IMMUNITY

Concept 20

Goals for This Concept Presentation

1. Define and describe the concept.

2. Notice risk factors for altered immune functioning.

3. Recognize when an individual has altered immune functioning.

4. Provide appropriate nursing and collaborative interventions to optimize the immune response and minimize the complications of an altered immune response.

Definition

The normal physiologic response to microorganisms and proteins as well as conditions associated with an inadequate or excessive immune response.

Altered Immunity

• What is meant by “altered” immunity?

Conditions in which immune responses are either suppressed or exaggerated

Suppressed responses are referred to as immunocompromised or immunodeficiency

Exaggerated responses are referred to as hypersensitive

Scope of Concept

Types of Immune Response

Collaborative Learning #1

In your learning group, define, compare, and contrast the following immunity terms:

•Innate immunity

•Active acquired immunity

•Passive acquired immunity

Review of Immune Response

• Major histocompatibility complex

• Organs involved with immune response

• Cells associated with immune response

Overview of Immune Response

Suppressed Immune Response

• Primary immunodeficiency

• Secondary immunodeficiency– Intentional– Adverse effect of treatment

Exaggerated Immune Response

• Four types of exaggerated immune response– Type I– Type II– Type III– Type IV

• Hypersensitive reactions– Localized effects– Systemic effects

Consequences of Suppressed Immune Response

The two major types of problems that result from suppressed immune response are

•Infection

•Cancer

What is the link between a suppressed immune response and these consequences?

Consequences of Exaggerated Immune Response

• Acute hypersensitive reaction– Localized effect– Systemic effect

• Chronic body-wide system disease– Destruction of body tissue– Abnormal organ growth– Change in organ function

Elements of History

• Past medical history• Family history• Genetic history • Current medications• Allergies to medications or other substances• Lifestyle behaviors• Occupation• Social environment

Exaggerated Immune Functioning*

Symptoms

• Allergic symptoms

• Pain

• Fatigue

• Fever

Clinical Findings

• Allergic response– Mild allergic response

– Severe allergic response

• Autoimmune disorders– Can range from vague

findings to findings associated with organ failure

*Note: Symptoms of autoimmune disorders tend to be vague. Clinical findings vary widely based on the severity of the problem.

Suppressed Immune Functioning*

Symptoms• Report of frequent

infections

• Report of poor wound healing

• Fatigue

• Malaise

• Weight loss

Clinical Findings• May appear poorly

nourished or have wasting syndrome

• May have chronic wounds

• May have enlarged lymph nodes

• Presence of opportunistic infection

*Note: Symptoms and clinical findings vary widely based on the severity of the problem.

Common Diagnostic Tests

Primary Testing

• Red blood cell count and white blood cell count with differential

• Fluorescent antinuclear antibody

• C-reactive protein (CRP)

• Erythrocyte sedimentation rate (ESR)

Other Diagnostic Tests and Disease-Specific Testing

• Allergy testing

• Genetic testing

• Rheumatoid factors (RFs)

• Western blot test

• TORCH antibody panel

• Organ function tests

Clinical Management:Primary Prevention

• Immunizations

• Avoid high-risk behaviors

• Adequate nutrition

• Exercise

• Infection control measures

Collaborative Care:Exaggerated Immune Response

• Remove exposure (if possible)• Airway support (if anaphylaxis occurs)• Pharmacotherapy

– Reduce response• Antihistamine• Sympathomimetic• Mast cell stabilizer • Immunosuppressive therapy• Antiinflammatory agents

– Symptomatic relief• Antipruritic• Decongestant• Analgesics

Collaborative Care:Immunodeficiency

• Monitor immune function

• Nutrition

• Prevent opportunistic infections

• Monitor and treat opportunistic infections

• Drug therapy

Interrelated Concepts

Collaborative Learning #4

In your learning group, develop a list of the four most important concepts related to immunity. Defend your answers. Compare your list with those of other learning groups.Interrelated Concept Rationale

Immunity

Suppressed Immune Response

Exaggerated Immune Response

ExemplarsCollaborative Learning #5 In your learning group, identify and discuss common conditions linked to suppressed or exaggerated immune responses. Write the conditions in the boxes.