Transcript Immune System Student Outline

The Immune System
John G. Summerville RN, MN
Main reference used: Lewis unless other wise indicated.
What organs are part of the
immune response?
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B____ M____
W___
L_______d tissue
Th_____ gland
S__________
L_____ nodes
Tonsils (similar in gi, resp,
reproductive)
• L_____
What cells are involved with an
immune response?
• P______, Mo_________ [in the blood]
• L______ __ and __, T cytotoxic cells, T
Helper & T Suppressor cells, Natural Killer
Cells [in the lymph system]
• C_____ the chemical messengers which
coordinate the response of the immune
cells.
Where do the blood cells come from?
Where are the Lymph Nodes?
What is Immunity?
• Responding to _______ substances or
_____ proteins.
What is an antigen?
• A substance ________________________
What are the types of immunity
or How can immunity develop?
Active
Natural:
Artificial:
Passive
Natural:
Artificial:
An example of A____ A_____
Immunity…immunizations
 T_____ or Clostridium Tetani = a gram positive,
spore-forming, anaerobic bacterium
 Suppresses spinal and brain-stem u___ m____
n______ with a 50% mortality rate
 Develops as a result of p_______ wounds,
human/animal bites, dirty needles, GSW's and
other open wounds
T_______
 Clinical findings:
 Treatments:
 Tetanus I______
G____ (if NEVER
immunized) [P_____
A_________________
_immunization]
 Tetanus t______
booster every 10 years
[A_____ A_______
Immunization]
What diagnostic tests can be done to
the Immune system?
• S
Tests
• Radio
: a collection of lab procedures based on
antigen-antibody reactions.
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(ANA): identifies the presence of antibodies
produced against the body's own cell nuclei. Helps
diagnose autoimmune diseases.
• C
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Function Tests: T-cells and B-cell counts.
• E
: separates charged particles in a solution.
Measures proteins, immunoglobulin, etc. EXPENSIVE!
• E
(E L Im
Assay): a sensitive, quick look for
antibodies to viral or bacterial infections. Can show
antibodies to HIV, and is the first test done to see if there is
HIV infection.
How
does the
immune
system
respond
to a
______?
What is H_____ vs C___
M________ Immunity?
What is the effect of A____on
the Immune system?
• Th___ ____creases in size and activity
• ____crease in precursor T cells for response
to new antigens…___________________
• _______________
What are the Types of
Hypersensitivity Reactions?
_____: A____
Response
• Antibody - IgE
• Mediator of injury –
H________
What can Happen When you stop
to smell the Roses?
What tests are done to determine
Type 1 allergies?
• _________________
If you Get bit by a Fire Ant,
What can happen and what
symptoms can occur?
Anaphylactic
Response
urticaria
angioedema
Erythema
Treatments
Local or Systemic Anaphylactic Response
Local treatments
Systemic Treatments
Identify allergans and control them
Quick Identification
Stress Management
Airway Maintenance
Medications
Control Allergen
Antihistimines
Decongestants
Corticosteriods
Mast Cell stabilizer
Treatment for Shock
Medications
Epinephrine
Plasma Expanders
Fluids
Dopamine
Vasopressors
Benedryl [diphenhydramine]
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You can type here is you like
Type _: C_____ Reaction
• Antibody – IgG and IgM
• Mediators of injury – Neutophils &
Compliment
• Example: A____He_____ Bl____ transfusion
reaction
– Blood reactions can be ___________________
What is the ABO Blood Type
System? (there are 27 different systems)
What is an Rh Factor?
• Rh factor acts as __ ______ in Rh-negative
persons, causing the production of a_______.
• If Rh-positive blood is transfused into an Rhnegative person, the latter will gradually develop
a______ called anti-Rh a________, that attach to
the Rh-positive red blood cells, causing them to
a________ (c_______)
What are the kinds of Blood
Products are available?
• P___ R___ B__ C___ (PRBC’s) 300mls.
(anemia & severe blood loss)
• F____ RBC’s (reactions to WBC or blood proteins)
• F____ F____ P____ (hypovolemia, clotting factors,
replacement)
• P_____ (low platelet levels)
• A______ (plasma expander, shock, protein replacement)
• C____________ (clotting factor replacement)
What adverse reactions can occur
with blood transfusions?
• F______ most common adverse reaction (WBC, platelets, proteins)
– Sudden f___r, c____s, a____y, flushing, muscle pain
• A___ H___ (antibodies from host attack new RBCs and they b____)
– Chills, fever, flushing, t______a, t_______a, hypo____, s___, c__ arrest,
low b___p__, dark u___, renal f___, j___
• Mild Allergy (plasma proteins)
• Ana_________ and Severe Allergy (plasma proteins)
• S______ (bacteria)
– Rapid fever, chills, vomiting, diarrhea, sever hypotension or shock
• Circulatory O_______ (fast infusion for person)
– Hyper________, headache, tachycardia, pul______ e_____, cough,
dyspnea
What Pre Treatments can be
given?
What are the safe Nursing practice steps for
giving blood and managing adverse reactions?
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Verify correct b___ and patient
Start blood on t___, end blood on time
Vital signs _____ to giving
Remain with patient _____ mins and observe for signs of a___
reaction
S___ b___ for fever or other symptoms (more blood more reaction)
D________ blood and IV tubing and s____ a Normal Saline Drip
Frequent vital signs
Assess & Respond to signs and symptoms
Contact physician
Collect b_____ and u____ sp_____ if needed
Type ______________ Reactions
• Antibody – IgG and IgM
• Mediator of injury – Neutrophils and
Complement
• Example: ____________________
What is ‘Autoimmunity’ and what
causes it?
What are some Examples of
Autoimmune Diseases
• Systemic Diseases: ______________________,
rheumatoid arthritis, scleroderma
• Blood Diseases: Autoimmune hemolytic anemia,
idiopathic, thrombocytopenia purpura
• Heart: Rheumatic fever
• Endocrine: Addison's disease, thyroiditis, Graves Disease,
hypothyroidism
• GI: Pernicious anemia, ulcerative colitis (Crohn's disease)
• CNS: Multiple sclerosis, Guillain-Barre
• Muscle: Myasthenias gravis
Systemic Lupus Erythematosus 1
• Mostly a _______ disease
• Characterized by periods of “_____" and
“________" .
• Immune system alterations: defective
phagocytosis, deficient antibody production
• Patho: deposit of a______- a_____ c_______ in the
c______ tissue causing a generalized
inflammatory response.
SLE
Diagnostic ‘Clues’
• The ‘great imitator’ is Hard to diagnose, because it
may affect only one organ (such as skin or kidneys)
or all body organs and mimics many other diseases.
• Blood Tests
– ____________________________ (ANA): 90% of people
have positive ANA
– Other auto________ tests (anti-DNA, anti-Sm, anti-RNP,
anti-Ro [SSA], anti-La [SSB])
– Erythrocyte sedimentation rate (ESR)
– Complement levels
• Kidney Assessments
– U_______
– K_____ b__________
• Skin biopsy
S_________ L____ Erythematosus 2
• Symptoms: photo________ (almost 100%),
fa____(81%), fe_____ (60%), chest pain
(pericarditis 48% or pleuritis 50%), joint and
muscle pain (50%), weight loss (40%), b______
r_____ across bridge of nose and cheeks (40%)
• V________with r____ f_____ are common caused
by a_________ of immune complexes within the
blood vessel walls causing I________ within
vessels.
• Treatment:
SLE Signs
and
Symptoms
Type ______________________
Reaction
• Antibody – None
• Mediators of injury: Cytokines, T cytotoxic
cells, Monocytes, macrophages, lysosomal
enzymes.
• Example: _______________
Organ Transplant
• Organ donation is voluntary, families must
____________________.
• U_________ An______ Gift Act
– People can l_____ d_______ organs after death
• Tell your family of your wishes for organ
donation
• All hospitals participate in organ
procurement
What organs can be transplanted?
• How Big is the Need?
– HHS Secretary Mike Leavitt announced that
26,984 Americans received an organ transplant
last year [2004], setting a new national record.
– http://www.unos.org/
• What is the need in Georgia?
– http://www.lifelinkfound.org/gawait.asp
HLA’s Self Antigens
Anti________ and Tis________
• ___________ are responsible for recognizing and
rejecting alien body tissues, or, more accurately,
the ________________________.
• There are more than 100 antigens on tissue
cells in humans resulting in approximately
30,000,000 possible _______________________.
• The chances of two unrelated people having the
same HLA genotypes is
____________. Subsequently, ___________________
between organ donors and recipients are
common.
What test is done to determine if
a Type 4 Hypersensitivity
reaction is possible with an
Organ Transplant?
His_________________
• H___le________ a_________ (HLA type)
• HLA-A, HLA-B, HLA-C, HLA-D,HLA-DR
• Present on ____________ and platelets
– Series of linked genes on the 6th
chromosome
– A genetic marker for self
– Inherited from _____________
– Associated with some ____________
What are the Types of Host Organ
Rejection (host cells attack transplant)?
• ____________ occurs in minutes to hours, violent attack
of the organ with no treatment and organ is lost.
• ______________ occurs days to one week, antibody attack
with no treatment and the organ is lost.
• ____________ occurs after one week, (most common
type) which does respond to immunosuppression drugs
• _____________ a gradual deterioration or organ function
as the result of acute rejection episodes. This causes
scaring and infarction of blood vessels.
What is it called when the
transplanted organ attacks the
host?
G___ __ _____ Disease
• When the organ or blood cells (____) _______________, hard to stop
when it starts.
• Occurs 7-30 days _______________ or blood transfusion
• Patho: ______________________ host’s skin, liver, and GI tract
• Signs:
– H_____ and F________ erythema with pain or itching and
s_________ of skin
– ________ gives diarrhea, pain, bleeding, malabsorption
– Liver attack shows J_________, mild to severe
– Infections and pneumonia develop
• Treatment: prevention is best with _______________________.
Immuno___________ Disorder
• ___________________
• Primary [Improperly formed = Genetics]
• Secondary [caused by illness of disease]
– ___________________
– Medications
Immunosuppressive Medications
• Calcineurin Inhibitors
– Suppress interleukin 2 and stop T cell production
[cyclosporines Sandimmune]
• C______________
– Suppress cytokines and T cell activation [prednisone]
• Mycophenolate Mofetil
– Inhibits production T & B cells
• Sirolimus
– Suppresses B cell production of antibodies
Immune System Destruction
• Example: Human Immunodeficiency Virus
What is the significance of HIV /
Aids?
• Who is most affected?
• How Big is the Health Problem?
How is HIV transmitted?
• Contact with ________________________
• _____________________________
• ____________transmission is the most
common.
How does HIV damage the
immune system?
What are the changes in the Viral
Load and CD4 Count over time?
Phases of HIV to AIDS
How is HIV diagnosed?
• Blood testing for ___________ to HIV.
• Enzyme-Linked Immunosorbent Assay
(________) [antibodies that bind with HIV
antigens]
• History assessed for ___________
• E_____ is repeated if first E____ is _________
• W______ B____ (immunofluoresence assay IFA)
is done if _______ positive ______ tests
What are the signs and symptoms
of HIV infection?
• Initially flu like symptoms then _________
• __________ for a while….mean time for
Aids to develop ____years.
What are the
clinical
manifestations
of _____?
How is Acquired
Immunodeficiency Syndrome
(AIDS) Diagnosed?
What are opportunistic infections?
• Classic Examples…
What groups of drugs are used to
control the HIV?
• Antiretroviral drug therapies (ART)
• _____________ reverse transcriptase
inhibitors (NNRTIs)
• _____________
• ____________ reverse transcriptase
inhibitors (NRTIs)
• _______________________
• ___________________________
Treatment Protocol!
• Combinations of Medications are
recommended to prevent drug
resistance
• Balance with individual response
How do we know the most
current treatment guidelines?
What are the general broad
Nursing Goals with HIV AIDS?