Exam 2

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Exam 2
2013-10-22 21:27:57
Nursing client concepts

immune system
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  1. 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
  2. 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
  3. Inflammatory response =non-specific response to any cell injury

    • destroy injurious agent
    • prevent spread of injury 
    • promote tissue repair
    • *keep it local,,,bring immune cells to area-increases swelling
  4. Immunocompetent cells (LEUKOCYTE) 
    • Arise from same kind of stem cells that give rise to RBC
    • 5 types: monocyte, neutrophil, basophil, eosinophil, lymphocyte
    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
  6. 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)
    • contains granules containing histamine and heparin 
    • lines respiratory tract
    • associated with hypersensitivity reactions
  8. 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
  9. 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)
    • 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 
  11. 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
  12. hummoral immunity actions ...antibody/antigen reactions 
    • agglutination
    • precipitation
    • opsonization
    • lysis
    • neutralization
    • activation of complement
  13. 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
  14. 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)
  15. modulation of immune response 
    • aging
    • nutrition
    • stress(cancer pt increased stress year before-->changed chemistry of immune system )
    • steroids
  16. 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
  17. Nutrition 
    • decreased protein intake(decreased t cell response)--can't make new cells 
    • prolonged wound healing 
    • decreased capability of neutrophils and macrophages
  18. 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
  19. 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
  20. ROLE of nurse 
    • protection of pt
    • recognize high risk: elderly, malnourished, newborns, steroid uses, NG tube(decreased acid), antibiotic therapy(decreased vaginal activity)
  21. NURSIng interventions
    • immunizations 
    • actue or chronic infections 
    • drug use(steroid, chemo therapy) 
    • co morbidity(DM, ETOH, drug abuse)
    • stressors 
    • nutrition
  22. 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)
  23. lab results 
    • WBC(5-11,000)
    • neutrophil count 
    • lymphocyte count(esp in bacteria/viral infection) 
    • monocyte count(esp in protozoan and Tb)
  24. interventions 
    • primary interventions: id high risk, infection control, education, nutrition
    • secondary : culture wounds, treat fever/pain/fluid loss, monitor VS