Altered Immunity
Immune System
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Protects the body from organisms, cancer cells, and foreign bodies
3 lines of defense
o Skin, Mucous membranes, body secretions
o Inflammatory response (white bloods cells increase and begin to fight off invader)
o Immunity
1st line of defense
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Skin, Mucous Membranes, and body secretions
Skin
Mucous membranes
Body secretions
Inflammatory Response
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Leukocytes and plasma move into the affected tissue
Symptoms: redness, swelling, pain or heat
Activates after the 1st line defenses are penetrated within seconds
Immunity
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Leukocytes (WBC) consist of granulocytes, monocytes, lymphocytes
Granulocytes- greatest number of WBC
Monocytes- largest WBC
Lymphocytes- B-cell, T-cell, and Natural killer cells
o B-cells and T-cells make up the basic immune response
Immune System
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Lymphoid system: bone marrow, thymus, spleen, lymph nodes, and lymphoid tissue
 Primary lymphoid organs- bone marrow and thymus (can’t live without them)
 Secondary lymphoid organs- spleen, lymph nodes, tonsils, appendix (can be removed)
Bone Marrow
Bone marrow- soft tissue in the center of the bones
Thymus gland- (in the neck) matures lymphocytes into T cells
Spleen- (upper left abdomen) contains macrophages to destroy bacteria and filters out damaged
RBC’s.
Lymphatic system
Lymph- clear, protein filled fluid
Lymphatic vessels send lymph to the lymph nodes
Lymph nodes- in the neck, groin, axillae, and abdomen
Nodes become tender when fighting infection
Recognition of normal tissue
Immune system must differentiate between normal (self) tissue and foreign tissue (nonself)
HLA (human leukocytes antigens_- coded genes
Immunity
Natural Immunity (Innate)- naturally exists without a response, protected by chemical/physical
barriers
Active Immunity- naturally acquired or artificially acquired
Naturally acquired- obtain the disease
Artificially acquired- immunization
Passive Immunity- injection of antibodies (immune globulin, gamma globulin)- lasts only for
weeks or months
Naturally acquired passive immunity: neonates received antibodies from their mother
Diagnostic Tests
Serum Immunoglobulins- level of IgA, IgD, IgE, IgM
Antibody titer testing- looks at antibodies for hepatitis, rubella, mononucleosis
Skin testing- detects impaired cell mediated immunity- (PPD)
Immunoglobulin
IgG- crosses the placenta providing immune protection to neonate and active against bacteria,
bacterial toxins, and viruses
IgA- local protection against bacteria to respiratory and GI tracts
IgM- reacts against blood borne bacteria and viruses
IgD- function unknown
IgE- stimulates relase of histamine
Increases permeablility of WBC’s to attack foreign antigen
Immunizations
MMR- Measles, Mumps, and Rubella
Td- Tetanus and diphtheria toxoids
Recombinant or Recombivax B- Hepatitis B
Fluzone- Influenza
Flumist- influenza
Pneumovax-23- Pneumococcal
Altered Immune Responses
Hypersensitivity- overreaction to an antigen that could cause harm to the client
Examples: runny nose, itchy eyes, hay fever, blood reaction from transfusion, organ
rejection from transplant
Severe case: blood hemolysis, anaphylaxis
Type 1- Immediate hypersensitivity
Asthma, hay fever, anaphylaxis, bee stings, food allergies (IgE)
Type 2- Cytotoxic
Blood Transfusion, hemolytic disease of the newborn (IgM or IgE)
Type 3- Immune Hypersensitivity
Rheumatoid arthritis, lupus (IgG or IgM)
Type 4- Delayed hypersensitivity
Contact dermatitis, TB skin test, organ rejection (T lymphocytes react to antigen)
Blood Cell Hemolysis
Define: breaking of RBC’s and releasing hemoglobin into the fluid
Ex: Bypass machine for CABG can cause hemolysis
Anaphylaxis
Type I hypersensitivity- whole body reaction
Release of large amounts of histamines, prostaglandins, and leukotrienes that causes systemic
vasodilations, bronchial mucosa edema, bronchoconstriction= death
Causes: Medications, bee stings, IVP dye
Symptoms: SOB, Hives, swelling, N/V/D, wheezing, hypotension, respiratory distress,
unconsciousness
Treatment: Epinephrine, Benadryl, and Steroids
Epinephrine
Body naturally produces: releases from the adrenal glands for the “fight or flight” reaction
Given IM
Increases O2, glucose, HR
Decreases the effects of the immune system
Anti-Histamines
Benadryl, Seldane, Hydroxyzine (Vistaril)
Stops the release of histamine
Treats allergic reactions
Encourage H2O intake, can be taken on empty stomach
Monitor for sedation
Allergy Shots
This is considered an immunotherapy- administers large doses of allergen to reduce symptoms
or eliminate sensitivity
IgE produced
Desensitizes the effects of the allergen
Treats hay fever, helps asthma clients, food allergies, bee allergies
AIDS
Acquired immunodeficiency virus
Found in 1981 in New York and Los Angeles in homosexual males
1982- CDC noted that there was a disease that affected the immune system
1985- HIV (human immunodeficiency virus) is virus that causes AIDS
HIV
1.1 million people living with HIV in the US
(1981-2006)- 57 documented cases of HIV from occupational exposure in healthcare workers
HIV (retrovirus)- RNA makes copies of the DNA
Reverse Transcriptase- enzyme that changes the RNA to DNA, the viral DNA duplicates during
cell division
Diagnose by client’s history, lab work, exam, and manifestations
HIV at risk
IV Drug Users
Unprotected sexual intercourse
Multiple sex partners
STD’s
Blood transfusion between 1979-1985
HIV Manifestations
No symptoms at first to flu-like symptoms
Acute infection- lymphadenopathy, fatigue, low-grade fever, night sweats, weight loss, diarrhea
AIDS
AIDS
Respiratory: Pneumocystis carinii pneumonia, Mycobacterium tuberculosis
Gastrointestinal: Candidiasis, Cryptosporidiosis, Wasting syndrome
Neurologic: Cryptococcosis, Toxoplasmosis
Other: Herpes, Cytomegalovirus, PID, HPV, Kaposi’s sarcoma
Pneumocystis Carinii Pneumonia
Cause: yeast
Symptoms: fever, nonproductive cough, SOB, weight loss, night sweats
Pathology: affects fibrous tissue of lungs which thickens the alveoli
Diagnostic tests: CXR, blood gases
Treatment: Septra, steroids
Tuberculosis
Organism: Mycobacterium
Diagnostic tests: sputum culture, TB test, or CXR
Symptoms: prolonged productive cough, hemoptysis (blood stained sputum), fever, chills, night
sweats
Transmission: cough, speak, sneeze
Site of infection: Lung most common, can spread to other organs
Candidiasis
(thrush) white patches in the mouth, sore mouth, painful
Treatment: Nystatin mouth wash
Cryptosporidiosis
Transmission: obtained from contaminated water, food, or human contact
Parasite settles in bowels causes:
Watery stool
Non-bloody diarrhea
Dehydration electrolyte imbalance/malnutrition
Diagnose: stool specimen
Treatment: no specific treatment, run its course
Wasting Syndrome
Unplanned weight loss
Chronic diarrhea
N/V
Poor food intake
Appears emaciated (loss of muscle, fat, very thin appearance)
Kaposi’s sarcoma
Most common in HIV clients
Red/Purple lesions
Skin, mouth, GI, respiratory
No cure
Prevention
No cure
Teach safe sex practices
Teach how HIV is spread
Healthcare workers use Standard Precautions
If exposed at work: report immediately and will be offered prophylaxis AZT
Limit number of partners
Use protection during sexual contact
Oral contraceptives does not protect from HIV
Do not share needles, toothbrushes, or anything that may be contaminated with blood
Standard Precautions
Hand washing
Wear gloves when handling bodily fluids
Wear eye shield or mask when potential for splash
Remove soiled clothing ASAP
Do not recap needles
Use with all patients regardless of HIV status
Diagnostic Tests
Enzyme-linked immunosorbent (ELISA) is the initial test done
Ora quick HIV-1 antibody test- fingerstick
Western Blot Assay
CD4+ cell count- is used to confirm progression from HIV infection to AIDS Normal- 800-1200
Less than 200 indicates AIDS
CBC- looks for anemia, leukopenia, thrombocytopenia
Medications
Antivirals: NRTI’s, NNRTI’s, Protease inhibitors, and fusion inhibitor
Chart 242: be familiar with names
Care of the AIDS client
Nutrition- high in protein, high in calories
Monitor skin for lesions
Wash with mild soaps
Keep nails cleaned and trimmed
Rest periods to reserve energy
Allow clients to continue to make decisions
Allow to perform ADL”s as tolerated
Be aware of support system
Good listener, Be positive