Immune System PDF

Immune system 1  Dr.Martha Melek Labieb Gerges Lecturer of gerontological nursing Assuit University – Faculty of nursing 2  Out lines Introduction. Anatomy of immune and lymphatic system. Function of the immu...

Immune system 1  Dr.Martha Melek Labieb Gerges Lecturer of gerontological nursing Assuit University – Faculty of nursing 2  Out lines Introduction. Anatomy of immune and lymphatic system. Function of the immune system. Types of immunity. Effect of age changes on immune system. Disorders of immune system. Rheumatoid arthritis Cancer Nursing care plans Promoting of immune system wellness among elderly:- Nutritional requirements for promotion of immune system wellness among elderly:- 3  Introduction Immune system is a complicated network of cells, tissues, and organs to keep us healthy and fight off disease and infection. The immune system keeps a record of every germ (microbe) it has ever defeated so it can recognize and destroy the microbe quickly if it enters the body again. 4 5 6 2-The function of the immune system:- 1. The main function of the immune system is to protect the human body against disease and other foreign bodies through the actions of white blood cells. 2. Phagocytes destroy non-native cells and organisms, while lymphocytes learn from infections and allow the body to fight repeated infections more easily. 7 Functions of the Lymphatic System The removal of excess fluids from body tissues. This process is crucial because water, proteins, and other substances are continuously leaking out of tiny blood capillaries into the surrounding body tissues. Absorption of fatty acids and subsequent transport of fat, to the circulatory system. Production of immune cells (such as lymphocytes, monocytes, and antibody producing cells called plasma cells). 8 3-The major components of the immune system include:- The bone marrow which produces the white blood cells (WBCs). The lymphoid tissues which include: The thymus gland. The spleen The lymph nodes, the tonsils and adenoids. Similar tissues in the gastrointestinal, respiratory, and reproductive systems. 9  2-Immune and Lymphatic System Anatomy:- The lymphatic vessels begin as open-ended capillaries, which feed into larger and larger lymphatic vessels, and eventually empty into the bloodstream by a series of ducts. Along the way, the lymph travels through the lymph nodes, which are commonly found near the groin, armpits, neck, chest, and abdomen. Humans have about 500–600 lymph nodes throughout the body. 10  1. Lymphatic Capillaries:- Lymphatic capillaries, also called the terminal lymphatic, are vessels where interstitial fluid enters the lymphatic system to become lymph fluid. 11  2. Larger Lymphatic Vessels: The lymphatic capillaries empty into larger lymphatic vessels, which are similar to veins in terms of their three-tunic structure and the presence of valves. These one-way valves are located fairly close to one another, and each one causes a bulge in the lymphatic vessel, giving the vessels a beaded appearance. 3. Lymphocytes: B Cells, T Cells, Plasma Cells, and Natural Killer Cells 12  Lymphocytes are the primary cells of adaptive immune responses. Lymphocytes Type of lymphocyte Primary function B lymphocyte Generates diverse antibodies T lymphocyte Secretes chemical messengers Plasma cell Secretes antibodies Natural Killer (NK) cell Destroys virally infected cells 13  4. Primary Lymphoid Organs and Lymphocyte Development The primary lymphoid organs are the bone marrow and thymus gland. Bone Marrow:- the bone marrow takes over most hematopoietic functions. Thymus:- is a bilobed organ found in the space between the sternum and the aorta of the heart. 5.Secondary Lymphoid Organs:- include Lymph Nodes:- Lymph nodes function to remove debris and pathogens from the lymph, and are thus sometimes referred to as the “filters of the lymph”. 14  Spleen:- The spleen is a major secondary lymphoid organ, it is called the “filter of the blood” because of its extensive vascularization and the presence of macrophages and dendritic cells that remove microbes and other materials from the blood, including dying red blood cells. - Tonsils are lymphoid nodules located along the inner surface of the pharynx and are important in developing immunity to oral pathogens. 15  4-Types of immunity: I- Innate or Genetic Immunity: present before any exposure to pathogens is effective from the time of birth First line of defense It involves nonspecific responses to pathogens Innate immunity consists of: Innate immunity is made up of barriers and certain cells that keep harmful germs from entering the body. 1. Physical barriers (skin, mucous membranes, stream of tears or urine, inflammation, phagocytosis and cough reflex,) 2. Chemical barriers (pH (stomach, vagina), enzymes (stomach, tears), Interferons, Complement system and natural killer lymphocytes). 16  II- Acquired Immunity: Immunity that an organism develops during lifetime, not genetically determined. Definition: special immune system that forms antibodies and/or activated lymphocytes that attack and destroy the specific invading organism or toxin. - develops after exposure to agents such as microbes, toxins, or other foreign substances - It involves a very specific response to pathogens. It is characterized by; specificity, diversity, memory, and self/nonself recognition 17  Two types: 1. humoral immunity or B-cell immunity (because B lymphocytes produce the antibodies; which are globulin molecules in the blood plasma that are capable of attacking the invading agent). 2. cell-mediated immunity or T-cell immunity which is achieved through the formation of large numbers of activated T lymphocytes that are specifically crafted in the lymph nodes to destroy the foreign agent. 18 19 5-Effects of Aging on the Immune System:- BODY SYSTEM CHANGES CONSEQUENCES Immune  Impaired function of B and T lymphocytes  Suppressed responses to pathogenic organisms with  Failure of lymphocytes to recognize mutant or increased risk for infection. abnormal cells  Increased incidence of cancers  Decreased antibody production  Anergy (lack of response to antigens applied to the skin  Failure of immune system to differentiate “self” from [allergens]). “non-self”  Increased incidence of autoimmune diseases  Suppressed phagocytic immune response  Absence of typical signs and symptoms of infection and inflammation  Dissemination of organisms usually destroyed or suppressed by phagocytes (reactivation or spread of TB) Gastrointestinal  Decreased gastric secretions and motility  Proliferation of intestinal organisms resulting in  Decreased phagocytosis by the liver’s Kupffer cells gastroenteritis and diarrhea  Altered nutritional intake with inadequate protein  Increased incidence and severity of hepatitis B; increased intake incidence of liver abscesses  Suppressed immune response Urinary  Decreased kidney function and changes in lower  Urinary stasis and increased incidence of urinary tract urinary tract function (enlargement of prostate  infections gland, neurogenic bladder).  Altered genitourinary tract flora. Pulmonary  Impaired ciliary action due to exposure to smoke  Impaired clearance of pulmonary secretions; increased and environmental toxins incidence of respiratory infections Integumentary  Thinning of skin with less elasticity; loss of adipose  Increased risk of skin injury, breakdown and infection tissue Circulatory  Impaired microcirculation  Stasis and pressure ulcers Neurologic function  Decreased sensation and slowing of reflexes  Increased risk of injury (ulcers, abrasions, burns) 20 21 6- Disorders of immune system Immune-senescence is defined as the state of des-regulated immune function that contributes to the increased susceptibility of the elderly to infection and, possibly, to autoimmune disease and cancer. there is growing interest in the role that a des-regulated immune system plays in common age- related illnesses, including atherosclerosis, Alzheimer's dementia, diabetes mellitus, and osteoporosis. 22 1-Rheumatoid Arthritis 1-Introduction:- It affects women three times more often than men. Rheumatoid arthritis can occur at any age; when it occurs in children it is called juvenile RA (JRA). 2-Definition of Rheumatoid Arthritis: Rheumatoid arthritis (RA) is a chronic, progressive, systemic inflammatory disease that destroys synovial joints and other connective tissues, including major organs. 23 24 3-Difference between OA and RA RA is characterized by remissions and exacerbations of inflammation within the joint. It affects the fingers, wrists, knees, and spine. In contrast to OA, RA is due to chronic inflammation that can cause severe joint deformities and loss of function over time. 4-Risk factors of RA Female, having a certain predisposing gene, and exposure to an infection. Advanced age is a risk factor until age 70, after which incidence decreases. Cigarette smoking over a period of years is another risk factor. 25 26 5-Signs and Symptoms of RA: The disease usually begins in the upper extremities and progresses to other joints over many years. The signs and symptoms can be divided into early and late manifestations: Early symptoms: Bilateral and symmetrical joint inflammation. Redness, warmth, swelling, stiffness, pain. Stiffness after resting (morning stiffness). Activity decreases pain and stiffness. Low-grade fever, weakness, fatigue, anorexia (mild weight loss). Organ system involvement. 27 28  Late symptoms: 7. Joint deformity. 8. Secondary osteoporosis. 6-Diagnosis of RA: - History: morning stiffness, pain, tenderness, erythema, swelling, over the affected joint, fatigue, weakness, and weight loss. - Physical examination: subcutaneous nodules over bony prominences. - Laboratory tests: An increase in white blood cells and platelets is typical. 29  A group of immunologic tests are usually performed, and typical findings for patients with RA include the following: Presence of rheumatoid factor (RF) in serum. Decreased red blood cell (RBC) count. Decreased C4 complement. 30  Increased erythrocyte sedimentation rate (ESR). Positive antinuclear antibody (ANA) test. Positive C-reactive protein (CRP) test. A bone or joint scan assesses the extent of joint involvement throughout the body. For some patients, an arthrocentes is may be performed; the synovial fluid is cloudy, milky, or dark yellow with inflammatory cells present. 31 7-Management MEDICATION Treatment for RA includes: Disease-modifying antirheumatic drugs (DMARDs), which can prevent joint destruction, deformity, and disability with early single or combination drug use. NSAIDs. Corticosteroids. 32 Rest and exercise The afternoon rest period help reduce mid afternoon fatigue. Although it is important to avoid immobilization in elderly Bed rest decreases systemic inflammation and may be necessary during acute episodes. With bed rest, ranges of motion exercises are needed to maintain function. Splinting is used to specific joint. As for patients with osteoarthritis, a program that balances rest and exercise later in the day is most beneficial for the patient. 33  HEAT AND COLD. Heat applications or hot showers help decrease joint stiffness and make exercise easier for the patient. For acutely inflamed, or “hot,” joints, cold applications are preferred. Nutrition Therapy Patients may need to be counseled about eating a healthy, calorie-restricted diet. Food selection should include the daily requirements from the basic food groups, with emphasis on foods high in vitamins, protein, and iron for tissue building and repair. Small, frequent feedings with increased protein supplements may be prescribed. 34 SURGERY. If nonsurgical approaches are not effective in relieving arthritic pain, the patient may have a total joint replacement. In general, patients with RA who have surgery are not as successful when compared with patients with osteoarthritis. The presence of a systemic disease predisposes patients with RA to more postoperative complications. 35  Cancer for elderly Introduction Cancers are a large family of diseases that involve abnormal cell growth with the potential to invade or spread to other parts of the body. Cancer treatment can be more challenging and complicated for older adults. This is because older adults are more likely to have chronic health conditions, such as diabetes or heart disease. 36 37  Definition of Cancer: It is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumor, which do not spread to other parts of the body. 38  Prevalence of cancer among elderly:- Most common cancers in elderly was (lung, breast, prostate, and colorectal) in 2019. The most commonly diagnosed cancers are lung (16%), prostate (13%) in old male, and breast (19%), colorectal (14%) in older women. 39  Causes of increase cancer in older people:- 1. Longevity: As more people avoid death from infection and vascular events, they remain alive to develop cancer. 2. Environmental susceptibility: due to longer exposure to environmental carcinogens. 3. Cellular alterations: Aging affects the process of cell replication, which increases the chance of malignant change. 40 Risk factors for cancer 1. Tobacco use 2. Obesity 3. Poor diet 4. Lack of physical activity 5. Excessive drinking of alcohol 6. Certain infections 7. Exposure to radiation and environmental pollutants. 8. genetic changes 41 Possible signs and symptoms of cancer:- 1. Changes in bladder or bowel habits 2. Unusual bleeding or discharges 3. Thickening or lumps 4. Indigestion or difficulty swallowing 5. Obvious changes in the skin 6. Irritating cough or hoarseness of voice 7. Unexplained anemia 8. Sudden loss of weight 42  Most common types of cancer among the elderly: 1. lung 2. breast 3. prostate 4. colorectal 43 Prevention most common types of cancer among the elderly 1-Preventing lung cancer 1. No smoking and avoid passive smoking. 2. Reduce or eliminate radon exposure 3. Avoid exposure to known cancer-causing chemicals 4. Follow a healthy diet 5. Screening is the use of tests or exams to find a disease in people without symptoms of that 44 disease. 2-Preventing breast cancer Breast self-exam for breast awareness. By inspecting their breasts during a breast self-exam to assess any new change; lumps or other unusual signs in the breasts and talk with doctor. Get to and stay at a healthy weight Be physically active Limit alcohol use Not using hormone therapy to deal with the symptoms of menopause. Preventive surgery for women with very high breast cancer risk Breast cancer screening is done with 45 Mammograms. 3-Prostate cancer in the Prevention of prostate cancer: 1. Choose a healthy diet full of fruits, vegetables and a low-fat diet. 2. Choose foods that are rich in vitamins and minerals 3. Eat tomatoes and other red foods rich with antioxidant 4. Consider soybeans and green tea 5. Exercise most days of the week. 46 6. Maintain a healthy weight and stop smoking 4-Prevention of colon cancer 1-Screening colon cancer: people with an increased risk, such as those with a family history of colon cancer, should consider screening sooner. 2-Lifestyle changes to reduce the risk of colon cancer Eat a variety of fruits, vegetables and whole grains. Fruits, vegetables and whole grains contain vitamins, minerals, fiber and antioxidants, which may play a role in cancer prevention. Avoid drink alcohol and stop smoking. Exercise most days of the week. Try to get at least 30 minutes of exercise on most days. 47 Role of gerontological nurse in caring of the patient with cancer:- A-Assessment: 1-Skin problem: the nurse should inspect for skin rash, erythema, inspect for pain, swelling with inflammation. 2-Gastrointestinal problem: The nurse assess for frequency of nausea and vomiting episodes before and after chemotherapy. 3- Infection: Assess factors predisposing patients to infection include impaired skin and mucous membrane integrity, chemotherapy, radiation therapy, malnutrition and medications. 48  4-Bleeding: assess medications that interfere with coagulation such as aspirin, heparin. 5-Hair loss: The nurse notes the presence of alopecia (hair loss)with radiation therapy or chemotherapy. 6-Nutritional concerns: Assessment includes diet history, anorexia, changes in appetite, situations and foods that aggravate or relieve anorexia, and medication history. 7-Pain: The nurse also assesses those factors that increase the patient’s perception of pain such as fear and fatigue. 8-Fatigue: The nurse assesses for feelings of weakness, lack of energy, inability to carry out necessary and valued daily functions. 49 B-Nursing diagnosis: Risk for infection related to altered immunologic response. Impaired skin integrity related to reactions to radiation therapy. Imbalanced nutrition less than body requirements related to nausea and vomiting, anorexia, cachexia, or related to cancer treatment. Chronic pain related to disease process and cancer treatment, Disturbed body image and low self-esteem related to changes in appearance, function, and roles. 50 C-Planning and Goal: The major goals for the patient may include maintenance of tissue integrity, maintenance of nutrition, relief of pain and improved body image. 51 D-Nursing Interventions: 1-Maintaining skin integrity: Avoid the use of soaps, cosmetics and lotions. Avoid applying hot-water bottles. Avoid exposing the area to sunlight Avoid tight clothing. Use cotton clothing. Do not disrupt any blisters that have formed. 52 2-For episodes of nausea and vomiting: The nurse should be assessing number and frequency of nausea and vomiting. Prevent unpleasant odors, and sounds in the environment Ensure adequate fluid hydration before, during, and after drug administration. Assess intake and output. Encourage frequent oral hygiene. Administer prescribed antiemetic, sedatives, and corticosteroids before chemotherapy and after as needed. 53 3-Maintenance of nutritional status: Avoid unpleasant odors. Suggest foods that are preferred by the patient, high- calorie and high-protein food. Encourage adequate fluid intake, but limit fluids at mealtime. Suggest smaller, more frequent meals. Promote relaxed, quiet environment during mealtime with increased social interaction as desired. Encourage frequent oral hygiene. Use of relaxation techniques; imagery at mealtime. Administer appetite stimulants as prescribed by physician. 54 4-Relieving Pain: The nurse should be use pain scale to assess pain and discomfort. Assess factors contributing to patient's pain: fear, fatigue and anger. Assess patient's behavioral responses to pain and pain experience. Teach patient new strategies to relieve pain and discomfort: distraction, imagery, relaxation technique. Administer analgesics to promote pain relief. 55 5-Improving body image and self-esteem: Assess patient's feelings about body image and level of self-esteem. Identify potential threats to patient's self-esteem (eg, altered appearance, decreased sexual function, hair loss, decreased energy, and role changes). Encourage continued participation in activities and decision making. Encourage patient to verbalize concerns Assist patient in self-care when fatigue, lethargy, nausea, vomiting, and other symptoms prevent independence. Assist patient in selecting and using cosmetics, scarves, hair pieces, and clothing that increase his or 56 her sense of attractiveness. Evaluation Expected outcomes may include the following: Maintains integrity of oral mucous membranes Maintains adequate tissue integrity Maintains adequate nutritional status Achieves relief of pain and discomfort Exhibits improved body image and self-esteem. 57 58