IMMUNOLOGY NURSING
Immune System
Vocabulary
→ Immunology- study of the immune system responses to
pathogen and damaged tissue (injury)
• Not only against pathogens but also when there is
injury→ inflammatory response
• Inflammation is how the body repairs injury and
hastens healing
• Patho- disease
• -gen- agent
• Pathogen- any agent that will produce a disease,
can be a bacterium, virus, fungi, etc.
→ Immune system- collection of cells, tissues and
molecules that mediate resistance to infection
• Resist- freedom from a disease
→ Immune response- coordinated reaction of the immune
cells to infectious microbes
→ Immunity- freedom from disease
→ Immune tolerance- ability of the immune system to
determine friend from a foe
• If not able to determine→ autoimmunity
→ Antigen (Ag)- substance either within or outside the
body triggers the immune system to produce antibody
against it
• Anything that is foreign
• Can be microorganisms, pathogens, drugs,
medical devices inserted in the body
→ Antibody (Ab)- defensive proteins the body makes
against the Ag
• Ab will attack anything that may cause problems in
the body
• Secreted by the plasma cells that are activated
from the B-cells
• AKA immunoglobulins (Ig, GAMED)
• E.g., tetanus Ig
• Identify and neutralize target cells—any antigen
→ Cytokines- proteins secreted by cells
• “messengers”
• Sends signals to the Ab that there are antigens in a
certain area of the body
• But if this becomes dysfunctional→ uncontrolled→
cytokine storm→ will not be able to determine what
is normal and abnormal
• Promotes chemotaxis
Anatomy and Physiology
→ Immunity- specific response (antibody) of the body to a
foreign agent (antigen)
• The immune system attacks Ag to make the body
free from diseases
• If the immune system is weak, it will not be able to
produce Ab and Ag will proliferate and cause
infection
→ Roles
• Defense against infections
• Defense against tumor (NK cells detects tumors)
• Recognize and respond to tissue grafts (organ
transplants) and newly introduced proteins
o That is why rejection is a problem in
transplantations
• Wound repair and tissue clean up- inflammatory
response
• The immune system can be overactive and can
injure cells and induce inflammation
Lymphatic System
→ Main system responsible
for the immunity
→ Consists of two semiindependent parts
• Lymphatic vesselstunnels
of
the
lymphatic system, where lymph passes through
• Lymphoid tissues and organs
Functions
→ Transports escaped fluids from the cardiovascular
system back to the blood
→ Plays essential roles in body defense and resistance to
disease
1. Lymphatic Vessels
→ Lymph- consists of excess tissue fluid and plasma
proteins carried by lymphatic vessels
→ If fluids are not picked up, edema occurs as fluid
accumulates in tissues
→ Lymphatic vessels (lymphatics)- pick up excess fluid
(lymph) and return it to the blood
→ This controls the hemodynamics in the body
→ Shifting and movement
of fluids will depend on
the
pressure—
hydrostatic,
colloid
oncotic, if there are
changes
in
the
pressures more water
will move via osmosis or
diffusion
→ Form a one-way system,
no backflow occurs
• (+) valves to ensure backflow
→ Lymph flow only towards the heart
2. Lymph capillaries- weave between tissue cells and blood
capillaries
→ Walls overlap to form a flap-like mini valves
→ Fluid leaks into lymph capillaries
→ Higher pressure on the inside closes mini valves
→ Capillaries are anchored to connective tissue by
filaments
→ Fluid is forced along the vessel
3. Lymphatic collecting vessels
→ Collect lymph from lymph capillaries
→ Carry lymph to and away from lymph nodes
→ Return fluid to circulatory veins near the heart
→ Right lymphatic duct drains the lymph from;
• Right arm
• Right side of the head and thorax
• Drains fewer areas because this is smaller than the
thoracic duct
• Location of the duct also affects because lymph
from the lower extremities will have a hard time
going up to the right LD
→ Thoracic duct drains lymph from the rest of the body
• Larger, therefore, allows collection of larger
amounts
4. Lymphatic vessels are similar to veins of the
cardiovascular system
→ Thin-walled
→ Larger vessels have valves
→ Low-pressure, pumpless system, needs aid
→ Lymph transport is aided by:
•
Milking action of skeletal muscles, LV are
intertwined with muscles
o Movement will cause ↑ pressure and
compression
• Pressure changes in thorax during breathing
o ↓ Pressure on the thoracic cavity will pull fluids
from the LV
• Smooth muscle in walls of lymphatics
5. Lymph nodes filter lymph before it is returned to the blood
→ Harmful materials filtered in the lymph nodes
• Bacteria
• Viruses
• Cancer cells
• Cell debris
→ Defense cells within lymph nodes
• Macrophages- swallows large antigens, engulf and
destroy bacteria, viruses, and other foreign
substances in the lymph
• Lymphocytes- respond to foreign substances found
in the lymph
→ Parts
• Cortex- outside,
contains
germinal centers
where Ab are
stored
o Contains
follicles
o Collections
of lymphocytes
o Germinal centers enlarge when antibodies are
released by plasma cells
• Medulla- inside/ middle, contains phagocytic
macrophages
Route of the Lymph Flow
→ Six lymphatic trunks
→ Jugular trunks: drain the neck
→ Subclavian trunks: drain the upper limbs
→ Bronchomediastinal trunks: drain the chest
→ Intercostal trunks: drain the chest wall
→ Lumbar trunks
→ Intestinal trunk: drains the gut
Lymphoid Organs
1. Spleen
→ In the LUQ
→ Filters and clean the blood of
pathogens, similar to the
action of lymph nodes
→ White pulp- provides a site
for lymphocytes
→ Red pulp- destroys worn-out
blood cells
→ Forms blood cells in the
fetus in utero
→ Acts as a blood reservoir
→ If the spleen gets damage→
rapid blood volume loss may
occur, as it may also damage normal RBCs
2. Thymus
→ In between the mediastinum (area between the two
lungs), above the heart
→ Maturation of the T-cells
→ After puberty, it slowly become fats and disappears in
the elderly→ ↑ risk for infection
→ Release thymosin- will stimulate the development of the
T-cells
3. Tonsils
→ Lingual, adenoid, palatine
→ Traps and remove pathogens from ingested foods and
fluids
→ If inflamed (↑ trapped pathogens)→ becomes engorged
and congested→ tonsilitis (most commonly caused by
viruses)
• Can also be caused by streptococcus→ can cause
rheumatic fever and AGN
• Until there are no pus→ viral infection
→ If not trapped by the tonsil, HCl of the stomach will kill it
4. Peyer's patches
→ Found in the walls of the small intestines
→ (+) Macrophages that captures and destroys bacteria
in the intestines
5. Appendix
→ Functions up until puberty only, involved in the immunity
Mucosa-associated Lymphoid Tissue (MALT)
→ Includes:
• Peyer's patches
• Appendix
• Tonsils
→ Acts as a sentinel to protect respiratory and digestive
tracts
Primary Lymphoid Organs
→ Bone marrow
• Red- Where RBCs are formed
• Yellow- fats
→ Thymus
Secondary Lymphoid Organs
→ Lymphoid
→ Spleen
→ Tonsils
→ Blood is also included in the immunity
→ Solid
• RBC (45%)- carries O2
• WBC (<1%)- involved in immunity
• Platelets (<1%)- for clotting
→ Liquid
• Plasma (55%)
o Made up of H2O (91%)
o Proteins (7%)
▪ Albumin (most abundant in the blood) and
globulin (both are produced by the liver)
▪ The albumin exerts oncotic pressure,
pulling water from the interstitial space to
the intravascular space
If (+) hypoalbuminemia→ water will move
out to the third space→ edema
o Fibrinogen (clotting factor I)
o Antibodies are proteins
o The rest of the components make up 2% of the
plasma
→ Waste products are in the plasma because it needs to
be excreted from the body
▪
Additional Notes
Convalescent plasma- plasma from a recovered person, (+)
antibodies already that is specific to the disease, done during
the peak of CoVid-19
→ This is a type of acquired passive immunity
FFP (fresh frozen plasma) is given hemophilic or bleeding
patients because it is a plasma expander and (+) clotting
factors
Formed Fragments
1. Lymphocytes are also called agranulocytes because (x)
release granules
→ All of the T- lymphocytes will assist the B- cells in
producing antibodies
→ T-lymphocytes come from the lymphoid cells
• Cytotoxic T-cells are AKA CD8+→ destroy or kill Ag
o Dysfunctional in autoimmune diseases
• Helper T-cells (CD4+)- initiate immune response,
who needs to be called? What needs to be done?
o Can be killed by HIV, without it there would be
no initiation of the immune system
• Regulator T-cells- suppresses the immune
response
o Way of the body to conserve immune cells
• Memory T-cells- will attack the same Ag in the
future immediately
2. B-lymphocytes
→ Plasma cells will secrete Ab, called Ig if (+) specific
functions
• Ab can be seen in the tonsils, appendix, and
Peyer’s patches
→ Immunoglobulins (GAMED)
3. Basophils
→ BEN- collectively called granulocytes
→ Myeloid and lymphoid all come from the stem cells
(baby cells)
Types of Immunity
→ Two mechanisms that make up the immune system
defend us from foreign materials
→ Innate (nonspecific) defense system
→ Adaptive (specific) defense system
Innate
Non-specific
Immediate response
→ Already present in the
body
No Memory
Adaptive
Specific
Slow response
→ Creates specific Ab for
the pathogen
(+) Memory
A. Barrier Immunity
→ Physical, chemical, and biological barriers
→ Breaks in the skin can be an entry point
→ Acidic skin secretions inhibit bacterial growth
→ Sebum is toxic to bacteria (oil in the skin)
→ Mucus traps microorganisms (in the genitourinary tract
and respiratory tract)
• But when microorganisms are trapped and hygiene
is not practiced→ (+) pimples
→ GIT (+) gastric juices are acidic and kill pathogens
→ Saliva and tears contain lysozymes that kills bacteria in
the mouth
• A dry oral cavity is prone to bad breath
• Speaking ↑ salivary production→ ↓ bad breath
B. Innate Immunity
→ In- inside, nate- born, present upon birth
→ Second line of defense
→ Cells and chemicals provide a second line of
→ defense
→ Natural killer cells and phagocytes
→ Chemicals that kill pathogens
→ Inflammatory response
→ Fever- a systemic response to infection
I. Internal Defenses: Cells and Chemicals
1. Natural killer (NK) cells
• Lyse (burst) and kill:
o Cancer cells
o Virus-infected cells that masks themselves
• Release chemicals
o Perforin
o Granzymes
o Both of these will degrade target cell contents
• Recognizes virally infected
• Changes on the surface of cells
• Apoptosis
• Cytotoxicity
• Attack our own cells that has become defective
• Tumor cells and virally infected cells
Other Cells
→ Neutrophils
• most abundant
• First cell to migrate to infection site phagocytosis
2. Monocytes
• Ability to destroy invaders
• Facilitates healing and repair
• If this is increased→ recent infection
• If this is needed outside the cells, it will transform to
become a macrophage (a wandering monocyte)
→ Affected in the ALL and AML
3. Eosinophil
• A kind of cytokine (an umbrella term for a lot of
cells)
• Fights multicellular parasites and some bacteria
• Allergic reaction
• Also, has a phagocytic action
4. Dendritic cells
• Ag presenting cell to lymphocytes
• Tagaturo
•
•
Activates to become macrophage
Secrete INTERFERON- for virus infection
5. Complement proteins
• “20” proteins complement the action of Ab and
other cells in destroying the bacteria
• Activated by Ag+Ab binding→ this will also aid in
destroying bacteria
6. Macrophages
• Can be from the dendritic cells or monocytes
• Phagocytosis
• Release of cytokines→ cell signaling
• Inflammation
• Migrate from blood to tissue spaces for invading
pathogens
o Wandering monocyte
• Release chemokines→ attract other immune cells
7. Mast cells
• Early recognition of pathogen
• Release of histamine, tryptase, chymase, TNF-a,
leukotriene
• Wound healing
• Have HISTAMINE and HEPARIN→ histamine
release will cause swelling of the cells to control or
contain the pathogen
o Heparin- prevents formation clots
8. Phagocytes
• Cells such as neutrophils and macrophages engulf
foreign material by phagocytosis
• The phagocytic vesicle is fused with a lysosome
9. Antimicrobial proteins
• Enhance innate defenses by:
o Attacking microorganisms directly
o Hindering reproduction of microorganisms
• Most important types
o Complement proteins- Ab +Ag complexes
o Interferon- for viruses
II. Antiviral Defense
Antimicrobial Proteins: Interferon
→ Small proteins secreted by virus-infected cells
→ Bind to membrane receptors on healthy cell surfaces to
interfere with the ability of viruses to multiply
Interferon and Antiviral Defense
→ The reason why viral infections are self-limiting is
because it needs to be within a host or a cell to live
→ Cells have natural antiviral proteins→ virus won’t be
able to enter→ death of virus
III. Inflammatory Response
→ A normal response of a vascularized tissue to an injury
→ Triggered when body tissues are injured
→ Four most common indicators (cardinal signs) of acute
inflammation
• Redness- rubor
• Heat- calor
• Pain- color
• Swelling (edema)- tumor
→ Damaged cells release inflammatory chemicals
• Histamine
• Kinin
→ These chemicals (histamine) cause:
• Blood vessels to dilate
• Capillaries to become leaky, ↑ capillary
permeability
• Phagocytes and white blood cells to move into the
area (called positive chemotaxis)
Functions of the Inflammatory Response
→ Prevents spread of damaging agents
→ Disposes of cell debris and pathogens through
phagocytosis
• Phagocytes that will eat pathogens will also die
→ Set the stage for repair
Process
→ Migration→ diapedesis→ (+) chemotaxis—call more
inflammatory cells to aid in destroying the bacteria
IV. Fever
→ Abnormally high body temperature
→ Systemic response to invasion by microorganisms
→ Hypothalamus regulates body temperature at 37° C
(98.6.F)
→ The hypothalamus thermostat can be reset higher by
pyrogens (secreted by white blood cells)
• Pyrogens will cross the BBB then go to the
hypothalamus
→ High temperatures inhibit the release of iron and zinc
(needed by bacteria) from the liver and spleen
• Iron and zinc are needed by bacteria
→ If fever is too high→ can cause seizures
→ Fever also increases the speed of repair processes in
the body
• ↑ BMR
C. Adaptive Immunity (Acquired)
→ T- lymphocytes→ cellular immunity
→ B- lymphocytes→ humoral immunity
→ Third line of defense
→ Acquired immunity
→ Specific immunity
→ Composed of: 2 trillion
• B-lymphocytes
• T-lymphocytes
→ Created as a response to an infection
→ Slow response
→ (+) Memory
Three Aspects
→ Antigen specific- made exactly for an Ag
• Able to recognize particular Ag
→ Systemic
• Not restricted to the initial site of infection
→ Memory
• Can identify pathogens from previous infections
• Mount an immediate and stronger attack for the
following infections
Two Types
Humoral Immunity
B- lymphocytes
Antibody-mediated immunity
→ B-lymphocytes create
antibodies
Develop
immunocompetence
(maturation) in the bone
marrow
Cell-Mediated Immunity
T- lymphocytes
Cell-mediated immunity
Develop
their
immunocompetence
(maturation) in the thymus
Targets
→ Virus infected cells
→ Cancer cells
→ Graft
cells/
organ
transplants
Antigens
→ Any substance capable of exciting the immune system
and provoking an immune response and release
antibodies
→ Examples of common non-self-antigens
• From outside the body
• Foreign proteins provoke the strongest response
• Nucleic acid's
• Large carbohydrates
• Some lipids
• Pollen grains
• Microorganisms (bacteria, fungi, viruses)
→ Self-antigens
• From inside the body
• Human cells have protein and carbohydrate
molecules
• Do not trigger an immune response because the
immune system knows that these are not abnormal
antigens
• If present or transplanted in another person's
body→ (+) immune response because they are
foreign
• Restricts donors for transplants
→ Antibodies are very specific to antigens
→ Found in poison ivy, animal dander, detergents, hair
dyes, cosmetics
• Therefore, patch testing is done
Cells of the Adaptive Defense System: An Overview
→ Crucial cells of the adaptive system
→ Lymphocytes- respond to specific antigens
• B lymphocytes (B cells) produce antibodies
• T lymphocytes (T cells) constitute the cell-mediated
• Do not make antibodies
→ Antigen-presenting cells (APCs)- help the lymphocytes
but do not respond to specific antigens
• Only the antibodies are Ag-specific
→ Lymphocytes
• Arise
from
hemocytoblasts of
bone marrow
• Matures into B cell
or T cell depends
→ Immunocompetence
• Ability to respond to
a specific antigen
• T- cells→ Thymus
• B- cells→ Bone
marrow
→ Only become active/ matured when it comes in contact
with Ag
→ Antigen-presenting cells (APCs)
• Engulf antigens and then
present fragments of them on
their own surfaces, where
they can be recognized by Tcells
→ Major types of cells behaving as
APCs
• Dendritic cells
• Macrophages
• B lymphocytes
→ When they present antigens, dendritic cells, and
macrophages activate T cells, which release chemicals
Humoral Immune Response
→ B-lymphocytes with specific receptors→ bind to a
specific Ag
→ Not all the clones will die, the remaining will still multiply
→ Haptens or incomplete antigens
→ Not antigenic by themselves
• Does not excite the immune system to release
antibodies
→ Haptens + body's proteins= immune system ID as
foreign= attack
→ Antigens will bind to receptors of antibody—T-cells→
cloning
→ After 3-5 days, plasma cells will die→ those that don’t
die will come memory cells
→ The second attack will be stronger and more rapid
→ These occurs or may be observed in Rh incompatibility
→ There is a decrease or down movement d/t death of
plasma cells
• Therefore, booster doses are needed
Antibody Classes
Ig
Class
IgG
Structure
IgA
Types of Humoral Immunity
Active immunity
→ Occurs when B cells encounter antigens and produce
antibodies
→ Active immunity can be:
• Naturally acquired during bacterial and viral
infections
→ Artificially acquired from vaccines
Passive Immunity
→ Occurs when antibodies are obtained from someone
else
• Naturally acquired from a mother to her fetus or in
the breast milk
→ Artificially acquired from immune serum or gamma
globulin (donated antibodies)
Passive
Active
The body actively
produces
antibodies
What is
introduced
in the
body?
Antibodies are
introduced
Antigens/ foreign
bodies
Onset of
immunity
Immediately
→ Ab are
introduced→ (+)
immunity
Delayed
→ Because the
body will still
produce the
Ab
Duration of
immunity
Temporary
→ About two weeks
Lifetime
Natural
Exposure
to
diseases
Active
Artificial/
acquired
All vaccinations
→ Either liveattenuated
or killed
→ Does
not
cause the
disease
→ Vaccines
differ
in
intervals,
because
there is still
a
natural
passive
immunity
→ Anti-rabies
vaccine
(given after
ErIg, after 2
weeks)
IgM
Functions
→ Can cross the placental
barrier
→ Fix complement;
→ Most abundant antibody in
plasma
→ Provides passive immunity
→ Present in secretions,
such as mucus or tears,
saliva
→ M- mauuna
→ First Ig class during
primary response
→ Can fix complement
IgE
→ Involved in allergies
IgD
→ Important in activation of B
cell
Interpretation
Patient not sick but
with
previous
infection
Patient is sick
Dengue
(4x,
4
strains), CoVid-19→
reinfection
of
a
different strain
→ Only for diseases
with
multiple
strains
IgG
IgM (eron sakit)
+
-
-
+
+
+
Antibodies
→ Antibody function
→ Antibodies inactivate antigens by;
• Complement fixation (pushes antibodies to kill
antigens, complement proteins)
• Neutralization
• Agglutination (clumping)
• Precipitation
Passive
Natural
Artificial/ acquired
Vertical
transmission
→ Mother
to baby
→ Breast
milk
Immunoglobulins
→ ErIg- injected
around the
bite
to
immediately
kill the rabies
virus
→ Antivenin
→ Antibodies (immunoglobulins, Igs)
• Constitute gamma globulin part of blood proteins
→ Soluble proteins
secreted
by
activated B cells
(plasma cells)
→ Formed
in
response to a
huge number of
antigens
→ Antibodies inactivate antigens in a number of ways
→ Complement fixation: chief antibody ammunition used
against cellular antigens
→ Neutralization (block): antibodies bind to specific sites
on bacterial exotoxins or on viruses that can cause cell
injury
→ Agglutination (clumping): antibody-antigen reaction
that causes clumping of cells
→ Precipitation (dissolution/ tutunawin): cross-linking
reaction in which antigen- antibody complex settles out
of solution
Antigens and Antibodies of the Blood
→ (+) Ag outside the RBCs determine the blood type
→ Blood type A needs
transfusion, the only
blood available is
blood type B
→ Antibody
A
will
recognize antigen A
and
result
agglutination→ clumping
Cellular Immune Response
B-cells (Lymphocytes)
→ Activated to form a
clone by binding
with a recognized
antigen
→ Bind
to
free
antigens
T-cells (Lymphocytes)
→ Activated to form a clone
by
binding
with
a
recognized antigen
→ UNABLE to bind to free
antigens
•
Must be presented by
•
Macrophage
•
Double
recognition
must occur
→ Antigen Presenting Cell
(APC)
•
Engulfs and presents
the processed antigen
to lymphocytes→ Ag
dies
• Most common type of graft
• From the same species
→ Xenografts- tissue taken from a different animal species
(never successful)
For transplant to be possible:
→ Blood group and tissue matching is done to ensure the
best match possible
• 75% match is needed to attempt a graft
→ Organ transplant is followed by immunosuppressive
therapy for life to prevent rejection
Hypersensitivity
→ Excessive immune response
→ An abnormal, heightened reaction to any type of stimuli
Four Types
→ Allergic disorders
• Anaphylaxis
• Allergic rhinitis
• Contact dermatitis
• Atopic dermatitis
• Food allergy
• Latex allergy
→ Rheumatic disorders
• Rheumatic diseases
• Systemic lupus erythematosus
• Sjogren's syndrome
• Scleroderma
I. Anaphylaxis
→ Allergy- (+) hives, rashes→ occurs d/t histamine that is
released d/t antigen-antibody complex, therefore,
allergies only occur on the succeeding exposures
because there are no antigen-antibody complexes in
the first exposure
• Inappropriate and harmful response to a normally
harmless substance
→ Allergen
• Substance causing allergy
• Foreign body
→ Atopy
• Allergic reaction
• igE antibodies & genetic predisposition to allergic
reactions
Physiologic Overview
Immune Response are Generally Protective but…
→ Antigen nonspecific mediators
• Uncontrolled cytokines and macrophages
→ Innocent bystander injury
→ Foreign bodies
→ IgE-mediated responses
• Allergies, hyperreactivities
→ Cross-reactive
• For antibodies, if the patient is allergic to PCN (x)
given, also cephalosporins because they have
cross reactivity
• Rheumatic fever and AGN
→ Intracellular infections
• Hepatitis B (virus)- the virus will not damage the
hepatocytes but the immune system does because
the virus inside the cells needs to be killed
→ Autoimmunity
→ Allograft rejection
Organ Transplants and Rejection
→ T-cells are involved
→ Major types of transplants, or grafts
→ Autografts- tissue transplanted from one site to another
on the same person
→ Isograft- tissue grafts from a genetically identical person
(identical twin)
→ Allografts- tissue taken from a person other than an
identical twin
→ B-lymphocytes respond
Type I: Anaphylactic Hypersensitivity
→ The most severe form
→ Occurs within minutes after exposure to an Ag
→ Mediated by Ige
→ If (+) antigen and binds of the receptor of a cell→
release histamines d/t rupture of the cell
Signs and Symptoms
→ Hives
→ Laryngeal stridor
→ Hypotension d/t vasodilation caused by histamine
→ Increased capillary permeability
Type III: Immune Complex Hypersensitivity
→ Ag binds to Ab→ phagocytosis→ tissue injury
→ E.g., rheumatoid arthritis, SLE
→ Binding of Ab- Ag→ complement protein will bind to the
complex→ infiltration of polymorphonuclear leukocytes
(WBCS)→ attack own tissues
Type II: Cytotoxic Hypersensitivity
→ "Mistaken identity"
→ Result of a cross-reacting antibody leading to cell death
→ Complement activates IgG or IgM antibody to bind to a
cell-bound Ag
→ MG, pernicious anemia, hemolytic disease of the
newborn, transfusion reaction
Hypersensitivity Immune Response
Types
I (Anaphylaxis)
Antigen
Immune
component
Freely moving
IgE
Type IV: Delayed (Cellular) Hypersensitivity
→ Occurs 1 to 3 days after exposure to an Ag
→ Mediated by sensitized T cells and macrophages
→ E.g., BCG injection→ T cells react→ lymphokines
attract macrophages
→ which releases lysozymes→ tissue damage
→ T1DM, Dermatitis
II (Cytotoxic)
•
•
Fixed
Complement
Freely moving IgG or
IgM
III (Immune
Complex)
Freely moving
Freely moving IgG
IV (Delayed)
Freely moving
Lymphocyte (CD4) T
cells
Mechanism
Disease example
Mnemonic
Legend
•
•
Asthma
Atopy
Transfusion incompatibility
A
C
•
•
SLE
Post strep GN
I
•
•
•
Dermatitis
Latex reaction
T1DM
D
• Antigen
• Antibody
Latex Allergy
→ The source of the allergic reaction is thought to be the
proteins in the natural rubber latex or various chemicals
used in the manufacturing process of latex gloves
→ Symptoms
• Contact dermatitis
• Rhinitis- powder may be inhaled
• Conjunctivitis
• Urticaria
• Bronchospasm
• Anaphylaxis
Common Routes
→ Cutaneous:
• Natural latex gloves and latex balloons
→ Percutaneous and parenteral:
• IV lines and catheters
• Hemodialysis equipment
→ Mucosal:
• Use of latex condoms, catheters, airways, nipples
→ Aerosol:
• Aerosolization of powder from latex gloves can
occur when gloves are dispensed from the box or
when removed from the hands
At Risk Individuals
→ At-risk individuals:
→ Health care workers
→ Individuals who:
• Working in rubber industry
• Spina bifida- undergo many surgeries→ develop
sensitivity to latex d/t succeeding exposures
• Wear gloves frequently
• Food handlers
• Hairdressers
• Auto mechanics
→ Allergic to:
• Kiwis
• Bananas
• Pineapples
• Tropical fruits
• Grapes
•
•
•
•
Avocados
Potatoes
Hazelnuts
Water chestnuts
Assessment
→ Anaphylaxis or Type I Hypersensitivity is a response to
natural rubber latex
→ Delayed type IV
→ 6 to 48 hours after exposure
→ Contact dermatitis
• Pruritus
• Edema
• Erythema
• Vesicles
• Papules
• Crusting and thickening of the skin
Management
→ Ask client about a known allergy to latex when
performing initial assessment
→ Identify risk factors for a latex allergy in the client
→ Use nonlatex gloves and all latex-safe supplies
→ Keep a latex-safe supplies
→ Keep a latex-safe supply cart near the client's room
→ Apply a cloth barrier to the client's arm under a BP cuff
→ Use latex-free syringes, medication containers (glass
ampoules) and latex-safe IV equipment
→ Instruct client about the importance of informing health
care providers and local and paramedic ambulance
companies about the allergy
Priority Nursing Actions
→ Quickly assess respiratory status and maintain a patent
airway
→ Call the physician or Rapid Response team
→ Administer O2
→ Start an IV line and infuse normal saline
→ Prepare to administer diphenhydramine (benadryl) and
epinephrine
• Diphenhydramine is only an antihistamine decrease
inflammation (↓ redness, warmth, and swelling),
epinephrine is a sympathomimetic drug can cause
bronchodilation
→ Document the event, actions taken and the client's
response
Why are there laryngospasms in allergic reactions?
→ D/t presence of histamine→ will cause vasodilation→ ↑
blood flow→ rubor and calor
→ Histamine will cause leakage of albumin→ tumor
(swelling)
d/t
third
spacing→
compression→
bronchospasms/ laryngospasms
Systemic Lupus Erythematosus
→ Chronic, progressive, systemic inflammatory disease
that cause major organs and systems to fail
→ Necrosis occurs because the body is trying to repair the
damage
Causes
→ Unknown
→ Defect
in
immunological
mechanisms with a genetic
origin
→ Precipitating factors:
o Medications
o Stress
o Genetic factors
o Sunlight or UV light
o Pregnancy
Assessment
→ Assess for precipitating factors
→ Erythema butterfly rash on the face or upper bodyhallmark sign
→ Dry, scaly, raised rash on the face or upper body
→ Fever
→ Weakness, malaise and fatigue
→ Anorexia
→ Weight loss
→ Photosensitivity
→ Joint pain
→ Erythema of the palms
→ Anemia
Laboratory Tests
→ (+) Antinuclear antibody (ANA) test
→ (+) Lupus erythematosus (LE) preparation
→ C-reactive protein
→ ESR
→ Nonspecific, only indicates (+) inflammatory response
Management
→ Monitor skin integrity and provide frequent oral care
→ Instruct the client to clean the skin with a mild soap
→ Assist with the use of ointments and creams for the rash
as prescribed
→ Identify factors contributing to fatigue
→ Administer iron, folic acid or vitamin supplements as
prescribed if anemia occurs
→ Provide a high-vitamin and high-iron diet
→ Provide a high-protein diet if there is no evidence of
kidney disease
• To hasten the healing
→ Instruct in measures to conserve energy, such as
pacing activities and balancing rest with exercise
→ Administer topical or systemic corticosteroids,
salicylates and NSAIDs as prescribed for pain and
inflammation
→ Administer meds to decrease the inflammatory
response as prescribed
→ Instruct the client to avoid exposure to sunlight and UV
light
→ Monitor for proteinuria and red cell casts in the urine
• To WOF lupus nephritis (a complication)
→ Monitor for bruising, bleeding and injury
→ Assist with plasmapheresis as prescribed to remove
autoantibodies and immune complexes from the blood
before organ damage occurs
→ Monitor for signs of organ involvement;
→ Pleuritis
→ Nephritis
→ Pericarditis
→ CAD
→ Hypertension
→ Neuritis
→ Anemia
→ Peritonitis
→ Note that lupus nephritis
occurs early in the
disease process
→ Provide
supportive
therapy as major organs
become affected
→ Provide
emotional
support and encourage
the client to verbalize
feelings
→ Provide
information
regarding
support
groups
Summary of Immunology
→ A condition in humans that permits innate and adaptive
resistance to disease
→ Promotes and maintains health through proper
recognition and management of external (infection,
pollution) and internal (wound repair, programmed cell
death) challenges
Two Types of Immunity
Innate
Adaptive
Nonspecific
Specific
→ Physical barrier
→ T lymphocytes
→ Chemical barrier
→ B lymphocytes
→ Biological barrier
Under Adaptive Immunity
Cell-mediated immunity (T Humoral
immunity
lymphocytes)
lymphocytes)→ antibody
→ Cytotoxic T cells
→ Active
→ Helper T cells
•
Natural
→ Regulator/
•
Acquired
Suppressor T cells
→ Passive
•
Natural
•
Acquired
(B