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