Med surg 2 chapter 14 immune responses and transplantation

What are the 3 functions that need to be intact to be immunocompetent?

antibody mediated immunity, cell mediated immunity, and inflammation.

Immunity is:

Body’s ability to resist disease

What three functions does immunity serve?

Defense, homeostasis, and surveillance

What are antigens?

On all of our cells, recognize foreign things.

Elicit an immune response

Unique to each person

Enables body to recognize itself

Innate immunity:

•Present at birth

•First-line defense against pathogens

•Quick response

Acquired immunity:

•Developed immunity

•Active

•Passive

Natural active immunity:

•Natural contact with antigen through actual infection (e.g., chickenpox, measles, mumps)

•Immunity takes time to develop but is long lasting

Natural passive immunity:

•Transplacental and colostrum transfer from mother to child (e.g., maternal immunoglobulins passed to baby)

•Immunity is immediate but short lived

Artificial active immunity:

•Immunization with antigen (e.g., vaccines for chickenpox, measles, mumps)

•Immunity takes time to develop but is long lasting

Artificial passive immunity:

•Injection of serum with antibodies from one person (e.g., injection of hepatitis B immune globulin) to another person who does not have antibodies

•Immunity is immediate but short lived

What is the most effective and efficient type of immunity?

Natural active

Mononuclear phagocytes (cells of immune):

 Have a critical role in immune system

 Include monocytes in blood and macrophages found throughout body

 Capture, process, and present antigens to lymphocytes to initiate an immune response

 Capture antigens by phagocytosis

Lymphocytes:

 Made in the bone marrow

 Eventually migrate to peripheral organs

 Differentiate into B and T lymphocytes

 T Cytotoxic cells

 T Helper cells (CD4 cells)

Dendritic cells:

Important in activating immune response

Cytokines:

Secreted by WBCs and a variety of other cells

Humoral immunity:

 Antibody-mediated immunity

 Primary immune response 4 to 8 days after the first exposure to antigen

Normal immune response

What immunoglobin is in secondary immune response?

IgG

What immunoglobulin is in initial infection?

IgM

When a person is exposed to the antigen for a second time,

response is faster (1 to 3 days) and lasts longer

Memory cells account for…

a more rapid production of antibodies

A patient with a sore throat and rhinitis has an elevated level of IgG in the blood. The nurse explains that the patient’s symptoms are most likely caused by

A re infection by bacteria

Immunocompetence:

Immune system identifies and inactivates or destroys foreign substances

Incompetent or under responsive immune system

Severe infections, cancers, immunodeficiency diseases

Overreactive immune system

Hypersensitivity disorders

Hypersensitivities/allergies:

Protective responses

If responses are excessive, widespread, or directed against normal body tissue, damage can result

Hypersensitivity occurs in the presence of an allergen

Problems range from minor inconvenience to life-threatening reactions

Type 1 hypersensitivity (or anaphylactic) reaction:

Hay fever, latex allergy, anaphylaxis. Smooth muscle begins to contract, increased secretions, vasodilation which causes BP to go down. Can see itching as well.

Type 2 hypersensitivity (cytotoxic) reaction:

mediated by IgG, classic reaction is a blood transfusion reaction.

Type 3 hypersensitivity (or immunocomplex) reaction:

Usually from something depositing into blood vessel wall, very complex.

Type 4 hypersensitivity (or delayed hypersensitivity) reaction:

like poison ivy, positive to TB test, a graft reaction like a reaction to a skin graft. Not a histamine related reaction, it is NOT mediated by histamine. Poison ivy is not a histamine problem, it will not help because there is no extra histamine with this.

Drugs especially for blood pressure control (especially ace inhibitors) can cause:

Angioedema, presents as swelling.

Physical assessment of angioedema:

•Lip swelling, itching in back of throat

•Deep, firm swelling of face, lips, tongue neck

•Difficulty speaking, drinking

•Nasal swelling

Angioedema involves the

blood vessels and mucus membranes

Angioedema interventions:

Ensure adequate airway

Stop the reaction

Oxygen, possible intubation or tracheostomy, drug therapy

 Epinephrine

 Recumbent position, legs and feet elevated

 Apply oxygen

 Antihistamines

 Corticosteroids

 Monitor pulse oximetry

What breath sound is heard when you are loosing the airway?

Stridor

What is angioedema?

 Life-threatening type I hypersensitivity reaction

 Rapid, systemic

 Can be fatal

What should you do immediately for angioedema reaction?

Give epi right away to get inflammation down, type 1 reaction. Weak thready pulse, impending doom, all warning signs.

Most common cause for angioedema:

ACE inhibitors

A client has been admitted to the ED with bilateral eyelid swelling and subsequent difficulty seeing. What is the priority nursing assessment?

Airway

Upon receiving a new IV medication, a client becomes short of breath with itching and hives. What is the priority nursing action?

Stop the IV infusion

Allergic rhinitis (atopic disease)

 Most common type I hypersensitivity reaction

AKA allergies/hay fever

Perennial allergic rhinitis

Year round

Dust, molds, animal dander

Seasonal allergic rhinitis:

Seasonal

Pollens, dust, molds

Allergic rhinitis presents as:

Nasal discharge; sneezing; tearing; mucosal swelling with airway obstruction; pruritus around eyes, nose, throat, mouth

Atopic dermatitis are:

Skin disorders caused by environmental exposure

Atopic is what type of sensitivity?

Type 1, IgE is elevated

Types of atopic dermatitis:

Chronic, inherited, and exacerbations and remissions

Urticaria

(Hives)

 Transient wheals vary in size and shape

 May occur all over the body

 Develop rapidly after exposure and last minutes to hours

Can be for a reason we know or we don’t know. This is a histamine issue, histamine caused localized vasodilation, hive starts to fill with fluid and become red and itchy.