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Assessment of Immune Function and Immunodeficiencies Health history:Age.Nutrition.Infection & immunization.Allergy.Disorders & diseases.Medications & blood transfusions.Lifestyle & other factors.Physical examination.Health History: AgeImmunodeficiencies Frequency & severity of infections are increased in elderly people due to:↓ ability to respond adequately to invading organisms.↓ production & function of T & B lymphocytes.↑ incidence of autoimmune “body attacking self” diseases. b/c surveillance system becomes weaker- body cannot detect between self and non-self. ↑ incidence of cancer.Age related changes…Normal age vs abn aging that’ll cause Immunodeficiencies Declining function of various organs:↓ gastric secretions & motility. So secretions that do seep out are gonna sit there. Higher chance of ulcers and for bacteria to enter. Leads to Diarrhea. ↓ renal circulation, filtration, absorption, & excretion. Will see severe UTIs. Prostatic enlargement & neurogenic bladder. Urinary stasis. Will also cause UTIs b/c of poor bacterial clearance. Exposure to tobacco & environmental toxins.Skin becomes thinner & less elastic. Peripheral neuropathy, decreased sensation & circulation. Pts may not realize they are injured. Health History: NutritionHealth History: NutritionFatty acidsProtein depletionDNA & protein synthesis. Regulationof cell proliferation.Maturation of immune cells.Structural components of cell membrane.Precursor of vitamins A, D, E, & K.Precursor of cholesterol.Atrophy of lymphoid tissues. Depression of antibody response.Reduction in number of circulating T cells.Impaired phagocytic function.Suppresses immune function.Vitamins & Trace elementsIncreased susceptibility to infections.9:33Health History: Infection & ImmunizationImmunodeficiencies Childhood/recent immunizations & diseases.TB: Exposure PPD (Tuberculin) test- purified protein derivative CXRRecent exposure to infections. Especially to STDs. Past & present infections. Make sense… Multiple persistent infections, fevers of unknown origin, lesions or sores, any type of drainage.Health History: Allergy Immunodeficiencies Allergies & types of allergens.Is the band on?Seasonal variations.Better in summer, worse in fall?Occurrence & severity of symptoms.Testing & treatments received.Effectiveness of treatments.Health History: Disorders & Diseases Immunodeficiencies Autoimmune disordersRare – All disorders account for 5% of U.S. population (lupus, RA, psoriasis,… very strong link to genetics and being female) Women more prone to autoimmune disorder. Strong genetic linkMore common in FemalesNeoplastic disease “abn tissue mass as a result of neoplasia” Type of CA & date of diagnosisImmunosuppression contributes to Cancer & Cancer contributes to ImmunosuppressionTreatmentsRadiation- Radiation for Local. Hair no grow.Chemo- Chemo for large/widespread. Hair regrow.Ask: who, what, where, when, successful?Leukemia and lymphoma… Chronic illness & surgery:Renal failure =↓ lymphocytes, uremia.DM = ↑ infections (Microorganisms love sugar), vascular insufficiency, & neuropathy (higher chance for injuries). COPD = recurrent respiratory tract infections → ineffective airway clearance.Surgery = Removal of spleen (results in life-long antibiotics, cause the spleen helps fight infection), lymph nodes, thymus, organ transplantation. Special problems:Burns, injury & infectionImpaired skin integrity & compromised first line of defense.Loss of large amounts of serum in burns patients → depletes body of immunoglobulins & antibodies.Physiological & psychological stress → cortisol release → suppression of normal immune responses.Health History: Medications & Blood Transfusions Immunodeficiencies Immunosuppressive drugs:High dose antibiotics- killin good w/ bad Corticosteroids- over time decr immun response Salicylates, NSAIDS- prone to ulcers Anesthetics- slow everything down (biological/immune processes) Blood Transfusions- multiple transfxns Herbal remediesHealth History: Lifestyle & Other Factors Immunodeficiencies SmokingAlcohol consumption- tear up liver and GI tract Dietary intake & nutritional statusAmount of perceived stressIV drug use- link to Aids and Hepatitis Sexual practicesOccupational or residential exposure to radiation or pollutantsPsychoneuroimmunologic Factors Immunodeficiencies Immune response regulated by neurotransmitters and endocrine function. And (at same time)Immune processes can conversely affect behavior. Bidirectional interaction. People w/ good self esteem will simply be “healthier” Evidence suggest immune function can be influenced via behavioral strategies. ex: Bio-feedback, …Physical Examination Immunodeficiencies Skin & mucous membranes lesions, dermatitis, purpura “reddish/purple discoloration of skin”, urticaria “rash/hives”Signs of infection High Temp, Chills, sweatingPalpable lymph nodesLarge, tender?JointsSwelling, warmth, tenderAssess major body systems (CV, Resp, GI, GU, Neuro, etc.)Diagnostic Evaluation Immunodeficiencies Blood tests. (WBC w/ differential, , H&H, anemia is indicated…) CulturesSkin tests. (Allergies, allergen exposure) Bone marrow biopsy. WBC and Differential Immunodeficiencies Normal- WBC values – 5000 – 10000/mm3Or 5-10 x 109/LElderly WBC values – 3000 – 9000/mm3Or 309 x 109/LDifferential – the % of each different type of WBCNeutrophil (and Bands)LymphocytesEosinophils- allergic reactionBasophils (Mast Cells)Nursing Management Immunodeficiencies Be aware of…Physical pain and discomfort of exams/testingPsychological stressNeutrophils- “new on the scene”. Severe bacterial infection, will see lots of bandsImmunodeficiency Disorders ImmunodeficienciesA defect or deficiency in phagocytic cells, B lymphocytes, T lymphocytes, or the complement system.***Reference bk, but Childhood/Pedi omittedImmunodeficiencies….Chart 51-1, pg 1804 Primary immunodeficienciesGenetic disordersCellular defectsPrimarily in infants and young childrenCommon Variable Immunodeficiency (CVID)aka HypogammaglobulinemiaVery low level of immunoglobulin or non-existentUsually seen in early adulthood (20-30) The MOST COMMON primary immunodeficiency in adults.A B-cell deficiencyRecurrent infection with feverIncreased incidence of autoimmune diseases (1 : 80000)Low serum immunoglobulin levelsAnd… Tired, don’t heal well Clinical ManifestationsPernicious anemia “Low B12”Lymphoid tissue hyperplasiaOther autoimmune disordersDiagnosisSerum immunoglobulin levelsManagementIntravenous immunoglobulin infusionsTreat symptomsTeach infection controlImmunodeficiencies….Secondary ImmunodeficienciesOccur as a result of underlying disease processes and their treatments.Example causes:Malnutrition- Chronic StressViruses- AlcoholRecreational drugs (injecting bacteria into body)DMMost common 2° Immunodeficiency is AIDSSecondary ImmunodeficienciesManagement:Diagnose and treat underlying diseaseFrequent reassessment (Follow-up)Monitor efficacy and side-effects of treatmentTeach infection controlManage stressLifestyle changes (Ex: Unprotected sex) Keep medical appointmentsChart 51-3, pg 1810 ................
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