ASSESSMENT OF IMMUNE FUNCTIONS

1. Define the following terms:

a. Immunity the bodys specific protective response to a foreign agent or organism;
resistance to disease, specifically infectious disease.
b. Immunopathology study of disease resulting in dysfunctions within the immune system.

2. What are the disorders of the immune system?
Autoimmunity Normal protective immune response paradoxically turns
against or attacks the body, leading to tissue damage
Hypersensitivity body produces inappropriate or exaggerated responses to
specific antigens.
Gammopathies Immune deficiencies immunoglobulins are overproduced.
Primary deficiency results from improper development of immune cells or
tissues; usually congenital or inherited.
Secondary deficiency results from some interference with an already
developed immune system; usually acquired later in life.

3. Anatomic and Physiologic Review
a. List the major components of the immune system and discuss each component
comprehensively.
Bone Marrow
-Where white blood cells (WBC) are produced
-Like other blood cells, lymphocytes are generated from stem cells, which are
undifferentiated cells.

2 kinds of lymphocytes:
o B lymphocytes (B cells) mature in the bone marrow and then enter the circulation
o T lymphocytes (T cells) move from the bone marrow to the thymus, where
they mature into several kinds of cells with different
functions.

Lymphoid Tissues
o Spleen composed of red and white pulp, acts somewhat like a filter. The red
pulp is the site where old and injured RBCs are destroyed. The white pulp
contains concentrations of lymphocytes.
o Lymph nodes connected by lymph channels and capillaries, are distributed
throughout the body. They remove foreign material from the lymph system
before it enters the blood stream. The lymph nodes also serve
as centers for immune cell proliferation.
*remaining lymphoid tissues contain immune cells that defend the bodys mucosal
surfaces against microorganisms (Levinson, 2008).

b. Describe the function of the immune system
The basic function of the immune system is to remove foreign antigens such as
viruses and bacteria to maintain homeostasis.

c. Distinguish the 2 major types of the immune system and discuss their corresponding
components.
1. Natural Immunity or nonspecific immunity
- Is present at birth.
- It provides a broad spectrum of defense against and resistance to infection.
It is consider the first line of host defense following antigen exposure,
because it protects the host without remembering prior contact with an
infectious agent (Kin & Sanders, 2006).
COMPONENTS:
White Blood Cell Action
- cellular response key to the effective initiation of the immune response

WBCs or Leukocytes participates in both natural and acquired

Granular Leukocytes (granulocytes) fight invasion by foreign bodies or toxins by releasing cell
mediators such as histamine, bradykinin and prostaglandins ; engulf the foreign bodies or toxins;
include neutrophils, eosinophils, and basophils
*neutrophils (polymorphonuclear leukocytes [PMNs]) are the first cells to arrive at
the site where inflammation occurs.
*Eosinophils and Basophils increase in number during allergic reactions and stress
responses.

Nongranular leukocytes referred to as histiocytes when they enter tissue spaces; include
monocytes or macrophages
*monocytes also fxn as phagocytic cells, engulfing, ingesting, and destroying greater
numbers and quantities of foreign bodies or toxins than granulocytes do.
*lymphocytes consisting of B cells and T cells, play major roles in humoral and cell-
mediated.
Inflammatory Response
- inflammatory response a major fxn of the natural immune system that is
elicited in response to tissue injury or invading organisms
Chemical mediators minimizes blood loss, wall off the invading microorganism, activate
phagocytes, promote formulation of fibrous scar tissue.

Physical and Chemical Barriers
- Physical surface barriers include intact skin, mucos membranes, and cilia
of the respiratory tract.
- Chemical barriers include mucus, acidic gastric secretions, enzymes in
tears and saliva, sebaceous and sweat secretions.

2. Acquired Immunity
- Usually develops as a result of prior exposure to an antigen through immunization or
by contracting a disease.

COMPONENTS:
Lymph nodes for surveillance; are widely distributed internally throughout the
body and in the circulating blood, as well as externally near the bodys surfaces.
They continuously discharge small lymphocytes into the bloodstream.
Lymphocytes patrol the tissues and vessels that drain the areas served by that
node.
Macrophages & Neutrophils both have receptors for antibodies and compliment;
as a result, they coat microorganisms with antibodies, complement, or both,
thereby enhancing phagocytosis.
T Lymphocytes
Types of T lymphocytes:
*Helper T cells secrete cytokines, which attracts and activate B cells, cytotoxic T cells, NK
cells, macrophages, and other cells of the immune system.

*Cytotoxic T cells (killer T cells) attack the antigen directly by altering the cell membrane
and causing cell lysis and by releasing cytolytic enzymes and cytokines.

*Supressor T cells have the ability to decrease B cell production, thereby keeping the
immune response at the level that is compatible with health (sufficient to fight infection
adequately w/o attacking the bodys health tissue).
*Memory T-cells are responsible for recognizing antigens from previous exposure and
mounting an immune response.
**B Lymphocytes recognize and respond to invading antigen and respond by producing and releasing
antibodies.
**Null Lymphocytes destroys antigens already coated with antibody.
**Natural Killer (NK) cells a class of lymphocytes that recognize infected and stressed cells and
respond by killing these cells and by secreting macrophage-activating cytokines
**Antibodies are large proteins, called Immunoglobulins; defend against foreign invaders in several
ways; facilitate phagocytosis; promote the release of vasoactive substances, such as histamine and slow-
reacting substances, two of the chemical mediator of the inflammatory response.
4. Make a diagram on how the body deals with invasion of microorganisms based on the
following:

- Phagocytic immune response

- Humoral or antibody immune response (include the major characteristics of the
immuonoglobulins)




































- Cellular immune response (include the types of T lymphocytes; null lymphocytes and
natural killer cells)













Antigens or antigenic
fragments in body fluids
most antigens must
either infect cell or be
processed by
phagocytes before
specific defenses are
activated. The trigger is
the appearance of
antigenic fragments in
plasma membranes: this
is called antigen
presentation
Specific defenses
Antigen
presentation
triggers specific
defenses , or an
immune response









Communication and feedback











d. Make a comparison of the cellular and humoral immune responses (Chart 50-1)

- Humoral Responses (B Cells)
Bacterial phagocytosis and lysis
Anaphylaxis
Allergic hay fever and asthma
Immune complex disease
Bacterial and some viral infection
- Cellular Responses (T Cells)
Transplant rejection
Delayed hypersensitivity (tuberculin reaction)
Graft-versus-host disease
Tumor surveillance or destruction
Intracellular Infections
Viral, fungal, and parasitic infection

e. Discuss comprehensively the complement system.

- The Complement System- Circulating plasma proteins, known as complement, are made
in the liver and activated when an antibody connects with its antigen. Complement
plays an important role in the defense against microbes. It has major actions:
a) Defending body against bacterial infection
Antibody-Mediated
Immunity
Activated B cells give
rise to cells that
produce antibodies.


Attack by Circulating
Antibodies



Direct Physical and
Chemical Attack
Activated T cells find
the pathogens and
attack them through
phagophagocytosis
or the release of
chemical toxins

Cell-Mediated
Immunity
Phagocytes
activated

T cells
activated

Destruction of
antigens
b) Bridging natural and acquired immunity
c) Disposing of immune complexes and the by products associated with inflammation.

The complement cascade may be activated by any of the three pathways: classic, lectin, and
alternative.
a) Classic pathway: triggered after antibodies bind to microbes or other antigens and is
part of the humoral type of adaptive immunity
b) Lectin pathway: activated when a plasma protein binds to terminal mannose residue on
the surface glycoproteins of microbes.
c) Alternative pathway: triggered when complement proteins are activated on microbial
surfaces.

f. Describe the immunomodulators.
- An Immunomodulators (also known as biologic response modifier) affects the host via
direct or indirect effects on one or more components of the immunoregulatory
network. Interferons and colony-stimulating factors are two of the more commonly and
Immunomodulators.

5. Research and download advances on the following in relation to health of human beings:
a. Genetic engineering
Effects of Genetic Engineering
By Jerry McPhersson - 2008-08-24
To some people, this is the chance for a better and healthier life, but there are other people fear that
it is "playing God" and trying to "program" a human being. Each of these views is right in certain
ways. Genetic engineering could be used to enhance peoples lives, but it could also be used to
harm peoples lives.
Some scientists involved in the field of genetic research have been moving toward the goal of
being able to change DNA.
To some people, this is the chance for a better and healthier life, but there are other people fear
that it is "playing God" and trying to "program" a human being. Each of these views is right in certain
ways. Genetic engineering could be used to enhance peoples lives, but it could also be used to harm
peoples lives.
If future research produces more effective and accurate processes to manipulate human DNA,
scientists will be able to create cures for diseases that are not curable today. Even birth defects
could be almost totally eliminated if doctors were able to change a childs genes before birth. The
process could also be adapted to cure hereditary diseases and prevent them from passing to future
generations. It could also allow people with family histories of diseases, such as cancer, to "fix" their
genetic predisposition to the disease.
Another way that genetic engineering could affect our lives is its application to genetically modified
plants and animals used for food. If farmers breed plants and animals specifically engineered to
produce more meat or fruit, faster and easier than normal, then food would become cheaper and
more plentiful. In addition, genetic engineering might allow the creation of better tasting, or
more nutritious foods.
Genetic engineering can also be applied in the fight against diseases.
Through genetic engineering, people could maintain their lifestyles without the threat
of AIDS orCancer.
People of the world would not have to live in fear of contracting a deadly virus or hereditary disease.
In theory, genetic engineering can accomplish this.
Genetic engineering can improve the health of society tremendously then as it is known today.
Today genetic engineering is used in the fight against problems such as cystic fibrosis, the "bubble
boy" disease (* see below), diabetes, and several more.
Cystic fibrosis is the leading hereditary cause of death among Caucasian Americans, affecting one in
every two thousand children and young adults.
Another deadly disease now being treated by genetic engineering is the "bubble boy" disease
(Severe Combined Immunodeficiency). This disease is characterized by a gene mutation that causes
a deficiency in ADA, which causes the cells of the immune system to be destroyed.
In 1990, copies of a normal ADA enzyme were inserted into an inactive virus a carrier; the carrier
was then introduced to a young girl s system who was suffering from the "bubble boy" disease. The
virus began to infect the girl s T-cells and the colony began to grow. She was then given several
other transfusions. In 1992 her treatment had proven successful and her immune system had grown
very strong.
Although they might have a positive effect, new organisms created by genetic engineering could
present an ecological problem.
The changes that a genetically engineered species would make on the environment of a region are
unpredictable. Just like an exotic species, the release of a new genetically engineered species would
also have the possibility of causing an imbalance in the ecology of a region. An accident or an
unknown result could present several problems. An accident in engineering the genetics of a virus or
bacteria could result in a stronger type, which, if released, could start a serious epidemic. Even
worse, accidents in human genetic engineering could cause problems ranging from minor medical
problems, to death.
Genetic engineering could also create unknown side effects or outcomes. Certain changes in a plant
or animal could cause unpredicted allergic reactions in some people which, in its original form, did
not occur. Other changes could make an organism toxic to humans or other organisms.
Like many other things, genetic engineering is a two-edged sword.
* Bubble Boy Disease - Severe combined immunodeficiency (SCID) represents a group of rare,
sometimes fatal, congenital disorders characterized by little or no immune response. The defining
feature of SCID, commonly known as "bubble boy" disease, is a defect in the specialized white blood
cells (B- and T-lymphocytes) that defend us from infection by viruses, bacteria and fungi
Reference: http://www.disabled-world.com/artman/publish/genetic-engineering.shtml

Genetic Inequality: Human Genetic Engineering
By: Danielle Simmons, Ph.D. (Write Science Right) 2008 Nature Education
Citation: Simmons, D. (2008) Genetic inequality: Human genetic engineering. Nature
Education 1(1):173

Genes influence health and disease, as well as human traits and behavior. Researchers are just
beginning to use genetic technology to unravel the genomic contributions to these different
phenotypes, and as they do so, they are also discovering a variety of other potential applications for
this technology. For instance, ongoing advances make it increasingly likely that scientists will
someday be able to genetically engineer humans to possess certain desired traits. Of course, the
possibility of human genetic engineering raises numerous ethical and legal questions. Although such
questions rarely have clear and definite answers, the expertise and research of bioethicists,
sociologists, anthropologists, and other social scientists can inform us about how different
individuals, cultures, and religions view the ethical boundaries for the uses of genomics. Moreover,
such insights can assist in thedevelopment of guidelines and policies.
Testing for Traits Unrelated to Disease
For adult-onset conditions, ethical concerns have been raised regarding whether genetic
testing should be performed if there is no cure for the disease in question. Many people wonder
whether positive diagnosis of an impending untreatable disease will harm the at-risk individual by
creating undue stress and anxiety. Interestingly, social science research has demonstrated that the
answer to this question is both yes and no. It seems that if genetic testing shows that an individual is
a carrier for a recessive disease, such as Tay-Sachs disease or sickle-cell anemia, this knowledge may
have a negative impact on the individual's well-being, at least in the short term (Marteau et al.,
1992; Woolridge & Murray, 1988). On the other hand, if predictive testing for an adult-onset genetic
disorder such as Huntington's disease reveals that an at-risk individual will develop the disorder later
in life, most patients report less preoccupation with the disease and a relief from the anxiety of the
unknown (Taylor & Myers, 1997). For many people who choose to have predictive testing, gaining
a locus of control by having a definitive answer is helpful. Some people are grateful for the
opportunity to make life changesfor instance, traveling more, changing jobs, or retiring early
in anticipation of developing a debilitating condition later in their lives.
Building Better Athletes with Gene Doping
Over the years, the desire for better sports performance has driven many trainers and athletes to
abuse scientific research in an attempt to gain an unjust advantage over their competitors.
Historically, such efforts have involved the use of performance-enhancing drugs that were originally
meant to treat people with disease. This practice is called doping, and it frequently involved such
substances as erythropoietin, steroids, and growth hormones (Filipp, 2007). To control this drive for
an unfair competitive edge, in 1999, the International Olympic Committee created the World Anti-
Doping Agency (WADA), which prohibits the use of performance-enhancing drugs by athletes.
WADA also conducts various testing programs in an attempt to catch those athletes who violate the
anti-doping rules.
Creating Designer Babies
Genetic testing also harbors the potential for yet another scientific strategy to be applied in the area
of eugenics, or the social philosophy of promoting the improvement of inherited human traits
through intervention. In the past, eugenics was used to justify practices including involuntary
sterilization and euthanasia. Today, many people fear that preimplantation genetic diagnosis may be
perfected and could technically be applied to select specific nondisease traits (rather than eliminate
severe disease, as it is currently used) in implanted embryos, thus amounting to a form of eugenics.
In the media, this possibility has been sensationalized and is frequently referred to as creation of so-
called "designer babies," an expression that has even been included in the Oxford English Dictionary.
Although possible, this genetic technology has not yet been implemented; nonetheless, it continues
to bring up many heated ethical issues.

Reference: http://www.nature.com/scitable/topicpage/genetic-inequality-human-genetic-
engineering-768
B. Stem cell
Stem cells are capable of self-renewal and differentiation; they continually replenish the bodys
entire supply of both RBCs and WBCs. Some stem cells, described as totipotent cells, have
tremendous capacity to self-renew and differentiate. Embryonic stem cells, described as
pluripotent, give rise to numerous cell types that are able to form tissues. Research has shown that
stem cells can restore an immune system that has been destroyed. Stem cell transplantation has
been carried out in humans with certain types of immune dysfunction; such as severe combined
immunodeficiency (SCID); Clinical trials using stem cells are under way in patients with a variety of
disorders having an autoimmune component, including systemic lupus erythematosus, rheumatoid
arthritis, scleroderma, and multiple sclerosis. (Goldman, 2007).
Can Stem Cells Mend a Broken Heart?: Stem Cells for the Future Treatment of Heart Disease
Cardiovascular disease (CVD), which includes hypertension, coronary heart disease, stroke, and
congestive heart failure, has ranked as the number one cause of death in the United States every
year since 1900 except 1918, when the nation struggled with an influenza epidemic. Nearly 2600
Americans die of CVD each day, roughly one person every 34 seconds. Given the aging of the
population and the relatively dramatic recent increases in the prevalence of cardiovascular risk
factors such as obesity and type 2 diabetes, CVD will be a significant health concern well into the
21st century.
Cardiovascular disease can deprive heart tissue of oxygen, thereby killing cardiac muscle cells
(cardiomyocytes). This loss triggers a cascade of detrimental events, including formation of scar
tissue, an overload of blood flow and pressure capacity, the overstretching of viable cardiac cells
attempting to sustain cardiac output, leading to heart failure, and eventual death. Restoring
damaged heart muscle tissue, through repair or regeneration, is therefore a potentially new strategy
to treat heart failure.
The use of embryonic and adult-derived stem cells for cardiac repair is an active area of research. A
number of stem cell types, including embryonic stem (ES) cells, cardiac stem cells that naturally
reside within the heart, myoblasts (muscle stem cells), adult bone marrow-derived cells including
mesenchymal cells (bone marrow-derived cells that give rise to tissues such as muscle, bone,
tendons, ligaments, and adipose tissue), endothelial progenitor cells (cells that give rise to the
endothelium, the interior lining of blood vessels), and umbilical cord blood cells, have been
investigated as possible sources for regenerating damaged heart tissue. All have been explored in
mouse or rat models, and some have been tested in larger animal models, such as pigs.
A few small studies have also been carried out in humans, usually in patients who are undergoing
open-heart surgery. Several of these have demonstrated that stem cells that are injected into the
circulation or directly into the injured heart tissue appear to improve cardiac function and/or induce
the formation of new capillaries. The mechanism for this repair remains controversial, and the stem
cells likely regenerate heart tissue through several pathways. However, the stem cell populations
that have been tested in these experiments vary widely, as do the conditions of their purification
and application. Although much more research is needed to assess the safety and improve the
efficacy of this approach, these preliminary clinical experiments show how stem cells may one day
be used to repair damaged heart tissue, thereby reducing the burden of cardiovascular disease.
Reference: http://stemcells.nih.gov/info/basics/pages/basics6.aspx

6. Assessment of the Immune System
a. Health History
Gender: There are differences in the immune system functions of men and women. Sex
hormones play definitive roles in lymphocytes maturation, activation, and synthesis of antibodies and
cytokines. For example, many autoimmune diseases have a higher incidence in females than in males. In
the last two decades it was discovered that these hormones are integral signalling modulators in the
immune system. In autoimmune disease, expression of sex hormone is altered, and this change
contributes to immune dysregulation.
Gerontologic considerations: Immunosenescence is a complex route in which the aging process
stimulates changes in the immune system. The immune system undergoes age-associated alteration
that leads to a progressive deterioration in the ability to respond to infections. The capacity for self-
renewal of hematopoietic stem cells diminishes. There is a notable decline in the number of phagocytes,
coupled with an intrinsic reduction in their activity. The cytotoxicity on NK cells decreases, contributing
to a decline in humoral immunity. Acquired immunity may be negatively affected; the efficacy of
vaccines is frequently decreased in older adults. Natural Immunity however, continues to function
reasonably well, perhaps as an adaptive response to the deterioration of cell-mediated immunity in old
age.
Nutrition: Traditionally, this relationship focused on the effect of nutrients on host defenses and
the effect of infection on nutritional needs. The list of nutrients affecting infection, immunity,
inflammation and cell injury have expanded from traditional proteins to several vitamins, multiple
minerals, and more recently specific lipid components of the diet. More recently the role of
micronutrients and fatty acids on the response of cells and tissues to hypoxic and toxic damage has been
recognized, suggesting that there is another dimension in the relationship.
Blood transfusion: A history of blood transfusion is obtained because previous exposure to
foreign antigens through transfusion may be associated with abnormal immune function. Additionally,
although the risk of HIV transfusion is extremely low in patients who received a transfusion after 1985 a
small risk still remains.
Lifestyle: Poor nutritional status, smoking, excessive consumption of alcohol, illicit drug use,
STDs, and occupational or residential exposure to environmental radiation and pollutants have been
associated with impaired immune function and are assessed in a detailed patient history. However
positive lifestyle factors can also negatively affect immune function and require assessment. For
example, rigorous and competitive exercise can be a physiologic stressor and cause negative effect on
immune response.
Psychoneuroimmunologic factor: It is thought that the immune response is regulated and modulated in
part by neuroendocrine influences. Lymphocytes and macrophages have receptors that are capable of
responding to neurotransmitters and endocrine hormones. Like all other biologic systems functioning to
maintain homeostasis, the immune system is integrated with other psychophysiologic processes and is
subject to regulation and modulation by the brain.
b. Assessing for Immune Dysfunction
Respiratory System
Changes in respiratory rate
Cough (dry or productive)
Abnormal lung sounds ( wheezing, crackles, ronchi)
Rhinitis
Bronchospasm
Hyperventilation
Cardiovascular System
Hypotension
Tachycardia
Dysrhythmia
Vasculitis
Anemia
Gastrointestinal System
Hepatosplenomegaly
Colitis
Vomiting
Diarrhea
Gentourinary System
Frequency and burning on urination
Hematuria
Discharge
Musculoskeletal System
Joint mobility, edema, and pain
Skin
Rashes
Lesions
Dermatitis
Hematomas or purpura
Edema or urticaria
Inflammation
Discharge
Neurosensory System
c. Selected Diagnostic Tests for Evaluating Immunologic Status
The studies assess leukocytes and lymphocytes, humoral immunity, cellular immunity, phagocytic cell
function, complement activity, hypersensitivity reactions, specific antigens-antibodies, or human-
immunodeficiency virus (HIV) infection
Humoral (Antibody-mediated) Immunity Tests
B-cell quantification with monoclonal antibody
In vivo immunoglobulin synthesis with T-cells subsets
Specific antibody response
Total serum globulins and individual immunoglobulins (electrophoresis, immunoelectrophoresis,
single radial immunodiffusion, nephelometry, and isohemagglutinin techniques)

Cellular (Cell-mediated) Immunity Tests
Total lymphocyte count
T-cell and T-cell subset quantification with monoclonal antibody
Delayed hypersensitivity skin test
Cytokine production
Lymphocytes response to mitogens, antigens, and allogenic cells
Helper and suppressor T-cell function

7. Describe the nurses roles for clients with inflammation and immunity problems.

Assess functional health status of clients with altered immunity and monitor, document,
and report abnormal manifestations.
Use evidence-based practice to plan and implement nursing care for clients with altered
immunity.
Assess for hypersensitivities and anticipate treatment if signs and symptoms develop.
Provide client teaching about hypersensitivities, avoidance of sensitizing agents, and
prophylactic treatment.
Determine priority nursing diagnosis, based on assessment data, to select and
implement individualized nursing interventions and teaching for clients with altered immunity.
Protect clients who are immune-suppressed.
Recognize signs and symptoms of developing anaphylaxis.
Recognize signs and symptoms of infection and minimize nosocomial exposure.
Utilize universal precautions to protect self and clients from HIV exposure.
Recognize the burden and benefit of HAART for the client with HIV infection.
Integrate interdisciplinary care into care of the client with altered immunity.
Revise plan of care as needed to provide effective interventions to promote, maintain,
or restore functional health status to clients with altered immunity.
Assess the clients with inflammatory problems present health status: General health
and nutritional status, describe any injuries, describe any redness, warmth, swelling, or pain. Is
drainage associated with current injury or previous procedure? Is drainage clear or purulent?
Changes in appetite or energy level.
Assess Past Medical history: Any frequent Infections? Use of anti-inflammatory
medications, corticosteroids, pr antibiotics.
Assessment of Vital signs, height and weight.
Observe client for fatigue and listlessness.
Assess Ability to move injured area and amount of pain.
Assess circulation to affected area.
Inspect skin and surrounding area of injury for redness and warmth, purulent drainage,
odor and poor healing.
Measure size (depth and width) of wounds.
Palpate the skin for the presence of edema.
Palpate for enlarged lymph nodes.
Monitor and report abnormal results of WBC count differentials, ESR, CRP.
Include knowledge of developmental levels and of activities to promote, restore, and
maintain health when planning and implementing care for adult clients.
Include family members in teaching to promote and maintain health of the adult client.
Reference: Pearson, Medical-Surgical Nursing Care 1995-2010