Anatomy + Physiology

The Immune System

Part I:
Anatomy + Physiology
Bone Marrow
● Produces blood cells
○ Stem cells
■ Erythrocytes
■ Leukocytes
■ Thrombocytes
● Immune response
White Blood Cells
● Leukocytes

Antigens vs. Antibodies

● Antigen
○ Protein marker on the outside of the cell
○ Marks “self” vs. “other”
○ Tells the body what belongs
○ Tells the body what to attack
● Antibody
○ Produced specifically for one antigen
○ Locks on like a key
○ Attacks cell
Active Immunity
Your body ACTIVELY builds antibodies to a foreign organism

Examples:

● You get sick

● Exposure to new organisms
● Vaccination

Passive Immunity
Your body PASSIVELY receives antibodies

Examples:

● From mother to fetus via placenta

● Breastfeeding
● Antibody administration
○ Immune globulins
 Part II:
Immune System Pharmacology

Antivirals
● Acyclovir
● Ganciclovir
● Remdesivir
Antifungals
● Miconazole
● Fluconazole
● Nystatin

Antibiotics
● Gentamicin
● Erythromycin
● Azithromycin
● Vancomycin
● Ciprofloxacin
● Levofloxacin
● Amoxicillin
● Ampicillin
 Aminoglycosides
Gentamycin, neomycin, tobramycin, septomycin, paromomycin

● Indication: Gram negative infections

● Action: Inhibition of bacterial protein synthesis

● Monitor for tinnitus

● Do not administer with penicillin

Vancomycin
Therapeutic class: Anti-infective; glycopeptide antibiotics

Indication: Infection; sepsis

Action: kills bacteria in the intestines

Nursing Considerations:

● Monitor for ototoxicity and nephrotoxicity

● Red-man syndrome
● Administer over at least 60 minutes; central line preferred.
Fluoroquinolones
Levofloxacin, ciprofloxacin, moxifloxacin, gemifloxacin, ofloxacin

● Indication: Urinary infection, resp infections, etc.

● Action: Inhibits synthesis of bacterial DNA

● Can cause QT prolongation

● Can cause tendon rupture
● Decreases effects of phenytoin

Penicillins
Amoxicillin, ampicillin, penicillin

● Indication: Infections; skin, respiratory, endocarditis

● Action: Inhibits synthesis of bacterial cell wall leading to cell death

● Monitor for rash

● Monitor kidney function
○ BUN, Cr
Immunosuppressants
Tacrolimus, Sirolimus

Indication: Autoimmune disorders, transplant recipients

Action: Decreases the activity of the immune system

Nursing Considerations:

● Makes the client more susceptible to infections

● Talk to the health care provider before receiving vaccinations
● No grapefruit
● Side effects:
○ Diarrhea, nausea, vomiting, anorexia, weakness, headache

Vaccinations
Small portion of a disease is used to induce active immunity - helping the body
create antibodies and therefore protecting it from disease in the future.

● Inactivated vaccines
○ Hep A
○ Flu
○ Polio
○ Rabies
● Live-attenuated vaccinations
○ MMR
○ Rotavirus
○ Smallpox
○ Chicken pox
○ Yellow fever
Immune Globulins
IVIG, RhoGAM

Indication: Immunodeficiency, autoimmune disorders

Action: Passive immunity through antibody administration

Nursing Considerations:

● High risk for a reaction. Common to premedicate with acetaminophen and

diphenhydramine.
● Titrated on slowly (especially the first infusion)

Part III:
Immune System Disorders
 Infections
● Communicable ● Healthcare Acquired Infections (HAIs)
○ Transmitted from person to person
○ CAUTIs
■ Influenza
○ CLABSIs
■ Pertussis
○ SSIs
■ Mumps
■ Rhinovirus
■ Adenovirus
■ Meningitis
■ Streptococcus Aureus
● Non-communicable
○ NOT transmitted from person to person
■ Peritonitis
■ Endocarditis

● Infections requiring contact precautions:

○ MRSA
○ VRE
○ Noroviruses
○ Rotavirus
○ Conjunctivitis
○ Diphtheria (cutaneous)
○ Herpes Simplex virus
○ Human Metapneumovirus
○ Respiratory Syncytial Virus
○ Pediculosis (lice)
○ Scabies
○ Poliomyelitis
○ Staphylococcus aureus
https://www.cdc.gov/infectioncontrol/basics/transmission-based-precautions.html
 ● Infections requiring droplet precautions:
○ Influenza
○ Pertussis
○ Mumps
○ Rhinovirus
○ Adenovirus
○ Meningitis
○ Streptococcus Aureus
○ Rubella
○ Haemophilus influenzae type B
■ Epiglottitis
○ Diphtheria (pharyngeal)

https://www.cdc.gov/infectioncontrol/basics/transmission-based-precautions.html

● Infections requiring airborne precautions:

○ Tuberculosis
○ Rubeola virus (Measles)
○ Varicella virus (Chickenpox)
○ Varicella zoster
○ SARS
○ Smallpox

https://www.cdc.gov/infectioncontrol/basics/transmission-based-precautions.html
Infections by system
● Cardiovascular ● Gastrointestinal ● Musculoskeletal
○ Myocarditis ○ Gastroenteritis ○ Osteomyelitis
○ Endocarditis Many bacteria,
○
● Integumentary
● Respiratory viruses, and parasites
○ Staph
○ Pneumonia can cause
○ Cellulitis
■ Bacterial or viral ● Renal ○ Impetigo
○ Bronchitis ○ UTI ○ MRSA
○ MANY viral infections ○ Pyelonephritis ○ Yeast infections
■ RSV
● Reproductive system ■ Candida
■ Flu Fungal infections
○ STDs ○
■ COVID ■ Tinea
● Neurology
○ Encephalitis
○ Meningitis

Sepsis
● A systemic inflammatory reaction to an infection.

https://www.heart.org/en/news/2021/10/25/never-heard-of-sepsis-its-common-dangerous-and-a-threat-to-your-heart
 Pathophysiology
● Infection spreads to the bloodstream
● Increased capillary membrane permeability
○ Fluid leaks out of the blood vessels
○ Low blood volume
○ Hypotension
● Massive vasodilation
○ Hypotension

● The blood pressure is not high enough to bring blood to the tissues.
● The tissues don’t get oxygen.
● Shock!

Assessment
● Elevated lactic acid
○ Indicates body has switched to anaerobic metabolism
○ Tissues are not getting sufficient oxygen
● Metabolic acidosis
● Leukocytosis
● Hypotension
● Tachypnea
● Tachycardia
● Febrile
Treatment
● Blood cultures first
● Broad spectrum IV abx within one hour
● IV fluids
● Vasopressors

http://www.sharinginhealth.ca/labs/micro/blood_culture.html

Autoimmune Disorders
Systemic Lupus Erythematosus (SLE)
● Immune system attacks the joints, skin, brain, lungs, kidneys and blood
vessels.
● Causes widespread inflammation and tissue damage
○ Fatigue
○ Rashes
○ Fever
○ Pain and swelling in joints
● ‘Flare ups’ and remissions
● No cure
● Symptom management
○ Immunosuppressants
○ Steroids
○ Hydroxychloroquine

What is Multiple Sclerosis?

● Autoimmune disorder
● CNS inflammation
● Damages and degrades the myelin sheath surrounding neurons
○ Demyelination
Myasthenia Gravis
● Autoimmune disorder
● Communication between nerves and muscles destroyed
● Diagnosis
○ Tensilon Test

Guillain-Barré
● Antibody and cell mediated immunologic reaction precipitated by a viral or
bacterial illness
● Immune system switches to attacking the nerves and demyelinates
peripheral nerves
● Causes ascending weakness and paralysis
● If ascends to the diaphragm can cause respiratory arrest
Rheumatoid Arthritis
● Chronic systemic inflammatory disease
● Leads to destruction of connective tissue and synovial membrane within the
joints
● Weakens the joint, leading to dislocation and deformity of the joint
● Pannus forms at the junction of synovial tissue and articular cartilage and
projects into the joint space which causes necrosis
● RA exacerbations or “flares” occur during periods of fatigue and stress
(emotional or physical)

Psoriasis
● Chronic autoimmune T-cell mediated inflammatory skin disease
● Periods of exacerbations and remissions
● Thickening of epidermis and dermis
● Scaly, erythematous, pruritic plaques
● Interventions
○ Light therapy
○ Systemic therapy
■ Methotrexate
■ Folic acid
■ Systemic retinoids
■ Infliximab

https://my.clevelandclinic.org/health/diseases/6866-psoriasis
Graves Disease
● Autoimmune disease with antibodies attacking the thyroid
● The body has too much thyroid hormone!
○ Decreased levels of TSH
○ Anterior pituitary see’s low TSH and signals to the Thyroid gland to secrete more T3 and T4
○ T3 and T4 continue to be secreted despite being high
○ The negative feedback loop is broken

High T4 / Low TSH

Type I Diabetes Mellitus (TIDM)

● Autoimmune disease
● Body has destroyed the beta cells of the pancreas that produce
insulin
● There is little or no insulin in the body
● Very high levels of glucose in the bloodstream
● No glucose can get to the cells for fuel