MedSurg Ch. 13 (Altered Immune Responses and Transplantation)

Acquired/specific immunity involves ___________, which helps the body respond rapidly to future exposure to microorganisms.

"memory"

What three processes are needed for immunocompetence?

1. inflammation 2. antibody/humoral immunity 3. cell-mediated immunity

An older adult patient who is having an annual check-up tells the nurse, "I feel fine, and I don't want to pay for all these unnecessary cancer screening tests!" Which information should the nurse plan to teach this patient? a. Consequences of aging on cell-mediated immunity b. Decrease in antibody production associated with aging c. Impact of poor nutrition on immune function in older people d. Incidence of cancer-associated infections in older individuals

ANS: A The primary impact of aging on immune function is on T cells, which are important for immune surveillance and tumor immunity. Antibody function is not affected as much by aging. Poor nutrition can also contribute to decreased immunity, but there is no evidence that it is a contributing factor for this patient. Although some types of cancer are associated with specific infections, this patient does not have an active infection.

The nurse is assessing an older adult patient. What type of age related disorders should the nurse assess for related to the increased immunologic response? a. Autoimmune response b. Cell-mediated immunity c. Hypersensitivity response d. Humoral immune response

ANS: A With aging, autoantibodies increase, which lead to autoimmune diseases (e.g., systemic lupus erythematosus, acute glomerulonephritis, rheumatoid arthritis, hypothyroidism). Cell-mediated immunity decreases with decreased thymic output of T cells and decreased activation of both T and B cells. There is a decreased or absent delayed hypersensitivity reaction. Immunoglobulin levels decrease and lead to a suppressed humoral immune response in older adults.

A healthy older adult patient requests a "flu shot" during an office visit. When assessing the patient, what other vaccinations should the nurse ask the patient about receiving (select all that apply.)? a. Shingles b. Pneumonia c. Meningococcal d. Haemophilus influenzae type b (Hib) e. Measles, mumps, and rubella (MMR)

ANS: A, B The patient should receive the vaccines for shingles (herpes zoster), pneumococcus, and influenza. The other options do not apply to this patient. Meningococcal vaccination is recommended for adults at risk (e.g., adults with anatomic or functional asplenia or persistent complement component deficiencies). Adults born before 1957 are generally considered immune to measles and mumps. Haemophilus influenzae type b (Hib) vaccination is only considered for adults with selected conditions (e.g., sickle cell disease, leukemia, HIV infection, or for those who have anatomic or functional asplenia) if they have not been previously vaccinated.

What are possible consequences of an incompetent or ineffective immune response (Select all that apply.)? a. severe infections b. immunodeficiency diseases c. allergic rhinitis d. angioedema e. malignancies

ANS: A, B, E

The nurse provides discharge instructions to a patient who has an immune deficiency involving the T lymphocytes. Which health screening should the nurse include in the teaching plan for this patient? a. Screening for allergies b. Screening for malignancies c. Screening for antibody deficiencies d. Screening for autoimmune disorders

ANS: B Cell-mediated immunity is responsible for the recognition and destruction of cancer cells. Allergic reactions, autoimmune disorders, and antibody deficiencies are mediated primarily by B lymphocytes and humoral immunity.

Give an example of artificial, active acquired immunity.

Vaccine (dead or attenuated pathogens)

The patient with diabetes mellitus has been chronically ill with a severe lung infection needing corticosteroids and antibiotics. What condition should the nurse monitor for related to the patient's condition? a. Major histoincompatibility b. Primary immunodeficiency c. Secondary immunodeficiency d. Acute hypersensitivity reaction

ANS: C Secondary immunodeficiency is most commonly caused by immunosuppressive drugs, such as corticosteroids. It can also be caused by diabetes mellitus, severe infection, malnutrition, and chronic stress, all of which are present in this patient.

Which class of immunoglobulin is the most prevalent and is responsible for secondary immune response?

IgG

Give an example of natural, passive acquired immunity.

Antibodies pass from mother to fetus (placenta) or mother to baby (milk)

Humoral immunity protects us from:

Bacteria; Viruses (outside cells)

______ lymphocytes secrete cytokines that stimulate bone marrow production of stem cells.

CD4

_______ lymphocytes secrete cytokines that inhibit growth and immune cell activation.

CD8

_______________ work as messengers directing cells (to multiply, secrete substances, etc.) which can have beneficial or detrimental effects.

Cytokines

_____________ cells transport antigens toward T cells that have specificity for that antigen.

Dendritic

Cell-mediated immunity protects us from:

Fungus; Virus (inside cells); Tumors

Give an example of natural, active acquired immunity.

Infection; contact with pathogen

Give an example of artificial, passive acquired immunity.

Injection of immune serum (gamma globulins)

Lymphocytes are produced in the ___________________ and differentiate into ______ cells that mature in the bone marrow and _______ cells that mature in the thymus and ____________________ cells.

bone marrow; B; T; Natural Killer (NK)

Colony stimulating factors are a type of ______________.

cytokine

When a person is exposed to an antigen for a second time, why does the immune system respond faster?

memory

Where does the immunoglobulin we administer to patients come from?

pooled platelets; human donors