antigen
substance that induces the production of antibodies
B-cells
Humoral immunity or anti-mediated responses, result is production of antibody
t-cells
Are produced in the thymus; AKA Killer Cells; are responsible for non specific immunities; will destroy but not create antibodies.
neutrophils
A type of white blood cell that engulfs invading microbes and contributes to the nonspecific defenses of the body against disease.
they are the first to go to an area of inflammation
response to invasion
Involves 3 means of defense: phagocytic immune response, humoral or antibody responce, and cellular response
first line of defense: phagocytic immune response
-involves the WBC which have the ability to ingest foreign particle, and destroy the invading ag
Spleen
is a large, highly vascular lymphoid organ, lying in the human body to the left of the stomach below the diaphragm, serving to store blood, disintegrate old blood cells, filter foreign substances from the blood, and produce lyphocytes.
*RBC, WBC, and plat
Natural Immunity
-present at birth
-nonspecific
-first line of host defense
- An individual's own genetic ability to fight off disease
Acquired Immunity
-Immunity obtained either from the development of antibodies in response to exposure to an antigen(ACTIVE ACQUIRED IMMUNITY)
-as from vaccination or an attack of an infectious disease, (PASSIVE ACQUIRED IMMUNITY)
-or from the transmission of antibodies, a
the four stages of immune response
recognition
proliferation
response
effector
complement
A group of proteins that normally circulate in the blood in an inactive form and are activated by contact with nonspecific antigens such as foreign blood cells or bacteria
Recognition Stage
*recognition of antigens as foreign, or nonself by the immune system.
-this is the initiating event of the immune response
-involves the use of lymph nodes and lymphocytes
-recognition depends on specific receptor sites on the surface of lymphocytes
*they
Proliferation stage
1.circulating lymphocytes containing antigens return to nearest lymph node
2. once in the node, t and b cells inside node begin to enlarge, divide, and proliferate
3. cells then diffentiate into cytotoxic t cells or b lymphocytes
Response stage
In this stage the differentiated lymphocytes function in either a humoral or cellular capacity
*begins with the production of antibodies by Bcells
*T cells then attack microbes
-viral antigens cause a cellular response
T cells perform cellular function, B
Effector Stage
either the antibody of the humoral response or the cytotoxic (killer) T cell of the cellular response reaches and connects with the antigen on the surface of the foreign invader.
Humoral Immune Response
The branch of acquired immunity that involves the activation of B cells and that leads to the production of antibodies, which defend against bacteria and viruses in body fluids.
Cellular Immune Response
cell-mediated immunity; it occurs when T cells attach to foreign, antigen-bearing cells such as bacterial cells, and interact with direct cell-to-cell contact to destroy the antigen
Age-related changes in immunologic function
Immune:
impaired B and T lympocytes
failure of lymphocytes to recognze mutant cells
failure of immune system to recognize self with nonself
suppressed phagocytic immune response
GI:
- decreased gastric secretions
-altered nutritional intake
Urinary:
decre
Stem Cells
-capable of self-renewal and differentiation
-they can continually replenish the body's supply of RBC and WBCs
-totipotent(high capacity to self renew) and pluripotent( numerous capcity)
*has been used to treat SLE, RA, slclerodema, MS
Assessment of Immune System
Nutrition:
require high amount of protein, depletion of protein causes atrophy of lymph tissues. depression of anibody response, reduction in B and T cells
PMH of infection and immunization:
childhood or adult immunizations ( pneumovax)
childhood diseases
Medications with Effects on Immune system
ANTIBIOTICS:
bone marrow suppression
ANTITHYROID:
leukopenia, agrnulocytosis
NSAIDS
inhibit prostaglandin synthesis or release
ADRENAL CORTICOSTERIODS
immunosuppresion
ANTINEOPLASTIC (CYTOTOXIC) AGENTS
immunosupression
ANTIMETABOLITES
immunosuppression
Naturally Acquired Active Immunity
Exposed to/have disease and because of that, your body produces antibodies against it.
Naturally Acquired Passive Immunity
A baby recieves antibodies from the mother either during gestation or in early infancy
Artificially Acquired Active Immunity
harmless Antigens Are INTRODUCED to the body viA A vAccination to elicit the body's own immune response
Artificially Acquired Passive Immunity
Vaccine, either alive or dead sample of the antigen is injected into the body so that B cells can be produced, Stimulated immune response without full exposure to the disease
Primary Immunodeficiencies
predispose people to frequent severe infections, autoimmunity, and cancer
(nonhodgkins lymphoma)
-often common in IgA immunoglobulin
*majority of primary immunodeficiency are diagnosed at infancy
-large fraction not diagnosed until adolescence or early ad
Wiskott-Aldrich syndrome
Primary immunodeficiency characterized by thrombocytopenia and the absence of T and B cells
-mutations in gene coding in WAS protein
Signs and Symptoms:
thrombocytopenia, bleeding, infections, malignancies, frequent infections, small platelets, eczema
tre
hyperimmunoglobulinemia
primary immunodeficiency disease
WBC cannot initiate an inflammatory response to infectious organisms.
Signs and symptoms
bacterial,fungal, and viral infections, deep-seated cold abscesses
The 10 Warning Signs of Primary Immune Deficiency
-8 or more new year infections in 1 year
-two or more serious sinus infections within 1 yr
-two or more months on antibiotics with little effect
-two or more pneumonia within 1 yr
-failure of an infant to gain weight or grow normally
-recurrent,deep skin,
Managing an IVIG infusion
1. pretreat
2. obtain height and weight
3. assess vitals
4. premedicate with acetaminophen and diphenhydramine 30min before
5. adminster IV push slowly, DO NOT EXCEED 3mL/min
6. assess for adverse affects
What are averse Affects of an IVIG infusion
FLANK PAIN
SHAKING AND CHILLS, FEVER
DYSPNEA, TIGHTNESS IN CHEST
HEADACHE
LOCAL REACTION AT INFUSION SITE
HYPOTENSION (SEVERE)
*ASEPTIC MENINGITIS, RENAL FAILURE, THROMBOEMBOLIC EVENTS, AND ANAPHYLAXIS MAY OCCUR
Secondary Immunodeficiency
More common than primary
occur from an underlying disease process
they have a poor response to antibiotics
inablity to fight off infectins
get infections from normal flora
*known has immunocompromised hosts
Nursing Management for Patients with Immunodeficiencies
Assessment for symptoms of infection
promote good dental hygiene
look for sudden changes in physical status
vitals signs (PULSE AND RR SHOULD BE TAKEN FOR 60 SECONDS)
assess for change in: neuro, cough, skin, oral cavity
continuously monitor lab values
as
What are symptoms of infection in an immunocompromised patient?
be alert for: fever, cough, sob, difficulty swallowing, white patches in mouth, swollen lymph nodes, nausea, vomiting, persistent diarrhea, UTI, lesions,vaginal discharge, abdominal pain
cytomegalovirus
a species-specific herpes virus that may cause retinitis in people with AIDS
HIV encephalopathy
degenerative neurological condition charcterized by a group of clinical presentations including loss of coordination, mood swings, loss of inhibitions, and widespread cognitive dysfunctions, formerly known as AIDS dementia complex
Kaposi's sarcoma
most common AIDS related malignancy that involves the epithelial layer of blood and lymphatic vessels
can appear anywhere on body-pink to brown to deep purple
Ulcerative lesions cause discomfort, and suseptability to infection
common sites of visceral inv
Mycobacterium avium complex
opportunistic infection caused by a mycobacterial organism that commonly causes a respiratory illness but it can infect other body systems
zythromax if CD4 is below 50
Pneumocystis pneumonia or Pneumocyctis jiroveci pneumonia (PCP)
common opportunistic lung infection caused by an organism believed to be a fungus based on its structure
Nsg diagnoses: impaired gas exchange
EIA (enzyme immunoassay) or ELISA (enzyme-linked immunosorbent assay)
a blood tests that can determine the presence of antibodies to HIV in the blood or salva
*positive results must be validated with a western blot assay
Western Blot Assay
a blood test that identifies antibodies to HIV and is used to confirm the results of an EIA (ELISA) test
viral load test
measures the quantity of HIV RNA in the blood
viral set point
amount of virus present in the blood after the initial burst of viremia and the immune response that follows
How is HIV transmitted?
Through body fluids that contain CD4+ T Cells such as blood, seminal fluid vaginal secretions, amniotic fluid, and breast milk.
How do you prevent HIV infections?
safer sex practices (condoms, abstinence, avoid anal intercourse, try dry activites)
do not share needles, razors, toothbrushes, sex toys
do not donate blood, sperm, organs, plasma
How to properly use a condom
1. put on a NEW condom
2. hold by tip to squeeze air out
3. unroll over entire erect penis
4. have sex
5. hold condom so it doesnt fall off
6. pull out
7. repeat with NEW CONDOM
latent reservoir
the integrated HIV provirus within the CD4 T cell during the resting memory state; does not express viral proteins and is INVISIBLE to the immune system and antiviral medications.
Primary Infection (Acute/Recent HIV infection, Acute HIV Syndrome)
HIV positive person may test negative because viral load is VERY HIGH
rapid destruction of CD4+ T cells (normally 500-1500 cells/mm3 in blood)
-has a latent reservoir
*HAVE FLU LIKE SYMPTOMS ( fever, pharyngitis, rash)
HIV Asymptomatic (CDC Category A: More Than 500 CD4+ T Lymphocytes/mm3)
Once viral set point is reached people enter a chronic stage in which their immune system is at standstill
on average 8-10 years pass before HIV related complications start
At this stage, patients feel good.
HIV Symptomaic (CDC Category B: 200 to 499 CD4+ T Lymphocytes/mm3)
CD4+ Lymphocytes fall over time
with no treatment patient would live about 3yr
they are very vulnerable to infection at this point
*must be caused by HIV infection, or defect in cell immunity
*must have clincal course or require management caused by HIV i
AIDS (CDC Category C: Fewer than 200 CD4+ T Lymphocytes/mm3)
CD4+ drops below 200 cells/mm3 of blood, person is said to have AIDS
immune system is significantly impaired
Antiretroviral Agents
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
-ziagen
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
-sustiva
Protease Inhibitors (PI's)
-norvir
Fusion Inhibitors
-fuzeon
Integrase Strand Transfer Inhibitors
-isentress
*to achieve sustaine
Wasting Syndrome
involuntary weight loss of 10% of baseline body weight with chronic diarrhe or chronic weakness and documented fever
TX: bed rest, anticholenergics, increase fluids to 3L/day
Cryptococcus neoformans
An opportunistic fungal infection that causes neurologic diseases
Nursing Diagnoses for the Patient with AIDS
Diarrhea
Risk for infection
ineffective airway clearence
imbalanced nutrition
deficient knowledge
social isolation
oppertunistic infections
Emotional and Ethical Concerns for AIDS Patient
Nurses are responsible for protecting the patient's rights to privacy by safegaurding confidential information
Treat all patients the same way
antibody
protein substance developed by the body in response to an interacting and specific antigen
immunoglobulins
a family of closely related proteins capable of acting as antibodies
IgE
the immunoglobulin that is most common to allergens
Histimine
histimine mediates the allergic response, it is released by mast cells
It's effects are greatest 15min after contact with antigen
includes: erythema, localized edema, pruitis, contraction of bronchioles, wheezing, bronchospasm, dilation of small venules,
What causes fever and pain from the production of smooth muscle contraction, vasodilation, and increased capillary permeability?
prostaglandins
Anaphylactic (Type 1) Hypersenstivity
The MOST severe hypersensitivity reaction
-often has an explosive onset
characterized by: edema in many tissues including the larynx, hypotension, bronchospasm, cardiovascular collapse
- may last up to 24h
Cytotoxic (Type II) Hypersensitivity
-autoimmune
-mistakes self as nonself
-examples: myasthenia gravis, Rh incompatibility in newborns, blood transfusion incompatibility*, drug induced hemolytic anemia
Immune Complex (Type III) Hypersensitivity
Involves immune complex reactions, including tissue damage and deposits
involves:
SLE (Lupus), RA, Nephritis
increases in vascular permeability resulting in greater tissues damage
Delayed-Type (Type IV) Hypersensitivity
occurs 24-72 hours after exposure to an allergen
Examples: Contact dermatitis
Symptoms: itching, rashes, raised lesions erythma
May happen from, adhesive tape, medication, plant toxins
Bee stings increase what WBC level?
eosinophils
While conducting a skin test, what should be readily available for the patient?
emergency equipment in case of anaphylaxsis reaction
How long should a patient stay at the doctor's office after receiving an allergy shot?
30-45 minutes
Provocative Testing
Direct administration of the suspected allergen to the sensitive area such as the conjunctiva, nasal, bronchial mucosa, or GI tract.
Radioallerfosorbent Test (RAST)
a radioimmunasay that measures allergen specific IgE
Indicates the quantity of allergen necessary to evoke an allergic reaction
values are reported on a scale 0-5
values 2 or higher are considered significant
Emergency equipment should be available
Atopic vs Nonatopic Allergic disorders
atopc disorders have a genetic component, and produce local reaction to IgE antibodies
examples: asthma, allergic rhinitis, eczema
Nonatopic
-lack genetic makeup and organ specificy
latex allergy, and contact dermatitis
Common Causes of Anaphylaxis
peanuts, tree nuts, shellfish, milk, eggs, soy wheat
antibiotics, penicillin*, vaccines, aspirin, insulin
animal serums
bee stings, ants, hornets, wasps,
latex
Mild Systemic Anaphylaxis
peripheral tingling, sing, tearing of eyesensation of warmth, fullness of the throat, nasal congestion, periorbital swelling, pruitus, sneezing
Usually happens within first 2h after exposure
Moderate Systemic Anaphylaxis
flushing, warmth, anixety, itching,and symptoms of mild anaphylaxs
Happens within first 2h after exposure
Severe Systemic Anaphylaxis
bronchospasm, laryngeal edema, severe dyspnea, cyanosis, hypotension, dysphagia, abdominal cramping, vomitting, diarrhea, seizures, cardiac arrest, coma
EpiPen
Should be carried around with people who have allergies
premeasured pens with 0.3-0.15mg
To use: remove from carrying tube, remove gray safety cap
hold black tip toward thigh
hold firmly for 10 sec
Medical Management for Anaphylaxis
monitor and maintain respiratory and CV function
Oxygen is provided in high concentrations
CPR
Epinephrine
Antihistimines and Corticosteriods, IV fluids
risk for rebound reaction 4-10hrs afterwards
monitor pt closely for 12-14h in er or icu
Allergic Rhinits
hay fever, seasonal allergies
type 1 hypersensitivy
s.s: sneezling, nasal congestion, clear nasal discharge, nasal itching, itchy throat, headache, sinus pressure, fatigue
Tx:
avoidance
antihistimines
adrenergic agets
corticosteriods
leukotriene
H1 Antihistimines
first generaton-non sedating:
benedryl, atarax
second generation-nonsedating
zyrtexc
clarinex, claritin, allegra
Contact Dermatitis
Type IV delayed hypersensitivty reaction
-caused from exposure to irritants (soap, detergent)
symptoms:
itching, burning, erthyema, skin lesions, edema, weping, crusting, and drying and peeling of skin. thickening of skin, pigment changes
Atopic Dermatitis
type 1 immediatee hypersensitivty disorder characterized by inflammtion and hyperreactivityof the skin
*pruitis and hyperirritability of the skin are most consistent clinical features r/t large amount of histimine in the skin
Populations at risk for latex allergy
healthcare workers
pts with atopic allergies
people who work with atex
females
pt with spina bifida
food handlers, mechanics and cops
ankylosis
fixation or immobility of a joint
pannus
proliferation of newly formed synovial tissues infiltrated with inflammatory cells
tophi
accumulation of crystalline deposits in articular surfaces, bones, soft tissues, and cartilage
Rheumatic Disorders
numerous disorders affecting skeletal muscles, bones, cartilage, ligaments, tendons, and joints
- has periods of remission and exacerbation
- patients have pain, inflammation, degeneration, swelling, fatigue
What to assess for rheumatic disorders
rashes, lesions, hair, eyes, tinnitus
Erythrocyte Sedimentation Rate ESR
measures the rate at which red blood cells settle out of unclotted blood in 1h
usually an increase in inflammatory connective tissue diseases
the higher the ESR, the greater the inflammatry activity
Uric Acid
Measures level of uric acid in serum
2.5-8 mg/dL
increase in patients with gout
Medications used for rheumatic diseases
salicylates
NSAIDS
DMARDS
Immunomodulators
Corticoteriods
Topical Analgesics
Rheumatoid Arthritis
autoimmune reaction that occurs in synovial tissues
clinical manifestation: bilateral, hand and feet deformities, fever, weight loss, fatigue, lymph node enlargement, raynauds phenomneon, rheumatoid nodules
*stiffness, tenderness, swelling worse in the AM
Systemic Lupus Erythematosus
most common in african american females
patients have exaggerated autoantbodies due to genetic and environmental, and hormonal factors
*B cells and T cells both contribute to immune responce in SLE
Patients have arthralgia, arthritis, joint swelling, and
Scleroderma
hard skin
manifestations: taut, smooth, shiny skin, loss of movement
starts with raynausd phenomenon and swelling of hands
causes heart failure, and failure of other organs
hardening of the esophagus causes inability to swallow
CREST
C: calcinosis
R: rayn
Polymyostitis
symmetric and diffuse affects muscles
clinical manifestations: proximal muscles weakness is typicallly a first symptom, DERMATOMYOSITIS: lesions over joint surface
Medical managemen:t:
put on a high dose of corticosteriods to put patient under remission
Polymyalgia Rheumatica
giant cells arteritis
characterized by severe proximal muscle discomfort with mild joint swelling
-severe proximal muscle discomfort with mild joint swelling
-severe ache in neck and shoulder and pelvic muscles
tx: NSAIDS, aspirn
Degenerative Joint Disease
most common disabling joint disorder
risk increases with age, weight, and use of joints
treat with NSAIDS, steriods for inflammation, keep active! exercise
WEIGHT REDUCTION
*pain, stiffness, functional impairment
Surgcal intervenion: osteotomy, arthtoplas
Gout
metabolic, endocrine, rheumatic disease related to defect of purine metabolim that results in hyperuricemia.
Sodium urate crystals tophi: in big toe, hands and ear
also kidney stones
Foods high in purine: organ meats, shellfish, spiniach, alcohol
****hype
Fibromyalgia
chronic pain syndrome that involves chronic fatigue, generalized muscle aching and stiffness
increased risk for depression