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83 terms

Immune system disorders

STUDY
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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