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Chapter 39 Medical Surgical Nursing

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Superficial lymph nodes in the axilla, groin and neck are palpable ... Palpate the lymph nodes in the neck, axilla, and groin for enlargement or tenderness. ... – PowerPoint PPT presentation

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Title: Chapter 39 Medical Surgical Nursing


1
Introduction to the Immune System
  • Chapter 39 Medical Surgical Nursing

2
Overview
  • The immune system is responsible for protecting
    the body from invasion by infectious, foreign, or
    cancerous cells.
  • It does this by activating the immune response.

3
Overview
  • The immune response is the protective mechanism
    that occurs in the presence of atypical or
    foreign proteins.
  • This response is carried out primarily by
    lymphocytes, specialized cells located in the
    blood and lymphoid tissue.

4
Overview
  • These cells search for and destroy unnatural or
    potentially harmful cells.
  • Hyperactivity of the immune system, as in
    allergic or autoimmune disorders, or a decrease
    in its function, as in AIDS, can be
    life-threatening.

5
Immune System
  • Consists of specialized lymphoid tissues (lymph
    nodes, spleen) and WBCs.
  • Blood cells comprising the immune system are
    WBCs-- lymphocytes, monocytes and neutrophils)

6
White Blood Cells
  • WBC (leukocytes) are produced in the bone marrow.
  • Initially they are nonspecific stem cells that
    later differentiate into various types of blood
    cells including lymphocytes, neutrophils, and
    monocytes.

7
Lymphocytes
  • Are either T-cell or B-cell lymphocytes, which
    comprises 20 to 30 of all leukocytes.
  • T- B- cell lymphocytes are primary participants
    in the immune response.
  • They distinguish harmful substances and ignore
    those natural and unique to the individual

8
T-cell Lymphocytes
  • Manufactured in bone marrow travel to the
    thymus gland where they mature to become either
    regulator T cells or effector T cells.
  • Regulator T cells are made up of helper and
    suppressor cells
  • Effector T cells are killer (cytotoxic) cells.

9
T-Cell Lymphocytes
  • Helper T cells are especially important in
    fighting infection due to the fact that they are
    cytotoxic.
  • Also called T4 cells or CD4 cells.
  • They recognize antigens, protein marker on cells,
    and form additional T-cell clones that stimulate
    B-cell lymphocytes to produce antibodies against
    foreign antigens.

10
T-Cell Lymphocytes
  • Antibodies are chemical substances that destroy
    foreign agents such as microorganisms.

11
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12
T-cell Lymphocytes
  • See Table 39-1 PG 603---type and functions of
    lymphocytes.

13
T-cell Lymphocytes
  • Antibodies are chemical substances that destroy
    foreign agents such as microorganisms.
  • Antigens are protein markers on cells. Foreign
    invaders!!!

14
T-cell Lymphocytes
  • The immune response performed by T-cell
    lymphocytes is called a cell-mediated response.
  • A cell-mediated response occurs when T cells
    survey proteins in the body, actively analyze the
    surface features, and respond to those that are
    different from the host by directly attacking the
    invading antigen.

15
T-cell Lymphocytes
  • An example of a cell-mediated responses is one
    that occurs when an organ is transplanted.

16
B-cell Lymphocytes
  • Formation of antibodies is called a humoral
    response because it involves substances, namely
    antibodies, contained in body fluid.
  • Antibodies are more correctly referred to as
    immunoglobulins (ig) because they are components
    of gamma globulins, serum (plasma) proteins.

17
Immune System
  • Immune response is one in which lymphoid tissues
    and specific WBCs work in a coordinated manner
    to search for and destroy that which is unnatural
    or potentially harmful to the body

18
Immunoglobulins
  • There are five classes of immunoglobulins IgA,
    IgD, IgE, IgG, and IgM.
  • Each immunoglobulin has a separate role in
    ensuring the maintenance of a healthy state.
  • See table 39-2 pg 605

19
Immunoglobulins
  • IgG-neutralizes bacterial toxins, accelerates
    phagocytosis
  • IgA-Interferes with entry thru exposed
    structures or pathways
  • IgM-agglutinates(clusters) antigens and dissolves
    (lyses) cell walls
  • IgD-binds to antigens promotes immuglobulin
    secretion
  • IgE-releases histamine in allergic, inflammatory
    responses

20
Neutrophils Monocytes
  • Perform phagocytosis (the process of engulfing
    and digesting bacteria and foreign material.
    (Pac-man)

21
Lymphoid Tissues
  • Such as the thymus gland, tonsils and adenoids,
    spleen, and lymph nodes play a role in the immune
    response and preventing infection.

22
Thymus Gland
  • Located in the neck below and anterior to the
    thyroid gland.
  • Produces lymphocytes during fetal development.
  • After birth, the thymus gland programs T
    lymphocytes to become regulator T cells or
    effector T cells.

23
Tonsils Adenoids
  • Filter bacteria from tissue fluid.
  • Because they are exposed to pathogens in the oral
    and nasal passages, they can become infected and
    locally inflammed.

24
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25
Spleen
  • Has both hematopoietic (blood cell producing) and
    immune functions.
  • Located in the upper left quadrant, below the
    diaphragm, and behind the stomach.
  • Acts as an emergency reservoir of blood and
    filters the blood as well.
  • Macrophages present in the spleen remove bacteria
    and old, dead, or damaged blood cells from
    circulation.

26
Lymph Nodes
  • The lymphatic system consists of vessels similar
    to capillaries that drain tissue fluid, called
    lymph into structures called lymph nodes.
  • The lymph nodes contain B T lymphocytes and
    remove bacteria and other foreign particles from
    the lymph.

27
Lymph Nodes
  • Superficial lymph nodes in the axilla, groin and
    neck are palpable when enlarged.

28
RALPHIE (Not in your book)
  • Remember how the germs/microorganisms tried to
    invade Ralphie by his respiratory system, but
    Ralphie coughed the germs away.
  • So they found another entry route, his cut on his
    leg.
  • Once the germs/microorganisms/foreign particles
    invade the body, it triggers the inflammatory and
    immune response.

29
RALPHIE
  • These foreign particles are known as antigens.
    Antigens are foreign substances such as bacteria
    or toxins that induce antibody formation.
  • Antigen Aunt Jen which is a horrible foreigner
    that you constantly fight with because she is
    always drunk on gin-tonics. Or antiGEN GERM

30
RALPHIE
  • When the inflammatory and immune response have
    been triggered-- Both of these responses involve
    stem cells in the bone marrow that form blood
    cells. This is the on your marks get set
    part. The body knows that something is about to
    happen so it has to get ready.vroom, vroom,
    vroom..

31
RALPHIE
  • What are stem cells?
  • Undifferentiated precursors to various types of
    cells including lymphocytes, neutrophils, and
    monocytes.
  • When you hear a siren, you are not sure if it is
    the DPS, Sheriff department, police department,
    EMS, Firemen, icecream truck
  • They need to send someone to respond but WHO?????

32
RALPHIE
  • Everyones body cells are coded with distinct
    histocompatibility (tissue cell) markers.
  • These markers act as a fingerprint that enables
    the immune system to differentiate self from
    nonself.
  • When it detects a nonself substance, the immune
    system sets about to protect, defend, and destroy
    what it perceives as atypical or abnormal.

33
Antigen Invades 2 types of immunity
  • Cell-mediated
  • T cells attack the antigen directly using the
    release of lymphokines to destroy the target
    cell.
  • 80
  • Humoral immunity
  • B Cells produce antibodies/immunoglobulins that
    incapacitate the antigen.

34
Antigen Invades 2 types of immunity
  • Cell-mediated
  • T-cells (Ted the police man) responds
  • 3 ways TED can respond
  • 1. Killerdestroy
  • 2. Helpstimulate the B-cellsantibodies
  • 3. Suppressturns off the immune response
  • Humoral immunity
  • B-cells (Billy Bob) is a funny fireman.
  • Produce antibodies to attack the antigens.

35
Types of Immunity
  • The 3 types of immunity are
  • naturally acquired active immunity,
  • artificially acquired active immunity,
  • passive immunity

36
Immunity
  • Both forms of active immunity require the
    individuals own production of plasma and memory
    cells.
  • Passive immunity occurs when ready-made
    antibodies are provided.

37
Naturally Acquired Active Immunity
  • Occurs as a direct result of infection by a
    specific microorganism.
  • Example is the immunity to measles that develops
    after the initial infection.
  • Not all give lifelong immunity
  • Person contacts the disease and actively works to
    build immunity.

38
Artificially Acquired Active Immunity
  • Provided by administration of a killed or
    weakened microorganism (attenuated) or toxoid
  • Ex. receives polio vaccine or other vaccine
  • Some immunizations, such as those for tetanus and
    influenza, require re-administration to retain
    adequate immunity.
  • Person receives a vaccine. Artificial because
    given with a needle and active because the body
    still has to respond/actively work to provide
    immunity.

39
Passive Immunity
  • Develops when ready-made antibodies are given to
    a susceptible individual.
  • The antibodies provide immediate but short-lived
    protection from the invading antingen. (several
    weeks to a few months)
  • Ready-made antibodies are obtained from the serum
    of another organism, either animal or human.

40
Passive Immunity
  • Immune serum globulin, also called gamma globulin
    or immunoglobulins, is recovered from pooled
    human plasma.
  • Because the pool comprises plasma from more than
    one donor, the serum is likely to contain a
    variety of specific antibodies

41
Passive Immunity
  • Human immune serum is used for passive
    immunization against measles (rubella), pertussis
    (whooping cough), hepatitis B, chickenpox
    (varicella), and tetanus.
  • Newborns receive passive immunity to some
    diseases for which their mothers have
    manufactured antibodies. (only a few months
    after birth)

42
Passive Immunity
  • No memory cells are produced and level drops over
    a few weeks or months. Gamma globulin given.

43
Passive Immunity
  • You get stuck with a dirty needle, which the
    patient had hepatitis B. You do not have time to
    build your own immunity, so they give you a gamma
    globulin of pooled human plasma to help you fight
    this scare with Hepatitis.
  • Hopefully you dont come down with it, however,
    it is short acting so if you get stuck with
    another dirty needle, you need to go back and
    review safety with syringes and get another gamma
    globulin.

44
History
  • Obtain history of immunizations, recent and past
    infectious diseases, and recent exposure to
    infectious diseases.
  • Review drug history (corticosteroids suppress the
    inflammatory and immune system) and allergy
    history
  • High risk behaviors

45
Assessment
  • V/S, wt,
  • Enlarged liver or spleen, tonsils, lymph nodes..
  • Skin for rashes or lesions
  • Palpate the lymph nodes in the neck, axilla, and
    groin for enlargement or tenderness.
  • Malnourished, listless, or extremely tired.

46
Management
  • Identify allergies
  • Universal precautions
  • Consent before testing for HIVresults
    confidential
  • Educate on immunizations
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