18 WH Immune revised 2 (1) (8).ppt

Chapter 18 Immune System Function, Assessment, and Therapeutic Measures Immune System Ability to destroy pathogens or other foreign material Memory Component-- Prevents further cases of certain infectious diseases Fighter Component– Body’s response to microorganisms/ foreign...

Chapter 18 Immune System Function, Assessment, and Therapeutic Measures Immune System Ability to destroy pathogens or other foreign material Memory Component-- Prevents further cases of certain infectious diseases Fighter Component– Body’s response to microorganisms/ foreign bodies & destroys them Autoimmune- body mistakenly reacts to self Immune System consists of: Lymphoid organs (bone marrow, thymus) Lymphocytes and white blood cells Chemicals (Interferon) Lymphatic system Lymphatic vessels- help return tissue fluid into circulation Lymph nodes- masses of lymphatic tissue grouped along lymph vessels Spleen- phagocytizes pathogens & produces WBC Lymph Vessels Highway Nodes: Toll booths Antigens- “Bad Guys” Chemical markers- identify type of cell & helps immune system determine = foreign or not. Stimulates immune system to produce antibodies against it. Can be: bacteria, viruses, or fungi Can be allergen that brings on allergic reaction Types of Antigens (chemical markers that identify cells) Exogenous enter from outside Endogenous generated w/in cell Autoantigens normal protein complex recognized by immune system of pts suffering autoimmune disease Tumor antigens on surface of tumor cells Human Leukocyte Antigens All human cells have self-antigens except RBC HLA’s genetically determined Great for tissue compatibility Immune system uses HLA’s to differentiate between self and non-self Blood test HLA- Blood Test DR1 Multiple Sclerosis DR2 Grave’s Disease, Celiac Disease DR3 Juvenile DM DR4 Rheumatoid Arthritis, Juvenile DM DR5 Kaposi Sarcoma DR6 Unknown DR7 Celiac Disease White Blood Cells/Leukocytes Main component of non specific and specific immune responses Begin in stem cells from bone marrow Circulate in blood throughout body and detect and destroy foreign bodies Infection occurs= increase WBC’s release from bone marrow to fight infection -called Leukocytosis Always on  White Blood Cell Red blood Cell Platelet  Germ appears—WBC’s Attack Produce protective antibodies to overpower germ Surround and devour bacteria  White Blood Cells/Leukocytes Granulocytes Agranulocytes Neutrophils Lymphocytes Segs (mature) B cell Bands (immature) T cell Basophils Natural killer cell Eosinophils Monocytes Engulf & destroy Normal count= 5,000- 10,000 White Blood Cells/Leukocytes Granulocytes (3 types) TAKE A STAND DURING INFECTION !!!! Neutrophils (phagocytes/phagocytosis) First to site of injury or infection (bacterial) Polys/Segs (mature) Bands/Stabs (immature) Basophils Mast cell, respond in allergy, not infection Releasing histamine, causing inflammation Eosinophils Responds in type 1 hypersensitivity reactions Allergic rhinitis and anaphylaxis Parasitic invaders The granulocytes -take the first stand during an infection. They attack any invaders in large numbers, and "eat" until they die. Pus in an infected wound is mainly dead granulocytes.. White Blood Cells Agranulocytes Lymphocytes (antibody formation) B cell- make antibodies that bond to pathogen and destruct/ some have memory response T cell- co-ordinate immune response/ memory Natural killers- able to destroy many kinds of pathogens and tumor cells by rupturing their membranes then phagocytized by WBC’s Monocytes Immature macrophages Attack, but share w/ T cells for memory for future T and B cells Each genetically programmed to respond to one kind of foreign antigen. Both T and B cells develop in bone marrow. T cells migrate to the Thymus, where they mature then go to spleen and lymph nodes. B cells mature in the Bone marrow and migrate directly to lymph tissue B cells- Body’s Intelligence System Seeking out targets & sending defenses to lock onto them Connects to antigens and signal triggered Antibody produced to seek out intruders and help destroy them. Memory B cells- 2nd type that have prolonged life span to “remember” specific intruders Activate faster the next time T cells- Soldiers Destroy invaders that intelligence systems identified Helper T cells- work w/ B cells (CD4) Killer T cells- destroy antigen Memory T cells (can be CD4 or CD8) Suppressor T cells- turn off immune system- prevents autoimmune response (CD8)  Agranulocytes Monocytes Lymphocytes -2nd line of defense B cells- bone marrow Produce antibodies & memory T-cells- bone marrow & thymus Coordinate/ unique memory Natural Killer cells Cytoxic action- rupture membranes Immune System Humoral Cell-Mediated B cells & some T T cells cells Helper T cells Generate antibodies Alarm system Memory Activate B cells to Disable pathogens remember next time & cytotoxic T cells by producing antibodies to hold Cytotoxic cells up the pathogens Attack and kill floating around infiltrated cells WBC Differential If decrease in one, usually means increase in another Neutrophils and Lymphocytes are the most abundant Increased Lymphocytes = Viral or chronic bacterial infection Increased Neutrophils = Bacterial Look at trends, not just numbers Shift to the left Increase in immature neutrophils (bands) Means infection in progress High WBC Typically means Infection Very high, persistent levels (Leukocytosis) could be leukemia Normal WBC = 5,000-10,000/mm3 Low WBC/Neutropenia Inability to fight off infection Absolute Neutrophil Count (ANC) WBC x % of neutrophils 3600 x.24 =864 ANC < 500 requires reverse isolation ANC < 100 severe risk for infection **deplete bone marrow of neutrophils Ie. Antineoplastic drugs, some antibiotics, lithium, diseases like hepatitis and influenza Immune Response 1 External Barriers Skin Hair Mucous Membranes Immune Response 2 Inflammatory Prevent invasion, wall off infection, destroy invader, repair/clean up Vascular (reaction crew) Rubor, calor, dolar, tumor Cellular response (clean-up crew) Neutrophils Monocytes (PacMen) Immune Response 3 Immune Lymphocytes B cells (20% mature in bone marrow) Humoral immunity T cells (80% mature in thymus) Cellular immunity Antigens- Bad Guys Chemical markers- identify type of cell & helps immune system determine = foreign or not. Stimulates immune system to produce antibodies against it. Antibodies- Table 18.1 Also called immunoglobulins/gammaglobulins Proteins in response to foreign antigens Each antibody is specific for one antigen Label antigens for destruction Have millions of antibodies Five classes of human antibodies IgG, IgM, IgA, IgE, IgD Antibodies NAM LOCATION FUNCTION E Blood Passive immunity/placental IgG barrier Long-term immunity/vaccine External Passive immunity/ breast-fed IgA secretions Found in secretions mucous Tears, saliva membranes Blood, lymph Produced 1st by maturing IgM immune system in infant Produced 1st in infection B cells Antigen-specific receptors on IgD B lymphocytes Mast cells Mast-release histamine IgE Two Mechanisms of Immunity Cell-Mediated Does not involve production of antibodies Involves activation of macrophages and natural killer cells Cytotoxic T cells Humoral or anti-body mediated Does involve production of antibodies Helper T cells (stimulate B cells to make antibodies) and B cells (memory cells) Hint: T mobile is a cellphone Involves T cells Lymphocytes-Cellular Cell-mediated immunity-(no antibodies) Recognition of foreign antigen by helper T cells (CD4) Killer T cells lyse cells & destroy Memory T cells remember specific foreign antigens Suppressor T (CD8) cells limit immune response—turn OFF immune response  Involves T cells Lymphocytes-Cellular Natural killer T cells Destroy pathogens and tumor cells Killer T cells are regulated by Helper T cells (ON switch) T4 or CD4, initiate immune response Too much is autoimmune disease Too little, increases risk of infection Suppressor T cells (OFF switch) T8 or CD8 Too much of them you get immunosuppression/self destruction  Antibodies produced Lymphocytes-Humoral Humoral immunity Antibodies label antigen for phagocytosis then call in the Killer T cells Also makes Memory B cells, to remember for next time. T cells stimulate B cells to make antibodies against antigen Complement- group of 20 plasma proteins that circulate in blood until activated by antigen-antibody complex to lyse cell and bring to cell death. Antibody Responses First exposure to foreign antigen stimulates antibody production in small amounts which may happen too late become infected (Chicken Pox) Second exposure to the antigen causes memory cells to initiate rapid production of large amounts of antibody Prevent infection Vaccines based on this principle Antibodies may also neutralize virus-not let in cell Figure 17.2- pg 291 Rapid production Antibody Responses Interferon release- chemical produced by cells infected by virus that protects surrounding cells not infected Allergic responses -antibodies respond to foreign but harmless antigens- IgE bond to mast cells and release histamine= inflammation Anaphylactic Shock = massive response Loss of plasma from capillaries—sudden drop in intravascular blood volume and blood pressure Epinephrine IV or Epi-pen (SQ)  The response to a cut Skin broken, microbes can enter the cut. Immune system sets up a defense to invasion WBC’s, ‘hear’ of cut via chemical alarm sent by damaged cells. The WBC’s move in and start ‘eating’ the bacteria. Pus occurs= dead microbes & dead WBC’s. (neutrophils) B-lymphocytes identify microbe. If the microbe has been defeated before, the lymphocytes know which antibodies have to be made in order to kill it. Different T-lymphocytes to rescue. Helper cells help the B-lymphocytes to make antibodies. Killer cells attack infection. Suppressor cells help to call a halt to the immune system response. Immune Mediators Antigen-antibody complex stimulates release of mediators Mediators are prostagladins, interleukens, interferon and complement Complement Group of 30 plasma proteins circulating in blood--- Complement cascade that causing lyses of cells. could result in Septic Shock Labels foreign antigens for phagocytosis Decreased Immunity Autoimmune Diseases Burns/Trauma More WBC’s needed to clean up and easily depleted Bone Marrow Suppression Chemotherapy  HINT: Pass along from outside Types of Immunity Passive immunity Antibodies obtained outside person Temporary- antibodies eventually breakdown Naturally acquired Placental transmission of antibodies Antibodies in breast milk Artificially acquired Injection of preformed antibodies Tetanus  Hint:Actively Produces own antibodies Types of Immunity Active immunity Produces own antibodies Naturally acquired Recover from disease, memory cells specific for that pathogen Artificially acquired Vaccine Stimulates production of antibodies and memory cells Some confer lifelong immunity  Immunity Passive Active Obtained from Produced on own another Naturally acquired Naturally acquired Artificially acquired Artificially acquired Active Immunity Passive immunity Active Immunity Passive immunity Pt. recovers from Maternal transfer Hepatitis B vaccine Tetanus Chickenpox & Chicken pox vaccine Memory cells here Aging and the Immune System Thymus gland size decreases Increased production of immature T cells Decreased antibody response More prone to autoimmune disorders Need for vaccinations Dpt q 10 years Pneumovax If given before age 65 give one time after a 5 yr period If high pulmonary history sometimes given q 5 yrs Influenza/H1N1 yearly Herpes zoster vaccine once after age 60 Immune System Assessment Subjective data Demographic data History Current problem Objective data Physical assessment Immunizations Diagnostic Tests Blood tests Titers CBC Radiographic tests Biopsies Skin tests Gene testing Therapeutic Measures Allergies Medic alert identification Assess allergies Anaphylaxis kit Epinephrine Antihistamine tablets Tourniquet – applied to extremity of sting to slow blood flow carrying allergen and released q 15 minutes to allow some blood flow  Epi-Pen Must be checked routinely and replaced as needed Epipen does not replace the need for immediate & continued medical attention Anaphylaxis can be biphasic –relapse a few hours after initial dose of Epinephrine Therapeutic Measures Immune Skin Testing AND Immunotherapy Desensitize patient with anaphylactic reactions or with chronic allergic symptoms Inject small amounts of extract of allergen, increasing dose each time Until hyposensitivity reached Anaphylactic reaction can occur Therapeutic Measures Medications Epinephrine Corticosteroids Antihistamines Histamine H2 blockers Decongestants Mast-cell stabilizing drugs Antivirals/antibiotics Therapeutic Measures Immunosuppressants Interferon Leukotriene antagonists (Singulair) Hormone therapy Therapeutic Measures Surgical management Splenectomy Do not want to remove spleen if possible Over whelming post spleenectomy sepsis syndrome Math Practice- In class Gentamycin 100 mg is mixed in 150 mL bag of NSS to run in 30 minutes. What is the rate of the secondary bag and the VTBI?  1000 mL D5 ½ to run in over 10 hours? The tubing you found has a drop factor of 20 gtt/mL. What is the rate off the pump? Quick questions- Pharm Review Therapeutic INR? Therapeutic PTT range? Antidote for Coumadin? Antidote for Heparin? Antidote for Digoxin? S/S of Digoxin toxicity? Normal Digoxin level?