Altered Immune Function

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Altered Immune Function

• From Wagner, Johnson, and Kidd

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Cells of the immune response

• T lymphocytes (T cells)
• Mature in the thymus
• B lymphcytes (B cells)
• Mature in the bursa equivalent of the bone marrow
• Monocyte-Macrophage system
• Require activation by the immune system to become
  macrophages
• Macrophages are powerful phagocytes

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• T cells
• B cells
• Monocytes

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• Monocytes are activated by the immune system and
  become macrophages
• Macrophages are powerful phagocytes

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Helper T cell activation
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Immunosuppression

• Aging
• Malnutrition
• Stress
• Trauma

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aging

• Decline in immune function

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Malnutrition

• Immune system is protein based

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Stress

• Cortisol
• Adrenocortical hormone
• Causes reduced T cell and B cell responses

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Trauma

• Suppresses T cell and B cell function

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Life threatening complications of devastation of
the immune system

• Infection
• Inability to heal
• Multiple organ dysfunction (MODS)

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Immunodeficiency

• Primary immunodeficiency
• Loss of function of component of immune system
• Problem with thymus or bone marrow
• Secondary immunodeficiency
• Loss of immune response
• Infection, splenectomy, malnutrition,
  immunosuppressive drugs, cancer chemotherapy and
  radiation

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• Acquired immunodeficiency
• Immunodeficiency as a result of direct attack on
  the immune system from pathogens
• Human immunodeficiency virus (HIV)
• Acquired immunodeficiency disease (AIDS)

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AIDS

• Clinical manifestations
• Debilitation, fevers, wasting, severe fatigue,
  pain
• Lymphadenopathy, pharyngitis, rash pulmonary
  infiltrates, neurologic abnormalities (dementia,
  tremors, encephalitis)
• Opportunistic infections
• Kaposis sarcoma
• P. carinii pneumonia
• TB

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Treatment

• Combination antiretroviral therapy and protease
  inhibitors
• Maintain viral load suppression
• Treating AIDS as a long-term chronic disease in
  adults

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Care of immunocompromised client

• Focused assessment
• Nursing history
• c/o fever, fatigue, weakness, swollen glands,
  light-headedness, visual disturbances
• Loss of appetite and weight loss
• Slow wound healing history
• Unexplained rashes, mouth sores, or oral patches
• Increased levels of stress, infection,
  malignancy, autoimmune disease
• History of exposure to infectious diseases

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• Immunocompetence in the high-acuity client
• Prolonged stress
• Severe infection
• Malnutrition
• diabetes

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• The nurse must monitor for critical cues of an
  underlying immunocompetence problem
• Fever
• Poor wound healing
• Joint pain
• White oral patches
• LOC and mental changes
• Abnormal CBC with differential
• Abnormal coagulation studies
• Recurrent, prolonged, severe infections
• Secondary infection
• Corticosteroids or cytotoxic drugs
• Risk factors splenectomy, DM, alcohol abuse,
  malnutrition, renal failure

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• Lab findings
• CBC with differential
• Serum prealbumin, albumin
• Cell specific and disorder specific lab tests (ie
  ELISA for exposure to HIV)

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Nursing Management

• Goals
• Adequate nutrition
• Reestablishing immunocompetence
• Prevent complications
• Collaborative interventions
• Lab testing
• Drug therapy
• Environmental protection
• Private room, positive airflow room
• Nursing interventions

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Domains of nursing practice (Benner)

• The helping role
• The teaching-coaching function
• The diagnostic and patient-monitoring function
• Effective management of rapidly changing
  situations
• Administering and monitoring therapeutic
  interventions and regimens
• Monitoring and ensuring the quality of health
  care practices