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Chapter 50 and Chapter 51 Assessment of Immune Function Management of Patients With Immunodeficiency Chapter 70 pp 2474-2484 PowerPoint PPT Presentation


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Inflammation Unit II Lecture 1. Chapter 50 and Chapter 51 Assessment of Immune Function Management of Patients With Immunodeficiency Chapter 70 pp 2474-2484 . The Immune System. Immunity: the body’s specific protective response to invading foreign agent or organism

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Chapter 50 and Chapter 51 Assessment of Immune Function Management of Patients With Immunodeficiency Chapter 70 pp 2474-2484

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Inflammation Unit IILecture 1

Chapter 50 and Chapter 51 Assessment of Immune Function Management of Patients With ImmunodeficiencyChapter 70 pp 2474-2484


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The Immune System

  • Immunity: the body’s specific protective response to invading foreign agent or organism

  • Immunopathology: the study of diseases that result from dysfunction of the immune system

  • Immune disorders:

    • Autoimmunity

    • Hypersensitivity

    • Immune deficiencies: primary and secondary

    • Infection


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Central and Peripheral Lymphoid Organs


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Development of Cells of the Immune System


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Lymphocytes

  • B lymphocytes mature in the bone marrow; T lymphocytes mature in the thymus where they also differentiate into cells with various functions


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Immune Function

  • Natural immunity: nonspecific response to any foreign invader

    • White blood cell action: release cell mediators such as histamine, bradykinin, and prostaglandins, and engulf (phagocytize) foreign substances

    • Inflammatory response

    • Physical barriers, such as intact skin, chemical barriers, and acidic gastric secretions or enzymes in tears and saliva

  • Acquired immunity: specific against a foreign antigen

    • Result of prior exposure to an antigen

    • Active or passive


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Defenses

  • Phagocytic immune response

  • Humoral/antibody response

  • Cellular immune response

  • Chemical Response


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Phagocytic Immune Response

  • WBC’s (leukocytes) participate in both, natural and acquired immunity

    • Granulocytes (granular leukocytes) release mediators (such as histamine, bradykinin and prostaglandins) and engulf antigen

      • (include neutrophils, eosinophils and basophils)

      • Neutrophils- first cells to arrive on scene

    • Nongranular leukocytes

      • Monocytes or macrophages (called Histiocytes when they enter the tissue spaces)- engulf, ingest and destroy greater number of foreign bodies/toxins that granulocytes do.


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Humoral/Antibody response

  • Humoral is Greek for “blood”

  • Lymphocytes

    • Consist of B-cells and T-cells

    • B lymphocytes: humoral immunity

      • Produce antibodies or immunoglobulins

  • Antibody response


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Role of Antibodies

  • Agglutination- (clumping of antigens)

    • Helps clear the body of the invading organism by facilitating phagocytosis

  • Opsonization- the antigen-antibody molecule is coated with a sticky substance to facilitate phagocytosis

  • Promote release of vasoactive substances; activation of complement system and phagocytosis

  • Act in concert with other components of the immune system

  • Types of immunoglobulins: IgA, IgD, IgE,IgG, and IgM


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Exposure


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Cellular immune response

  • T lymphocytes: cellular immunity

    • Attack invaders directly, secrete cytokines, and stimulate immune system responses

    • Helper T cells

    • Cytotoxic T cells

    • Memory cells

    • Suppressor T cells (suppress immune response)

  • T cells help the cells when the cell figures out there is a problem………..(Cells will “hold” the antigen at the surface and wait for the T cells to come get it……)


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Chemical Immune Response

  • Histamine- source: basophils, mast cells, platelets

    • causes vasodilation and  vascular permeability

  • Kinins- source: precursor factor from clotting system

    • causes vasodilation and  vascular permeability as well as pain receptors stimulated

  • Fibrinopeptides- source: activation of clotting system

    •  vascular permeability and stimulates Chemotaxis

  • Prostaglandins/leukotrienes- source: substances synthesized from the phospholipids of cell membranes of most body tissues

    •  vascular permeability and stimulates Chemotaxis


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Chemical Immune Response

  • Enhanced Phagocytosis- WBC’s ingest or engulf any unwanted organism and kill it

  • Enhanced Vascular Permeability- allows cells to move back and forth to cells

  • Chemotaxis- directional migration of WBC’s along a concentration gradient

  • Cell Lysis-breakdown of cell


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Complement System

  • Circulating plasma proteins, know as complement, are made in the liver and are activated when an antibody connects with and antigen.

  • Three major physiologic functions

    • Defending the body against bacterial infection

    • Bridging natural and acquired immunity

    • Disposing of immune complexes and the byproducts associated with inflammation

  • The proteins that comprise the complement system interact sequentially

  • Three ways to active:

    • Classic pathway

    • Alternative pathway

    • Lectin pathway


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Autoimmune disorders

  • Inability to determine self from non-self

  • Lupus Erthematosis, Rheumatoid arthritis


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Variables That Affect Immune System Function

  • Age and gender

  • Nutrition

  • Presence of conditions and disorders: cancer/neoplasm, chronic illness, autoimmune disorders, surgery/trauma

  • Allergies

  • History of infection and immunization

  • Genetic factors

  • Lifestyle

  • Medications and transfusions: see Table 50-6

  • Pyschoneuroimmunologic factors


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Tests to Evaluate Immune Function

  • WBC count and differential

    • Bone marrow release more neutrophils, may release “bands” which are immature cells to keep up. “shift to the left” means acute bacteria infection. (mature neutrophils=segmented neutrophils)

  • Bone marrow biopsy

  • Phagocytic cell function test

  • Complement component tests

  • Hypersensitivity tests

  • Specific antigen–antibody tests

  • HIV infection tests


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Immunodeficiency Disorders

  • Primary

    • Genetic

    • May affect phagocytic function, B cells and/or T cells, or the complement system

  • Secondary

    • Acquired

    • HIV/AIDS

    • Related to underlying disorders, diseases, toxic substances, or medications


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Primary Immunodeficiencies

  • Usually seen in infants and young children

  • Manifestations: vary according to type; severe or recurrent infections; failure to thrive or poor growth; and positive family history

  • Potential complications: recurrent, severe, potentially fatal infections; related blood dyscrasias and malignancies

  • Treatment: varies by type; treatment of infection; pooled plasma or immunoglobulin; GM-CSF or GCSF; thymus graft, stem cell, or bone marrow transplant


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Nursing Management

  • Monitor for signs and symtoms of infections

    • Symptoms of inflammatory response may be blunted

  • Monitor lab values

  • Promote good nutrition

  • Address anxiety, stress, and coping

  • Strategies to reduce risk of infection

    • Handwashing and strict aseptic technique

    • Patient protection and hygiene measures: skin care, promote normal bowel and bladder function, and pulmonary hygiene


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Patient Teaching

  • Signs and symptoms of infection

  • Medication teaching

  • Prevention of infection

    • Handwashing

    • Avoid crowds and persons with infections

    • Hygiene and cleaning

  • Nutrition and diet

  • Lifestyle modifications to reduce risk

  • Follow-up care


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Colonization, Infection, and Disease

  • Colonization: describes microorganisms present without host inference or interaction

  • Infection:indicates host interaction with the organism

  • Disease: the infected host displays a decline in wellness due to the infection


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Interpreting the Microbiology Report

  • A tool to determine colonization, infection, or disease

  • The organism reported may reflect colonization rather than infection

  • Mix of cells in smear and stain report may indicate cellular response

  • Culture and sensitivity specify the organism and which antibiotic will inhibit growth

  • Analyze results in conjunction with the clinical assessment of the patient


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Isolation Precautions

  • Guidelines to prevent the transmission of microorganisms in hospitals

  • Standard precautions used for all patients

  • The primary strategy for preventing HAIs

  • Transmission-based precautions are for patients with known infectious diseases spread by airborne, droplet, or contact routes


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Elements of Standard Precautions

  • Hand hygiene

  • Use of gloves and other barriers

  • Proper handling of patient care equipment and linen

  • Environmental control

  • Prevention of injury from sharps and needles

  • Patient placement


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Transmission-Based Precautions

  • Airborne precautions

    • Hospitalized patient should be in negative pressure room with the door closed; health care providers should wear an N-95 respirator (mask) at all times when in the room

  • Droplet precautions

    • Wear a face mask but door may remain open; transmission is limited to close contact

  • Contact precautions

    • Use of barriers to prevent transmission; emphasize cautious technique as organism is easily transmitted by contact between the health care worker and the patient


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Antibiotic –resistant organisms

  • Nosocomial: Caused by exposure to an organism in the hospital setting

  • Best way to prevent the spread of infection----good hand washing (waterless gel, ok)

    • Methicillin-resistant Staphylococcus Aureus (MRSA)

    • Vancomycin-resistant enterococci (VRE)

    • Penicillin-resistant Streptococcus pneumoniae (PRSP)

    • C. Difficile


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Methicillin-resistant Staphylococcus Aureus (MRSA)

  • Most prevalent nosocomial pathogen.

  • Main mode of transmission is via direct contact-especially health care workers hands.

  • Staph bacteria and MRSA can be found on the skin and in the nose of people without causing illness

  • Can survive on hands for 3 hours if not washed properly

  • Colonization occurs when the staph bacteria are present on or in the body without infection (20-30% of the population is colonized in the nose with staph at any given time)

  • Infection is when causes disease, typically in a compromised patient.

  • Contact precautions

  • Treatment of choice is Vancomyacin


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Vancomyacin-Resistant Enterococcus

  • Major source of transmission is health care workers hands.

  • Can survive on environmental surfaces for weeks without proper disinfectants.

  • Contact precautions with a special disinfectants

  • Treatment includes Beta-lactam and aminoglycoside antibiotics


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Clostridium difficile

  • occurs when the normal intestinal flora is altered, allowing C. difficile to flourish in the intestinal tract and produce a toxin that causes a watery diarrhea.

  • Spores can survive up to 70 days in the environment and can be transported on the hands of health care personnel who have direct contact with infected patients

  • Symptoms:

    • Watery diarrhea

    • Cramps

    • Fever

    • Abd pain

  • Treatment: related to Cause


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Infectious Terrorism

  • Biologic agents of terrorism

    • Anthrax

    • Plague

    • Tularemia

    • Botulism-treat with antitoxin

    • Small pox-vaccination

    • Hemorrhagic fever-no established treatment


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Nursing Process—Assessment of the Patient With an Infectious Disease

  • Health history: investigate the likelihood and probable source of infection, associated pathology, and symptoms

  • Administer a physical exam

  • Vital Signs


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Nursing Process—Diagnosis of the Patient With an Infectious Disease

  • Risk for infection transmission

  • Deficient knowledge

  • Risk for ineffective thermoregulation


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Collaborative Problems/Potential Complications

  • Septicemia, bacteremia, or sepsis

  • Septic shock

  • Dehydration

  • Abscess formation

  • Endocarditis

  • Infectious disease-related cancers

  • Infertility

  • Congenital abnormalities


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Nursing Process—Planning the Care of the Patient With an Infectious Disease

  • Major goals include prevention of the spread of infection, increased knowledge about the infection and its treatment, control of fever and related discomforts, and absence of complications


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Interventions

  • Prevent the spread of infection

    • Perform handwashing

    • Exercise Standard Precautions

    • Recognize mode of transmission and establish Transmission-Based Precautions as indicated

  • Teach about infectious process and the prevention of the spread of infections

  • Assess and treat fever

    • Increases metabolic rate by 7% each 1 degree above normal


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