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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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Inflammation Unit IILecture 1

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

the immune system
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
  • B lymphocytes mature in the bone marrow; T lymphocytes mature in the thymus where they also differentiate into cells with various functions
immune function
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
  • Phagocytic immune response
  • Humoral/antibody response
  • Cellular immune response
  • Chemical Response
phagocytic immune response
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.
humoral antibody response
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
role of antibodies
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
cellular immune response
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……)
chemical immune response
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
chemical immune response14
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
complement system
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
autoimmune disorders
Autoimmune disorders
  • Inability to determine self from non-self
  • Lupus Erthematosis, Rheumatoid arthritis
variables that affect immune system function
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
tests to evaluate immune function
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
immunodeficiency disorders
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
primary immunodeficiencies
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
nursing management
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
patient teaching
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
colonization infection and disease
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
interpreting the microbiology report
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
isolation precautions
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
elements of standard precautions
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
transmission based precautions
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
antibiotic resistant organisms
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
methicillin resistant staphylococcus aureus mrsa
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
vancomyacin resistant enterococcus
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
clostridium difficile
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
infectious terrorism
Infectious Terrorism
  • Biologic agents of terrorism
    • Anthrax
    • Plague
    • Tularemia
    • Botulism-treat with antitoxin
    • Small pox-vaccination
    • Hemorrhagic fever-no established treatment
nursing process assessment of the patient with an infectious disease
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
nursing process diagnosis of the patient with an infectious disease
Nursing Process—Diagnosis of the Patient With an Infectious Disease
  • Risk for infection transmission
  • Deficient knowledge
  • Risk for ineffective thermoregulation
collaborative problems potential complications
Collaborative Problems/Potential Complications
  • Septicemia, bacteremia, or sepsis
  • Septic shock
  • Dehydration
  • Abscess formation
  • Endocarditis
  • Infectious disease-related cancers
  • Infertility
  • Congenital abnormalities
nursing process planning the care of the patient with an infectious disease
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
  • 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