Chapter 50 and Chapter 51

Assessment of Immune Function

Management of Patients With Immunodeficiency
Chapter 70
pp 2474-2484

The Immune System

Immunity: the bodys specific protective
response to invading foreign agent or
organism
Immunopathology: the study of diseases that
result from dysfunction of the immune system
Immune disorders:
Autoimmunity
Hypersensitivity
Immune deficiencies: primary and
secondary
Infection
2

Central and Peripheral Lymphoid

Organs

Development of Cells of the

Immune System

Lymphocytes

B lymphocytes mature in the bone marrow; T

lymphocytes mature in the thymus where they also
differentiate into cells with various functions

Immune Function
Natural immunity: nonspecific response to any
foreign invader
White blood cell action: release cell mediators such
as histamine, bradykinin, and prostaglandins, and
engulf (phagocytize) foreign substances
Inflammatory response
Physical barriers, such as intact skin, chemical
barriers, and acidic gastric secretions or enzymes in
tears and saliva
Acquired immunity: specific against a foreign antigen
Result of prior exposure to an antigen
Active or passive
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Defenses
Phagocytic immune
response
Humoral/antibody response
Cellular immune response
Chemical Response

Phagocytic Immune
Response
WBCs (leukocytes) participate in both, natural and
acquired immunity
Granulocytes (granular leukocytes) release
mediators (such as histamine, bradykinin and
prostaglandins) and engulf antigen
(include neutrophils, eosinophils and
basophils)
Neutrophils- first cells to arrive on scene
Nongranular leukocytes
Monocytes or macrophages (called Histiocytes
when they enter the tissue spaces)- engulf,
ingest and destroy greater number of foreign
bodies/toxins that granulocytes do.
8

Humoral/Antibody
response
Humoral is Greek for blood
Lymphocytes
Consist of B-cells and T-cells
B lymphocytes: humoral immunity
Produce antibodies or
immunoglobulins
Antibody response
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Role of Antibodies
Agglutination- (clumping of antigens)
Helps clear the body of the invading organism by
facilitating phagocytosis
Opsonization- the antigen-antibody molecule is
coated with a sticky substance to facilitate
phagocytosis
Promote release of vasoactive substances; activation
of complement system and phagocytosis
Act in concert with other components of the immune
system
Types of immunoglobulins: IgA, IgD, IgE,IgG, and IgM
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Exposure

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Cellular immune response

T lymphocytes: cellular immunity
Attack invaders directly, secrete cytokines, and
stimulate immune system responses
Helper T cells
Cytotoxic T cells
Memory cells
Suppressor T cells (suppress immune response)
T cells help the cells when the cell figures out
there is a problem..(Cells will hold the
antigen at the surface and wait for the T cells to
come get it)
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Chemical Immune
Response
Histamine- source: basophils, mast cells, platelets
causes vasodilation and vascular permeability
Kinins- source: precursor factor from clotting
system
causes vasodilation and vascular permeability
as well as pain receptors stimulated
Fibrinopeptides- source: activation of clotting
system
vascular permeability and stimulates
Chemotaxis
Prostaglandins/leukotrienes- source: substances
synthesized from the phospholipids of cell
membranes of most body tissues
vascular permeability and stimulates
Chemotaxis

13

Chemical Immune
Response
Enhanced Phagocytosis- WBCs ingest
or engulf any unwanted organism and
kill it
Enhanced Vascular Permeability- allows
cells to move back and forth to cells
Chemotaxis- directional migration of WBCs
along a concentration gradient
Cell Lysis-breakdown of cell
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Complement System
Circulating plasma proteins, know as complement,
are made in the liver and are activated when an
antibody connects with and antigen.
Three major physiologic functions
Defending the body against bacterial infection
Bridging natural and acquired immunity
Disposing of immune complexes and the
byproducts associated with inflammation
The proteins that comprise the complement system
interact sequentially
Three ways to active:
Classic pathway
Alternative pathway
Lectin pathway

15

Autoimmune disorders
Inability to determine self from nonself

Lupus Erthematosis, Rheumatoid

arthritis

16

Variables That Affect

Immune System Function
Age and gender
Nutrition
Presence of conditions and disorders:
cancer/neoplasm, chronic illness, autoimmune
disorders, surgery/trauma
Allergies
History of infection and immunization
Genetic factors
Lifestyle
Medications and transfusions: see Table 50-6
Pyschoneuroimmunologic factors

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Tests to Evaluate Immune

Function
WBC count and differential
Bone marrow release more neutrophils,
may release bands which are
immature cells to keep up. shift to the
left means acute bacteria infection.
(mature neutrophils=segmented
neutrophils)
Bone marrow biopsy
Phagocytic cell function test
Complement component tests
Hypersensitivity tests
Specific antigenantibody tests
HIV infection tests

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Immunodeficiency Disorders
Primary
Genetic
May affect phagocytic function, B cells
and/or T cells, or the complement
system
Secondary
Acquired
HIV/AIDS
Related to underlying disorders,
diseases, toxic substances, or
medications

19

Primary Immunodeficiencies
Usually seen in infants and young children
Manifestations: vary according to type; severe or
recurrent infections; failure to thrive or poor
growth; and positive family history
Potential complications: recurrent, severe,
potentially fatal infections; related blood
dyscrasias and malignancies
Treatment: varies by type; treatment of
infection; pooled plasma or immunoglobulin;
GM-CSF or GCSF; thymus graft, stem cell, or
bone marrow transplant
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Nursing Management
Monitor for signs and symtoms of infections
Symptoms of inflammatory response may be
blunted
Monitor lab values
Promote good nutrition
Address anxiety, stress, and coping
Strategies to reduce risk of infection
Handwashing and strict aseptic technique
Patient protection and hygiene measures: skin
care, promote normal bowel and bladder
function, and pulmonary hygiene
21

Patient Teaching
Signs and symptoms of infection
Medication teaching
Prevention of infection
Handwashing
Avoid crowds and persons with infections
Hygiene and cleaning
Nutrition and diet
Lifestyle modifications to reduce risk
Follow-up care
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Colonization, Infection, and

Disease
Colonization: describes
microorganisms present without
host inference or interaction
Infection: indicates host interaction
with the organism
Disease: the infected host displays a
decline in wellness due to the
infection
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Interpreting the Microbiology

Report
A tool to determine colonization, infection, or
disease
The organism reported may reflect colonization
rather than infection
Mix of cells in smear and stain report may
indicate cellular response
Culture and sensitivity specify the organism and
which antibiotic will inhibit growth
Analyze results in conjunction with the clinical
assessment of the patient
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Isolation Precautions

Guidelines to prevent the transmission of

microorganisms in hospitals

Standard precautions used for all patients

The primary strategy for preventing HAIs

Transmission-based precautions are for patients with

known infectious diseases spread by airborne,
droplet, or contact routes

25

Elements of Standard
Precautions
Hand hygiene
Use of gloves and other barriers
Proper handling of patient care equipment and linen
Environmental control
Prevention of injury from sharps and needles
Patient placement

26

Transmission-Based Precautions

Airborne precautions

Hospitalized patient should be in negative pressure room

with the door closed; health care providers should wear
an N-95 respirator (mask) at all times when in the room
Droplet precautions

Wear a face mask but door may remain open;

transmission is limited to close contact
Contact precautions
Use of barriers to prevent transmission; emphasize
cautious technique as organism is easily transmitted by
contact between the health care worker and the patient
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Antibiotic resistant
organisms
Nosocomial: Caused
by exposure to an organism in the

hospital setting
Best way to prevent the spread of infection----good
hand washing (waterless gel, ok)

Methicillin-resistant Staphylococcus Aureus (MRSA)

Vancomycin-resistant enterococci (VRE)
Penicillin-resistant Streptococcus pneumoniae (PRSP)
C. Difficile

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Methicillin-resistant
Most prevalent nosocomial pathogen.
Staphylococcus
Aureus
(MRSA)
Main mode of transmission is via direct
contact-especially
health
care workers hands.

Staph bacteria and MRSA can be found on the skin and in the nose
of people without causing illness
Can survive on hands for 3 hours if not washed properly
Colonization occurs when the staph bacteria are present on or in
the body without infection (20-30% of the population is colonized
in the nose with staph at any given time)
Infection is when causes disease, typically in a compromised
patient.
Contact precautions
Treatment of choice is Vancomyacin

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Vancomyacin-Resistant Enterococcus

Major source of transmission is health care workers hands.

Can survive on environmental surfaces for weeks without
proper disinfectants.
Contact precautions with a special disinfectants
Treatment includes Beta-lactam and aminoglycoside
antibiotics

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Clostridium difficile

occurs when the normal intestinal flora is altered, allowing

C. difficile to flourish in the intestinal tract and produce a
toxin that causes a watery diarrhea.
Spores can survive up to 70 days in the environment and
can be transported on the hands of health care personnel
who have direct contact with infected patients
Symptoms:
Watery diarrhea
Cramps
Fever
Abd pain
Treatment: related to Cause

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Infectious Terrorism

Biologic agents of terrorism

Anthrax
Plague
Tularemia
Botulism-treat with antitoxin
Small pox-vaccination
Hemorrhagic fever-no established
treatment
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Nursing ProcessAssessment of
the Patient With an Infectious
Disease

Health history: investigate the likelihood and probable

source of infection, associated pathology, and
symptoms

Administer a physical exam

Vital Signs

33

Nursing ProcessDiagnosis of
the
Patient With an Infectious
Disease

Risk for infection transmission

Deficient knowledge

Risk for ineffective thermoregulation

34

Collaborative Problems/Potential
Complications

Septicemia, bacteremia, or sepsis

Septic shock
Dehydration
Abscess formation
Endocarditis
Infectious disease-related cancers
Infertility
Congenital abnormalities

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Nursing ProcessPlanning the

Care of the Patient With an
Infectious Disease

Major goals include prevention of the spread of

infection, increased knowledge about the
infection and its treatment, control of fever
and related discomforts, and absence of
complications

36

Interventions

Prevent the spread of infection

Perform handwashing
Exercise Standard Precautions
Recognize mode of transmission and establish
Transmission-Based Precautions as indicated

Teach about infectious process and the prevention of the

spread of infections

Assess and treat fever

Increases metabolic rate by 7% each 1 degree above normal
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