Med-Surg: Immune Function

Cellular immune response

- T cells attack foreign pathogens directly rather than by producing antibodies - T cells include: helper T cells, cytotoxic T cells, suppressor T cells, and memory T cells - Natural kills cells are other lymphocytes that assist in combating organisms

Secondary immunodeficiency

- affect the normal immune system. resulting in increased susceptibility to infection & certain types of cancer - usually acquired later in life

Advances in immunology: stem cell research

- stem cells can restore an immune system that has been destroyed - stem cell is known as a precursor that continually replenishes the body's entire supply of WBCs & RBCs

Primary immunodeficiency

- that are genetic in origin & manifest in infancy/childhood as abnormally recurrent infections - improper development of immune cells

Examples of cellular responses

- transplant rejection - delayed hypersensitivity (tuberculin reaction) - graft-verus-host disease - intracellular infections - viral, fungal, parasitic infections

Stages of immune response

1. Recognition stage: identification of antigens as foreign 2. Proliferation stage: lymphocytes stimulate some of the dormant T & B lymphocytes to enlarge, divide & proliferate 3. Response stage: differentiated lymphocytes function in either humoral or cellular capacity 4. Effector stage: the antibody of the humoral response or the cytotoxic T cell of the cellular response connects with the antigens on the surface of the pathogen

Acquired immunity divided into 2 mechanisms

1. The cell-medicated response: T cell activation 2. Effector mechanisms: B-cell maturation & production of antibodies

The body has 3 major means of defense

1. The phagocytic immune response = FIRST LINE of defense: involves WBCs which have the ability to ingest foreign particles 2. The humoral/antibody response = SECOND LINE: begins with B lymphocytes which can transform themselves into plasma cells that manufacture antibodies 3. The cellular immune response = THIRD LINE: T lymphocytes turn into cytotoxic (or killer) T cells that attack pathogens

2 types of acquired immunity

1. active immunity: immunologic defenses are developed by the person's own body 2. passive immunity: transmitted from a source outside the body (i.e., immune globulin injections)

Humoral response begins with

B lymphocytes recognizing & responding to invading antigens, antibodies are then produced which bind to antigens

What diagnostic test is used to identify HIV infection?

CD4 cells counts

Blood test that confirms the presence of antibodies to HIV

ELISA

True or false: interferons modify the immune response by suppressing antibody production & humoral immunity

False

What kind of T cells are activated on recognition of antigens and stimulate the rest of the immune system?

Helper T cells

Null lymphocytes

Lymphocytes that destroy antigens already coated with the antibody

What medications inhibit prostaglandin synthesis or release?

NSAIDs

Cells capable of directly killing invading organisms & producing cytokines

Natural killer cells

What antidepressants are used in the treatment of AIDS

Prozac Norpramin Tofranil

Which stage of the immune response occurs when differentiated lymphocytes function in either a humoral or cellular capacity?

Response stage

True or false: HIV dementia can mimic Alzheimer's Disease

True

True or false: natural immunity provides a nonspecific response to any foreign pathogen, regardless of the pathogen's composition

True

True or false: suppressor T-cells have the ability to decrease B-cell production

True

True or false: the recognition stage of the immune response is dependent on the actions of the lymphocytes and the lymph nodes

True

True or false: lymph nodes are the centers for immune cell proliferation

True (bone marrow, lymph nodes. lymphatic tissue)

Antibody

a protein substance developed by the body in response to & interacting with a specific antigen

Complement

a series of enzymatic preteens in serum, that when activated, destroy bacteria & other cells

The structural part of the invading or attacking organisms that is responsible for stimulating antibody production is called

antigen

How soon do you want to start Post Exposure Prophylaxis (PEP)?

as soon as possible (has little to no effect which is why timing is so crucial)

Which category of HIV correlates with asymptomatic AIDS?

category A

Memory cells

cells responsible for recognizing antigens

B cells

cells that are important in producing circulating antibodies

Phagocytic cells

cells that engulf, ingest & destroy foreign bodies or toxins

Assess respiratory system for

changes in respiratory rate cough abnormal lung sounds rhinitis hyperventilation bronchospasm

Assess neurosensory system for

cognitive dysfunction hearing loss visual changes headaches & migraines ataxia tetany

Cellular immune response response also involves the action of the ____ system

complement system

Renal failure is associated with

deficiency of circulating lymphocytes

Nezelof Syndrome

disorder involving lack of thymus gland

Acquired (Learned) immunity develops as a result of

exposure to an antigen

What should the nurse encourage to replace loss of electrolytes and fluids in a patient with AIDS?

fluids (AVOID iron, gluten, zinc)

Assess GU system for

frequency & burning on urination hematuria discharge

Interferons

proteins formed when cells are exposed to viral or foreign agents; capable of activating other components of the immune system

What adverse effects should the nurse monitor for someone on immunosuppressive drugs?

respiratory & urinary system infections

HIV is a _____ virus

retrovirus (not transmitted through casual contact)

Physical & chemical barriers of natural immunity

skin, mucous membranes, cilia of respiratory tract

These cells are potentially immortal cells that are capable of self-renewal & differentiation

stem cells

Antigen

substance that induces the production of antibodies

Lymphokines

substances released by sensitized lymphocytes when the contact specific antigens

HIV staging is based on

symptoms & CD4 levels

Immunity defined as

the body's specific protective response to an invading foreign agent/organism

Opsonization

the coating of an antigen; antibody molecules with a stick substance to facilitate phagocytosis

Phagocytic immune response

the immune system's first line of defense, involving white blood cells that have the ability to ingest foreign particles

Humoral immune response

the immune system's second line of defense; often termed the "antibody response"

Cellular immune response

the immune system's third line of defense, involving T cells attacking the pathogen

Humoral immune response characterized by the

the production of antibodies by B lymphocytes in response to a specific antigen

Acquired immunity relies on

the recognition of specific foreign antigens

Stem cells

undifferentiated precursors of all blood cells; reside primarily in bone marrow

Diagnostic test that measures HIV RNA in the plasma

viral load

Examples of humoral responses

- bacterial phagocytosis & lysis - anaphylaxis - allergic hay fever & asthma - immune complex disease - bacterial & some viral infections

Natural immunity

- dependent on the ability to distinguish between self & non-self - coordinates the initial response to pathogens through the production of cytokines - cells involved in this response include: macrophages, dendritic cells, natural killer cells

Physical assessment of the immune system

- immune dysfunction may have many manifestations in various body systems - the nurses assess the pt's respiratory, GI, cardiovascular, GU, and neurosensory satis for signs/symptoms of immune dysfunction

Post exposure prophylaxis (PEP)

- involves taking antiretroviral medicines as soon as possible, but no more then 72 hours after you may have been exposed to HIV, to try to reduce the chance of becoming HIV positive - these medication keep HIV from making copies and spreading - PEP is not always effective

More epidemiology about HIV/AIDS

- more than 1.1 million, ages 13+ are living with HIV - 1 in 6 people are unaware of their infection - African Americans at highest risk

Manifestations of HIV

- pneumocystis pneumonia - tuberculosis - loss of appetite, nausea, vomiting, oral candidiasis, diarrhea - Wasting Syndrome - Kaposi's sarcoma - B-cell lymphomas - HIV encephalopathy - cytomegalovirus - depression - integumentary manifestations - gynecologic manifestations - immune reconstitution inflammatory syndromes (IRIS)

Actions of chemical mediators

- promote formation of fibrous scar tissue - walling off the pathogen - minimizing blood loss - regeneration of scar tissue - activating phagocytes

Nursing interventions for a patient with AIDS

- promoting skin integrity - promoting normal bowel patterns - preventing infection - improving activity intolerance - maintaining thought processes - promoting airway patency - promoting effective coping - relieving pain - improve nutritional status

Assessment of the immune system: health history

- signs/symptoms of an immune response - immunization status - allergies - autoimmune disorders - personal hx & family hx of cancer - chronic illness & surgery - blood transfusions - nutrition

Components of natural immunity

1. physical & chemical barriers 2. inflammatory response 3. immune response will eliminate the antigen when effective

Cytokines

generic term for non-antibody proteins that act as intercellular mediators, as in the generation of immune response

WBCs involved in phagocytosis

granulocytes & macrophages

Early manifestation of HIV encephalopathy

headache

Assess GI system for

hepatosplenomegaly colitis vomiting diarrhea

The protective effects of a vaccination are a result of what immune process?

humoral immunity (immunization prompts the production of antibodies)

Assess cardiovascular system for

hypotension tachycardia arrhythmia vasculitis anemia

Assess the skin & mucous membranes for

lesions rashes inflammation discharge dermatitis urticaria purpura (subcutaneous bleeding) : purport may indicate life-threatening infections such as meningitis

Center for immune cell proliferation

lymph node

HIV is harbored within which type of cell?

lymphocyte

Helper T cells

lymphocytes that attack foreign invaders (antigens) directly

Suppressor T cells

lymphocytes that decrease B-cell activity

Natural killer cells

lymphocytes that defend against microorganisms & malignant cells

Cytotoxic T cells

lymphocytes that lyse cells infected with a virus

# People living with HIV/AIDS in the United States

more than 1 million (33 million people in the world) - 2.7 new infections each year - every 9.5 minutes, someone in the U.S. in infected with HIV

CDC Category A - HIV asymptomatic

more than 500 CD4 T lymphocytes

What kind of immunity provides a nonspecific response to any foreign pathogen, regardless of the pathogen's composition?

natural/innate immunity

What effect does Ibuprofen (Motrin) have on the immune system?

neutropenia

Natural immunity provides a ______ response

nonspecific response

Thymus

organ in the upper mediastinum; where T cells mature

What is a physiological process involved in the inflammatory response?

participating in hemostasis to prevent hemorrhage; inflammation results in vessels changes that reduce the change of bleeding

Primary infection (of HIV)

period from infection with HIV to the development of antibodies to HIV

Agglutination help clear the body of the pathogen by facilitating

phagocytosis

During what stage of the immune response does the circulating lymphocyte containing antigenic message return to the nearest lymph node

proliferation stage