Immunology
Immunity is:
oOrganized series of actions by the body in order to protect itself against a
pathological organism resulting in destruction or neutralization of the organism
oA state of responsiveness to foreign substances such as microorganisms and tumor
proteins
oFunctions of the immune system:
Homeostasis
D__________
S______________
Foreign Substances
(Antigens)
oB__________
oV_________
oFungi
oPrions
oParasites
oHaptens vs. Antigens
Cells Involved with Immune System (The Major Players)
oMononuclear Phagocytes
oLymphocytes
•B lymphocytes
•T lymphocytes
•T cytotoxic cells (CD8)
•T helper cells (CD4)
•Natural Killer Cells
•Dendritic Cells
•Cytokines
Types (Ways) of Immunity
•Innate Immunity
•Natural Immunity
OR
•Acquired Immunity
•Active Acquired Immunity
•Passive Acquired Immunity
Innate Immunity
•Innate Immunity or Natural Immunity
oExists __________ former contact with antigen
o“Born with it” (human specific immunity)
oIncludes natural barriers (skin, mucous membranes)
oInvolves inflammatory response
Acquired Immunity
•Active Acquired immunity
oOccurs when body responds to presence of pathologic organism and produces
antibodies against them
oComes following an invasion and results in sensitized antibodies
oWhen reinvaded by organism response is __________
oCan take a while to develop but lasts a long time
oEx: when body produces antibodies because of vaccine targeted by the
immunization
•Passive Acquired Immunity
oTemporary
oReceives antibodies to antigen “passively” instead of making them
oIs _________ but doesn’t last long= temporary because there are no memory cells
specific to the antigen
Ex: Immunoglobulin from Mother to fetus
Ex: Injection of gamma-globulins (serum antibodies)
Types of Immune Response
•Humoral Immunity
•Cell-Mediated Immunity
**** Each has unique properties and actions based on the antigens involved
Humoral Immunity
•The antigen that invades causes B cells to divide and become plasma cells (differentiated
B cells) which produce antibodies (immunoglobulin) that travel in the bloodstream to
communicate with other cells
•“Humor” is the Latin word for “liquid”
•Primary immune response takes _________ days after initial exposure
•2nd exposure takes ________ days,
STRONGER, LONGER longer lasting
Cell Mediated Immunity
•When T Cells recognize antigen and start immune response
•Production of sensitized T-Lymphocytes to kill and destroy pathologic organisms
•Protection primarily against cancer cells, virus-infected cells, fungal infections
•Rejection of _______________ tissue
•Contact hypersensitivity reactions
Normal Immune Response
Comparison of
Humoral and Cell-Mediated Immunity
Humoral Cellular
Cell involved B lymphocytes •T lymphocytes
•Macrophages
Products Antibodies •Sensitized T cells
•Cytokines
Memory cells Present Present
Normal Immune Response
Comparison of
Humoral and Cell-Mediated Immunity
Humoral Cellular
Protection •Bacteria
•Viruses (extracellular)
•Respiratory pathogens
•Gastrointestinal pathogens
•Fungus
•Viruses (intracellular)
•Chronic infectious agents
•Tumor cells
Immunological Effects on Aging
•↓ immune system function
•↑ susceptibility to infection
•See alterations in T cell
•↑ incidence in tumors
•Immunity because of vaccines may not be as strong
Altered Immune Response
•Overacting Immune Response:
oHypersensitivity Reactions
Allergies
Autoimmune
•Under responsive immune system
oSevere infections
oImmunodeficiency diseases
oMalignancies
Overacting immune response:
•O______ reactive against antigens
•Can’t practice self-limitation
•4 Classifications:
oType I: IgE-Mediated
oType II: Cytotoxic Reaction
oType III: Immune-Complex Reaction
oType IV: Delayed Hypersensitivity Reaction
Type I IgE Mediated Reaction
•Chemical Mediators are released from Mast Cells:
oH____________
oSerotonin
oLeukotriene
oEosinophil chemotactic factor
oKinins
oBradykinin
•Symptoms associated with:
oIncrease mucosal ______________
oI__________
oIncreased vascular permeability
oSmooth muscle contraction
Anaphylaxis
•Medical Emergency!
•Shock can occur
•Treatment:
oMaintain/Secure Airway
oHigh Flow Oxygen
oMaintain circulatory volume, IV Access
oEpinephrine
oOther drugs – Albuterol, diphenhydramine, corticosteroids
Type II Cytotoxic (IgG or IGM) Reaction
•Target Cells are usually Red Cells, White Cells and Platelets
•Commonly antigens involved are ABO blood group, Rh Factor and drugs
•If a patient is transfused with incompatible blood
oAntibodies immediately coat the foreign RBCs
oRBCs ______________ (clump)
oLife threatening
oCellular lysis and possibly renal failure secondary to hemaglobinuria
Collaborative Care of Hypersensitivity Reactions
•After allergy is diagnosed:
oAvoid __________/__________
oTreat symptoms
oIf needed, desensitization through immunotherapy
•Document allergies
•Drug therapy
Drug Therapy for Chronic Allergies
•A________________
•Sympathomimetic/Decongestant Drugs
oEpinephrine (Adrenalin)
oPseudoephedrine (Sudafed)
•Corticosteroids
oMost commonly given Nasally
•Topical Antipruritic Drugs
oCalamine Lotion
•M____________- Stabilizing Drugs
oCromolyn (Intal, Nasalcrom, Rynacrom)
oNedocromil (Tilade)
oBoth available as nasal spray or inhalant nebulizer solution
Latex Allergies
•The longer one uses latex, the likelihood of getting latex allergy _____________
•Two Types of Latex Allergies can Occur
oType IV
•Contact dermatitis
•Delayed reaction occurs up to 6-48 hours
oType I
•Occurs within minutes of contact
***Symptoms of Latex Allergy: skin rash, hives, flushing, itching, nasal, eye or sinus symptoms,
asthma and shock
Autoimmunity
•Immune response attacks itself because it cannot tell self from non-self (absence of self
recognition)
•Cause is unknown
•Classified by ______________________ of disease
•Treatment
oApheresis: procedure where blood components are separated then one of those
components are removed
•Ex: Plasmapheresis
•Watch for hypotension and citrate toxicity
Examples of Autoimmune Diseases
•Systemic Diseases
•Systemic lupus Erythematosus
•Rheumatoid Arthritis
•Scleroderma
•Mixed Connective Tissue Disease
•Organ-Specific Diseases
•Autoimmune hemolytic anemia
•Immune thrombocytopenic purpura
•Central Nervous System
•Multiple Sclerosis
•Guillain-Barre’ Syndrome
•Muscle
oMyasthenia Gravis
•Heart
oRheumatic Fever
•Endocrine System
oAddison’s Disease
oThyroiditis
oHypothyroidism
oType 1 DM
•GI System
oPernicious Anemia
oUlcerative Colitis
•Kidney
oGoodpasture Syndrome
oGlomerulonephritis
•Liver
oPrimary biliary cirrhosis
oAutoimmune hepatitis
•Eye
oUveitis
Immunodeficiency
Disorders
•Occurs when immune system does not provide adequate protection to the body
•One or more immune mechanisms is impaired
Primary Immunodeficiency Disorder: ___________ ________________________ immune
cells
Secondary Immunodeficiency Disorder: caused by illness or treatment
Causes of Secondary Immunodeficiency
*Drug –Induced Immunodeficiency*
•Chemotherapy Drugs
•Corticosteroids
Age
•Infants
•Older Adults
Malnutrition
•Dietary Deficiency
•Cachexia
Stress
•Chronic stress
•Emotional trauma
Diseases/Disorders
•AIDS
•Cirrhosis
•Chronic Kidney Disease
•Diabetes Mellitus
•Malignancies
•Systemic Lupus Erythematosus
•Burns
•Trauma
•Severe Infection
Therapies
•Radiation
•Surgery
•Anesthesia
Adult Immunizations
•How do Vaccines Work?
•Vaccines contain small amounts of _____________ ___________(altered so that it doesn’t
cause disease)
•Administered to patient
•Patient produces _____________ against that pathogen so that it can recognize it in the
future
•Later, when patient is exposed to pathogen the body can get rid of it before it can advance
into the disease
•Therefore, patient is protected from disease without ever having disease
Precautions/Contraindications for Adult Vaccinations
•History of _______________ reaction
•Immunocompromised state (refers to live vaccines)
•Patients with febrile illness
•Allergy to ________ (influenza, pneumococcal and meningococcal vaccines)
Nursing
•Assess for:
oContraindications
oHistory of reaction
oAllergies to components of vaccine
•Educate:
oSide Effects
•Soreness at site of injection
•Low-grade fever
•Myalgia
•Malaise for 1-2 days
•Monitor:
oMonitor for local or systemic reactions
