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300 terms

Chapter 50: Assessment of Immune Function

pg 1544 - 1559
STUDY
PLAY
What is the body's specific portective response to a foreign agent?
immunity
What functions are the body's defense mechanism against invasion and allows a rapid response to foreign substances in a specific manner?
immune system
What can result from immune system activation?
genetic and cellular responses
What factors affect the immune system?
CNS integrity, general physical and emotional status, medications, dietary patterns, stress of illness, trauma or surgery
What are two types of dysfunctions involving the immune system?
many genetically based, others acquired
What is a property of the immune system that provides protection against harmful microbes?
immune memory
What is the mechanism by which the immune system is programmed to eliminate foreign substances, but maintains ability to accept self antigens?
Tolerance
What is the concept of surveillance?
the immune system is in a perpetual state of vigilance, screening, and rejecting any invader that is recogned as foreign to the host
What is immunopathology?
study of diseases that result from dysfunctions within the immune system
Where might disorders from the immune system stem?
excesses or deficiences of immunocompetent cells, alterations in the function of these cells,
immunologic attack on self antigens
inappropriate or exaggerated responses to specific antigens
Where are the central and peripheral lymphoid organs, tissues and cells? (11 - head to toe)
-adenoids
-tonsil
-axillary lymph nodes
-thymus
-bronchus-associated lymphoid tissue
-spleen
-intestine
-Peyer's patches (ascending colon)
-Appendix
-Inguinal lymph nodes
-Bone marrow (B cells and T cells)
**They are also scattered throughout your upper abdomen & left clavicular area
What is autoimmunity?
normal protective immune response paradoxically turns against or attacks the body
What does autoimmunity lead to?
tissue damage
What is hypersensitivity?
Body produces exaggerated or inappropriate response to specific antigens
What are gammopathies?
Immunoglobulins are overproduced
What are primary immune deficiencies?
Deficiency results from improper development of immune cells or tissues
usually congential or inherited
What are secondary immune deficiencies?
Results from interference with an already developed immune system, usually acquired later in life
What do the different cells tyles of the immune system defend again?
infection and invasion by other organisms
What supports the immune system?
molecules responsible for the interactions, modulations, and regulation of the system
What are immunogenic epitopes?
antigenic determinants
Immune system molecules interact with immunogenic epitopes and do what?
present on foreign materials
After presenting what do these immune system molecule/epitopes interactions do?
initiate a series of actions in a host
What actions do epitopes initiate?
inflammatory response
lysis of microbial agents
disposal of foreign toxins
What are the major components of immune system?
central and peripheral organs, tissues and cells
Where are the WBC involved in immunity produced?
bone marrow
Lymphocytes (like other blood cells) are generated from what type of cells?
stem cells
What are stem cells?
undifferentiated cells
What are the two types of lymphocytes?
B lymphocytes (B cells)
T lymphocytes
Which WBC matures in the bone marrow and then enters circulation?
B lymphocytes
Where do T lymphocytes mature?
thymus (into several kinds of cells)
What red and white pulp organ acts somewhat like a filter?
spleen
What is the red pulp a site for?
old and injured RBCs destroyed
What does the white pulp contain?
lymphocytes
What connects the lymph nodes?
lymph channels and capillaries
Where are lymph nodes distributed?
throughout the body
What do lymph nodes do?
remove foreign material from the lymph system before it enters the blood stream
centers of immune cell proliferation
What is the basic function of the immune system?
remove foreign antigens to maintain homeostasis
What are some exampls of foreign antigens?
viruses and bacteria
What are the two general types of immunity?
natural (innate)
acquired (adaptive)
Which type of immunity is present at birth?
natural
Which types develops after birth?
acquired
Is natural immunity specific or nonspecific?
nonspecific
What does natural immunity provide?
a broad spectrum of defense against and resistance to infection
Following antigen exposure, what is natural immunity considered?
the first line of defense
Why is natural immunity considered the first line of defense?
protect the host with "remembering" prior contact with an infectious agent
How does the natural immune system co-coordinate the initial response to pathogens?
production of cytokines and other effector molecules
What do cytokines do? (2)
EITHER
(1) activate cells for control of the pathogen (by elimination)
(2) promote the development of the acquire immune response
What cells are involved in the acquired immune response? (7)
monocytes
macrophages
dendritic cells
natural killer cells
basophils
eosinophils
granulocytes
What are the two stages of the natural immune response mechanisms?
immediate (within 4 hrs)
delayed (b/t 4 and 96 hrs after exposure)
What is key to effective initiation of the immune response?
cellular response
What participates in both the natural and acquired immune responses?
WBCs
How do granulocytes fight invasion by foreign bodies?
releasing cell mediators - histamine, bradykinin, prostaglandins
What are the (3) types of granulocytes?
-neutrophils
-eosinophils
-basophils
Which are the first cells to arrive at the site where inflammation occurs?
Neutrophils
Which granulocytes increase in number during allergic reactions and stress responses?
eosinophils
basophils
What are the nongranular leukocytes?
monocytes
macrophages (histiocytes in tissue spaces)
lymphocytes
Which type of nongranular leukocytes functions as a phagocytic cell?
monocytes
What do phagocytic cells do?
engulf, ingest, destroy foreign bodies or toxins
Which destroys great numbers, monocytes or granulocytes?
monocytes
Which cells play major roles in humoral and cell-mediated immune responses?
lymphocytes (T and B cells)
Are there more T cells or B cells in the blood?
T cells (60-70%)
What is a major function of the natural immune system?
inflammatory response
What is elicited in response to tissue injury or invading organisms?
inflammatory response
How do chemical mediators assist in the inflammatory response? (5)
minimizing blood loss
walling off the invading organism
activating phagocytes
promoting formation of fibrous scar tissue and regeneration of injured tissue
What facilitates the inflammatory response?
physical and chemical barriers that are part of the human organism
What enhances activation of the natural immunity response?
processes inherent in physical and chemical barriers
What does physical surface barriers include?
intact skin
mucus membranes
cilia of the resp tract
What do physical surface barriers do?
prevent pathogens from gaining access to the body
What filter and clear pathogens from the upper resp tract?
cilia
coughing
sneezing
What are some chemical barriers of the natural immune response?
mucus
acidic gastric secretion
enzymes in tears, saliva
substances in sebaceous & sweat secretions
What do these chemical barriers do?
act in a nonspecific way to destroy invading bacteria and fungi
How are viruses countered?
"other means" - interferon
What does regulation of the immune response involve?
balance and counterbalance
How can dysfunction of the natural immune system occur?
when immune system components are inactivated or when they remain active long after their effects are beneficial
When is a person considered immocompromised or immunodeficient?
If an immune response fails to develop and clear an antigen sufficiently
What results if an immune system is overtly robust or misdirected?
allergies
asthma
autoimmune disease
What is the basis of many autoimmune disorders?
immune systems recognition of one's own tissues are "foreign" rather than as self
Which cells mediate the inflammatory response in microbial infections?
T cells
cytokines
How is the inflammatory response regulated?
cytokines
transformation of macrophage activation-inhibiting growth factor
What holds the promise of preventing graft rejection and aiding the body in eliminating cancerous or infected cells?
research on immunoregulation
When is acquired immunity acquired?
when pathogenic microbes resist natural immunity
How does acquired immunity usually develop?
prior exposure to antigen -
(1) immunization
(2) contracting a disease
How long after the exposure does the body produce an immune response sufficient to defend against reexposure?
weeks or months
What does acquire immunity rely on?
recognition of specific foreign antigens
What are the two mechanisms of the acquired immune response?
(1) cell-mediated response - T cell activation
(2) effector mechanisms - B cell maturation, antibodies
What are the two types of acquired immunity?
active -
passive
Which type of acquire immunity involves the immunologic defenses developed by the person's own body?
active
How long does active immunity last?
years or even a lifetime
What is a temporary immunity transmitted from a source outside the body?
passive immunity
What are examples of passive immunity?
immune globulin or immunity resulting from the transfer of antibodies from the mother to an infant in utero or through breast feeding
What do active and passive acquired immunity involve?
humoral & cellular immunologic responses
What are the body's three means of defense when under attack?
phagocytic immune response
humor or antibody immune response
cellular immune response
What is the first line of defence?
phagocytic immune response
What does the phagocytic immune response primarily involve?
WBCs (granulocytes & macrophages)
Which types of granulocytes are only weakly phagocytic?
eosinophils
Which type of cells also remove the body's own dying or dead cells?
phagocytes
What do dying cells in necrotic tissue release?
substances that trigger an inflammatory response
What is apoptosis?
programmed cell death
What is the body's way of destroying worn-out cells?
apoptosis
What is the second protect response?
humoral or antibody response
What does the humoral response begin with?
b lymphocytes
What can B cells transform themselves into?
plasma cells which become antibodies
What are antibodies?
highly specific proteins that are transported in the bloodstream
attempt to disable invaders
What is the third mechanism of defense?
cellular immune response
Which cells can turn into special cytotoxic (or killer) cells that can attack pathogens?
T cells (cytotoxic T cells)
What is the structural part of the invading or attacking organism that is responsible for stimulating antibody production?
antigen
Are all antigens naturally immunogenic?
No
Why would the body produce a number of antibodies in response to a single single bacterium?
The bacterium has a number of antigens on its surface
What happens once an antibody is produced?
it is released into the bloodstream and carried to the attacking organism
What does the antibody do once it "finds" the antigen?
combines with it
binding with it like a puzzle piece
What are the four well-defined stages in the immune response?
1. recognition
2. proliferation
3. response
4. effector
What is the initiating event in any immune response?
recognition of antigens as foreign by the immune system
What organs play the role of surveillors in the recognition process?
lymph nodes & lymphocytes
Where are lymph nodes distributed?
internally throughout the body, in the circulating blood, externally near the body's surface
What do the lymph nodes continuously discharge?
small lymphocytes
What is the continuous circuit of the lymphocytes?
blood > lymph nodes > blood > lymph nodes
What play an important role in helping the circulating lymphocytes process the antigens?
macrophages
Which immunity cells have receptors for antibodies and completment?
macrophages and neutrophils
What do macrophages and neutrophils coat microorganisms with to enhance phagocytosis?
antibodies, completement
What triggers the proliferation phase?
circulating lymphocytes containing antigenic messages return to nearest lymphocyte
What do the "sensitized" lymphocytes stimulate once in the node?
T & B lymphocytes to enlarge, divide, proliferate
T cell > cytotoxic T cells
B cell > produce and release antibodies
What does the response stage begin with?
the production of antibodies by the B lymphocytes in response to the specific antigen
What stimulates the resident lymphocytes to become cells that attack microbes directly?
cellular response
What are microbe-attacking transformed lymphocytes known as?
cytotoxic (killer) T cells
What type of antigens induce a cellular response?
viral (rather than bacterial)
What are the manifestations of the cellular response?
increasing number of lymphocytes
What is lymphocytosis?
increased T lymphocytes
When is lymphocytosis seen in the blood tests of patients?
viral illness
example: infectious mononucleosis
When does the humoral response predominate in the immune response?
bacterial pneumonias & sepsis
When does the cellular response predominate?
transplant rejection
Most immune responses to antigens involve which acquired responses?
both - humoral & cellular
What happens in the effector stage?
either the antibody of the humoral response or the cytotoxic T cell of the cellular response reaches and connects with the antigen on the surface of the foreign invader.
What characterizes the humoral response?
production or antibodies by B lymphocytes in response to a specific antigen
What is the role of the macrophages and the special T lymphocytes in the humoral immune response?
recognition
What are the ways in which B cells recognize and response to invading antigens?
1. directly triggering antibody formation
2. with T cell assistance. T cell returns antigenic material to nodes.
Why does a person who is repeatedly exposoed to the same antigen get an exaggerated and rapid immune response?
B lymphocyte clones with a memory for the antigen.
Memory Cells
What are antibodies?
large proteins
immunoglobulins
What are the subunits of antibodies?
light and heavy peptide chain held by disulfide bonds
each unit has a binding site for the antigen and complement system molecule.
How do antibodies defend against foreign invaders?
1. agglutination
2. opsonization
3. promote the inflammatory response
What are the combining sites of antibody molecules?
Fab fragments
What is agglutination?
cross-linking antigens causing them to bind or clump together
facilitates phagocytosis
What is opsonization?
antigen-antibody molecule is coated with a sticky substance
facilitates phagocytosis
How do antibodies promote the inflammatory response?
promoting the release of vasoactive substances
e.g. histamine, slow-reacting substances
What are the (5) different types of immunoglobulins the body can produce?
IgG - 75%
IgA - 15%
IgM - 10%
IgD - .2%
IgE - .004%
What are the major characteristics of IgG?
appears in serum & tissues
assumes a major role in bloodborne and tissue infections
activates the complement system
enhances phagocytosis
crosses the placenta
What are the major characteristics of IgA?
appear in body fluids
protects against resp, gi and gu infections
prevents absorption of antigens from food
passes to neonate in breast milk for protection
What are the major characteristics of IgM?
mostly in intravascular serum
first immunoglobulin produced in response to bacterial and viral infections
activates the complement system
What are the major characteristics of IgD?
Appears in small amounts in serum
possibly influences B-lymphocyte differentiation, but role is unclear
What is the characteristic of IgE?
appear in serum
takes part in allergic and some hypersensitivity reactions
combats parasitic infections
What is the antigenic determinant?
portion of the antigen involved in binding with the antibody
When do the most efficient immunologic responses occur?
whent he anitbody and antigen fit like a lock and key
What is cross reactivity?
poor fit of an antibody to antigen
antibody made in response to a diff antigen
Why does streptococcus pyogenes (acute rheumatic fever) sometimes cause heart valve damage?
cross reactivity
the antibody produced cross-reacts with the pts heart tissue - heart valve damage.
Which cells are primarily responsible for cellular immunity?
T lymphocytes
What type of cells continuously migrate from the bone marrow to the thymus gland?
stem cells
Which type of cells represent foreign invaders directly rather than by producing antibodies?
T cells
How are cellular reaction initiated?
by the binding of an antigen to an antigen receptor located on the surface of a T cell
Once the T cell identifies an antigen?
carry the antigenic message to the lymph nodes
T cell proliferation stimulated
What are the different types of T Lymphocytes?
effector T cells
suppressor T cells
memory T cells
Which T cell type are activated on recognition of antigens and stimulate the rest of the immune system?
Helper T cells
Which T cell type secrete cytokines when activated?
Helper T cells
What do cytokines attract?
activated B cells
cytotoxic T cells
NK cells
macrophages
Which cell type determine whether the immune response will be the production of antibodies or a cell-mediated immune response?
Helper T cells (through the production of specific cytokines)
Which T cell type attack the antigen directly by altering the cell member and causing cell lysis?
Cytotoxic T cells
Killer T cells
What do cytotoxic T cells release?
cytolytic enzmes
cytokines
What category of cytokines can recruit, activate, and regulate other lymphocytes and WBCs?
lymphokines
What is delayed-type hypersensitivity an example of?
immune reaction that protects the body from antigens through the production and release of lymphokines
Which cell type have the ability to decrease B-cell production?
suppressor T cells
What is the purpose of being able to decrease of B-cell production?
keep immune system response at a level that is compatible with health
What types of T cells are responsible for recognizing antigens from previous exposure and mounting an immune response?
Memory cells
What lymphocytes assist in combating organisms?
Null lymphocytes
NK cells
Which type of lymphocyte are a subpopulation that destroys antigens already coated with antibody?
null lymphocytes
Which cells have special receptor sites on their surface that allow them to connect with the end of antibodies?
Null cells
What is antibody-dependent, cell-mediated cytotoxicity?
null lymphocytes have a special receptor on their surface that allow them to connect with antibodies
Which class of lymphocytes recognize infected and stressed cells?
NK cells
How do NK cells respond to infection?
killing infected/stressed cells and by secreting macrophage-activating cytokine
What cell type contributes to the differentiation of null and NK cells?
helper T cells
What is complement?
circulating plasma proteins
What is complement made?
the liver
What is the complemented activated?
antibody connects with its antigen
What is the role of the complement?
defend against microbes
How is destruction of an invading or attacking organism or toxin achived?
-binding of the antibody and antigens
-activation of complement
-arrival of killer T cells
-attraction of macrophages
What are the three major physiologic functions of the complement system?
-defending the body against bacterial infection
-bridging natural and acquired immunity
-disposing of immune complexes and the byproducts associated with inflammation
Why is the complement cascade important?
modifies the effector arm of the immune system
What important events does activation of the complement allow for?
removal of infectious agents
initiation of the inflammatory response
What points of modication improve the inflammation response and infectious agent removal?
-enhancement of chemotaxis of macrophages & granulocytes
-alter blood vessel permeability
-change blood vessel diameter
-cause cells to lyse
-alter blood clotting
What three pathways activate the complement cascade?
1. classic
2. lectin
3. alternative
What triggers the classic pathway?
1. antibodies bind to microbes (classic)
part of the humoral type of adaptive immunity
What triggers the lectin pathway?
2. plasma protein + terminal mannose residue on glycoproteins of microbes (lectin)
What triggers the alternative pathway?
complement proteins are activated on microbial surfaces
part of the natural immunity
What contributes to the recruitment of inflammatory cells?
completement components
prostaglandins
leuokotrienes
other inflammatory mediators
What do complement components and inflammatory mediators contribute to?
recruitment of inflammatory cells
What else (other than complement and other meditators) contribute to the recruitment of inflammatory cells?
chemokines (group of cytokines)
What type of cells pass through the vessel walls to accumulate at the site of infection?
activated neutrophils
What do activated neutrophils do at the site of infection?
phagocytose complement-coated microbes
What is thought to be the cause of many autoimmune diseases?
continued or chronic activation of complement (which in turn results in chronic inflammation)
What blood cells have complement receptors?
RBCs
platelets
What is an immunomodulator?
affects the host via direct or indirect effects on one or more components of the immunoregulatory network
What are two of the more commonly used immunomodulators?
interferons
colony-stimulating factors
What are interferons?
biologic response modifier
nonspecific viricidal protein
naturally produced by the body
capable of activating other parts of the immune system
Interferons have anti-what properties?
antiviral
antitumor
Interferons are produced by what type of immune system cells?
T lymphocytes
B lymphocytes
macrophages
How are interferons thought to modify the immune response?
suppressing antibody production & cellular immunity
facilitate the cytolytic role of macrophages & NK cells
What are interferons used to treat?
immune-related disorders (MS)
chronic inflammatory conditions (chronic hepatitis)
tumors & AIDS (maybe)
What are colony-stimulating factors?
group of naturally occurring glycoprotein cytokines
What do CSFs do?
regulat production, differentiation, survival, activation of hematopoietic cells
What stimulates RBC production?
erythropoietin
What plays a key reulatory role in the growth and differentiation of bone marrow cells?
thrombopoietin
What stimulates the growth and survival of eosinphils and basophils?
interleukin-5 (IL-5)
What serves as stimuli for multiple hematopoietic cell lines?
stem cell factor
IL-3
What stimulating factors all serve as growth factors for specific cell lines?
granulocyte colony-stimulating factor
granulocyte-macrophage colony-stimulating factor
macrophage colony-stimulating factor
What does genetic engineering use?
recombinant deoxyribonucleic acid (DNA) technology
What are the two facets of genetic engineering?
1. combine genes from one type of org with genes from another
2. gene therapy
What is the advantage of mixing genes?
allows cells and microorganisms to manufacture proteins, monokins, lymphokines that can enhance immune system function
What is the advantage of gene therapy?
restoring normal gene function if particular gene is abnormal or missing
What are stem cells capable of?
self-renewal
differentiation
What are totipotent cells?
stem cells with the tremendous capacity to self-renew and differentiate
What are pluripotent cells?
embryonic stem cells
give rise to numerous cell types that are able to form tissue
When does an assessment of immune function begin?
health history
physical exam
What areas are assessed with regards to immunity?
nutritional status
immunizations
allergies
disorders and disease states
surgeries
medications
blood transfusions
What should be the focus of the physical exam?
general inspection
palpation of lymph nodes
examinations of skin, mucous membranes, resp, gi, gu, cv, neurosensory & musculoskeletal
What are alerting respiratory signs and symptoms with regards to immune dysfunction?
changes in rate
cough (dry or productive)
abnormal lung sounds (wheeze, crackle, rhonchi)
rhinitis
hyperventilation
bronchospasm
What are alerting cardiovascular signs and symptoms with regards to immune dysfunction?
hypotension
tachycardia
dysrhythmia
vasculitis
anemia
What are alerting gi signs and symptoms with regards to immune dysfunction?
hepatosplenomegaly
colitis
vomiting
diarrhea
What are alerting gu signs and symptoms with regards to immune dysfunction?
freq & burning on urination
hematuria
discharge
What are alerting musculoskeletal signs and symptoms with regards to immune dysfunction?
joint mobility, edema, pain
What are alerting SKIN signs and symptoms with regards to immune dysfunction?
rashes
lesions
dermatitis
hematomas or purpura
edema or urticaria
inflammation
discharge
What are alerting neurosensory signs and symptoms with regards to immune dysfunction?
cognitive dysfunction
hearing loss
visual changes
headaches & migraines
ataxia
tetany
What are the differences in the immune system functions of men and women?
higher incidence of autoimmune diseases in women
sex hormones
What is the role of sex hormones in the immune system?
lymphocyte maturation, activation, synthesis of antibodies and cytokines
What happens in autoimmune disorders with regards to sex hormones?
expression of sex hormones is altered = immune disregulation
What is immunosenescence?
aging stimulates changes in immune system
progressive deterioration in the ability to respond to infections
What are some affects of age on the immune system?
-self-renewal capacity of blood cells decreases
-decline in phagocytes & their activity
-NK cells cytotoxicity decreases (decreased humoral immunity)
-decreased vacine efficacy (decreased acquired immunity)
-increase incidence of autoimmune diseases
What type of immunity continues to function relatively well as we age?
natural immunity
What is a suspected reason for the increase in autoimmune disorders in the aged?
1. antibodies can't distinguish between self and nonself
What is a suspected reason for the high incidence of cancer in the aged?
surveillance system can't recognize mutant or abnormal cells
What causes gastroenteritis and diarrhea int he eldeR?
decreased gastric secretions & motility allow normal flora to proliferate = infection
What contributes to the increased risk for UTI in the elderly?
decreased renal circulation, filtration absorption and excretion
prostatic enlargement or a neurogenic bladder
What permits the growth of microorganisms in the bladder?
urinary stasis
What effect does prolonged exposure to tobacco and environmental toxins have on pulmonary function?
impairs it - decreases elasticity, cilia effectiveness, ability to cough
What happens to the skin of an elderly person?
thinner and less elastic
What does impaired skin integrity predispose older people to?
infection from organisms that are part of normal skin flora
What are some secondary changes experienced int he aged?
malnutrition
poor circulation
breakdown of natural mechanical barriers (skin)
peripheral neuropathy
decreased sensation, circulation
What may lead to stasis ulcers, pressure ulcers, abrasions and burns?
increased peripheral neuropathy
decrased sensation, circulation
What is imperative with the older pt?
continual assessment of the physical and emotional status
What is a key determinant of human health?
relationship of infect to nutrition status
Deficiency of what vitamin has been assocaited with incrased risk of common cancers, autoimmune disease and infectious diseases?
Vitamin D
Which micronutrient may have widespread negative effects on the immune response?
zinc, copper, manganese, selenium
Which nutritent may have benefcial or deleterious effects on the immune system?
iron
Micronutrients and what other nutrient have a recognized effect on the response of cells and tissues to hypoxic and toxic damage?
fatty acids
Diets high in which oil are not as immunosuppressive as those high in fish oil?
olive oil
What does depletion of protein reserves result in?
atrophy of lymphoid tissue
depression of antibody response
reduction in the number of circulation T cells
impaired phagocytic function
What alteration in nutrition can occur during periods of infection or serious illness?
depletion of protein, fatty acid, vitamin, trace elements
What affect does nutrition status have on postop recovery?
delayed
more severe infections
delayed wound healing
What must the nurse assess in regards to nutrtion?
nutritional status
caloric intake
quality of foods ingested
Diet and exercise can alter the risk of what developing?
cancer, as well as other chronic diseases
What type of infections have a significant inmpact on health and causes a wide range of deases (oral & genital)?
Herpes simplex virus (HSV)
What immunizations/vaccination does a nurse ask about?
influenza
pneumococcal disease (Pneumovax)
pertussis
herpes simplex
measles, mumps
What should be initiated during the immunization discuss?
the importance of adhering to the recommended schedule
What is assess and documented with regards to resp infections?
known past or present exposures to TB
dates and results of any tuberculin tests & chest xrays
What are the tuberculin tests?
purified protein derivative (PPD)
tine test
What STDs is it important a nurse assess for?
hepatitis A, B, C, D, E viruses
HIV
gonorrhea
chlamydia
HPV
syphilis
What can alter the nurse that the pt may have been exposed to HIV or hepatitis?
history of STDS - gonorrhea, syphilis, HPV, chlamydia
plus
Where are all medication and food allergies listed?
allergy alert sticker and place on the front of the pts health record or chart
What do you ask a pt in regards to allergies?
-types of allergens
-symptoms experienced
-season variations
-history of testing & treatments (inc OTC)
-treatment effectiveness
Specific autoimmune disordesr affect approximately what percent of the U.S. population?
5%
What are autoimmune disorders more common in women?
estrogen enhances immunity
What sex hormone tends to be immunosuppressive?
androgen
What is the fifth leading cause of death by disease in females of reproductive age?
autoimmune disorders
What are some autoimmune disorders to ask about?
lupus erythematosus
rheumatoid arthritis
multiple sclerosis
psoriasis
What strongly suggests a genetic predisposition to moer than one autoimmune disease?
occurence of different autoimmune diseases within a family
What contrubutes to the development of cancers?
immunosuppression (however cancer is immunosuppressive & as is its treatment)
How do tumors prevent the immune system from attack it?
releasing antigens into the blood and preventing the antibodies from attack the tumor itself
also they have blocking factors that prevent killer T cells from attacking it
Which cancers are associated witha ltered production and function of WBCs and lymphocytes?
hematologic cancers - leukemia, lymphoma
What does radiation do?
destroys lymphocytes
decreases ability to mount an effective immune response
What determines the extent of immunosuppression caused by radiation?
size and extent of the irradiated area
What may leave the body totally immunosuppressed?
whole-body irradiation
What affects bone marrow function, destryoing cells that contribute to immune system function?
chemotherapy
How might chronic illness contribute to immune system impairments?
...
What is renal failure associated with?
deficiency in circulating lymphocytes
What else may alter immune defenses?
acidosis
uremic toxins
What factors cause the increased incidence of infection in diabetes?
vascular insufficiency
neuropathy
poor control of serum glucose levels
Why are recurrent resp tract infections associated with COPD?
altered inspiratory & expiratory function
ineffective airway clearance
Why is a history of organ transplantation noted? (also removal of spleen, lymph nodes, thymus)
place pt at risk for impaired immune function
What do major burns cause?
impaired skin integrity
compromise body's first line of defense
loss of large amnts of serum, inc proteins and immunoglobins
What do the stressors associated with surgery or injury stimulate?
cortisol release from the adrenal cortex
What does increased serum cortisol contribute to?
suppression of normal immune response
What drugs in large doses can cause immunosuppression?
antibiotics
corticosteriods
cytotoxic agents
salicyclates
NSAIDS
anesthetic agents
What is a history of blood transfusion obtained?
previous exposure to foreign antigens through transfusion may be associated with abnormal immune function
also small risk of HIV
What "positive" lifestyle factors can also negatively affect immune function?
rigorous exercise
competitive exercise (causes stress)
MADE WORSE - if exercise is done in a stressful environment
What are psychoneuroimmunologic factors?
bidirectional between the brain and immune system
immune response regulated by neuroendocrine influences
What is the relationship between lymphocytes and the neuroendocrine system?
lymphocytes and macrophages have receptors capable of responding to neurotransmitters & endocrine hormones
lymphocytes can produce & secrete adrenocorticotropic hormone & endorphine like compounds
What can brain cells recognize?
(esp in hypothalamus)
-prostaglandins, interferons, interleukins, histamine, serotonin (inflammatory response mediators)
What biobehavioral strategies can positively influence a measurable immune response?
positively influence relaxation, imagery techniques, biofeedback, humor, hypnosis, conditioning
What may be performed to assess a pts immune competence?
blood tests
skin tests
bone marrow biopsy
What drug classification causes bone marrow surpression?
antibiotics
What drug classification can cause agranulocytosis and leukopenia?
antithyroid drugs
some NSAIDs
What drug classification inhibits prostaglandin synthesis or release?
NSAIDs
What drug classification causes immunosuppression?
adrenal corticosteriods
antineoplastic agents (cytotoxic agents)
Antimetabolites
When is an ideal time for the nurse to provide counseling and education?
when pt is waiting for results of dx tests and is anxious.