normal immunology
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NORMAL IMMUNOLOGY
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Overall Characteristics of the Specific Immune System
Response (5 Cardinal Features)
Self/ Not Self Tolerance A unique feature of the immune system.
Discrimination of self from not- self is the recursiveability of the immune cells to engage in the processof exploring the cellular environment.
Healthy cells are left alone, and the immune cells
identify and mount responses against foreign cells aswell as cancerous or infected self- cells.
Example of error- free self- identification that leadsto self tolerance: maturation process of T Cells.
Self- regulation
The ability of the immune system to initiate,maintain, and down regulate immune activityindependent of the nervous system or othercontrols.
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Overall Characteristics of the Specific Immune
System Response (5 Cardinal Features) Specificity
The ability of the immune system to design and implement asimmune response that is targeted only to a single, specificantigen or foreign cell.
Diversity The body has an ability to develop a specific response to an
indefinite number of different antigens. The human genetic repertoire provides us with an ability to
mount a specific response to about 10, 000 different antigens.
Memory
Once the immune system identifies antigen and mounts animmune response, it can store a memory of antigen and keep
memory cells available throughout the life span to provide aprompter response to secondary exposure
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The Immune System
1. Central Lymphoid Organs
Bone Marrow It contains the parent or stem cells from which lymphoid cells are
derived.
Red marrow- provides all of the blood cells in the body.
Yellow marrow- stores lipids, serving as an energy reserve.
Immature T lymphocytes are formed in the bone marrow.
The originating cells (prulipotent hematopoietic stem cells) produce: All the circulating blood cells
Lymphoid and myeloid cells (WBC)s Erythrocytes (RBCs)
Thrombocytes (platelets)
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Thymus Gland
A primary lymphoid gland located in the mediastinal area of the chest.
It weighs about 20 gm. At birth, grows rapidly in children, and reaches a maximum size
at puberty (about 35 gm.), after which it gradually begins the process of involution.
The thymus processes and matures lymphocytes in large numbers from the early years
of life until puberty at diminishing rates throughout adult life.
Lymphocyte maturation is the process of transformation of lymphocyte precursor cellsinto antigen- specific lymphocytes regulated only to respond to specific antigens under
proper conditions of antigen recognition.
Bone marrow produces immature immune cells
Immature cells travels via the blood
Cells reaches the cortex of thymus
Maturation and development
Reaches the medullary area of the thymus
Lymphocytes become differentiated and transforms into immunocompetent cells.
Cells enters the circulation.
Identifies and reacts to foreign tissues.
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Bone marrow produces immature immune cells
Immature cells travels via the blood
Cells reaches the cortex of thymus
Maturation and development
Reaches the medullary area of the thymus
Lymphocytes become differentiated and transforms into immunocompetent cells.
Cells enters the circulation.
Identifies and reacts to foreign tissues.
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. Peripheral Lymphoid Organs and
Tissues
Lymph Nodes Are encapsulated secondary lymphoid organs that
systematically distributed throughout the body to receive
and process the lymph circulation. Mucosa- Associated Lymphoid Tissue (MALT)
Aggregates of lymphoid tissue that are found in manyorgans specially the GI and respiratory tracts.
Gut- associated lymphoid tissues (GALT)
Lymph node- like tissues in the GI tract that collect antigen fromepithelial surfaces in the lumen of the bowel.
The lymphocytes form a follicle that protrudes within the lumen toenhance potential contact with antigen entering the GI tract.
Include: tonsils, adenoids, vermiform appendix, and Payer's patches.
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Peripheral Lymphoid Organs and
Tissues
Bronchial- associated lymphoid tissue (BALT)
It has specificity for airborne pathogens.
It is facilitated by the flow of mucus out of the lungs through
the ciliary action of the columnar epithelial cells and the
cough reflex.
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Peripheral Lymphoid
Organs and Tissues
Spleen
The largest internal lymphatic organ, weighing about180 to 240 gm.
It can function as a reservoir for blood in its venoussinuses and pulp.
It also processes RBCs that squeeze through its pores.
Phagocytic cells, especially macrophages, line the
pulp and sinuses of the spleen. These cellsfunction in the process of immunity to clearblood- borne pathogens
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Peripheral Lymphoid Organs and
Tissues Structural and Physiologic Barriers in Bodily Defense
Physical barriers
Intact skin Primary barrier to entry into the body.
The tight junctions of the skin in the skin, the presence of antibacterialpeptides, and the shedding property of surface cells in the skin makes itdifficult for pathogens to colonize or enter.
The Mucous membranes Serve as physical barriers to invasion because of cellular alignment, ciliated
epithelial functions, longitudinal flow over their surfaces, the movement ofmucus, the presence of microbeactive enzymes, various pH levels, and fattyacids.
Saliva
Tears
Urine flow
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Peripheral Lymphoid
Organs and Tissues Physiologic Barriers
Acidic pH A barrier to pH- sensitive pathogens.
Soluble factors in tissue and tissue secretions
Many chemicals are bacterially active and function throughenzymatic reactions.
High tissue or body temperature A defensive mechanism against temperature- sensitive
pathogens.
Commensal organisms in the GI tract Serve to regulate pH, available pathogen food supply, and
available binding sites and access points for microbial invasion.
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Peripheral Lymphoid
Organs and Tissues . Cells of the Immune System
Cells of Innate, Non- specific Immunity
It includes the interaction of phagocytes with antigen as well as chemical mediators from other WBCs.
Macrophages The mature cells of the mononuclear phagocyte system (or monocyte- macrophage system).
They function in phagocytosis of antigen and in processing and presenting antigen to specific
lymphocytes. They serve an essential function in removing foreign and devitalized mineral from the body.
They trap and process antigens to present them to specialized lyphocytes.
Neutrophils The most numerous and the most important cellular component of the innate, non- specific immune
response.
They serve to complete the phagocytic family of cells and a first-line defender in the body againstbacterial invasion, colonization and infection.
Eosinophils They are believed to play a pivotal role in defense against parasitic infections. They are components of
innate immunity but can be activated by lymphocytes, and serve an adapted immunity
Basophils They play a role in protecting mucosal surfaces throughout the body, and, like mast cells, they release
substances that assist other cells in the inflammatory response.
Mast Cells Derived from bone marrow cells that are distinct from basophils.
They serve to provide substances that are supportive and enhancing of immune responses.
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Peripheral Lymphoid
Organs and Tissues Cells of Adaptive, Specific Immunity
They are essential for producing immunity to disease and protectionfrom other foreign agents.
B Lymphocytes
Are responsible for humoral immunity or immunoglobulin- mediated immunity, which isspecific immunity for antigens that are found outside of the host cells.
They originate in the bone marrow and mature either there or in some other site.
They are capable of proliferating and differentiating into plasma cells and memory cellswhen exposed into a specific antigen.
Plasma cells- capable of secreting large quantities of specific immunoglobulin, theimmune active portion of humoral immunity. Immunoglobulin secreted by plasmacells is called antibody.
Memory cells- serve the purpose of stockpiling a specific clone of B cells, so that
immediate production of large quantities of the specific immunoglobulins resultswhen the cells are next exposed to a particular antigen.
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Immunoglobulins
1IgG- makes up about 75% of the antibodies normally circulating in plasma.
IgG has been shown to carry the major burden in neutralizing bacterial toxins.
This function is essential in accelerating the process of phagocytosis.
2IgA- most of IgA is in the form of secretory IgA in the external body secretions
such as saliva, sweat, tears, bile, and colustrum. It provides a defense against
pathogens on exposed surfaces of the body, especially those entering the
respiratory and GI tract.
3IgM- Often called the macroglobulin (because it is the largest). It is the first
immunoglobulin produced in quantity during an immune response, and so rise
early in the course of infection. It is efficient in agglutinating antigen, fixing
complement, and lysing cell walls.
4IgD- is present in plasma in very low concentration and is readily broken down.Its exact function is not well understood, but its presence on lymphocyte surfaces
together with IgM suggests that it may be a receptor that helps find antigens to
the cell surfaces. Its levels are elevated in chronic infections.
5IgE- serves to activate mast cells. It is normally fixed on tissue surfaces.
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Cells of Adaptive, Specific Immunity
T Lymphocytes They account for about 75% of the serum lymphocytes. They
originate from stem cells in the bone marrow but are matured inthe thymus gland and are sometimes called thymocytes.
They can be functionally divided into three subgroups: Helper T Cells- stimulates B Lymphocytes to differentiate into
antibody producers and serve to activate cytotoxic Tlymphocytes and other T cell responses; they are thereforeresponsible for activating the specific immune response.
Killer T Lymphocytes- bind to the surface of the infected cells,disrupt its membranes, and kill it by altering intracellular
environment. Suppressor T Cells- reduce the humoral response. The
production of immunoglobulins against a particular antigencan be reduced or abolished in the presence of these cells.
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Types of Immunity
Innate (Natural) Immunity Refers to those factors a person is born with to prevent disease.
These can either be: physical barriers (skin, mucous membranes, cough etc.)
Chemical barriers
Internal factors (mononuclear phagocytes and leukocytes)
Acquired Immunity Refers to passive and active immune process.
Passive active immunity- occurs in early neonatal life, when some of the mothersimmunity, which was passed through the placenta prenatally, continues to protect theinfant from the disease. It protects for the first few months of life.
Acquired active immunity- involves the response mounted by the persons immune
system. Scientists have discovered the process of inducing acquired immunity throughvaccination.
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Types of Immunity
Adaptive Immunity It is responsible for the protection of the human body from the disease. It
requires a cellular and/or humoral response to an antigen.
This type of immunity is an active process of specifics recognition of antigenand the production of a bank of cells that remember the antigen and quicklyrespond to repeat antigen introduction.
Cell- mediated Immunity Is mediated through contact between T cells and antigen and by cystokines.
The interaction sets off a complex series of steps leading to subsequentdestruction of the antigen.
Stages of the Immune Response (Please see attachment)
I. Recognition Stage II. Prilifiration Stage
Response Stage
Effector Stage
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INTEGRATION OF THE NURSING PROCESS
I. ASSESSMENT: Identifying modifiable risks based on:
Health History Age
People at the extremes of the lifespan are more likely to developproblems related to immune system functioning than are those inmiddle years.
Nutrition
Adequate nutrition is essential for optimal functioning of the immunesystem.
Vitamins: Essential for DNA and protein synthesis, if inadequate, may lead to protein-
calorie deficiency and subsequently to impaired immune function.
Also help in the regulation of cell proliferation and maturation of immunecells.
Fatty acids: the building blocks that that make up the structuralcomponent s of cell membrane.
Depletion of protein reserves results in atrophy of lymphoid tissue,depression of antibody response, reduction in the number of circulatingT cells, and impaired phagocytic function.
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INTEGRATION OF THE NURSING
PROCESS Infection and Immunity
Immunizations received recently and those in childhood and the usualchildhood disease.
Known past or present exposure to tuberculosis.
A history of past and present infections and the dates and types of treatmentsthat were used, along with a history of any multiple persistent infections, FUO,
lesions or pores, or any type of drainage, are obtained. Allergy
History of any allergy and types of allergens: Pollens
Dust
Plants
Cosmetics
Food
Medications
Vaccines etc.
Symptoms experienced
History of testing and treatment
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Disorders and Diseases
Autoimmune disorders:
More common in females Believed to be the result of the activity of the sex hormones.
Lupus erythematosus
Rheumatoid arthritis
Psoriasis
Neoplastic Disease
Any history of cancer, its type and date of diagnosis.
Dates and results of any cancer screening tests. All treatments that the patient has received or is currently
receiving, such as radiation or chemotherapy.
Family History of cancer
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Disorders
and Diseases Chronic Illness and Surgery
History of Chronic Illness: DM
Renal diseases
COPD
History of surgical removal of: Spleen
Lymph nodes
Thymus
History of organtransplantation
Special problems Burns and other forms of injury
and infection
Physiologic and Psychologicalstressors
Medications and BloodTransfusions
Large doses of:
Antibiotics
Corticosteroids
Cytotoxic agents
Salicylates
NSAID
Anesthetics Single or multiple blood
transfusions
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Disorders and Diseases
Lifestyle and other factors
Smoking
Alcohol consumption
Dietary intake
Nutritional status
Amount of perceived stress
Occupational or residential exposure to radiation and
pollutants
Physical Examination (Indications of
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Physical Examination (Indications of
Immune Dysfunction)
Skin Lesions
Dermatitis
Purpura
Urticaria
Inflammation
Any Discharge
Temperature is recorded Note chills and sweating
Posterior cervical, axillary, and inguinal lymph nodes are
palpated Location Size
Consistency
Tenderness
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Physical Examination (Indications of
Immune Dysfunction
Joints
Tenderness
Swelling
Limited ROM
Respiratory System Changes in RR
Cough
Abnormal lung
sounds Rhinitis
Hyperventilation
Bronchospasm
CardiovascularSystem Hypotension
Tachycardia
Dysrhythmia
Vasculitis Anemia
GastrointestinalSystem Hepatosplenomegaly
Colitis
Vomiting
Diarrhea
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Physical Examination (Indications of
Immune Dysfunction
Genitourinary system
Frequency and burning on urination
Hematuria
Discharge
Neurosensory Cognitive dysfunction
Hearing loss
Visual changes
Headaches and migraines Ataxia
Tetany
Selected Tests for Evaluating
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Selected Tests for Evaluating
Immunologic Status
Leukocytes and Lymphocyte Tests
WBC Count and differential
Bone marrow high
Humoral (Antibody- mediated) Immunity Tests B- cell quantification with monoclonar antibody
In vivo immunoglobulin synthesis with T- cells subsets
Specific antibody response
Total serum globulins and individual immunoglobulins Phagocytic Cell Function Tests
Nitroblue tetrazolium reductase assay
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Selected Tests for Evaluating
Immunologic Status Complement Component Tests
Total serum hemolytic complement
Individual complement component titrations
Radial immunodiffusion
Electroimmunoassay Radioimmunoassay
Immunophlelometric assay
Immunoelectrophoresis
Hypersensetivity Tests Scratch test Patch test
Intradermal test
Radioallergosorbent test (RAST)
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PLANNING AND IMPLEMENTATION
Maintenance and Promotion of Normal
Immune System Response
Dietary/ nutritional instruction
Vaccination/ Immunization
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PLANNING AND IMPLEMENTATION
Prevention Against Microbial Invasion
Aseptic Techniques
Universal Precaution