Jose Leo V. Nastor, Jr. BSN3 C Clinical Instructor: Mrs. Bernalyn O.

Pascual

Clinical Group 7

IMMUNE SYSTEM Functions: - Defense - Homeostasis - Surveillance Sturctures: A. Lymphoid System Central Lymphoid Organs Bone Marrow and Thymus Peripheral Lymphoid Organs Tonsils, Lymph Nodes, Spleen, Lymphoid Tissues in the gut, genitals, bronchi, and skin B. Immune System Components STEM CELSS Pluripotent stem cells WBC o TYPES Granulocytes Neutrophils greatest number Monocytes phagocytic macrophages Eosinophils multicellular parasitic infections o Allergic reactions and other inflammatory processes Basophils attract igE to their cell membrane Mast cells attract igE antibodies and triggers inflammatory response o Survives several months Lymphocytes B cells manufacture immunoglobulins o Plasma cells manufacture antibodies o Memory B cells inactive & reactivate by exposure to same antigen TYPES OF ANTIBODIES a) igM first immunoglobulin to be secreted in the primary immune response b) igG secreted in the secondary immune response has more antigen specificity c) igA found in mucus, breast milk and other secretions d) igE triggers the release of histamine T cells responsible for immunity to viruses, tumor cells and fungi o CLASSIFICATION T cytotoxic, T helper, T suppressor NATURAL KILLER CELLS Cytotoxic against tumor cells and cells inflected wit bacteria and viruses Are not T or B lymphocytes They do not express antigen binding receptors COMPLEMENT group of proteins that act sequentially to lyse microorganisms and inflected cells CYTOKINES messenger among macrophages and various lymphocytes. Secreted by cells in the immune response. Include a variety of interleukins, interferons, tumor necrosis, colony stimulating factors and transforming growth factors EICOSANOIDS includes prostaglandins, thrombaxines, and leukotrienes. Regulate various processes by signaling cells in a local area FUNCTION A. Inmate Immunity a. Lines of Defense Surface Defense physical barriers o Mechanical removal, Normal bacterial flora, Chemical inhibitors, Antimicrobial substances Nonspecific Resistance Factors o Fever, Interferons, Complement, Lysozyme, C reactive protein, Lactoferrin, A1 antitrypsin Inflammation o Soluble factors: Clothing system, Complement system, Kinin system o Phagocytes circulating neutrophils, eosinophils, monocytes, macrophages fixed in alveoli, spleen, luier, bone marrow Immune Response o Humoral Immune Response: B cells, plasma cells, Ig o Cell mediated Immune Response: T cells, lymphokins FIRST LINE OF DEFENSE Mechanical and Chemical barriers SECOND LINE OF DEFENSE Inflammation Response and Phagocytosis THIRD LINE OF DEFENSE Specific immune response, Natural killer cells B. INFLAMMATION Immediate response to cell injury Engages cells, platelets, complement, clotting, kinin systems, and Ig

C. MAST CELLS Bags of granules located close to blood vessels Release content and system mediators o Biochemical mediators cause dilaton of post capillary venules and increase capillary permeability o Chemotatic factors attract blood cells to area Synthesize leukotrienes and prostaglandins D. PHAGOCYTOSIS most important phagocytes are neutrophils and macrophages E. COMPLEMENT SYSTEMS One of the plasma protein system Non specific, powerful defenders against bacterial invasion F. ACQUIRED (ADAPTIVE) IMMUNITY ACTIVE AQUIRED develops antibodies as a result to exposure to an antigen either naturally or by immunization PASSIVE ACQUIRED performed antibodies are administered as an undine serum G. ANTIBODY MEDIATED (HUMORAL IMMUNITY) TWO STEP PROCESS IN ANTIBODY PRODUCTION FIRST STEP B cells migrate to lymphoid tissue and generate antobides of IgM and IgD classes. SECOND STEP initial encounter antigen, stimulates proliferation of the immunocompetent B cells o IMMUNOGLOBULINS o ANTIBODIES: neutralize bacterial toxins and viruses, Phagocytes bacteria (opsonization), Activates components of the inflammatory response o MONOCLONAL ANTIBODIES H. CELL MEDIATED IMMUNE RESPONSE FIVE TYPES OF CELLS T lymphocyte memory cells: induce secretary immune response Lymphokine producing cells: secrete proteins that activates other cells such as Macrophages, transfer delayed hypersensitivity Cytotoxic cells directly attack antigens, destroy cells bearing foreign antigens Helper T cells control cell mediated and humoral processes I. HYPERSENSITIVITY 3 types Autoimmunity, Alloimmunity, Allergic reaction FOUR TYPES OF HYPERSENSITIVITY REACTION a.) TYPE I igE mediated. Occurs as a result of the release of inflammatory substances including histamine b.) TYPE II tissue specific and may be caused by complement mediated lyses opsonization and phagocytosis, antibody dependent cell mediated cytotoxicity or modulation of cellular function c.) TYPE III formation of immune complexes that are deposited in target tissues d.) TYPE IV caused by specifically sensitized T cells, destroy antigens NORMAL AGING CHANGES: IMMUNE AGE RELATED CHANGES MUCOCUTANEOUS BARRIERS (SKIN & MUCOUS MEMBRANE) Decreased circulating thymus derived lymphocytes. Cytokines and epidermal Langerhans cells Slower, less dramatic hypersensitivity reactions PHAGOCYTOSIS Decline in effective or chemotaxis in less vascular areas Fever local T cells activated in response to infection Markers that normally attract peripheral T cells are defective Impaired capacity to focus mediator cells and the cytokines they express Impaired cell adhesion Macrophages & neutrophils less effective against bacteria CELL LYSIS natural killer cell activity declines CELL MEDIATED IMMUNITY Equivocal changes in ration of helper T cells and suppressor cells Increase memory cells Decline in T cell function and proliferative capacity in response to nitrogen Predominance of helper T cells response shifts from type 1 to type 2 Depletion of nave T cells Decrease relative number of CD8 (+) T cells Aged dendrites less able to stimulate T and B cells Percentage of B and T lymphocytes stable ANTIBODY MEDIATED IMMUNITY Total number of peripheral blood cells is stable Increased auto antibody frequency Increased serum igG and IgA CYTOKINE DYSREGULATION Proinflammatory cytokines (particularly IL 6) increase IMPACT OF CHANGES IN THE IMMUNE SYSTEM

 VACCINATION IN OLDER ADULTS - Peak antibody titers are lower, peak titer occurs 2 to 6 weeks after vaccination - Influenza vaccination higher risk of morbidity - Augments NK activity CANCER AND IMMUNOSENESCENCE - Greatest prevalence of metastatic disease between ages 75 90 - FACTOR: o Lymphocyte proliferative disorders o Defective immune surveillance o Imbalance between immune restraining and growth enchancing effects on tumors INFECTION & IMMUNOSENESCENCE - Increase incidence with age - Changes in cellular immunity may help to explain - Reactivation of infections such as TB and shingles PATCH TEST REACTIVITY COMMON DISORDERS A. INFECTION DISEASE PNEUMOCOCCAL DISEASE o Factors which increases risk: COPD, swallowing disorders, revaccinations is recommended for 65 and older who were vaccinated 5 or more years in the past and before the age of 65 VARICELLA (HZ) VIRAL DISEASE immune suppression is a risk B. AUTOIMMUNE DISORDERS AND IMMUNOSENESCENCE Rheumatoid Arthritis, Thyroiditis, Pernicious Anemia C. ACQUIRED IMMUNE DEFFIENCY HIV/AIDS in older persons NURSING CARE Immune health assessment HEALTH HISTORY Chief complaint: recent, recurrent, or chronic infections; delayed healing, prolonged bleeding Past Medical History: cancer, liver or kidney disorders, HIV infection, malabsorption, blood transfusions, spleenectomy, prosthetic heart value, indwelling venous access device Review of Systems o General: fatigue, fever, chills, night sweats, headache o Integumentary: lesions in the skin & mucous membrane, pruritus, bruising or bleeding o Respiratory: sore throat, dyspnea, cough, hemoptysis o Cardiovascular: palpitations, dizziness with position change o Genitourinary: hematuria, dysuria, menorrhagia o Musculoskeletal: joint pain, swelling, bone pain o Family history: cancer, blood or immune system disorders Social History: chemical exposure, heavy alcohol consumption, sexual preference and pattern, number of sexual partners, history of STDs, safe sex practices Medications: particularly immunosuppressions, corticosteroids, NSAIDS, antineoplastic, antibiotics PHYSICAL EXAMINATION VITAL SIGNS: fever, tachycardia, hypotension, tachypnea Cardiopulmonary: heart rate, breath sounds Integumentary: lesions, pallor, purpura, ecchymoses, hematomas, rash Oral cavity: appearance of tongue Musculoskeletal: joint swelling, tenderness Lymph nodes, fever, spleen: enlargement DIAGNOSTIC TESTS A. Blood studies Humoral Immune System Serum electrophoresis, Immunoelectrophoresis, Quantitation of Ig levels, specific antibody Cellular immune system blood leukocyte count, absolute lymphocyte counts Differential count (WBC) monocytes, neutrophils, basophils, eosinophils, lymphocytes Others T cell count, serum electrophoresis, HIV antibody test( ELISA) & Western Blot B. Radiologic Procedures ultrasonography and Gallium scan C. Invasive Procedures lymph node removal and pathological examination and skin test NURSING DIAGNOSIS Risk for infection related to suppressed immune response, inadequate secondary defenses

Ineffective coping related to uncertainty, light degree of threat, inadequate social support created by characteristics of relationship Interrupted family processes related to shift in health status of a family member, situational crisis Fatigue r/t anxiety, depression, disease state drugs side effect Grieving r/t change in health status, risk for life threatening complications Ineffective health maintenance r/t perceptual/cognitive impalement lack of material resources, ineffective individual coping Imbalanced nutrition: less than body requirement r/t anorexia Deficient knowledge r/t lack of exposure, cognitive limitation. Social isolation r/t altered state of wellness Ineffective therapeutic regimen management r/t perceived barriers, social support deficit, complexity of therapeutic regimen Disturbed thought process r/t disease process INTERVENTIONS: A. Measure to improve immune function - Nutrition: antioxidants, nutritional supplements, Vitamin C; Exercise B. Measures to manage symptoms of HIV and adverse effect of treatment - Testosterone treatment reduce loss of lean body & bone mass and improves mood & libido in women with HIV and increase bone density in men C. Measure to reduce the risk of infection - Handwashing, Asceptic technique, Oral care D. Measure to promote effective self-care - Hygiene measures, Education about self-protection E. Measures to provide support - Spiritual and family support COMPROMISED HOST PRECATIONS The patient should have a private room, does not have to be an isolation room, the door may be left open, Compromised Host Precatution sign should be posted on the door Monitor V/S every 2 4 hours All persons entering the patients room must wash hands Invasive procedures should be kept to a minimum Asceptic technique must be observed Designate a particular stethoscope and thermometer Masks are not required, staff with URT and other infections should not care for the patient Clean table tops, equipment, and the floor frequently with hospital approved disinfectant Patient should wash his or her hands before and after eating, using the toilet, and doing any self-care procedures Encourage the patient to cough and DBE every 4 hours Only canned or cooked foods should be served Tests, scans, and appointments away from the patients room Patient should wear a clean mask Flowers and plants should not be handled by the patient No humidifiers with standing water should be used in patients room Teach the patient and family about the underlying pathophysiology and about precautions to minimize the risk of infection jlnastor16