Immune system Flashcards
what produces WBCs, RBCs, B-lymphocytes
Bone marrow: produces a type of stem cell that is able to produce all types of blood cells. (RBC,WBC and platelets), which then differentiate into the cells of the hematologic and immune system. B lymphocytes are produced and mature in the BONE marrow and they play significant role in humoral response.
Where do T-lymphocytes reside until needed
The THYMUS gland, behind the sternum in the mediastium, is the place where T cells mature and are released into the blood stream.
What system do the tonsils and spleen belong to?
lymphatic system
Immune system Infants/young:
- Neonates are susceptible to infection due to an immature immune system.
- The thymus gland is largest during childhood and adolescence. After adolescence it begins to shrink in size and its production of T lymphocytes decreases.
Immune system Elderly
- Aging causes skin to become thin, less elastic, and more prone to injury. The skin is the first barrier to defense against pathogens.
- Decreased ciliary action in the respiratory tract and GI tract results in decreased removal of potentially harmful organisms.
- the presence of chronic diseases can decrease the immune response.
Inflammatory response
Recognition microorganisms or unknown antigens causes the body to immediately launch a defense because the tissue damage created by the invading microorganisms releases certain chemicals within the body. These chemical triggers, such as histamine , lead to the activation of the inflammatory response, which then, causes the blood and lymphatic systems to deliver certain WBC, lymphocytes, proteins , and other nutrients to the effected area. Trauma, pathogenic microorganisms, chemicals, or heat may cause injury to tissues inside or outside of the body. Redness, swelling, warmth, and tender to the touch. Blood flow is increased to the area by dilating the blood vessels/lymphatic vessels upstream of the injury, resulting in warmth and redness. The same substances also effect downstream vessels, causing vasoconstriction and swelling. If the effects of swelling are not quickly controlled, the edema can compress nerve endings surrounding injury leading to pain. - may be enough to kill the invading organisms by creating hostile environment. Protective proteins that are activated include the complement system.
Antigen
Foreign substance or component of cell that stimulates immune response
Antibody
Specific protein produced in the humoral response to bind with antigen
Innate
(natural) immunity is non specific. In humans when they are born, making them less susceptible to animal diseases. The body has the ability to recognize certain microorganisms as harmful, even without prior exposure
Cell-mediated response (weeks to produce antibodies)
Helper T Cells
Killer T Cells
Memory T Cells
Suppressor T Cells
Complement system
- Proteins produced in the LIVER that work with antibodies to help kill invaders
- Especially useful in viral infections
Immunity Key Points
B-Cells and T- Cells must work together for proper immunity
T-Cells provide defense against VIRAL infections
Immune response
-Proper response and invader is wiped out
-Improper response and
-Immune deficiency
-Autoimmune disease ( T-cells fault)
-Iatrogenic –treatment for one condition causes decreased immunity*
Alcohol consumption—decreases the effectiveness of B-cells to produce antibodies (2 drinks)
Immunization
- Contraindications
- Fever
- Pregnancy
- Decreased immunity
- Allergies
- Blood transfusions 6-8 weeks –prior
Nursing Key Points
- further investigate if pt has active infection without clinical signs
- If pt has recurrent infections or extreme infections from those organisms that typically do not cause much harm.
- Signs of shock? decreased BP, tachycardia, cold/clammy, diaphoretic
SIRS and Septic shock
ch45 pg 1037
Thymus
Gland located in the mediastinum, large in children, decreasing size in adults; site of maturation and proliferation of lymphocytes.
Lymphatic tissue
contains many lymphocytes; filters body fluids, removes foreign matter, immune response
Neutrophils (non specific)
WBC;for phagocytosis; non specific defense; active in inflammatory process
Basophils (mast cells) igE
WBC; bind immunoglobulin E; release histamine in anaphylaxis.
Eosinophils (allergic resp)
WBC; participate in allergic responses
monocytes
WBC: migrate from blood into body tissues to become macrophages
macrophages
phagocytosis; process and present antigens to lymphocytes for the immune response
Mast cells
Release chemical mediators such as histamine in connective tissue
B lymphocytes
Humoral immunity-activating cell becomes an antibody- producing plasma cell or or B memory cell.
T- Lymphocytes
WBC; cell mediated immunity. T cells respond to viruses on the surface of cells. T cells and macrophages produce
Memory T cells
Remember antigens and quickly stimulate an immune response upon re-exposure
Helper T cells
Activate B and T cells; control or limit the immune response.
First-line of defense
Skin, tears, earwax, mucus membranes, and urinary tract. All provide external barriers to prevent foreign microorganisms from entering the body.
Immune and Lymphatic systems
- Work together to defend against threats from multiple sources inside and out of the body.
CNS
Transports chemical messages that the body is under attack to the brain.
Complement system
works with the inflammatory response. Several of these protein enzymes, when sequentially activated, form a “ membrane attack complex” (MAC) that embeds itself into the cell membrane of the attacking microbe. This activation occurs when there is an exposure of complement binding sites on antibodies after they attach to antigens. This binding allows for a break in the cell wall allowing ions , such as salt, to enter the cell. the salt followed by water causes swelling and bursting of the microbe.
Immune response
The immune response is a remarkable series of complex chemical and mechanical activities that take place in the body. They include 1. Constant surveillance to detect entry of foreign agents (antigens) as soon as they gain access to body’s cells. @. immediate recognition of antigens as “non self” 3. The ability to distinguish one kind of foreign agent from another, and remember it it again if it enters the body at a later time. The thymus gland, lymphatic system, spleen, lymph nodes, bone marrow, peyers patches.
Deficiency of immune response
- Lack of appropriate response, immunodeficiency is present.
- Body produces an immune response to a “self” cell or tissue, causing autoimmune disease.
-Massive trauma
-Chronic illness
can inhibit immune response.
BOdy’s response to foreign substance has been detected and identified. the body responds in two general ways.
- It immediately produces a protein called ( an antibody). that is specifically designed to kill the antigen. The immediate response is called a HUmoral response.
- Cellular or cell mediated response. T lymphocytes,
Humoral
refers to any fluid of semifluid. there is also a delayed response that involves the use of sensitized lymphocytes to attack whole cells, such as bacteria, viruses, and malignant (cancer) cells.
Types of antigens
Bacteria, viruses, fungi, infectious microorganisms, toxins, non living matter, pollen, dust, chemicals, , some foods,
Primary Humoral response
Lymphocytic B cells are involved in humoral immunity and the production of antibodies. And the production of antibodies, they arise from stem cells in the bone marrow and undergo a maturation process that involves bone marrow stromal cells (Cells that contribute to the development of multiple tissues and blood cells)
Stromal cells
(Cells that contribute to the development of multiple tissues and blood cells) and their cytokines (messenger hormones). When mature, the B cells migrate to the lymph nodes. When the stimulated by an antigen, a B cell becomes a plasma cell that secrete immunoglobulins called antibodies in response to the specific antigen they encounter. This antibody mediated or Humoral immunity. Some of the antigen stimulated B cells become memory cells.
acquired immunity
Some of the antigen stimulated B cells become memory cells. This mechanism is the basis for acquired immunity. The memory cells cells reactivate the plasma cells to produce large quantities of the specific type of antibody needed to fight for the particular type of antigen, when the same antigen, when the same antigen enters the body a second time. It is an immediate and potent response, and antibodies continue for many months.
Immunoglobulins
when the body is exposed to harmful substances, the immune system produces antibodies, which are a type of proteins synthesized by plasma cells. these antibodies are called immunoglobulins.
Immunoglobulins (GAMED)
IgG
IgG: 75-85% ; blood plasma; Major antibody in primary and secondary immune responses; activates complement system; inactivates antigen; neutralizes toxins; crosses placenta to provide immunity for newborn; responsible for Rh reactions.
Immunoglobulins (GAMED)
IgA
IgA: 5-15%; Tears, Saliva; Mucus; breast milk; GI, Pulmonary, Prostatic, vaginal fluids; Protects mucus membranes on body surfaces; provides immunity for newborn; prevents antigens n food from being absorbed.
Immunoglobulins (GAMED)
IgM
IgM:5-10 %; Attached to B cells ; released into plasma during immune response. First Ig to respond to microbial invasion ; activates complement systems; causes antigens to clump together; responsible for transfusion reactions in the ABO blood typing system.
Immunoglobulins (GAMED)
IgE
IgE:0.5; Produced by plasma cells in mucous membranes and tonsils; Binds to mast cells and basophils, causing release of histamine; responsible for allergic reactions; helps fight parasitic reactions; helps fight off parasitic invasion.
Immunoglobulins (GAMED)
IgD
IgD: 0.2; Attached to B cells: Receptor sites for antigens on B cells; binding with antigen results in B cell activation.
Immunoglobulin attachment
Each immunoglobulin is able to attach to the kind of antigen for which it is made. The antibody’s ability to form a bond with its antigen, but it can sometimes result in damage to the bodies own cells. Antibodies are found in the serum of blood and in other body fluids and tissues, including tears, saliva, breast milk, spinal fluid, interstitial fluid, lymph nodes, the spleen and urine. An antibody can either destroy or inactivate its particular antigen by. 1. Mechanically harming it. 2. Activating a complement system or 3. Causing the release of chemicals that affect the environment of the antigen.
Toxin
If the antigen is a Toxin (poison) produced by a bacterial or viral cell, the antibody produced to fight it is an antitoxin. This antitoxin is capable of neutralizing the poisonous chemical of the antigen by covering the antigenic agent. An antitoxin is therefore a specific type of antibody that acts through the process of neutralization.
Macrolides (Mycin)
Pg. 740
USED FOR : Respiratory, GI, skin, soft tissue, STIs, bacterial infections. NURSING PROCESS: Administer at least 1 hr prior and 2 hrs after meals.
IM administration is generally not recommended. TEACHING/SAFETY: Gastric irritation, nausea, vomiting, diarrhea, abnormal taste. All mild effects and will resolve with continued use. Do not stop taking medications. DRUG INTERACTIONS : Birth control and many other numerous medication interactions.
Cephalosporins
Cefepine, ceftriaxone, cephalexin (-CEF)
USED FOR : for patients who are allergic to penecillins (WITH CAUTION) UTI, Resp/abd infection, bacteremia, meningitis, osteomyelitis
NURSING PROCESS: ABaseline vitals and CBC
ASSESS FOR ALLERGIES
Monitor I & Os
TEACHING/SAFETY: Oral care after admin
Take antacids and iron supplements 2 hours before or after to avoid inhibiting absorption. DRUG INTERACTION: Probenecid (toxicity) Alcohol Oral contraceptives
WARAFIN (increased anticoagulant effect)
Penicillins (cillin) 743 Amoxicillin Ampicillin Oxacillin Pen G
USED FOR :Bacterial Infections; UTI’s, Gonorrhea & Syphilis, Otis Media NURSING PROCESS:Monitor electrolytes, bowel function, assess infection, and s/s anaphylaxis TEACHING/SAFETY:Seizure precautions Notify Dr. if fever & diarrhea develop, do not take antidiarrheals consult with Dr. Signs of superinfection DRUG INTERACTION: Antacids Probenecid Methotrexate (serious toxicity) Warfarin Allopurinol
Quinilones ( floxacin)
Levofloxacin
ciprofloxacin
ROOT: floxacin
USED FOR :Broad spectrum antibiotics, UTI’s, skin and soft tissue infections, respiratory infections…Treats gram + and gram – and some anaerobes
NURSING PROCESS:Assess for infection, take vitals, assess allergies, review labs and cultures, and ensure patients are not pregnant.
TEACHING/SAFETY:Take as directed. Take 4 hours before or after iron ,zinc, and didanosine – lowers absorption. May cause drowsiness or dizziness
Can be taken with food.
Wear sunscreen – phototoxicity
Ototoxicity possibility
DRUG INTERACTION:Iron and zinc; Avoid NSAIDs
Avoid some heart medications
Theophylline can cause toxicity
Sulfonamides
Sulfadizine
Co-trimoxazole
Pg. 748
ROOT: SULF- AZOLE
USED FOR :UTI, otitis media, prevention of strep in patients allergic to penicillin, Traveler’s diarrhea, acute bronchitis, prevent pneumonia in immunocompromised pts.
NURSING PROCESS:Baseline vitals and CBC, ASSESS FOR ALLERGIES, Monitor I & Os
TEACHING/SAFETY: Drink plenty of water throughout the day to prevent crystal formation in urinary tract. Protection from sun/ u/v light, repeat labs if taken>14 days. Report tinnitus, headache, dizziness.
DRUG INTERACTION:
Oral hypoglycemic
Warfarin
Methotrexate
Phenytoin
ACE inhibitors
Tetracyclines (Demeclocycline (Declomacin) Doxycycline (Vibramycin) Minocycline (Minocin)
ROOT: Cycline
USED FOR :Pts with PCN allergies. Tx of certain venereal diseases, UTIs, Upper respiratory tract infections, PNA, and meningitis. Useful against skin (ACNE), rickettsial, micoplasmic infections
NURSING PROCESS: PO medications with exception of doxycycline, take medication 1 hr before or 2 hrs after eating a meal or having mild and dairy products as it inhibits absorption. Don’t give to children under 8. Do not use while breastfeeding as it can change the color of the infants teeth, use different birth control.
TEACHING/SAFETY: N/V, anorexia, ABD cramps, Diarrhea, photosensitivity, teeth coloring, loss of appetite
Take with full glass of water not milk. Take full prescription
Do not double the doses, take missed one as soon as possible.
DRUG INTERACTION: Antacids
Calcium, Iron, Cholesterol medication, Birth control pills,
PCN, Dairy products/mild
Antitubercular agents
isoniazid INH, (pg751)
rifampin Rifadin (pg 752)
USED FOR : Used to treat tuberculosis And a strain of meningitis. And influenza type B.
NURSING PROCESS:Assess lung sounds, character and amount of sputum
Monitor hepatic function due to extreme hepatotoxicity
Take on an empty stomach at least 1 hour before or 2 hours after meals with a full glass of water
TEACHING/SAFETY:Teach patients to notify if yellow skin and eyes occur (hepatotoxicity) anorexia, unusual tiredness, weakness occurs
Let them know that all of their bodily secretions can be tinged an orange color. Decreases oral contraceptives
DRUG INTERACTION:Carbamazepine
Theophilline
Phenytoin
All decrease absorption
Zyvox
oxazoldinones class
USED FOR :VRE and MSRA
+gram Microorganism
Community acquired pneumonia
NURSING PROCESS: Watch for vision function with tx over 3months
Monitor bowel function signs of pseudomembranous colitis
Obtain culture and sensitivity
Assess infection
TEACHING/SAFETY: Take as directed
Take full dose
Avoid lg. quantities of tyramine ex. (Chocolate, beer, coffee ,soda, yogurt)
Report diarrhea, bloody stool and adb. cramping
DRUG INTERACTION: MAO inhibitors, vasopressors, dopaminergic, SSRI’s, phenytoin, phenobarbital, meperidine, buspirone
Flagyl
ROOT: Dazole
USED FOR :Treatment of anaerobic infections(skin/skin structure, CNS, lower respiratory tract ,bone/joints, intrabdominal, septicemia, ) trichomonias, amebias, anti-biotic assoiated pseudomembranous cholitis. Topical Rx rosacea.
NURSING PROCESS:Assess wound and culture
Give with food to decrease GI upset. XR- on empty stomach 1hr before or 2 hrs after meals
Baseline assessment
Bowel activity; stool consistency
TEACHING/SAFETY: Urine may be red-dark brown , avoid alcohol, cough syrups; elixers x48hrs. Refrain from sexual contact
Watch fornumbness/tingling/hands and feet, Seizures, Can cross placenta and breast milk
DRUG INTERACTION: Alcohol, Disulfiram, oral anticoagulants
Concurrent corticosteroids
Vancomycin
ROOT: mycin
USED FOR : Gram (+) bacteria-strep, staph, c-diff, listeria-life threatening infections.
NURSING PROCESS: Assess hearing/renal function/allergies. Adjust dosage for renal impairment. Rapid administration causes severe hypotension. Assess IV site. Check for anaphylaxis.
TEACHING/SAFETY: Report changes in urination/hearing/secondary infections. Finish meds. Use secondary birth control.
DRUG INTERACTION:Use with skeletal muscle relaxants causes respiratory depression. Monitor concurrent oto/nephron toxic agent use.
Topical antifungals
Nystatin, meconozole
ROOT: ZOLE
USED FOR : Decrease skin irritation and resolution of variety cutaneous fungal infections: thrush, diaper rash, athletes foot, jock itch, ringworm, tinea versicolor, dandruff onychomycosis of fingernails and toes, yeast infections (nystatin)
NURSING PROCESS:Inspect involved areas frequently ; Cleanse area properly before applying; wear gloves/wash hands; apply small amount to cover affected area completely; avoid the use of occlusive wrappings or dressings unless directedNystatin oral sol: swish before swallowing- do not drink anything for about 20 min afterwards
TEACHING/SAFETY:report burning itching, local hypersensitivity reaction, redness, stinging; avoid the eyes; caution pts that some products may stain fabric, skin, or hair. Nystatin vaginal: do not use tampons during therapy
DRUG INTERACTION:Either not known or insignificant; some products contain alcohol or bisulfites and should be avoided in pts with known tolerance
B lymphocyte
That is specific for that bacterium or an antigen. The B lymphocyte becomes a plasma cell that secretes IgM (antibody) , which attacks the bacterium or antigen. After the particular bacterium or antigen is encountered for the first time, it takes 4-8 days for B lymphocyte to produce immunoglobulins that can attack.
Antigen-Antibody Response
is to provide protection against acute, rapidly developing bacterial and viral diseases. the antigen-antibody response is also involved in allergic and transfusion reactions.
Secondary cellular response
The second type of immunologic response of the body involves various interactions with antigens by T lymphocytes. . Unlike the humoral response, which takes place in the plasma, the cellular response involves whole cells called sensitized lymphocytes and occurs out in the tissues. They are said to be sensitized because they have been made sensitive to a specific antigen after their first contact with it.