immunology

Assessment of the Immunologic System

History Components

  • Current/past medical conditions (especially persistent infections)

  • Allergies and severity of reactions

  • Medication inventory and vaccination history

  • Nutritional status: dietary intake, energy levels, weight changes

  • Additional factors: pregnancy complications, wound healing, psychological stress, environmental exposures, trauma, exposure to viruses (Epstein-Barr, HIV, CMV, HSV-6, Hepatitis B)

Physical Assessment

Assess for:

  • Weight changes and wound healing

  • Cognition status

  • Allergic responses (red/watery eyes, nasal congestion, swelling, rashes)

  • Organ dysfunction (cardiovascular, respiratory, renal, musculoskeletal)

Diagnostic Tests

Basic Tests:

  • CBC with differential (RBC and WBC counts)

  • C-reactive protein (CRP) - biomarker for inflammation

  • Erythrocyte sedimentation rate (ESR) - monitors inflammatory/autoimmune diseases

  • Fluorescent antinuclear antibody (ANA) test - evaluates autoimmune diseases

  • Rheumatoid factor (RF)

  • Allergy testing

Age-Related Changes in Immunity

Infants

  • Immature immune system with inadequate lymphocyte function

  • T-lymphocyte deficiency

  • Rely on maternal antibodies from placenta and colostrum

Older Adults

  • Decreased innate immunity: Reduced neutrophils and macrophages

  • Altered adaptive immunity: Decreased T-cell function, slower B-lymphocyte sensitization

  • Thymus gland shrinking

  • Fewer T lymphocytes, less immunoglobulin production

  • Delayed/diminished immune response

  • Increased autoantibodies (higher autoimmune disease risk)

  • May not present with fever during severe infection

  • Delayed/absent WBC count elevation

  • Decreased toll-like receptors (TLRs)

  • Changed microbiome with pathogenic organism overgrowth

Nursing Implications

  • Monitor closely for infection without typical signs

  • Consider repeat vaccinations to boost immunity

  • Increased infection risk requires vigilant assessment