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IMMUNITY RNSG 2572 Health Care Concepts 2 Concept – IMMUNITY Concept Definition A physiologic process that provides an individual with protection or defense from disease. Exemplars Vaccines Otitis Media Urinary Tract Infection Cellulitis Pneumonia Appendicitis Trauma-Sprain Objectives Part 1 – Alterations in Immunity Exemplars 1. Explain the correlation between otitis media, urinary tract infection, cellulitis, pneumonia, appendicitis, and trauma-sprain and the concept of Immunity (including compromised antecedents, deficit measurement in attributes, a list of negative consequences, and the interrelated concepts which may be involved). 2. Identify conditions that place an individual at risk for imbalance leading to compromised Immunity resulting in otitis media, urinary tract infection, cellulitis, pneumonia, appendicitis, and trauma-sprain. 3. Apply the nursing process with collaborative interventions for individuals experiencing otitis media, urinary tract infection, cellulitis, pneumonia, appendicitis, and trauma-sprain. Part 2 – Immunizations (Vaccines) 1. Correlate the administration of Immunizations (Vaccines) to the concept of Immunity to include: a. A description of the antecedents of active and passive immunity b. The promotion of attributes of immunity by immunizations, c. The positive outcome of protection from microorganisms with immunizations d. The relationship of the subconcepts of Immune response and Infectious response with immunizations. 2. Identify conditions that place an individual at risk for a compromise in immunity that can be resolved with immunizations. 3. Apply the nursing process with collaborative interventions for individuals receiving immunizations. Concept Analysis Diagram Note: Diagram on separate page Explanation of Immunity Diagram: The Immunity Concept Analysis Diagram begins with the definition of the concept, as based on the attributes and antecedents. The attributes - normal WBC and differential counts, 1 IMMUNITY negative bacterial and viral cultures, soft, non-tender lymph nodes, recognition of self and recognition of foreign proteins - are the defining characteristics of immunity or what constitutes immunity. The antecedents are events or incidents that must be in play in order for immunity to exist. The antecedents for immunity consist of intact non-specific defenses or barriers, a functional lymphatic system, an optimal innate immune response, a functional inflammatory response, and appropriate adaptive (acquired) immune response—active and passive. With these attributes and antecedents, immunity is a physiologic process that provides an individual with protection or defense from disease. There are interrelated concepts that impact immunity throughout the lifespan. These interrelated concepts include tissue integrity, cellular regulation, thermoregulation, comfort, coping, nutrition, mobility and functional ability. There are also sub-concepts that are major components of the immunity concept – inflammatory response, infectious response, and immune response. The sub-concepts are manifested when immunity is challenged. Consequences, positive or negative, are reliant upon the performance of the immune system. If any of the antecedents fail, for example, the result would be a negative outcome, such as infection-localized or systemic, cancer, immune suppression, immune deficiency, and chronic inflammatory response or exaggerated immune response that may lead to an allergic, cytotoxic or autoimmune reaction. If the immune system is healthy, positive outcomes will result; in that, damaged tissue and cells are replaced with repaired or functional tissue (i.e., healing), recognition and removal of cell mutations that have demonstrated abnormal cell growth and development is effected, and protection of the body from invasion of microorganisms and other antigens occurs. Last, but not least, nursing care may or may not be required, as indicated by the dotted directional lines on the diagram. Nursing care may/may not be needed to keep immunity intact, or assist with negative consequences. Assignments Prior to class: 1. Review definitions of inter-rated concepts on concept analysis diagram. 2. Review concept analysis diagram. 3. Review the following content from previous courses Immunity Concept Analysis Diagram Oxygenation Concept Analysis Diagram Gas Exchange Concept Analysis Diagram Tissue Integrity Concept Analysis Diagram Thermoregulation 4. Assigned reading: Giddens, J.F. (2013). Concepts for nursing practice. St. Louis. MO: Mosby Elsevier. Chapter 20: Immunity Chapter 22: Infection Lewis, S.L., Heitkemper, M.M., Dirksen, S.R., O’Brien, P.G., & Bucher, L. (2011). Medical surgical nursing (8th ed). St. Louis: Mosby Elsevier. Chapter 24: Integumentary Problems; Cellulitis; pg. 454 2 IMMUNITY Chapter 22: Visual and Auditory Problems; Otitis Media; pg. 425-426 Chapter 28: Lower Respiratory Problems; Pneumonia; pg. 546553. Chapter 43: Lower Gastrointestinal Problems; Appendicitis; pg. 1020-1022 Chapter 46: Renal and Urologic Problems; Urinary Tract Infection; pg. 1122-1127 Chapter 63: Musculoskeletal Trauma and Orthopedic Surgery; Sprain; pg. 1584-1586 McKinney, E, James, S., Murray, S., Nelson, K., & Ashwill, J. (2013). Maternal-child nursing (4th ed). St. Louis: Elsevier Saunders. Chapter 41: The Child with an Infectious Disease; pg. 10071028 Chapter 45: The Child with a Respiratory Alteration; Otitis Media; pg. 1151-1156 5. Internet Resources: Otitis Media http://www.mayoclinic.com/health/ear-infections/DS00303 Urinary Tract Infection http://www.cdc.gov/ncidod/dbmd/diseaseinfo/urinarytractinfecti ons_t.htm Cellulitis http://www.medicinenet.com/cellulitis/article.htm http://www.bing.com/images/search?q=cellulitis&qpvt=cellulitis &FORM=IGRE Pneumonia http://www.lung.org/lung-disease/pneumonia/ Appendicitis http://digestive.niddk.nih.gov/ddiseases/pubs/appendicitis/ Immunizations CDC: 2013 Combined Immunization Schedule Birth through 18 Years http://www.cdc.gov/vaccines/schedules/downloads/child/018yrs-schedule.pdf Adult Immunization Schedule 2013 http://www.cdc.gov/vaccines/schedules/hcp/adult.html Overview of VAERS (Vaccine Adverse Effects Reporting System) http://www.youtube.com/watch?v=a9bXB3R2qP8&feature=yout u.be 6. Review the following Nursing Diagnoses: Otitis Media Pain Hyperthermia 3 IMMUNITY Fatigue Deficient knowledge Urinary Tract Infection Pain Impaired urinary elimination Deficient knowledge Ineffective health maintenance Trauma—sprain Acute Pain Impaired physical mobility Deficient knowledge Pneumonia Ineffective breathing pattern Ineffective airway clearance Impaired gas exchange Activity intolerance Anxiety Sleep disturbance Acute pain Cellulitis Ineffective Health Acute Pain Ineffective peripheral tissue Perfusion Impaired Tissue integrity Risk for vascular Trauma: Risk factor: infusion of antibiotics Imbalanced nutrition: Less than body requirements Appendicitis Dysfunctional gastrointestinal Acute Pain Risk for infection Disturbed Body image Ineffective Breathing pattern Deficient Fluid volume Imbalanced Nutrition: less than body Immunity Risk for infection Effective therapeutic regimen management 4 IMMUNITY Concept content outline: Concept: Immunity Sub Concepts: Inflammatory Response Infectious Response Immune Response Risk Factors: Applies to each exemplar Genetic predisposition Age Socioeconomic status Lack of knowledge about infection prevention Presence of other illness Drugs and medical treatment Environmental factors Assessment: Comprehensive history Physical assessment Cultural, behavioral, social assessment Physical and psychological clinical manifestations Diagnostic tests Positive Outcomes: Replaces damaged tissue with repaired or functional tissue Recognizes and removes cell mutations Negative Outcomes: Physiological Psychological Clinical Management: Nursing interventions Collaborative interventions Pharmacological therapy Non Pharmacological therapy Procedural therapy Diagnostic studies Exemplars: Vaccines Otitis Media Urinary Tract Infection Cellulitis Pneumonia Appendicitis Trauma-Sprain 5