IMMUNOLOGIC

FUNCTIONS
FUNDAMENTAL CONCEPTS

What is immunity?

 Refers to the body’s specific response to a

foreign agent.
What is the immune system?

 Functions as the body’s defense

mechanism against invasion and allows a
rapid response to foreign substances in a
specific manner.
Factors that affect the immune function: ANATOMY AND PHYSIOLOGIC
 CNS integrity OVERVIEW
 General physical and emotional status
 Medications
 Dietary patterns ANATOMY OF THE IMMUNE SYSTEM
 Stress of illness, trauma, and surgery
Immune memory:

 A property of the immune system that

provides protection against harmful
microbial agents despite the timing of re-
exposure to the agent.
Tolerance:

 The mechanism by which the immune

system is programmed to eliminate foreign
substances such as microbes, toxins, and
cellular mutations but maintains the ability to
accept self-antigens.
Immunopathology:

 Refers to the study of diseases that result

from dysfunctions within the immune
system.
Causes of immune system disorders:

 Excesses or deficiencies of
immunocompetent cells
 Alterations in the functions of these cells
 Immunologic attack on self-antigens
 Inappropriate or exaggerated responses to
specific antigens
IMMUNOLOGIC
FUNCTIONS
Bone Marrow
 Lymphocytes – a type of WBC that are
generated from stem cells, which are
undifferentiated cells.
o B-lymphocytes (B cells) – mature
in the bone marrow.
o T-lymphocytes (T cells) – move
from the bone marrow to the thymus
where they mature into several kinds
of cells with different functions.
 Helper T cells - help activate
B cells to secrete antibodies
and macrophages to destroy
ingested microbes. They also
help activate cytotoxic T cells
to kill infected target cells.
 Cytotoxic T cells - kill target
cells bearing specific antigen
while sparing neighboring
uninfected cells.
Thymus

 Located in the mediastinum, the thoracic

cavity between the lungs and above the
heart.
 Primary function is to train special white
blood cells called T-lymphocytes or T-cells
which travel from the bone where they are
produced.
 The lymphocytes mature and become
specialized T-cells in the thymus.
 After they mature, these T-cells enter the
bloodstream and travel to the lymph nodes
and other organs of the lymphatic system.

Lymphoid Tissues

 Spleen – composed of red and white pulp

 Produces white blood cells (WBCs) –
involved in immunity.
that function as follows:
o White pulp – fights invading germs
in the blood (contains concentrations
of lymphocytes)
o Controls the level of blood cells
(WBCs, RBCs, and platelets)
o Red pulp – filters the blood and
removes any old or damaged RBCs
 Lymph nodes – connected by lymph
channels and capillaries. They function as
follows:
IMMUNOLOGIC
FUNCTIONS o Remove foreign material from the
lymph system before it enters the
bloodstream.
o Serve as centers for immune cell
proliferation.
 The remaining lymphoid tissues contain
immune cells that defend the body’s
mucosal surfaces against microorganisms.
FUNCTION OF THE IMMUNE SYSTEM
Natural (innate) immunity:
 Also called non-specific immunity, is present
at birth.
 Provides a broad spectrum of defense
against and resistance to infection.
 First line of host defense without
“remembering” prior contact with an
infectious agent.
 Responses to foreign invader are very
similar from one encounter to the next.
 Coordinate initial response to pathogens
through the production of cytokines and
other effector molecules, which either
activate cells for control of the pathogen (by
elimination) or promote the development of
the acquired immune response.
 Cells involved in this response are:
o Monocytes
o Macrophages
o Dendritic cells
o Natural killer (NK) cells
o Basophils
o Eosinophils
o Granulocytes
 Two stages of adaptive immune response:
o Immediate (occurring within 4 hours)
o Delayed (occurring between 4 and
96 hours after exposure).
White Blood Cell Action – participate in both the
natural and the acquired immune responses.
 Granulocytes – fight invasion by foreign
bodies or toxins by releasing cell mediators,
such as histamine, bradykinin, and
prostaglandins, and engulfing the foreign
bodies or toxins. Granulocytes include:
o Neutrophils – first cells to arrive at
the site where inflammation occurs.
o Eosinophils – increase in number
during allergic reactions and stress
responses.
o Basophils – same as eosinophils.
 Monocytes – function as phagocytic cells,
engulfing, ingesting, and destroying greater
numbers and quantities of foreign bodies or
toxins than granulocytes do.
 Lymphocytes (consisting of B and T
cells) – play major roles in humoral and
cell-mediated immune responses.
o 60-70% are T-cells
o 10-20% are B-cells.
Inflammatory Responses – elicited in response to
tissue injury or invading organisms.
 Assisted by chemical mediators by
minimizing blood loss, walling off the
invading organism, activating phagocytes,
and promoting formation of fibrous scar
tissue and regeneration of injured tissue.
Physical and Chemical Barriers –
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FUNCTIONS
 Physical barriers include intact skin, mucous
membrane, and cilia of the respiratory tract.
 Chemical barriers include mucus, acidic
gastric secretions, enzymes in tears and
saliva, and substances in sebaceous and
sweat secretions.
 Viruses are encountered by other means,
such as interferon.
Immune Regulation – involves balance and
counterbalance.
 Immunocompromise or
immunodeficiency – occurs when an
immune response fails to develop and clear
an antigen sufficiently.
 Allergies, asthma, or autoimmune
disease – occurs when immune response is
overtly robust and misdirected.
 Most microbial infections induce an
inflammatory response mediated by T-cells
and cytokines, which, in excess, can cause
tissue damage. Therefore, regulatory
mechanisms must be in place to suppress
or halt the immune response.
 This is achieved by the production of
cytokines and transformation of growth
factor that inhibits macrophage activation.
Acquired immunity:
 Usually develops because of prior exposure
to an antigen through immunization
(vaccination) or by contracting disease, both
of which generate a protective immune
response.
 Exposure to disease or vaccine induces the
body to produce an immune response that
is sufficient to defend against the disease
on re-exposure.
 This form of immunity relies on the
recognition of specific foreign antigens.
 Two mechanisms of acquired immune
response:
o Cell-mediated response involving
T-cell activation, and
o Effector mechanisms involving B-
cell maturation and production of
antibodies.
 Two types of acquired immunity:
o Active – refers to immunologic
defenses developed by the person’s
own body.
o Passive – temporary immunity
transmitted from a source outside
the body that has developed
immunity through previous disease
or immunization. Examples are
immunoglobulin (Igb) or immunity
resulting from the mother to an infant
in utero or through breastfeeding.
 Both active and passive acquired immunity
involve humoral and cellular immunologic
response.
Response to Invasion:
Three means of defense –
 Phagocytic immune response
o First line of defense.
o Primarily involves the WBCs
(granulocytes and macrophages)
which can ingest foreign particles
and destroy the invading agent.
o Eosinophils are only weakly
phagocytic.
o Phagocytes also remove the body’s
own dying or dead cells.
o Cells in necrotic tissue that are dying
release substances that trigger an
inflammatory response.
o Apoptosis – or programmed cell
death, is the body’s way of
destroying worn-out cells.
 Humoral or antibody response
o Sometimes called the antibody
response.
o Begins with the B-lymphocytes
which can transform themselves into
plasma cells that manufacture
antibodies.
o These antibodies are highly specific
proteins that are transported in the
bloodstream and attempt to disable
invaders.
 Cellular immune response
o Also involves the T-lymphocytes,
which can turn into special cytotoxic
IMMUNOLOGIC
FUNCTIONS (or killer) T-cells that can attack the
pathogens.
Antigen – the structural part of the invading or
attacking organism that is responsible for
stimulating antibody production.
 Not all antigens are naturally immunogenic;
some must be coupled to other molecules to
stimulate immune response.
 A single bacterium or large molecule (such
as diphtheria or tetanus toxin) may have
several antigens or markers on its surface,
thus inducing the body to produce several
different antibodies.
 Once produced, antibodies are released
into the bloodstream and carried to the
attacking organism where it combines with
the antigen, binding with like an interlocking
piece of a jigsaw puzzle.
Stages of Immune Response:
1. Recognition Stage – recognition of
antigens as foreign, or non-self, by the
immune system.
a. Involves the use of lymph nodes and
lymphocytes for surveillance.
b. A lymph node continuously
discharges small lymphocytes into
the bloodstream to patrol the tissues
and vessels that drain the areas
served by that node.
c. Lymphocytes recirculate from the
blood to the lymph nodes and from
the lymph nodes back into the
bloodstream.
d. Lymphocytes recognition is thought
to depend on specific receptor sites
on the surface of the lymphocytes.
e. Macrophages help the circulating
lymphocytes process the antigens.
f. Both macrophages and neutrophils
have receptors for antibodies and
complement; as a result, they coat
microorganisms with antibodies,
complement, or both, thereby
enhancing phagocytosis.
2. Proliferation Stage – circulating
lymphocytes containing the antigenic
message return to the nearest lymph node.
a. Once in the node, these sensitized
lymphocytes stimulate some of the
resident T and B-lymphocytes to
enlarge, divide, and proliferate.
b. T-cells differentiate into cytotoxic (or
killer) cells, whereas B-lymphocytes
produce and release antibodies.
c. Enlargement of the lymph nodes in
the neck in conjunction with a sore
throat is one example of the immune
response.
3. Response Stage – differentiated
lymphocytes function in either humoral or a
cellular capacity.
a. Begins with the production of
antibodies by the B-lymphocytes in
response to specific antigen.
b. The cellular response stimulates the
resident lymphocytes to become
cells that attack microbes directly
rather than through the action of
antibodies. These transformed
lymphocytes are known as cytotoxic
(killer) T-cells.
c. Viral rather than bacterial antigens
induce a cellular response. This is
manifested by increased number of
T-lymphocytes (lymphocytosis) seen
in blood tests of people with viral
illnesses, such as infectious
mononucleosis.
d. Most immune responses to antigens
involve both humoral and cellular
IMMUNOLOGIC
FUNCTIONS responses, although one usually
predominates.
4. Effector Stage – either the antibody of the
humoral response or the cytotoxic (killer) T-
cells of the cellular response reaches and
connects with the antigen on the surface of
the foreign invader.
a. These initiates activities involving
interplay of antibodies (humoral
immunity), complement, and action
by the cytotoxic T-cells (cellular
immunity).
Humoral Immune Response:
 Characterized by the production of
antibodies by B-lymphocytes in response to
a specific antigen.

depends on the structure and composition
of both the antigen and the immunoglobulin.
Agglutination – clumping effect of antigens
produced by an antibody which helps clear
the body of the invading organisms by
facilitating phagocytosis.
 Opsonization – a process in which the
antigen-antibody molecule is coated with a
sticky substance that also facilitates
phagocytosis.
 Antibodies promote the release of
vasoactive substances, such as histamine
and slow-reacting substances, two of the
chemical mediators of the inflammatory
response.
 Antibodies mobilize other components of
the immune system to defend against the
invader.

Antigen Recognition –
Types and Characteristics of Immunoglobulins:
 B-lymphocytes respond to some antigens
by directly triggering antibody formation;
however, in response to other antigens,
they need the assistance of T-cells to trigger
antibody formation.
 With the help of macrophages, T-
lymphocytes are believed to recognize the
antigen of a foreign invader.
 The T-lymphocyte picks up the antigenic
message, or “blueprint”, of the antigen and
returns to the nearest lymph node with that
message.
 B-lymphocytes stored in the lymph nodes
are subdivided into thousands of clones,
which are stimulated to enlarge, divide,
proliferate, and differentiate into plasma
cells capable of producing specific
antibodies to the antigen.
 Other B-lymphocytes differentiate into B-
lymphocyte clones with a memory for the
antigen. These memory cells are
responsible for the more exaggerated and
rapid immune response in a person who is
repeatedly exposed to the same antigen.
Role of Antibodies –
Antigen-Antibody Binding –
 They defend against foreign invaders in
several ways, and the type of defense used
IMMUNOLOGIC
FUNCTIONS
 Antigenic determinant – the portion of the
antigen involved in binding with an antibody.

response at a level that is
compatible with health.
Memory Cells
 Efficient immunologic responses occur
when the body and antigen fit like a lock o Responsible for the recognition of
and key. antigens from previous exposure
 Poor fit can occur with an antibody that was and mounting an immune response.
produced in response to a different antigen
Null Lymphocytes and Natural Killer Cells –
known as cross-reactivity.
 Null lymphocytes
o For example, in acute rheumatic o Destroy antigens coated with
fever, the antibody produced against antibody.
Streptococcus pyogenes in the o Have receptor sites on their surface
upper respiratory tract may cross- that allow them to connect with the
react with the patient’s heart tissue, end of antibodies; this known as an
leading to heart valve damage. antibody-dependent, cell-mediated
cytotoxicity.
Cellular Immune Response:  NK cells
o Recognize infected and stressed
 T-lymphocytes – primary responsible for cells and respond by killing these
cellular immunity. cells and by secreting macrophage-
 Initiated with or without the assistance of activating cytokines.
macrophages, by the binding of an antigen
to an antigen receptor located on the
surfaces of a T-cell. T-cells then carry the
antigenic message, or blueprint, to the
lymph nodes, where the production of other
T-cells is stimulated.
Types of T Lymphocytes –

 Effector T cells
o Helper T cells
 Activated on recognition of
antigens and stimulate the
rest of the immune system.
 Activated helper T cells
secrete cytokines which
attract and activate B cells,
cytotoxic T cells, NK cells,
macrophages, and other
cells of the immune system.
o Cytotoxic T cells
 Attack the antigen directly by
altering the cell membrane
and causing lysis and by
releasing cytolytic enzymes
and cytokines. Complement System:
 Suppressor T cells
o Can decrease B-cell production,  A part of the immune system that enhances
thereby keeping the immune the ability of antibodies and phagocytic cells
to clear microbes and damaged cells from
IMMUNOLOGIC
FUNCTIONS
an organism, promote inflammation, and
attack the pathogen's cell membrane.
 Functions –
o Defending the body against bacterial
infections.
o Bridging natural and acquired
immunity.
o Disposing of immune complexes and
the byproducts associated with
inflammation.
Immunomodulators:
As the name implies, immunomodulators modify
the activity of the immune system, in turn,
decreasing the inflammatory response.
Interferons –
 A non-specific viricidal protein that is
naturally produced by the body and can
activate other components of the immune
system.
 Thought to modify the immune response by
suppressing antibody production and
cellular immunity.
 They also facilitate the cytolytic role of
macrophages and NK cells.
 Interferons are used to treat immune-related
disorders (eg, multiple sclerosis) and
chronic inflammatory conditions (eg, chronic
hepatitis).
Colony-Stimulating Factors –
 A group of naturally occurring glycoprotein
cytokines that regulate production,
differentiation, survival, and activation of
hematopoietic cells.
ASSESSMENT OF THE IMMUNE
SYSTEM
The assessment of the immune function begins
during the health history and physical examination.
Areas to be assessed include:
 Nutritional status
 Infections and immunizations
 Allergies
 Disorders and disease states, such as
autoimmune disorders, cancer, and chronic
illnesses.
 Surgeries
 Medications
 Blood transfusions
In addition, the following are also performed:
 Inspection of general characteristics.
 Palpation of the lymph nodes.
 Examinations of the skin, mucous
membranes, and respiratory,
gastrointestinal, musculoskeletal,
genitourinary, cardiovascular, and
neurosensory systems.
HEALTH HISTORY
The history should note the patient’s –
 Age
o Important factor to elicit from the
patient as people at the extremes of
the life span are more likely to
develop problems related to
immune system functioning than
those in their middle years.
 Past and present conditions
IMMUNOLOGIC
FUNCTIONS
 Events that may provide clues to the status
of the patient’s immune system
PHYSICAL EXAMINATION

 Inspection
o Inspect the skin or mucous
membranes for lesions, dermatitis,
purpura, urticaria, inflammation, or
any discharge. Any signs of infection
are noted.
o Patient’s temperature is recorded,
and the patient is observed for chills
and sweating.
o Assess sputum for color,
consistency, and odor.
 Palpation
o The anterior and posterior cervical,
axillary, and inguinal lymph nodes
are palpated for enlargement; if
palpable nodes are detected, the
location, size, consistency, and
reports of tenderness upon palpation
are noted.
o Joints are assessed for tenderness
and swelling and for limited range of
motion.
 Auscultation
o Listen for lungs sounds.
o Listen for heart sounds. DIAGNOSTIC EVALUATION
o Listen for bowel sounds.
o Auscultate blood pressure.  Leukocytes and Lymphocyte
 Other physical assessments Tests
o Respiratory, cardiovascular, o White blood cell count and
gastrointestinal, genitourinary, and differential
neurosensory status is evaluated for o Bone marrow biopsy
signs and symptoms of immune  Humoral (Antibody-mediated)
dysfunction. Immunity Tests
o Nutritional status is evaluated. o B-cell quantification with
o Level of stress. monoclonal antibody
o Coping ability, along with his/her o In vivo IgG synthesis with T-
age, and any functional limitation or cell subsets
disabilities. o Specific antibody response
o Total serum globulins and
individual IgG
(electrophoresis,
immunoelectrophoresis,
single radial
immunodiffusion,
nephelometry, and
IMMUNOLOGIC
FUNCTIONS

isohemagglutinin
techniques).
Cellular (Cell-mediated) Immunity
o Polymerase chain reaction
(PCR)
NURSING MANAGEMENT
Tests
o Total lymphocyte count  It is the nurse’s role to counsel, educate,
o T-cell and T-cell subset and support patients throughout the
quantification with diagnostic process.
monoclonal antibody.
o Delayed hypersensitivity skin
test
o Cytokine production
o Lymphocyte response to
mitogens, antigens, and
allogenic cells
o Helper and suppressor T-cell
functions
 Phagocytic Cell Function Tests
o Nitroblue tetrazolium
reductase essay
 Complement Component Tests
o Total serum hemolytic
complement
o Individual complement
component titrations
o Radial immunodiffusion
o Electro immunoassay
o Radio immunoassay
o Immunophelometric assay
o Immunoelectrophoresis
 Hypersensitivity Tests
o Scratch test
o Patch test
o Intradermal test
o Radioallergosorbent test
(RAST)
 Specific Antigen-Antibody Tests
o Radio immunoassay
o Immunofluorescence
o Agglutination
o Complement fixation test
 HIV Infection Tests
o Enzyme-linked
immunoabsorbent assay
(ELISA)
o Western blot
o CD4 and CD8 cell counts
o P24 antigen test
IMMUNOLOGIC
FUNCTIONS
INFECTIOUS DISORDERS IN Mode of Transmission by Infectious Diseases:

CHILDREN  Contact –
o Direct
o Indirect
OVERVIEW OF THE INFECTIOUS PROCESS  Airborne
o Droplet
 Common Vehicles for Transmission –
WHAT IS AN INFLAMMATION? o Towels
 An immediate response of the body to an o Eating utensils
injury or cell death.  Vector Transmission

Purposes of inflammation:

 Confines injurious agents.

 Increases blood cell and plasma movement
to injured areas.
 Enhances immune response.
 Destroys injurious agents.
 Promotes healing.
Cardinal Signs of Inflammation:

 Rubor (redness)
 Calor (heat)
 Dolor (pain)
 Tumor (swelling)
 Functio Laesa (altered function)
WHAT IS AN INFECTION?

 An invasion of the pathogenic

microorganism (pathogen) and the reaction
of the tissue to their presence to the toxins
generated.
Infection Precautions:
Chain of Infection:
Masks Gloves Gown Room HW
Strict ✓ ✓ ✓ PR ✓
Enteric ✓ PR ✓
Droplet ✓ PR ✓
Blood
and
✓ PR ✓
Bodily
Fluids
Revers
✓ ✓ PR ✓
e

 Strict Precautions – for unknown disease

or very contagious diseases.
o SARS
IMMUNOLOGIC
FUNCTIONS o Tuberculosis
o Rubeola
 Enteric Precautions – for diseases
involving intestinal fluids.
o Hepatitis A
o Typhoid Fever
 Droplet Precautions – for infections
involving respiratory and throat secretions.
o German Measles
o Pneumonia
o Meningitis
 Blood and Bodily Fluids Precautions –
for infections involving blood and body
secretions.
o Hepatitis B
 Reverse Precautions – for protection of the
patient.
o AIDS
o Cancer
Clinical Stages of Infection:
1. Incubation Phase – the infectious agent
invades the host and invades itself.
a. Time of exposure until the onset of
symptoms.
b. Viral and bacterial particles replicate
during the incubation stage.
2. Prodromal Phase – the organism
disseminates throughout the body.
a. After incubation and before the
characteristic symptoms of infection
occur.
b. Infection can be transmitted during
this stage.
3. Acute Phase – the interaction between the
host and the agent reaches its full intensity.
4. Recovery Phase – begins with the decline
of symptoms and the recovery of health.
VIRAL INFECTIONS
ROSEOLA INFANTUM
Characteristics:
 Causative agent – Human herpesvirus 6
(HHV-6), less frequently by HHV-7.
 Onset – usually starts at night with fever of
39°C (103°F),
 Incubation period – approximately 10
days, usually between 8-14 days.
 Period of communicability – during febrile
period
 Mode of transmission – unknown
 Immunity –
o Contracting the disease offers
lasting natural immunity.
o No artificial immunity is available.
 Prevalence –
o Mostly affects children between the
age of 6 months and 3 years old.
o Also known as sixth disease.
Symptoms:
 Fever that may exceed 40-degree Celsius.
 Malaise
 Conjunctivitis
 Orbital edema
 Inflammation of tympanic membranes
 Lymphadenopathy
 Irritability
 Anorexia
 Bulging fontanelle
 Diarrhea
 Cough
 Upper respiratory tract symptoms.
 Uvulo-palatoglossal spots also referred to
as Nagayama spots, are erythematous
papules found on the soft palate and uvula
 After 3 or 4 days, the fever falls abruptly,
and a distinctive rash appears.
 Small, rose-pink, or red 2 mm to 5mm
papules and macules will develop (most
prominent in the trunk). The rash is typically
nonpruritic, blanching and can persist from
one to two days.
Diagnostic findings:
 Laboratory tests are not necessary.
However, children with HHV-6 can have
elevated WBC count.
Treatment / Management:
No specific treatment. Treatment is supportive with:
IMMUNOLOGIC
FUNCTIONS
 Antipyretics such as acetaminophen or
ibuprofen to control fever, especially if over
38.5°C.
 Give a lukewarm bath if it seems to help the
patient, if not cause shivering.
 Rest.
 Maintaining fluid intake.
Nursing Interventions:

 Adequate handwashing is important to

prevent spread
 Avoiding close contact with infected person
 Keeping the child cool. Take extra layers of
clothes off the child if room is in normal
room temperature. Use light cotton clothes
or bedding.
 Give lots of drink.
Nursing Diagnosis:

 Hyperthermia r/t dehydration.

 Fluid volume deficit r/t increased metabolic
demand (fever/infection).
 Risk for impaired skin integrity r/t decreased
skin turgor.
 Impaired skin integrity r/t alteration in skin
appearance as manifested by presence of
rashes.