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Immunity

N322

Immunity
An antigen is a body invader that is
recognized as foreign by the immune
system so provokes an immune response
Could be pollen, food, a drug, particle
inhaled.
An antibody is a protein the body
produces to counteract and destroy
antigens.
A hapten is a particle so small it does
not evoke an response until it combines
with protein. Penicillin is a hapten.

Immune System
LOCATION:
Thymus gland
Tonsils
Spleen
Intestine
Lymphatics
Lymph nodes & Lymphocytes

Leukocytes
Granulocytes (Polymorphonuclear):
Neutrophils: 55-65% of WBC total
Basophils:
0.3-0.5%
Eosinophils: 1-4%
Action of all granulocytes is
phagocytosis.
Agranulocytes (Mononuclear):
Monocytes: 3-8%
Lymphocytes:
25-30%
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Leukocytes
Granulocytes (Polymorphonuclear):
Neutrophils:
55-65% of WBC total
Do not stain (neutral)
1st to arrive at scene (within 90 minutes)
Bands or stabs are immature form.
Segs (for segmented nucleus) are mature
form.
Main action: phagocytosis
Life: 3 days
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Leukocytes
Granulocytes (polymorphonuclear)
Basophils:
0.3-0.5% of WBC total
Stain blue
Back up to neutrophils
Main action: phagocytosis.

Leukocytes
Granulocytes (polymorphonuclear)
Eosinophils:
1-3% of WBC total
Stain red
Increase with allergic or parasitic
infection.

Leukocytes
Agranulocytes (Mononuclear):
Monocytes:
Largest size leukocytes.
Macrophages are mature form.
3-8% of WBC total.
Live 1-3 days.
Active in removing devitalized tissue.
Process antigens and present them to
lymphocytes.
Attracted to lymphocytes by
lymphokines.

Lymphocytes
All begin in bone marrow.
20-30% of WBC total.
B-lymphocytes:
Mature in bone marrow.
Form plasma cells and memory cells
Responsible for antibody-mediated
-immunity (immunoglobulin production)
Plasma cells produce antibodies;
memory cells remember how to
produce them.
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Antibodies (Immunoglobulins)
Five Classes:
IgM:
First to respond to foreign invasion.
Six days for response. Fade after 14 days.
IgA:
80% of antibodies
Increase with bacterial invasion.
Crosses the placenta to give fetus
passive antibody protection.

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Antibodies
IgA:
Found in mucus membrane, tears,
colostrum, saliva. Responds to
respiratory, GI and skin invasion.
IgD:
Little known.
IgE:
Causes immediate sensitivity reaction.
Elevated with allergy or parasitic
invasion.
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Primary & Secondary Responses


PRIMARY:
The first time an antigen enters, it
evokes a primary response.
In 6 days, the B-lymphocytes produce
IgM antibodies, then IgG specific for the
antigen.
SECONDARY RESPONSE:
IgG specific to antigen produced
immediately.

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Complement Activation
20 different proteins that circulate as
inactive protein molecules.
First one binds with a released
immunoglobulin
(IgG & IgM)
Cascade of molecules leads to
inflammatory reaction.
vascular permeability
Chemotaxis (calls in leukocytes)
Phagocytosis; Lysis of foreign cells
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Complement Activation
Disadvantages:
Some normal tissue may be damaged in
process.
May block glomeruli of kidney

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Lymphocytes
T-lymphocytes leave the bone and mature
in the thymus gland (T-cells)
Job is immnuno surveillance
Five types of T-cells:
(1) Cytotoxic or Killer cells (Tc):
Bind to invading antigen (virus, tumor or
foreign material) and destroy it.
(2) Delayed Hypersensitivity (Td):
Provoke inflammatory response.
Secrete lymphokines (chemotaxic agents)
that attract other leukocytes into area.

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Lymphocytes
(3) Helper T cells
CD4 & CD8 cells
Responsible for cell-mediated Immunity
(CMI) or direct cytotoxic cells to destroy
Directly interact with cancer, fungal &
parasitic infection.
No B-lymphocyte involvement is necessary
Escherichia coli needs no B-cell response.
Stimulate B Lymphocytes
(IgA most dependent on helper cells; IgM
least dependent)

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Lymphocytes
(4) Suppressor T cells:
Suppress B-lymphocyte response
(5) Memory cells
Help activate the secondary immune
response

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Thymus Gland
LOCATION:
In the mediastinum
STRUCTURE:
Cortex & medulla
FUNCTION:
Store and mature T-lymphocytes.
Is large until puberty and then recedes.

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Tonsils
Palatine, lingual, pharyngeal, adenoid.
LOCATION:
Back of throat and nose.
STUCTURE:
Web-like inner core.
FUNCTION:
Filter lymph that passes through them.

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Intestine & Spleen


INTESTINE:
Peyers Patches
Lymph tissue found in intestine
SPLEEN:
LOCATION:
Below left ribs.
Giant web that filters blood. Destroys
aged RBCs. Stores mature lymphocytes.
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Lymphatics
Accessory system to remove excess fluid
and large particles from interstitial fluid
and turn them to circulation.
Fluid travels for capillaries to interstitial
space because of hydrostatic pressure.
Fluid returns to capillaries by osmotic
pressure. Some fluid and protein do not
return.
Are returned by lymphatics.

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Lymphatics
Lympatics run beside arterioles and
major arteries. Join and enter into
thoracic duct then into subclavian and
internal jugular veins.
Lymphocytes travel through lymphatics
as surveillance activity.
Lymph Nodes are interspersed in system.
Act as filters and home locations for
lymphocytes.
Secondary system to restore osmotic
pressure & filter blood.
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Potential Problems:
Autoimmune (lymphocytes fail to
identify self from non self).
Immune deficiency (lymphocytes are
not adequate to cause response).
Allergy (abnormal antibody/antigen
response).

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Autoimmune Disorders
Tolerance is the bodys ability to
tolerate or not provoke an immune
response to its own self.
Autoimmune conditions arise when
tolerance fails.
The person develops an infection (usually
viral; the body produces antibodies
against organism;
It clears them from the body but then
continues to manufacture antibodies and
directs them against its own tissue.
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Autoimmune Disorders
The body identifies its own tissue by HLA
(histocompatibility antigens) or protein
found on cell membranes.
Tendency to autoimmune is familial.
Rheumatic fever is an autoimmune
disorder that occurs after invasion of one
type e of group A streptococcal infection.
Multiple sclerosis, hyperthyroidism
(Graves Disease), nephrotic syndrome
are thought to be autoimmune.
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Autoimmune Disorders
Therapy:
Decrease immune response: cortisol
(hydrocortisone, prednisone)

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Severe Combined
Immunodeficiency Disease
(SCID)
Stem cell defect both B an T cell

deficiency
Thymus gland is small and underdeveloped.
All immunoglobulins are depressed
Cell mediated action is limited.
Infant develops diarrhea, pneumonia,
failure to thrive ( 5th % on weight chart).
Used to die in infancy
Bone marrow transplant is necessary.

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IgA Deficiency
Inability to produce IgA
Develops sinus, respiratory, GI, skin
infections.
Ulcerative colitis is a risk.
High rate of malignancy and autoimmune
disease (IgE is overproduced)

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DiGeorges Syndrome
cell-mediated action (lack thymus
gland)
Susceptible to viral and fungal infections
No reaction to skin tests like PPD
Suppressed humoral response (reduce
helper T cells.

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Secondary Suppression
Stress (sympathetic nervous system
blood flow to thymus gland)
Aging
Infection (protein is used elsewhere)
Chemotherapy (kills fast growing cells)
Corticosteroids (hydrocortisone;
prednisone) cell mediated response
Starvation ( protein and lymphocytes)
Malignancy (drains protein &
lymphocytes)
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Prednisone
CLASSIFICATION:
Corticosteroid
ACTION:
Binds to cortical receptors to achieve antiinflammation and immunosuppressor
effects.
PREGNANCY RISK CATEGORY: C
ADMINISTRATION: P.O.

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Prednisone
ADVERSE EFFECTS:
Susceptible to infection.
Increased appetite & weight gain.
Increased blood sugar
Hirsutism
Stomach irritation
NURSING IMPLICATIONS:
Give in a.m. to mimic normal cortisone rise.
Caution about changes in physical
appearance.
Advise not to discontinue abruptly.

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Acquired Immunodeficiency Syndrome


(HIV/AIDS)
Immune deficiency caused by a retrovirus
(HIV-1 or HIV-2)that specifically attacks
CD4 T (helper) cells.
Without CD4 cells, body is unable to use
cell-mediated or humoral immune
responses.
Transmission:
Sexually transmitted (semen or vaginal
fluid); blood (contaminated needles or
blood products); perinatally & breast milk
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Acquired Immunodeficiency Syndrome


(HIV/AIDS)
People with STDs or tuberculosis are
more susceptible than others. Can
transmit the disease b/4 antibodies are
present.

People at risk:
Males sexually active with other males
Injection drug users
Heterosexual contact with a partner who
is HIV-infected or in a high-risk group.

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Acquired Immunodeficiency Syndrome


(HIV/AIDS)
Receipt of blood or blood products prior
to 1985 or outside North America,
Western Europe, Australia and Japan.
Infants born of HIV+ mothers
HCWs exposed to blood through needle
sticks or blood contamination.

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Acquired Immunodeficiency Syndrome


(HIV/AIDS)
Assessment:
Child-bearing age
Black and Hispanic are highest incidence.
Susceptibility to infection (URIs, diarrhea)
Particular susceptibility to fungal infection:
esophageal or vaginal candidiasis.
Susceptible to parasitic infection:
toxoplasmosis found in uncooked meat; cat
feces

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Acquired Immunodeficiency Syndrome


(HIV/AIDS)
HIV dementia (confusion, memory loss)
Wasting syndrome
Kaposis Sarcoma: rare malignancy of the
lining of blood vessels; develop silver
dollar sized painless papular purple skin
lesions mainly on trunk, head and neck.
Pneumocystis carinii pneumonia: rare
fungal pneumonia; fever, SOB, chest
pain; x-ray +

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Acquired Immunodeficiency Syndrome


(HIV/AIDS)
Antibody test:
By 1-3 month after exposure, antibodies
to HIV virus will be present. Although
present, they do not destroy virus.
ELISA (enzyme linked immunosorbent
assay)
Western Blot

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Acquired Immunodeficiency Syndrome


(HIV/AIDS)
Categories: Normal = 800-1000 CD4 cells
I
= 500 CD4 cells/uL
II
= 200-499 CD4/uL
III
= 200 CD4/uL
Stages:
A = Asymptomatic
B = Minor symptoms
C = Major symptoms

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Acquired Immunodeficiency Syndrome


(HIV/AIDS)
Stages:
Initial infection: May have fever, rash,
headache, sore throat - mono symptoms)
Clinical Latency :Lymphopathy (up to 10
years)
Clinically apparent disease: Opportunistic
infections (organisms that do not
ordinarily invade cause illness); CD4
under 200.
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Acquired Immunodeficiency Syndrome


(HIV/AIDS)
Nursing Diagnosis:
Fear related to diagnosis
Social isolation (50% develop AIDS
within 10 years of seroconversion)
Risk for infection
Therapy/Interventions:
Antibiotics, antivirals, antifungals,
antiparasitics, protease inhibitors,
reverse transcriptase inhibitors; good
nutrition, supplemental vitamins

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Zidovudine (AZT)
CLASSIFICATION:
Reverse transcriptase inhibitor
ACTION:
Antiviral; inhibits replication of viruses.
PREGNANCY RISK CATEGORY: C
ADMINISTRATION:
Oral or IV
ADVERSE EFFECTS:
Fatigue, malaise, headache, nausea, bone
marrow suppression, neutropenia.
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Zidovudine (AZT)
NURSING IMPLICATIONS;
Take q4H around the clock.
Does not halt opportunistic infections.
Monitor WBC
Does not reduce the risk of transmission
of HIV

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Acquired Immunodeficiency Syndrome


(HIV/AIDS)
PREVENTION:
Universal precautions
Do not share articles possible
contaminated with blood (razors,
toothbrushes, etc.)
No not share injection equipment.
HIV+ persons should not donate blood,
breast milk, plasma, sperm or organs.
Follow sexual risk reduction (safer sex)
guidelines.

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Safer Sex Practices


Be selective who are your sexual
partners. The more partners you have,
the greater your chance of contracting a
STD.
Ask sexual partners about their lifestyle.
Avoid partners with a history of casual
contacts, bisexual or unprotected sex, IV
drug users, prostitutes (male or female)
and people who have sex with
prostitutes.

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Safer Sex Practices


Use a condom (male or female).
Prelubricated ones tear less than
nonlubricated. Do not use oil based
lubricants.
The spermicide Nonoxynol-9 can provide
lubrication and destroys HIV, herpes,
gonorrhea and chlamydia.
Voiding immediately after sex may aid in
washing away contaminants on the vulva
or in the urinary tract.

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Safer Sex Practices


Anal intercourse carries a high risk for
HIV and hepatitis B infection as well as
infection from intestinal organisms.
Use lubricants to reduce condom
breakage.
Do not engage in oral-penile sex unless
the male wears a condom because
even preejaculatory fluid may contain
viruses and bacteria.

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Safer Sex Practices


For safer oral-vaginal sex, a condom split
in two or a plastic dental dam covering
the mouth should be used to protect
against the exchange of body fluids.
Hand-to-genital contact may be
hazardous if open cuts are present on
hands. Use a latex glove for protection.
Do not share sexual aids such as
vibrators or birth control aids such as
diaphragms.

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Safer Sex Practices


Inspect a sexual partner for any lesions
or abnormal drainage in genital area. Do
not engage in sex with anyone who has
these signs.
If you think you have contracted a
sexually transmitted disease, do not
engage in sexual relations and contact
your HCP.

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Universal Precautions
1. Routinely use barrier protection to
prevent skin and mucous membrane
contamination with blood or body fluids
of all patients and specimens.
2. Wear gloves when engaging in the
following:
Touching all laboratory specimens and
tissues.
Touching mucous membranes and
nonintact skin of all patients
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Universal Precautions
Handling items contaminated with blood or
body fluids, including specimen containers,
laboratory instruments, counter tops, etc.
Performing venipuncture, arterial puncture,
skin puncture, and vascular access
procedures.
3. Change gloves between each patient.
4. wear a mask and covering, or preferably a
face shield, during procedures that are likely
to generate droplets of blood or body fluids to
prevent exposure to the mucous membranes
of the mouth, nose, and eyes.

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Universal Precautions
5. Wear a gown, apron, or other covering
when there is a potential for splashing
or spraying blood or body fluids.
6. Wash hands or other skin surfaces
thoroughly if contaminated with blood
or body fluids.
7. Wash hands immediately after gloves
are removed.

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Universal Precautions
8. Take care to avoid accidental injuries
caused by needles, scalpel blades,
laboratory instruments, etc, when
performing procedures, cleaning
instruments, handling instruments, and
disposing of used needles.
9. Place used needles, skin lances, scalpel
blades, and other sharp items into a
puncture-resistant biohazard container for
disposal. The container should be located
as close as possible to the work area.

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Universal Precautions
10. To prevent needlestick injuries,
needles should not be recapped,
purposely bent, cut, broken, removed
from disposable syringes, or otherwise
manipulated by hand.
11. Place large-bore reusable needles
(e.g. bone-marrow needles and biopsy
needles) and other reusable sharps
into a puncture-resistant container for
transport to the reprocessing area.

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Universal Precautions
12. Minimize the need for mouth-to-mouth
emergency resuscitation procedures. Mouth
pieces, resuscitation bags, or other
ventilation devices should be used routinely.
13. Take care to minimize the formation of
droplets spatters, splashes, and spills of
blood or body fluids.
14. Clean all surfaces exposed to blood and
body fluids with a detergent solution
followed by decontamination with an
appropriate EPA approved chemical
germicide.

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