Nursing: A Concept-Based Approach to Learning, 2nd Edition

- 3 - 3 Click to edit Master text styles Second level Third level Fourth level Fifth 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 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 - 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