NCM 119 – RLE (PRELIM) WEEK 1 Hypersensitivity Body produces

inappropriate or
---------------------------------------------------------------- exaggerated
responses to specific
IMMUNE RESPONSE IMMUNITY: Natural and antigens
Acquired Immunity – Ma’am VAB Gammopathies Overproduction of
IMMUNE RESPONSE immunoglobulin
Immune Deficiencies Deficiency results
 IMMUNITY  is the body’s specific Primary from improper
protective response to a foreign agent development of
or organism. immune cells or
 IMMUNE SYSTEM  functions as the tissues; usually
body’s defense mechanism against congenital or
invasion and allows a rapid response to inherited.
Secondary Deficiency results
foreign substances in a specific manner.
from some
FACTORS THAT AFFECT IMMUNE SYSTEM: interference with an
already developed
 central nervous system integrity; immune system;
 general physical and emotional status; usually acquired later
 medications; in life.
 dietary patterns; and
 the stress of illness, trauma, or surgery.
Growing numbers of patients with primary
IMMUNOPATHOLOGY immune deficiencies live to adulthood, and
many others acquire immune disorders during
 refers to the study of diseases that
their adult years.
result from dysfunctions within the
immune system. ANATOMY & PHYSIOLOGY

FACTORS THAT CAUSE THE DISORDERS OF THE  ANATOMY OF THE IMMUNE SYSTEM
IMMUNE SYSTEM:

 excesses or deficiencies of
immunocompetent cells,
 alterations in the function of these cells,
 immunologic attack on self-antigens, or
 inappropriate or exaggerated responses
to specific antigens

IMMUNE SYSTEM DISORDERS

Disorder Description
Autoimmunity Normal protective
immune response
paradoxically turns
against or attacks the
body, leading to
tissue damage
Bone Marrow
 The white blood cells (WBCs) involved
in immunity are produced in the bone
marrow
Lymphoid Tissues
 The spleen composed of red and white
pulp, acts somewhat like a filter.
NATURAL IMMUNITY
 The red pulp is the site where old
and injured red blood cells (RBCs)
are destroyed.
 The white pulp contains
concentrations of lymphocytes
Lymphoid Tissues
White Blood Cell Action
 The lymph nodes,
 which are connected by lymph
channels and capillaries, are
distributed throughout the body.
 They remove foreign material from
the lymph system before it enters
the bloodstream.
 They also serve as centers for
immune cell proliferation.
 The remaining lymphoid tissues
contain immune cells that defend
the body’s mucosal surfaces against
microorganism’s concentrations of
lymphocytes.
Granulocytes includes:
FUNCTIONS OF THE IMMUNE SYSTEM
 The basic function of the immune
system is to remove foreign antigens
such as viruses and bacteria to
maintain homeostasis.
There are two general types of immunity:
NATURAL (INNATE)
Non-Granulocytes includes:
 Natural immunity or nonspecific
immunity is present at birth.
ACQUIRED (ADAPTIVE)
 Acquired or specific immunity develops
after birth. Each type of immunity has a
distinct role in defending the body
against harmful invaders, but the
various components are usually
interdependent (Levinson, 2014).
 It is considered the first line of host
defense following antigen exposure,
because it protects the host without
remembering prior contact with an
infectious agent.
 WBCs, or leukocytes, participate in
both the natural and the acquired
immune responses.
 Granular leukocytes, or
granulocytes (so called because
of granules in their cytoplasm),
fight invasion by foreign bodies
or toxins by releasing cell
mediators, such as histamine,
bradykinin, and prostaglandins,
and by engulfing the foreign
bodies or toxins.
 Neutrophils (polymorphonuclear
leukocytes) are the first cells to arrive at
the site where inflammation occurs.
 Eosinophils and basophils, other types
of granulocytes, increase in number
during allergic reactions and stress
responses.
 Monocytes or Macrophages (referred
to as histiocytes when they enter tissue
spaces are the first to arrive on the
scene and function as phagocytic cells,
 engulfing, ingesting, and destroying
greater numbers and quantities of
foreign bodies or toxins than
granulocytes do.
 Lymphocytes, consisting of B cells and T
cells, play major roles in humoral and
cell mediated immune responses.
Inflammatory Response
 is a major function of the natural
immune system that is elicited in
response to tissue injury or invading
organisms.
Physical and Chemical Barriers
 Physical surface barriers include intact
skin, mucous membranes, and cilia of
the respiratory tract, which prevent
pathogens from gaining access to the
body.
 Example: The cilia of the
respiratory tract, along with
coughing and sneezing
responses, filter and clear
pathogens from the upper
respiratory tract before they
can invade the body further
 Chemical barriers, such as mucus, acidic
gastric secretions, enzymes in tears and
saliva, and substances in sebaceous and
sweat secretions, act in a nonspecific
way to destroy invading bacteria and
fungi.
Immune Regulation
 Dysfunction of the natural immune
system can occur when the immune
components are inactivated or when
they remain active long after their
effects are beneficial.
 If an immune response fails to develop
and clear an antigen sufficiently, the
host is considered to be
immunocompromised or
immunodeficient.
 If the response is overly robust or
misdirected, allergies, asthma, or
autoimmune disease results.
ACQUIRED IMMUNITY
 usually develops as a result of prior
exposure to an antigen through
immunization (vaccination) or by
contracting a disease, both of which
generate a protective immune
response.
TWO TYPES OF ACQUIRED IMMUNITY:
 Active acquired immunity  refers to
immunologic defenses developed by
the person’s own body. This immunity
typically lasts many years or even a
lifetime.
 Passive acquired immunity  is
temporary immunity transmitted from a
source outside the body that has
developed immunity through previous
disease or immunization.
CANCER AND IMMUNOTHERAPY
 It has long been understood that the
immune system plays a role in fighting
off malignancies.
 Recent advances in cancer treatment
have sought to augment the body’s
natural antitumor activity and to shut
down the pathways that allow
malignancies to elude the immune
system
HEALTH HISTORY AGE/PAST & PRESENT
CONDITIONS
 The history should note the patient’s
AGE along with information about past
and present conditions and events that
may provide clues to the status of the
patient’s immune system.
Gender
 There are differences in the immune
system functions of men and women.
For example, many autoimmune
diseases have a higher incidence in
females than in males, a phenomenon
believed to be correlated with sex
hormones.
Gerontologic Considerations
 Immunosenescence  is a complex
route in which the aging process
stimulates changes in the immune
system. (Shekarabi & Asgari, 2014)
 Older adults have increased the
incidence of infections, autoimmune
diseases, metabolic diseases,
osteoporosis, and neurologic disorders.
(Müller & Pawelec, 2014)
 The increased incidence of autoimmune
diseases may be from a decreased
ability of antibodies to differentiate
between self and nonself.
 Failure of the surveillance system to
recognize mutant or abnormal cells also
may be responsible, in part, for the high
incidence of cancer associated with
increasing age.
Nutrition
 The relationship of infection to
nutritional status is a key determinant
of health.
 Traditionally, this relationship focused
on the effect of nutrients on host
defenses and the effect of infection on
nutritional needs.
 The nurse must assess the patient’s
nutritional status, caloric intake, and
quality of foods ingested.
 There is evidence that nutrition plays a
role in the development of cancer and
that diet and lifestyle can alter the risk
of cancer development as well as other
chronic diseases. (Supic, Jagodic, & Magic,
2013)
Immunization
 The patient is asked about childhood
and adult immunizations, including
vaccinations to provide protection
against influenza, pneumococcal
disease (Pneumovax), pertussis, herpes
simplex, and the usual childhood
diseases (e.g., measles, mumps).
 Education about the importance of
adhering to the recommended schedule
for adult vaccines should be initiated.
Infection
 Known past or present exposure to
tuberculosis is assessed, and the dates
and results of any tuberculin tests
(purified protein derivative [PPD] test)
and chest x-rays are documented
 The nurse must assess whether the
patient has been exposed to any
sexually transmitted infections (STIs) or
bloodborne pathogens such as hepatitis
B, C, and D viruses and human immune
deficiency virus (HIV).
 A history of past and present infections
and the dates and types of treatments,
along with a history of any multiple
persistent infections, fevers of unknown
origin, lesions or sores, or any type of
drainage, as well as the response to
treatment, are obtained.
Allergy
 The patient is asked about any allergies,
including types of allergens (e.g.,
pollens, dust, plants, cosmetics, food,
medications, vaccines, latex), the
symptoms experienced, and seasonal
variations in occurrence or severity in
the symptoms.
  All medication and food allergies are
listed on an allergy alert sticker and
placed on the front of the patient’s
health or medical record to alert others.
Assessment of the Immune System – Ma’am EP
- It has long been understood that the
immune system plays a role in fighting
off malignancies
- Recent advances in cancer treatment
have sought to augment the body’s
natural antitumor activity and to shut
down the pathways that allow
malignancies to elude the immune
system
HEALTH HISTORY AGE/PAST & PRESENT
CONDITIONS
- The history should note the patient’s
AGE along with information about past
and present conditions and events that
may provide clues to the status of the
patient’s immune system
HEALTH HISTORY
Gender
- There are differences in the immune
system functions of men and women.
For example, many autoimmune
diseases have a higher incidence in
females than in males, a phenomenon
believed to be correlated with sex
hormones.
- There are differences in the immune
system functions of men and women.
For example, many autoimmune
diseases have a higher incidence in
females than in males, a phenomenon
believed to be correlated with sex
hormones.
Gerontologic Considerations
- Immunosenescence is a complex route
in which the aging process stimulates
changes in the immune system.
(Shekarabi & Asgari, 2014)
- Older adults have increased the
incidence of infections, autoimmune
diseases, metabolic diseases,
osteoporosis, and neurologic disorders.
(Müller & Pawelec, 2014)
 The increased incidence of autoimmune
diseases may be from a decreased
ability of antibodies to differentiate
between self and non-self.
 Failure of the surveillance system to
recognize mutant or abnormal cells also
may be responsible, in part, for the high
incidence of cancer associated with
increasing age.
Nutrition
- The relationship of infection to
nutritional status is a key determinant
of health.
- Traditionally, this relationship focused
on the effect of nutrients on host
defenses and the effect of infection on
nutritional needs
 The nurse must assess the patient’s
nutritional status, caloric intake, and
quality of foods ingested.
 There is evidence that nutrition plays a
role in the development of cancer and
that diet and lifestyle can alter the risk
of cancer development as well as other
chronic diseases. (Supic, Jagodic, &
Magic, 2013)
Immunization
- The patient is asked about childhood
and adult immunizations, including
vaccinations to provide protection
 against influenza, pneumococcal
disease (Pneumovax), pertussis, herpes
simplex, and the usual childhood
diseases (e.g., measles, mumps).
 Education about the importance of
adhering to the recommended schedule
for adult vaccines should be initiated.
 Education about the importance of
adhering to the recommended schedule
for adult vaccines should be initiated
Infection
 Known past or present exposure to
tuberculosis is assessed, and the dates
and results of any tuberculin tests
(purified protein derivative [PPD] test)
and chest x-rays are documented
 The nurse must assess whether the
patient has been exposed to any
sexually transmitted infections (STIs) or
bloodborne pathogens such as hepatitis
B, C, and D viruses and human immune
deficiency virus (HIV).
 A history of past and present infections
and the dates and types of treatments,
along with a history of any multiple
persistent infections, fevers of unknown
origin, lesions or sores, or any type of
drainage, as well as the response to
treatment, are obtained.
Allergy
 The patient is asked about any allergies,
including types of allergens (e.g.,
pollens, dust, plants, cosmetics, food,
medications, vaccines, latex), the
symptoms experienced, and seasonal
variations in occurrence or severity in
the symptoms.
 All medication and food allergies are
listed on an allergy alert sticker and
placed on the front of the patient’s
health or medical record to alert others
Role of the Immune System (Immune System
Failure)
Theories suggest how tumor cells can evade an
apparently intact immune system
 Is when the body fails to recognize or
has potential to distinguish cells that
are normal (self) from abnormal
(nonself), the immune response may
not be stimulated
For example: Cells of transplanted
organs can be recognized by the
immune system as nonself and thus
elicit an immune response. This
response can ultimately result in the
rejection of the organ.
 When the immune system fails to
identify and stop the growth of
malignant cells, clinical cancer develops.
 Patients who for various reasons are
immune incompetent have been shown
to have an increased incidence of
cancer
 When the immune system is
incompetent or under responsive,
severe infections, immunodeficiency
diseases, and malignancies may occur.
 When the immune system overreacts,
hypersensitivity disorders such as
allergies and autoimmune diseases may
develop.
- Carcinogens, such as viruses and certain
chemicals, including chemotherapeutic
agents, may weaken the immune
system and ultimately enhance tumor
growth.
  When tumors do not possess tumor-
associated antigens that label them as
foreign, the immune response is not
alerted.
- These tumor antigen–antibody
complexes can suppress further
production of antibodies. Tumors are
also capable of changing their
appearance or producing substances
that impair usual immune responses.
These substances not only promote
tumor growth but also increase the
patient’s susceptibility to infection by
various pathogenic organisms.
DIAGNOSTIC EXAMS FOR CANCER – Ma’am VJ
Diagnostic exams
PURPOSE
 Determining the location, extent and
type of malignancy
 Basis for cancer treatment decisions
STEPS
 History taking and physical exam- risk
factors confirm diagnosis Treatment
plan (staging)
NURSING RESPONSIBILITY
 Explaining rationale
 Preparations
 NPO *Consent if invasive
procedure
 Bowel cleansing
 emotional support
 Expectations before, during and after
exams
Screening for Cancer
 30-39 y/o every 3 year
 40 y/o and above every year
 Breast
 Women 40 years or older -
annual mammogram, an annual
CBE and monthly BSE
 Women aged 20-39 - CBE every
3 years and monthly BSE
Screening
 Cervix
 all women who are or have been
sexually active
 annual Pap smear and pelvic exam.
Test for HPV is recommended
 Endometrium
 Women at high risk for cancer of the
uterus = sample endometrial tissue
examined when menopause begins.
CANCER DETECTION EXAMS
Screening
 Prostate
 PSA blood test and DRE, annually for
aged 50.
 Men in high-risk groups such as those
with strong familial predisposition (2 or
more 1st degree relatives)
 Lungs
 Annual CXR, stop smoking!!!
 Colon and Rectum
50 y/o or older should follow 1 of these
schedules:
  Fecal occult blood test every year & a indicative of a particular disease process, and
flexible sigmoidoscopy every 5 years o- they are used in oncology to help detect the
Colonoscopy every 10 yrs. presence of cancer.

 Double contrast barium enema

every 5 – 10 yrs.
 DRE should be done at the same
time with the above procedures

CANCER DETECTION EXAMINATIONS

A tumor marker is a biomarker found in blood,

urine, or body tissues that can be elevated by
the presence of one or more types of cancer.
There are many different tumor markers, each
 NUCLEAR MEDICINE SCAN

 3D ultrasounds create a three-

dimensional image, while 4D
ultrasounds create a live video effect,
like a movie.

Sample NMS image

MRI
 Describing node

Describing masses

Staging and Grading Neoplasia

Kidney FNAB
 STAGING - determining the size of the
tumor and existence of metastasis
Staging is necessary at the time of
diagnosis to determine the extent of
the disease (local vs metastatic), to
determine prognosis and to guide
proper management
 GRADING - classification of tumor cells

TNM classification system that can be applied

to all solid tumor types.
 T - tumor size
 N - presence or absence of regional
lymph node involvement
 M - presence or absence of distant
metastasis

Benign vs Malignant Neoplasm

CHARACTERIS BENIGN MALIGNANT

TICS
Speed of Grows Grows
Growth slowly rapidly
Mode of Remains Infiltrates
Growth Localized surrounding
tissues
Capsule Encapsulate Not
d encapsulated
Recurrence Extremely Common
unusual after surgery
when bec cancer
surgically cells spread
removed into other
tissues

Detection and Prevention of Cancer (Primary

and Secondary Prevention) – Ma’am PL

Primary Prevention

Primary prevention is concerned with reducing

the risks of disease through health promotion
strategies.

 By acquiring the knowledge and skills

necessary to educate the community about
cancer risk.

 Nurses in all settings play a key role in cancer

prevention.

 One way to reduce the risk of cancer is to

help patients avoid known carcinogens.

 Encouraging patients to make dietary and

lifestyle changes (smoking cessation, decreased
caloric intake, increased physical activity) that • Drinking alcohol is related to increased
studies show influence the risk for cancer. risk of breast, colon and liver cancers.

 Nurses use their teaching and counseling • Even a little bit increases the risk
skills to provide patient education and support
Eat a healthy and varied diet
public education campaigns through
organizations, such as the ACS • Keep calories in healthy range.
Provide Patient Education: • Eat plenty of plant-based foods including
fruit, nuts and whole grains.
Don’t smoke
• Keep diet low in salt and processed meats
 Smoking is number one preventable
cause of cancer • Associated with lower risk of cancers of
 Causes almost all cases of lung cancer breast, colon, oesophagus and stomach.
 Increases cancers of upper airway,
• Plus, you’ll lower your risk of heart
stomach, mouth, tongue, liver, cervix,
disease and diabetes
bladder…
 So: Don’t start smoking Avoid excess sun exposure
 If you smoke, quit. Your risk of cancer
• Causes thousands of skin cancers every
starts coming down about two years.
year.
 Plus, you reduce your chance of other
chronic diseases including heart • Keep out of the sun in the middle of the
disease, emphysema and bronchitis day, wear protective clothing, sun glasses, a
hat and sunscreen (you know the drill)
Provide Patient Education:
Get regular (evidence-based) screening
Keep your weight in the healthy range.
• There is good evidence that regular,
• Being overweight or obese is one of the
organized screening reduces risk of dying
most important risk factors for a number of
from breast, cervical and bowel cancers.
cancers.
• Cervical and bowel cancer screening can
• Increases risk of bowel, breast, kidney,
actually prevent cancer
stomach, uterine.
• Be aware of risks and benefits of
• Plus, you’ll reduce your chance of
screening
developing heart disease, diabetes, stroke,
arthritis. Avoid chronic infections
Exercise regularly • Hepatitis B and C cause liver cancer
• Will reduce your chances of developing • Human papilloma virus causes cervical
colon and breast cancers. cancer
• Plus, you’ll be at reduced risk of heart • Helicobacter Pylori causes stomach cancer
disease, diabetes and osteoarthritis.

Drink little or no alcohol

Primary Prevention (Cont.)

 Several clinical trials have been

conducted to identify medications or
supplements that may help reduce the
incidence of certain types of cancer.

 For example, large-scale breast cancer

prevention studies supported by the
National Cancer Institute (NCI) indicated
that chemoprevention.

- Tamoxifen (Nolvadex) can reduce the

incidence of breast cancer by 50% in
women at high risk for breast cancer
(Fisher, Constantino, Wickerham, et al.,
2005).