decreased immune response infection immunity
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DECREASED IMMUNE RESPONSE: SUSCEPTIBILITY TO INFECTION
C Washington RN, MSNEd
Infection Host organism’s
response to a pathogen or disease causing substance
Infection Tissue destroying
microorganisms enter & multiply in the body
Invasion of the body by pathogenic organisms that multiply and produce injurious effects
Four types of microorganisms can enter the body & cause infection
Harmless Organisms Resident flora
-E Coli (intestine)
-Staph aureus (skin)
Colonization-microorganisms
become resident
flora
Intestinal flora help synthesize vitamin K
Harmful Actions of Microorganisms
# of organism present
Ability of organism to cause disease
Person’s immune system
Length of contact between person & organism
Climate for Infection Poor nutrition Stress Humidity Poor sanitation Crowded living conditions Pollution Dust Medications
Risk for InfectionInhalation
Opportunistic infections
Risk for Infection
Direct contact
Insect or animal bite
Ingestion
Controlling Microorganism Medical Asepsis Clean technique Limit #, growth, &
transmission of microorganisms
Handwashing Barrier techniques Environmental cleaning
Surgical Asepsis Sterile technique Completely free of
microorganisms
The Spread of Infection An elderly pt, admitted with a GI disorder, is on
bedrest and requires assistance with ADLs. Frequent uncontrolled diarrhea stools; the nurse
provided excellent care to maintain cleanliness & comfort.
After one episode of cleaning the pt & changing the bed linen, the nurse went over to a second pt to adjust foley cath tubing.
The nurse’s hands were not washed before assisting the second patient.
Breaking the Chain A patient assigned for morning care has
an open wound on her left lower leg. The wound is draining & when last
cultured, the organism MRSA was identified.
What steps would you take to break the chain of infection while changing the patients bed.
Nosocomial Infections
Drug Resistant Organisms Vancomycin-resistant enterococcus
(VRE)
Methicillin-resistant Staph aureus (MRSA)
Clostridium difficile (C Diff)
Nosocomial Infections Pneumonia
-Pseudomonas-Improper suctioning technique
Nosocomial Infections Bloodstream
-Staph aureus-Improper IV site care
Nosocomial Infections
Surgical Site-Enterococcus-Improper dsg
change
Nosocomial Infections Urinary Tract
-E Coli-Poor cath care
Preventing Nosocomial Infections
Transmission Based Precautions
Droplet precautions (pneumonia, meningitis)-Private room/mask <3 ft from pt
Transmission Based Precautions
Airborne precautions (measles, TB)-Private neg airflow room 6 air exchanges/hr
Transmission Based Precautions Contact
precautions-Direct (kissing, bathing, toughing)-Indirect (instruments, needles, dressing)
Transmission Based Precautions
Protective Precautions
What might you NOTICE (subjective & objective) if the patient has inadequate protection as a result of infection or infectious disease?
What should you ASSESS for a patient with inadequate protection as a result of infection or infectious disease?
How should you INTERVENE for a patient with inadequate protection as a result of infection or infectious disease?
What should you EVALUATE when a patient is being treated for an infection or infectious disease
2 days post-op below-the-knee amputation
Reports feeling hot and sweaty VS 100-98-30 156/88 What is your best action at this time
Adm from nursing home H/O Stroke MRSA urine Incontinent of urine & stool No private room available Semi private bed with older pt with
fractured leg
Immune Response recognize foreign substances
neutralize, eliminate, or metabolize them with or without injury to the body's own tissues.
Functions of the Immune System
Defense: protection against antigens
Homeostasis: removal of worn out or damaged components (e.g., dead cells)
Surveillance: ability to perceive or destroy mutated cells or nonself cells.
Alterations in Immune Functioning
Immune Function: Defense
Hypofunction: Immunosuppression with increased susceptibility to infection (neutropenia, AIDS, immunosuppression
Hyperfunction: Inappropriate and abnormal response to external antigens; an allergy
Alterations in Immune Functioning
Immune function: Homeostasis
Hypofunction: No known effect
Hyperfunction: Abnormal response where antibodies react against normal tissues and cells; an autoimmune disease
Alterations in Immune Functioning
Immune function: Surveillance
Hypofunction: Inability of the immune system to perceive and respond to mutated cells, suspected mechanism in cancer
Hyperfunction: No known effect
Immune Response: Inflammation
Reaction of the tissues of the body to injury in order to destroy or dilute an injurious agent
prevent the spread of injury
promote repair of damaged tissue
Inflammatory Response: Cause
Physical irritants (e.g., trauma or a foreign body)
Chemical irritants (e.g., strong acids or alkalis)
Microorganisms (e.g., bacteria and viruses)
Inflammatory Response: Local
Pain Swelling Heat Redness impaired function
of part
*five cardinal signs of inflammation
Inflammatory Response: Systemic appear with
moderate to severe response
Fever Leukocytosis Chills
sweating Anorexia weight loss general malaise
Types of Immunity
Test Yourself A baby is born temporarily immune to
thediseases to which the mother is immune.
The nurse understands that this is an example of which type of immunity?
Test Yourself A mother brings her children into the
clinic & they are diagnosed with chicken pox
The mother had chicken pox as a child and is not concerned with contracting the disease when caring for her children
What type of immunity does this mother have?
Factors Influencing Immunity Age Sex Nutritional Status Stress Treatment Modalities
Nursing HistoryChief complaint Lack of energy Light-headedness Frequent infections Bruising Slow wound healing
Present illness Associated symptoms Location Radiation Intensity Duration Frequency Precipitating &
alleviating factors
Nursing HistoryPresent illness Prescription drugs Over the counter
drugs Herbal remedies Vitamins & nutritional
supplements Alternative therapies
Medical history Changes in overall
health Allergies Childhood diseases Recurrent infections Innumizations Rashes Visual disturbances
Nursing History
Medical history Fever Changes in
elimination h/o immune
disorders Menstural patterns
Family history Recurrent infections Allergies Cancer
Nursing HistorySocial history Work Exercise Diet Recreational drugs & alcohol Hobbies Stress Support systems Coping mechanisms
Physiologic Responses Immunologic Dysfunction
Urticaria Hives (wheals)
Physiologic Responses Immunologic Dysfunction
Angioedema Generalized swelling
Physiologic Responses Immunologic Dysfunction
Conjunctivitis Inflammation of membranes of
eyelids
Physiologic Responses Immunologic Dysfunction
Bronchoconstriction Swelling of airway
Physiologic Responses to Immunologic Dysfunction
Pruritis Associated with
erythema & urticaria
Hypotension
Physiologic Responses Immunologic Dysfunction
Leukocytopenia Abnormal decrease in WBCs
Physiologic Responses Immunologic Dysfunction
Hypersensitive Immune Responses Allergies Anaphylaxis Transfusion reactions Transplant rejection Latex allergy
Allergies Allergic disorders are the result of a
hypersensitivity (excessive reaction to a stimulus) of the immune system to allergens (a type of antigen commonly found in the environment).
Allergies A pt has allergic rhinitis. If the pt does not remain compliant with
the treatment regime, the patient is at risk for developing an infection
Such as Sinusitis
Anaphylaxis A systemic reaction to allergens and the
most serious type of allergic reaction.
Foods, drugs, hormones, insect bites, blood, and vaccines are all associated with anaphylactic reactions.
Anaphylaxis
Anaphylactic Reaction A patient is being given PCN via IVPB. Develops an anaphylactic reaction What would you do first? What symptom may the pt be
experiencing? What is the medication of choice for
anaphylaxis?
Transfusion Reactions Any client receiving blood products that
are homologous or from a donor may develop a transfusion reaction.
Five types: febrile nonhemolytic; allergic urticarial; delayed hemolytic; acute hemolytic; and anaphylactic.
Transplant Rejection Even with the use of immunosuppressive
medications, 10% to 15% of transplanted organs fail.
Latex Allergy Since 1987, when universal precautions
(now called Standard Precautions) were mandated, exposure to latex by health care workers has dramatically increased.
By June, 1996, 28 latex-related deaths had been reported to the FDA.
Latex in our lives A combination of
exposures to proteins found in latex products and certain foods may be the cause of a rise in latex allergies
Latex in our lives Assess for allergies to avocados, bananas,
kiwi or chestnuts for cross sensitivity to latex
Latex Allergies: Signs & Symptoms Contact dermitis Facial swelling Itching Hives Rhinitis eye symptoms
Bronchospasms generalized edema difficulty breathing cardiac arrest
Latex cart at bedside
Latex Allergy Precautions Mrs. Smith tells you she has allergic reactions
when she eats bananas, seafood, eggs Based on this information what would you
ask Mrs. Smith
What actions would you take?
Nursing DiagnosisIneffective
airwayClearance
(obstructed airway)
Facial edema Bronchospasms Laryngeal
edema
Decreased cardiac output
(Histamine release) Peripheral
vasodilation Increased capillary
permeability
Nursing DiagnosisRisk for Injury Hypersensitivity
responses high Blood
transfusions
Components of Immune Response
Located throughout the body
Organs include thymus, bone marrow, lymph nodes, spleen, tonsils, appendix, Peyer's patches of small intestine.
Components of Immune Response
Main cell types are WBCs (especially lymphocytes, plasma cells, and macrophages)
all originate from the same stem cell in bone marrow, then differentiate into separate types
Components of Immune Response
Granulocytes Eosinophils: increase with allergies and
parasites
Basophils: contain histamine and increase with allergy and anaphylaxis
Neutrophils: involved in phagocytosis
Components of Immune Response
Monocytes (macrophages) (e.g., histiocytes, Kupffer cells): involved in phagocytosis
Lymphocytes (T cells and B cells): involved
in cellular and humoral immunity
Immune System Response
Infection WBCs released from bone marrow into
blood
Bone marrow increases production of additional leukocytes
White Blood Cell Count & Differential
Leukocytes (WBC)
4,500 to 10,000 cell per cubic millimeter Transports themselves to site of
inflammatory or immune response Detect, attack, & destroy anything foriegn Locates damaged tissue & infection by
responding to chemicals released by other leukocytes & damaged tissue
WBC Leukocytosis WBC greater than
10,000/mm3 Infection or
inflammation Leukemia trauma or stress tissue necrosis
Leukopenia bone marrow depression overwhelming infection viral infection Immunosuppression autoimmune disease dietary deficiency
Differential WBCGranulocytes Play key role in protecting body from
harmful microorganisms during acute inflammation & infection-neutrophils-eosinophils-basophils
Neutrophils (55% to 70%)
Neutrophilia Acute infection Stress response Myelocytic
leukemia Inflammatory
disorders Metabolic
disorders
Neutropenia Bone marrow
depression Overwhelming
bacterial infection Viral infection Addison’s disease
Eosinophils (1% to 4%)Eosinophilia Parasitic infections Hypersensitivity
reactions Autoimmune
disorders
Eosinopenia Cushing’s
syndrome Autoimmune
disorders Stress Certain drugs
Basophils (0.5% to 1%)Basophilia
Hypersensitivity responses
Chronic myelogenous leukemia
Chickenpox/smallpox Splenectomy hypothyroidism
Basopenia Acute stress Hypersensitivity
reactions, hyperthyroidism
Monocytes (monos)Monocytosis Chronic inflammatory
disorders Tuberculosis Viral infections Leukemia Hodgkin’s disease Multiple myeloma
Monocytopenia Bone marrow
depression Corticosteroid
therapy
Lymphocytes (lymphs)Lymphocytosis Chronic bacterial
infection Viral infections Lymphocytic
leukemia
Lymphocytopenia Bone marrow
depression Immunodeficiency Leukemia Cushing’s disease Hodgkin’s disease Renal failure
Autoimmune Diseases Systemic lupus erythematosus Rheumatoid arthritis Myasthenia gravis Multiple Sclerosis AIDS
Systemic Lupus Erythematosus (SLE) A chronic, progressive, incurable
autoimmune disease affecting multiple body organs.
T cells attack the skin, kidneys, and other organs
Characterized by periods of remission and exacerbation.
Rheumatoid Arthritis A chronic, systemic autoimmune disease
characterized by joint stiffness
T cells attack the linings of joints
Myasthenia Gravis
Acquired Immune Deficiency Syndrome
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