2Revised_Health_Illness_ Immunity_2024 (2).pptx

Immunity NRSG 3301 C RY S TA L T R E I G E M N N P Concept(s) & Exemplar(s) Concept(s): Immunity Exemplar(s): Allergic Reaction Anaphylaxis Systemic Lupus Erythematous (SLE) Concept: Immunity The normal physiological response to microorganisms and proteins as well as conditions associ...

Immunity NRSG 3301 C RY S TA L T R E I G E M N N P Concept(s) & Exemplar(s) Concept(s): Immunity Exemplar(s): Allergic Reaction Anaphylaxis Systemic Lupus Erythematous (SLE) Concept: Immunity The normal physiological response to microorganisms and proteins as well as conditions associated with an inadequate or excessive immune response. The ability of the human body to sustain health within the environment requires multiple protective mechanisms. One of the most complex protective mechanisms is the immune response. When immune processes are functioning optimally, the body has the ability to mount an efficient defense in response to the invasion of foreign substances. It is a characteristic that allows one to be resistant to a particular disease or condition; Immunity is accomplished through the actions of the immune system, which is a body-wide, complex process, involving interrelated groups of cells, tissues, and organs that work within a dynamic communication network to protect the body from attacks by Scope of Immunity To the far left of the immune response spectrum is a hypo- or suppressed immune response. Individuals who have suppressed immune responses are referred to as immunocompromised or are considered to be in a state of immunodeficiency. Individuals with suppressed immune responses are at significant risk for infection, or if immunosuppression occurs over time, they are at risk for cancer because of the loss of removal of mutating cells To the far right of the immune response spectrum is a hyperimmune or exaggerated immune response. Hyperimmune responses range among allergic reactions, cytotoxic reactions, and autoimmune reactions. A critical component of the immune system is its ability to differentiate between “self” and “non-self.” When this recognition fails, the immune system may begin attacking host cells in an exaggerated immune response. This process leads to the development of Normal Immune Response The immune response involves the following three primary protective functions: 1. Defense - Protects the body from invasion of microorganisms and other antigens 2. Homeostasis - Removes dead or damaged tissue and cells 3. Surveillance - Recognizes and removes cell mutations that have demonstrated abnormal cell growth and development Organs of the immune system are spread throughout the body. They are termed lymphoid organs and include the bone marrow, thymus gland, spleen, tonsils, adenoids, and appendix. From these organs, the lymphocytes are formed, grow, mature, and released into the body. The body’s lymphatic system provides the network by which organs of the immune system are connected. The blood also provides a connection among the organs and provides the route for lymphocyte movement throughout the body. Immunity the First Response Overview of Immune Response Immunoglobulin IgG: Primary immunoglobulin in the blood (80% to 85% of circulating immunoglobulins); may enter tissue spaces; selectively crosses the placenta; coats antigen for more effective and efficient presentation for an immune response; binds to macrophages and neutrophils for increased phagocytosis IgD: Found within the cell membrane of B lymphocytes IgE: Responsible for allergy symptoms; normally found in trace amounts IgA: Protects entrances to the body; found in high concentrations in body fluids (tears, saliva, and secretions of the respiratory and gastrointestinal tracts) IgM: Remains in the blood and efficiently kills bacteria; largest of the immunoglobulins; first antibody produced with an initial (primary) immune response Immune Response IMMUNODEFICIE HYPERSENSITIVIT NCY Y Age Gender Immunization status Age Medical treatments Ethnicity Chronic illness Environmental Environmental Medications Genetics Genetics High risk behaviours Suppression (Immunodeficiency) Primary immunodeficiency (PI) - is a Secondary immunodeficiency (SI) - is situation in which the entire immune a loss of immune functioning (in a defense system is inadequate and the individual is missing some, if not all, of the person with previously normal components necessary for a complete immune function) as a result of an immune response. illness or treatment. Mild to severe A depressed immune system may be Generalized malaise/fatigue created with medication in order to Weight loss avoid rejection of transplanted tissue, or it may be induced as a result of Impaired healing treatment for various types of cancer. Opportunistic infections Symptoms are dependant on organs affected Exaggerated Immune Response Exaggerated immune responses may Allergic Response be localized or they may affect all Mild (sneezing, watery eyes congestion) body systems. A bee sting may cause Severe (rashes ,swelling, shock) a localized Type I allergic reaction or it may cause a systemic anaphylactic Symptoms dependant on system reaction. affected cardiac, renal, msk, etc. Autoimmune response Often vague and less obvious while often affecting multiple organ systems. For example, cardiovascular symptoms may include pericarditis, congestive heart failure, pulmonary or peripheral edema, and anemia Immunity Testing Primary Screening Secondary Screening Basic CBC (basic blood tests to determine red Rheumatoid Factor- Anitbodies blood cell and white blood cell counts with ELISA-The ELISA and confirmatory Western blot differential evaluation) tests are done to confirm the presence of antibodies to HIV infection IgE – basic levels TORCH – This antibody panel searches for the CRP (used to determine inflammation in the presence of antibodies to toxoplasmosis, rubella, body and not to diagnose a specific immune cytomegalovirus, and herpes simplex dysfunction. It may also be used to follow the Genetic or Cytotoxic (chromosomal) analysis progress of and response to treatment for diseases such as rheumatoid arthritis, SLE, Complement proteins - Complement system and other autoimmune disorders) testing is done to determine the presence of deficiencies or abnormalities in complement ESR (is useful in monitoring inflammatory or proteins, addressing both quality and activity of cancerous diseases, rheumatoid arthritis and the proteins. Deficiencies contribute to increased other autoimmune diseases, and tuberculosis) incidence and severity of infections and autoimmune dysfunction. Diagnostics Allergy Testing Often important in diagnosis, and it may necessitate a skin test, an allergen-specific immunoglobulin (IgE) blood test, or both. Skin testing helps determine allergens to which the individual is sensitive, and the IgE blood test measures the amount of IgE in the blood—higher levels are associated with a more severe allergic response. Group Activity Allergy Systemic Lupus Erythematosus What is a hypersensitivity response? What is SLE? Risk factors? Describe the types of hypersensitivity responses. Risk Factors? Pharmacological treatment for a hypersensitivity Clinical manifestations? response? Anaphylaxis Diagnostics? What is anaphylaxis? Pharmacological therapies? 3 types? Non-pharmacological therapies? Categories of typical triggers? Manifestations? Treatments? Allergic Reaction Hypersensitivity: altered immune response to an antigen that may result in harm to the patient When the antigen is environmental it is referred to as an allergen. * * Response may be mild or life threatening * * Hypersensitivity Type I Immediate hypersensitivity (anaphylaxis) IgE- mediated release of histamine from mast cells and basophils, most common (e.g.-dust, drugs, bees) Type II Cytotoxic (cell death) IgM or IgG antibodies affect cell surface antigens and cause phagocytosis and cell death (e.g. – transfusion reaction) Type III Immune complexes deposited in and cause damage to tissues (e.g. –SLE, Nephritis) Type IV T cell-mediated hypersensitivity reaction - This is localized, and Allergy Exposure  Allergic reaction Risk Factors: Previous exposure , age, sex, concurrent illnesses, previous reactions, & family history Severity of anaphylaxis depends on: antigen’s route amount of antigen rate of absorption Individuals degree of sensitivity Allergic Reaction: Treatment Pharmacologic therapy: Epinephrine Antihistamines Corticosteroids Bronchodialators Leuktriene modifiers (e.g. Singulair) Immunotherapy (1-3 x weekly x 6 months, then monthly x 3-5 years) Nonpharmacologic therapy: The plasma of a person with lupus contains immune complexes and autoantibodies that attack the body's healthy tissue. Plasmapheresis replaces that unhealthy plasma with healthy plasma. Allergic Reaction: Pharmacotherapy Histamine 1-receptor antagonists Block the action of histamine released from mast cells and basophils. They’re most effective when used prophylactically (antihistamines), e.g. diphenhydramine (Benadryl) Histamine 2-receptor antagonists H2 blockers can be administered with H1 blockers for additional control of urticaria and angioedema e.g. ranitidine (Zantac) Immunosuppressants / Immunomodulators Originally used for transplant patients, these agents are now used to alter the immune response. They’re usually given when steroids are no longer effective.e.g. - azathioprine (Imuran, Cellcept) Type I IgE Response Anaphylaxis Anaphylaxis is an extreme, exaggerated allergic response to foods, medication, stinging insects, and exercise May involve a few or multiple body organs or systems, with symptoms ranging from non-life-threatening (sneezing, hives, itching, and diarrhea) to life-threatening with restriction of breathing and circulation. Symptoms can occur from minutes to hours after exposure to the allergen, with the reaction being one of three types: ◦ single reaction occurring immediately after exposure, ◦ a second reaction 8 to 72 hours after the first reaction ◦ a single long-lasting reaction that may last hours to days Anaphylaxis: Common Triggers Drugs: Penicillins, insulins, tetracyclines, chemotherapeutic agents, nonsteroidal anti-inflammatory drugs, sulfonamides, aspirin, local anaesthetics, cephalosporins. Insect venoms: Wasps, hornets, yellow jackets, bumblebees, ants. Foods: Eggs, nuts, shellfish, chocolate, milk, peanuts, fish, strawberries Animal: Tetanus antitoxin, Diphtheria antitoxin, rabies antitoxin, snake venom antitoxin Treatment measures: Blood products (whole blood), allergenic extracts in hypo-sensitization therapy, iodine-contrast media for intravenous pyelography or angiography. Manifestations of Anaphylaxis Anaphylaxis: Management - Basic life support- AIRWAY - Epinephrine - Oxygen - Antihistamines - Corticosteroids Systemic Lupus Erythematosus (SLE) Systemic Lupus Erythematosus (SLE) A chronic, inflammatory, connective Autoantibodies: (antinuclear antibodies, tissue disease of unknown origin that ANA) affects almost all body systems, Hyperreactivity of B cells including the musculoskeletal system, and is characterized by Disordered T-cells remissions and exacerbations. It can range from a mild, episodic Affected tissues include: disorder to a rapidly fatal disease brain, heart, lung, kidneys, process. spleen, GI tract, peritoneum, MSK, skin SLE: Butterfly Rash Systemic Lupus Erythematosus (SLE) Risk factors: Most common in women of childbearing age Rare in children < age 5 Ethnicity Drug-induced lupus: - Procainamide (antiarrythmic), hydralazine (Bp, Apresoline), isoniazid (TB) - Usually resolves when medication is discontinued Systemic Lupus Erythematosus (SLE) Systemic Lupus Erythematosus (SLE) Considerations: Diagnostic Tests: Pregnancy (High-risk): Anti-DNA antibody testing Preeclampsia, HELLP Syndrome & Erythrocyte sedimentation rate spontaneous abortion Serum complement level Adolescents: Complete blood count (CBC) Side effects of corticosteroids and Urinalysis immunosuppressants, significant for adolescents concerned with Kidney biopsy (nephritis appearance & fitting in (hair loss, *inflammation, protein & blood) susceptibility to infection, ‘moon face,’ retinal damage, bone loss) Systemic Lupus Erythematosus (SLE) Pharmacologic Therapy: Asprin or other NSAIDs (help reduce muscle and joint stiffness) Antimalarial drugs (modulate immune system without increasing risk for infection) Corticosteroids (help with pain and inflammation) Immunosuppressive agents (certain cytotoxic or antineoplastic drugs) Immunosupressants (e.g. - Imuran) Clients are at an increased risk for infection, malignancy, bone marrow depression, and the toxic effects specific to the drug prescribed. **Monitor blood counts (WBC < 4000 & plts < 75000), bleeding Oral preparations with food, ↓ GI effects ↑ fluids (monitor intake & output) Handwashing No aspirin or ibuprofen Contraception (birth defects) Systemic Lupus Erythematosus (SLE) Non-pharmacological Therapy Plasmapheresis ◦ The plasma of a person with lupus contains immune complexes and autoantibodies that attack the body's healthy tissue. Plasmapheresis replaces that unhealthy plasma with healthy plasma. Nursing management includes monitoring for treatment side effects including hypotension, parasthesias and dizziness. Smoking Cessation ◦ Several studies have shown that smokers, and especially smokers with lupus, have higher levels of certain antibodies in their bloodstream. Higher levels of these antibodies are tied to developing lupus, having more active lupus, and developing more serious complications from lupus Limit Sun Exposure ◦ Lupus increases photosensitivity, making unprotected skin cells more vulnerable to UV damage Interrelated Concepts References Giddens, J. F. (2017). Concepts for nursing practice (2nded.). St. Louis, MO: Elsevier. Lewis, S. L., Dirksen, S. R., Heitkemper, M.M., Bucher, L., Barry, M.A., Goldsworthy, S., Lok, J., & Tyerman, J. (Eds.). (2018). Medical-surgical nursing in Canada: Assessment and management of clinical problems (4th Cdn. ed.). Toronto, ON: Elsevier.