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Medical Surgical Nursing – Immune Disorders Lecture 8


Presented by:

Janet Maloney RN, MSM/HM

Assistant Professor-MDCC

Overview of Immune System

· Immune response is to recognize foreign substances and to neutralize, eliminate, or metabolize them with or without injury to the body’s own tissues

Functions of the Immune System

· Homeostasis: removal of worn out or damaged components (e.g., dead cells)

· Surveillance: ability to perceive or destroy mutated cells or nonselfcells

· Defense: protection against antigens. An antigen is a protein or protein complex recognized as nonself


Types of Immunity

· Natural immunity: Presented at birth. Immune responses that exist without prior exposure to an immunologically active substance.Genetically acquired immunity is natural immunity.

· Acquired immunity: immune responses that develop during the thecourse of a persons lifetime.


Components of Immune Response

· Located throughout the body

· Organs include thymus, bone marrow, lymph nodes, spleen, tonsils, appendix, Peyers’spatches of small intestine.

· Main cell types are WBCs(especially lymphocytes, plasma cells, and macrophages);

Roles of Cellular and HumoralImmune Responses


· involves the WBC’swhich have the ability to ingest foreign particles

· Theymove to the point of attach where they engulf and destroy the invading agents.

Roles of Cellular and HumoralImmune Responses

· Cellular Responses (T Cells)

· Transplant rejection

· Delayed hypersensitivity

· Tumor surveillance

· Intracellular infections

· Viral, fungal and parasitic infections

· attack the pathogens themselves


· Humoral Responses (B cells)

· Bacterial phagocytosis and lysis

· Anaphylaxis

· Allergic hay fever and asthma

· Immune complex disease

· Bacterial and some viral infections

· Attempt to disable the invaders


Recognition stage

· The immune system’s ability to recognize as foreign, or nonself, is the initiating even in any immune response.

· Body must first recognize as foreign invaders before it can react to them.

· It uses recognition using lymph nodes and lymphocytes for surveillance.

Proliferation stage

· The circulating lymphocyte containtfthe antigenic message returns to the nearest lymph node.

· Once in the node, the sensitized lymphocyte stimulates some of the resident dormant T and B lymphocytes to enlarge,divide and proliferate.

Response stage

· Function in either humoralor cellular response

Effector stage

· The antibody of the humoral response or cytotoxic(killer) T cell of the cellular response reaches and couples with the antigen on the surface of the foreign invader.

Please read this chapter very well. You must understand it. If you understand the immune system you are a step ahead of the game.

Chapter 46


Human Immunodeficiency Virus


· Pathophysiology/Etiology

· HIV is an RNA virus called retroviruses, thatreplicates itself only in a living cell

· Initial infection with HIV results in viremia, during which large amounts of virus can be isolated in the blood

· HIV replication occurs at rapid and constant rates in the blood and lymph tissue from early infection


· Pathophysiology:

· The causative agent is a retrovirus that attacks and depletes the T-4 lymphocytes

· The body responds to the presence of this virus by forming antibodies to attack the virus

· HIV destroys the CD4 molecules as it enters to infect the T4 helper lymphocytes

· Mode of Transmission:

· Sexual contact (semen, vaginal secretions, blood)

· Injection of contaminated blood or blood components (sharing of hypodermic needles, needle sticks injuries)

· Perinatally from infected mother to child (in uteroand breast feeding)

· Clinical Manifestations:

· Acute retroviral syndromemaybe mistaken for cold or flu like symptoms, occurs 1-3 weeks after initial infection and last 1-2 weeks

· Early infectionthis phase is referred to as asymptomatic disease with vague symptoms (e.g., fatigue, headache, low grade fever and night sweats may occur)

· Early asymptomatic disease the CD4+ T cells ct drops below 500-600 cells/uland s/s of early disease develops (I.e., fatigue, persistent fever, chronic diarrhea and night sweats)


Presented by

Janet Maloney, RN, MSM/HM

Assistant Professor

· Key terms:

· AIDS (Acquired Immunodefiencysyndrome)

· HIV (Human ImmunodefiencyVirus)

· Kamposi’ssarcoma

· Enzymed-linked immunosorbantassay (ELISA)

· AIDS dementia complex

· Candida albicans Burkitt’s lymphoma

· Epstein-Barr Virus

· Seroconversion

· PCP (Pneumocystis carinii pneumonia

· Western blot assay


· An acquired disease caused by the human immunodefiencyvirus (HIV)

· Characterized by severe deficit in cellular immune function with the development of opportunistic infections and malignancies

· Causes the body’s immune system to become ineffective to fight off infections

Clinical Manifestations:

· Respiratorymanifestations

· Pulmonarymanifestations

· Gastrotestinalmanifestations

· Oral/integumentmanifestations

· Neurology/endocrine manifestations

· Malignancies

· Diagnostic Evaluation:

· History and Physical

· HIV test (ELISA)

· Western blot test (to confirm dx)

· HIV tracking

· CD4 count

· Lymphocytes panel

· Diagnostic Evaluation:


· Chemistry Panel

· Toxoplasma IgG

· Viral hepatitis screen

· Syphilis serology


· Medical Management:

· Collaborative and supportive approach

· Antiretroviral therapy

· Immunomodulatortherapy (alpha interferon) stimulates macrophages and T-cell

· Radiation/chemotherapy (Decreases the size of lesions)

· Antibiotics/antidepressant

· Antidiarrheal/antifungals

· vaccines(working on finding)

· Complications:

· Opportunistic infections

· Respiratory failure

· Cachexiaand Wasting syndrome

· Death

· Nursing Diagnoses:

· Fear r/t disease process and its management

· Risk for infection r/t immunodefiency

· Altered Nutrition (less than body requirements) r/t GI symptoms

· Altered skin integrity r/t KS

· Altered Thought Processes r/t disease process

· Nursing Diagnoses cont:

· Ineffective breathing pattern r/t SOB

· Fatigue r/t reactive depression

· Disturbance in body image r/t rapid body changes

· Pain r/t infection, KS ,peripheral neuropathy

· Nursing Diagnoses cont:

· Ineffective family coping r/t crisis by AIDS

· Knowledge deficit r/t disease process and its management

· Anticipatory Grieving r/t awareness of AIDS implications, dying and death

· Nursing Interventions:

· Supportive and nonjudgmental care

· Improve and maintain airway

· Relieve pain and discomfort

· Prevent infections

· Nursing Intervention cont:

· Promote usual bowel habits

· Promote skin integrity

· Improve activity tolerance

· Maintain thought processes

· Decrease the sense of isolation

· Monitor/manage potential complications

· Evalution:

· Maintains airway

· Experiences no infections

· Maintains adequate nutritional status

· Resumes usual bowel habits

· Maintains adequate activity tolerance

· Experiences decreased pain and comfort

· Evaluation cont:

· Progress through grieving process

· Experiences decreased sense of isolation

· Reports increased understanding of AIDS and participates in self care activities

· Remains free from complications/injury

· Resources:

· National AIDS Hotline (1-800-342-AIDS)

· Spanish (1-800-344-7432)

· Creole (1-800-AIDS-101)

· TDD Service for death (1-800-243-7889)

Drug Therapy

Combination therapy of drugs has improved the quality of life, slowed disease progression and increased survival

· Nucleoside Reverse Transcriptase Inhibitors (NRITs):

·Major action is to protect non-infected CD4 cells by blocking the replication of cells containing HIV

·Retrovir (Zidovudine, AZT, ZDV); Videx (Didanosine, DDI); Havid (Zalcitabine, DDC; Zenith (Stauvudine, D4T); Epivir (Lamivudine, 3TC)

· Protease Inhibitors (PIs): Has the most impact on prolonging the life of a cline with aids.

·Action is to inhibit an enzyme that allows the viral protein in an infected cell to be transformed into smaller protein chain necessary for viral replication

·Saquinavir (Invirase, Fortovase); Indinavir (Crixivan); Ritonavir (Norvir); Nelfinavir (viracept); Amprenavir (Agenerase)

· Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs):

· Work early in the life cycle of the HIV to stop the replication of HIV-containing cells

· Delavirdine (Rescriptor); Nevirapine (Viramune); Efavirenz (Sustiva)

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