NUR 320 Care of Patients with Immune Disorders
Care of Patients with Immune Disorders
Adequate function of the immune system
- Provides protection from infectious diseases
- Maintain homeostasis
o By removing damage or dead cells
▪ Important in regard to cancer
o Immune system has a surveillance system and looks for damaged or unusual cells
and kill them
▪ Sometimes this doesn’t work, cancer cells escape surveillance and you
can develop a malignancy
Role in rejecting transplanted organs
- Innate function of immune system is to recognize self vs non-self
o It attacks non-self
- Theory around rejection and the need for immunosuppressants
o To prevent rejection
Structures of the Immune System: Lymphoid organs
- Concerned with growth and development of lymphocytes
o White blood cells
- Key operatives of immune system
- 2 types
o B lymphocytes
o T lymphocytes
- Organs of the immune system relate to one another and with other organs of the body
o Connection of organs through lymphatic vessels
o Lymphatic very similar to blood vessels
Central organs of immune system
- Bone marrow
- Thymus
o Located in mediastinum cavity
o Essential for manufacturing of T lymphocytes
Peripheral organs
- Tonsils
- Lymph nodes
o Axillary
▪ Armpit
o Inguinal
▪ Femoral area
o Cervical
o All used to determine infections, malignancy etc.
- Spleen
,NUR 320 Care of Patients with Immune Disorders
- Gut
o Layers of tissue have protective function built in from immune system
- Spleen
o Stores lymphocytes and macrophages
o Patients can live without a spleen
o Slightly higher risk of infection long term without it
o After splenectomy need to make sure they are up to date on vaccines
▪ Slightly higher risk of infection long term due to no spleen
Types of Immunity
- Natural immunity
o Also called innate
o Non-specific chemical and anatomic barriers
o Non-specifically recognize damaged cells
- Active immunity
o Occurs when body develops antibodies or immune lymphocytes against specific
antigens
o Naturally acquired
▪ By getting infected with antigen resulting in producing antibodies
• i.e: chicken pox
o Artificially acquired
▪ By vaccine
▪ Property of the immune system where there is memory
▪ Immune system responds more effectively to antigen on subsequent
exposure
- Passive immunity
o Naturally acquired
▪ i.e. infants are protected by antibodies received from mothers before
birth
o Artificially acquired
▪ Short term
▪ Injection of antibodies that are not produced by recipient
• i.e. rabies exposure – requires series of injections of antibodies
▪ Not as common
External Non-Specific Defense Mechanisms
- Important as nurse because we will see this a lot of this as nurses that patients have
break in external non-specific defense mechanism
- Skin and mucous membranes
o First line of defense
o Protects body from adverse environmental conditions
o Mucosal secretions have a high concentration of immunoglobulin
▪ Protective function
,NUR 320 Care of Patients with Immune Disorders
- Biochemical factors
o Skin
▪ Acetic acid and salt that are toxic to many pathogens
o GI
▪ Acidic – pH of about 2
▪ Kills and detoxifies
▪ Maintained with good oral intake – maintains natural flora
• NPO will disrupt this
• Higher risk for infection
o Vagina
▪ Before puberty neutral
▪ At puberty becomes more acidic
• Strongly acidic during pregnancy
• How the body is protecting fetus/women of child-bearing age
▪ More alkaline after menopause
• Sometimes as we age at higher risk for vaginal associated
infections because first line of defense is diminished
o Lysozyme
▪ Enzyme
▪ Aids in destruction of bacteria
▪ i.e. tears, saliva
- THINK OF THESE IN TERMS OF THE HOSPITALIZED PATIENT
Specialized Structures of the External Non-Specific Defense System
- Cilia
o Little nasal hairs in nose
o Help protect from substances getting into respiratory system
o Going back to COPD
▪ Decreased or altered ciliary function
▪ Nasal hairs don’t provide protection mechanism they should
▪ Other reasons they are at higher risk for infection, but this is one of them
• Loss of ciliary function – EXTERNAL defense system
- Saliva
- Eye lashes
- Tears
- Peristaltic action
o Nausea/vomiting to remove harmful substances
Acute Inflammatory Response – non-specific
- A biochemical and cellular process that occurs in vascular tissue due to cellular injury
- Non–specific elimination of microorganisms
- Occurs in the same manner whether initial or second exposure to the antigen
, NUR 320 Care of Patients with Immune Disorders
o i.e: wound from surgery - body does not remember this happening before, so it
reacts the same way
- Occurs when first line of defense is broken by cellular injury
- Injury can be caused by:
o Trauma or surgery
o Chemical agents
o Temperature extremes
o Invasion of microorganisms
o Oxygen/nutrient deprivation (ischemic damage)
o Genetic immune defects (autoimmune diseases)
Non-Specific Cellular Inflammatory Response
- Neutrophils arrive first to site of infection
o Phagocytose bacteria
▪ Eat it up
o Short life span
o Accumulate at site and cause pus
▪ Shows acute inflammatory response
▪ Remember this in patient with chemotherapy
• Causes WBC count to go down because of bone marrow
suppression
o Chemo is NON-SPECIFIC treatment of cancer
▪ kills everything
▪ malignant & normal cells
• these patients develop neutropenia
o low neutrophil (WBC) count
o Don’t see classic signs and symptoms of infection because
you lack the neutrophils that cause the reaction
- Phagocytes
o Migrate to area
o Clean up the area
o Initiate the healing process
Inflammatory Response
- Vascular response
o Vasoconstriction (stress response)
o Vasodilation caused by histamine and other mediator release
▪ Histamine is main mediator
- Fluid exudation
o Increased permeability of the capillaries
o Edema formation
- Cellular response
Care of Patients with Immune Disorders
Adequate function of the immune system
- Provides protection from infectious diseases
- Maintain homeostasis
o By removing damage or dead cells
▪ Important in regard to cancer
o Immune system has a surveillance system and looks for damaged or unusual cells
and kill them
▪ Sometimes this doesn’t work, cancer cells escape surveillance and you
can develop a malignancy
Role in rejecting transplanted organs
- Innate function of immune system is to recognize self vs non-self
o It attacks non-self
- Theory around rejection and the need for immunosuppressants
o To prevent rejection
Structures of the Immune System: Lymphoid organs
- Concerned with growth and development of lymphocytes
o White blood cells
- Key operatives of immune system
- 2 types
o B lymphocytes
o T lymphocytes
- Organs of the immune system relate to one another and with other organs of the body
o Connection of organs through lymphatic vessels
o Lymphatic very similar to blood vessels
Central organs of immune system
- Bone marrow
- Thymus
o Located in mediastinum cavity
o Essential for manufacturing of T lymphocytes
Peripheral organs
- Tonsils
- Lymph nodes
o Axillary
▪ Armpit
o Inguinal
▪ Femoral area
o Cervical
o All used to determine infections, malignancy etc.
- Spleen
,NUR 320 Care of Patients with Immune Disorders
- Gut
o Layers of tissue have protective function built in from immune system
- Spleen
o Stores lymphocytes and macrophages
o Patients can live without a spleen
o Slightly higher risk of infection long term without it
o After splenectomy need to make sure they are up to date on vaccines
▪ Slightly higher risk of infection long term due to no spleen
Types of Immunity
- Natural immunity
o Also called innate
o Non-specific chemical and anatomic barriers
o Non-specifically recognize damaged cells
- Active immunity
o Occurs when body develops antibodies or immune lymphocytes against specific
antigens
o Naturally acquired
▪ By getting infected with antigen resulting in producing antibodies
• i.e: chicken pox
o Artificially acquired
▪ By vaccine
▪ Property of the immune system where there is memory
▪ Immune system responds more effectively to antigen on subsequent
exposure
- Passive immunity
o Naturally acquired
▪ i.e. infants are protected by antibodies received from mothers before
birth
o Artificially acquired
▪ Short term
▪ Injection of antibodies that are not produced by recipient
• i.e. rabies exposure – requires series of injections of antibodies
▪ Not as common
External Non-Specific Defense Mechanisms
- Important as nurse because we will see this a lot of this as nurses that patients have
break in external non-specific defense mechanism
- Skin and mucous membranes
o First line of defense
o Protects body from adverse environmental conditions
o Mucosal secretions have a high concentration of immunoglobulin
▪ Protective function
,NUR 320 Care of Patients with Immune Disorders
- Biochemical factors
o Skin
▪ Acetic acid and salt that are toxic to many pathogens
o GI
▪ Acidic – pH of about 2
▪ Kills and detoxifies
▪ Maintained with good oral intake – maintains natural flora
• NPO will disrupt this
• Higher risk for infection
o Vagina
▪ Before puberty neutral
▪ At puberty becomes more acidic
• Strongly acidic during pregnancy
• How the body is protecting fetus/women of child-bearing age
▪ More alkaline after menopause
• Sometimes as we age at higher risk for vaginal associated
infections because first line of defense is diminished
o Lysozyme
▪ Enzyme
▪ Aids in destruction of bacteria
▪ i.e. tears, saliva
- THINK OF THESE IN TERMS OF THE HOSPITALIZED PATIENT
Specialized Structures of the External Non-Specific Defense System
- Cilia
o Little nasal hairs in nose
o Help protect from substances getting into respiratory system
o Going back to COPD
▪ Decreased or altered ciliary function
▪ Nasal hairs don’t provide protection mechanism they should
▪ Other reasons they are at higher risk for infection, but this is one of them
• Loss of ciliary function – EXTERNAL defense system
- Saliva
- Eye lashes
- Tears
- Peristaltic action
o Nausea/vomiting to remove harmful substances
Acute Inflammatory Response – non-specific
- A biochemical and cellular process that occurs in vascular tissue due to cellular injury
- Non–specific elimination of microorganisms
- Occurs in the same manner whether initial or second exposure to the antigen
, NUR 320 Care of Patients with Immune Disorders
o i.e: wound from surgery - body does not remember this happening before, so it
reacts the same way
- Occurs when first line of defense is broken by cellular injury
- Injury can be caused by:
o Trauma or surgery
o Chemical agents
o Temperature extremes
o Invasion of microorganisms
o Oxygen/nutrient deprivation (ischemic damage)
o Genetic immune defects (autoimmune diseases)
Non-Specific Cellular Inflammatory Response
- Neutrophils arrive first to site of infection
o Phagocytose bacteria
▪ Eat it up
o Short life span
o Accumulate at site and cause pus
▪ Shows acute inflammatory response
▪ Remember this in patient with chemotherapy
• Causes WBC count to go down because of bone marrow
suppression
o Chemo is NON-SPECIFIC treatment of cancer
▪ kills everything
▪ malignant & normal cells
• these patients develop neutropenia
o low neutrophil (WBC) count
o Don’t see classic signs and symptoms of infection because
you lack the neutrophils that cause the reaction
- Phagocytes
o Migrate to area
o Clean up the area
o Initiate the healing process
Inflammatory Response
- Vascular response
o Vasoconstriction (stress response)
o Vasodilation caused by histamine and other mediator release
▪ Histamine is main mediator
- Fluid exudation
o Increased permeability of the capillaries
o Edema formation
- Cellular response
