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Nature of ImmunityFunctions of the immune systemProtect the body’s internal environment against invading organismsMaintain homeostasis by removing damaged cells from the circulationServe as a surveillance network for recognizing and guarding against the development and growth of abnormal cellsNature of ImmunityImmunocompetenceThe immune system responds appropriately to a foreign stimulusImmunityThe quality of being insusceptible to or unaffected by a particular disease or conditionImmunologyThe study of the immune systemNature of ImmunityInappropriate responses of the immune systemHyperactive response against environmental antigens (allergy)Inability to protect the body, as in immunodeficiency disorders (AIDS)Failure to recognize the body as self, as in autoimmune disorders (systemic lupus erythematosus)Attacks on beneficial foreign tissue (organ transplant rejection or transfusion reaction)Nature of ImmunityInnate (natural) immunityFirst line of defenseProvides physical and chemical barriers to invading pathogens and protects against the external environmentComposed of the skin, mucous membranes, cilia, stomach acid, tears, saliva, sebaceous glands, and secretions and flora of the intestines and vaginaNonspecific immunityNature of ImmunityAdaptive (acquired) immunitySecond line of defenseProvides a specific reaction to each invading antigenProtects the internal environmentComposed of thymus, spleen, bone marrow, blood, and lymphProduces antibodies in the cells after an infection or vaccinationFigure 55-2Figure 55-3Nature of ImmunityMacrophages (phagocytes)Engulf and destroy microorganisms that pass the skin and mucous membraneCarry antigen to the lymphocytesLymphokineOne of the chemical factors produced and released by T cells that attracts macrophages to the site of infection or inflammationAntigenA substance recognized by the body as foreign that can trigger an immune responseNature of ImmunityHumoral immunityResponds to antigens such as bacteria and foreign tissueResult of the development and continuing presence of circulating antibodies in the plasmaActive immunityAntibodies are produced by one’s own body (vaccines)Passive immunityAntibodies are formed by another in response to a specific antigen and administered to an individual (HBIG)Nature of ImmunityCellular immunityAlso called cell-mediated immunityPrimary importance in:Immunity against pathogens that survive inside cellsFungal infectionsRejection of transplanted tissuesContact hypersensitivityTumor immunityCertain autoimmune diseasesComplement SystemThe complement system can destroy the cell membrane of many bacterial species, and this action attracts phagocytes to the areaGenetic Control of ImmunityThere is a genetic link to both well-developed immune systems and poorly developed or compromised immune systemsEffects of Normal Aging on the Immune SystemAging causes a decline in the immune systemHigher incidence of tumorsGreater susceptibility to infectionsAging does not affect the bone marrowImmune ResponseImmunizationA controlled exposure to a disease-producing pathogen that triggers antibody production and prevents diseaseProvides protection for months to yearsImmune ResponseImmunotherapyTreatment of allergic responses that involves administering increasingly large doses of the offending allergens to gradually develop immunityPreseasonal, coseasonal, or perennialSevere side effect: anaphylaxisDisorders of the Immune System Altered immune responseHypersensitivityAn abnormal condition characterized by an excessive reaction to a particular stimulusHypersensitivity reactionAn inappropriate and excessive response of the immune system to a sensitizing antigenHypersensitivity disordersHarmless substances such as pollens, danders, foods, and chemicals are recognized as foreignDisorders of the Immune SystemHypersensitivity disordersEtiology/pathophysiologyGenetic defect that allows increased production of immunoglobulin E (IgE) Exposures may occur by inhalation, ingestion, injection, or touchDisorders of the Immune SystemHypersensitivity disorders (continued)Clinical manifestations/assessmentPruritusNauseaSneezingExcessive nasal secretions and tearingInflamed nasal membranesSkin rashDiarrheaCough; wheezes; impaired breathingDisorders of the Immune SystemHypersensitivity disorders (continued)Diagnostic testsHistoryPhysical examLaboratory studies: CBC, skin testing, total serum IgE levelsMedical management/nursing interventionsSymptom management: antihistaminesEnvironmental control: avoidance of the allergenImmunotherapyDisorders of the Immune SystemAnaphylaxisEtiology/pathophysiologySystem reaction to allergensVenomsDrugs—penicillin Contrast media dyesInsect stingsFoodsDisorders of the Immune SystemAnaphylaxis (continued)Clinical manifestations/assessmentFeelings of uneasiness to impending deathUrticaria (hives) and pruritusCyanosis and pallorCongestion and sneezingEdema of the tongue and larynx with stridorBronchospasm, wheezing, and dyspneaNausea and vomitingDisorders of the Immune SystemAnaphylaxis (continued)Clinical manifestations/assessment (continued)Diarrhea and involuntary stoolsTachycardia and hypotensionCoronary insufficiency, vascular collapse, dysrhythmias, shock, cardiac arrest, respiratory failure, and deathDisorders of the Immune SystemAnaphylaxis (continued)Medical management/nursing interventionsPharmacological managementEpinephrine BenadrylAminophyllineIV accessOxygenTeaching: avoid allergen; use medical alert ID; administration of epinephrineDisorders of the Immune SystemLatex allergiesAllergic reaction when exposed to latex productsType IV allergic contact dermatitisCaused by the chemicals used in the manufacturing process of latex glovesType I allergic reactionsResponse to the natural rubber latex proteinsDisorders of the Immune SystemLatex allergies (continued)Clinical manifestations/assessmentType IV contact dermatitisDryness; pruritus; fissuring and cracking of the skin followed by erythema, edema, and crustingType I allergic reactionSkin erythema, urticaria, rhinitis, conjunctivitis, or asthma to anaphylactic shockDisorders of the Immune SystemLatex allergies (continued)Medical management/nursing interventionsIdentification of patients and health care workers sensitive to latex is crucial in the prevention of adverse reactionsUse nonlatex gloves when possibleUse powder-free glovesDo not use oil-based hand creamsKnow the signs and symptoms of latex allergyWear a medical alert bracelet and carry an epinephrine pen Disorders of the Immune SystemTransfusion reactionsEtiology/pathophysiologyReactions that occur with mismatched bloodClinical manifestations/assessmentMildDiarrheaFever and chillsUrticariaCoughOrthopneaDisorders of the Immune SystemTransfusion reactions (continued)Clinical manifestations/assessment (continued)ModerateFever and chillsUrticariaWheezingSevereFever and extreme chillsSevere urticariaAnaphylaxisDisorders of the Immune SystemTransfusion reactions (continued)Medical management/nursing interventionsMildPharmacological managementCorticosteroidsDiureticsAntihistamines Stop transfusionAdminister salinePhysician may order transfusion continued at a slower rateDisorders of the Immune SystemTransfusion reactions (continued)Medical management/nursing interventions (continued)ModerateStop transfusionAdminister salinePharmacological managementAdminister antihistamines and epinephrineDisorders of the Immune SystemTransfusion reactions (continued)Medical management/nursing interventions (continued)SevereStop transfusionAdminister salinePharmacological managementAdminister antihistamines and epinephrineReturn blood or blood product to lab for testingObtain urine specimenDisorders of the Immune SystemDelayed hypersensitivityReaction occurs 24 to 72 hours after exposureExamples include:Poison ivyTissue transplant rejectionDisorders of the Immune SystemTransplant rejectionTypes of graftsAutograftIsograftAllograft (homograft)HeterograftAntigenic determinants on the cells lead to graft rejection via the immune process7 to 10 days after vascularization, lymphocytes appear in sufficient numbers for sloughing to occurDisorders of the Immune SystemTransplant rejection (continued)ImmunosuppressiveAgents that significantly interfere with the ability of the immune system to respond to antigenic stimulation by inhibiting cellular and humoral immunityDisorders of the Immune SystemImmunodeficiencyAn abnormal condition of the immune system in which cellular or humoral immunity is inadequate and resistance to infection is decreasedMay cause recurrent infections, chronic infections, severe infections, and/or incomplete clearing of infectionsCan be induced (chemotherapy)Disorders of the Immune SystemPrimary immunodeficiency disordersPhagocytic defectsB-cell deficiencyT-cell deficiencyCombined B-cell and T-cell deficiencyDisorders of the Immune SystemSecondary immunodeficiency disordersDrug-induced immunosuppressionStressMalnutritionRadiationSurgical removal of lymph nodes, thymus, or spleenHodgkin’s diseaseAutoimmune DisordersAutoimmuneThe development of an immune response to one’s own tissuesBody is unable to distinguish “self” protein from “foreign” proteinExamples of disorder: pernicious anemia; Guillain-Barré syndrome; scleroderma; systemic lupus erythematosusPlasmapheresisRemoval of plasma that contains components causing diseaseUsed to treat autoimmune disease ................
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