UNIT 3 Chapter 19 Inflammation and the Immune Response

2 Explain the differences between inflammation and immunity in terms of cells, functions, and features.

----LOOK AT TABLE 19-1 For all WBC's and their functions---- • Inflammation is a nonspecific body defense to invasion or injury and can be started quickly by almost any event, regardless of where it occurs or what causes it. So, inflammation triggered by a scald burn to the hand is the same as inflammation triggered by bacteria in the middle ear. How widespread the symptoms of inflammation are depends on the intensity, severity, and duration of exposure to the initiating event. For example, a splinter in the finger triggers inflammation only at the splinter site, whereas a burn injuring 50% of the skin leads to an inflammatory response involving the entire body. Inflammatory responses start tissue actions that cause visible and uncomfortable symptoms. Despite the discomfort, these actions are important in ridding the body of harmful organisms. However, if the inflammatory response is excessive, tissue damage may result (Landis, 2009). Inflammatory responses also help start both antibody-mediated and cell-mediated actions to activate a full immune response. •Leukocytes- White blood cells (leukocytes or WBCs) protect the body from the effects of invasion by organisms. These cells are the immune system cells—the knight and soldiers protecting the castle inhabitants after invaders get through the castle wall. The leukocytes provide protection through many defensive actions. These actions include: •Recognition of self versus non-self •Destruction of foreign invaders, cellular debris, and unhealthy or abnormal self cells •Production of antibodies directed against invaders •Complement activation •Production of cytokines that stimulate increased formation of leukocytes in bone marrow and increase specific leukocyte activity •(HLA)- Human leukocyte antigens are on the surfaces of most body cells—not just on leukocytes. They are a normal part of the person and act as antigens only if they enter another person's body. These antigens determine the tissue type of a person. Other names for these cellular fingerprints are human transplantation antigens, human histocompatibility antigens, and class I antigens. The HLAs are key for recognition and self-tolerance.

3 Use knowledge of physiology to describe the basis for the five cardinal manifestations of inflammation.

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4 Discuss the influences of the aging process on inflammation and immunity and how these changes increase health risks for older adults.

Changes in Immune Function Related to Aging ---------------IMMUNE COMPONENT 1 FUNCTIONAL CHANGE 2 NURSING IMPLICATIONS ------------Inflammation 1 There is a probable defect in neutrophil function. 2 Neutrophil counts may be normal, but activity is reduced or impaired, increasing the risk for infection. ------------Leukocytosis does not occur during episodes of acute infection. 1 Patients may have an infection but not show expected changes in white blood cell counts. ------------Older adults may not have a fever during inflammatory or infectious episodes. 1 Not only is there potential loss of protection through inflammation, but also minor infections may be overlooked until the patient becomes severely infected or septic. -------------Antibody-mediated immunity 1 The total number of colony-forming B-lymphocytes and the ability of these cells to mature into antibody-secreting cells are diminished. 2 Older adults are less able to make new antibodies in response to the presence of new antigens. Thus they should receive immunizations, such as "flu shots," the pneumococcal vaccination, and the shingles vaccination. 1 There is a decline in natural antibodies, decreased response to antigens, and reduction in the amount of time the antibody response is maintained. 2 Older adults may not have sufficient antibodies present to provide protection when they are re-exposed to microorganisms against which they have already generated antibodies. Thus older patients need to avoid people with viral infections and need to receive "booster" shots for old vaccinations and immunizations, especially tetanus and pertussis (whooping cough). ------------Cell-mediated immunity 1 Thymic activity decreases with aging, and the number of circulating T-lymphocytes decreases. 2 Skin tests for tuberculosis may be falsely negative. 2 Older patients are more at risk for bacterial and fungal infections, especially on the skin and mucous membranes, in the respiratory tract, and in the genitourinary tract.

1 Describe the concept of self-tolerance

Non-self proteins and cells include infected body cells, cancer cells, cells from other people, and invading organisms. Recognizing self versus non-self, which is necessary to prevent healthy body cells from being destroyed along with the invaders, is called self-tolerance. The immune system cells are the only cells capable of determining self from non-self. Self-tolerance is possible because of the different proteins present on cell membranes.