Altered Immune Responses and Transplantation

Which processes do cytokines instruct cells to alter?

Activity, Secretion, Proliferation, Differentiation

Endocrine System

Addison's disease, Graves' disease, hypothyroidism, thyroiditis, Type 1 diabetes mellitus

Mediators of Allergic Response

Anaphylatoxins, Histamine, Kinins, Leukotrienes, Platelet-activating factor, Prostaglandins, Serotonin

Immunity that is developed by vaccination or immunization is known as:

Artificial active

B Lymphocytes

B cells differentiate into plasma cells when activated. Plasma cells produce antibodies (immunoglobulins)

Latex-Food Syndrome

Banana, avocado, chestnut, kiwi, tomato, water chestnut, guava, hazelnut, potato, peach, grape, apricot.

Immunity

Body's ability to resist disease.

Where and into what do activated B lymphocytes differentiate?

Bone marrow; plasma cells that secrete immunoglobulins.

GI System

Celiac disease, inflammatory bowel disease, pernicious anemia

T Lymphocytes

Cells that migrate from the bone marrow to the thymus. Thymus secretes hormones, including thymosin, that stimulate the maturation and differentiation of these.

Which type of immunity occurs when a patient receives a hepatitis B immune globulin injection?

Passive-artificial

Human Leukocyte Antigen (HLA)

Preset on all nucleated cells and platelets. Primarily used in matching organs and tissues for transplantation.

Early Manifestation of a Systemic Reaction

Pruritus, sneezing, laryngeal edema, hypotension.

T Helper Cells

Regulation of cell-mediated immunity and the humoral antibody response.

Which organs contain lymphoid tissue and are considered central or peripheral organs of the immune system?

Skin, lymph nodes, bronchial tissue, gastrointestinal tract

The nurse differentiates between the types of hypersensitivity reactions and recognizes that which type is related to cell-mediated immunity?

Type IV

Eye

Uveitis

What accurately describes artificial passive acquired immunity?

Gamma globulin injection. Immediate effect, lasting a short time.

Kidney

Glomerulonephritis, goodpasture syndrome

Central Nervous System

Guillan-Barre Syndrome, Multiple Sclerosis

Transfusion reactions are from?

Humoral Immunity

Which immune response is an autoimmune disorder?

Hypersensitivity

What happens when the immune system overreacts?

Hypersensitivity disorders such as allergies and autoimmune diseases may develop.

Autoimmunity

Immune response against self in which the immune system no longer differentiates self from non-self. Autoantibodies and auto-sensitized T cells cause pathophysiologic tissue damage.

Artificially acquired Passive Immunity

Injection of serum with antibodies fro one person to (injection of hepatitis B immune globulin) to another person who does not have antibodies. Passive, short lived.

How does an antigen stimulate an immune response?

It is captured and processed by a macrophage and then presented to lymphocytes.

A nurse is teaching at a health fair about immunizations. How will this nurse educate the people at the fair about the benefits of immunization? Select all that apply.

It reduces and can possibly eliminate diseases like polio. It can prevent disability and death from certain infectious disease. It can help control the spear of infections within the community

The nurse is reviewing the laboratory report of a patient who has been admitted to the hospital for a stab wound in the abdomen. Which finding is likely to be seen in the report?

Leukocytosis

Localized Infection

Limited to a small area

A nursing instructor asks a student to identify the central lymphoid organs. Which are correct examples provided by the student nurses?

Lymph nodes, thymus gland

Peripheral lymphoid organs

Lymph nodes, tonsils, spleen, gut-, genital-, bronchial-, and skin associated tissues.

Examples: Emerging Strains of Antibiotic-Resistant Organisms

MRSA, CRE, VRSA, CRE

Autoimmune Diseases

Occur when the body fails to recognize self-proteins and reacts against self-antigens.

Which cells play a critical role in capturing, processing, and presenting an antigen to lymphocytes?

Mononuclear phagocytes

VRE

More virulent than MRSA and can remain viable on environmental surfaces for weeks.

Muscle

Myasthenia gravis

Which type of immunity is the result of contact with the antigen through infection and is the longest lasting type of immunity?

Natural Active Acquired Immunity

Naturally Acquired Active Immunity

Natural contact with antigen through actual infection (chicken pox, measles, mumps). Active = lasts longer.

Innate Immunity

Present at birth and its primary role is first-line defense against pathogens. Nonspecific response. Neutrophils and monocytes are the primary WBCs involved. Not antigen specific, can respond within minutes to an invading microorganism without prior expose to that organism.

Spleen

Primary site for filtering foreign antigens from the blood.

Antibodies

Produced by plasma cells (differentiated B cells) and found in plasma. Production of these is an essential component in humoral immune response.

Lymphocytes

Produced in bone marrow.

What is included in the humoral immune response?

Production of antigen-specific immunoglobulins.

After assessing a patient with delayed hypersensitivity reaction, the nurse suspects that the patient has contact dermatitis. Which symptoms support the nurse's conclusion?

Pruritic lesions, erythematous skin lesions, skin lesions covered in papules, vesicles, and bullae

Gerontologic Considerations: Infections

Rate of HAIs is 2-3x higher than for younger patients. Infections commons include pneumonia, UTIs, skin infections, and TB. Infections often have atypical manifestations (cognitive/behavioral changes) before the emergence of fever, pain, or alterations in laboratory values. DO NOT rely on the presence of fever to indicate infection in older adults: many have lower core body temperatures and decreased immune responses.

Natural Killer Cells

Involved in cell mediated immunity. Large lymphocytes with numerous granules in the cytoplasm. Do not require prior sensitization for their generation. Involved in recognition and killing of virus-infected cells, tumor cells, and transplanted grafts. Significant role in immune surveillance for malignant cell changes.

Thymus

Involved in differentiation and maturation of T lymphocytes and is therefore essential for a cell-mediated immune response. Shrinks with age.

A nurse is administering epinephrine to a patient who has developed an anaphylactic reaction after the injection of an antibiotic. What should the nurse tell the patient regarding epinephrine?

It relaxes bronchial smooth muscles. It causes vasoconstriction of peripheral blood vessels.

Autoimmunity: Treatment

No cure. Corticosteroids #1 treatment but must be used cautiously as they suppress the immune system. Immunosuppressants, apheresis, plasmapheresis

Autoimmunity: Causes

Age, genetic actors provide disposition towards development, environment

Blood

Autoimmune hemolytic anemia, hemochromatosis, immune thrombocytopenic purpura

Pathogen

Microorganism that causes disease

Heart

Rheumatic fever

Systemic Diseases

Rheumatoid arthritis, scleroderma, systemic lupus erythematosus

One function of cell mediated immunity is:

Surveillance for malignant cell changes.

Before the patient receives a kidney transplant, a crossmatch test is ordered. What does a positive crossmatch indicate?

Cytotoxic antibodies to the donor, which contraindicates transplanting this donor's organ.

Health-care associated infections

Infections that are acquired as a result of exposure to microorganisms in a health care setting.

Emerging Infections

Infectious disease that has recently increased in incidence or that threatens to increase by the immediate future

Although the cause of autoimmune disorders is unknown, which factors are believed to be present in most conditions?

Inheritance of susceptibility genes, initiation of auto reactivity by triggers.

Principle Factors in the Development of Autoimmunity

Inheritance of susceptibility genes, which may contribute to the failure of self-tolerance, initiation of auto-reactivity by triggers, such as infections, which may activate self-reactive lymphocytes.

T Cells

70-80% of circulating lymphocytes. Primarily responsible for immunity to intracellular viruses, tumor cells, fungi. Account for long-term immunity. Attack mutated cells and prevent cancer from forming.

The nurse is caring for a patient in the Emergency Department who is having a type I allergic reaction. What steps does the nurse determine are occurring in this type of reaction?

A type I allergic reaction takes place when a person is first exposed to an allergen. After this, a large amount of IgE antibody is made, and these IgE antibodies attach to mast cells. When the person is exposed to an allergen for the second time, this allergen binds to the IgE antibodies that are attached to the mast cells. Finally, chemical mediators are released from the mast cells.

Types of Hypersensitivity Reactions:

Allergic rhinitis, asthma, atopic dermatitis, urticaria, angioedema, transfusion reaction, goodpasture syndrome, immune thrombocytipenic purpuram, Graves' disease, systemic lupus erythematosus, Rheymatoid arthritis, acute glomerulonephritis, contact dermatitis, latex, anaphylactic reactions

The nurse is comparing cell-mediated immunity and humoral immunity. Which of these are characteristics of humoral immunity? Select all that apply.

Antibodies are produced, involves B lymphocyte cells, examples include anaphylactic shock and transfusion reaction as well as atopic diseases and bacterial infections.

Liver

Autoimmune hepatitis, primary biliary cirrhosis

When assessing an older adult patient, the nurse should observe for characteristics of certain types of diseases due to what type of immunologic response that increases with age?

Autoimmune response.

What cell differentiate into plasma cells upon activation?

B-cells.

Antihistamines

Best drugs for treatment of allergic rhinitis and urticaria. Act by competing with histamine for H1 receptor sites and thus blocking the effect of histamine.

Anaphylaxis

Can occur when mediators are released systemically. Reaction occurs within minutes and can be life threatening because of bronchial constriction and subsequent airway obstruction and vascular collapse.

The function of monocytes in immunity is related to their ability to:

Capture antigens by phagocytosis and present them to lymphocytes.

Older Person: Thymus

Collection of lymphocytes and connective tissue.

Humoral Immunity

Consist of antibody mediated immunity. B cells differentiate into plasma cells. Mature plasma cell secretes immunoglobulins. Primary immune response becomes evident 4 to 8 days after the initial expose to the antigen. When the individual is exposed to the antigen the second time, a secondary antibody response occurs. This response is faster (1-3 days), is stronger, and lasts for a longer time than a primary response.

The nurse is caring for a patient who had an exposure to poison ivy, which initiated a cell-mediated immune response. The production of what type of cell is increased as a result of this response?

Cytokines

Mononuclear Phagocytes

Critical role in the immune system. Responsible for capturing, processing, and presenting the antigen to the lymphocytes. Stimulates a humoral or cell-mediated immune response.

Which changes occur in the immune system of a geriatric patient?

Decrease in primary antibody response, decreased delayed hypersensitivity reaction, and decreased cell mediated immunity. Thymus undergoes involution. Autoantibodies increase with age.

Immune Responses Serve 3 Functions:

Defense, Homeostasis, Surveillance

A nurse develops contact dermatitis after wearing latex gloves. What accurately describes this?

Demonstrated a type IV allergic reaction to chemicals used in the manufacture of latex gloves.

Acquired Immunity

Development of immunity, either actively or passively

Cell-mediated immune response triggers?

Differentiation of T helper cells into T cytotoxic cells, which produce cytokines.

Reemerging Infections

Diphtheria, pertussis, tuberculosis, dengue ever, measles, giardiasis

Epinephrine

Drug of choice to treat an anaphylactic reaction.

Immunocompetence

Exists when the body's immune system can identify and inactivate or destroy foreign substances.

Functions of the Lymph Nodes

Filtration of foreign material brought to the site and circulation of lymphocytes.

What is Innate Immunity's primary role?

First defense against any pathogens.

What are the important functions of cell-mediated immunity?

Fungal infections, rejection of transplanted tissues, contact hypersensitivity reactions, immunity against pathogens that survive inside cells.

Systemic Infection

Have spread extensively throughout the body, often via the blood.

Cell Mediated Immunity

Immune responses that are initiated through specific antigen recognition by T cells. Cell types involved include T cells, macrophages, and NK cells. Primary importance in: Immunity against pathogens that survive inside of cells, including viruses and some bacteria, fungal infections, rejection of transplanted tissues, contact hypersensitivity reactions and tumor immunity.

Artificially Acquired Active Immunity

Immunization with antigen (Vaccines for chickenpox, measels, mumps) Lasts a lifetime.

lgE

Immunoglobulin, produced during humoral immunity. Present in plasma and interstitial fluids. Causes symptoms of allergic reactions.

Disseminated Infection

Infection that has spread to areas of the body beyond initial site of infection.

Cytokines

Soluble factors secreted by WBCs and a variety of other cells in the body that act as messengers between cell types. Instruct cells to alter their proliferation, differentiation, secretion or activity. Have a beneficial role in hematopoiesis and immune function.

Common Antibiotic Resistant Organisms

Staphylococcus aureus, Staph epidermidis, enterococcus faecalis, enterococcus faecium, streptococcus pneumoniae, klebsibella pneumonia, meisseria gonorrheae

Secondary Immunodeficiency Disorders

Stress, malnutrition, corticosteroid drugs, and AIDS

Antigen

Substance that elicits an immune response. Most are composed of protein. All of the body's cells have them on their surface that are unique to that person and enable the body to recognize itself. Immune system is non-responsive to "self"

Function of T Lymphocytes in Cellular Immunity

Surveillance of malignant cell changes, releasing cytokines responsible for destruction of antigens.

Characteristics of cell mediated immunity

T lymphocytes and macrophages, examples include cancer cell destruction and graft rejection

Effects of Aging on the Immune System

Thymic involution. Decreased cell mediated immunity. Delayed hypersensitivity reaction. Decreased IL-1 and IL-2 receptors. Decrease in proliferative response of T and B cells. Decrease in primary and secondary antibody responses. Increase in autoantibodies. Far more susceptible to pneumonia, influenza, infectious endocarditis, tetanus. More likely to die from them.

Central Lymphoid Organs

Thymus gland, bone marrow

Why is plasmapheresis indicated in the treatment of autoimmune disorders?

To remove autoantibodies, antigen-antibody complexes, and inflammatory mediators of immune reactions.

Naturally Acquired Passive Immunity

Transplacental and colostrum transfer from mother to child. Passive = short lived.

A patient given an IM injection of penicillin in the gluteus maximus and developed dyspnea and weakness within minutes following the injection. Which additional assessment findings indicate the patient is having an anaphylactic reaction?

Wheezing, Hypotension, Dilated Pupils, Rapid, Weak Pulse, Edema & Itching at the injection site, Feeling of Impending Doom.