Assessment of Immune Function

Assessment of Immune Function
Copyright 2008 Lippincott Williams & Wilkins.
The Immune System

Immunity: the bodys specific protective response to invading foreign agent or organism Immunopathology: the study of diseases that result from dysfunction of the immune system Immune disorders:
Autoimmunity Hypersensitivty Gammopathies Immune deficiencies: primary and secondary

Central and Peripheral Lymphoid Organs
Development of Cells of the Immune System
Lymphocytes
B lymphocytes mature in the bone marrow; T lymphocytes mature in the thymus where they also differentiate into cells with various functions
Immune Function
Natural immunity: nonspecific response to any foreign invader

White blood cell action: release cell mediators such as histamine, bradykinin, and prostaglandins, and engulf (phagocytize) foreign substances Inflammatory response Physical barriers, such as intact skin, chemical barriers, and acidic gastric secretions or enzymes in tears and saliva
Acquired immunity: specific against a foreign antigen

Result of prior exposure to an antigen Active or passive
Stages of Immune Response
Defenses

Phagocytic immune response Humoral or antibody response Cellular immune response
Role of Antibodies

Agglutination of antigens Opsonization Promote release of vasoactive substances; activation of complement system and phagocytosis Act in concert with other components of the immune system Types of immunoglobulins: IgA, IgD, IgE,IgG, and IgM
IgG (75% of Total Immunoglobulin)

IgA (15% of Total Immunoglobulin)
Appears in serum and tissues (interstitial fluid) Assumes a major role in bloodborne and tissue infections Activates the complement system Enhances phagocytosis Crosses the placenta
Appears in body fluids (blood, saliva, tears, breast milk, and pulmonary, gastrointestinal, prostatic, and vaginal secretions) Protects against respiratory, gastrointestinal, and genitourinary infections Prevents absorption of antigens from food Passes to neonate in breast milk for protection
IgM (10% of Total Immunoglobulin)
IgD (0.2% of Total Immunoglobulin)
Appears mostly in intravascular serum Appears as the first immunoglobulin produced in response to bacterial and viral infections Activates the complement system Appears in small amounts in serum Possibly influences B-lymphocyte differentiation, but role is unclear
IgE (0.004% of Total Immunoglobulin)

Appears in serum Takes part in allergic and some hypersensitivity reactions Combats parasitic infections
Antibody Molecule
AntigenAntibody Binding
Cellular Immune Response

B lymphocytes: humoral immunity

Produce antibodies or immunoglobulins
T lymphocytes: cellular immunity

Attack invaders directly, secrete cytokines, and stimulate immune system responses Helper T cells Cytotoxic T cells Memory cells Suppressor T cells (suppress immune response)
Non-T and Non-B Lymphocytes Involved in Immune Response
Null cells Destroy antigen coated with antibody
Natural killer cells

Defend against microorganisms and some malignant cells
Complement-Mediated Immune Responses
Variables That Affect Immune System Function

Age and gender Nutrition Presence of conditions and disorders: cancer/neoplasm, chronic illness, autoimmune disorders, surgery/trauma Allergies History of infection and immunization Genetic factors Lifestyle Medications and transfusions Pyschoneuroimmunologic factors
Tests to Evaluate Immune Function

WBC count and differential Bone marrow biopsy Humoral and cellular immunity tests Phagocytic cell function test Complement component tests Hypersensitivty tests Specific antigenantibody tests HIV infection tests
Management of Patients With Immunodeficiency

Immunodeficiency Disorders
Primary Genetic May affect phagocytic function, B cells and/or T cells, or the complement system Secondary Acquired HIV/AIDS Related to underlying disorders, diseases, toxic substances, or medications
Primary Immunodeficiencies

Usually seen in infants and young children Manifestations: vary according to type; severe or recurrent infections; failure to thrive or poor growth; and positive family history Potential complications: recurrent, severe, potentially fatal infections; related blood dyscrasias and malignancies
Treatment: varies by type; treatment of infection; pooled plasma or immunoglobulin; GM-CSF or GCSF; thymus graft, stem cell, or bone marrow transplant
Granulocyte macrophage colony-stimulating factor
Nursing Management
Monitor for signs and symtoms of infections

Symptoms of inflammatory response may be blunted
Monitor lab values Promote good nutrition Address anxiety, stress, and coping Strategies to reduce risk of infection
Handwashing and strict aseptic technique Patient protection and hygiene measures: skin care, promote normal bowel and bladder function, and pulmonary hygiene
Patient Teaching

Signs and symptoms of infection Medication teaching Prevention of infection
Handwashing
Avoid crowds and persons with infections Hygiene and cleaning

Nutrition and diet Lifestyle modifications to reduce risk Follow-up care

Management of Patients With HIV Infection and AIDS

Transmission of HIV
Transmitted by body fluids containing HIV or infected CD4 lymphocytes Blood, seminal fliud, vaginal secretions, amniotic fluid, and breast milk Most prenatal infections occur during delivery
Casual contact does not cause transmission Breaks in skin and mucosa increase risk
High-Risk Behaviors

Sharing infected injection equipment Having sexual relations with infected individuals
Prevention

Standard precautions Practice safer sex practices and safer behaviors
Do not share drug injection equipment Blood screening and treatment of blood products
Abstain from sharing sexual fluids Reduce the number of sexual partners to one Always use latex condoms; if allergic to latex, use nonlatex condoms
Structure of HIV-1
Life Cycle of HIV-1
Stages of HIV Disease
Primary infection
HIV asymptomatic
HIV symptomatic
AIDS
Primary Infection
Acute HIV infection/acute HIV syndrome Part of CDC category A Symptoms: none to flu-like syndrome Window period: lack of HIV antibodies Period of rapid viral replication and dissemination through the body Viral set point: balance between amount of HIV and the immune response
HIV Asymptomatic
CDC category A
More than 500 CD4+ T lymphpocytes/mm3

Upon reaching the viral set point, chronic asymptomatic state begins Body has sufficient immune response to defend against pathogens
HIV Symptomatic

CDC category B 200 to 499 CD4+ lymphpocytes/mm3
CD4 T cells gradually fall

The patient develops symptoms or conditions related to the HIV infection that are not classified as category C conditions Patients who are once treated for a category B condition are considered category B
AIDS
CDC category C
Less than 200 CD4+ lymphocytes/mm3

As levels drop below 100 cells/mm3, the immune system is significantly impaired Development of listed conditions
Treatment
Treatment and protocols are continually evolving Antiretroviral agents

Nucleoside reverse transcriptase inhibitors (NRTIs) Non-nucleoside reverse transcriptase inhibitors (NNRTIs) Protease inhibitors (PIs) Fusion inhibitors Use of combination therapy
Management focuses upon the treatment of specific manifestations and conditions related to the disease
Manifestations of AIDSRespiratory
Pneumocystis carinii pneumonia (PCP)

Most common infection Initial symptoms may be nonspecific and may include nonproductive cough, fever chills, dyspnea, and chest pain If untreated, progresses to pulmonary impairment and respiratory failure Treatment: TMP-SMZ or pentamidine; prophylactic TMP-SMZ
Mycobacterium avium complex (MAC) Tuberculosis

Manifestations of AIDSGI
Oral candidiasis
May progress to esophagus and stomach Treatment with Mycelex troches or nystatin and ketoconazole Octreotide acetate for severe chronic diarrhea
Diarrhea related to HIV infection or enteric pathogens Wasting syndrome

10% weight loss and chronic diarrhea or chronic weakness and fever with absence of other cause Protein energy malnutrition Anorexia, diarrhea, GI malabsorption, and lack of nutrition may contribute
Manifestations of AIDSOncologic
Kaposi's sarcoma Cutaneous lesions but may involve multiple organ systems Lesions cause discomfort, disfigurement, ulceration, and potential for infection
B cell lymphomas
Lesions of Kaposis Sarcoma
Manifestations of AIDSNeurologic
HIV encephalopathy Progressive cognitive, behavioral, and motor decline Probably directly related to the HIV infection Cryptococcus neoformans Other neurologic disorders Depression
Nursing ProcessAssessment of the Patient With AIDS

Assess physical and psychosocial status Identify potential risk factors: IV drug abuse and risky sexual practices Assess immune system function Assess nutritional status Assess skin integrity Assess respiratory status and neurologic status Assess fluid and electrolyte balance Assess knowledge level
Nursing ProcessDiagnosis of the Patient With AIDS

Impaired skin integrity Diarrhea Risk for infection Activity intolerance
Pain
Imbalanced nutrition Social isolation Anticipatory grieving
Disturbed thought processes

Ineffective airway clearance
Deficient knowledge
Collaborative Problems/Potential Complications

Opportunistic infections
Impaired breathing or respiratory failure Wasting syndrome
Fluid and electrolyte imbalance

Adverse reaction to medication
Nursing ProcessPlanning the Care of the Patient With AIDS (cont.)
Goals may include (cont.) Increased comfort Improved nutritional status
Increased socialization
Expression of grief Increased knowledge regarding disease prevention and self-care Absence of complications
Skin Integrity
Conduct frequent routine assessment of skin and mucosa
Encourage patient to maintain balance between rest and activity

Reposition at least every two hours and as needed Use pressure reduction devices Instruct patient to avoid scratching Use gentle, nondrying soaps or cleansers Avoid adhesive tape
Provide perianal skin care
Promoting Usual Bowel Pattern

Assess bowel pattern and factors that may exacerbate diarrhea Avoid foods that act as bowel irritants, such as raw fruits and vegetables, carbonated beverages, spicy foods, and foods of extreme temperatures Small, frequent meals Administer medications as prescribed Assess and promote self-care strategies to control diarrhea
Nursing ProcessPlanning the Care of the Patient With AIDS
Goals may include:

Achievement and maintenance of skin integrity Resumption of usual bowel patterns
Absence of infection
Improved activity tolerance Improved thought processes Improved airway clearance
Activity Intolerance

Maintain balance between activity and rest Instruction regarding energy conservation techniques Relaxation measures Collaboration with other members of the health care team
Maintaining Thought Processes

Assess mental and neurologic status Use clear, simple language if mental status is altered Establish and maintain a daily routine Use orientation techniques Ensure patient safety and protect from injury Implement strategies to maintain and improve functional ability Instruct and involve family in communication and care
Nutrition

Monitor weight, I&O, dietary intake, and factors that interfere with nutrition Provide dietary consultation Control nausea with antiemetics Provide oral hygiene Treat oral discomfort Administer dietary supplements May require enteral feedings or parenteral nutrition
Decreasing Isolation

Promote an atmosphere of acceptance and understanding Assess social interactions and monitor behaviors Allow patient to express feelings Address psychosocial issues Provide information related to the spread of infection Educate ancillary personnel, family, and partners
Other Interventions
Improve airway clearance Use semi-Fowler's or high-Fowlers position Pulmonary therapy; coughing and deep breathing; postural drainage; percussion; and vibration Ensure adequate rest Pain Administer medications as prescribed Provide skin and perianal care

Assessment of Immune Function

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Assessment of Immune Function

Uploaded by

Copyright:

Available Formats

Assessment of Immune Function

Copyright 2008 Lippincott Williams & Wilkins.

The Immune System

Autoimmunity Hypersensitivty Gammopathies Immune deficiencies: primary and secondary

Central and Peripheral Lymphoid Organs

Copyright 2008 Lippincott Williams & Wilkins.

Development of Cells of the Immune System

Copyright 2008 Lippincott Williams & Wilkins.

Copyright 2008 Lippincott Williams & Wilkins.

Natural immunity: nonspecific response to any foreign invader

Acquired immunity: specific against a foreign antigen

Copyright 2008 Lippincott Williams & Wilkins.

Stages of Immune Response

Copyright 2008 Lippincott Williams & Wilkins.

Phagocytic immune response Humoral or antibody response Cellular immune response

Copyright 2008 Lippincott Williams & Wilkins.

Copyright 2008 Lippincott Williams & Wilkins.

IgG (75% of Total Immunoglobulin)

IgA (15% of Total Immunoglobulin)

Copyright 2008 Lippincott Williams & Wilkins.

IgM (10% of Total Immunoglobulin)

IgD (0.2% of Total Immunoglobulin)

IgE (0.004% of Total Immunoglobulin)

Copyright 2008 Lippincott Williams & Wilkins.

Copyright 2008 Lippincott Williams & Wilkins.

Copyright 2008 Lippincott Williams & Wilkins.

Copyright 2008 Lippincott Williams & Wilkins.

Cellular Immune Response

B lymphocytes: humoral immunity

T lymphocytes: cellular immunity

Copyright 2008 Lippincott Williams & Wilkins.

Non-T and Non-B Lymphocytes Involved in Immune Response

Null cells Destroy antigen coated with antibody

Natural killer cells

Copyright 2008 Lippincott Williams & Wilkins.

Complement-Mediated Immune Responses

Copyright 2008 Lippincott Williams & Wilkins.

Variables That Affect Immune System Function

Copyright 2008 Lippincott Williams & Wilkins.

Tests to Evaluate Immune Function

Management of Patients With Immunodeficiency

Copyright 2008 Lippincott Williams & Wilkins.

Copyright 2008 Lippincott Williams & Wilkins.

Monitor for signs and symtoms of infections

Signs and symptoms of infection Medication teaching Prevention of infection

Nutrition and diet Lifestyle modifications to reduce risk Follow-up care

Management of Patients With HIV Infection and AIDS

Copyright 2008 Lippincott Williams & Wilkins.

Standard precautions Practice safer sex practices and safer behaviors

Copyright 2008 Lippincott Williams & Wilkins.

Life Cycle of HIV-1

Copyright 2008 Lippincott Williams & Wilkins.

Stages of HIV Disease

Copyright 2008 Lippincott Williams & Wilkins.

Copyright 2008 Lippincott Williams & Wilkins.

More than 500 CD4+ T lymphpocytes/mm3

Copyright 2008 Lippincott Williams & Wilkins.

CDC category B 200 to 499 CD4+ lymphpocytes/mm3

CD4 T cells gradually fall

Less than 200 CD4+ lymphocytes/mm3

Copyright 2008 Lippincott Williams & Wilkins.

Treatment and protocols are continually evolving Antiretroviral agents