1. CHAPTER 7 IMMUNITY MITZY D. FLORES, MSN, RN

2. 2 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. IMMUNE SYSTEM RESPONSIBLE FOR BODY DEFENSES NONSPECIFIC RESPONSE (DEFENSE) EXAMPLES: PHAGOCYTOSIS, INFLAMMATION SPECIFIC RESPONSE (DEFENSE) PRODUCTION OF SPECIFIC ANTIBODIES AGAINST FOREIGN SUBSTANCES

3. 3 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. COMPONENTS OF THE IMMUNE SYSTEM LYMPHOID STRUCTURES LYMPH NODES SPLEEN TONSILS INTESTINAL LYMPHOID TISSUE LYMPHATIC CIRCULATION IMMUNE CELLS LYMPHOCYTES MACROPHAGES

4. 4 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. COMPONENTS OF THE IMMUNE SYSTEM (CONT.) TISSUES—IMMUNE CELL DEVELOPMENT BONE MARROW ORIGINATION OF ALL IMMUNE CELLS THYMUS MATURATION OF T LYMPHOCYTES

5. 5 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. STRUCTURES OF THE IMMUNE SYSTEM

6. 6 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. ELEMENTS OF THE IMMUNE SYSTEM ANTIGENS SELF HLA PROTEINS LABEL CELLS OF THE INDIVIDUAL. IMMUNE SYSTEM IGNORES SELF CELLS. NON-SELF IMMUNE SYSTEM RECOGNIZES SPECIFIC NONSELF ANTIGENS AS FOREIGN. DEVELOPMENT OF A SPECIFIC RESPONSE TO THAT PARTICULAR ANTIGEN MEMORY CELLS PRODUCED TO RESPOND QUICKLY TO ANTIGEN

7. 7 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. ANTIGENS (IMMUNOGENS) USUALLY EXOGENOUS SUBSTANCES CELL SURFACE ANTIGENS PROTEINS POLYSACCHARIDES GLYCOPROTEINS

8. 8 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. CELLS MACROPHAGES INITIATION OF IMMUNE RESPONSE DEVELOP FROM MONOCYTES PART OF THE MONONUCLEAR PHAGOCYTOTIC SYSTEM ENGULF FOREIGN MATERIAL DISPLAY ANTIGENS OF FOREIGN MATERIAL SECRETE CHEMICALS EXAMPLES: MONOKINES, INTERLEUKINS PRESENT THROUGHOUT THE BODY

9. 9 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. CELLS LYMPHOCYTES T LYMPHOCYTES FROM BONE MARROW STEM CELLS FURTHER DIFFERENTIATION IN THYMUS CELL-MEDIATED IMMUNITY CYTOTOXIC T KILLER CELLS HELPER T CELLS MEMORY T CELLS

10. 10 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. CELLS (CONT.) LYMPHOCYTES B LYMPHOCYTES RESPONSIBLE FOR PRODUCTION OF ANTIBODIES HUMORAL IMMUNITY MATURE IN BONE MARROW PROCEED TO SPLEEN AND LYMPHOID TISSUE PLASMA CELLS PRODUCE ANTIBODIES B MEMORY CELLS CAN QUICKLY FORM CLONE OF PLASMA CELLS

11. 11 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. TYPES OF IMMUNITY HUMORAL IMMUNITY: ANTIBODIES ARE PRODUCED TO PROTECT THE BODY. CELL-MEDIATED IMMUNITY (CMI): LYMPHOCYTES ARE PROGRAMMED TO ATTACK NONSELF CELLS TO PROTECT THE BODY.

12. 12 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. DEVELOPMENT OF CELLULAR AND HUMORAL IMMUNITIES

13. 13 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. ANTIBODIES AND IMMUNOGLOBULINS IGG MOST COMMON IN BLOOD IGM FIRST TO INCREASE IN IMMUNE RESPONSE IGA IN SECRETIONS TEARS SALIVA AND MUCOUS MEMBRANES COLOSTRUM

14. 14 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. ANTIBODIES AND IMMUNOGLOBULINS (CONT.) IGE ALLERGIC RESPONSE CAUSES RELEASE OF HISTAMINE AND OTHER CHEMICALS RESULTS IN INFLAMMATION IGD ATTACHED TO B CELLS ACTIVATES B CELLS

15. 15 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. REVIEW OF THE MAJOR COMPONENTS OF THE IMMUNE SYSTEM MAJOR COMPONENTS OF THE IMMUNE SYSTEM AND THEIR FUNCTION

16. 16 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. COMPLEMENT SYSTEM ACTIVATED DURING IMMUNE REACTIONS WITH IGG OR IGM GROUP OF INACTIVE PROTEINS CIRCULATING IN BLOOD C1 TO C9 CAUSES CELL DAMAGE AND FURTHER INFLAMMATION WHEN ACTIVATED

17. 17 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. CHEMICAL MEDIATORS INVOLVED IN INFLAMMATION AND IMMUNE REACTIONS EXAMPLES: HISTAMINE, INTERLEUKINS VARIETY OF FUNCTIONS SIGNALING CAUSING CELLULAR DAMAGE

18. 18 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. DIAGNOSTIC TESTS TITER (TITRE) MEASURES LEVELS OF SERUM IMMUNOGLOBULINS INDIRECT COOMBS’ TEST DETECTS RH BLOOD INCOMPATIBILITY ELISA DETECTS HIV ANTIBODIES USED FOR A NUMBER OF OTHER DISEASES MHC TYPING TISSUE MATCHING BEFORE TRANSPLANTATION PROCEDURES

19. 19 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. IMMUNITY NATURAL IMMUNITY SPECIES-SPECIFIC INNATE IMMUNITY GENE-SPECIFIC RELATED TO ETHNICITY

20. 20 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. IMMUNITY (CONT.) PRIMARY RESPONSE FIRST EXPOSURE TO ANTIGEN 1 TO 2 WEEKS BEFORE ANTIBODY TITER REACHES EFFICACY SECONDARY RESPONSE REPEAT EXPOSURE TO THE SAME ANTIGEN MORE RAPID RESPONSE, WITH EFFICACY IN 1 TO 3 DAYS

21. 21 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. PRIMARY AND SECONDARY IMMUNE RESPONSES

22. 22 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. IMMUNITY ACTIVE NATURAL IMMUNITY NATURAL EXPOSURE TO ANTIGEN DEVELOPMENT OF ANTIBODIES ACTIVE ARTIFICIAL IMMUNITY ANTIGEN PURPOSEFULLY INTRODUCED TO BODY STIMULATION OF ANTIBODY PRODUCTION IMMUNIZATION BOOSTER IMMUNIZATION

23. 23 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. IMMUNITY (CONT.) PASSIVE NATURAL IMMUNITY IGG TRANSFERRED FROM MOTHER TO FETUS: ACROSS PLACENTA THROUGH BREAST MILK PROTECTION OF INFANT FOR THE FIRST FEW MONTHS OF LIFE OR UNTIL WEANED PASSIVE ARTIFICIAL IMMUNITY INJECTION OF ANTIBODIES SHORT-TERM PROTECTION

24. 24 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. TYPES OF ACQUIRED IMMUNITY

25. 25 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. TISSUE AND ORGAN TRANSPLANT REJECTION HYPERACUTE REJECTION IMMEDIATELY AFTER TRANSPLANTATION ACUTE REJECTION DEVELOPS AFTER SEVERAL WEEKS CHRONIC, LATE REJECTION OCCURS AFTER MONTHS OR YEARS

26. 26 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. IMMUNOSUPPRESSION REDUCTION OF IMMUNE RESPONSE TO PREVENT REJECTION COMMONLY USED DRUGS CYCLOSPORINE, AZATHIOPRINE, PREDNISONE HIGH RISK OF INFECTION CAUSED BY IMMUNOSUPPRESSION OPPORTUNISTIC ORGANISMS

27. 27 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. HYPERSENSITIVITY REACTIONS TYPE I HYPERSENSITIVITY—ALLERGIC REACTIONS COMMON CAUSED BY ALLERGEN SKIN RASHES HAY FEVER CAUSATIVE MECHANISM EXPOSURE TO ALLERGEN DEVELOPMENT OF IGES MAST CELLS COMPLICATIONS ANAPHYLAXIS

28. 28 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. HYPERSENSITIVITY REACTIONS (CONT.)  Type I hypersensitivity–allergic reactions (Cont.)  Hay fever: allergic rhinitis Nasal mucosa  Food allergies Digestive tract mucosa  Atopic dermatitis/eczema Skin  Asthma Bronchial mucosa

29. 29 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. TYPE I HYPERSENSITIVITY

30. 30 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. ANAPHYLAXIS: ANAPHYLACTIC SHOCK SEVERE, LIFE-THREATENING SYSTEMIC HYPERSENSITIVITY REACTION DECREASED BLOOD PRESSURE CAUSED BY RELEASE OF HISTAMINE AIRWAY OBSTRUCTION SEVERE HYPOXIA CAN BE CAUSED BY: LATEX MATERIALS INSECT STINGS NUTS OR SHELLFISH; VARIOUS DRUGS

31. 31 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. ANAPHYLAXIS (CONT.) SIGNS AND SYMPTOMS GENERALIZED ITCHING OR TINGLING, ESPECIALLY IN ORAL CAVITY COUGHING DIFFICULTY BREATHING FEELING OF WEAKNESS DIZZINESS OR FAINTING SENSE OF FEAR AND PANIC EDEMA AROUND EYES, LIPS, TONGUE, HANDS, FEET HIVES COLLAPSE WITH LOSS OF CONSCIOUSNESS

32. 32 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. EFFECTS OF ANAPHYLAXIS

33. 33 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. SIGNS AND SYMPTOMS OF ANAPHYLAXIS

34. 34 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. TREATMENT FOR ANAPHYLAXIS REQUIRES FIRST AID RESPONSE: ADMINISTER EPIPEN IF AVAILABLE CALL 911 (MANY PARAMEDICS CAN START DRUG TREATMENT AND OXYGEN) TREATMENT IN EMERGENCY DEPARTMENT: EPINEPHRINE GLUCOCORTICOIDS ANTIHISTAMINES OXYGEN STABILIZE BP

35. 35 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. TYPE II: CYTOTOXIC HYPERSENSITIVITY ANTIGEN IS PRESENT ON CELL MEMBRANE MAY BE NORMAL BODY COMPONENT OR EXOGENOUS CIRCULATING IGGS REACT WITH ANTIGEN DESTRUCTION BY PHAGOCYTOSIS OR CYTOLYTIC ENZYMES EXAMPLE RESPONSE TO INCOMPATIBLE BLOOD TRANSFUSION

36. 36 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. TYPE II HYPERSENSITIVITY

37. 37 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. TYPE III: IMMUNE COMPLEX HYPERSENSITIVITY ANTIGEN COMBINES WITH ANTIBODY FORMS IMMUNE COMPLEXES, DEPOSITED IN TISSUE ACTIVATION OF COMPLEMENT SYSTEM PROCESS CAUSES INFLAMMATION AND TISSUE DESTRUCTION EXAMPLES: GLOMERULONEPHRITIS RHEUMATOID ARTHRITIS

38. 38 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. TYPE III: IMMUNE COMPLEX REACTION

39. 39 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. TYPE IV: CELL-MEDIATED OR DELAYED HYPERSENSITIVITY DELAYED RESPONSE BY SENSITIZED T LYMPHOCYTES RELEASE OF LYMPHOKINES INFLAMMATORY RESPONSE DESTRUCTION OF THE ANTIGEN EXAMPLES: TUBERCULIN TEST CONTACT DERMATITIS ALLERGIC SKIN RASH

40. 40 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. AUTOIMMUNE DISORDERS DEVELOPMENT OF ANTIBODIES AGAINST OWN CELLS OR TISSUES AUTOANTIBODIES ARE ANTIBODIES FORMED AGAINST SELF-ANTIGENS—LOSS OF SELF-TOLERANCE. DISORDER CAN AFFECT SINGLE ORGANS OR TISSUES OR CAN BE GENERALIZED. EXAMPLES: HASHIMOTO THYROIDITIS, SYSTEMIC LUPUS ERYTHEMATOSUS, RHEUMATIC FEVER, MYASTHENIA GRAVIS, SCLERODERMA, PERNICIOUS ANEMIA

41. 41 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. THE AUTOIMMUNE PROCESS

42. 42 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. TYPE IV: CELL-MEDIATED DELAYED HYPERSENSITIVITY

43. 43 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. SYSTEMIC LUPUS ERYTHEMATOSUS (SLE) CHRONIC INFLAMMATORY DISEASE AFFECTS A NUMBER OF ORGAN SYSTEMS CHARACTERISTIC FACIAL RASH—“BUTTERFLY RASH” AFFECTS PRIMARILY YOUNG WOMEN INCIDENCE IS HIGHER IN AFRICAN AMERICANS, ASIANS, HISPANICS, NATIVE AMERICANS

44. 44 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. BUTTERFLY RASH ASSOCIATED WITH SLE

45. 45 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. SLE LARGE NUMBER OF CIRCULATING AUTOANTIBODIES AGAINST DNA, PLATELETS, ERYTHROCYTES FORMATION OF IMMUNE COMPLEXES DEPOSITED INTO TISSUES INFLAMMATION AND NECROSIS VASCULITIS DEVELOPS IN MANY ORGANS. IMPAIRS BLOOD SUPPLY TO THE TISSUES

46. 46 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. SLE (CONT.) SINGS AND SYMPTOMS VARY BECAUSE OF ORGAN INVOLVEMENT BUT COMMONLY INCLUDE: ARTHRALGIA, FATIGUE, MALAISE CARDIOVASCULAR PROBLEMS POLYURIA DIAGNOSTIC TEST SERUM ANTIBODIES, LE CELLS, OTHER BLOOD WORK TREATMENT USUALLY TREATED BY A RHEUMATOLOGIST PREDNISONE (GLUCOCORTICOID) NONSTEROIDAL ANTI-INFLAMMATORY DRUGS

47. 47 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. COMMON MANIFESTATIONS OF SLE

48. 48 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. IMMUNODEFICIENCY PARTIAL OR TOTAL LOSS OF ONE OR MORE IMMUNE SYSTEM COMPONENTS INCREASED RISK OF INFECTION AND CANCER PRIMARY DEFICIENCIES BASIC DEVELOPMENTAL FAILURE SOMEWHERE IN THE SYSTEM SECONDARY OR ACQUIRED IMMUNODEFICIENCIES LOSS OF THE IMMUNE RESPONSE FROM SPECIFIC CAUSES CAN OCCUR AT ANY TIME DURING THE LIFE SPAN INFECTIONS, SPLENECTOMY, MALNUTRITION, LIVER DISEASE, IMMUNOSUPPRESSANT DRUGS, RADIATION, CHEMOTHERAPY (CANCER)

49. 49 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. IMMUNODEFICIENCY (CONT.) PREDISPOSITION TO THE DEVELOPMENT OF OPPORTUNISTIC INFECTIONS CAUSED BY NORMAL FLORA USUALLY DIFFICULT TO TREAT BECAUSE OF IMMUNODEFICIENCY PROPHYLACTIC ANTIMICROBIAL DRUGS MAY BE USED PRIOR TO INVASIVE PROCEDURES.

50. 50 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. ACQUIRED IMMUNODEFICIENCY SYNDROME (AIDS) AIDS—CHRONIC INFECTIOUS DISEASE CAUSED BY THE HUMAN IMMUNODEFICIENCY VIRUS (HIV) HIV DESTROYS HELPER T CELLS—CD4 LYMPHOCYTES LOSS OF IMMUNE RESPONSE INCREASED SUSCEPTIBILITY TO SECONDARY INFECTIONS AND CANCER PROLONGED LATENT PERIOD DEVELOPMENT MAY BE SUPPRESSED BY ANTIVIRALS

51. 51 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. AIDS (CONT.) HIV-POSITIVE INDIVIDUAL VIRUS IS KNOWN TO BE IN THE BODY. NO EVIDENCE OF IMMUNOSUPPRESSION AIDS MARKED CLINICAL SYMPTOMS, MULTIPLE COMPLICATIONS INDIVIDUAL OFTEN IDENTIFIED AS HIV-POSITIVE BEFORE DEVELOPMENT OF AIDS CURRENT THERAPIES START IF HIV INFECTION IS DIAGNOSED IN THE EARLY STAGES.

52. 52 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. STAGES IN THE DEVELOPMENT OF AIDS

53. 53 Copyright © 2014, 2011, 2006 by Saunders, an imprint of Elsevier, Inc. HISTORY OF AIDS FIRST CASE RECOGNIZED IN 1979; HIV IDENTIFIED IN 1984 EVIDENCE OF EARLIER SPORADIC CASES NOW CONSIDERED TO BE A PANDEMIC OCCURS IN MEN AND WOMEN 2006, CDC: 1 MILLION CASES IN NORTH AMERICA 2007, UN: 33 MILLION CASES GLOBALLY; 22 MILLION OF THOSE IN SUB- SAHARAN AFRICA

54. THE END MITZY D. FLORES, MSN, RN HAVE A NICE DAY 54