IMMUNE SYSTEM

The collection of organs. cells, tissues, and molecules that mediate the immune response
Lymphatic system is under
immune system
and complimentary to the circulatory system

IMMUNE RESPONSE
The coordinated response of the components of the immune system to a foreign agent or
Organism
IMMUNITY (protection)
The body's specific protective response to a foreign agent or organism; resistance disease,
specifically infectious diseases
IMMUNOPATHOLOGY
Study of diseases resulting in dysfunctions within the immune system

FUNCTIONS OF LYMPHATIC SYSTEM

1. Fights infections
2. Removes waste products
3. Drains excessive fluids,tissues and return them back to the blood stream

ADENOIDS
Lymphatic tissue that can be found at the upper back of the nasal cavity
Protects body against infection that enters the nose

Adenoidectomy - Surgery to remove the adenoids

TONSILS
-can be found in the middle of the nose, mouth and throat
-protects the body against infection that enters the mouth
Tonsilectomy-removal of tonsils

PEYER PATCHES
can be found at ileum
protects the body against infection that can be found in GIT

KUPFFER CELLS
it is found in the liver

ORGANS OF IMMUNE SYSTEM

THYMUS
in front of the lungs by the sternum
-butterfly shape.
Largest during childhood period and production and maturations of T cells.
SPLEEN
LUQ just beneath the diaphragm
Largest internal organ of the immune system
25% of the blood from the heart goes to the spleen
Highly vascular organ
N Weight: 170 grams, 1.8 kgs if the pt has splenomegaly
Removal of spleen requires daily
antibiotics since the pt doesn't have protection

1. White Pulp- cleansing and filtering

Destroys old and damaged cells
Red Pulp- protection
Increases the amount of lymphocytes
HAMATOPOIESIS
Production of red blood cells
Stan cell (sarting cell)
HEMATOPOIETIC STEM CELLS
Cells
Cells t damenter tells
MYELOID STEM CELLS (WBC.
RBC, PLATELETS)
Produces A daughter cells
Megakaryoblasts
o Megakaryocytess Platelets
2. Proenthroblasis
O Reticulocyte= Erythrocytes
(blood cells)
3. Mreloblasts ( WDC)
Basophils
Neutrophils
o
Eosinophil
4 Monoblasts
O Monocytes= Macrophages
LYMPHOID STEM CELLS
1. Lymphoblasts o Natural Killer Cells
Small Lymphocytes
T Lymphocytes
B Lymphocytes= Plasma
Cells

TYPES OF IMMUNE RESPONSE

INNATE (first responders)
-non-specific (can't distinguish one pathogen to other pathogen)
-fast (e.g., fever response)
-has no memory (like they have amnesia)
- Physical (skin, mucus membranes) and Chemical barriers (sweat, saliva and tears;
IgA antibodies)
INNATE IMMUNE RESPONSE

1. NEUTROPHILS
(POLYMORPHONUCLEAR)
Most abundant
Short lived (because they burst when they're full)
Most (60-70%) circulating white blood cells,
Being the first white blood cells to arrive at the infected site, they phagocytose and degrade
pathogens
2. EOSINOPHILS
contain histamine and other proin flammatory molecules, best known for fighting large and
unwieldy helminthic parasites, or "worms" can't kill bacteria and viruses but can kills parasites
3. BASOPHILS(allergic responses)
Contain histamine and other proinflammatory molecules, respond to infections, particularly
those against large parasites such as ticks and
worms.
Allergic responses, exclusively found in the blood
4. MAST CELLS
Live in the tissues and not in blood; non-phagocytie and are involved in allergic responsos
5. MONOCYTES
Only circulate in the blood. Some monocytes migrate into tissues and differentiate into
MACROPHAGES, which remain in tissues and aren't found in the blood
Phagoevtic same with neutrophils
6. DENDRITIC CELLS
Survey the blood and external environment for pathogens. Should it detect a pathogen, the
dendritic cell will digest it and present a piece of the pathogen to a T cell to initiate adaptive
miane reseonses
Presenting cell, prototypical antigen
NATURAL KILLER CELLS
innate immune system: large lymphocytes with granules and they target cells infected with
intracellular organisms, like viruses, as well as cells that pose a threat like cancer cells

ADAPTIVE (backup responders)

High specific
Has to be activated, takes weeks
Has memory (natural adaptive immunity)
1. B CELLS
adaptive immune system; involves antibodies that bind to pathogens, not only neutralizing and
killing them (via lysis) but also enabling them to be engulfed and degraded by phagocytes. Most
activated B cells transform into plasma cells that produce antibodies
Secretes antibodies
2. T CELLS
make up 90% of lymphocytes in the blood can be found in the thymus if immature
3. CYTOTOXIC T CELLS
Responsible for killing cells that have been infected by pathogens such as virally infected cells.
4. HELPER T CELLS

Travel to arens of infection and secrete eytokines that help to recruit monocytes and
macrophages to the infected tissue and activate
the macrophages to cause inflammation and
start the process o pragocylosis
Coordinates immune respor
5. KILLER T CELLS
Kill cells in the body that have been infected, transformed, or foreign.
REGULATORY T-CELLS
Regulated and limit response especially after the infection is resolved.

TYPES OF IMMUNOGLOBULIN
«GAmED"
1. leG
75%
Most abundant antibody
Only antibody to cross placenta to fetus
Protects against bacteria, virus, toxins Main antibody in secondary response
]gA
Produced by mucus membranes
Can pass through breast milk to fetus Can also be found in saliva, sweat, tears
Prevents bacteria, viruses to attach to epithelial surfaces
Colostrum (natural Passive adaptive immunity)
]gM
Largest antibody
Found in blood and lymphatic fluid
Main antibody in primary resporine, 1 in early infection
IgE
Immediate allergic response
Found in basophils and mast cells
Found in the lungs, skin, mucus membranes
Least amoun of antibody (0,001 or 1%)
leD
Least understood antibody
Found on B cells surfaces • helps in action of differentiation from B cell to plasma cell
HYPERSENSITIVITY
An exagerated and abnormal immune response to any type of stimulus

SENSITIZATION
-1st immune response to any type of stimulus
TYPE I ALLERGIES /ALLeRGIC RESPONSES
-An immediate reaction mediated by IgE antibody, laryngeal stridor, angioedema, hypotension,
spasms, hives
-Most severe is anaphylaxis (epinephrine)
Bronchospasm; increase smooth muscle contraction
-Hypotension and Hypovolemia, peripheral vasodilation and increase capillary permeability
-Erythema; extravasation of capillary blood
-Edema; fluid shifting to interstitial spaces
Allergic rhinitis, conjunctivitis, asthma anaphylactic reaction

DIAGNOSTIC TESTS
1. Skin Prick Test- most common sites (upper arm, forearm, and back)
2. Scratch Test- same sites, seratch with associated antigen
3. Intradermal Test- more sensitive than skin prick test, high risk for false positive result
4. Blood Test- allergen specific IgE test
MANAGEMENT
Treatment will depend on the cause of reaction and preventive management (most effective
form)

TYPE II
-Antigen (cell sirface)- antibody complex
an IgG or igM antibody-mediated -Cytotoxic reaction occuring in hours to days
-Hemolytic blood transfusion reaction
-Antigen-antibody complex
Hemolysis, systemic disorders (Myasthenia Gravis, Rheumatic fever, Graved disease)
TYPEIII immune complex
Antigen-antibody immune complex mediated reaction, which can occur over hours, days or
weeks
-Antigen soluble-antibody-deposits in the tissue-complement cascade
Examples include serum sickness, rheumatoid arthntis (RA). systemic lupus erythematous (SLE)
and post-streptococcal glomerulonephritis
Antigen-antibody-complement cascade
LOW COMPLIMENT TEST
C3 and C4 proteins: low because nauubos due to inflammation

Type IV delayed after 2-3days

Delayed hypersensitivity
T cell mediated
-Contact dermatitis. Graft rejection, tuberculin skin test
GRAFT VS. HOST DISEASE
Donate stem cell or blood
Must be allogeneic (donated by other person) and not Autologous (self-donation)
TRANSPLANT REJECTION
-Donate organs

DIFFUSE CONNECTIVE TISSUE DISEASES

Group of systemic disorders that are chronic in nature and are characterized by diffuse
inflammation and degeneration
tin.
the
connective tissues.

RHEUMATOID ARTHRITIS
Autoimmune disease of unknown origin
Causes inflammation of the joints (synovium)
Females having 3x more at risk than males
Onset occurs between third and sixth decade of life.
Other factors, genetics, obesity, smoking

SYNOVIUM- joints, RA, systemic effect, bilateral

CARTILAGE- bones, shock abnorber, unilateral
If damaged- osteoarthritis (wear and tear disease), not autoimmune disease!!

STAGES OF RHEUMATOID ARTHRITIS

Synovitis: inflammatory synovium, fibrous
Pannus- fibrous tissue formation at the joints
anyklosis-fusion of the joints
Fibrous ankylosis- fusion of a joint because of fibrous tissue
Bony Ankylosis- permanent of immobility and loss of flexibility

DIAGNOSTIC TEST:
Anti-nuclear antibody test- auto antibodies
Rheumatoid factor-auto antibodies
ESR; amount of inflammation
Anti-CCP, inflammation
C-Reactive Protein test amount of inflammation
Complement test (C3. C4); low (+) for RA CBC, serum chemistry
Xray of joints, direct arthroscopy
Synovial fluid aspirate/biopsy

SIGNS AND SYMPTOMS

Symmetnc joint pain
Morning joint stiffness lasting longer than 1 hr. (if <ihr OA sya)
•Small joints of hands, wrists, and feet knees shoulders, hips, elbows, ankles, cervical spine
• Red hot swollen joints
Extra-articular features (outside the joints)
• Fever
Weight loss, fatigue, anorexia (first sign)
• Anemia, lymph node enlarged
• Raynaud's phenomenon (vasospasm= cyanotic and become red after, return of blood flow)
Late Stage
• Boutonniere's deforming- Flexed PIP, hyperextended DIP
• Swann neck deformity- hyperextended PIP, flexed DIP
Ulnar deviation of metacarpophalangeal joints
If OA bony swelling/ outgrowth
• Heberden's Node- swelling of DIP
Bouchard' Node- swelling of PIP
MEDICATIONS
Non-Steroidal Antiadommator Drugs
•Ibuprofen, naproxen (not for long term= GI Ulcer)
Corticosteroids
• Dexamethasone, methylprednisolone, prednisone (OA, Hyperglycemia, immunosuppressant)
Disease modifving anti-rheumatic drugs
Hydroxychloroquine (irreversible retinopathy).
methotrexate surasalazine
SURGICAL MANAGEMENT:
Reconstrictive surger
Synovectomy: removal of inflamed svnovial membrane (not recommended because it will
relapse)
Arthrodesis- surgical fusion of joint (for palliative purposes)
Arthroplasty- surgical replacement of the joint (substituted by prosthesis)

NURSING MANAGEMENT:
1. ACUTE AND CHRONIC PAIN Address immobility, prevent contractures and deformities)
Provide variety of comfort measures
Application of heat and cold, massage position changes, supportive pillow, splints, relaxation
techniques
• Administer medications as preseribed.
Encourage verbalization of feelings.
2. FATIGUE
• Provide education about fatigue
• Facilitate making of activity/rest schedule
• Encourage adequate nutrition
Encourage adherence to treatment program
3. IMPAIRED MOBILITY
Encourage verbalization regarding limitations in mobilit
Assess need for physical therapy referral
Assist to identify environmental barriers
Encourage independence in mobility and assist as needed