NCLEX Review Guide: Adult Health - Immune System & Autoimmune Diseases

Types of Immunity

• Innate immunity provides immediate, non-specific defense through barriers like skin and mucous membranes, while adaptive immunity develops specific responses to particular antigens through B and T lymphocytes.
• Humoral immunity involves B cells producing antibodies, whereas cell-mediated immunity uses T cells to directly attack infected or abnormal cells.

Rheumatoid Arthritis (RA)

• Systemic inflammatory disease affecting synovial joints bilaterally, causing morning stiffness lasting >1 hour and joint deformities including swan-neck and boutonniere deformities.
• Elevated rheumatoid factor (RF) and anti-CCP antibodies are diagnostic markers, with ESR and CRP indicating active inflammation.

1. Assess joint pain using 0-10 scale
2. Evaluate range of motion and deformities
3. Monitor for systemic symptoms (fatigue, fever)
4. Assess functional capacity for self-care

Systemic Lupus Erythematosus (SLE)

• Multi-system autoimmune disease with characteristic butterfly rash across cheeks and nose, photosensitivity, and potential kidney involvement (lupus nephritis).
• Positive ANA (antinuclear antibodies) and anti-dsDNA antibodies are key diagnostic markers, with complement levels (C3, C4) often decreased during flares.

Multiple Sclerosis (MS)

• Demyelinating disease of the central nervous system causing progressive neurological deficits including vision changes, muscle weakness, and cognitive impairment.
• Relapsing-remitting pattern is most common, with symptoms worsening during exacerbations and partially improving during remissions.

Disease-Modifying Antirheumatic Drugs (DMARDs)

• Methotrexate is first-line DMARD requiring folic acid supplementation and regular liver function monitoring due to hepatotoxicity risk.
• Monitor CBC, liver enzymes, and creatinine every 4-8 weeks for patients on methotrexate or other DMARDs.

1. Obtain baseline labs (CBC, LFTs, creatinine)
2. Educate on folic acid supplementation
3. Monitor for infection signs (immunosuppression)
4. Schedule regular follow-up labs

Corticosteroids

• Used for acute flares but require gradual tapering to prevent adrenal insufficiency and rebound inflammation.
• Long-term use causes osteoporosis, hyperglycemia, increased infection risk, and cushingoid appearance.