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Medical-Surgical Nursing

Summary

Medical-Surgical NursingSummary

29.1 Immune Response

  • The immune system is an intricate and complex system of specialized cells, organs, and tissues.
  • The main functions of the immune system are to recognize and destroy harmful substances or malignant cells, fight and remove disease-causing pathogens, and remove and destroy dead or damaged cells.
  • Natural (innate) immunity is nonspecific and present at birth. Acquired (adaptive) immunity develops after birth in response to specific pathogens.
  • Assessment of the immune system starts with obtaining the health history of the patient and performing a physical examination.
  • Assessment should include the patient’s nutritional status and history of immunizations, infections, allergies, surgeries, medications, blood transfusions, and disease and disorder states (such as cancer, chronic illnesses, or autoimmune conditions).
  • Lifestyle considerations should be taken into account when assessing the patient’s immune system.
  • Physical examination should include palpation of the lymph nodes and assessment of the skin and mucous membranes, as well as the neurosensory, cardiovascular, genitourinary, musculoskeletal, gastrointestinal, and respiratory systems.
  • Immunosuppressive therapy is designed to stop the immune system from mistakenly attacking healthy cells and may be prescribed for autoimmune diseases or for those undergoing organ or stem cell transplantation.
  • There have been several advances in immunology, such as stem cells, genetic engineering, and immunotherapy.

29.2 Autoimmunity

  • With autoimmunity, the immune system mistakenly targets the body’s own healthy tissues, organs, and cells and attacks itself.
  • The exact cause of autoimmunity is unknown, but it is thought to have a genetic predisposition.
  • There are over 100 autoimmune conditions, and one in five Americans has been diagnosed with at least one autoimmune disorder.
  • Common autoimmune disorders include lupus, type 1 diabetes mellitus, Graves disease, Hashimoto thyroiditis, idiopathic thrombocytopenic purpura, autoimmune hemolytic anemia, rheumatic heart disease, inflammatory bowel disease, celiac disease, irritable bowel syndrome, psoriasis, scleroderma, rheumatoid arthritis, and multiple sclerosis.
  • Many autoimmune disorders have a complex disease process and their own unique pathogenesis.

29.3 Immunodeficiency

  • Immunodeficiency is the result of malfunctioning of the immune system. This may lead to infections that develop and recur often and are typically more severe and last longer than usual.
  • Primary immunodeficiencies generally are present at birth, genetic, and hereditary.
  • Primary immunodeficiencies may be caused by mutations in a specific gene. Immune cells involved in primary immunodeficiencies include B and T lymphocytes.
  • Clinical manifestations vary and may include fever, thrush, gingivitis, warts, pus-filled sores, loss of appetite, abdominal pain, liver or spleen enlargement, ear infections, or skin infections.
  • Secondary immunodeficiencies generally develop later in life and are caused by another disorder or the use of various medications. An example is HIV, which progresses into AIDS.
  • HIV destroys the body’s cell-mediated immunity, leaving affected individuals at risk for life-threatening infections from other pathogens.
  • Symptoms of HIV may include fever, fatigue, malaise, dermatitis, sore throat, lymphadenopathy, herpes, vaginal candidiasis, pneumococcal infections, decreased appetite, various cancers, wasting syndrome, and skin changes such as crusted scabies, disseminated bartonellosis, anal carcinoma, and Kaposi sarcomas. There are three stages of HIV infection: acute, chronic, and AIDS.
  • Prevention is key for secondary immunodeficiencies. Standard precautions should be used for all patients. Prevention measures should include safe sex practices, avoiding individuals with illness or infection, and avoiding sharing needles or anything that could be contaminated with blood. Pre- and postexposure prophylactic measures can be taken. Those with HIV or AIDS are not to donate blood, organs, or plasma.
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