The Moat The Castle Walls The knights Copyright

Immunological and Hematological: 1) Summarize the physiological processes of the immune and hematological systems.

Immunity Definition The normal physiologic response to microorganisms and proteins as well as conditions

Inflammation & Immunity Purpose: To meet the human need for protection by neutralizing, eliminating,

Proteins on Human Cell Membranes Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders,

Self versus Non-Self Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint

Human Leukocyte Antigens Found on the surface of most body cells Determine the tissue

Organization of the Immune System Immune system Ø Stem cells Ø Influenced by many

Stem Cell Differentiation and Maturation Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders,

The Moat: Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of

The Walls: Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of

The knights: Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of

Inflammation: “Innate Native Immunity” Any natural protective feature of a person Provides immediate protection

Altered Immunity What is meant by “altered” immunity? Conditions in which immune responses are

Infection Occurs in response to tissue injury, invasion of organisms Usually accompanied by inflammation,

Cell Types Involved in Inflammation Neutrophils Macrophages Basophils Eosinophils Copyright © 2016, 2013, 2010,

Phagocytosis Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier

Sequence of Inflammatory Responses Five cardinal manifestations of inflammation: Ø Ø Ø Warmth Redness

Sequence of Inflammatory Responses (Cont. ) Stage I (vascular) – Change in blood vessels

Antibody-Mediated Immunity Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of

Agglutination Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier

Immunity Adaptive internal protection resulting in longterm resistance to effects of invading microorganisms Body

Acquiring Antibody-Mediated Immunity Innate-native immunity – Natural immunity Adaptive immunity Active immunity Natural active

Cell-Mediated Immunity (CMI) Also called cellular immunity Involves many WBC actions and interactions Another

Protection Provided by CMI Helps protect body through ability to differentiate self from non-self

Transplant Rejection Hyperacute rejection Acute rejection Chronic rejection Management of transplant rejection Maintenance therapy

Case Study Mrs. T, a 37 year old female, arrives at the ED immediately

Case Study cont. Mrs. T is diagnosed with a sprained ankle, and she is

Case study cont: Two weeks later, Mrs. T follows up with her provider because

NANDA Risk for Infection (related to impaired immune system) i. e. : Cancer, Altered

Chapter 17 Audience Response System Questions Copyright © 2016, 2013, 2010, 2006, 2002 by

Question 1 Immune function is most efficient when people are which age? A. B.

Question 2 A 37 -year-old man with polycystic kidney disease is on the kidney

Question 3 True or False: Inflammation means that an infection is always present. A.

Chapter 39 Assessment of the Hematologic System Copyright © 2016, 2013, 2010, 2006, 2002

Anatomy & Physiology Review Bone marrow Blood components Ø Ø Ø Red blood cells

Hemostasis and Blood Clotting Multi-stepped process of controlled blood clotting Platelet aggregation Blood clotting

Anticlotting Forces Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of

Assessment Methods Patient history Use of medications Nutritional status Family history Genetic risk Current

Physical Assessment Skin Head and neck Respiratory Cardiovascular Kidney and urinary Musculoskeletal Abdominal Central

Diagnostic Assessment Laboratory tests Ø Ø Ø Peripheral blood smear CBC Reticulocyte count Hemoglobin

Bone Marrow Aspiration Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint

Disorders of hematological system Decreased RBC production: Ø RBC Loss: Ø Ø Iron Deficiency

NANDA Impaired Nutrition Status: Less than Required Iron Impaired oxygenation Activity intolerance Pain (will

Interventions Fluids Oxygen Pain control Determine cause and treat the problem Stop bleeding Vit

Case Study Ms. V, a 19 year-old female student from Holland, visits the college

Case Study Cont. Ms. V is diagnosed with Iron Deficiency Anemia related to inadequate

Chapter 39 Audience Response System Questions Copyright © 2016, 2013, 2010, 2006, 2002 by

Question 1 The nurse is taking a history for an 80 -year-old female patient

Question 2 A patient reports increased fatigue, malaise, bleeding gums, and frequent “chills” to

Question 3 A patient is transitioning from IV heparin therapy to oral warfarin. The

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Immunological and Hematological: 1) Summarize the physiological processes of the immune and hematological systems. 2) Identify factors affecting and common problems with immunological and hematological systems. 3) Identify common lab and diagnostic tests (ie: CBC with differential, Immunoglobulins, RBC, platelets, PT/PTT, labs may also be specific to disorder so not necessary to know all of those) 4) Identify medications commonly used, which is based on particular problem (ie: antibiotics, preventionvaccines, supportive care) 5) Apply the nursing process to the care of a patient with immunological or hematological issues. 6) Know terminology 7) Know NANDA: Based on symptoms Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 2

Immunity Definition The normal physiologic response to microorganisms and proteins as well as conditions associated with an inadequate or excessive immune response. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Inflammation & Immunity Purpose: To meet the human need for protection by neutralizing, eliminating, or destroying organisms invading the internal environment Inflammation and immunity are critical to maintaining health and preventing disease Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 4

Human Leukocyte Antigens Found on the surface of most body cells Determine the tissue type of a person Ø Ø Unique protein Determines “universal product code” Key for recognition and self-tolerance Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 7

Organization of the Immune System Immune system Ø Stem cells Ø Influenced by many systems (e. g. , nervous system, endocrine system, GI system) Immature, undifferentiated cells; produced by bone marrow Leukocytes (WBCs) Ø Protect body from effects of invasion by organisms Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 8

Inflammation: “Innate Native Immunity” Any natural protective feature of a person Provides immediate protection against effects of tissue injury and foreign proteins Ø Critical to health and well-being Causes visible symptoms and can rid body of harmful organisms Ø Tissue damage may result from excessive response Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 13

Altered Immunity What is meant by “altered” immunity? Conditions in which immune responses are either suppressed or exaggerated Suppressed responses are referred to as immunocompromised or immunodeficiency Exaggerated responses are referred to as hypersensitive Copyright © 2013 by Mosby, an imprint of Elsevier, Inc. 14

Infection Occurs in response to tissue injury, invasion of organisms Usually accompanied by inflammation, but inflammation can occur without infection Inflammation does not always mean infection is present! Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 15

Sequence of Inflammatory Responses Five cardinal manifestations of inflammation: Ø Ø Ø Warmth Redness Swelling Pain Decreased function Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 18

Sequence of Inflammatory Responses (Cont. ) Stage I (vascular) – Change in blood vessels Ø Ø Phase I – Constriction Phase II – Hyperemia and edema Stage II (cellular exudate) – Neutrophilia, pus Stage III (tissue repair and replacement) – WBCs trigger new blood vessel and growth (angiogenesis) and scar tissue formation Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 19

Immunity Adaptive internal protection resulting in longterm resistance to effects of invading microorganisms Body must learn to generate specific immune responses when infected by or exposed to specific organisms Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 22

Acquiring Antibody-Mediated Immunity Innate-native immunity – Natural immunity Adaptive immunity Active immunity Natural active immunity Artificial active immunity Passive immunity Natural passive immunity Artificial passive immunity Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 23

Cell-Mediated Immunity (CMI) Also called cellular immunity Involves many WBC actions and interactions Another type of adaptive/acquired true immunity For total immunocompetence, CMI must function optimally Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 24

Protection Provided by CMI Helps protect body through ability to differentiate self from non-self Prevents development of cancer and metastasis after exposure to carcinogens Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 25

Transplant Rejection Hyperacute rejection Acute rejection Chronic rejection Management of transplant rejection Maintenance therapy Rescue therapy Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 26

Case Study Mrs. T, a 37 year old female, arrives at the ED immediately after falling off a curb and injuring her right ankle, back, and right elbow. Her back has multiple large skin abrasions and the elbow has a 2 -inch long laceration. Mrs. T states, “I think my ankle is sprained. ” Ø Which signs and symptoms should the nurse expect to see at the ankle and surrounding the abrasions? Why? Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 27

Case Study cont. Mrs. T is diagnosed with a sprained ankle, and she is taught how to walk on crutches. Before Mrs. T leaves the ED, she tells the nurse, “I think my elbow is infected”. Ø How should the nurse respond to Mrs. Morale’s statement? Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 28

Case study cont: Two weeks later, Mrs. T follows up with her provider because she isn’t feeling well. Her elbow is painful to touch, hot, edematous, red, and contains pus. Mrs. T’s temperature is 100 F and she states she is feeling “achy all over” Ø What laboratory values should the nurse expect to see? Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 29

NANDA Risk for Infection (related to impaired immune system) i. e. : Cancer, Altered or insufficient leukocytes, Arthritis, Respiratory disorders, Renal failure, Hematologic disorders, Hepatic disorders, AIDS, Alcoholism, Immunosuppression, Immunodeficiency secondary to: ? Risk for Infection Transmission (related to lack of knowledge of reducing the risk of transmitting HIV) Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 30

Question 1 Immune function is most efficient when people are which age? A. B. C. D. Infancy Teen years 20 to 30 years 50 years and older Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 32

Question 2 A 37 -year-old man with polycystic kidney disease is on the kidney transplant list. He is to receive 2 units of leukocyte-poor packed red blood cells to treat a low hemoglobin. He asks the nurse why he needs this type of blood. What is the nurse’s best response? A. B. “It causes fewer blood reactions for pre-transplant patients. ” “It is less likely to causes hemolysis, or destruction of the blood cells, after transfusion. ” C. “All pre-transplant patients receive leukocyte-poor blood because it is absorbed better by the body. ” D. “It will decrease the risk of obtaining white blood cells from the donor that could make it harder for your transplanted kidney to function. ” Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 33

Anatomy & Physiology Review Bone marrow Blood components Ø Ø Ø Red blood cells (erythrocytes) White blood cells Platelets Accessory organs of blood formation Ø Ø Spleen Liver Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 36

Hemostasis and Blood Clotting Multi-stepped process of controlled blood clotting Platelet aggregation Blood clotting Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 37

Assessment Methods Patient history Use of medications Nutritional status Family history Genetic risk Current health problems Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 39

Physical Assessment Skin Head and neck Respiratory Cardiovascular Kidney and urinary Musculoskeletal Abdominal Central nervous system Psychosocial Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 40

Diagnostic Assessment Laboratory tests Ø Ø Ø Peripheral blood smear CBC Reticulocyte count Hemoglobin electrophoresis Coombs’ tests (direct and indirect) Serum ferritin, transferrin, and TIBC PT INR PTT Anti-factor Xa test Platelet aggregation Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 41

Disorders of hematological system Decreased RBC production: Ø RBC Loss: Ø Ø Iron Deficiency Anemia Hemorrhage Blood clotting disorder RBC destruction: Ø Sickle cell anemia Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 43

NANDA Impaired Nutrition Status: Less than Required Iron Impaired oxygenation Activity intolerance Pain (will go into detail next week) Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 44

Interventions Fluids Oxygen Pain control Determine cause and treat the problem Stop bleeding Vit K Iron as prescribed Plasma infusion as prescribed Energy conservation – ADL’s as tolerated. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 45

Case Study Ms. V, a 19 year-old female student from Holland, visits the college health center for “being tired all the time”. The nurse notes that she is pale with cool skin, mucous membranes are pale and moist, and lungs are clear. Ms. V states that she does get short of breath climbing the stairs or walking up hill. Laboratory results are: Ø RBC 3. 8 million µL, HGB 9. 8 g/d. L, HCT 37%, MCV 70 f. L, MCH 25 pg, MCHC 300 g/d. L, and WBC 6000/mm 3 How should the nurse interpret these results? What questions should the nurse ask Ms. V to help differentiating the type of anemia? Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 46

Case Study Cont. Ms. V is diagnosed with Iron Deficiency Anemia related to inadequate iron intake. What instructions/teaching should the nurse provide to help resolve the anemia? How would Ms. V know that the plan of treatment is working? Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 47

Question 1 The nurse is taking a history for an 80 -year-old female patient who reports progressive fatigue, shortness of breath, and headaches. What is the priority assessment question the nurse should ask? A. B. C. D. “Can you tell me about your diet? ” “Have you been feeling depressed lately? ” “What medications do you routinely take? ” “Do you have a history of cardiovascular disease? ” Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 49

Question 2 A patient reports increased fatigue, malaise, bleeding gums, and frequent “chills” to the nurse. What is the priority nursing intervention? A. Document assessment findings. B. Notify the health care provider of the patient’s symptoms. C. Obtain vital signs and administer antipyretic medications. D. Review laboratory analysis for signs and symptoms of bone marrow suppression. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 50

Question 3 A patient is transitioning from IV heparin therapy to oral warfarin. The nurse recognizes which laboratory finding that indicates warfarin treatment efficacy? A. B. C. D. Bleeding time of 5 minutes Prothrombin time (PT) of 18 seconds International normalized ratio (INR) of 2. 5 Partial thromboplastin time (PTT) of 24. 3 seconds Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 51