Inflammation & Immunity

Definition of Inflammation?

Non specific, immediate response to injury or infection

Definition of Immunity?

Specific adaptive defenses and recognizing and remembering pathogens.

Inflammation & Immunity Shared Characteristics?

Restore homeostasis & protect body

Inflammation Trigger?

Tissue injury, infection, trauma, irritants,

Immunity Trigger?

Antigens

Inflammation & Immunity Shared Trigger Characteristics?

Respond to potential threats

Inflammation Key Cells?

Neutrophils, Macrophages, mast cells

Immunity Key Cells?

B Cells, T Cells, Macrophages, NK Cells

Inflammation & Immunity Shared Key Cells?

WBC's & Leukocytes

Inflammation Cardinal Signs?

Redness, heat, swelling, pain

Immunity Cardinal Signs?

None in particular. Can cause fever or malaise

Inflammation & Immunity Shared Cardinal Signs?

Can cause fever or systemic changes

Inflammation Outcome?

Removes debris & contains infection

Immunity Outcome?

Produces antibodies & Immune Memory

Inflammation & Immunity Shared Outcome?

Eliminate threat & promote healing

Inflammation memory component?

No memory -same response every time

Immunity memory component?

Has memory - stronger & faster each time

Inflammation & Immunity Shared Memory Component?

Both enhanced by vaccines

Inflammation Response?

• Sequential reaction to cell injury:

- Neutralizes and dilutes the

inflammatory agent

- Removes necrotic materials

- Sets up an environment suitable for

healing and repair.

Can inflammation always be present with infection?

No

First Line of Defense?

Non-Specific & External

- Physical & chemical

barriers that prevent

entry of pathogens.

- Skin, mucous membranes, tears,

saliva, normal flora, stomach acid.

- Skin blocks pathogens, stomach acid destroys microbes.

Second Line of Defense?

Non-Specific & Internal

- Innate immune responses that act after

pathogen enters.

- Inflammation, phagocytosis (neutrophils, macrophages), fever, complement proteins, NK cells.

- Redness & swelling

around a cut, fever.

Third Line of Defense?

Specific/Adaptive

- Learned, targeted immune responses with

memory.

- Immunity: B cells, T cells, antibodies,

memory cells.

- Antibodies produced after infection or

vaccination.

First Line of Defense: Anatomical/chemical barriers?

Skin

Mucous membranes

Hair

Sweat

Saliva

Tears

Gastric juices

Urine

Vaginal Secretions

Second line of defense: inflammatory response?

• Occurs in response to injury

• Localized

• Immediate

• Beneficial

• Appropriate level of response

• Non-Specific

What causes inflammation?

Any stimuli or events that trigger the body's innate immune

response, resulting in the classic signs of inflammation

Physical causes of inflammation?

Trauma, Lacerations, Burns

Chemical causes of inflammation?

Bites, Stings, Allergic Reactions

Microorganisms that cause inflammation?

Bacteria, Viruses, Fungi

First Phase of Inflammation?

Vascular response

• Think blood vessels

Second Phase of Inflammation?

Cellular response

• Think WBC's

Third Phase of Inflammation?

Formation of exudate

• Fluid & neutrophils

Fourth Phase of Inflammation?

Healing

• Regeneration or repair of tissue

During the First Phase of Inflammation, what happens?

• local vasoconstriction

• release of kinins, histamines, prostaglandins

• local vasodilation and hyperemia

• increased capillary pressure and permeability

• fluid exudate from capillaries to tissue spaces leading to edema

During the Second Phase of Inflammation, what happens?

Chemotaxis begins

• WBCs rush in to help

• Neutrophils and monocytes

migrate through capillary walls

to the site of injury

• Macrophages signal the

immune response

Other cells that may need to be released during the second phase of inflammation?

• Eosinophils—allergic responses

• Lymphocytes—help develop

immunity

• Basophils—carry histamine and

heparin

What happens during the third phase of inflammation?

Exudate forms when fluid leaks from

capillaries into tissue spaces

• Made up of serous fluid, cells,

chemical mediators; has no odor vs infection

What happens during the fourth phase of inflammation?

• Healing

• Minor injury

• Return to normal structure & function as cells

are replaced and tissues with cells of the same

type are regenerated

What happens during the fourth phase of inflammation with extensive damage?

• Infection with abscess or granuloma formation

• Repair takes place but with replacement of

destroyed tissue with scar tissue

• Cover, seal, or shrink the wound

Signs & symptoms of Inflammation?

• Redness

• Swelling

• Pain

• Heat

• Loss of function

Laboratory tests for Inflammation & Immunity?

• WBCs - normal is 5,000 to 10,000 mm3

- Higher the count, the more severe the infection

- Lower the count, the more vulnerable the body

is to infection

• ESR - Erythrocyte sedimentation rate

- Normal is <20 mm/hr

• CRP - C reactive protein

- Non-specific test identifying the presence of inflammation

- Normal is <1.0 mg/dl

Data/Assessment with Inflammation & Immunity?

- History

- Local S/S

- Pain

- Applicable lab work

Where do immune cells form and mature?

Bone Marrow - Produces all white

blood cells; B cells mature here

Thymus Gland - T cells mature and

are programmed here

Where are immune responses activated?

o Lymph Nodes - Filter lymph; activate immune cells

o Spleen - Filters blood; responds to blood-borne pathogens

o Tonsils & Adenoids - Trap pathogens entering respiratory tract

o Mucosa-Associated Lymphoid Tissue (MALT) - Protects GI, respiratory, GU tracts

o Appendix - Contains lymphoid tissue supporting gut immunity

Innate Immunity?

- Present at birth; nonspecific; first lineof defense.

- Skin, mucous membranes, phagocytosis, inflammatory

response.

Active Immunity?

Body produces its own antibodies after exposure. Long-lasting protection.

- Natural: Infection(e.g., chickenpox).

- Artificial: Vaccination (MMR, flu shot).

Passive Immunity?

Antibodies are given to the person; no

memory formed. Temporary protection.

- Natural: Maternal antibodies via placenta or breast milk.

- Artificial: Immunoglobulin injection (rabies, hepatitis B immune globulin).

Lymphocytes?

A type of WBC that allows the body to

remember and recognize previous invaders

B lymphocytes?

Cells that produce antibodies. Antibodies attach to a specific antigen and make it easier for the immune cells to destroy

the antigen.

T lymphocytes?

Attack antigens directly and help control the immune response. They also release chemicals, known as cytokines, which control the entire immune response.

Immunity related to geriatrics?

- at-risk d/t declined function with age

- Decreased T-cell and specific antibody function

- Increased auto antibodies that attack normal tissue

- Infections, cancers, and auto-immunity take place

Data/Assessment related to immunity & geriatrics?

• History (age, nutrition, recent infections, immunization status, allergies)

• Pain

• Medication

• Lifestyle, stress, and other factors

• Neoplastic disease

• Autoimmune disease

• Chronic illness

• Surgery

Interventions to improve immune status for Older Adults?

• identifying active, positive coping strategies, especially following stressful events

• Educate the person, family, and friends about

the effects of stress

• daily vitamin & mineral supplementation

• exercise plan

• Administer pneumococcal vaccine at age 65

or revaccinate after the age of 65

• importance of obtaining yearly flu immunizations

How do immunizations work?

• Antibodies produced in response to the pathogen (antigen)

• Vaccines contain weakened or inactive

parts of a particular organism (antigen)

that triggers an immune response within the body.

• This weakened version will prompt immune

system to respond much as it would have on its first reaction to the actual pathogen.

• Memory T-cells and B-cells remain ready to fight off the pathogen if it is encountered again.

Vaccine screening/education?

• Does the patient have a fever or

feel sick today?

- For fever, vax is ok, but sick sick = no

• Has the patient ever had a serious

reaction to the vaccine before?

• Does the patient have an allergy to

eggs?

- Ask about egg or latex allergy for flu shot.

• Has the patient ever experienced

Guillain-Barre syndrome?

- Body attacks myelination and you cannot move due to it.

What is the primary difference between the inflammatory response and the immune response?

Inflammation is non-specific & Immunity is specific

Flu Season?

September and continues in April: peak between December to February.

What are the types of influenza?

A, B, C, D

What are the types of influenza humans can get?

A & B

When is the peak transmission of flu occurring?

1-day before the onset of symptoms and continuing for 5-7 days after a person becomes sick

Flu Pathophysiology?

acute disease that targets the upper respiratory tract and causes inflammation of the upper respiratory tree and trachea.

Flu Risk Factors?

Age, Immuno- compromised, Hygiene, Rest/Sleep

dysfunction, Stress, Environmental

Flu S/S?

chills, fever, malaise, headache, cough, sore throat, runny nose, watery eyes, congestion, sneezing, body aches, loss of appetite, fatigue

Flu Treatment?

Symptom Management, Relenza, Tamiflu

Flu Vaccine Considerations?

Allergies, Guillain-Barre, Current Illness, 2 weeks to build immunity