NCM 212 - Immunology & Inflammation Concept PDF

SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS IMMUNOLOGY AND INFLAMMATION CONCEPT...

SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS IMMUNOLOGY AND INFLAMMATION CONCEPT OBJECTIVES Additional Notes: That within 3 hours of classroom discussion Live attenuated vaccines the students will be able to: - contains weakened pathogens, but 1. Recall the basic components and are still potent enough to create major functions of the immune antibodies system; Drugs that deplete the immune system 2. compare the structure and functions - Corticosteroids of the primary and secondary - anti-inflammatory drugs that lymphatic organs and tissues; suppress the immune system 3. discuss the properties of immune - if prescribed for 3 months, response; the drug will be tapered (the 4. compare the natural and acquired dosage decreases every immunity; week) 5. differentiate specific immunity and nonspecific immunity; REVIEW OF ANATOMY AND PHYSIOLOGY 6. describe the different types of an OF THE IMMUNE SYSTEM immune response, and; 7. identify the actions of IMMUNE SYSTEM immunoglobulins in the human body comprises cells and molecules Functions as the body’s defense mechanism against invasion INTRODUCTION TO IMMUNOLOGY AND INFLAMMATORY IMMUNITY refers to the body’s specific protective response to an invading foreign agent (antigen) or organism antigen stimulate the release of antibodies LYMPHATIC SYSTEM major part of immune system It is a subsystem of circulatory and immune system lymphatic vessels carry lympha / lymph 20L blood/day - 17L - reabsorbed by blood vessels Homeostasis - 3L - accessory route to return Maintaining homeostasis in the body to the blood (lymphatic vessels requires ways to continually combat through lymph); recycled blood harmful agents in our environment. plasma Despite constant exposure to a variety of pathogens, most people remain PRIMARY FUNCTIONS OF LYMPHATIC healthy. SYSTEM AND IMMUNE SYSTEM ○ Immune functions are affected 1. Draining excess interstitial fluids by: age, risky lifestyle, heredity, 2. Transporting dietary lipids environment, central nervous 3. Carrying out immune responses function, emotional state, medications (pseudolupus erythematosus), the stress of illness, trauma, and surgery 1 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS Additional Notes: ORGANS OF THE IMMUNE SYSTEM Blood contains plasma (90% water) Based on functions: & formed elements (RBC, WBC, 1. Primary Lymphatic Organs platelets) a. Bone marrow Some fluids from a blood vessel b. Thymus (disappears when we (inside intravascular space) escape grow older, at the age of 65 it into the interstitial space to give totally disappears) nutrients to the outside tissues. The 2. Secondary Lymphatic organs lymphatic vessel is intertwined with a. Lymph nodes - bigger than the blood vessels and will drain the nodule excess fluid from the interstitial b. Lymph nodules space, to clean it. (The fluid - Tonsils absorbed by the lymphatic vessel is - Peyer’s patches (found also called lymph). in the small intestine) The lymph will enter the lymphatic c. Spleen (graveyard of dead vessel (pathway) and will be trapped RBC) inside the nodules, or nodes to filter. Additional Notes: The filtered fluid will be recycled and Red Blood Cell will go back to the heart to be used Not a true cell. Has 120 days to live again. because it does not have a nucleus The nodes and nodules are the Leukemia house of white blood cells Splenomegaly (enlargement of the spleen) happens because of the fast production of immature WBC which affects and stimulates the release of immature RBC. Due to the large number of immature RBCs, the patient may have difficulty of breathing, become pale, etc. I. PRIMARY LYMPHATIC ORGAN A. Bone Marrow WBC (leukocytes) found in medullary cavities (center) of LONG BONES and spaces of SPONGY Bone. Functions of lymph Production of - WBC (leukocytes) protecting your body from illness - RBC (erythrocytes) causing invaders - fats (glycerides) maintaining body fluid levels - lymphocytes absorbing digestive tract fats B (Bursa) Cells- mature in removing cellular waste bone marrow blockages, disease, or infections can - responsible for Humoral affect your lymphatic system’s function Immunity T Cells- migrate from bone marrow to the thymus where it matures. - responsible for Cell-mediated immunity 2 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS B. Thymus Additional Notes: Two Types of Bone Marrow bilobed organ (two lobes) 1. Red Bone Marrow - produce (mediastinum - between platelets, RBCs, and WBCs sternum and aorta) 2. Yellow Bone Marrow - store/produce Disappears when we grow adipose (fat) cells that give rise to older at the age of 65 it triglycerides and fats completely disappears Hematopoiesis Hugging will increase your responsible for the production of immune system, it will stimulate whole blood the thymus and produce Erythropoiesis decreases in size or stops responsible only for the production growing after puberty called of RBC (erythrocytes) (thymic Involution) produce by the liver, by a hormone Lobule secreted by the kidney which is the Outer cortex erythropoietin ○ a Large number of T Bone Marrow contains: Cells RBC Central Medulla WBC (Lymphocytes, Monocyte, ○ Widely Scattered, more Eosinophil, Basophil, Neurophil) mature cells Platelets White Blood Cells Additional Notes: Agranulocytes - no granules (no sac Progenitor cells - ability to differentiate inside the cytoplasm) T-cells has the ability to further ○ lymphocytes, monocyte differentiate to create specialized cell Granulocytes - with granules (w/ types sac) T-Cells can differentiate into ○ Eosinophil, basophil, Killer T cells (CD8+) (cytotoxic T neutrophil cells) Helper T cells (CD4+) - (mostly attacked by AIDS) the ones that direct the role of killer T cells, and memory T cells memory T cells AIDS Acquired Immunodeficiency Syndrome patients with AIDS are very susceptible for infection since AIDS directly attack the CD4+ (helper T cell). When CD4+ is under attack, the killer and memory T cell will most likely don't function. 3 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS The functions of the Thymus: Additional notes: Immature T cells migrate Phagocytosis - Cell eating (happens once The epithelial cells secrete a hormone there is an invasion of foreign substance) called thymosin (stimulates the Pinocytosis - cell drinking maturation of the T cells) The site of maturation of T cells Lymphatic vessels are the pathways, the nodes and nodules are the ones that filter Cells in the Thymus are: the fluids back to the heart Thymic stromal cells: (secretes a substance that helps mature T cells ) ○ Thymic cortical epithelial cells Site of precursor development ○ Thymic medullary epithelial cells ○ Dendritic cells an example of APC (Antigen Presenting Cells) connects the nonspecific to your specific immunity. Cells of hematopoietic origin ○ Developing T cells= thymocytes Additional Notes: Dendritic cells APC (Antigen-presenting Cells) presents antigen to the cells either the T cells or the B cells to create an Immune response ( Adaptive Immunity/specific immunity) “messenger”/ MEDIATOR II. SECONDARY LYMPHATIC ORGANS A. Lymph Nodes containing large numbers of leukocytes (WBC) mammary glands, axillae & groin has borders Functions: B. Lymph Nodules - to filter the lymph (the fluid) - serve as a center for the Tonsils production of phagocytes (cell Peyer’s Patches (in intestines) eating) - smaller and localized - They act as a filter and traps collection of lymphoid the foreign particles tissue and have no border or not well-defined borders. - found below the 4 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS covering of the Additional notes: membranes Monocytes - already matured but can still differentiate into a macrophage - the origin of macrophage Macrophages - “Big eaters” the scavengers of WBCs Iron - can be found in the blood (RBC) - Hemoglobin (RBC) - heme - contains the iron - globin - protein (discarded by spleen) - Spleen restores or recycles iron during hemolysis of RBCs. Hemolysis - the death of RBC Functions of the Spleen: Removal & destruction of foreign particles & worn blood cells from the blood. Stores and releases blood during hemorrhage Normal Tonsils: Inflamed tonsils: Site of B cell proliferation into plasma cells to antibodies Storage of platelets, 1/3 of body supply Production of cells during fetal life. Additional notes: Pus - caused by the death of neutrophils C. Spleen is located in the upper left portion of the abdominal cavity (behind the stomach) Contains two types of tissues: a. White pulp - contains lymphocytes and macrophages b. Red pulp - site for old and injured RBCs to be destroyed 5 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS WHITE BLOOD CELLS “LEUKOCYTES” Additional Notes: Defends our body from foreign bodies Mast cells (7L or 7,000 WBC per microliter of - Roam around and detect allergens blood). They make up 1% of the total (even the tiniest) that trigger the blood volume of a healthy patient. It release of histamine serves as an indicator of infection or Histamine effects disease - Blood vessels dilate (expand) - Respiratory tract constricts BASIC TYPES OF LEUKOCYTES (WBC) (bronchus) caused by the build-up of A. PHAGOCYTES mucus Desensitization - cells that “chew up” invading - a systemic exposure therapy to organism overcome certain allergy Types of phagocytic cells: 1. Neutrophils 2. Eosinophils 3. Mast cells - releases Histamine 4. Monocytes - Macrophages (scavengers) - Dendritic cells (APC) B. LYMPHOCYTES - Cells that allow the body to remember and recognize previous invaders and help the body destroy them - Governs specific immunity - they develop into a certain cell that would kill a foreign object Highest number of WBC population in or a certain pathogenic order: microorganism 1. Neutrophils - 63% - B cells develop antibodies and 2. Eosinophils - 2.3% secretes them to the 3. Basophils - 0.5% - 5% bloodstream to create a chain 4. Lymphocytes of reactions to kill viruses and 5. Monocytes - even bacteria. - T cell produces cells to combat Additional notes infected cells Nonspecific immunity - 3 Kinds of Lymphocytes: - does not need a certain protein. 1. B lymphocytes - Bone Analogy: marrow - B cells Nonspecific 2. T lymphocytes - - police (walang sinasalto) that roams Thymus Gland- T Cells around. 3. Natural Killer Cells/ Specific NK C - SWAT teams specialized to combat foreign agents - specifically viruses or even bacterial infections. 6 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS TYPES OF PHAGOCYTIC CELLS Additional Notes: I. GRANULOCYTES (with sac) Inflammatory response (cardinal signs): 1. Neutrophils (nonspecific) - 62% 1. Redness - first to respond to bacteria, 2. Heat viruses, and small particles 3. Pain 4. Swelling 2. Eosinophils (nonspecific) - 2.3% 5. Loss of function - known for their role in allergy Hepatitis symptoms ○ inflammation of the liver - parasitic infection - Involved also in hypersensitivity response IgE 3. Basophils (nonspecific) - 0.5% - 5% - known for their role in asthma - release histamine, bradykinin, serotonin, and leukotrienes in acute hypersensitivity reactions. II. AGRANULOCYTES (without sac) 1. Monocytes/Macrophage - 2-3% - clean up dead cells - mature into macrophages when in the body tissues - mature forms of blood monocytes - general scavenger cells of the body that roams around - process & present antigen to specific lymphocytes - can be classified as APC 2. Lymphocytes (specific) - 20-40% - fight infections by producing antibodies - involves in cellular and humoral immunity - 3 Kinds of Lymphocytes: 1. B lymphocytes 2. T lymphocytes 3. Natural Killer Cells Additional Notes: Effector T cells - promote inflammatory response - Cytotoxic T cells (Killer T cells) Regulatory T cells - take control - Helper T cell and Suppressor T cells 7 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS 3. Natural Killer cells/ NK cells - not identifiable as either T cells or B cells (not lymphocytes) - non-specific effector cells that can kill tumor and virus-infected cells - Do not need to recognize a specific antigen before being activated. - Knows how to detect which is a normal cell and an abnormal cell - they do not require prior activation. They function on their own. - MHC I can be found in normal cells & it acts as the sign/basis for NK Cells to differentiate normal cells from infected ones. Explanation: - When a pathogen is present, the first immunity that will kick in will be the non-specific immunity (such as NK cells, antimicrobial proteins, etc.). - If the first immunity (non-specific) can’t fight the pathogen, they would ask for help from the specific immunity to fight the pathogen through APC (example of APC are Additional notes: dendritic cells, monocytes) NK Cells do not need APC cells - APC (antigen-presenting cell) will act as the mediator to signal the MHC CLASS I (Major Histocompatibility specific immunity to release a T-cells Complex class I) (cell-mediated immunity) - basis for natural killer cells (NK) to - The antigen will be presented to kill the infected cells, if mhc1 is not either cytotoxic T-cells and helper present. T-cells (works either way). The - Virus-infected cell has no ability to helper T-cells will now direct the produce mhc1 cytotoxic (killer T-cells) to reproduce - cancer cells have no mhc1 more and evolved its component to - Special protein on the surface of the kill the pathogen. uninfected cell - Once all the pathogen is eradicated, - NK cells poke the cell (not the suppressor T-cells will now direct phagocytosis) which triggers an the cytotoxic t-cells to stop its enzyme that facilitates APOPTOSIS mitosis or replication. - - Now, the memory T-cells will - “programmed cell death” remember the composition of the pathogen. Lymphocytes are more specific than leukocytes. Lymphocytes are part/type of the leukocytes. 8 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS CYTOKINES DENDRITIC CELLS - Regulatory proteins that are produced - Is an example of APCs during all phases of an immune - together with macrophages, the response. present antigen to T cells - Molecules that form a communication - found in lymphoid tissues & other body link between immune cells & other areas where antigen enters the body tissues & organs of the body - The link between the nonspecific and a. Interleukin 1/ IL-1 the specific immunity - mediator of the - “messenger” link between inflammatory response non-specific and specific immunity b. Interleukin 2 / IL –2 - necessary for the Additional notes: proliferation and Viral Infection is harder to treat function of helper T, than a bacterial infection. cytotoxic T, B cells, & Difference between bacterial infection NK cells and viral infection: c. Interferons/ IFNs Bacteria - protect neighboring - Has its own cell cells from invasion by - contains toxins intracellular parasites, - It does not go inside the normal cell, including viruses, it will only stay beside the normal rickettsiae, malarial cell to compete with the nutrients parasites, and other from the normal cell organisms Virus - Has no cell but has DNA Additional notes: - self-limiting (no specific treatment) Prostaglandins (palliative care) - mediators for pain - Gets inside the cell and proliferates Interleukins and IFNs are examples of - Virus will enter the cell receptor and antimicrobial proteins (nonspecific will be engulfed inside immunity) (cell-mediated endocytosis). The virus will enter the nucleus MAST CELLS membrane and will direct the nucleus to replicate the virus RNA. - contains many granules rich in Then, the virus will proliferate and histamine and heparin will be excreted (cell-mediated - has a role in allergy & anaphylaxis exocytosis). (dangerous) - involved in wound healing and defense The proper sequence of palpation: against pathogens. Additional notes: Status Asthmaticus - Severe form of asthma (has no sound or wheezing because of severe constriction of the respiratory tract) - Give epinephrine (could also be given for anaphylaxis) 9 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS SPECIFIC AND NON SPECIFIC NON-SPECIFIC RESISTANCE TO RESISTANCE DISEASE TERMINOLOGY: Types RESISTANCE - the ability to ward off 1) External defense/ 1st line of defense damage or diseases through our a) Epidermis/skin defenses b) Mucus membrane SUSCEPTIBILITY - lack of resistance c) lacrimal duct or vulnerability of a person d) saliva e) defecation & vomiting RESISTANCE AND ITS TYPES f) urine 1. Non-specific resistance or innate g) lysozyme defense h) gastric juices 2. Specific resistance or adaptive 2) Internal defense/ 2nd line of defense immunity a) Internal microbial CHONs b) Phagocytes c) NK cells Additional Notes: d) Inflammation 3 types of Defenses e) Fever 1st line, 2nd line, 3rd line defense Mechanism Non-specific - 1st & 2nd line defense a. physical/mechanical barriers ○ 1st - skin, mucous membranes b. Chemical barriers ○ presents at birth - e.g. lysozymes (enzymes) → Specific - 3rd line defense tears, saliva, breast milk ↑ resistance = ↓ susceptibility - (inversely proportional) 1ST LINE OF DEFENSE MECHANICAL BARRIERS Very young & Very old - highly susceptible 1. Epidermis/Skin - very young - not yet fully developed forms a physical barrier to the - very old - deterioration of organ fx entrance of microbes ○ Keratinocytes produces keratin (physical barrier) ○ Keratin acts as a barrier ○ sweat glands produce sebum that has bactericidal effects ○ Sebum is toxic to bacteria ○ Vaginal secretions = acidic 2. Mucus membrane Inhibit the entrance of many microbes but not as effective as the skin ○ Mucus - (sticky) traps microbes in the respiratory tract and gastrointestinal tracts & excreted through coughing, spitting, defecating, etc. 10 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS ○ Nasal hairs- filter out 2ND LINE OF DEFENSE microbes and dust in A. INTERNAL MICROBIAL PROTEINS the nose → booger (ANTIMICROBIAL CHONs) ○ Cillia- traps and remove microbes & 1. INTERFERONS (IFNs) dust from upper - interferes with viral replication respiratory tract - released by host cells in response to the presence of CHEMICAL BARRIERS pathogens such as viruses, bacteria, parasites, or tumor 3. Lacrimal duct cells Tears dilute and wash away Functions irritating substances and antiviral and antitumor microbes properties ○ Tears contains modify immune response by lysozymes selectively suppressing (immunoregulation) antibody 4. Saliva production and cellular Washes microbes from the immunity surface of teeth and mucous facilitate the cytolytic role of membranes of mouth macrophages & NK cells ○ bactericidal effects Other functions: activate immune cells 5. Defecation and vomiting specifically the T cells expel microbes from the body increase recognition of LBM (acidosis), Vom. infection or tumor cells. (Alkalosis) increase the ability of uninfected host cells to resist 6. Urine new infection by the virus. washes microbes from urethra if infection → promotes acid ash diet Additional Notes: The IFNs selectively stimulate the activity of 7. Lysozyme T cells to be activated and selectively An enzyme capable of breaking suppress B cells to be less active. down the cell walls of certain bacteria (tears, saliva, nasal Antiviral - indirectly inhibits the virus secretions, and tissue fluids) multiplication by stimulating infected cells to natural antibiotic - bactericidal produce proteins. 8. Gastric juices The virus needs to invade another cell in A mixture of hydrochloric acid order for it to replicate while the bacteria (HCl), enzymes, and mucus. does not need another cell to replicate. Acidity destroys many bacteria and their toxins B cells has protein-digesting enzymes responsible for humoral immunity. concerns of the pathogens that are outside of the cells T cells responsible for cell-mediated immunity. concerns of the pathogens that are inside of the cells 11 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS 2. COMPLEMENT Additional notes: - refers to a group of at least 20 naturally acquired immunity - the plasma proteins that normally antibodies that are formed naturally circulate in the blood in an Artificially acquired immunity - inactive state. intentional exposure of a person to - its activation unleashes antigens in a vaccine chemical mediators that amplify (increase) virtually all aspects Effects: of the inflammatory process cytolysis - lysis and destruction of cell - it also causes cell lysis membranes of body cells or pathogens (cytolysis) that killed certain opsonization - complement proteins bacteria and other cell types attach to antigen particles (labeling) chemotaxis - chemical attraction of Additional notes: neutrophils and phagocytic cells to The complement is activated if there antigen are certain stimuli that are being Anaphylaxis - activation of mast cells presented inside our body i.e basophils - release histamin Antigen - Antibody response chemical mediators such as Additional notes: histamine and prostaglandins that Opsonization will strengthen the inflammatory opsonin is a molecule that binds to response of the body antigen particles and they will be identified as something pathological. They are trying to label those cells that are damaged or infected. Chemotaxis The phagocytic cells such as macrophages will eat the damaged or infected cells Anaphylaxis Histamine is the one that alerts and promotes the inflammatory response. 3. TRANSFERRINS - iron-binding proteins that inhibit the growth of certain bacteria by reducing the amount of available iron Functions: defending the body against bacterial Additional notes: infection Most bacteria need iron. iron is a bridging natural and acquired immunity micronutrient that is needed by the disposing of immune complexes and bacteria to survive. The bacteria will the byproducts associated with harvest the iron in its surrounding inflammation cells. High levels of transferrins will cause iron deficiency anemia. A decrease in levels of transferrins will cause an increase in the levels of iron in the body which is also bad. 12 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS B. PHAGOCYTES C. NATURAL KILLER CELLS (NK) - specialized cells that perform - kill a wide variety of infectious phagocytosis microbes and certain tumor cells Types: ways: Neutrophils - 1st to arrive release of perforins - chemicals Macrophages inserted into plasma membrane → ○ “wandering cells”, “scavenger” leaky ○ big eaters (eats around 100 release molecules that may cause cells) apoptosis ○ eats infected, tumor, dying/damaged cells. Additional notes: Phases The natural killer cells detect infected 1. Chemotaxis cells which are basically not a normal - chemically stimulated cell. Once the cell is abnormal it stops movement of phagocytes to a producing a major histocompatibility site of damage complex I (MHC I). - they are just alarming the Apoptosis - programmed cell death neutrophils and macrophage (cell suicide) / induced cell death - waits for the opsonization (labeling) to alarm 2. Adherence D. FEVER - attachment of the phagocyte to the microbe or other foreign - Enhances the innate immune defenses material by stimulating leukocytes to kill 3. Ingestion pathogens - A process of engulfing - Occurs during infection and microbes inflammation - it forms a vesicle - Pyrogen (caused) chemicals tap the 4. Digestion hypothalamus causing systemic fever - Phagosome + lysosome (digestive proteins) E. INFLAMMATION - microbe-containing vesicle fuses with a lysosome 5. Killing - release of lysozyme, other digestive enzymes, lethal oxidants 13 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS SPECIFIC RESISTANCE TO DISEASE 3 Means of Defending the Body TYPES OF IMMUNITY 1. Phagocytic Immune Response NATURAL (INNATE) IMMUNITY (WBC) - also called in born/inherent - involvement of WBC. immunity 2. Cellular Immune Response - physical barrier; skin, chemical - involves the T lymphocytes, barrier; substance produced by which can turn into special the body cellular barrier and B cytotoxic (or killer) T cells that lymphocytes can attack pathogens. ACQUIRED (ADAPTIVE) IMMUNITY 3. Humoral or Antibody Immune - developed after exposure to Response (B-lymphocytes) the disease and immunization - involved B lymphocytes, which can transform themselves into plasma cells that manufacture antibodies. ANTIGEN - Any substance capable of exciting the immune system and provoking an immune response - Examples common antigens - Foreign proteins - Nucleic acids - Large carbohydrates - Some lipids - Pollen grains - Microorganisms Functional properties of antigen Immunogenicity ○ ability to stimulate proliferation of specific lymphocytes and antibody ○ the ability of the antigen to provoke the immune response. Ability to proliferate. (Anti generator). Reactivity ○ ability to react or activate lymphocytes and antibodies by the immunogenic reaction. ○ Ability to stimulate proliferation; ability to provoke an immune response; antibody generator [due to provocation] Self-Antigens Out immune cells do not attack our own proteins Our cells in another person’s body can trigger an immune response because they are foreign ○ Restricts donors for transplants 14 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS PROCESSING OF ANTIGENS ANTIBODY CLASSES EXOGENOUS antigens 5 types of Immunoglobulin (GAMED) - Bacteria and toxins, worm Ig G (placenta), Ig A (breast milk) parasites, pollen, dust, viruses Ig M (Breast milk), Ig E, Ig D - APC process exogenous antigens Ig G - i.e. macrophages, B - 80% or 75% cells, dendritic cells. - present in tissue and serum ENDOGENOUS antigens - a major role in bloodborne and - Foreign antigens that are tissue infection synthesized within a body cell - crosses the placenta - viral CHONs, abnormal CHONs responsible for the protection of - antigen fragment - MHC I newborns. complex - Antiviral; anti-toxin; anti-bacterial - Enhance phagocytosis Additional Notes: Ig A EXOGENOUS antigens - 10 - 15 %, an average of 30% synthesized within our body’s cell - Sweet, tears, mucus, Antigens inside the body. (they are breastmilk, GI secretion initially harmless) But once they are - Tends to decrease during triggered, they will create a stress pathogenic activity (MHC 1) - Help prevent attachment of Cancer Cells; MHC2 antigen to epithelial cells ENDOGENOUS antigens surface. synthesized outside the body (e.g. - Protect body surfaces that are bacteria, worms, parasites, pollen, exposed to outside foreign dust) substances Antigens coming from the outside. Ig M (alarms complement) They are identified with the surface - 5 - 10% average of 6% which is the Major histocompatibility - Limited to the vascular system complex. Introduced by the (MHC 2) - The first immunoglobulin produces in response to ANTIBODY bacterial and viral infection for - Called “Ig” or immunoglobulins or initial response gamma globulins - Agglutinating agent and - Protein produced by plasma cells in activates complement response to foreign antigens. Ig E - Originated from the bone marrow - - 0-1% or trace plasma cells- b cells - Present in Serum - A heavy chain and 2 binding sites - Involved in allergic and - Heavy chains are called monomer hypersensitivity reaction - Agammaglobulinemia - help defend against parasites - Similar to eosinophils - They activate mast cells, eosinophils, basophils - Help defense against parasites. Ig D - Location: B Lymphocytes - Receptors on B lymphocytes - Total: 0.2 % - 15 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS Antibody class / immunoglobulin Lysis - antibodies attack cell comparison membrane of antigens (disintegration or breakdown, cell rupture or death) Opsonization - fixation of complement and Ig particles. (coating or engulfing) the start of the phagocytic reaction) ACTIONS IMMUNE RESPONSE 1. Neutralizing foreign antigens Recognition Stage 2. Immobilizing bacteria - Body accomplished recognition - because of complement (IgM) using lymph nodes (filter 3. Agglutinating and precipitating plasma/ fluid portion of blood) Antigens and lymphocytes for - clumping surveillance 4. Activating complements system - Continuously discharges small - if activated can cause an lymphocytes into the inflammatory response and bloodstream. cytolysis - Macrophages, neutrophils and 5. Enhancing phagocytosis complement help TYPES OF ANTIGEN - ANTIBODY Proliferation Stage REACTION: - The sensitized lymphocyte stimulates some of the resident Agglutination - clumping of cells dormant T and B lymphocytes Precipitation - soluble antigens, when to enlarge, divide, and crossed with antibodies, may become proliferate insoluble; phagocytic cells more - T lymphocytes differentiate into readily ingest insoluble materials cytotoxic (or killer) T cells, Neutralization - antibodies combine whereas B lymphocytes with the toxins, neutralizing their produce and release antibodies effects. (they block/ slow down the - Enlargement of lymph nodes effect of the antigen - The proliferation is inside lymph nodes 16 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS Response Stage T LYMPHOCYTES - Actual humoral and on exposure to antigen, proliferate and cell-mediated immune differentiate into: response. Helper T cells (CD4) ○ Activated upon recognition of Effector Stage antigen & stimulates the rest of - Total destruction of the immune response invading microbes or the ○ Differentiate only when there is complete neutralization of the direct contact with antigen toxin. ○ Directs the traffic/role Suppressor T cells ○ Has the ability to decrease B cell production, thereby keeping immune response at the level compatible with health Additional Notes: Helper T cells (CD 4) Helper T1 - activates cytotoxic t cell Helper T2 - increase B cell antibody production Helper T4 - initiates and augments inflammatory response Helper T8 - kills tumor cells because of the cytotoxic effect Interleukin (IL - 4 & 8) for proliferation for B lymphocyte THE IMMUNE RESPONSE I. Humoral Immunity (antibody-mediated immunity) Dominate by B lymphocytes Works mainly against ○ antigens dissolved in body fluids ○ extracellular pathogens (bacteria) II. Cell-mediated Immunity Memory T cells ○ responsible for recognizing Dominated by T lymphocytes antigens from previous Needs the signal of TCR and APC for exposure and mounting an immune response to occur immune response Particularly effective against cells ○ Are programmed to recognize attacking cells. the original invading antigen. ○ Intracellular pathogen (parasite, fungi, viruses) Cytotoxic T cell / T8 cells ○ Some cancer cells ○ attach the antigen directly ○ Foreign tissue transplant by altering the cell Often termed as delayed membrane and causing cell lysis (disintegration) and hypersensitivity. releasing cytotoxic enzymes & cytokines. ○ perforin and lymphotoxin. 17 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS III. Complement System (innate Difference between T-cells and B-cells immunity) Promotes inflammatory process The complement system consists of a number of small proteins found in blood Major effects: A. Cytolysis - lysis and destruction of cell membrane of body cells of pathogens. B. Opsonization - targeting of the antigens so they can be easily engulfed and digested by the macrophages and other phagocytic cells. C. Chemotaxis - Chemical attraction of neutrophils and phagocytic cells to the antigen. D. Anaphylaxis - Activation of the mast cells (histamines) and basophils. Comparison of Humoral & Cell-Mediated Immunity VIDEO SUMMARY: Immune System: Innate and Adaptive… 18 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS INFLAMMATORY PROCESS Chemical mediators assist this Inflammation (2nd line of defense) response by non-specific body defense to Minimizing blood loss cell/tissue injury. It is the mechanism of - minimizes due to the elimination of harmful substances. vascular spasm or (the process of reaction/mechanism) constriction Helps restore tissue homeostasis Walling off the invading organism STAGES OF INFLAMMATORY RESPONSE - due to chemotactic I. Vasodilation & Increased vessel (neutrophils, permeability macrophage) will go the - the stage where there is infected area damage in a cell or in the Activating phagocytes tissue Promoting the formation of - Increases vessel permeability fibrous scar tissue and (Blood vessel) regeneration of injured tissue - causes swelling due to (healing part) influx of cells & fluids going out to the tissues II. Emigration of Phagocytes in the interstitial space within an hour after, (from BV) phagocytes appear on the - Vasodilation scene - vasodilating effect of neutrophils begin to squeeze inflammation to the BV through the wall of the blood Substances: vessel - EMIGRATION a. Histamine monocytes follow neutrophils - released by Mast cell (macrophage) - Alarms the WBC for III. Repair inflammatory response b. Kinins (polypeptide) Other Effects of Inflammation - inactive precursor, 1. Production of acute phase proteins kininogens affect some - (Ex. Complement- that nerve endings amplifies the immune - Ex of kinins: bradykinin response) (facilitates vasodilation) c. prostaglandins (lipids) 2. Fever - chemical mediator for - occurs during infection and pain inflammation - released by damaged - systemic response invading cells microorganism - stimulates emigration - not equivalent to hyperthermia - intensify histamine & - hyperthermia caused by kinin a regulation problem in - intensify & prolong pain the hypothalamus, d. leukotrines (LTs) eternal factors - chemotactic agent - pathogens leave a protein (signaling/alarming) called pyrogens (causes fever) - cause constriction in the - Effects: airway a. intensify interferons e. Complement b. inhibits microbe growth - stimulate the release of c. speeds up body histamines reactions - chemotactic agent 19 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS - High temperatures inhibit the b. increase in capillary release of iron and zinc from permeability wherein the fluid the liver and spleen needed by escapes into tissues and bacteria results in tumor or swelling and - Fever also increases the speed the dolor or the pain which will of tissue repair lead to immobility or the 3. Systemic immunity → lymphocyte functiolaesa) activation (peripheral lymphoid tissues Purpose of Vascular Changes 1. Increase blood flow to the local Main Features of Inflammatory Response area (dilation) 2. Mobilize the transport cells to 1.) Vasodilation the area (increased - widening of the blood vessels permeability) to increase the blood flow to 3. Initiate healing (constriction) the area. (Histamine, cell mediators) B. CELLULAR RESPONSE 2.) Increased Vascular Permeability Key Players: Tissue or cells - to allow the diffusal of the 1. Leukocyte (WBC) (granulocyte components to enter the injury - neutrophils, etc. - which is the site. first one to arrive at the site) 3.) Cellular Infiltration a. Emigration of - due to chemotaxis (attraction) Phagocytes - The movement of the Squeezing through the inflammatory cell to the walls blood vessels and to the injury. The changes (Immigration) in the biosynthetic of the - Margination- leukocytes organs (there will be changes exit the central in the enzymes) bloodstream and initiate 4.) Changes in the biosynthetic profile leukocyte and of organs endothelial cell 5.) Activation of the Cells of the interaction Immune System - Diapedesis - the - Phagocytic Cells, Plasma Cell. passage of blood cells into the intact walls of 5 Cardinal Signs: Prish the capillaries or the P- Pain (dolor) movement of WBC to R- Rubor (redness) injured area I- Immobility (functiolaesa) 2. Erythrocyte (RBC) S- Swelling (tumor) a. Leak to tissue if there is H- Heat (calor) hemorrhage helps in clogging Blood STAGES OF INFLAMMATORY RESPONSE vessels & damaged I. ACUTE INFLAMMATION tissue (short duration, minutes-several days) Key Players: Vessels 1. Fibrinogen - (clotting) protein or A. VASCULAR RESPONSE (change) the clotting factor 1. Essential a. Momentary Constriction of for blood clot formation small vessels. Followed by 2. Fibronectin- (pag dikit) general Vasodilation. This will result in cell adhesion by anchoring cell a hyperemic response (time 3. Platelets- to prevent the when increased blood flow bleeding causes congestion, rubor 4. RBC - “rouleau” they stack (redness), and callor (heat) together. It coils or clamping. 20 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS Additional Notes: Additional Notes: FIbrogen, Fibronectin, Platelets, RBC kinins and histamine can cause the these proteins and cells are blood vessels to dilate (vasodilation) promoting homeostasis there will be chemotaxis (migration Hemo (blood) + stasis (stop) of WBC, neutrophils, monocytes) Homeostasis to control bleeding Increased blood flow in the area will can increase in redness (rubor), heat ➔ vascular spasm (calor) ➔ platelet plug formation possible/temporary limitation of joint ➔ coagulation (further clotting) movement - loss of function explanation: in vascular spasm, there will be Removal of damaged cell recruitment, and from there the platelets will (debridement) stack together (platelet plug formation), and coagulation will further clot the injured area Local Manifestations of Inflammation Serous exudates WBC Function in Cellular Response - watery fluids. Plasma proteins Destroying infective organism and cell count. Fluid with high Remove damaged cell content of protein and cellular (debrided/debridement - trying to debris. It has been deposited in remove dead cells) tissues caused by Releasing more inflammatory inflammation. mediators (backup) (basophils) - Result from Plasma entering ○ Control further inflammation the inflammatory sites. ○ Healing - Pus - dead neutrophils (infection). Cloudy, thick, and yellowish/white compared to exudates which are watery. Hemorrhagic Exudates - severe tissue injury - damage to blood vessels - leakage of red cells from capillaries - a mixture of blood and plasma 21 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS Fibrinous Exudates - contain fibrinogen Abscesses - Form a blood clot - typically have a central necrotic - Common in abrasion core containing purulent - Thick and sticky exudates surrounded by a layer - seen after the laceration dries of neutrophils. Membranous or pseudomembranous exudates - Develop on the surfaces of the mucous membranes - Composed of necrotic (dead) cells enmeshed in a fibro purulent exudate. Ulceration - refers to a site of inflammation where an epithelial surface (e.g., skin or gastrointestinal epithelium) has become necrotic and eroded (erosion), often with associated sub-epithelial inflammation. Purulent or suppurative exudate - Bedsore or decubitus ulcer (center is pus) - Contains pus, which is composed of degraded white blood cells, proteins, and tissue debris. 22 I BSN 3E - GROUP 4 SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS 23 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS II. CHRONIC INFLAMMATION 2. Maturation - the last stage of the A. CELLULA RESPONSE (only) development of the Key players: reconstruction. 1. Macrophages - Scar tissue is remodeled a. Microbial killing capillaries contract, structure, b. Clearing up cellular and and function of damaged tissue tissue debris are restored. c. Remodeling the tissue - there like Janitors inside 3. Aberrant to Healing - big eaters that can eat - may cause complications, up to 100 cells deformity, and decrease in the 2. Lymphocytes function of the injured tissue a. Either b or t cells - results from an abnormality in - T cells - cellular healing mechanisms. immunity - deviation to the healing - B cells - humoral a. Exuberant Granulations and immunity Keloids - proud flesh” - protruding III. FLUID EXUDATION (EDEMA) - Keloids- excessive, bulging, tumorous scars most active: 24 hours after injury or that extend beyond the invasion. confines of the original Fibrinogen is converted into a thick wound and seldom network of fibrin threads → clot regress. isolates the invading microbes and their toxins. Palpable lymph nodes Exudate Component: It involves the movement of b. Excessive Contracture 1. Plasma fluid - wound that continues to 2. Immunoglobulins into the inflamed contract after closure tissue and produces disfiguring scar or IV. HEALING: RECONSTRUCTION AND disability. MATURATION 1. Reconstruction - begins once the inflamed area is cleaned and debrided (removal of dead c. Dehiscence- (wound tissues/cells/debris), producing separation) new cells to fill in the space left - is a surface disruption by the injury. (Resolution in the that results in the process of infection) builds bursting open of a something that is destroyed previously closed - happens if the body was able wound. to adapt to that injury a. Fibrinogen, new endothelial cells 24 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS d. Evisceration - refers to internal organs moving through a dehiscence A. Inflammatory response 4. Adhesion - Begins at the time of injury - Exudates cause scar tissue to - Prepares wound environment bind or adhere to adjacent for healing surfaces - Hemostatic processes are activated (vascular spasm, platelets clog formation, coagulation) - Cells migrate in areas are essential for healing (chemotaxis) - Phagocytosis and release of growth factor that stimulates epithelial growth, angiogenesis (reconstructions of bloos vessel), and fibrogenesis - Initiated immediately during the inflammatory response or after the injury - Lasts 3-5 days Sign and Symptoms - Pain - Warmth - Swelling - Palpable Tenderness - limitation in joint or muscle range of motion Focus of Care - Decrease pain and swelling WOUND HEALING - Prevent chronic inflammation the primary objective is to fill the gap - Maintain mobility and strength created by tissue destruction and in adjacent areas while injured restore the structural continuity of the areas are rested injured part. (regeneration of the cells - Manage the PRISH and the tissues) depending on the extent of tissue loss, wound closure and healing occur by primary or secondary intention 25 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS B. Proliferative Phase ASSESSMENT Health HIstory - Begins 2-3 days of injury and - Age may last as long as 8 weeks - there could be infections or - Focus on building on new autoimmune diseases that are tissues to fill the wound space common in a group age: young - Key cells: Fibrolast- connective adult, tissue that synthesizes and - Infection (talks about secrestes collagen and autoimmune diseases) intercellular elements needed - when talking about infection for wound healing (clotting) (talking about extreme clients - final component: like very young and very old epithelialization who are the most susceptible) Signs and Symptoms - as we grow old, susceptibility - Less warmth and swelling becomes higher when it comes - Palpable tenderness decreases to acquiring/getting an infection - Pain felt with tissue resistance or getting infected. or stretch of the tissue - - Nutrition Focus of Care - malnutrition causes higher risks - Range of motion exercises of susceptibility - Joint mobilizations - Infection and immunization - Scar mobilization to produce a - fully immunized child (received mobile scar 3 doses of DPT, MMR, BCG - Light loads to promote tissue (immediately given after birth), remodel OPV, Hepatitis B, (also include tetanus toxoid) C. Remodelling - allergies - Food allergies - Begins approximately 3 weeks - asthma (triggering factors for after injury and can continue for asthma) 6 months or longer or even - Disorders and diseases years - Autoimmune diseases, - Simultaneous synthesis of neoplastic collagen by fibroblast result to - check for family history (for the architecture of the scar autoimmune diseases) becomes reoriented to increase - the tensile strength of the - Chronic illness and surgery wound. - Patients could be Signs and Symptoms immunocompromised (because - Improved range of motion and of the breakage of the skin) , strength post surgery (we must observe Focus of Care sterile technique - Stretching - - Active contraction - special problems like burns - Resistive loads - medications and lab transfusions - there are medications that could lower down/suppresses the immune system (corticosteroids) - lifestyle and other factors. - Vices (lowers down the immune system) 26 I BSN 3E - GROUP 4  SAN PEDRO COLLEGE COLLEGE OF NURSING BATCH 2024 NCM 212 - IMMUNOLOGY & INFLAMMATION CONCEPT Aldrin Antone, RN ADAPTED FROM: POWERPOINT/ CONCEPT LECTURE 1ST SEMESTER PRELIMS Additional Notes: Multiple organ failure also causes Neoplastic septic shock. - new growth (for cancer) Corticosteroids (anti-inflammatory) CARDIOVASCULAR SYSTEM - medications that could lower down/suppress the immune system - Hypotension - vasodilation causes lower PHYSICAL ASSESSMENT blood pressure Indications of Immune dysfunction - septicemia or septic shock causes generalized or systemic RESPIRATORY SYSTEM vasodilation which causes hypotension. - Changes in respiratory rate - Tachycardia - most of the time it is higher - hypotension, it may cause during allergic attacks hypoxia (decrease oxygen - cough (dry or productive) levels), and the heart will try to - Dry (if ever it will not entail your compensate by pumping fast. respiratory tract to secrete - tachycardia during the mucous membrane assessment is a compensatory - Abnormal lung sounds (wheezing, mechanism where there are crackles, rhonchi) also times it could be caused - Wheezing (usually heard by the disease itself during expiration, can also be - Dysrhythmia heard during inhalation) - could be caused by rheumatic - adventitious breath sounds heart disease (wheezing, crackles, rhonchi) - Vasculitis - Rhinitis - Inflammation of the blood - Hyperventilation vessels - Bronchospasm - (Phlebitis) - Inflammation of - once there is an inflammatory the veins response your histamine - (Arteritis) - inflammation of the creates bronchospasm arteries - caused by the WBC which triggers an inflammatory Additional Notes: response (chemotaxis) Physical assessment - Anemia - These are the things that are - (autoimmune hemolytic observable if ever they have an anemia) - eats the red blood infection, autoimmune disorders, cells inflammatory responses can be found out in this assessment. Stridor Additional Notes: - is heard during inhalation Septicemia Adventitious breath sounds - there will be generalized/systemic - Ex: wheezing, crackles, rhonchi vasodilation Tissue Necrosis Bronchospasm - Hypoxia causes lower oxygen levels - the product/effect of histamine that cause lower oxygen levels on If the blood vessels were