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Immune Function
by Zelne Zamora, DNP, RN
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The Immune System
• Immunity: the body’s specific protective response to
invading foreign agent or organism
• Immunopathology: the study of diseases that result from
dysfunction the immune system
• Components of immune system
– Bone marrow: T cells and B cells
– Lymphoid tissue: spleen and lymph nodes
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The Immune System
 Immune disorders: see Table 35-1
 Automimmunity
 Hypersensitivty
 Gammopathies
 Immune deficiencies: primary and secondary
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Central and Peripheral Lymphoid Organs
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Development of Cells of the Immune
System
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Maturity of Lymphocytes
• B lymphocytes mature in the bone marrow.
• T lymphocytes mature in the thymus, where they also
differentiate into cells with various functions.
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Cellular Response: WBCs
 Cellular response is important
to starting the immune
response: white blood cells/
leukocytes
 Granulocytes
 Neutrophils
 Eosinophils & Basophils
 Monocytes/macrophages –
phagocytic cells
 Lymphocytes
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WBCs – Neutrophils
Neutrophils
Most abundant
“Patrol blood”
First on scene
Initiate immune
response
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WBCs – Eosinophils & Basophils
Eosinophils
 Usually see increase
during allergic response
 Seen in parasite invasion
Basophils
 Least number
 Release is receptormediated
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WBCs – Monocytes & Lymphocytes
Mononuclear cells
Monocytes
 Macrophage – in tissue
 “Eat” foreign particles
 Give rise to osteoclasts
Lymphocytes
 T-cells and B-Cells
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Differential
• “Differentiates” out the
white count
• WBCs – granulocytes,
neutrophils, basophils,
etc
• Segment = mature
neutrophil
• Band = stab neutrophil
or immature neutrophil
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Normal numbers
• WBC – 7,000 – 11,000 (numbers will vary with dx
books. Sometimes will see 7-11 with x109 implied)
• 2-6% bands (immature WBC)
• Infection can cause “shifts” on reports
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Shift to the Left
• Increase in immature
WBCs
• “kicked out” into
bloodstream
• Ratio of immature WBCs
greater than mature
cells
• Usually seen in cases of
increasing infection, i.e.,
bacterial infection or
postop infection
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Shift to the Left
• A left shift can occur with either a HIGH or LOW white
blood count.
• A high WBC count indicates release of immature
neutrophils in response to overwhelming
inflammation or infection.
• A left shift with low WBC count indicates infection of
such intensity that demand for neutrophils exceeds
supply, or it can indicate recovery from bone marrow
suppression.
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Shift to the Left
• Usually seen: active infection, hypoxia or shock,
sepsis, or severe inflammatory responses
• Accelerates the release of cells from reserve pool in
bone marrow therefore more immature WBCs
released into the blood stream
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Shift to the right
• Ratio of mature WBCs
greater than production
of immature WBCs
• Can see “giant
neutrophils” due to
large size
• Seen with suppression
of bone marrow activity
• i.e., pernicious anemia,
radiation sickness, viral
infection
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Shift to the right
• A right shift indicates that
cells have more than the
usual number of nuclear
segments
• For Infections:
• the infection is clearing
• the store of
polymorphonuclear
leukocytes is exhausted and
the body cannot keep up
with the supply that is
required to fight off the
infection
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Left vs. Right Shift
• Shift to left = Incr. bands Means acute infection, usually
bacterial.
Shift to right = Incr. mature cells
• Degenerative shift to left: Overwhelming infections, incr.
in bands without leukocytosis
Regenerative shift to left: Incr. in bands with leukocytosis,
bacterial infections, Good prognosis
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Left vs. Right Shift
• Shift to right: Few bands with neutrophilia, *viral
infections, liver disease, megaloblastic anemia, hemolysis,
drugs, cancer (leukemia), allergies
Hypersegmentation without bands: Pernicious anemia,
chronic morphine addiction
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Function of the Immune System
• To remove foreign antigens such as viruses and bacteria
to maintain homeostasis
• Types
– Natural: acquired at birth
– Acquired: develops after birth
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Immune Function
 Natural immunity:
nonspecific response to
any foreign invader
 White blood cell action
 Inflammatory response
 Physical barriers, such
as intact skin, chemical
barriers, and acidic
gastric secretions or
enzymes in tears and
saliva
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Immune Function
 Acquired immunity:
specific against a
foreign antigen
 Result of prior
exposure to an
antigen
 Active or passive
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Stages of Immune Response
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Stages of Immune Response
 Recognition
 Lymph nodes and
lymphocytes
 Use circulation to
“patrol” tissues and
vessels
 Once foreign invader
discovered, immune
process initiated
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Stages of Immune Response
 Proliferation
 T-cells and B-cells
divide rapidly
 T-cells  Killer T-cells
 B-cells  antibodies
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Stages of Immune Response
 Response
 Humoral – antibodies
released into the
bloodstream
 Cell-mediated – direct
attack on microbe by
killer T-cells
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Stages of Immune Response
 Effector
 Depends on which
response reaches
antigen first: humoral
or cell-mediated
 Outcome: total
destruction vs.
complete
neutralization of
invading microbe
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Defenses
 Phagocytic immune response
 WBCs – granulocytes & macrophages
 Apoptosis
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Immunity
• Cell-mediated
• T cells(helper/CD4) activates
immune cells
• T cells (cytotoxic/killer CD8)
• T cells produce cytokines
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Cellular Immune Response
 T lymphocytes: cellular immunity
 Attack invaders directly, secrete
cytokines, and stimulate immune
system responses
 Helper T cells
 Cytotoxic T cells
 Memory cells
 Suppressor T cells (suppress
immune response)
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Cytotoxic T-Cells/ T-helper cells
 Cytoxic T lymphocytes
 Unique antigen CD8
 Kill infected cells,
preventing spread
 Helper T cells
 Unique antigen CD4
 Pathogens that live
in vesicles
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Immunity
• Antibody (humoral)
mediated
• B cell activation
• B cell clones itself and
produces antibodies
• Some vaccines work in this
manner
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Defense: Humoral Immune Response
 B lymphocytes: humoral
immunity
 Produce antibodies
or immunoglobulins
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Defense: Humoral - Antibodies
 Agglutination of antigens
 Neutralization
 Opsonization
 Promote release of
vasoactive substances;
activation of complement
system and phagocytosis
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Defense: Humoral - Antibodies
 Promote release of
vasoactive substances;
activation of complement
system and phagocytosis
 Act in concert with other
components of the immune
system
 Types of immunoglobulins:
IgA, IgD, IgE,IgG, and IgM
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Immunoglobulins (Antibodies)
“G-A-M-E-D”
• G – granulocytes or greatest
number (75%)
• A – air and absorption (15%)
• M – miserable (10%)
• E – Ant –E – histamine
(0.004%)
• D – differentiation (0.2%)
For major characteristics, See chart 35-2
[p. 975] in your textbook
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Antibody Molecule
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Antigen–Antibody Binding
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Non-T and Non-B Lymphocytes Involved
in Immune Response
• Null cells
– Destroy antigen
coated with antibody
• Natural killer cells
– Defend against
microorganisms and
some malignant cells
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Complement System
• Circulating plasma proteins made in the liver and
activated when antibody connects to antigen playing an
important defense against microbes
• Activated by three pathways: classic, lectin, and
alternative
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Complement-Mediated Immune Responses
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Variables That Affect
Immune System Function
 Age and gender (Table 35-4)
 Nutrition
 Presence of conditions and
disorders: cancer/neoplasm,
chronic illness, autoimmune
disorders, surgery/trauma
 Allergies
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Variables That Affect
Immune System Function
 History of infection and
immunization
 Genetic factors (chart 35-4)
 Lifestyle
 Medications and transfusions:
(Chart 35-5)
 Pyschoneuroimmunologic factors
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Tests to Evaluate Immune Function
 WBC count and differential
 Bone marrow biopsy
 Humoral and cellular
immunity tests
 Phagocytic cell function test
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Tests to Evaluate Immune Function
 Complement component tests
 Hypersensitivty tests
 Specific antigen–antibody tests
 HIV infection tests
 See Chart 35-6
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Vaccines
• Abate serious possibly lifethreatening infections
• Titers
• Microbes are either
– Killed
– Live, attenuated
– Toxoids – hazardous properties
have been removed from the
bacteria
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Vaccines
• Active immunity – pt’s
immune system stimulated
to produce antibodies after
exposure to antigen
• Passive immunity – direct
administration of antibodies
– usually short lived
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Vaccines
• Diphtheria, tetanus,
pertussis
• Haemophilus influenza
• Hepatitis B
• Measles, mumps, rubella
• Poliovirus
• Varicella zoster
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Side Effects of Vaccines
• Redness and discomfort at the
site of injection
• Fever
• Contraindicated in people who
are immunocompromised,
immunosuppressed, have
diarrhea, vomiting, or fever
• Anaphylaxis
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Immunomodulators
• Affects the host via direct
or indirect effects on one
or more components of
the immuno-regulatory
network; help to enhance
the immune system
– Interferons: antiviral and
antitumor properties
used to treat multiple
sclerosis and chronic
hepatitis
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Immunomodulators
• Colony-stimulating factors: play a key regulatory
role in the growth and differentiation of bone
marrow cells.
• Monoclonal antibodies: growth and production of
targeted antibodies for specific pathologic
organisms
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Immunology Advances
• Normal DNA matched with
others to enhance immunity
• Alter current genetic
problems (recombinant DNA)
• Stem cells – restore
immunity
• Controversy with stem cell
therapy
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 Allergy
Allergic Reactions
 An inappropriate, often harmful response of the
immune system to normally harmless substances
 Hypersensitive reaction to an allergen initiated by
immunological mechanisms that is usually mediated by
IgE antibodies
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Allergic Reactions
 Allergen: the substance that
causes the allergic response
 Atopy: allergic reactions
characterized by IgE antibody
action and a genetic
predisposition
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Immunoglobulins and Allergic Response
 Antibodies (IgE, IgD, IgG, IgM, and IgA) react with
specific effector cells and molecules, and function to
protect the body
 IgE antibodies are involved in allergic disorders
 IgE molecules bind to an allergen and trigger mast cells
or basophils
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Immunoglobulins and Allergic Response
• These cells then release chemical
mediators such as histamine,
serotonin, kinins, SRS-A, and
neutrophil factor
• These chemical substances cause
the reactions seen in allergic
response
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Allergic Reaction
• Allergen triggers the B cell to make IgE antibody, which
attaches to the mast cell. When that allergen reappears,
it binds to the IgE and triggers the mast cell to release
its chemicals.
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Chemical Mediators
• Primary
– Histamine
– Eosinophil chemotactic
factor of anaphylaxis
– Platelet-activating
factor
– Prostaglandins
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Chemical Mediators
• Secondary
– Leukotrienes
– Bradykinin
– Serotonin
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Hypersensitivity
 A reflection of excessive or aberrant immune
response
 Sensitization: initiates the buildup of antibodies
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Hypersensitivities
(Figure 38-2)
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Type I—Anaphylactic Reaction
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Anaphylactic Reaction
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Chart 38-3 – Common causes
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Type I Hypersensitivity
 Clinical symptoms
determined by:
 Amt of exposure
 Amt of mediator
released
 Sensitivity of organ
 Route of allergy entry
 Can also affect skin, GI
tract, lungs
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Type II—Cytotoxic Reaction
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Type II Hypersensitivity
 Normal body constituent
identified as foreign
 Chemical mediators released
 See table 38-1
 Activation of complement
cascade  cell destruction
 Diseases: myasthenia gravis,
Goodpasture [lung and renal
damage], blood transfusion
incompatibility
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Type II Hypersensitivity
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Type III—Immune Complex Reaction
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Type III Hypersensitivity
 Immune complex hypersensivity
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Type III
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Type IV—Delayed or Cellular Reaction
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Management of Patients With
Allergic Disorders
 History and manifestations
 Comprehensive allergy
history
 See Chart 38-1 – sample
allergy assessment
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Management of Patients With
Allergic Disorders
 Diagnostic tests
 CBC-eosinophil count
 Total serum IgE
 Skin tests: note
precautions
 Screening procedures
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Intradermal Testing
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Interpretation of Reactions
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Medication
• Oxygen, if respiratory assistance
needed
• Epinephrine for anaphylactic
reactions
• Antihistamines
• Corticosteroids
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Prevention and Treatment of Anaphylaxis
• Screen and prevent: (see Chart
38-7)
• Treat respiratory problems:
– provide oxygen
– intubation
– cardiopulmonary
resuscitation as needed
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Prevention and Treatment of Anaphylaxis
 Epinephrine: 1:1,000 SQ
 Auto injection system: EpiPen
 May follow with IV epinephrine
 IV fluids
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Self-Administration of Epinephrine
(Chart 38-4)
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HYPERSENSITIVITIES
• What is happening in the body?
• Can you recognize the signs and symptoms?
• What nursing actions are a priority?
• What type of hypersensitivity is it?
• What blood tests might you expect?
• What drugs may be given to manage the problem?
• How can the nurse demonstrate vigilance?
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Allergic Rhinitis
• Hay fever, seasonal
allergic rhinitis
• A common respiratory
allergy presumed to be
mediated by a type I
hypersensitivity
• Affects 10% to 25% of
the population
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Allergic Rhinitis
• Symptoms include
sneezing and nasal
congestion, clear watery
discharge, nasal itching,
itching of throat ands soft
palate, dry cough,
hoarseness, headache
• May affect the quality of
life, producing fatigue,
loss of sleep, and poor
concentration
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Nursing Process: The Care of the Patient
With Allergic Rhinitis—Assessment
• Health history
• Include personal and family history
• Allergy assessment
• Subjective data include symptoms and how the patient
feels before symptoms become obvious
• Note relationship between symptoms and seasonal
changes, emotional problems, or stress
• Identify nature of antigens, seasonal changes in
symptoms, and medication history
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Nursing Process: The Care of the Patient
With Allergic Rhinitis—Diagnoses
• Ineffective breathing pattern related to allergic reaction
• Deficient knowledge about allergy and the recommended
modifications in lifestyle and self-care practices
• Ineffective individual coping with chronicity of condition
and need for environmental modifications
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Collaborative Problems and Potential
Complications
• Anaphylaxis
• Impaired breathing
• Nonadherence to
therapeutic regimen
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Nursing Process: The Care of the Patient
With Allergic Rhinitis—Planning
• Goals may include
– Restoration of normal
breathing pattern
– Increased knowledge
about the causes and
control of allergic
symptoms
– Improved coping with
alterations and
modifications
– Absence of
complications
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Nursing Process: The Care of the Patient
With Allergic Rhinitis—Intervention:
Breathing
• Modify the environment to reduce allergens
• Reduce exposure to people with URI
• Take deep breaths and cough frequently
• Tx therapy similar to asthma treatment regimen
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Nursing Process: The Care of the Patient
With Allergic Rhinitis—Intervention:
Teaching
• Instruction to minimize
allergens
• Use of medications
• Desensitization
procedures
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Hypersensitivity
 Types of hypersensitivity reactions
 Anaphylactic: type I
 Cytotoxic: type II
 Immune complex: type III
 Delayed type: type IV
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