻣﻛﺗﺳﺑﺔ ▶ HIV antibody ELISA – if positive, is always followed by a confirmatory Western Blot ﺗﺣ ﻠ ﯾل ا ﻻ ﻟ ﯾز ا ا ﻻ ﺟ ﺳ ﺎ م ا ﻟ ﻣ ﺿ ﺎ د ة ،ا ذ ا ﻛ ﺎ ن إ ﯾ ﺟ ﺎ ﺑﻲ ﯾﺟ ب ا ن ﯾﺗﺑﻊ ﺑﺗﺣ ﻠ ﯾل ﺗ ﺎ ﻛ ﯾ د ي ﯾﺳ ﻣ ﻲ و ﯾﺳ ﺗ ر ن ﺑﻠ و ت ﻓﺣص اﻻﺟﺳﺎم اﻟﻣﺿﺎدة اﻟﺳرﯾﻊ ﻟﻔﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﻣﻛﺗﺳﺑﺔ ▶ Rapid HIV antibody test ﺣﺳﺎس و ﺧﺎص ﺑﻧﺳﺑﮫ ▶ Sensitivity and Specificity 99%! ٪٩٩ ﺗظﮭر اﻟﻧﺗﯾﺟﺔ ﺧﻼل ﻣن ﺧﻣس دﻗﺎﯾق اﻟﻲ أرﺑﻌﯾن دﻗﯾﻘﮫ ﺗﻘرﯾﺑﺎ ▶ Results in 5 to 40 minutes usually ﯾﺳﺗﺧدم ﻓﻲ ▶ Used in: اﻟﺗﻌرض اﻟﻣﮭﻧﻲ ) ﺗﻌرض ﻻﻣﻛﺎﻧﯾﮫ ﺣدوث اﻻﺻﺎﺑﮫ وﻗت ﻋﻣﻠﮫ و ﯾﺣﺗﺎج اﻻطﻣﺋﻧﺎن (▶ Occupational Exposure اﻟﻧﺳﺎء اﻟﺣواﻣل ﻓﻲ اﻟﻣﺧﺎض ▶ Pregnant women presenting in labor with no previous HIV testing ﺑدون أي ﺗﺣﺎﻟﯾل ﺳﺎﺑﻘﮫ ﻟﻠﻔﯾروس ▶ Patients who are unlikely to return for results of HIV test اﻟﻣرﺿﻰ اﻟذﯾن ﻣن ﻏﯾر اﻟﻣﺣﺗﻣل أن ﯾﻌودوا ﻟﻧﺗﺎﺋﺞ اﺧﺗﺑﺎر ﻓﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﺑﺷرﯾﺔ اﻟﺣﻣل اﻟﻔﯾروﺳﻲ ﻟﻠﻔﯾروس ▶ HIV viral load اول ﺧﯾﺎر ﻣﺗﺎح ﻟﺗﺷﺧﯾص ﺣﺎﻻت اﻻﺻﺎﺑﮫ اﻟﺣﺎده ▶ First choice for diagnosing possible acute HIV ﺗﺣﻠﯾل ﯾﺑﺣث ﻋن وﺟود اﻧﺗﯾﺟﯾن ﻣﻌﯾن ▶ HIV p24 Antigen ھو اول اﻧﺗﯾﺟﯾن ﯾرﺗﻔﻊ ﻓﻲ ﺣﺎﻟﮫ اﻻﺻﺎﺑﮫ اﻟﺣﺎده ▶ Is the first antigen to be elevated in acute HIV ﯾﺳﺗﺧدم ﻟﺗﺷﺧﯾص ﺣﺎﻻت اﻻﺻﺎﺑﮫ اﻟﺣﺎدة اﻻوﻟﯾﮫ ▶ Can be used for diagnosis of primary (acute) HIV Acquired Immunodeficiency Syndrome (AIDS) ﻣﺗﻼزﻣﺔ ﻧﻘص (اﻟﻣﻧﺎﻋﺔ اﻟﻣﻛﺗﺳب )اﻹﯾدز ▶ CD4 count < 200/mm3 (regardless of presence or absence of symptoms) ﺳﻲ دي ﺑﻐض٢٠٠ ﻋدد اﻗل ﻣن ا ﻟ ﻧ ظ ر ﻋ ن و ﺟ و د ا و ﻋ د م و ﺟ و د ا ﻋ ر ا ض. ▶ Infection with HIV and one of the following conditions: اﻹﺻﺎﺑﺔ ﺑﻔﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﺑﺷرﯾﺔ وإﺣدى اﻟﺣﺎﻻت ا ﻟ ﺗﺎ ﻟ ﯾﺔ ▶ ▶ Recurrent bacterial pneumonia Invasive cervical cancer اﻻﻟﺗﮭﺎب اﻟرﺋوي اﻟﺑﻛﺗﯾري اﻟﻣﺗﻛرر اﻟذي ﻣن اﻟﻣﻣﻛن ان ﯾودي اﻟﻲ ﺳرطﺎن اﻟﻌﻧق ▶ Candidiasis of esophagus, trachea, bronchi, or lungs Coccidiodomycosis, extrapulmonary ﻋدوي اﻟﻛﺎﻧدﯾدا ﻓﻲ اﻟﻣرئ و اﻟﻘﺻﺑﮫ اﻟﮭواﺋﯾﺔ و اﻟرﺋﺔ او ﺧﺎرج ▶ اارﺋﺔ ▶ ▶ Cryptococcosis, extrapulmonary Cryptosporidiosis with diarrhea > 1 month ادري اﻟﻛرﯾﺑﺗوﻛوﻛس ﺧﺎرج اﻟرﺋﺔ ﻣﻊ اﺳﮭﺎل ﻟﻣده اﻛﺗر ﻣن ﺷﮭر ▶ ▶ Cytomegalovirus of any organ other than lymph nodes, liver, spleen اﻟﻔﯾروس اﻟﻣﺳﺑب ﻟﺗﺿﺧم اﻷﻋﺿﺎء ﻓﯾﻣﺎ ﻋدا اﻟﻐدد اﻟﻠﯾﻣﻔﺎوﯾﺔ و اﻟﻛﺑد و اﻟطﺣﺎل ▶ Herpes simplex with mucocutaneous ulcer >1 month, or bronchitis, pneumonitis or esophagitis Histoplasmosis, extrapulmonary ▶ اﻟﮭرﺑس اﻟﺑﺳﯾط اﻟﻣﺻﺣوب ﺑﻘرﺣﺔ ﺟﻠدﯾﺔ ﻣﺧﺎطﯾﺔ< ﺷﮭر واﺣد أو اﻟﺗﮭﺎب اﻟﺷﻌب اﻟﮭواﺋﯾﺔ أو اﻟﺗﮭﺎب اﻟرﺋﺔ أو اﻟﺗﮭﺎب اﻟﻣريء داء اﻟﻧوﺳﺟﺎت ﺧﺎر▶ج اﻟرﺋﺔ ▶ HIV-associated dementia اﻟﺧرف اﻟﻣرﺗﺑط ﺑﻔﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﺑﺷرﯾﺔ ▶ ▶ HIV-associated wasting (involuntary weight loss of >10%, with diarrhea for > 30 days) Kaposi’s sarcoma in patient under age 60 ٦٠ ﯾوًﻣﺎ( ﺳﺎرﻛوﻣﺎ ﻛﺎﺑوﺳﻲ ﻟدى اﻟﻣرﯾض دون ▶ﺳن30 ﻣﻊ اﻹﺳﮭﺎل ﻟﻣدة ﺗزﯾد ﻋن، ٪10 <اﻟﮭزال اﻟﻣرﺗﺑط ﺑﻔﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﺑﺷرﯾﺔ )ﻓﻘدان اﻟوزن ﺑﺷﻛل ﻻ إرادي ﺑﻧﺳﺑﺔ ▶ Lymphoma of brain in patient under age 60. Non-Hodgkins Lymphoma ﺳرطﺎن اﻟﻐدد اﻟﻠﯾﻣﻔﺎوﯾﺔ.60 ﺳرطﺎن اﻟﻐدد اﻟﻠﯾﻣﻔﺎوﯾﺔ ﻓﻲ اﻟدﻣﺎغ ﻋﻧد ﻣرﯾض ﺗﺣت ﺳن اﻟﻼھودﺟﻛﯾن ▶ Disseminated Mycobacterium avium or Mycobaterium kansasii ﻣﯾﻛوﺑﺎﻛﺗﯾرﯾم اﻓﯾم او ﻣﯾﻛوﺑﻛﺗﯾرﯾم ﻛﺎﻧﺳﺎﺳﻲ اﻟﻣﻧﺗﺷره ▶ Disseminated Mycobacterium tuberculosis Pulmonary tuberculosis ﻣﯾﻛوﺑﺎﻛﺗﯾرﯾم ﺗﯾوﺑرﻛﻠوﺳﯾزس ▶ Nocardiosis ▶ ﻧوﻛﺎردﯾﺎﺳﯾس Pneumocytis jiroveci pneumonia Progressive Multifocal Leukencephalopathy Salmonella septicemia ▶ Strongyloides, extraintestinal Toxoplasmosis of internal organ. داء اﻟﻣﻘوﺳﺎت ﺧﺎرج اﻷﻣﻌﺎء ﻣن اﻷﻋﺿﺎء اﻟداﺧﻠﯾﺔ، اﻷﺳطوﻧﯾﺎت ▶ ▶ ﻓﻲ اول زﯾﺎره HIV – Initial Visit ﻓﻲ اﻟﻣﻌﺎﻣل Labs ﻋد ﺳﻲ دي ﻓور CD4 Count ▶ اﺧﺗﺑﺎر اﻷﺟﺳﺎم اﻟﻣﺿﺎدة ﻟﻔﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﺑﺷرﯾﺔ HIV Antibody Test ▶ )!HIV Viral Load (need to check this when concerned about Primary HIV ▶ ▶ اﻟﺣﻣل اﻟﻔﯾروﺳﻲ ﻟﻠﻔﯾروس و ھذه ھﻲ اﻟطرﯾﻘﮫ اﻟﺗﻲ ﯾﺟب اﺳﺗﺧداﻣﮭﺎ و ﻓﺣﺻﮭﺎ ﻋﻧدﻣﺎ ﺗﺻﺑﺢ ﻗﻠﻘﺎ ﺑﺷﺎن ﺣدوث ﻋدوي ﻟك اﺧﺗﺑﺎر ﻣﻘﺎوﻣﺔ ﻓﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﺑﺷرﯾﺔ ﻟﺷﺧص ﻣﻌﯾن ﻣﺧﺗﺎر HIV Resistance Testing – for selected patient ▶ ﻓﺣص ﻓﯾروس اﻟﺗﮭﺎب اﻟﻛﺑد )ﻓﺣص اﻷﺣﻣﺎل اﻟﻔﯾروﺳﯾﺔ()Hepatitis virus screening (check viral loads ▶ اﺧﺗﺑﺎر اﻟﺗوﺑرﻛوﻟﯾن اﻟﺟﻠدي و ھذا اﻻﺧﺗﺑﺎر ﯾﺳﺗﺧدم ﻟﻠﺳل أﯾﺿﺎ Tuberculin skin testing ▶ ﻣﺳﺣﺔ ﻋﻧق اﻟرﺣم Pap smear ▶ )PPD (positive if >/ = 5mm ▶ اﻷﻣراض اﻟﺗﻲ ﺗﻧﺗﻘل ﺟﻧﺳﯾﺎ ﺧﺎﺻﮫ )Sexually transmitted disease (especially RPR ▶ RPR اﺧﺗﺑﺎر اﻟﺗوﻛﺳوﺑﻼزﻣﺎ او داء اﻟﻘطط Toxoplasma serologic test ▶ cytomegalovirusاﺧﺗﺑﺎر )CMV serologic test (optional ▶ و ھًوﻓﯾروس ﯾﺳﺑب ﺗﺿﺧم اﻟﺧﻼﯾﺎ اﻻﺷﻌﮫ ﻋﻠﻲ اﻟﺻدر و ھﯾراﺧﺗﯾﺎرﯾﺔ )▶ Chest radiograph (optional اﻟﺗطﻌﯾﻣﺎت Vaccinations ﻟﻘﺎح اﻟﻣﻛورات اﻟرﺋوﯾﺔ )ﯾﻛرر ﺑﻌد 5ﺳﻧوات( )Pneumococcal Vaccine (repeat after 5 years ▶ اﻻﻧﻔﻠوﻧزا Influenza ▶ ▶ Bاﻻﻟﺗﮭﺎب اﻟﻛﺑدي اﻟوﺑﺎﺋﻲ Hepatitis B Aاﻻﻟﺗﮭﺎب اﻟﻛﺑدي اﻟوﺑﺎﺋﻲ ▶ Hepatitis A !Don’t give live vaccines – no Varicella, no MMR if CD4 count < 200 ﻻ ﺗﻌطﻲ ﺗﺣﺻﯾﻧﺎت ﺣﯾﮫ ،ﻻ ﺟدري وﻻ ﺗﺣﺻﯾن اﻟروﺑﯾﻼ اذا ﻛﺎن ﻋدد ﺧﻼﯾﺎ ﺳﻲ دي اﻗل ﻣن ٢٠٠ ▶ HIV - Opportunistic Infections CD4 > 500/mm 3 Acute HIV Vaginal candidiasis CD4 of 200-500/mm 3 Bacterial pneumonias Pulmonary tuberculosis Oral thrush (candidiasis) Oral hairy leukoplakia Herpes Zoster ھﺮﺑﺲ ز و ﺳ ﺘﺮ CD4 < 200 Kaposi’s sarcoma Candida esophagitis Toxoplasmosis داء اﻟﻘﻄﻂ Cryptococcosis CD4 < 50 Pneumocystis jiroveci pneumonia Disseminated Mycobacterium avium complex HIV-Associated Malignancies اﻷورام اﻟﺧﺑﯾﺛﺔ اﻟﻣرﺗﺑطﺔ ﺑﻔﯾروس ﻧﻘص اﻟﻣﻧﺎﻋﺔ اﻟﺑﺷرﯾﺔ ▶ Kaposi’s Sarcoma Due to excessive proliferation of spindle cells thought to have an endothelial cell origin. ▶ Associated with Human Herpesvirus-8 (HHV-8), which is also known as Kaposi’s Sarcoma Virus (KSV). ▶ ﻧوع ﻣن اﻟﺳرطﺎن ﯾﺷﻣل أوراًﻣﺎ ﻣﺗﻌددة ﻓﻲ اﻟﻐدد ▶ Most common malignancy in HIV وﯾﺣدث ﺑﺷﻛل رﺋﯾﺳﻲ ﻓﻲ، اﻟﻠﯾﻣﻔﺎوﯾﺔ أو اﻟﺟﻠد ▶ Clinical Findings: ▶ Skin: Deep purple/red lesions; Canﻌappear ﺟﮭﺎز ف ﻓﻲ ﻣن ﺿanywhere ﻌﺎﻧونon ن ﯾskin (ﻟذﯾsometimes ﺷﺧﺎص اon اﻷsoles of feet, causing pain with walking) ▶ Gastrointestinal: Nausea, bowel اﻹﯾدزvomiting, ل ﻧﺗﯾﺟﺔabdominal ﺑﯾل اﻟﻣﺛﺎpain, ﻰ ﺳodynophagia, ﻋﻠ، ﻣﻧﺎﻋﺔdysphagia, اﻟ obstruction, ▶ Found in 90% of cases ▶ Pulmonary: cough, dyspnea, shortness of breath, chest pain Diagnosis: Biopsy ▶ Treatment: Antiretrovirals, Local therapy (radiation, topicals), Systemic Chemotherapy ▶ Kaposi’s Sarcoma HIV-Associated Malignancy AIDS defining malignancies: Non-Hodgkin’s Lymphoma اﻹﯾدز ﯾﺣدد اﻷورام اﻟﺧﺑﯾﺛﺔ: ▶ ▶ ▶ ﻟﯾﻣﻔوﻣﺎ اﻟﻼھودﺟﻛﯾﻧﻌﺎدة أورام ▶ Usually B Cell lymphomas اﻟﻐدد اﻟﻠﯾﻣﻔﺎوﯾﺔ ﻣن اﻟﺧﻼﯾﺎ اﻟﺑﺎﺋﯾﺔ Includes primary CNS lymphoma and body cavity lymphoma (primary effusion lymphoma ﯾﺷﻣل ﺳرطﺎن اﻟﻐدد اﻟﻠﯾﻣﻔﺎوﯾﺔ اﻟﺟﮭﺎز اﻟﻌﺻﺑﻲ اﻟﻣرﻛزي وﺳرطﺎن اﻟﻐدد اﻟﻠﯾﻣﻔﺎوﯾﺔ ﻓﻲ ﺗﺟوﯾف اﻟﺟﺳم )ﺳرطﺎن اﻟﻐدد اﻟﻠﯾﻣﻔﺎوﯾﺔ اﻻوﻟﻲ ﻏﺎﻟًﺑﺎ ﻣﺎ ﯾرﺗﺑط ﺑﻔﯾروس إﺑﺷﺗﺎﯾن ﺑﺎر)▶ Often associated with Epstein Barr Virus (EBV )▶ Treatment: Anti-retrovirals, chemotherapy, steroids (for CNS اﻟﻌﻼج :ﻣﺿﺎدات اﻟﻔﯾروﺳﺎت اﻟﻘﮭﻘرﯾﺔ ،اﻟﻌﻼج اﻟﻛﯾﻣﯾﺎﺋﻲ ،اﻟﻣﻧﺷطﺎت )ﻟﻠﺟﮭﺎز اﻟﻌﺻﺑﻲ اﻟﻣرﻛزي( ▶ ﺳﺎرﻛوﻣﺎ ﻛﺎﺑوﺳﻲ )ﻓﯾروس اﻟﮭرﺑس اﻟﺑﺷري()Kaposi’s Sarcoma (Human herpesvirus- 8 – HHH-8 ﺳرطﺎن ﻋﻧق اﻟرﺣم /اﻟﺷرج )ﻓﯾروس اﻟورم اﻟﺣﻠﯾﻣﻲ اﻟﺑﺷري)Cervical/Anal Cancer (Human papillomavirus - HPV ▶ ▶ اﻷورام اﻟﺧﺑﯾﺛﺔ ﻏﯾر اﻟﻣرﺗﺑطﺔ ﺑﺎﻹﯾدزNon-AIDS defining malignancies: ﺳرطﺎن اﻟﻐدد اﻟﻠﯾﻣﻔﺎوﯾﺔ ھودﺟﻛﯾنHodgkin’s Lymphoma اﻟﻣﺎﯾﻠوﻣﺎ اﻟﻣﺗﻌددة Multiple myeloma ﺳرطﺎن اﻟدم ▶ Leukemia ﺳرطﺎن اﻟرﺋﺔ ▶ Lung Cancer ﺳرطﺎن اﻟﺧﻼﯾﺎ اﻟﻘﺎﻋدﯾﺔ ﻓﻲ اﻟﺟﻠد▶ Basal Cell Carcinoma of the skin ورم ﻣﻧوي Seminoma ▶ ▶ ▶ Treatment of HIV Anti-retrovirals ﻣﺿ ﺎدات ا ﻟ ﻔ ﯾر و ﺳ ﺎ ت ا ﻟ ﻘ ﮭ ﻘ ر ﯾﺔ ▶ ▶ Infection prophylaxis ﺣ ﻣ ﺎ ﯾﺔ ﺿ د ا ﻟ ﻌ د و ي Antiretrovirals – When to Start Therapy اﻣﺗﻲ اﺑدا ﻋﻼج Symptomatic HIV Disease ﻓﻲ ﺣﺎﻟﺔ وﺟﻮد اﻋﺮاض Asymptomatic HIV Disease ﻓﻲ ﺣﺎﻟﺔ ﻋﺪم وﺟﻮد اﻋﺮ اض CD4 count ≤ 200 CD4 count > 200 but <350 CD4 count ≥ 350 Antiretroviral therapy recommended ﻣ ﻀ ﺎ د ا ت ا ﻟ ﻔ ﯿ ﺮ و ﺳ ﺎ ت ھﻲ ا ﻷﻓ ﻀ ﻞ Antiretroviral therapy recommended ﻣ ﻀ ﺎدات اﻟﻔ ﯿ ﺮ وﺳﺎت Antiretroviral therapy should be considered and individual decision (if viral load > 100,000) ﻻﺑﺪ ﻣﻦ ا ﺧ ﺬ ا ﻟ ﻘ ﺮ ا ر ا ﻟ ﺸ ﺨ ﺼ ﻲ ﺑﺨ ﺼ ﻮ ص ا ﻟ ﻌﻼ ج ﺑﻤﻀ ﺎ د ﻓ ﯿﺮ و س ا ﻟ ﺮ ﯾﺘﺮ ر Antiretroviral therapy generally not recommended ﻣﻀﺎدات اﻟﻔﯿﺮوﺳﺎت ﻏﯿﺮ ﻣ ﺤ ﺒ ﺒ ﮫ ﻓ ﻲ ھ ﺬه ا ﻟ ﺤ ﺎ ﻟ ﮫ Antiretrovirals ▶ Nucleoside/Nucleotide Analogue Reverse Transcriptase Inhibitors (NRTI’s) اﻟﻧوﻛﻠﯾوﺗﯾدات اﻟﺗﻧﺎظرﯾﺔ/ ﻣﺛﺑطﺎت اﻟﻧﺳﺦ اﻟﻌﻛﺳﻲ ﻟﻠﻧﯾوﻛﻠﯾوزﯾد ▶ Block reverse transcriptase activity by incorporating themselves into the viral DNA and acting as chain terminators in the synthesis of proviral DNA. ﻣﻧﻊ ﻧﺷﺎط اﻟﻧﺳﺦ اﻟﻌﻛﺳﻲ ﻣن ﺧﻼل دﻣﺞ أﻧﻔﺳﮭم ﻓﻲ اﻟﺣﻣض اﻟﻧووي اﻟﻔﯾروﺳﻲ واﻟﻌﻣل ﻛﻣﻧﮭﻲ ﺳﻠﺳﻠﺔ ﻓﻲ ﺗﺧﻠﯾق اﻟﺣﻣض اﻟﻧووي اﻷوﻟﻲ اﻟﻔﯾروﺳﻲ Non-nucleoside Analogue Reverse Transcriptase Inhibitors (NNRTI’s) ﻣﺛﺑطﺎت اﻟﻧﺳﺦ اﻟﻌﻛﺳﻲ ﻏﯾر اﻟﻧوﻛﻠﯾوزﯾدﯾﺔ اﻟﺗﻧﺎظرﯾﺔ ▶ ▶ Bind directly and non-competitively with reverse transcriptase, blocking its activity ﻣﻣﺎ ﯾﻌﯾق ﻧﺷﺎطﮫ، ارﺑط ﺑﺷﻛل ﻣﺑﺎﺷر وﻏﯾر ﺗﻧﺎﻓﺳﻲ ﻣﻊ اﻟﻧﺳﺦ اﻟﻌﻛﺳﻲ ▶ Protease Inhibitors ﻣﺛﺑطﺎت اﻟﺑروﺗﯾﺎز ▶ Inhibit HIV-1 protease, resulting in release of structurally disorganized and non-infectious viral particles. . ﻣﻣﺎ ﯾؤدي إﻟﻰ إطﻼق ﺟزﯾﺋﺎت ﻓﯾروﺳﯾﺔ ﻏﯾر ﻣﻧظﻣﺔ وﻏﯾر ﻣﻌدﯾﺔ، ﻣﻧﻊ ﺑروﺗﯾﺎز ▶ Fusion Inhibitors ﻣﺛﺑطﺎت اﻻﻧﺻﮭﺎر Inhibit fusion of initial virus with CD4 cell ﻣﻧﻊ اﻧدﻣﺎج اﻟﻔﯾروس اﻷوﻟﻲ ﺑﺧﻠﯾﺔ ﺳﻲ دي ﻓور Only member is Enfuvirtide (T20) اﻟﻌﺿو اﻟوﺣﯾد ھو ▶ Only used in salvage therapyﺗﺳﺗﺧدم ﻓﻘط ﻓﻲ اﻟﻌﻼج اﻹﻧﻘﺎذي ▶ ▶ Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTI’s) اﻟﻧوﻛﻠﯾوﺗﯾدات/ ﻣﺛﺑطﺎت اﻟﻧﺳﺦ اﻟﻌﻛﺳﻲ ﻟﻠﻧﯾوﻛﻠﯾوﺳﯾد ▶ Include: ﯾﺷﻣل Abacavir (ABC) Didanoside (ddI) ▶ Emtricitabine (FTC) ▶ Lamivudine (3TC) ▶ Stavudine (d4T) ▶ Tenofovir (TDF) ▶ Zalcitabine (ddC) ▶ Zidovudine (AZT, ZDV) ﻛﻠﮭﺎ اﺳﻣﺎء ﻣواد ﺗﺳﺗﺧدم ﻓﻲ اﻟﺗﺛﺑﯾط و ھﻲ أﺳﻣﺎء ﻋﻠﻣﯾﮫ ﻛﯾﻣﯾﺎﺋﯾﺔ ﻻ ﯾوﺟد ﺗرﺟﻣﮫ ﺣرﻓﯾﮫ ﻟﮭﺎ ▶ ▶ ▶ Side Effects: اﻻﺛﺎر اﻟﺟﺎﻧﺑﯾﮫ Lactic Acidosis ﺣﻣﺿﯾﮫ اﻻﻛﺗﯾك ▶ Hepatic Steatosis ﺗﻧﻛس دھﻧﻲ ﻛﺑدي ▶ Peripheral neuropathy اﻟﺗﮭﺎب اﻻﻋﺻﺎب اﻟطرﻓﻲ ▶ ***Hypersensitivity reaction with Abacavir ﺷده اﻟﺣﺳﺎﺳﯾﺔ ﻣﻊ اﻻﺑﺎﻛﺎﻓﯾر ▶ Non-nucleoside reverse transcriptase inhibitors ﻣﺛﺑطﺎت اﻟﻧﺳﺦ اﻟﻌﻛﺳﻲ ﻏﯾر اﻟﻧوﻛﻠﯾوزﯾدﯾﺔ)(NNRTI’s ﺗﺷﻣل ▶ Include: ﻧﯾﻔﯾراﺑﯾن )Nevirapine (NVP اﻻﻋراض اﻟﺟﺎﻧﺑﯾﺔ Side effects: طﻔﺢ ﺟﻠدي ﻣن اﻟﻣﻣﻛن ان ﯾودي اﻟﻲ ﻣﺗﻼزﻣﮫ ﺳﺗﯾﻔﯾن)▶ Rash (can cause Stevens Johnson ﺟوﻧز اﻟﺗﺳﻣم اﻟﻛﺑدي ﻓﻲ اﻟﻧﺳﺎء اذا ﻛﺎن ﻋدد ﺳﻲ Hepatotoxicity in women with CD4 ≤ 250 دي اﻗل ﻣن٢٥٠ اﯾﻔﺎﭬﯾرﯾﻧز )Efavirenz (EFV اﻻﻋراض اﻟﺟﺎﻧﺑﯾﺔ Side Effects CNS side effects: dizziness, insomnia, hallucinations اﻷﻋراض اﻟﺟﺎﻧﺑﯾﺔ ﻟﻠﺟﮭﺎز اﻟﻌﺻﺑﻲ اﻟﻣرﻛزي :دوار ،أرق ،ھﻠوﺳﺔ Can cause fetal malformations, neural tube defects ﯾﻣﻛن أن ﯾﺳﺑب ﺗﺷوھﺎت ﺟﻧﯾﻧﯾﺔ وﻋﯾوب ﻓﻲ اﻷﻧﺑوب اﻟﻌﺻﺑﻲ دﯾﭭﯾرﯾدﯾن )Dilavirdine (DLV اﻻﻋراض اﻟﺟﺎﻧﺑﯾﺔ Side Effects طﻔﺢ ﺟﻠدي Rash زﯾﺎده اﻧزﯾم اﻟﺗراﻧﺳﻣﯾﻧﺎز Increased transaminases Protease Inhibitors ﺗﺛﺑﯾط اﻟﺑروﺗﯾز ▶ Include: ﺗﺷﻣل ▶ Amprenavir (APV)اﻻﻣﺑرﯾﻧﺎﻓﯾر ▶ Atazanavir (ATV) اﺗﺎذاﻧﺎﻓﯾر ▶ Fosamprenavir (f-APV) ﻓوﺳﺎﻣﺑﯾﻧﺎﭬﯾر ▶ Indinavir اﻧداﭬﯾر ▶ Lopinavir + Ritonavir (Kaletra) ﻟوﺑﯾﻧﺎﭬﯾر ▶ Nelfinavir ﻧﯾﻠﻔﯾﻧﺎﭬﯾر ▶ Ritonavir رﯾﺗوﻧﺎﭬﯾر VERY IMPORTANT – Is able to boost levels of other protease inhibitors! ! ﻗﺎدر ﻋﻠﻰ ﺗﻌزﯾز ﻣﺳﺗوﯾﺎت ﻣﺛﺑطﺎت اﻷﻧزﯾم اﻟﺑروﺗﯾﻧﻲ اﻷﺧرى- ﻣﮭم ﺟدًا ▶ ▶ Saquinavir ▶ ﺳﯾﻛوﯾﻧﺎﭬﯾر Side Effects اﻻﻋراض اﻟﺟﺎﻧﺑﯾﮫ ▶ Inhibit CYP450 system ﯾﺛﺑط ﺟﮭﺎزcyp450 ▶ Hyperlipidemia ﯾﺳﺑب زﯾﺎده ﻧﺳﺑﺔ اﻟدھون ﻓﻲ اﻟدم ▶ Hyperglycemia زﯾﺎده ﻧﺳﺑﺔ اﻟﺳﻛر ﻓﻲ اﻟدم ▶ GI upset اﺿطرابGl ▶ Kidney stones – Indinavir ﺣﺻوات اﻟﻛﻠﻲ Human Immunodeficiency Virus (Acute Immunodeficiency Syndrome) ( ﻓ ﯾ ر و س ﻧ ﻘ ص ا ﻟ ﻣ ﻧ ﺎ ﻋ ﺔ ا ﻟ ﺑ ﺷ ر ﯾ ﺔ ) ﻣ ﺗﻼ ز ﻣ ﺔ ﻧ ﻘ ص ا ﻟ ﻣ ﻧ ﺎ ﻋ ﺔ ا ﻟ ﺣ ﺎ د ▶ ▶ Anaphylaxis اﻟﺣﺳﺎﺳﯾﺔ اﻟﻣﻔرطﺔ ▶ Atopic Dermatitis اﻟﺗﮭﺎب اﻟﺟﻠدي اﻟﺗﺟﺳﺳﻲ ▶ Rheumatic Disorder اﻻﺿ طراﺑﺎت اﻟروﻣﺎﺗﯾزﻣﯾﺔ ▶ Systemic Lupus Erythematosus ا ﻟ ذ ﺋﺑﺔ ا ﻟ ﺣ ﻣ ﺎ ﻣ ﯾﺔ ا ﻟ ﺟ ﮭ ﺎ ز ﯾﺔ Anaphylactic (Type I) Hypersensitivity ﻓرط اﻟﺣﺳﺎﺳﯾﺔ اﻟﻧوع اﻻول ▶ The most severe hypersensitivity reaction is anaphylaxis. An unanticipated severe allergic reaction that is rapid in onset, anaphylaxis is characterized by edema in many tissues, including the larynx, and is often accompanied by hypotension, bronchospasm, and cardiovascular collapse in severe cases. ﯾﺗﻣﯾز ﺑﺎﻟﻠورم ﻓﻲ اﻟﻌدﯾد ﻣن، رد ﻓﻌل ﺗﺣﺳﺳﻲ ﺷدﯾد ﻏﯾر ﻣﺗوﻗﻊ وﺳرﯾﻊ ﻓﻲ اﻟﺑداﯾﺔ.إن أﺷد ﺗﻔﺎﻋﻼت ﻓرط اﻟﺣﺳﺎﺳﯾﺔ ھو اﻟﺣﺳﺎﺳﯾﺔ اﻟﻣﻔرطﺔ وﻏﺎﻟﺑًﺎ ﻣﺎ ﯾﻛون ﻣﺻﺣوﺑًﺎ ﺑﺎﻧﺧﻔﺎض ﺿﻐط اﻟدم واﻟﺗﺷﻧﺞ اﻟﻘﺻﺑﻲ وھﺑوط اﻟﻘﻠب واﻷوﻋﯾﺔ اﻟدﻣوﯾﺔ ﻓﻲ، ﺑﻣﺎ ﻓﻲ ذﻟك اﻟﺣﻧﺟرة، اﻷﻧﺳﺟﺔ .اﻟﺣﺎﻻت اﻟﺷدﯾدة ▶ Type I or anaphylactic hypersensitivity is an immediate reaction beginning within minutes of exposure to an antigen. Primary chemical mediators are responsible for the symptoms of type I hypersensitivity because of their effects on the skin, lungs, and gastrointestinal tract. If chemical mediators continue to be released, a delayed reaction may occur and may last for up to 24 hours. Clinical symptoms are determined by the amount of the allergen, the amount of mediator released, the sensitivity of the target organ, and the route of allergen entry. اﻟوﺳطﺎء اﻟﻛﯾﻣﯾﺎﺋﯾون اﻷﺳﺎﺳﯾون.اﻟﻧوع اﻷول أو ﻓرط اﻟﺣﺳﺎﺳﯾﺔ اﻟﺗﺄﻗﯾﺔ ھو ﺗﻔﺎﻋل ﻓوري ﯾﺑدأ ﻓﻲ ﻏﺿون دﻗﺎﺋق ﻣن اﻟﺗﻌرض ﻟﻼﻧﺗﯾﺟﯾن إذا اﺳﺗﻣر إطﻼق.ﻣﺳؤوﻟون ﻋن أﻋراض ﻓرط اﻟﺣﺳﺎﺳﯾﺔ ﻣن اﻟﻧوع اﻷول ﺑﺳﺑب ﺗﺄﺛﯾرھم ﻋﻠﻰ اﻟﺟﻠد واﻟرﺋﺗﯾن واﻟﺟﮭﺎز اﻟﮭﺿﻣﻲ ﯾﺗم ﺗﺣدﯾد اﻷﻋراض اﻟﺳرﯾرﯾﺔ ﻣن ﺧﻼل ﻛﻣﯾﺔ. ﺳﺎﻋﺔ24 ﻓﻘد ﯾﺣدث ﺗﻔﺎﻋل ﻣﺗﺄﺧر وﻗد ﯾﺳﺗﻣر ﻟﻣدة ﺗﺻل إﻟﻰ، اﻟوﺳطﺎء اﻟﻛﯾﻣﯾﺎﺋﯾﯾن وﻣﺳﺎر دﺧول ﻣﺳﺑﺑﺎت اﻟﺣﺳﺎﺳﯾﺔ، وﺣﺳﺎﺳﯾﺔ اﻟﻌﺿو اﻟﻣﺳﺗﮭدف، وﻛﻣﯾﺔ اﻟوﺳﯾط اﻟﻣﻧطﻠق، اﻟﻣﺎدة اﻟﻣﺳﺑﺑﺔ ﻟﻠﺣﺳﺎﺳﯾﺔ Cytotoxic (Type II) Hypersensitivity Type II, or cytotoxic, hypersensitivity ﺳﻣﯾﺔ اﻟﺧﻼﯾﺎ )اﻟﻧوع اﻟﺛﺎﻧﻲ( ﻓرط اﻟﺣﺳﺎﺳﯾﺔ ﻣن اﻟﻧوع اﻟﺛﺎﻧﻲ occurs when the system mistakenly identifies a normal constituent of the body as foreign. . ﯾﺣدث ﻋﻧدﻣﺎ ﯾﺣدد اﻟﻧظﺎم ﻋن ط رﯾق اﻟﺧطﺄ ﻣﻛوﻧًﺎ ط ﺑﯾﻌﯾًﺎ ﻣن اﻟﺟﺳم ﻋﻠﻰ أﻧﮫ ﻏرﯾب ▶ ▶ This reaction may be the result of a cross-reacting antibody, possibly leading to cell and tissue damage. . ﻣﻣﺎ ﻗد ﯾؤدي إﻟﻰ ﺗﻠف اﻟﺧﻼﯾﺎ واﻷﻧﺳﺟﺔ، ﻗد ﯾﻛون ھذا اﻟﺗﻔﺎﻋل ﻧﺎﺗًﺟﺎ ﻋن ﺟﺳم ﻣﺿ ﺎد ﻣﺗﺻ ﺎﻟب ▶ Type II hypersensitivity reactions are associated with several disorders. For example, in myasthenia gravis, the body mistakenly generates antibodies against normal nerve ending receptors. In Goodpasture syndrome, it generates antibodies against lung and renal tissue, producing lung damage and kidney injury (Grossman & Porth, 2014). ﻓ ﻲ ﺣ ﺎ ﻟ ﺔ ا ﻟ و ھ ن ا ﻟ ﻌ ﺿ ﻠ ﻲ ا ﻟ و ﺑﯾل، ﻋ ﻠ ﻰ ﺳ ﺑﯾل ا ﻟ ﻣ ﺛﺎ ل. ﺗر ﺗﺑط ﺗﻔ ﺎ ﻋ ﻼ ت ﻓ ر ط ا ﻟ ﺣ ﺳ ﺎ ﺳ ﯾﺔ ﻣ ن ا ﻟ ﻧو ع ا ﻟ ﺛﺎ ﻧﻲ ﺑﻌ د ة ا ﺿ ط ر ا ﺑﺎ ت ﻓﻲ ﻣﺗﻼزﻣﺔ ﺟودﺑﺎﺳﺗر. ﯾﻧﺗﺞ اﻟﺟﺳم ﻋن ط رﯾق اﻟﺧطﺄ أﺟﺳﺎًﻣﺎ ﻣﺿ ﺎدة ﺿ د ﻣﺳﺗﻘﺑﻼت ﻧﮭﺎﯾﺔ اﻟﻌﺻ ب اﻟط ﺑﯾﻌﻲ، ، ﻣ ﻣ ﺎ ﯾؤ د ي إ ﻟ ﻰ ﺗﻠ ف ا ﻟ ر ﺋﺔ و إ ﺻ ﺎ ﺑﺔ ا ﻟ ﻛ ﻠ ﻰ، ﯾو ﻟ د ا ﻷ ﺟ ﺳ ﺎ م ا ﻟ ﻣ ﺿ ﺎ د ة ﺿ د أ ﻧﺳ ﺟ ﺔ ا ﻟ ر ﺋﺔ و ا ﻟ ﻛ ﻠ ﻰ Anaphylaxis اﻟﺣﺳﺎﺳﯾﺔ اﻟﻣﻔرطﺔ Definition of anaphylaxis ﺗﻌرﯾف اﻟﺣﺳﺎﺳﯾﺔ اﻟﻣﻔرطﺔ ▶ clinical response to an immediate (type I hypersensitivity) immunologic reaction between a specific antigen and an antibody . اﺳﺗﺟﺎﺑﺔ إﻛﻠﯾﻧﯾﻛﯾﺔ ﻟﺗﻔﺎﻋل ﻣﻧﺎﻋﻲ ﻓوري )ﻓرط اﻟﺣﺳﺎﺳﯾﺔ ﻣن اﻟﻧوع اﻷول( ﺑﯾن اﻧﺗﯾﺟﯾن ﻣﻌﯾن وﺟﺳم ﻣﺿﺎد ▶ The reaction results from a rapid release of IgE-mediated chemicals, which can induce a severe, life-threatening allergic reaction. ﯾﻧﺗﺞ اﻟﺗﻔﺎﻋل ﻋن اﻹطﻼق اﻟﺳرﯾﻊ ﻟﻠﻣواد اﻟﻛﯾﻣﯾﺎﺋﯾﺔ اﻟﺗﻲ ﯾﺗوﺳطﮭﺎ اﻻي ﭼﻲ إي Department of Nursing ﯾﻣﻛن أن ﺗﺳﺑب ﺗﻔﺎﻋًﻼ ﺗﺣﺳﺳﯾًﺎ ﺷدﯾدًا ﯾﮭدد اﻟﺣﯾﺎة 35 Pathophysiology ▶ caused by interaction of a foreign antigen (allergen) with specific IgE antibodies found on surface membrane of mast cells and peripheral blood basophils. ﻧﺎ ﺗﺞ ﻋ ن ﺗﻔ ﺎ ﻋ ل ﻣ ﺳ ﺗﺿ د ﻏ ر ﯾب ) ﻣ ﺳ ﺑب ﻟ ﻠ ﺣ ﺳ ﺎ ﺳ ﯾﺔ ( ﻣ ﻊ أ ﺟ ﺳ ﺎ م ﻣ ﺿ ﺎ د ة ▶ﻣ ﺣ د د ة ﻣ و ﺟ و د ة ﻋ ﻠ ﻰ ا ﻟ ﻐ ﺷ ﺎ ء ا ﻟ ﺳ ط ﺣ ﻲ ﻟ ﻠ ﺧ ﻼ ﯾ ﺎ ا ﻟ ﺑ د ﯾ ﻧ ﺔ و ﻗ و ا ﻋ د ا ﻟ د م ا ﻟ ﻣ ﺣ ﯾ ط ﺔ The subsequent release of histamine and other bioactive mediators causes activation of platelets, eosinophils, and neutrophils. واﻻﺳﯾﻧوﻓﯾﻠس و، ﯾؤدي اﻹط ﻼق اﻟﻼﺣق ﻟﻠﮭﯾﺳﺗﺎﻣﯾن وﻏﯾره ﻣن اﻟوﺳط ﺎء اﻟﻧﺷطﯾن ﺑﯾوﻟوﺟﯾًﺎ إﻟﻰ ﺗﻧﺷﯾط اﻟﺻ ﻔﺎﺋﺢ اﻟدﻣوﯾﺔ.ﯾﺔ . ا ﻟ ﻧﯾو ﺗر و ﻓ ﯾﻠ س ▶ Histamine, prostaglandins, and inflammatory leukotrienes are potent vasoactive mediators that are implicated in vascular permeability changes, flushing, urticaria, angioedema, hypotension, and bronchoconstriction that characterize anaphylaxis. ا ﻟ ﻠ ﯾﻛ و ﺗر ﯾﻧﺎ ت ا ﻻ ﻟ ﺗﮭ ﺎ ﺑﯾﺔ ھ ﻲ و ﺳ ط ﺎ ء ﻓ ﻌ ﺎ ﻟ و ن ﻓ ﻲ ا ﻷ و ﻋ ﯾﺔ ا ﻟ د ﻣ و ﯾﺔ ﺗﺷ ﺎ ر ك ﻓ ﻲ ﺗﻐ ﯾر ا ت ﻧﻔ ﺎ ذ ﯾﺔ، ا ﻟ ﺑر و ﺳ ﺗﺎ ﺟ ﻼ ﻧد ﯾن، ا ﻟ ﮭ ﯾﺳ ﺗﺎ ﻣ ﯾن و ﺗﺿ ﯾق ا ﻟ ﻘ ﺻ ﺑﺎ ت ا ﻟ ﺗﻲ ﺗﻣ ﯾز، ا ﻧﺧ ﻔ ﺎ ض ﺿ ﻐ ط ا ﻟ د م، ا ﻟ ﺗو ر ﻣ ﺎ ت ا ﻟ و ﻋ ﺎ ﺋﯾﺔ، ا ر ﺗﻛ ﺎ ﺗر ﯾﺎ، ا ﻻ ﺣ ﻣ ر ا ر، ا ﻷ و ﻋ ﯾﺔ ا ﻟ د ﻣ و ﯾﺔ ا ﻟ ﺣ ﺳ ﺎ ﺳ ﯾﺔ ا ﻟ ﻣ ﻔ ر ط ﺔ ▶ Smooth muscle spasm, bronchospasm, mucosal edema and inflammation, and increased capillary permeability. و ز ﯾﺎ د ة ﻧﻔ ﺎ ذ ﯾﺔ ا ﻟ ﺷ ﻌ ﯾر ا ت ا ﻟ د ﻣ و ﯾﺔ، و ر م و ا ﻟ ﺗﮭ ﺎ ب ا ﻷ ﻏ ﺷ ﯾﺔ ا ﻟ ﻣ ﺧ ﺎ ط ﯾﺔ، ﺗﺷ ﻧﺞ ﻗ ﺻ ﺑﻲ، ﺗﺷ ﻧﺞ ﻋ ﺿ ﻠ ﻲ أ ﻣ ﻠ س ▶ These systemic changes characteristically produce clinical manifestations within seconds Department of Nursing 36 or minutes after antigen exposure. ﺗﻧﺗﺞ ھذه اﻟﺗﻐﯾﯾرات اﻟﺟﮭﺎزﯾﺔ ﺑﺷﻛل ﻣﻣﯾز ﻣظ ﺎھر ﺳرﯾرﯾﺔ ﻓﻲ ﻏﺿ ون ﺛواٍن أو دﻗﺎﺋق ﺑﻌد اﻟﺗﻌرض ﻟﻼﻧﺗﯾﺟﯾن Common Causes of Anaphylaxis اﻻﺳﺑﺎب اﻟﺷﺎﺋﻌﺔ ﻟﻔرط اﻟﺣﺳﺎﺳﯾﺔ ▶ Foods اﻷطﻌﻣﺔPeanuts, tree nuts (eg, walnuts, pecans , cashews, almonds), shellfish (eg, shrimp, lobster, crab), fish, milk, eggs, soy, wheat - ، ﺳرطﺎن اﻟﺑﺣر، اﻟﺟﻣﺑري، اﻟﻣﺣﺎر )ﻋﻠﻰ ﺳﺑﯾل اﻟﻣﺛﺎل، ( اﻟﻠوز، اﻟﻛﺎﺟو، اﻟﺑﻘﺎن، اﻟﺟوز، واﻟﻣﻛﺳرات )ﻋﻠﻰ ﺳﺑﯾل اﻟﻣﺛﺎل، اﻟﻔول اﻟﺳوداﻧﻲ اﻟﻘﻣﺢ، ﻓول اﻟﺻوﯾﺎ، اﻟﺑﯾض، اﻟﺣﻠﯾب، اﻷﺳﻣﺎك، (اﻟﺳﻠطﻌون ▶ Medications اﻻدوﯾﺔ - Antibiotics, especially penicillin and sulfa antibiotics, radiocontrast agents, anesthetic agents (lidocaine, procaine), vaccines, hormones (insulin, vasopressin, adrenocorticotropic hormone [ACTH]), aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) - واﻟﮭرﻣوﻧﺎت، واﻟﻠﻘﺎﺣﺎت، ( ﺑروﻛﺎﯾﯾن، وﻋواﻣل اﻟﺗﺧدﯾر )ﻟﯾدوﻛﺎﺋﯾن، وﻋواﻣل اﻟﺗﺑﺎﯾن اﻹﺷﻌﺎﻋﻲ، وﺧﺎﺻﺔ اﻟﺑﻧﺳﻠﯾن واﻟﺳﻠﻔﺎ، اﻟﻣﺿﺎدات اﻟﺣﯾوﯾﺔ واﻟﻌﻘﺎﻗﯾر اﻟﻣﺿﺎدة ﻟﻼﻟﺗﮭﺎﺑﺎت )اﻟﻣﺳﻛﻧﺎت، واﻷﺳﺑرﯾن، واﻟﮭرﻣون اﻟﻣوﺟﮫ ﻟﻘﺷر اﻟﻛظر، واﻟﻔﺎزوﺑرﯾﺳﯾن، )اﻷﻧﺳوﻟﯾن ▶ Other Pharmaceutical/Biologic Agents - Animal serums (tetanus antitoxin, snake venom antitoxin, rabies antitoxin), antigens used in skin خtesting - اﻻﻧﺗﯾﺟﯾﻧز، ( ﻣﺿﺎد ﺳم داء اﻟﻛﻠب، ﻣﺿﺎد ﺳم اﻷﻓﻌﻰ، ﺑﯾوﻟوﺟﯾﺔ أﺧرﯨﻣﺻل اﻟﺣﯾواﻧﺎت )ﻣﺿﺎد ﺳم اﻟﺗﯾﺗﺎﻧوس/ ﻋواﻣل ﺻﯾدﻻﻧﯾﮫ اﻟﻣﺳﺗﺧدﻣﺔ ﻓﻲ اﺧﺗﺑﺎر اﻟﺟﻠد ▶ Insect Stings ﻟدﻏﺎت اﻟﺣﺷرات - Bees, wasps ,homests , yellow jackets, ants, including fire ants ﺑﻣﺎ، اﻟﻧﻣل، اﻟﺳﺗرات اﻟﺻﻔراء، اﻟدﺑﺎﺑﯾر، اﻟدﺑﺎﺑﯾر،اﻟﻧﺣل اﻟﻧﺎريDepartment ذﻟك اﻟﻧﻣلof ﻲ ﻓ Nursing ▶ Latex:Medical and nonmedical products containing latexاﻟﻣﻧﺗﺟﺎت اﻟطﺑﯾﺔ وﻏﯾر اﻟطﺑﯾﺔ اﻟﺗﻲ ﺗﺣﺗوي ﻋﻠﻰ ﻣﺎدة اﻟﻼﺗﻛس 37 Department of Nursing 38 Clinical Manifestations اﻟﻣظﺎھر اﻟﺳرﯾرﯾﮫ ▶ Anaphylactic reactions produce a clinical syndrome that affects multiple organ systems. ﺗﻧﺗﺞ اﻟﺗﻔﺎﻋﻼت اﻟﺗﺄﻗﯾﺔ ﻣﺗﻼزﻣﺔ إﻛﻠﯾﻧﯾﻛﯾﺔ ﺗؤﺛر ﻋﻠﻰ أﺟﮭزة أﻋﺿﺎء ﻣﺗﻌددة ▶ Reactions may be categorized as mild, moderate, or severe. ▶ The time from exposure to antigen to onset of symptoms is a good indicator of the severity of the reaction: the faster the onset, the more severe the reaction. أو ﺷدﯾده، أو ﻣﺗوﺳطﺔ، ﯾﻣﻛن ﺗﺻﻧﯾف اﻟﺗﻔﺎﻋﻼت ﻋﻠﻰ أﻧﮭﺎ ﺧﻔﯾﻔﺔ . زادت ﺣدة اﻟﺗﻔﺎﻋل، ﻛﻠﻣﺎ ﻛﺎﻧت اﻟﺑداﯾﺔ أﺳرع:اﻟوﻗت ﻣن اﻟﺗﻌرض ﻟﻠﻣﺳﺗﺿد إﻟﻰ ظﮭور اﻷﻋراض ھو ﻣؤﺷر ﺟﯾد ﻋﻠﻰ ﺷدة اﻟﺗﻔﺎﻋل. ▶ The severity of previous reactions does not determine the severity of subsequent reactions, which could be the same or more or less severe. ▶ The severity depends on the degree of allergy and the dose of allergen. ▶ ﺗﻌﺗﻣد اﻟﺷدة ﻋﻠﻰ. واﻟﺗﻲ ﯾﻣﻛن أن ﺗﻛون ﻣﺗﺷﺎﺑﮭﺔ أو أﻛﺛر أو أﻗل ﺣدة، ﻻ ﺗﺣدد ﺷدة اﻟﺗﻔﺎﻋﻼت اﻟﺳﺎﺑﻘﺔ ﺷدة اﻟﺗﻔﺎﻋﻼت اﻟﻼﺣﻘﺔ 39 Department of Nursing درﺟﺔ اﻟﺣﺳﺎﺳﯾﺔ وﺟرﻋﺔ اﻟﻣﺎدة اﻟﻣﺳﺑﺑﺔ ﻟﻠﺣﺳﺎﺳﯾﺔ Clinical Manifestations اﻟﻣظﺎھر اﻟﺳرﯾرﯾﺔ Reactions may be categorized as : Mild systemic reactions Moderate systemic reactions Severe systemic reactions: ﺗﻔﺎ ﻋ ﻼ ت ﺟ ﮭ ﺎ ز ﯾﺔ ﺧ ﻔﯾﻔﮫ: ﯾﻣ ﻛ ن ﺗﺻ ﻧﯾف اﻟﺗﻔﺎ ﻋ ﻼ ت ﻋ ﻠﻰ اﻟﻧﺣ و اﻟﺗﺎ ﻟﻲ ﺗﻔﺎ ﻋ ﻼ ت ﺟ ﮭ ﺎ ز ﯾﺔ ﻣ ﻌ ﺗدﻟﺔ ﺗﻔﺎ ﻋ ﻼ ت ﺟ ﮭ ﺎ ز ﯾﺔ ﺷ دﯾدة Department of Nursing 40 Clinical Manifestations Mild systemic reactions - peripheral tingling and a sensation of warmth, possibly accompanied by a sensation of fullness in the mouth and throat. - Nasal congestion, periorbital swelling, pruritus, sneezing, and tearing of the eyes - Onset of symptoms begins within first 2 hours after exposure. - ﺗﻔﺎﻋﻼت ﺟﮭﺎزﯾﺔ ﺧﻔﯾﻔﺔ - . وﻗد ﯾﻛون ﻣﺻﺣوًﺑﺎ ﺑﺈﺣﺳﺎس ﺑﺎﻻﻣﺗﻼء ﻓﻲ اﻟﻔم واﻟﺣﻠق، وﺧز ﻣﺣﯾطﻲ وإﺣﺳﺎس ﺑﺎﻟدفء - اﺣﺗﻘﺎن ﺑﺎﻷﻧف وﺗورم ﺣول اﻟﺣﺟﺎج وﺣﻛﺔ وﻋطس وﺗﻣزق ﻓﻲ اﻟﻌﯾﻧﯾن Department of Nursing - .ﯾﺑدا ظﮭور اﻷﻋراض ﺧﻼل أول ﺳﺎﻋﺗﯾن ﺑﻌد اﻟﺗﻌرض 41 Clinical Manifestations Moderate systemic reactions - Flushing, warmth, anxiety, and itching in addition to any of the milder symptoms. - ردود اﻟﻔﻌل اﻟﺟﮭﺎزﯾﺔ اﻟﻣﻌﺗدﻟﺔاﺣﻣرار اﻟوﺟﮫ واﻟدفء واﻟﻘﻠق واﻟﺣﻛﺔ ﺑﺎﻻﺿﺎﻓﮫ اﻟﻲ أي ﻋرض ﺑﺳﯾط ﯾﻣﻛن ﺣدوﺛﺔ - More serious reactions include bronchospasm and edema of the airways or larynx with dyspnea, cough, and wheezing. ﺗﺷﻣل اﻟﺗﻔﺎﻋﻼت اﻷﻛﺛر ﺧطورة ﺗﺷﻧﺞ اﻟﻘﺻﺑﺎت ووذﻣﺔ اﻟﺷﻌب اﻟﮭواﺋﯾﺔ أو اﻟﺣﻧﺟرة ﻣﻊ ﺿﯾق اﻟﺗﻧﻔس واﻟﺳﻌﺎل واﻟﺻﻔﯾر The onset of symptoms is the same as for a mild reaction..ظﮭور اﻷﻋراض ھو ﻧﻔﺳﮫ ﺑﺎﻟﻧﺳﺑﺔ ﻟرد ﻓﻌل ﺧﻔﯾف - Department of Nursing 42 Clinical Manifestations Severe systemic reactions: - Have an abrupt onset with same signs and symptoms described previously. - ﺗﺑدأ ﺑﺷﻛل ﻣﻔﺎﺟﺊ ﺑﻧﻔس اﻟﻌﻼﻣﺎت واﻷﻋراض اﻟﻣوﺻوﻓﺔ:ردود اﻟﻔﻌل اﻟﺟﮭﺎزﯾﺔ اﻟﺷدﯾدة ﺳﺎﺑﻘًﺎ - These symptoms progress rapidly to bronchospasm, laryngeal edema, severe dyspnea, cyanosis, and hypotension. - ، وزراق، وﺿﯾق ﻓﻲ اﻟﺗﻧﻔس اﻟﺷدﯾد، وذﻣﺔ ﺣﻧﺟرﯾﺔ، ﺗﺗطور ھذه اﻷﻋراض ﺑﺳرﻋﺔ إﻟﻰ ﺗﺷﻧﺞ ﻗﺻﺑﻲ واﻧﺧﻔﺎض ﺿﻐط اﻟدم - Dysphagia (difficulty swallowing), abdominal cramping, vomiting, diarrhea, and seizures can also occur. - Cardiac arrest and coma may follow. وﻗﻲء، وﺗﻘﻠﺻﺎت ﻓﻲ اﻟﺑطن، (ﺿﺎ ﻋﺳر اﻟﺑﻠﻊ )ﺻﻌوﺑﺔ ﻓﻲ اﻟﺑﻠﻊ ً ﯾﻣﻛن أن ﯾﺣدث أﯾ ﻗد ﯾﺗﺑﻊ ذﻟك ﺳﻛﺗﺔ ﻗﻠﺑﯾﺔ وﻏﯾﺑوﺑﺔ. وﻧوﺑﺎت ﺻرع، وإﺳﮭﺎل، Department of Nursing 43 44 Department of Nursing Preventive measures ﻛﯾﻔﯾﺔ ﻣﻧﻊ ﺣدوث اﻹﺻﺎﺑﺔ ▶ Strict avoidance of potential allergens for patient at risk for anaphylaxis. ﺗﺟﻧب ﺻﺎرم ﻟﻣﺳﺑﺑﺎت اﻟﺣﺳﺎﺳﯾﺔ اﻟﻣﺣﺗﻣﻠﺔ ﻟﻠﻣرﺿﻰ اﻟﻣﻌرﺿﯾن ﻟﺧطر اﻟﺣﺳﺎﺳﯾﺔ اﻟﻣﻔرطﺔ ▶ Patients at risk for anaphylaxis from insect stings should avoid areas populated by insects and should use appropriate clothing, insect repellent, and caution to avoid further stings. ﯾﺟب ﻋﻠﻰ اﻟﻣرﺿﻰ اﻟﻣﻌرﺿﯾن ﻟﺧطر اﻟﺣﺳﺎﺳﯾﺔ اﻟﻣﻔرطﺔ ﻣن ﻟﺳﻌﺎت اﻟﺣﺷرات ﺗﺟﻧب اﻟﻣﻧﺎطق اﻟﺗﻲ ﺗﺳﻛﻧﮭﺎ اﻟﺣﺷرات وﯾﺟب ﻋﻠﯾﮭم اﺳﺗﺧدام اﻟﻣﻼﺑس اﻟﻣﻧﺎﺳﺑﺔ وطﺎرد اﻟﺣﺷرات واﻟﺣذر ﻟﺗﺟﻧب اﻟﻣزﯾد ﻣن اﻟﻠﺳﻌﺎت ▶ If avoidance of exposure to allergens is impossible, patient should be instructed to carry and administer epinephrine to prevent an anaphylactic reaction in event of exposure to the allergen. ﯾﺟب ﺗوﺟﯾﮫ اﻟﻣرﯾض ﻟﺣﻣل وإﻋطﺎء اﻹﺑﯾﻧﻔرﯾن، إذا ﻛﺎن ﺗﺟﻧب اﻟﺗﻌرض ﻟﻣﺳﺑﺑﺎت اﻟﺣﺳﺎﺳﯾﺔ أﻣًرا ﻣﺳﺗﺣﯾًﻼ .ﻟﻠوﻗﺎﯾﺔ ﻣن ﺗﻔﺎﻋل اﻟﺣﺳﺎﺳﯾﺔ ﻓﻲ ﺣﺎﻟﺔ اﻟﺗﻌرض ﻟﻣﺳﺑﺑﺎت اﻟﺣﺳﺎﺳﯾﺔ 45 Department of Nursing Preventive measures • • People who are sensitive to insect bites and stings, those who have experienced food or medication reactions, and those who have experienced idiopathic or exercise-induced anaphylactic reactions should always carry an emergency kit that contains epinephrine وأوﻟﺋك اﻟذﯾن ﻋﺎﻧوا ﻣن ﺗﻔﺎﻋﻼت، واﻟذﯾن ﻋﺎﻧوا ﻣن ﺗﻔﺎﻋﻼت ﻏذاﺋﯾﺔ أو دواﺋﯾﺔ، ﯾﺟب أن ﯾﺣﻣل اﻷﺷﺧﺎص اﻟذﯾن ﻟدﯾﮭم ﺣﺳﺎﺳﯾﺔ ﻣن ﻟدﻏﺎت وﻟﺳﻌﺎت اﻟﺣﺷرات . ﻣﺟﻣوﻋﺔ أدوات اﻟطوارئ اﻟﺗﻲ ﺗﺣﺗوي ﻋﻠﻰ اﻹﺑﯾﻧﻔرﯾن، ﺗﺄﻗﯾﺔ ﻣﺟﮭوﻟﺔ اﻟﺳﺑب أو ﺑﺳﺑب اﻟﺗﻣﺎرﯾن اﻟرﯾﺎﺿﯾﺔ .▶ The EpiPen (epinephrine injection, USP) Auto-Injectors from Dey Pharmaceuticals (Napa, CA) is a commercially available first-aid device that delivers premeasured doses of 0.3 mg for adults (EpiPen) or 0.15 mg for paediatric patient (EpiPen Jr.) of epinephrine ▶ EpiPen should only be injected into the middle of outer thigh (upper leg), through clothing if necessary . 46 Department of Nursing Preventive Measures ▶ The auto injection system requires no preparation, and the self-administration technique is not complicated. و ﺗﻘﻧﯾﺔ اﻹ دار ة اﻟذاﺗﯾﺔ ﻟﯾﺳ ت، ﻻ ﯾﺗط ﻠب ﻧظ ﺎ م اﻟﺣ ﻘن اﻟﺗﻠﻘﺎ ﺋﻲ أي ﺗﺣ ﺿ ﯾر ﻣ ﻌ ﻘدة ▶ Verbal and written information about the emergency kit, as well as strategies to avoid exposure to threatening allergens, must also be provided. ، ﺿ ﺎ ﺗو ﻓ ﯾر ﻣ ﻌ ﻠو ﻣ ﺎ ت ﺷ ﻔﮭ ﯾﺔ و ﻣ ﻛ ﺗو ﺑﺔ ﺣ و ل ﻣ ﺟ ﻣ و ﻋ ﺔ أد و ات اﻟط و ار ئ ً ﯾﺟ ب أﯾ .ﺑﺎ ﻹ ﺿ ﺎ ﻓ ﺔ إﻟﻰ اﺳ ﺗر اﺗﯾﺟ ﯾﺎ ت ﺗﺟ ﻧب اﻟﺗﻌ ر ض ﻟﻣ ﺳ ﺑﺑﺎ ت اﻟﺣ ﺳ ﺎ ﺳ ﯾﺔ اﻟﻣ ﮭ ددة Department of Nursing 47 Preventive Measures ▶ Screening for allergies before a medication is prescribed or first administered is an important preventive measure ﯾﻌد ﻓﺣص اﻟﺣﺳﺎﺳﯾﺔ ﻗﺑل وﺻف اﻟدواء أو ﺗﻧﺎوﻟﮫ ﻷول ﻣرة إﺟراء وﻗﺎﺋﯾًﺎ ﻣﮭًﻣﺎ ▶ A careful history of any sensitivity to suspected antigens must be obtained before administering any medication, particularly in parenteral form, because this route is associated with the most severe anaphylaxis. ﻷن ھذا اﻟطرﯾق ﯾرﺗﺑط ﺑﺄﺷد أﻧواع اﻟﺣﺳﺎﺳﯾﺔ، ﺧﺎﺻﺔ ﻓﻲ ﺷﻛل اﻟﺣﻘن، ﯾﺟب اﻟﺣﺻول ﻋﻠﻰ ﺗﺎرﯾﺦ دﻗﯾق ﻷي ﺣﺳﺎﺳﯾﺔ ﺗﺟﺎه اﻻﻧﺗﺟﯾﻧز اﻟﻣﺷﺗﺑﮫ ﺑﮭﺎ ﻗﺑل إﻋطﺎء أي دواء .اﻟﻣﻔرطﺔ ▶ Nurses caring for patients in any setting (hospital, home, outpatient diagnostic testing sites, long-term care facilities) must assess patients’ risks for anaphylactic reactions. وﻣراﻓق اﻟرﻋﺎﯾﺔ طوﯾﻠﺔ، وﻣواﻗﻊ اﻻﺧﺗﺑﺎرات اﻟﺗﺷﺧﯾﺻﯾﺔ ﻟﻠﻣرﺿﻰ اﻟﺧﺎرﺟﯾﯾن، واﻟﻣﻧزل، ﯾﺟب ﻋﻠﻰ اﻟﻣﻣرﺿﺎت اﻟذﯾن ﯾﻌﺗﻧون ﺑﺎﻟﻣرﺿﻰ ﻓﻲ أي ﻣﻛﺎن )اﻟﻣﺳﺗﺷﻔﻰ اﻷﺟل( ﺗﻘﯾﯾم ﻣﺧﺎطر اﻟﻣرﺿﻰ ﻟﻠﺗﻔﺎﻋﻼت اﻟﺗﺄﻗﯾﺔ ▶ Patients are asked about previous exposure to contrast agents used for diagnostic tests and any allergic reactions, as well as reactions to any medications, foods, insect stings, and latex. ، وﻛذﻟك ردود اﻟﻔﻌل ﺗﺟﺎه أي أدوﯾﺔ، ﯾ ُﺳﺄل اﻟﻣرﺿﻰ ﻋن اﻟﺗﻌرض اﻟﺳﺎﺑق ﻟﻌواﻣل اﻟﺗﺑﺎﯾن اﻟﻣﺳﺗﺧدﻣﺔ ﻓﻲ اﻻﺧﺗﺑﺎرات اﻟﺗﺷﺧﯾﺻﯾﺔ وأي ﺗﻔﺎﻋﻼت ﺣﺳﺎﺳﯾﺔ واﻟﻼﺗﻛس، وﻟﺳﻌﺎت اﻟﺣﺷرات، وأطﻌﻣﺔ ▶ People who are predisposed to anaphylaxis should wear some form of identification, such as a Medic Alert bracelet, which names allergies to medications, food, and other substances. ﻣﺛل ﺳوار ال ﻣﯾدﯾك ارت اﻟذي ﯾﺗﻌرف ﻋﻠﻲ اﻟﺣﺳﺎﺳﯾﺔ، ﯾﺟب ﻋﻠﻰ اﻷﺷﺧﺎص اﻟﻣﻌرﺿﯾن ﻟﻺﺻﺎﺑﺔ ﺑﺎﻟﺣﺳﺎﺳﯾﺔ اﻟﻣﻔرطﺔ ارﺗداء ﺷﻛل ﻣن أﺷﻛﺎل اﻟﺗﻌرﯾف Department of Nursing 48 .ﻟﻸدوﯾﺔ واﻟطﻌﺎم واﻟﻣواد اﻷﺧرى Preventive measures ▶ People who are allergic to insect venom may require venom immunotherapy, which is used as a control measure and not a cure. واﻟذي ﯾﺳﺗﺧدم ﻛﺈﺟراء ﺗﺣﻛم وﻟﯾس ﻋﻼًﺟﺎ، ﻗد ﯾﺣﺗﺎج اﻷﺷﺧﺎص اﻟذﯾن ﻟدﯾﮭم ﺣﺳﺎﺳﯾﺔ ﻣن ﺳم اﻟﺣﺷرات إﻟﻰ ﻋﻼج ﻣﻧﺎﻋﻲ ﺑﺎﻟﺳم ▶ Immunotherapy administered after an insect sting is very effective in reducing the risk of anaphylaxis from future stings . ا ﻟ ﻌ ﻼ ج ا ﻟ ﻣ ﻧﺎ ﻋ ﻲ ا ﻟ ذ ي ﯾﺗم إ ﻋ ط ﺎ ؤ ه ﺑﻌ د ﻟ ﺳ ﻌ ﺔ ﺣ ﺷ ر ة ﻓ ﻌ ﺎ ل ﻟ ﻠ ﻐ ﺎ ﯾﺔ ﻓ ﻲ ﺗﻘ ﻠ ﯾل ﺧ ط ر ا ﻟ ﺣ ﺳ ﺎ ﺳ ﯾﺔ ا ﻟ ﻣ ﻔ ر ط ﺔ ﻣ ن ﻟ ﺳ ﻌ ﺎ ت ﻣ ﺳ ﺗﻘ ﺑﻠ ﯾﺔ ▶ Insulin-allergic patients with diabetes and those who are allergic to penicillin may require desensitization. ﻗ د ﯾﺣ ﺗﺎ ج ﻣ ر ﺿ ﻰ ﺣ ﺳ ﺎ ﺳ ﯾﺔ ا ﻷ ﻧﺳ و ﻟ ﯾن ا ﻟ ﻣ ﺻ ﺎ ﺑﯾن ﺑد ا ء ا ﻟ ﺳ ﻛ ر ي و ا ﻟ ذ ﯾن ﻟ د ﯾﮭ م ﺣ ﺳ ﺎ ﺳ ﯾﺔ ﺗﺟ ﺎ ه ا ﻟ ﺑﻧﺳ ﻠ ﯾن إ ﻟ ﻰ إ ز ا ﻟ ﺔ ا ﻟ ﺗﺣ ﺳ س ▶ Desensitization is based on controlled anaphylaxis, with a gradual release of mediators. ﻣ ﻊ إ ط ﻼ ق ﺗد ر ﯾﺟ ﻲ ﻟ ﻠ و ﺳ ط ﺎ ء، ﺗﻌ ﺗﻣ د إ ز ا ﻟ ﺔ ا ﻟ ﺗﺣ ﺳ س ﻋ ﻠ ﻰ ا ﻟ ﺣ ﺳ ﺎ ﺳ ﯾﺔ ا ﻟ ﻣ ﻔ ر ط ﺔ ا ﻟ ﺧ ﺎ ﺿ ﻌ ﺔ ﻟ ﻠ ر ﻗ ﺎ ﺑﺔ ▶ Patients who undergo desensitization are cautioned that there should be no lapses in therapy, because this may lead to reappearance of allergic reaction when the use of medication is resumed. Department of Nursing 49 ﻷ ن ھ ذ ا ﻗ د ﯾؤ د ي إ ﻟ ﻰ ظ ﮭ و ر ر د ﻓ ﻌ ل ﺗﺣ ﺳ ﺳ ﻲ ﻋ ﻧد، ﯾﺗم ﺗﺣ ذ ﯾر ا ﻟ ﻣ ر ﺿ ﻰ ا ﻟ ذ ﯾن ﺧ ﺿ ﻌ و ا ﻹ ز ا ﻟ ﺔ ا ﻟ ﺗﺣ ﺳ س ﻣ ن ﻋ د م ﺣ د و ث ا ﻧﻘ ط ﺎ ع ﻓ ﻲ ا ﻟ ﻌ ﻼ ج ا ﺳ ﺗﺋﻧﺎ ف ا ﺳ ﺗﺧ د ا م ا ﻟ د و ا ء Medical Management ▶ Management depends on severity of reaction. .ﺗﻌﺗﻣد اﻹدارة ﻋﻠﻰ ﺷدة اﻟﺗﻔﺎﻋل ▶ Initially, respiratory and cardiovascular functions are evaluated. . ﯾﺗم ﺗﻘﯾﯾم وظﺎﺋف اﻟﺟﮭﺎز اﻟﺗﻧﻔﺳﻲ واﻟﻘﻠب واﻷوﻋﯾﺔ اﻟدﻣوﯾﺔ، ﻓﻲ اﻟﺑداﯾﺔ ▶ If patient is in cardiac arrest, cardiopulmonary resuscitation is instituted. ﻓﯾﺗم إﺟراء إﻧﻌﺎش ﻗﻠﺑﻲ رﺋوي، إذا ﻛﺎن اﻟﻣرﯾض ﯾﻌﺎﻧﻲ ﻣن ﺳﻛﺗﺔ ﻗﻠﺑﯾﺔ ▶ Oxygen is provided in high concentrations during cardiopulmonary resuscitation or if the patient is cyanotic, dyspneic, or wheezing. ﯾﺗم ﺗوﻓﯾر اﻷﻛﺳﺟﯾن ﺑﺗرﻛﯾزات ﻋﺎﻟﯾﺔ أﺛﻧﺎء اﻹﻧﻌﺎش اﻟﻘﻠﺑﻲ اﻟرﺋوي أو إذا ﻛﺎن اﻟﻣرﯾض ﯾﻌﺎﻧﻲ ﻣن ▶.اﻟزرﻗﺔ أو ﺿﯾق اﻟﺗﻧﻔس أو اﻟﺻﻔﯾر Department of Nursing 50 Medical Management ▶ Epinephrine, in a 1:1000 dilution, is administered subcutaneously in the upper extremity or thigh and may be followed by a continuous IV infusion. ﺗﺣت اﻟﺟﻠد ﻓﻲ اﻟطرف اﻟﻌﻠوي أو اﻟﻔﺧذ وﯾﻣﻛن أن ﯾﺗﺑﻌﮫ1000 :1 ﯾ ُﻌطﻰ اﻹﺑﯾﻧﻔرﯾن ﺑﺗﺧﻔﯾف ﺗﺳرﯾب ورﯾدي ﻣﺳﺗﻣر ▶ Most adverse events associated with administration of epinephrine (ie, adrenaline) occur when dose is excessive or it is given intravenously. ﺗﺣدث ﻣﻌظم اﻷﺣداث اﻟﺿﺎﺋرة اﻟﻣرﺗﺑطﺔ ﺑﺈﻋطﺎء اﻹﺑﯾﻧﻔرﯾن )ﻣﺛل اﻷدرﯾﻧﺎﻟﯾن( ﻋﻧدﻣﺎ ﺗﻛون اﻟﺟرﻋﺔ زاﺋدة أو ﺗﻌطﻰ ﻋن طرﯾق اﻟورﯾد ▶ Patients at risk for adverse effects include elderly patients and those with hypertension, or known ischemic heart disease. ﯾﺷﻣل اﻟﻣرﺿﻰ اﻟﻣﻌرﺿون ﻟﺧطر اﻵﺛﺎر اﻟﻌﻛﺳﯾﺔ اﻟﻣرﺿﻰ اﻟﻣﺳﻧﯾن واﻟذﯾن ﯾﻌﺎﻧون ﻣن ارﺗﻔﺎع ﺿﻐط اﻟدم أو ﻣرض اﻟﻘﻠب اﻟذي ﯾﻛون ﻋﺑﺎره ﻋن ﻋدم وﺻول اﻟدم ﻟﻠﻘﻠب اﻟﻣﻌروف Department of Nursing 51 Department of Nursing 52 Medical Management ▶ Antihistamines and corticosteroids may also be administered to prevent recurrences of reaction and to treat urticaria and angioedema. ﺿﺎ اﺳﺗﺧدام ﻣﺿﺎدات اﻟﮭﯾﺳﺗﺎﻣﯾن واﻟﻛورﺗﯾﻛوﺳﺗﯾروﯾدات ﻟﻣﻧﻊ ﺗﻛرار اﻟﺗﻔﺎﻋل وﻟﻌﻼج ً ﯾﻣﻛن أﯾ اﻻرﺗﻛﺎرﯾﺎ واﻟوذﻣﺔ اﻟوﻋﺎﺋﯾﺔ ▶ IV fluids (eg, normal saline solution), volume expanders, and vasopressor agents are administered to maintain blood pressure and normal hemodynamic status. ﻣﺣﻠول ﻣﻠﺣﻲ ﻋﺎدي( وﻣوﺳﻌﺎت اﻟﺣﺟم وﻋواﻣل، ﯾﺗم إﻋطﺎء ﺳواﺋل ورﯾدﯾﺔ )ﻋﻠﻰ ﺳﺑﯾل اﻟﻣﺛﺎل .ﺿﺎﻏطﺔ ﻟﻸوﻋﯾﺔ ﻟﻠﺣﻔﺎظ ﻋﻠﻰ ﺿﻐط اﻟدم وﺣﺎﻟﺔ اﻟدورة اﻟدﻣوﯾﺔ اﻟطﺑﯾﻌﯾﺔ Department of Nursing 53 Medical Management In patients with episodes of bronchospasm or a history of bronchial asthma or chronic obstructive pulmonary disease, aminophylline and corticosteroids may also be administered to improve airway patency and function. ﻓﻲ اﻟﻣرﺿﻰ اﻟذﯾن ﯾﻌﺎﻧون ﻣن ﻧوﺑﺎت ﺗﺷﻧﺞ ﻗﺻﺑﻲ أو ﺗﺎرﯾﺦ ﻣن اﻟرﺑو اﻟﻘﺻﺑﻲ أو ﻣرض ﺿﺎ إﻋطﺎء أﻣﯾﻧوﻓﯾﻠﯾن واﻟﻛورﺗﯾﻛوﺳﺗﯾروﯾدات ﻟﺗﺣﺳﯾن ً ﯾﻣﻛن أﯾ، اﻻﻧﺳداد اﻟرﺋوي اﻟﻣزﻣن ﻗدرة ﻣﺟرى اﻟﮭواء ووظﺎﺋﻔﮫ ▶ If hypotension is unresponsive to vasopressors, glucagon may be administered intravenously for its acute inotropic and chronotropic effects. ﻓﯾﻣﻛن إﻋطﺎء، إذا ﻛﺎن اﻧﺧﻔﺎض ﺿﻐط اﻟدم ﻏﯾر ﻣﺳﺗﺟﯾب ﻟﻣﺿﺎدات اﻷوﻋﯾﺔ اﻟدﻣوﯾﺔ اﻟﺟﻠوﻛﺎﺟون ﻋن طرﯾق اﻟورﯾد ﻟﺗﺄﺛﯾراﺗﮫ اﻟﺣﺎدة اﻟﻣؤﺛرة ﻓﻲ اﻟﺗﻘﻠص اﻟﻌﺿﻠﻲ واﻟﺗﺄﺛﯾرات ▶.اﻟﻣزﻣﻧﺔ ▶ Department of Nursing 54 Medical Management ▶ Patients who have experienced anaphylactic reactions and received epinephrine should be transported to the emergency department for observation and monitoring because of the risk for a “rebound” reaction 4 to 10 hours after the initial allergic reaction. ﯾﺟب ﻧﻘل اﻟﻣرﺿﻰ اﻟذﯾن ﻋﺎﻧوا ﻣن ﺗﻔﺎﻋﻼت ﺗﺄﻗﯾﺔ وﺗﻠﻘوا اﻹﯾﺑﯾﻧﯾﻔرﯾن إﻟﻰ ﻗﺳم اﻟطوارئ ﻟﻠﻣراﻗﺑﺔ ﺳﺎﻋﺎت ﻣن رد اﻟﻔﻌل اﻟﺗﺣﺳﺳﻲ10 إﻟﻰ4 واﻟﻣراﻗﺑﺔ ﺑﺳﺑب ﺧطر ﺣدوث ﺗﻔﺎﻋل "ارﺗداد" ﺑﻌد .اﻷوﻟﻲ ▶ Patients with severe reactions are monitored closely for 12 to 14 hours in a facility that can provide emergency care, if needed. ﺳﺎﻋﺔ ﻓﻲ14 إﻟﻰ12 اﻟﻣرﺿﻰ اﻟذﯾن ﯾﻌﺎﻧون ﻣن ردود ﻓﻌل ﺷدﯾدة ﯾﺧﺿﻌون ﻟﻠﻣراﻗﺑﺔ ﻋن ﻛﺛب ﻟﻣدة إذا ﻟزم اﻷﻣر، ﻣﻧﺷﺄة ﯾﻣﻛن أن ﺗﻘدم رﻋﺎﯾﺔ طﺎرﺋﺔ ▶ Because of the potential for recurrence, patients with even mild reactions must be informed about this risk. ﯾﺟب إﺑﻼغ اﻟﻣرﺿﻰ اﻟذﯾن ﯾﻌﺎﻧون ﻣن ردود ﻓﻌل ﺧﻔﯾﻔﺔ ﻋن ھذا، ﺑﺳﺑب اﺣﺗﻣﺎﻟﯾﺔ اﻟﺗﻛرار 55 اﻟﺧطر Department of Nursing Nursing Management ▶ If a patient is experiencing an allergic response, nurse’s initial action is to assess patient for signs and symptoms of anaphylaxis. ﻓﺈن اﻹﺟراء اﻷوﻟﻲ ﻟﻠﻣﻣرﺿﺔ ھو ﺗﻘﯾﯾم اﻟﻣرﯾض ﺑﺣﺛ ًﺎ ﻋن ﻋﻼﻣﺎت وأﻋراض اﻟﺣﺳﺎﺳﯾﺔ اﻟﻣﻔرطﺔ، إذا ﻛﺎن اﻟﻣرﯾض ﯾﻌﺎﻧﻲ ﻣن رد ﻓﻌل ﺗﺣﺳﺳﻲ ▶nurse assesses airway, breathing pattern, and vital signs. ﺗﻘﯾم اﻟﻣﻣرﺿﺔ ﻣﺟرى اﻟﮭواء وﻧﻣط اﻟﺗﻧﻔس واﻟﻌﻼﻣﺎت اﻟﺣﯾوﯾﺔ ▶patient is observed for signs of increasing edema and respiratory distress. ﻟوﺣظ وﺟود ﻋﻼﻣﺎت ﻋﻠﻰ زﯾﺎدة اﻟورم وﺿﯾق اﻟﺗﻧﻔس ﻟدى اﻟﻣرﯾض Prompt notification of physician and preparation for initiation of emergency measures (intubation, administration of emergency medications, insertion of IV lines, fluid administration, oxygen administration) are important to reduce the severity of the reaction and to restore cardiovascular function. إﻋطﺎء اﻷﻛﺳﺟﯾن( ﻣﮭم ﻟﺗﻘﻠﯾل ﺷدة، إﻋطﺎء اﻟﺳواﺋل، إدﺧﺎل اﻷﻧﺑوب اﻟورﯾدي، إﻋطﺎء اﻷدوﯾﺔ اﻟطﺎرﺋﺔ، اﻹﺧطﺎر اﻟﻔوري ﻟﻠطﺑﯾب واﻟﺗﺣﺿﯾر ﻟﺑدء إﺟراءات اﻟطوارئ )اﻟﺗﻧﺑﯾب .اﻟﺗﻔﺎﻋل واﺳﺗﻌﺎدة وظﯾﻔﺔ اﻟﻘﻠب واﻷوﻋﯾﺔ اﻟدﻣوﯾﺔ ▶ nurse documents interventions used and patient’s vital signs and response to treatment. اﻟﻣﻣرﺿﺔ ﺗوﺛق اﻟﺗدﺧﻼت اﻟﻣﺳﺗﺧدﻣﺔ وﺣﯾوﯾﺔ اﻟﻣرﯾض و اﻻﺳﺗﺟﺎﺑﮫ ﻟﻠﻌﻼج 56 Department of Nursing Nursing Management ▶ Patient who has recovered from anaphylaxis needs an explanation of what occurred and instruction about avoiding future exposure to antigens and how to administer emergency medications to treat anaphylaxis. ﯾﺣﺗﺎج اﻟﻣرﯾض اﻟذي ﺗﻌﺎﻓﻰ ﻣن اﻟﺣﺳﺎﺳﯾﺔ اﻟﻣﻔرطﺔ إﻟﻰ ﺷرح ﻟﻣﺎ ﺣدث وﺗﻌﻠﯾﻣﺎت ﺣول ﺗﺟﻧب اﻟﺗﻌرض ▶اﻟﻣﺳﺗﻘﺑﻠﻲ ﻟﻣوﻟدات اﻟﻣﺿﺎدات وﻛﯾﻔﯾﺔ إﻋطﺎء أدوﯾﺔ اﻟطوارئ ﻟﻌﻼج اﻟﺣﺳﺎﺳﯾﺔ اﻟﻣﻔرطﺔ Patient must be instructed about antigens that should be avoided and about other strategies to prevent recurrence of anaphylaxis. ﯾﺟب إرﺷﺎد اﻟﻣرﯾض ﺣول اﻟﻣﺳﺗﺿدات اﻟﺗﻲ ﯾﺟب ﺗﺟﻧﺑﮭﺎ وﺣول ▶اﻻﺳﺗراﺗﯾﺟﯾﺎت اﻷﺧرى ﻟﻣﻧﻊ ﺗﻛرار اﻟﺣﺳﺎﺳﯾﺔ اﻟﻣﻔرطﺔAll patients who have experienced an anaphylactic reaction should receive a prescription for preloaded syringes of epinephrine. ﯾﺟب أن ﯾﺗﻠﻘﻰ ﺟﻣﯾﻊ اﻟﻣرﺿﻰ اﻟذﯾن ﻋﺎﻧوا ﻣن رد ﻓﻌل ﺗﺣﺳﺳﻲ وﺻﻔﺔ طﺑﯾﺔ ﻟﻣﺣﺎﻗن إﺑﯾﻧﯾﻔرﯾن ▶ﻣﺣﻣﻠﺔ ﻣﺳﺑﻘًﺎNurse instructs patient and family in their use and has patient and family demonstrate correct administration ﺗﻘوم اﻟﻣﻣرﺿﺔ ﺑﺈرﺷﺎد اﻟﻣرﯾض واﻷﺳرة ﻓﻲ اﺳﺗﺧدام اﻻدوﯾﮫ اﻟﺻﺣﯾﺢ . 57 Department of Nursing