Transcript Immune File
The Immune System Nursing 202 Janie McCloskey, RN, MSN Immunocompetence An intact and responsive system that provides adequate protection against invading bodies Invading organisms include • • • • Bacteria Virus’ Fungi Parasites Compromising Factors • • • • Diseases Age Stress Medical Therapy Immunity The state of responsiveness to invading organisms and foreign or tumor protein Functions of the Immune System Defense- Resists invading organisms and attacks foreign bodies Homeostasis- Digests and removes foreign cells Surveillance- Recognizes mutations in the body as foreign and destroys them Autoimmunity When the bodies proteins are changed due to chemicals or invading tissues. These cells are seen as foreign and can illicit a response Antigen A protein that illicits an immune response. The surface is slightly different than the bodies protein Common Antigens • • • • IMMUNITY Natural Acquired Active Passive Natural Artificial Natural Artificial Types of immunity Natural- Natural resistance • Race • Genetics • Species Acquired-Develops antibodies after exposure • Active • Passive Acquired Active Immunity Natural • Exposed to an antigen in the environment • Weeks to develop • Lasts a lifetime Artificial • Purposeful immunization with an antigen • Lasts several years • Need boosters Acquired Passive Immunity Natural • Antibodies are produced in one individual and given to another • Temporary Artificial • Actual antibodies are given • Temporary Parts of the Immune System Lymphoid Organs- Produce Lymphocytes located throughout the body • Central- Thymus gland and bone marrow • Peripheral • • • • Tonsils Lymph Tissue Lymph nodes Spleen Bone Marrow • All blood cells produced. Lymphocytes produced and then move to the peripheral tissue Thymus Gland • Site where T Lymphocytes distinguish self from nonself Lymph tissue-protects the body’s surface from microorganisms • • • • • Tonsils Gut Genital Bronchial Skin Peripheral Lymph Tissue (cont.) Lymph Nodes • Filtration of foreign material • Circulation of lymphocytes able to come in contact with antigen Spleen • Primary Source for filtering blood of foreign substances Cells of The Immune System Bone Marrow produces lymphocytes Differentiate into • B lymphocytes- Bursa equivalent lymphocytes • T lymphocytes- Thymus dependent cells • 70-80% of lymphocytes • Primarily responsible for immunity Immunity Response Humoral Immunity (from bone marrow) Bacteria enters the body-comes in contact with B lymphs- B lymphs become activechanges to plasma cell that secretes immunoglobulins-illicits an immune response IgM is the first antibody released for 4-8 days IgG is produced next and is longer acting 30 days • Neutralizes toxins • Agglutinates microorganisms Cell Mediated Immunity Immune response involving interaction of cells with an antigen (Usually T Lymphs) ***Immunity against pathogens that live inside cells Virus Contact Hypersensitivity Fungus Tumor immunity Rejection of transplanted tissues T Lymphocytes-CD3 (Mature T) CD4- Helper Cells-Help produce antibodies CD8- Cytotoxic cells-Attack antigens of the cell membrane and release cytolytic substances Factors Affecting the Immune Response Medications Usage- Use it and • Antibiotics loose it • corticosteroids Age-Decreased • NSAIDS number of T Lymphs • Cytotoxic Drugs Stress and DepressionDecreased lymphocyte Radiation-Decreased cell production stimulation Cancerimmunosuppressive Nursing History Susceptibility to infection Nutritional Status Integumentary System status Childhood diseases Chronic Diseases Autoimmune Disorders Environmental Factors Medication Intake Radiation Exposure Physical Assessment Signs of infection • Skin • Mucous Membranes Palpate lymph nodes • • • • • Size and tenderness Sublingual Cervical Axillary Inguinal What happens with a suppressed immune system? How would we know? TST Read by induration meaning- positive exposure If decreased immune system suspected, then need to make sure that the client can generate an immune reponse Use controls-which should always be positive (mumps and candidiasis) Altered Immune Response Hypersensitivity Reaction • When an immune response is overreactive and results in tissue damage • 4 Types • Type I – Anaphylaxis – Other • Type II – Cytotoxic • Type III – Immune Complex Reactions • Delayed Hypersensitivity Reactions Anaphylactic Reactions Allergen exposure results in IgE being produced. On subsequent exposure, the allergen links up with mast cells on the skin, lungs and nasal region. This stimulates the release of histamine, seratonin and bradykinin. Anaphalactoid Chemicals Constrict smooth muscles and increase vascular permeability • • • • • • • • anxiety laryngeal edema bronchospasm flushing nausea itching weakness edema of hands, face, feet Nursing Diagnosis Ineffective airway clearance Alteration in comfort Anxiety Causes Drugs Allergen Extracts Foods Venom Treatment Epinephrine Oxygen Antihistamines Steroids H2 Blockers Nursing Considerations Monitor Airway • • • • Ability to talk Ability to swallow External Swelling Drooling Assess Breathing • • • • Breath Sounds Work of breathing Position High Flow Oxygen Monitor Circulation • Vitals esp. P & BP • End organ perfusion • Capillary Refill Assist with alteration of Comfort • Medications • Hot and Cold Decrease Anxiety • Calm environment • Allow calm family to remain • Reassure frequently Client Teaching Know Precipitating factors • How to avoid • Know like substances Wear ID tags Carry ANAKit Desensitization Other Type I Reactions Allergies • The binding of the antigen and the antibody to the mast cells but the target organs are nasal mucosa, bronchi, skin or GI tract • Asthma • Allergic Rhinitis- Profuse watery discharge, sneezing, swollen eyes and conjunctivitis Type II Reactions Cytotoxic and Cytolytic Reactions • Actual binding of antibodies to cells that triggers a cascade of reactions that results in cytolysis or cytotoxsis • Hemolytic anemia – drugs – ABO blood group incompatibilities Type III Immune Complex Reactions Antibody-antigen complexes are formed that are extremely small and the phagocytic response isn’t effective. The complexes are deposited in the bodies tissues. This leads to inflammation and tissue destruction • Local vs Systemic • Immediate vs delayed • Serum Sickness • Systemic Lupus Erythematosis Systemic Lupus Erythematosis Long-term chronic condition that that is classifies as an multisystem inflammatory disease. Develops antibodies to own DNA and RNA as well as erythrocyte and platelet antibodies Results in an immunodeficient state with decreased WBCs (B-cells T-cells and phagocytes) Periods of exacerbation and TRIGGERS remission Drugs Oral contraceptives Viral infections Stress environmental pollutants overexposure to UV light XR exposure Pregnancy Symptoms Fever Weight loss Arthralgia Excessive fatigue Body System involvement Body Systems Musculoskeletal Morning Stiffness** Arthritic Joint symptoms Cardiopulmonary Pericarditis Atherosclerosis Pleurisy pain with abnormal PFT Skin Erythematous rash on face, neck and extremities Butterfly rash Alopecia Renal renal Failure Nephritis Body Systems (con’t) Central Nervous System Seizures Organic Brain Syndrome Hematalogic Anemia Mild leukopenia Thrombocytopenia Infection Increased susceptibility Pneumonia major cause of death Medical Management Anti-inflammatory Drugs- Mild symptoms • ASA • NSAIDS Antimalarials • helps skin problems Corticosteroids • During exacerbation Immunosuppressive therapy • Cyclophosphamide, azothioprine Plasmapheresis Pain related to disease process AEB joint discomfort and decreased mobility Analgesics-monitor effects Provide frequent rest periods Heat or cold Joint protection measures Nonpharmacological measure support Impaired skin integrity related to rash, uticaria and alopecia Keep skin clean and dry Use prescribed ointments only Avoid direct sunlight Assist with body image changes Acquired Immunodeficiency Syndrome (AIDS) Chronic, progressive immune function disorder caused by human immunodificiency virus (HIV) HIV Virus and Viral Load Retrovirus- RNA virus that replicates backwards RNA DNA Fragile Virus Readily attacks CD4 cells due to increased receptor sites • Normal CD4 Count 8001200 • Minor problems between 500 & 800 • Severe problems if <500 Amount of virus in the body fluid Nursing Diagnosis Risk for altered Health Maintenance Diarrhea Altered Mucous Membranes Psychosocial Issues Risk for Altered Health Maintenance Teach Causes • Homosexual with HIV partner • Heterosexual with HIV partner • Recipient of contaminated blood products • Hemophiliac • Sharing of IV needles • Mother child transfer Teach Methods of Transmission Sexual contact is the most common form of transmission Found in infected blood, semen, vaginal secretions, cerebrospinal fluid and breast milk. Not transmitted by casual contact Not found in tears, saliva, sweat or from insect bites Transmitted few days after inoculation through a lifetime How to reduce risk Abstinence Condoms Vaginal condoms No IV drugs Teach Stages of AIDS Acute Retroviral Syndrome-HIV specific antibodies are being formed • 1-3 weeks after infection lasting 1-2 weeks • Severe flu like symptoms • fever, pharyngitis, headache, malaise, nausea, rash Stage 2- Asymptomatic phase • Lasts approximately 10 years • Vague symptoms • low grade fever, headache, night sweats • Progresses into early symptomatic disease • • • • • CD4 count <500 Persistent fevers Chronic diarrhea Headache Fatigue AIDS-Final stage-Severe immunocompromised. Diagnosed with specific CDC criteria • CD4 count <200/microliter • Development of one of the following opportunistic infections • Fungal-Candidiasis, histoplasmosis • Viral-Cytomegalovirus (CMV), CMV retinitis, herpes simplex with chronic ulcers • Protozoa-Toxoplasmosis of the brain • Pneumocystis Carinii pneumonia (PCP) • Bacterial-Mycobacterium tuberculosis Opportunistic Infections: Fungal Aspergillosis Candidiasis TX: Fluconazole Coccidioidomycosis TX: amphoterican, Fluconazole Cryptococcal meningitis TX: amphoterican, Fluconazole Histoplasmosis VIRAL Cytomegalovirus - CMV CMV is a common organism found in esophagitis stomatitis colitis pneumonia neurological problems i.e. retinitis (late symptom) Development of one of the following opportunistic cancers • Invasive cervical cancer • Kaposis Sarcoma • Immunoblastic lymphoma Wasting Syndrome • loss of 10% or more of ideal body mass Dementia See Health Care Provider for early detection ELISA-Enzyme linked immunosorbent Assay. • Initial test for antibodies • Detects antibodies within 6 weeks Western Blot-More sensitive testing CD4 Count-Measures progression of the disease HIV Testing Ora Quick – rapid HIV-1 antibody test Early detection = Decrease spreading Treatments Education before and after exposure Abstinence Protection Follow up Medications Nutrition Support Medication Issues Cost of medications Availability of medications Medication regime (combinations) Medication resistance Side affects and reactions Antiretroviral medications: Antiretroviral Agents Reverse Transcriptase Inhibitors (NRTIs): Zidovudine Didanosine Protease Inhibitors : Saquinavir Ritinavir Inhibitors: Enfuvirtide (Fuzeon injections) Other medications Anti-infective Trimethoprim/ sulfamethoxazole Chemotherapy Antifungal Fluconazole Amphotericin B Side Effects • • • • • Fatigue Diarrhea Headache Nausea Pancreatitis Abnormal lab tests WBC decreased (neutropenia) Platelet counts decreased (d/t drug therapy) Anemia – chronic disease process and antiviral agents Altered liver function tests (LFT’s) - d/t disease process and drug therapy Diarrhea related to opportunistic infections and side effects Assess elimination pattern Bowel Sounds Intake and output Administer antimotility drugs Assess for dehydration Rehydrate- Oral & IVF • Prevent skin breakdown Altered oral mucous membranes related to candidiasis, dehydration and drug therapy Dental prophylaxis every 3 months antinfectives and analgesics Soft toothbrushes Saline rinse Psychosocial Issues Ineffective coping anxiety Change in body image Anticipatory grieving impaired social interaction Caregiver role strain Ethical dilemma for the health care provider