Nursing A ConceptBased Approach to Learning VOLUME ONE
Nursing: A Concept-Based Approach to Learning VOLUME ONE | SECOND EDITION MODULE 8 Immunity Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
The Concept of Immunity • Function of immune system § Protect body § Identify and destroy harmful cells § Remove cellular debris Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Physiology Review • Leukocytes § § Primary cells in specific immune responses Derived from stem cells in bone marrow Attack, destroy anything "foreign" Normal number: 4, 500– 10, 000 cells/mm 3 Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Physiology Review, continued • Leukocytes § Granulocytes • 60– 80% of total leukocytes • Key role during acute inflammation, infection • Three types • Neutrophils: phagocytic • Eosinophils: phagocytic • Basophils: contain chemicals Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Physiology Review, continued • Leukocytes § Monocytes • 2– 3% of circulating leukocytes • Migrate to tissues and mature into macrophages - Wait to be activated Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Physiology Review, continued • Leukocytes § Lymphocytes • 20– 40% of circulating leukocytes • Immune surveillance • Memory cells - Activate immediately when exposed to same antigen • Responsible for acquired immunity Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Physiology Review, continued • Leukocytes § Lymphocytes • Three Types • T cells - On contact with APCs, mature into active helper T cells, cytotoxic T cells, or memory T • B cells - On contact with antigen, activated and mature into plasma cells or memory cells • Natural killer cells - Immune surveillance, resistance to infection - Destruction of early malignant cells Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Physiology Review, continued • 1. The Humoral Immune Response (Antigens) In the body fluids Provoke specific immune response B cell produces antibodies Subsequent encounters with an antigen trigger memory cells § “The Primary Immune Response” § § Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Physiology Review, continued • Antibodies § Classes of antibodies • • • Ig. M: responsible for primary immunity Ig. G: major immunoglobulin Ig. A: protects mucous membranes Ig. D: role unknown Ig. E: increases during allergic reactions, anaphylaxis Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Physiology Review, continued • 2. The Cellular Immune Response § Intracellular pathogens activate T lymphocytes (in bodys cells) • Helper T cells initiate immune response • Suppressor T cells limit immune response • Complement: component of blood serum • Activates general inflammatory reaction • Immune cells secrete cytokines • Cytokines carry messages for immune system function Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Physiology Review, continued • Lymphoid system • Protects bloodstream from invading organism § Lymph nodes • Filter foreign products or antigens § Spleen • Filters blood § Thymus gland • Stimulates lymphopoiesis Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Physiology Review, continued • Lymphoid system § Bone marrow • Produces, stores hematopoietic stem cells § Lymphoid tissues • Diffuse collections of lymphocytes, plasma cells, phagocytes § Tonsils and adenoids • Protect from inhaled, ingested foreign agents Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nonspecific Inflammatory Response • Barrier protection: first line of defense • Skin and Bactericidal substances in body fluids § Barrier breached inflammatory response • Nonspecific because same events occur regardless of cause • Invader neutralized, eliminated • Destroyed tissue removed • Healing, repair initiated Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Genetic and Lifespan Considerations • Pediatric considerations § Immune system development influenced by early in utero experiences, environmental exposures after birth, other factors • Ig. G: only immunoglobulin crosses placenta • Maternal Ig. G disappears by 6– 8 months • Child's Ig. G increases gradually until 7– 8 years Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Genetic and Lifespan Considerations, continued • Normal changes associated with aging • Immune function declines • External factors • Nutrition • Effects of exposure to toxins Nursing: A Concept-Based Approach to Learning Volume One, Second Edition • Internal factors • Genetics • Neurological, endocrine system functioning • Chronic, prior illnesses • Individual variations • Decrease in immune response • Lowered resistance to infection • Poor response to immunizations • Autoantibodies more common Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Concepts Related to Immunity Page 446 • Comfort • Inflammation • Tissue Integrity Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Alterations and Manifestations • Hypersensitivity Reactions § Allergic Reactions • Four types § Autoimmune diseases (Table 8 -2) • Immune system loses ability to distinguish self from others • Attacks own body § Transplant rejection § Impaired immune response Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Alterations • • Exemplar 8. 1 8. 2 8. 3 8. 4 HIV Hypersensitivity Rheumatoid Arthritis Lupus Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Prevalence • Estimated 40– 50% of schoolchildren worldwide sensitized to one or more allergens • Prevalence increasing in U. S. Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Genetic Considerations and Nonmodifiable Risk Factors • Genetics key component in immune disorders, deficiencies Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Prevention • Prevention of immune disorders • Vaccines to prevent infections diseases Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Modifiable Risk Factors • • • Nutrition Weight Stress Alcohol, drug and cigarette use Intravenous drug use and risky sexual behaviors Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Immunizations • Introduce antigen into body, allowing immunity to develop § Active immunity • Vaccine § Passive immunity • Injection of antibodies produced by another host Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Immunizations, continued • Immunization schedule § Specific ages and intervals § Children • Transplacental immunity decreases § Adults • May need boosters of childhood vaccines § Schedule updated annually § Assess immunization status at every visit Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing Assessment • Health history § Review biographical data § Family history § Provide privacy and be sensitive Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Assessment Interview • What infections have you had in the past? • When were your last immunizations? • Do you have any allergies? Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Nursing Assessment, continued • Physical examination § § § § General appearance Vital signs Inspect mucous membranes Assess skin color, temperature, moisture Inspect skin Inspect, palpate lymph nodes Assess musculoskeletal system Check joint ROM Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Diagnostic Tests Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Diagnostic Tests, continued • Radioallergosorbent • Enzyme test immunoassay • Skin reactions • Enzyme-linked immunosorbent • Western blot test assay • Complete CBC • Immunoglobulins • Complement • Polymerase chain reaction • Rapid HIV tests Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Interventions and Therapies • Independent § § Nutrition Exercise Sleep Stress reduction, management Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Interventions and Therapies, continued • Collaborative § Pharmacologic therapy • • Anti-inflammatories Antibiotic therapy Intravenous immunoglobulin Hematopoietic stem cell transplantation Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
Interventions and Therapies, continued • Collaborative § Nonpharmacologic therapy • Gene transfer § Complementary and alternative therapy • • Acupuncture Hydrotherapy Dietary supplements Immune stimulation Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved
- Slides: 33