The work of nurses at the Immunology

Institute ward

Bc.Dita Růčková

Charles University Immunology Institute 2nd Medical Faculty and University Hospital Motol

Our patients

Immunodeficiency: primary

secondary

Most frequent types of Dg.

CVID ( common variable immunodeficiency)Atopic eczema (more severe cases, methylprenisolon

i.v.)Bruton agammaglobulinemia Selective IgA deficiencySelective IgG subclass deficiencyHereditary angioedema type I.,II.Transient hypogammaglobulinemia in childhood

Main clinical symptoms in immunodeficiency

Increased predisposition to bacterial infections and frequent relapses

Increased inclination to infections caused by viruses, bacteria, fungi, parasites

i.e. persistent sinusitis, temperature, productive cough, chronic fatigue

Frequent otitisWeak or no response to vaccinationLack of progress

Treatment on the ward.

Intravenous immunoglobulin (IVIG)

regularly once every month ● measuring physiological functions, ● control blood samples, (M+S,KO, immunology,

biochemistry),● bioassay● Infusion takes approximately 2-4hours,

Treatment on the ward

Subcutaneous immunoglobulin (SCIG)●abdomen area 15 ml may be administered into one place application time ½ h – 1 h the speed depends on the child’s age, the

quality of the subcutaneous and the amount of the medicine (Newborn baby– 5ml/h)

using a special infusion pump or rapid push up

metod● can be delivered once a week or twice a

month

S.C. application

education for home caretraining parents for treating the child at home

using an infusion pump parents receive written step-by-step

instructions how to work at homeindividual approach to training parents, min. 3

appl. on our care centrecontrol patients on home therapy is every

three month

S.C. application patients get material for home therapy we have a plan monitoring the skill of

application technology on home therapy one or twice a year

we focus on the psychological work with patients and their family

Our capacity

s.c. application

Subcutaneous infusion set, especially, for small children,

Measuring physiological functions

i.v.application

Frequent concerns of parents

The sterile preparation of the actual drugAdministering to their own child (we guide

by hand for the 1st application.)

Anatomy of the communication

Factual content

Self-disclosure

ChallengeR

elationship

Factual content

The content of the communication comprises one fourth

(1/4 ) of what takes place between the speaker and the

listener

(for instance: a husband is eating a sauce and spots

something green swimming inside and observes: “There’s

something green in here (he enquires about factual

content)”.

Each communication not only hides information Each communication not only hides information about the factual content conveyed but also self-about the factual content conveyed but also self-disclosure about the person confessing. “I don’t disclosure about the person confessing. “I don’t know what it is” (self-disclosure)know what it is” (self-disclosure)

Said in an exasperated fashion i.e. I’m tired.

In a curiously manner................I’m surprised that you have neglected something

Ironically.................I don’t respect you.

Self-disclosure

Relationship

Or rather how I judge you and how we work together.

The report reveals how the speaker relates to the listener, what kind of relationship they have.

We learn about the mutual relationship in communications by means of gestures, tone of voice and its gradient, the suitability or unsuitability of timing assertions, facial expressions and other accompanying signals of a non-verbal nature.

In terms of these aspects of the report, the recipient has especially sensitive hearing because he feels like a person who is being treated in a certain way.

(I’m relying on the fact that you know. I trust that you wouldn’t put anything bad in the sauce because we care about each other.)

ConclusionsConclusions

Or rather what I’d like to encourage you to do.

We rarely say something just for the sake of it.

Almost every communication assumes the role

of influencing the listener to do or not to do

something. This attempt at influencing may be

more or less clear or hidden, we then talk of

handling (I want you to tell me what it is.)

A piece of communication took place in our examples

which involved a relationship of trust between the

speaker and the listener (wife), but also involved a

relaxed moment eating.

If this information is conveyed in a offended voice, it will

come out entirely differently. The communication:

“There’s something green here”, reveals that the

speaker doesn’t like the sauce (self-disclosure), that

he considers his wife to be a bad cook (relationship)

and he wants the sauce to be removed from the table

(challenge).

Thank you for your Thank you for your attentionattention