Tabloski ch23 lecture

Gerontological NursingGerontological Nursing

CHAPTER

THIRD EDITION

Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.All Rights Reserved

The Immune System

23

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Objectives

1. Define the role of the immune system in the maintenance of health.

2. Describe the three unique characteristics of the immune system.

3. Identify factors that affect proper immune system function.


Learning Objectives

4. Distinguish the similarities, differences, and interactions between the humoral immune response and the cellular immune response.

5. Associate the pathology that underlies illnesses associated with both excessive and deficient immune responses.


Learning Objectives

6. Outline the unique characteristics associated with HIV infection in the older person.

7. Relate the care of the patient with a rheumatoid disorder to the pathology involved.


Learning Objectives

8. Explain the physiological processes that increase the susceptibility of the older person to infections.

9. Identify nursing interventions that can be effective in improving immune status in the older person.


Introduction

• Three major biological defense mechanisms protect the human body from injurious chemicals, foreign bodies, microorganisms, and parasites.

• The first line of defense is the physical, anatomical, and biochemical barriers provided by our skin and the mucous membranes that line our digestive, respiratory, urinary, and reproductive tracts.


Introduction

• The second line of defense is often called the “innate” immune system because it is present from birth in all animals. It includes mechanical clearance. The inflammatory response is also part of the second line of defense.


Introduction

• The third line of defense is the immune response or the “adaptive” immune system, a highly complicated, integrated system that is controlled by a complex communication mechanism.


The Immune System

• The immune response has the capability to confer long-term and, sometimes, permanent protection against living organisms such as bacteria, viruses, and parasites.

• It also protects the body from its own cancer cells. It is a diverse and complicated system made up of interrelated parts, but functions as a whole.


The Immune System

• Multiple factors affect the individual’s immune system.

• The internal characteristics of the individual include factors such as age, gender, and inherited genetic sequence.

• External factors also can have a substantial effect on a person’s immune system.


Characteristics Unique to the Immune System

• Three characteristics are unique to the immune system: –Self-recognition–Specificity–Memory


Characteristics

• In self-recognition (tolerance), the immune system differentiates between substances that are normal constituents of a person’s body and those that are not.

• Specificity means that the immune response reacts to only one antigen.


Characteristics Unique to the Immune System

• Memory means that the immune system has the capacity to develop long-lasting protection against specific invaders.


Cell-mediated Immune Response

• A highly regulated communication system with a series of positive and negative feedback systems regulates and coordinates the immune response so that normal body tissues are not injured. These regulatory functions can be affected by the aging process and the presence of chronic disease.


Normal Changes of Aging

• Generally, aging is associated with physiological changes that cause stiffness or rigidity and decreased levels of functioning in many systems.

• One of the most important biological changes occurring during human aging is a progressive decrease in immune functioning, or immunosenescence.


Normal Changes of Aging

• A decreased ability to respond to antigenic stimulation by B lymphocytes is a common characteristic of the aging humerol immune system.

• The number of B cells in the circulation decreases in some individuals. As a result, tissues are slower to repair and are more vulnerable to disease, especially infections.


Factors Affecting Aging of the Immune System

• Many factors directly or indirectly associated with aging can affect the immune system. These factors include stress, chronic illness, exercise, and dietary nutrients.

• An increase in the amount of stress perceived by individuals is generally associated with poorer cellular immunity.


Factors Affecting Aging of the Immune System

• Mood, stress, depression, and mental illness influence the immune system.


Healthy Aging Tips

• Regular, moderate, exercise 30 minutes a day, five days a week

• Take a multivitamin/mineral supplement daily.

• Consider vitamin D supplementation.• Maintain a healthy weight.• Report increased infections to your

health care practitioner.


Excessive Immune Responses

• Hypersensitivity and autoimmunity are types of excessive responses. Overreaction of the immune system is believed to result from interplay between environmental factors and the genetic makeup of the individual.


Hypersensitivity

• Hypersensitivity is either an excessive response to antigen stimulation or a normal response that is inappropriate.


Deficient Immune Responses

• Deficient immune responses occur when there is a functional decrease in one or more components of the immune system.


Primary Immunodeficiency Disorders

• Primary immunodeficiency disorders are either congenital or acquired, and are not attributed to other causes.


Primary Immunodeficiency Disorders

• HIV/AIDS– Infection with the human

immunodeficiency virus (HIV) and the resulting acquired immunodeficiency syndrome (AIDS) is the best example of a primary immunodeficiency disorder. The hallmark of this infection is a decrease in cellular (T cell) immunity.


Susceptibility to Infections

• Infections are one of the most frequently encountered problems in the older population. Although specific relationships between an aging or compromised immune system and infection are not clear, the decline in responsiveness of the immune system to harmful foreign invaders leads to an increase in the incidence and severity of infections.


Pneumonia

• Pneumonia is a common condition in immune deficient people and is the leading cause of death in people over 65 years of age.

• The combination of pneumonia and influenza causes the greatest number of deaths.


Monoclonal Antibodies

• The scientific community can now mass produce immune cell secretions, such as antibodies. The availability of these products has revolutionized the study of the immune system and has had a significant impact not only upon medicine, but upon agriculture and industry as well.


Genetic Engineering

• Genetic engineering, recombinant DNA technology, genetic modification/manipulation (gm), and gene splicing are all terms that are applied to the direct manipulation of an organism’s genes.


Nursing Assessment

• Multiple factors underlie immune problems in the older person. Therefore, a health history and physical examination are essential.


Nursing Interventions

• The nurse often will engage in teaching older patients and families about prevention of infectious disease like influenza.

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