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increased WBC

leukocytosis

small

penia

occurs in plasma

humoral

substance that when introduced into body stimulates the production of an antibody. Antigens inlude toxins, bacteria, foreign blood cells, and the cells of transplanted organs.

Antigen

the main components of nonspecific and specific immune responses

leukocytes (WBC)

largest number of leukocytes that includes neutophils, eosinophils, and basophils

Granulocytes

mature into macrophages that trap and consume foreign bodies (phagocytosis)

Monocytes

found in the blood and lymph and are involved in the IMMUNE capability of the body; includes B-cell and T-cell lymphocytes

Lymphocytes

responsible for antibody-mediated immunity/HUMORAL IMMUNITY (meaning immunity occurring in the plasma)

B-cell lymphocytes

stimulate B cells to produce antibodies (friends with the B cells)

T-cell lymphocytes

Mature in the bone marrow
"recognize/memorize" specific germs, either bacteria/viruses, and in the presence of those specific germs, they reproduce rapidly
Mature into plasma cells and responsible for producing ANTIBODIES

B-cell

Humoral immunity

B cells
Pathogen enters
They remember: some things are hard to forget, antibodies are formed, and quick response after the initial invasion

Immature cells start in spleen, lymph nodes and bone marrow
Thymus gland matures them to T-cell lymphocytes
Important for control to help fight virus, bacterial, fungal and rejection of transplanted tissue

T-cells mediated immunity

involve cell-mediated immunity (specific responses); the 3 types are HELPER T CELLS, SUPPRESSOR T CELLS, AND CYTOTOXIC
T CELLS

T-cell lymphocytes

aka CD4; if it's low the immune system will not work
switch on the immune/allergic system
recognize a virus/transplanted tissue

Helper T cells

turn off immune (autoimmune) so body does not kill itself

Suppressor T cells

Cells kill tumor, viral, foreign cells (kill cells of transplanted organs)
vital to the control of viral and bacterial infections

Cytotoxic T cells

groups of lymphocytes that kill many diverse types of cancer and virus-infected cells (non-specific responses)

Natural killer cells

Antibody/Antigen Reactions

B cells able to produce many different antibodies
The "effectiveness of the immune system" depends on whether the body is able to distinguish between its own body tissues and foreign tissue

Summary

Humans need humoral and cell-mediated immunity to stay healthy
Each type has unique properties and reacts against particular antigens

aka Immunoglobulin Ig
large molecules of proteins produced in reaction to antigens (foreign substance or toxin)

Antibodies

What are the 5 categories of immunoglobulin?

IgG, IgA, IgM, IgE, and IgD

most abundant, antibodies are found in all body fluids and high during infection, lower in cancer

IgG

What Ig are lower in cancer?

IgG, IgA, and IgM

Human leukocyte antigens (HLA)

everybody is different
rare for 1 person to have the same HLA
Identical twins have same HLA
Organ transplant-rejection lower if HLA closely matched
Done for organ transplant

Occurs when a person produces his/her own antibodies

Active immunity

Chickenpox

Natural active immunity

Immunization/vaccines

Artificial active immunity

Occurs when a person is given antibodies from another source

Passive Immunity

Antibodies passed by the mother to the fetus

Passive natural immunity

Rabies shot

Passive artificial immunity

Factors that affect immunity

Age
Gender (women-autoimmune disorders and men-immunosuppressant)
Poor nutrition/nutritional imbalances
Alcohol use/abuse, smoking
Environment
Limited options for health care

Tests for Immune System Status

CBC
Sedimentation rate
Measurement of immunoglobulin levels
Antibody titer testing
Skin testing (TB-PPD)
Radiographic tests
Biopsy

Results of TB-PPD

postive if person has been exposed, but does not mean active TB
Assessed in 48 hrs
Signs of redness and induration (area of hardened raised tissure of 10 mm-considered postive)

Person to develop active immunity against a specific organism.
Given by injection, inhalation, or as an oral suspension

Immunizations/vaccines

Types of vaccines

Attenuated vaccines
Inactivated vaccines
Combined vaccines
Recombinant genetic engineering
Live, attenuated vaccines

Contain weak/dead pathogens

attenuated vaccines

Contain inactivated pathogens-eg. flu vaccine-elicits weak immune response-developed according to strain that is expected to predominate

Inactivated vaccines

A group of vaccines in one protects against multiple diseases-eg. MMR

combined vaccines

vaccines are engineered from components of the antigen

recombinant genetic engineering

Pathogens grown in a lab, less virulent
Toxid-toxic properties removed

Live, attenuated vaccines

S/S of anaplylactic shock

nasal congestion, palpitations, erythema, pruritus, a wet-sounding nonproductive cough, and slurred speech

Immediate medical intervention:epinephrine

use a 1:1000 conc. for severe urticaria.
administer subq in abdominal fat/upper arm
Also administered IM in the anterolateral portion of the thigh, through clothes if necessary with an EpiPen
briskly massage injection site to speed up drug reaction
Might have to be administered every 10-15 mins.

Anaphylaxis nursing care

elevate feet and keep warm
administer 02 if needed
Give antihistamines-dephenhydramine (Bendryl) and corticosteroids (prednisone)
instruct client to wear a medical alert bracelet/necklace identifying the allergy
instruct client to keep EpiPen with them at all times and to avoid allergan

HIV/AIDS (1981)

major epidemic and 1/4 of African nations infected.
destroys immune system
Retrovirus
ATTACK T CELLS (CD4)
window period may take up to 2 yrs.

One has AIDS

positive ELISA test, Western blot test, PCR
CD4<200
opportunistic

Within 6-12 weeks of infection there are usually detectable levels of antibodies against the virus in the blood

seroconversion

Common Indicator Diseases

Pneumocystis jiroveci pneumonia-most common of the indicator diseases
Kaposi's Sarcoma-keeps reoccuring
Cryptosporidium
Oral cnadidiasis (superinfection)

Severe watery diarrhea, nausea, vomiting, abdominal cramping, fever, and weakness caused by drinking municipal water

Cryptosporidium

HIV/AIDS diagnosis

ELISA, Western blot test, PCR
Possible to test positive after 2 weeks/10 full yrs for full AIDS
Treatment-no cure
May live several yrs w/o developing AIDS
Treatmetn started if experiencing severe symptoms

HIV/AIDS

invade the T-helper cells and decreases the number of cells
This decreases the immune system

Organ transplant

Types are skin, cornea, bone, and heart valve
HLA

Particularly important in organ and tissue transplantation. Closer match a higher success rate

HLA

client's own tissue, most successful type of graft

autograft

identical twin

Isograft

transplant from same species (living/cadavers)

allograft

xenografttransplant from animal to human and pig used to cover large burn

xenograft

determines the ability of cells to be compatible
Human leukocyte antigen (HLA) type identified

Tissue typing

collaborative care

CBC with diff
blood type and cross-matching
HLA-closely matched
MLC immune similarity permits successful transplant
Reverse isolation

transplant rejection

usually occurs 24 hrs after transplant
hyperactive
acute/chronic
graft versus host disease-1/2 of all BMT develop-to prevent anti-rejection drugs
TAKE IMMUNOSUPPRESSANTS for the rest of their life.

Care of clients with organ transplants

Monitor for signs of tissue rejection, elevated lab values (BUN, liver, cardiac enzymes, bilirubin levels), decreasing BP, increasing HR, or loss of function of the transplanted organ
Monitor for skin changes for several months, reporting signs of rashes, hives/peeling skin

Occur when the body's own cells are not recognized properly and are perceived as foreigh. The body then attacks the cells.
Prevalent in females
Increases with age
Familial connection: RA, SLE, MG, Scleroderma

Autoimmune diseases

Dx for autoimmune disorders

Antinuclear antibody (ANA) for SLE; ordered when someone shows similar S/S to SLE/another autoimmune disorder.
Lupus erythematosus (LE) for SLE
RF present in 80% of RA

Tx for autoimmune disorders

anti-inflammatory
COX 2 inhibitors
Antirheumatics

Bone marrow transplant

Aplastic anemia
Leukemia

grave muscle weakness
weakness increases with activity, improves with rest
average life span

Myasthenia Gravis

Myasthenia gravis manifestations

first muscles affected are eyes, eyelid movement, facial expression, slurred speech and swallowing
Other symptoms: unstable gait, weakness in arms, hands, fingers, legs, and neck; facial expression and SOB

MG dx

difficult cause weakness symptom of may disorders
TENSILON-IV test if improvement, then MG is dx
electromyography-evaluating electrical activity of muscles

MG tx

to control the disease and therapy to reduce and improve muscle weakness
Thymectomy

What is the function of the thymus and is its removal harmful?

plays a major role in the development of the body's immune system. Function appears virtually complete at birth. Removal of the thymus in the tx of MG does not affect the immune system thereafter.

Butter-fly shaped rash
Raynaud's phenomenon
avoid sun exposure
reduce stress

SLE

hands/feet turning white and cold, and then turning blue

Raynaud's phenomenon

abnormal growth of connective tissue that supports the skin and internal organs. Too much collagen

Scleroderma

Scleroderma manifestations

Calcinosis-calcium deposits in CT
Raynaud's phenomenon
Esophageal dysfunction
Sclerodactyly-excess collagen
Telangiectasis-spider like spots

Scleroderma Tx

Steroids and immunosuppressant drugs

Nursing care of autoimmune disorders

Stress reduction, nutrition, and medication
Rest during the day
Assess for fatigue, muscle pain and weakness
Assess stress level and coping strategies
Teach client and family about the disease process

The 4 classes of hypersensitivity

Level I-immediate response
Level II-cytotoxic hypersensitivity
Level III-immune hypersensitivity
Level IV-delayed hypersensitivity

immediate response related to foods, pollens, and insect bites

Level I

cytotoxic hypersensitivity due to an incompatible blood transfusion

Level II

immune hypersensitivity to horse antitoxin, bacteria, fungi, and viruses

Level III

delayed hypersensiticity response that is caused by chemicals or plants, fungi, and mycobacteria

Level IV

Allergies tx

antihistamines-benadryl
decongestants
corticosteriods
epinephrine-immediately if severe reaction
allergy injections

Nursing Considerations for allergies

gather a detailed allergy history and direct care toward helping the client learn to avoid allergy reactions
document the allergy and communicate data to the interdisciplinary healthcare team

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