The document discusses the immune system and immunity from a nursing perspective. It covers the physiology of the immune system including leukocytes and the humoral and cellular immune responses. It also discusses immunity concepts, alterations like hypersensitivity and autoimmune diseases, risk factors, prevention through immunizations, nursing assessment of the immune system, diagnostic tests, and interventions and therapies for immune-related issues.

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Nursing:
A Concept-Based Approach to Learning
VOLUME ONE | SECOND EDITION
Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
Immunity
8
Nursing:
A Concept-Based Approach to Learning
MODULE
VOLUME ONE | SECOND EDITION

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The Concept of Immunity
• Function of immune system
 Protect body
 Identify and destroy harmful cells
 Remove cellular debris

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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/mm3

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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

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Physiology Review, continued
• Leukocytes
 Monocytes
• 2–3% of circulating leukocytes
• Migrate to tissues and mature into
macrophages
- Wait to be activated

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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

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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

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Volume One, Second Edition

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Nursing: A Concept-Based Approach to Learning
Volume One, Second Edition
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”

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Physiology Review, continued
• Antibodies
 Classes of antibodies
• IgM: responsible for primary immunity
• IgG: major immunoglobulin
• IgA: protects mucous membranes
• IgD: role unknown
• IgE: increases during allergic reactions,
anaphylaxis

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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

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Physiology Review, continued
• Lymphoid system
• Protects bloodstream from invading
organism
 Lymph nodes
• Filter foreign products or antigens
 Spleen
• Filters blood
 Thymus gland
• Stimulates lymphopoiesis

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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

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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

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Genetic and Lifespan
Considerations
• Pediatric considerations
 Immune system development influenced by
early in utero experiences, environmental
exposures after birth, other factors
• IgG: only immunoglobulin crosses placenta
• Maternal IgG disappears by 6–8 months
• Child's IgG increases gradually until 7–8
years

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Genetic and Lifespan
Considerations, continued
• Normal changes
associated with
aging
• Immune function
declines
• External factors
• Nutrition
• Effects of exposure
to toxins
• 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

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Concepts Related to Immunity
Page 446
• Comfort
• Inflammation
• Tissue Integrity

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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

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Alterations
• Exemplar 8.1 HIV
• Exemplar 8.2 Hypersensitivity
• Exemplar 8.3 Rheumatoid Arthritis
• Exemplar 8.4 Lupus

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Prevalence
• Estimated 40–50% of schoolchildren
worldwide sensitized to one or more
allergens
• Prevalence increasing in U.S.

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Genetic Considerations and
Nonmodifiable Risk Factors
• Genetics key component in immune
disorders, deficiencies

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Prevention
• Prevention of immune disorders
• Vaccines to prevent infections diseases

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Modifiable Risk Factors
• Nutrition
• Weight
• Stress
• Alcohol, drug and cigarette use
• Intravenous drug use and risky sexual
behaviors

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Immunizations
• Introduce antigen into body, allowing
immunity to develop
 Active immunity
• Vaccine
 Passive immunity
• Injection of antibodies produced by another
host

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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

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Nursing Assessment
• Health history
 Review biographical data
 Family history
 Provide privacy and be sensitive

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Assessment Interview
• What infections have you had in the past?
• When were your last immunizations?
• Do you have any allergies?

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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

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Diagnostic Tests

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Diagnostic Tests, continued
• Radioallergosorbent
test
• Skin reactions
• Western blot test
• Complete CBC
• Complement
• Enzyme
immunoassay
• Enzyme-linked
immunosorbent
assay
• Immunoglobulins
• Polymerase chain
reaction
• Rapid HIV tests

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Interventions and
Therapies
• Independent
 Nutrition
 Exercise
 Sleep
 Stress reduction, management

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Interventions and Therapies,
continued
• Collaborative
 Pharmacologic therapy
• Anti-inflammatories
• Antibiotic therapy
• Intravenous immunoglobulin
• Hematopoietic stem cell transplantation

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Interventions and Therapies,
continued
• Collaborative
 Nonpharmacologic therapy
• Gene transfer
 Complementary and alternative therapy
• Acupuncture
• Hydrotherapy
• Dietary supplements
• Immune stimulation