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Second level
Third level
Fourth level
Fifth level
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Copyright 2015, 2011 by Education, Inc.
All Rights Reserved
Nursing A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright 2015, 2011 by Education, Inc.
All Rights Reserved
Nursing
A Concept-Based Approach to Learning
VOLUME ONE SECOND EDITION
Nursing A Concept-Based Approach to Learning
Volume One, Second Edition
Copyright 2015, 2011 by Education, Inc.
All Rights Reserved
Nursing A Concept-Based Approach to Learning
Volume One, Second Edition
Click to edit Master text styles
Second level
Third level
Click to edit Master title style
Copyright 2015, 2011 by Education, Inc.
All Rights Reserved
Nursing A Concept-Based Approach to Learning
Volume One, Second Edition
Click to edit Master text styles
Second level
Third level
Fourth level
Fifth level
Immunity
Nursing
A Concept-Based Approach to Learning
MODULE
VOLUME ONE SECOND EDITION
The Concept of Immunity
Concept Learning Outcomes
Concept Learning Outcomes, continued
After reading about this concept, you will be able to
Differentiate common assessment procedures used to examine immune health across the life span.
Describe diagnostic and laboratory tests to determine the individual s immune status.
Concept Learning Outcomes, continued
Concept Learning Outcomes, continued
After reading about this concept, you will be able to
Compare and contrast common independent and collaborative interventions for clients with alterations in immune function.
The Concept of Immunity
Human body constantly threatened by
Foreign substances
Infectious agents
Abnormal cells
Function of immune system
Protect body from foreign antigens
Identify, destroy potentially harmful cells
Remove cellular debris
The Concept of Immunity, continued
Body s natural or induced response to infection
Immunocompetent clients
Effective immune system
Hypersensitivity
Overreaction of immune system
Autoimmune disorders
Immune system attacks own body
Immunodeficiency
Incompetent immune system
Normal Presentation
Normal Presentation, continued
Nonspecific responses
Prevent, limit entry of invaders
Limit tissue damage
Reduce immune system workload
Inflammation is nonspecific response
Specific response
When inflammatory process cannot destroy invaders
Physiology Review
Physiology Review, continued
Leukocytes
Leukopenia decrease in number of circulating leukocytes
When bone marrow activity suppressed
When leukocyte destruction increases
Physiology Review, continued
Physiology Review, continued
Leukocytes
Granulocytes
Three types
Neutrophils
Eosinophils
Basophils
Physiology Review, continued
Physiology Review, continued
Leukocytes
Monocytes
Kupffer cells
Alveolar macrophages
Microglia
Activate immune response against chronic infections
Physiology Review, continued
Leukocytes
Dendritic cells
Originate in myeloid, lymphoid cell lines
Antigen-presenting cells (APCs)
Operate in most organs
Langerhans cells specialized dendritic cells in skin
Physiology Review, continued
Leukocytes
Two types develop from pluripotent stem cells in bone marrow
DC1s activate T cells against cancer cells
DC2s assist B lymphocytes to produce antibodies, downregulate immune system
Physiology Review, continued
Physiology Review, continued
Leukocytes
Lymphocytes
Memory cells
Stay inactive, sometimes for years
Activate immediately when exposed to same antigen
Proliferate rapidly, intense immune response
Responsible for acquired immunity
Physiology Review, continued
Leukocytes
Lymphocytes
T cells
Mature in thymus
On contact with APCs, mature into active helper T cells, cytotoxic T cells, or memory T
B cells
Mature in bone marrow
On contact with antigen, activated and mature into plasma cells or memory cells
Physiology Review, continued
Leukocytes
Lymphocytes
Natural killer cells
In spleen, lymph nodes, bone marrow, blood
15 of circulating lymphocytes
Immune surveillance, resistance to infection
Destruction of early malignant cells
Physiology Review, continued
Antigens
Provoke specific immune response
Typically, large protein molecules
Antigenic determinant site (epitope)
Characteristics of complete antigens (immunogens)
Immunogenicity
Specific reactivity
Physiology Review, continued
Antigens
Small molecules (e.g., dust) may link to proteins (haptens) to form complete antigens
When antigen encountered in the body, two major groups of cells generate effective immune response
Lymphocytes
APCs
Physiology Review, continued
Antigens
Primary immune response
B cell produces antibodies to eliminate extracellular antigens
Antibodies react specifically to that antigen
Takes 3 days
Secondary immune response
Subsequent encounters with an antigen trigger memory cells
Physiology Review, continued
Antibodies
Classes of antibodies (immunoglobulins)
IgM responsible for primary immunity
IgG major immunoglobulin
IgA protects mucous membranes
IgD role unknown
IgE increases during allergic reactions, anaphylaxis
Physiology Review, continued
Antibodies
Intracellular pathogens activate T lymphocytes
Primary agents of cell-mediated immune response
Cell-mediated immunity attacks antigens directly and by activating B cells
Physiology Review, continued
Antibodies
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
Physiology Review, continued
Antibodies
Cytokines carry messages for immune system function
Cytotoxic T lymphocytes
Attack malignant cells
Responsible for rejection of transplants
Physiology Review, continued
Lymphoid system
Recovers proteins for vascular system
Protects bloodstream from invading organism
Lymph nodes
Most numerous elements of lymphoid system
Filter foreign products or antigens
House, support lymphocytes and macrophages
Physiology Review, continued
Lymphoid system
Spleen
Largest lymphoid organ
Filters blood
Two kinds of tissue
White pulp lymphoid proliferation, immune surveillance
Red pulp blood filtration
Physiology Review, continued
Lymphoid system
Thymus gland
Stimulates lymphopoiesis
During fetal life, childhood, site for maturation, differentiation of thymic lymphoid cells
Physiology Review, continued
Nonspecific Inflammatory Response
Genetic and Lifespan Considerations
Genetic and Lifespan Considerations, continued
Genetic and Lifespan Considerations, continued
Normal changes associated with aging
Immune function declines
External factors
Nutrition
Effects of exposure to toxins
Genetic and Lifespan Considerations, continued
Concepts Related to Immunity
Comfort
Inflammation
Tissue Integrity
Alterations and Manifestations
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Alterations and Manifestations, continued
Hypersensitivity reactions, continued
Transplant reactions
Hyperacute rejection
Occurs minutes, hours after transplantation
Acute rejection
Occurs in weeks after transplantation
Alterations and Manifestations, continued
Hypersensitivity reactions, continued
Transplant reactions
Chronic rejection
Occurs months after transplantation
Impaired immune response
Secondary deficiencies caused by trauma, cancer therapies
AIDS
Prevalence
Prevalence, continued
0
Genetic Considerations and Nonmodifiable Risk Factors
Genetics key component in immune disorders, deficiencies
Children at greater risk of allergies if parents have allergies
Predisposition to autoimmune diseases in presence of environmental trigger
Genetic Considerations and Nonmodifiable Risk Factors, continued
Gender
Many conditions more prevalent in female
Age
Race
African Americans
Higher rates of transplant rejection
Increased prevalence of autoimmune diseases
Prevention
Prevention, continued
Modifiable Risk Factors
Nutrition
Weight
Stress
Alcohol, drug and cigarette use
Intravenous drug use
Risky sexual behaviors
Immunizations
Introduce antigen into body, allowing immunity to develop
Active immunity
Vaccine
Passive immunity
Injection of antibodies produced by another host
Immunizations, continued
Types of vaccines
Killed virus
Toxoid
Live virus
Recombinant
Conjugated
Immunizations, continued
Responses to vaccines
Local reaction
Systemic reaction
Local allergic reactions
Life-threatening allergic reaction
Anaphylaxis
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
Immunizations, continued
Contraindications
Acute illness with high fever
Hypersensitivity reaction
Recent immunoglobulin therapy
Cancer treatments
Pregnancy
Immunizations, continued
Parent education and informed consent
Concerns about overloading immune system at young age
Doubts about efficacy
Lack of confidence in immunization recommendations, vaccine testing
Belief in herd immunity
Immunizations, continued
Parent education and informed consent
Fear of side effects
Previous negative vaccine reactions in family members, friends
Belief that vaccines compromise immune system
Immunizations, continued
Parent education and informed consent
Healthcare providers roles
Consistent message about value of vaccines
Answer parents questions
Give VISs to parents/guardians
Discuss risks, benefits of vaccines
Immunizations, continued
Parent education and informed consent
Healthcare providers roles
Obtain written consent before administering vaccine
Document informed refusal
Parents have the right to refuse immunizations
Assessment
Integrated throughout health history, physical examination
Nursing Assessment
Health history
Review biographical data
Family history
Provide privacy
Individualize terms used
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
Diagnostic Tests
Enzyme immunoassay
Enzyme-linked immunosorbent assay
Immunoglobulins
Polymerase chain reaction
Rapid HIV tests
Diagnostic Tests, continued
Radioallergosorbent test
Skin reactions
Western blot test
Complete CBC
Complement
Interventions and Therapies
Independent
Nutrition
Exercise
Sleep
Stress reduction, management
Interventions and Therapies, continued
Collaborative
Pharmacologic therapy
Anti-inflammatories
NSAIDs
Corticosteroids
Antibiotic therapy
Cytomegalovirus-negative, irradiated blood products for clients with T-cell deficiencies
Intravenous immunoglobulin
Hematopoietic stem cell transplantation
Interventions and Therapies, continued
Collaborative
Nonpharmacologic therapy
Gene transfer
Complementary and alternative therapy
Acupuncture
Hydrotherapy
Dietary supplements
Immune stimulation
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