By: Diana Blum RN MSN
Metropolitan Community College


Bone marrow= spongy center of the bones
where WBCs are made
Lymphatic System= network of open ended
tubes separate from the blood circulation
system that collects the plasma left behind
and returns it to the venous system.
 WBC travel through the tissues looking infection

Lymph fluid=mix of plasma and cells
 Propelled along the lymphatic system by normal muscle
contraction
 One way valves prevent the fluid from pooling

Lymph nodes= small patches of tissue that filter
microorganisms from the lymph fluid before it is returned
to the bloodstream.
 Located throughout the body
 Swell with infection and cancer

Spleen= in LUQ of the abdomen. Filters microorganisms
from the blood. Once trapped, WBCs destroy them
 Removed if Trauma (MVA), hodgkin’s dx
▪ Greater risk of infection

Thymus= located below the thryoid
 Early in life WBCs called lymphocytes migrate
from bone marrow to the thymus where they
mature into T Cells
 As humans age the thymus shrinks

Stem Cells=called progenitor cells
 Develop into various WBCs, RBCs, or Platelets
 Most located in bone marrow
 Some circulate in blood

WBCS (Leukocytes)=produced by bone
marrow
 Identify and destroy antigens (proteins)
 Life span of WBC is 12 hours

Macrophages= clean up WBC debris
 If WBCs build faster than macrophages can clean
pus is formed.


Neutrophils=fight bacterial infections
Most numerous of the WBCs about 60%


Monocytes= circulate for 1 day before
entering tissue
Macrophages=monocytes when they enter
tissue
 Destroyed during phagocytosis
▪ Ingest foreign material and can live months to years

Eosinophils=combat parasitic infections
 Also associated with allergic responses

Basophils= can initiate massive inflammatory
response to bring other WBCs to infection
site
 Work with Immunoglobin E (IgE) by releasing
histamine from cell vesicles in the basophil
▪ Histamine is a potent vasodialator that increases blood
circulation to the site


Mast cells= store histaminein cell vesicles. Located in tissue
B cells= manufacture antigen binding proteins (immunoglobins)
on the cell membrane
 when immunoglobin binds w/ antigen, the b cell is stimulated to
produce plasma cells and memory B cells.
 Plasma cells are antibody factories that produce large amounts of
immunoglobins.
 Memory B cells go into a resting state but can be quickly reactivated.
 Once immunoglobin released it is called an antibody.
▪ 4 types
▪ IgM=first to be secreted during primary immune response
▪ IgG= secreted during 2nd ary immune response
▪ IgA=present in secretions like mucus and mother’s milk
▪ IgE=attaches to the cell membrane of basophils and mast cells where it
triggers the cell to release histamine.

T Cells= 2 types: T helper(CD4) and T cytotoxic
 CD4 cells are found on cell membrane
 When CD4 cells come in contact with foreign antigens they
secrete cytokines that activate other components of immune
system
 CD4 cells can be infected with HIV
 Tc cells= CD8 cells because protein complex on cell membrane.
 Tc cells destroy invaders
Cytokines= hormones secreted by cells to signal others
(interferon, interleukin, tumor necrosis factor,
granulocyte=macrophage colony stimulating factor, EPO)
 Eicosanoids=class of fatty acids that regulate blood vessel
vasodilation, temperature elevation, WBC activation

 NSAIDS disrupt production

Innate immunity: operational at all times
 Present at birth
 Include– barriers, inflammatory response,
phagocytosis
▪ Barriersskin and mucous membranes= first line of defense,
sweat glands
▪ Inflammatory responsedilate capillaries to increase
permeability of affected area
▪ s/s: rubor (redness), tumor (swelling), Calor (heat), and dolor (pain)
▪ Phagocytosis process of ingesting and digesting invading
pathogens, dead cells, and cellular debris
▪ Neutrophils, monocytes, and macrophages are capable and
sometimes refered to as phagocytes

Acquired immunity=fights a particular pathogen and
is only activated when needed
 2 types
▪ Antibody mediated: activated when IgM detects foreign antigen.
See page 594
▪ Can be active or passive
 Active:the person manufactures antibodies in response to infection
***permanent
 Passive:antibody is produced by animal or person and then transferred to
another (ex. through breast milk)
***lasts 1-2 months after antibodies received
▪ Cell mediated: aimed at intracellular defects like virus and cancer
▪ Delays hypersensitivity reactions and transplant rejections
▪ Tc are primary component
▪ When Tc cells recognize foreign antigens they secrete cytotoxic substances
to destroy the defective cell (transplant organ)

Immune system must be able to recognize its
own proteins and not fight itself
 Occurs as part of neonatal growth

Autoimmune diseases occur when:
 Example: acute rheumatic fever, lupus,
rheumatoid arthritis, diabetes, thyroiditis, graves
disease




Bone marrow is less productive
Immunity not usually affected unless unusual
stress, trauma, chronic infection, cancer tx
Lymphatic tissue grows between age 6-20
As we age lymph tissue shrinks
 Result is fewer and smaller lymph nodes
Hx of present illness: frequent infections, prolonged
bleeding, easy bruising, chronic fatigue
 PMH: cancer, HIV, Splenectomy, long term venous access
device, infections, current meds, immunizations
 System review: skin-rash ulcers, enlarged lymph nodes







NeuroRespiratoryGIGUMuscleEndocrine-
See page 630









Hobbies
Occupation
Self concept
Activity and exercise
Sleep and rest
Nutrition
Interpersonal relations
Coping and stress
Health perception


Urine Tests-urine protein electrophoresismeasures immunoglobin in the urine
Blood tests:
 CBC
 Serum protein electrophoresis(measures
immunoglobin in the blood) (used to look for multiple
myeloma)
 Antinuclear antibody test-looks for lupus
 ELIZA- looks for HIV/AIDS
 Cultures-detect infection of blood, sputum, urine,
stool

Bone marrow biospy- done if CBC abnormal
 Diagnoses leukemia, WBC cancer, and Multiple
Myeloma
 See page 600

Lymphangiography-evaluates anatomy of
lymph vessels and lymph nodes
 Helps stage cancer
Liver- Spleen Scan-evaluates size and function
of liver and spleen
 Gallium Scan-uses radioactive tracer to detect
presence of malignancy
 Skin tests-Ex. TB tine



The lower the WBC the greater chance of
infection
See page 635








Pvt room
Vistors wash hands
Monitor vs q2-4 hours
Aseptic technique
Isolation
C and DB
Patient wears mask when outside room
No fresh flowers or plants in room


Stimulates bone marrow to produce more
blood cells
Drugs may be given to stimulate ex.
Neupogen


Done to restore immune system
Complications: infection, thrombocytopenia,
renal insufficiency, graft vs host dx


Neutropenia: neutrophils level low
Leukemia: cancer of WBC- bone marrow produces too
many immature cells
 Cause: exposure to benzene, large dose of radiation
 2 types:
▪ myelogenous-most often in adults
▪ Lymphocytic-most often in kids 2-6 yrs old-
 At risk for severe infection and bleeding
 s/s:infection, fever, nite sweats, low RBC ct, fatigue,
paleness, tachycardia, tachypnea, petechiae, purpura,
epistaxsis, gingival bleed, melena (blood in stool), bone
pain, weight loss, swollen lymph nodes
 Tx: high dose chemo, therapy



Induction therapy-initial dose of chemo
Maintenance therapy- lower dose of chemo
over 1-3 years
Intensification and consolidation therapybone marrow transplant(monitor for
infection, bleeding)

Risk for injury r/t infection aeb
thrombocytopenia and anemia.
 Goal absence of injury from infection, bleeding, and
inadequate oxygenation aeb normal body
temperature, no bruising, or frank bleeding, pulse and
respiratory, rates WNL





Fatigue
Impaired oral mucous membranes
Imbalanced nutrition<less than body
requirements
Anxiety
Ineffective therapeutic regimen management






Thorough hand washing
Encourage patient to shower everyday
Discourage patients from eating fresh fruit
and veggies and dairy
Possible transfusions
Monitor for stomatitis
Encourage patients and family to express
their feelings and ask questions




LUPUS
S/S: Butterfly rash= characteristic sign,
malaise, anorexia, muscle pain, swollen
joints, photosensitivity etc
DX: no one test definitely diagnoses SLE
Tx: No cure. Minimize symptoms, steroids,
cytotoxic agents

Initial: lasts 4-8 weeks
 High levels in blood
 Flulike symptoms

Latent: inactive until a virus presents than
replication begins
 Lasts 2-12 years
 Asymptomatic

Third stage=opportunistic infections
 2-3 years
 Once CD4 Level below 200 it is considered AIDS


Opportunistic infections
 Pneumonia
 Herpes
 CMV retinitis
 Meningitis
 toxoplasmosis
Wasting
 Weight loss
 malnutrition

Cancer
 Kaposi’s sarcoma
 Non hodgkins
 Anal cancer
 Cervical cancer

Dementia
 From encephalitis










Flu like symptoms
Fever
Night sweats
Swollen lymph nodes
Headache
Skin lesions that don’t
heal
Sore throat
Dyspnea
Burning with urination
diarrhea


Fatigue
Weight loss


Positive ELIZA test
Positive Western Blot test










No cure
Treat symptoms
Prevent infections
Encourage to eat balanced diet
Exercise regularly
Maintain good dental hygiene
Smoking/illegal drug cessation
Limit alcohol
Minimize stress
Practice safe sex



Early stages- usually treated outpatient
Late stages- more intensive in nature
Infection is the leading cause of death in
those with HIV







Ineffective therapeutic regimen
Anxiety
Infection
Impaired oral mucosa
Imbalanced nutrition less than body
requirements
Disturbed thought process
pain











Provide education
Offer support group
Encourage questions
Encourage them to express self
Anti infectives
Medication education
Encourage regular dental hygiene
Have dietician see
Appetite stimulants
Saftey precautions
Monitor pain


Estimated 53900 new cases diagnosed in
2002
Stages
 Low grade
 Intermediate grade
 High grade



The higher the grade the more aggressive
Tx: chemo, bone marrow transplant, stem cell
transplant
5 year survival rate is 52%






Characterized by reed- sternberg cells in the
lymph nodes
Highest occurance is in 20s and50s
Men are more likely than women to have
Tx: radiation, chemo, bone marrow
transplant, stem cell transplant
Survival rates vary
5 yr survival rate is 82%



Cancer of the plasma cells
Most common over the age of 60
No known cause
 Genetics and radiation exposure play a part




s/s: bone pain, hyperuricemia (kidneys),
anemia, hypercalcemia, fractures, spinal cord
compression
Diagnosis: radiographs, serum and urine
protein electrophoresis, bone marrow biopsy
No known cure
Tx: chemo and radiation to treat symptoms