chapter 31

immune system introduction

IgM

1st responder for generically everything that triggers a B cell

IgG

specific antigen and holds memories. Does not forgive easily

IgA

found in secretions and transfers from mother to baby through breast milk

IgE

Triggers b cell histamines

eicosanoids

fatty acids that regulate blood vessels, WBC activation, and increase tempwhich

which vaccine is recommended for a spleenectomy?

Pneumovax since pt becomes more prone to pneumonia

Innate immunity

operational all the time from birth. Ex\] skin, sweat, mucous, gi acids

inflammation-→ vasodilation and increased permeability

Acquired immunity

response from B cells being activated because it has a memory and knows how to fight it with IgG

antibody mediated immunity

also called humoral immunity

B cell is triggered by antigen- CD4 cell comes to help initiate response, B cell makes plasma antibodies and memory b cells

active vs passive immunity

active- body makes its own antibodies from vaccines or previous exposure

passive- antibodies from another source like breast milk having IgA (only lasts 1-2 months)

cell mediated immunity

virus or cancer in a cell and other cells will kill it

responsible for delayed hypersensitivity and transplant rejection

autoimmune disorders

ITP, TTP, rheumatic fever, T1DM, MS, Graves, lupus

neutrophils

55-70% is normal range

fights bacterial infections with a left side shift being indicative of infection at 70%

monocytes

called macrophages in tissues that clean up all the debris and eat lots of things

eosinophils

fights against parasites and allergies

basophils

starts the inflammatory process with IgM activation and use IgE to release histamine

also called Mast Cells in tissues

lymphocytes

B cells produce Ig and memory cells

T cells either help (and get infected with HIV) or kill cells

blood cultures

make sure to not start antibiotics before culture

draw at least 5 ml

results make take up to 4 days

sputum cultures

collect in a sterile cup without saliva when awakening before eating or drinking

1 tsp is needed

results can take 48 hours or 6-8 weeks for fungus

LAG

lymphangiography

1-2 in incision in each distal extremity with dye injected that can take up to three hours'

must sign consent and ask about allergies to shellfish or iodine, check vs q4h for 48 h, elevate incisions and sutures may be left 5-7 d

CT

computed tomography

reveals tumors, hematomas and cysts

procedure takes 30 min, ask about allergies to dye and encourage fluids after, watch for delayed dye reaction 2-6h

PET

positron emmisison tomography

can reveal lymphoma

fasting 4 hours before, avoid caffiene for 24 hours before, scan takes 40-90min, monitor for postural hypotensionorticoster

corticosteriods

s/sx: adrenal insufficiency, osteoporosis, increased risk of infection, muscle wasting, thin skin, fluid and electro imbalance, glucose intolerance, peptic ulcers

I: taper doses, risk of infection, risk of skin impairment

methotrexate

interferes with folate and b and t lymphocyte production

s/sx: high doses cause liver damage, GI, decreased blood, headache, confusion, hair loss, rash

I: regular blood tests, infection precautions

stages of organ rejection

hyperacute- within 24 hours and organ must be removed

acute- less than 6 mos can be treated with immunosuppressant

chronic- over 6 mos-1 year, supportive of sx

Any can be on immunosuppressants for rest of life to preserve allograft

graft vs host disease

transplant attacks host

s/sx: skin rash, green watery heme - diarrhea, and elevated liver enzymes

compromised host precautions (neutropenic precautions)

1. HAND WASHING
2. VS q2h, notify any temp >101\*F
3. invasive procedures kept to minimum
4. personal equipment for patient
5. clean frequently
6. liquid soap and shower daily
7. no raw foods or milk
8. mask outside of room


1. no live plants or standing humidifiers