Immune Function, Deficiency, and Disorders

Immune Function and Dysfunction

• Immunocompetence refers to the immune system's ability to mount an appropriate immune response.
• Immune deficiency is the lack of an adequate immune response.
• Autoimmune disorders occur when the immune system attacks the body's own tissues.

Immune Deficiency Conditions

• Immune deficiency has two forms: primary and acquired.
• Primary immune deficiency is an inherited genetic mutation.
• Acquired immune deficiency includes human immunodeficiency syndrome (HIV) and acquired immune deficiency syndrome (AIDS).

Therapeutic Immunosuppression

• Drug-induced immunosuppression requires a balance between controlling the body's immune response and managing side effects.
• Indications for immunosuppression:
  • Organ transplant recipients
  • Management of autoimmune disorders
  • Non-Hodgkin lymphoma
  • Rheumatoid arthritis
  • Neoplastic growths

Diagnostic Tests and Treatment of Immune Deficiencies

• Diagnostic tests include health history, current complaints/symptoms, and physical examination findings.
• Treatments include:
  • Immune globulin (Ig)
  • Bone marrow transplant
  • Granulocyte colony-stimulating factor (filgrastim [Neupogen])
  • Antimicrobial agents

Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)

• HIV has two types, HIV-1 and HIV-2.
• The viral pathophysiology involves a retrovirus and reverse transcriptase.

HIV Transmission

• The three highest risks for contracting HIV:
  • Unprotected sex (oral, vaginal, or anal) with an HIV-positive person
  • Sharing needles and syringes with an HIV-infected person
  • Maternal-fetal exposure

HIV Exposure Prophylaxis

• Pre-exposure prophylaxis (PrEP) involves using Truvada (tenofovir disoproxil fumarate and emtricitabine) combined with safer sexual practices.
• Postexposure prophylaxis (PEP) is more effective when the exposure is a single episode with an HIV-positive partner.
• PEP should be initiated less than 72 hours after exposure.

Key points on Answer

• Breast milk can harbor the HIV virus.
• Using personal protective equipment reduces the risk of disease transmission.
• Needle exchange programs do not facilitate spread.
• Needle-stick injuries place health professionals at risk.

HIV Prevention

• Safe sexual practices: barrier protection and various forms of intimacy
• The risk of contracting HIV from blood transfusions, blood products, or donated organs/tissue is about 1 in 2 million.
• Clinical trials show promise for an HIV vaccine, according to a July 2018 report with the lancet
• Educating the public with accurate facts is an important prevention strategy.

HIV: Signs and Symptoms

• Some infected patients may experience no symptoms or flu-like symptoms.
• Signs of sentinel infections:
  • Oral thrush
  • Recurrent infections
  • Skin disorders
  • Night sweats
  • Swollen lymph glands
  • Significant unintended weight loss

HIV Diagnosis

• Diagnostic tools:
  • HIV-1 Test System and OraQuick In-Home HIV tests
  • Enzyme-linked immunosorbent assay (ELISA)
  • HIV-1 nucleic acid (NAT) test

Management of HIV Infection

• Initiate antiretroviral therapy (ART) if CD4 lymphocyte count is less than 350 cell/mm³.
• Management also involves World Health Organization (WHO) staging and antiretroviral drugs.

Question 2 Answer key points:

• Optimizing therapy for patients with HIV involves considering:
  • Clinical data
  • Compliance with therapy
  • Medication tolerance
  • Insurance coverage

HIV Stages

• First Stage:
  • Acute HIV infection develops within 2 to 4 weeks, presenting flu-like symptoms.
  • HIV level is high during this stage, making transmission to others easier.
  • Antibody testing is negative for approximately 1 1/2 months.
• Second Stage:
  • Chronic HIV infection is often asymptomatic.
  • HIV however can be transmitted to others during this stage
  • Without treatment, the infection usually progresses to AIDS.
• Third Stage:
  • Terminal stage resulting in severe damage to the immune system, leading to opportunistic infections and cancer.
  • Without treatment, life expectancy is about 3 years.

Opportunistic Infections

• Viral:
  • Herpes simplex virus type 1 and type 2
  • Varicella zoster virus
  • Cytomegalovirus
  • Hepatitis
• Bacterial:
  • Mycobacterium tuberculosis
  • Mycobacterium avium complex
• Fungal:
  • Cryptococcosis
  • Histoplasmosis
  • Coccidiomycosis
  • Candidiasis
  • Pneumocystis jiroveci
• Parasitic:
  • Toxoplasmosis
  • Cryptosporidiosis

Other HIV Complications

• Wasting syndrome
• Neoplasms: Kaposi sarcoma and lymphomas
• Neurologic complications

Other Health Issues

• HIV risk in the over 50 population is a concern.
• Focus on community education and care.
• Maintain HIV confidentiality and disclosure.
• Be aware of issues when a nurse is HIV positive.
• Understand bloodborne pathogen exposure for health care workers.

Autoimmune and Autoinflammatory Disorders

• These disorders cause the immune system to react against the body's own cells, creating local, systemic, and mixed responses.

Autoimmune and Autoinflammatory: Signs and Symptoms

• General signs and symptoms include fever, fatigue, abdominal pain or digestive issues, swollen glands, joint pain, and swelling.

Autoimmune and Autoinflammatory: Diagnosis

• Diagnosis includes health history, complete physical examination, as well as blood tests

Autoimmune and Autoinflammatory: Treatment and Nursing Management

• Replacement or support of lost body function is necessary.
• Treatments should target halting destructive processes.

Systemic Lupus Erythematosus (SLE)

• It is an autoimmune disease where the body produces abnormal antibodies that attack target tissues instead of foreign agents.
• SLE manifests in discoid, systemic, and drug-induced forms.

SLE: Etiology and Pathophysiology

• In SLE, there's an abnormal reaction against proteins in the nucleus of body cells.
• Prolonged exposure to sunlight is a factor.
• Certain drugs can exacerbate SLE.

SLE: Signs and Symptoms

• Common symptoms include:
  • Painful/swollen joints and muscle pain
  • Extreme fatigue
  • Unexplained fever
  • Red rash on the face (malar/butterfly rash)
  • Hair loss
  • Sensitivity to the sun
  • Weakness and profound fatigue
  • Mouth ulcers, poor appetite, weight loss
  • Abnormal menses
  • Edema and swollen glands

SLE: Diagnosis

• No single test confirms SLE.
• Diagnosis requires at least 4 of 11 clinical presentations or specific laboratory test results.

SLE: Treatment

• There is no cure for SLE.
• Treatment aims at symptom control and preventing exacerbations.

SLE: Nursing Management

• Focus on caring for patients with low immune response.
• Assess the patient's ability to participate in ADLs.
• Implement pain management strategies.
• Assist with mobility and provide support.
• Educate the patient about the disease and review appropriate skin care.

Hodgkin Lymphoma

• Hodgkin Lymphoma (HL) etiology can be genetic, environmental, or a combination.
• The pathophysiology involves Reed-Sternberg cells.
• Signs and symptoms: lymphadenopathy, abdominal fullness, fatigue, night sweats, weight loss, and pruritus.
• Treatment depends on the stage of HL.
  • Chemotherapy can be used in all stages.
  • Treatment option involves radiation: Involved-node radiotherapy (INRT)
• During Remission, the disease is under control
• Nursing care focuses on managing current symptoms and side effects of prescribed therapies.

Non-Hodgkin's Lymphoma (NHL): Etiology and pathophysiology

• NHL is the seventh most common cancer in men and women.
• The incidence is higher in men than women.
• NHL is less predictable and spreads more rapidly than HL.

NHL: Signs and Symptoms

• Signs and symptoms:
  • Unilateral, painless lymph node enlargement that may progress to generalized, painless lymphadenopathy
  • High fevers, chills, night sweats, weight loss, cough, dyspnea, chest pain, nausea, vomiting
  • Fullness in the abdomen
  • Constipation
  • Hepatomegaly or splenomegaly

NHL: Diagnosis and Treatment

• Diagnosis: CT, MRI, PET, or ultrasound can be used for staging.
• A biopsy of body tissues is performed for classification.
• Treatment: Chemo, Radiation, bone marrow transplant, and surgery

Primary Lymphedema

• This presents as an inherited condition caused by deficient growth of the lymphatic system.
• Lower extremity is mainly affected.
• Chiefly affects 20s females

Secondary Lymphedema

• Secondary Lymphedema is an acquired condition caused by obstruction from trauma to lymph vessels and nodes.
• Such obstructions include: Mastectomy lymph node removals, soft injury-tissue, and scarring.
• Otherwise also caused by Parasites that enter and block lymph channels
• Variety of symptoms can appear like lack of motion, discomfort, infection, and thick skin.
• The treatment regardless of cause, is to reduce the diseases affect.

Fibromyalgia

• Fibromyalgia presents as prolonged systematic pain and other symptoms not sourced from original.
• Common in woman 10x more than men ranging from 25 to 60
• Stressors include infection, drugs, injury, and psychological distress can trigger events.
• Commonly musculoskeletal pain is felt.
• Heightened response to painful stimuli while having pain is allodynia.

Allergy and Hypersensitivity

• Allergy: It marks an abnormal system response rather than a local one.
• Hypersensitivity reaction: The body shows excessive harmful reactions as response to harmless substances
• These are usually systemic after entering the body.

Allergy and Hypersensitivity: Signs and Symptoms

• signs and symptoms of said problems
  • Itchy, inflamed, water eyes, soft palate pruritus, runny nose, sneezing,
  • Red Edema and Trouble breathing.

Allergy and Hypersensitivity: Diagnosis

• These can have many tests for their diagnosis
• patient history
• radioallergosorbent test
• skin tests like patch and scratch

Anaphylactic Reaction and Anaphylactic Shock

• IgE-mediated immune responses: If mast cells depend on IgE to be activated, then produce localized allergenic response
• Non-IgE allergen response: Iodine-based dyes for radiologic studies and Narcotics such as morphine and vancomycin.

Anaphylactic Reaction and Anaphylactic Shock: Signs and Symptoms

• Urticaria (hives/ wheals), Angioedema , Tachycardia/ decreased pulse/ Rapid blood drop
• Signs include Trouble breathing

Effects of Anaphylaxis

• Blood Pressure Decreased
• Edema with Mucus
• Airways Obstructed

Treatment for Anaphylaxis

• Patent airway
• Oxygen
• Administer epinephrine/antihistamine
• And support patient psychologically