Chapter 50 and Chapter 51 Assessment of Immune Function Management of Patients With Immunodeficiency Chapter 70 pp 2

1. Inflammation Unit IILecture 1 Chapter 50 and Chapter 51 Assessment of Immune Function Management of Patients With ImmunodeficiencyChapter 70 pp 2474-2484

2. The Immune System • Immunity: the body’s 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

3. Central and Peripheral Lymphoid Organs

4. Development of Cells of the Immune System

5. Lymphocytes • B lymphocytes mature in the bone marrow; T lymphocytes mature in the thymus where they also differentiate into cells with various functions

6. 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

7. Defenses • Phagocytic immune response • Humoral/antibody response • Cellular immune response • Chemical Response

8. Phagocytic Immune Response • WBC’s (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.

9. 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

10. 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

11. Exposure

12. 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……)

13. 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

14. Chemical Immune Response • Enhanced Phagocytosis- WBC’s 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 WBC’s along a concentration gradient • Cell Lysis-breakdown of cell

15. 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

16. Autoimmune disorders • Inability to determine self from non-self • Lupus Erthematosis, Rheumatoid arthritis

17. 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

18. 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 antigen–antibody tests • HIV infection tests

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. Methicillin-resistant Staphylococcus Aureus (MRSA) • Most prevalent nosocomial pathogen. • 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

30. 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

31. 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

32. Infectious Terrorism • Biologic agents of terrorism • Anthrax • Plague • Tularemia • Botulism-treat with antitoxin • Small pox-vaccination • Hemorrhagic fever-no established treatment

33. Nursing Process—Assessment 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

34. Nursing Process—Diagnosis of the Patient With an Infectious Disease • Risk for infection transmission • Deficient knowledge • Risk for ineffective thermoregulation

35. Collaborative Problems/Potential Complications • Septicemia, bacteremia, or sepsis • Septic shock • Dehydration • Abscess formation • Endocarditis • Infectious disease-related cancers • Infertility • Congenital abnormalities

36. Nursing Process—Planning 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

37. 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