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What are the parts of the immune system?
- -lymph nodes
- -thymus(active in childhood,Tcells)
- -spleen(filters)
- -tonsils(lymph node WBC live here)
- -bursa equivalent(B cells)
- -peyer's patch..appendix
- -immunocompentent cells
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Non specific Defenses
-normal flora
-inflammatory response
-Organ systems
- skin:barrier
- eyes:tears(mechanical rinse of eye)
- nose: cilia, sneeze(mucous blankets...cough it up)
- URI:cilia, cough
- Mouth: saliva, enzymes
- GI: acid, normal flora
- BU: urine flow, PH
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Inflammatory response =non-specific response to any cell injury
PURPOSE?
- destroy injurious agent
- prevent spread of injury
- promote tissue repair
- *keep it local,,,bring immune cells to area-increases swelling
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Immunocompetent cells (LEUKOCYTE)
- Arise from same kind of stem cells that give rise to RBC
- 5 types: monocyte, neutrophil, basophil, eosinophil, lymphocyte
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MONOCYTE
or macrophage
- released and ciruculates for 24 hours then moves to tissue location(lungs,liver, speeln, lymph nodes, peritoneal cavity)
- produces growth factors for other WBC
- clears necrotic debris(macrophage)
- second line of defense
- plays a regulatory role( chemical messenger..monokine... stimulates chemotaxis)
- engulfs antigen and presents it to the B and T cells ...puts chunks of cell membrane (antibody) for other to see
- *can help other WBC and send SOS
- *chemotaxis-other WBC moving to area due to chemicals sent by monokine
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Neutrophil
*most important "granulocyte"
- )50-79%) of total WBC
- first line of defense
- contains granules filled with lysosomal enzymes (breaks up stuff)
- immature(bands)
- mature(segs...takes 7-14 days to mature)
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BASOPHIL
- contains granules containing histamine and heparin
- lines respiratory tract
- associated with hypersensitivity reactions
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basophil...heprin
and histamine and resp
- heprin-anticoagulant and brings more blood --to get more help
- histamine-causes swelling
- -bleed/swell--wall it off and keep it there ...swells ultimatly due to location
- -resp-trying to reduce exposure to irritating stimuli
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Eosinophil
- (2-4% of leukocytes)
- found in GI and lungs
- phagocytize parasites(eats them)
- release histaminease to alleviate allergic symptoms (turns of swelling, asthma may be low)
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LYMPHOCYTES
- precursor cells formed in fetal bone marrow..migrate to lymph nodes, thymus and spleen
- thymus cells become t cells
- cells from other tissues(Bursa equivalent) become B cells
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HUMORAL immunity
- Mature B cells(plasma cell) activate to produce antibodies
- igM occurs first in fetal life..most effective against bacterial invasion
- igG -activates complement (clotting cascade..necessary for babies)-can cross placenta, effective against bacteria
- IgA-found in saliva, tears, mucus, urinary tract, prevents adherence of antigens
- IgD -activates B lymphocytes to become plasma cells
- IgE - important in allergic responses
- liquid immunity B cells=plasma cells=antibody
- immunogloblins=antibodies
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hummoral immunity actions ...antibody/antigen reactions
- agglutination
- precipitation
- opsonization
- lysis
- neutralization
- activation of complement
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cell mediated immunity
- T cells, release lymphokines(interleukin II)
- -attracts other WBC to area
- -destroys target cells
- -inhibits viral replication
- -regulates other lymphocytes
- -differentiate into subpopulations:cyotoxic, helper, suppressor, memory
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sequence of events??
- neutrophil
- macrophage
- monokin
- chemotaxis
- lymphocytes
- -b-antibodies
- -t-lymphokines
- ---b cell growth
- ---helper t production(bring more macrophages, make memory t cells)
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modulation of immune response
- aging
- nutrition
- stress(cancer pt increased stress year before-->changed chemistry of immune system )
- steroids
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aging
- thymus begins to deterioate after age 50
- decreases differention of T cells
- decreases T cell action (esp helper t )
- decreased antibody levels
- increased likelihood of auto-antibody production
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Nutrition
- decreased protein intake(decreased t cell response)--can't make new cells
- prolonged wound healing
- decreased capability of neutrophils and macrophages
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steroid use
- lymphopenia
- neutropenia
- cortizone decreases inflammation which dampens immune response
anabolic-at risk for hidden infections decrease immune .. may have an infection but show no symptoms
- self from non self.autoimmune disease body attacks self(rheumatoid arthritis,lupus(rash resembles a wolf bite or a butterfly rash on any organ)
- penia-shortage of
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immunizations
- passive(give pre-formed antibodies such as hepB)
- active-vaccines developed form disease producing microorganisms or their antigens...tiny peive of virus or broken down
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ROLE of nurse
- protection of pt
- recognize high risk: elderly, malnourished, newborns, steroid uses, NG tube(decreased acid), antibiotic therapy(decreased vaginal activity)
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NURSIng interventions
- immunizations
- actue or chronic infections
- drug use(steroid, chemo therapy)
- co morbidity(DM, ETOH, drug abuse)
- stressors
- nutrition
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Physical exams
- local signs
- fever
- increased HR, RR (most sensitive)
- malaise (not wanting to do anything)
- anorexia(lack of appetite)
- headache
- enlarged lymph nodes(lymphadenopathy-swelling lymph nodes)
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lab results
- WBC(5-11,000)
- neutrophil count
- lymphocyte count(esp in bacteria/viral infection)
- monocyte count(esp in protozoan and Tb)
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interventions
- primary interventions: id high risk, infection control, education, nutrition
- secondary : culture wounds, treat fever/pain/fluid loss, monitor VS
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