By: Diana Blum RN MSNMetropolitan Community College

Bone marrow= spongy center of the bones where WBCs are made

Lymphatic System= network of open ended tubes separate from the blood circulation system that collects the plasma left behind and returns it to the venous system. WBC travel through the tissues looking

infection

Lymph fluid=mix of plasma and cells Propelled along the lymphatic system by normal

muscle contraction One way valves prevent the fluid from pooling

Lymph nodes= small patches of tissue that filter microorganisms from the lymph fluid before it is returned to the bloodstream. Located throughout the body Swell with infection and cancer

Spleen= in LUQ of the abdomen. Filters microorganisms from the blood. Once trapped, WBCs destroy them Removed if Trauma (MVA), hodgkin’s dx▪ Greater risk of infection

Thymus= located below the thryoid Early in life WBCs called lymphocytes

migrate from bone marrow to the thymus where they mature into T Cells

As humans age the thymus shrinks Stem Cells=called progenitor cells

Develop into various WBCs, RBCs, or Platelets

Most located in bone marrow Some circulate in blood

WBCS (Leukocytes)=produced by bone marrow Identify and destroy antigens (proteins) Life span of WBC is 12 hours

Macrophages= clean up WBC debris If WBCs build faster than macrophages can

clean pus is formed. Neutrophils=fight bacterial infections Most numerous of the WBCs about

60%

Monocytes= circulate for 1 day before entering tissue

Macrophages=monocytes when they enter tissue Destroyed during phagocytosis▪ Ingest foreign material and can live months

to years

Eosinophils=combat parasitic infections Also associated with allergic responses

Basophils= can initiate massive inflammatory response to bring other WBCs to infection site Work with Immunoglobin E (IgE) by

releasing histamine from cell vesicles in the basophil▪ Histamine is a potent vasodialator that increases

blood circulation to the site

Mast cells= store histaminein cell vesicles. Located in tissue

B cells= manufacture antigen binding proteins (immunoglobins) on the cell membrane when immunoglobin binds w/ antigen, the b cell is

stimulated to produce plasma cells and memory B cells. Plasma cells are antibody factories that produce large

amounts of immunoglobins. Memory B cells go into a resting state but can be quickly

reactivated. Once immunoglobin released it is called an antibody.▪ 4 types▪ IgM=first to be secreted during primary immune response▪ IgG= secreted during 2nd ary immune response▪ IgA=present in secretions like mucus and mother’s milk▪ IgE=attaches to the cell membrane of basophils and mast

cells where it triggers the cell to release histamine.

T Cells= 2 types: T helper(CD4) and T cytotoxic CD4 cells are found on cell membrane When CD4 cells come in contact with foreign antigens they

secrete cytokines that activate other components of immune system

CD4 cells can be infected with HIV Tc cells= CD8 cells because protein complex on cell

membrane. Tc cells destroy invaders

Cytokines= hormones secreted by cells to signal others (interferon, interleukin, tumor necrosis factor, granulocyte=macrophage colony stimulating factor, EPO)

Eicosanoids=class of fatty acids that regulate blood vessel vasodilation, temperature elevation, WBC activation NSAIDS disrupt production

Innate immunity: operational at all times Present at birth Include– barriers, inflammatory response,

phagocytosis▪ Barriersskin and mucous membranes= first line

of defense, sweat glands▪ Inflammatory responsedilate capillaries to

increase permeability of affected area▪ s/s: rubor (redness), tumor (swelling), Calor (heat), and

dolor (pain)▪ Phagocytosis process of ingesting and digesting

invading pathogens, dead cells, and cellular debris▪ Neutrophils, monocytes, and macrophages are capable

and sometimes refered to as phagocytes

Acquired immunity=fights a particular pathogen and is only activated when needed 2 types▪ Antibody mediated: activated when IgM detects foreign

antigen. See page 594▪ Can be active or passive

Active:the person manufactures antibodies in response to infection

***permanent Passive:antibody is produced by animal or person and then

transferred to another (ex. through breast milk) ***lasts 1-2 months after antibodies received

▪ Cell mediated: aimed at intracellular defects like virus and cancer▪ Delays hypersensitivity reactions and transplant rejections▪ Tc are primary component▪ When Tc cells recognize foreign antigens they secrete cytotoxic

substances to destroy the defective cell (transplant organ)

Immune system must be able to recognize its own proteins and not fight itself Occurs as part of neonatal growth

Autoimmune diseases occur when: Example: acute rheumatic fever, lupus,

rheumatoid arthritis, diabetes, thyroiditis, graves disease

Bone marrow is less productive Immunity not usually affected unless

unusual stress, trauma, chronic infection, cancer tx

Lymphatic tissue grows between age 6-20

As we age lymph tissue shrinks Result is fewer and smaller lymph nodes

Hx of present illness: frequent infections, prolonged bleeding, easy bruising, chronic fatigue

PMH: cancer, HIV, Splenectomy, long term venous access device, infections, current meds, immunizations

System review: skin-rash ulcers, enlarged lymph nodes Neuro- Respiratory- GI- GU- Muscle- Endocrine-

See page 630

HobbiesOccupationSelf conceptActivity and exerciseSleep and restNutrition Interpersonal relationsCoping and stressHealth perception

Urine Tests-urine protein electrophoresis-measures immunoglobin in the urine

Blood tests: CBC Serum protein electrophoresis(measures

immunoglobin in the blood) (used to look for multiple myeloma)

Antinuclear antibody test-looks for lupus ELIZA- looks for HIV/AIDS Cultures-detect infection of blood, sputum,

urine, stool

Bone marrow biospy- done if CBC abnormal Diagnoses leukemia, WBC cancer, and

Multiple Myeloma See page 600

Lymphangiography-evaluates anatomy of lymph vessels and lymph nodes Helps stage cancer

Liver- Spleen Scan-evaluates size and function of liver and spleen

Gallium Scan-uses radioactive tracer to detect presence of malignancy

Skin tests-Ex. TB tine

The lower the WBC the greater chance of infection

See page 635 Pvt room Vistors wash hands Monitor vs q2-4 hours Aseptic technique Isolation C and DB Patient wears mask when outside room No fresh flowers or plants in room

Stimulates bone marrow to produce more blood cells

Drugs may be given to stimulate ex. Neupogen

Done to restore immune systemComplications: infection,

thrombocytopenia, renal insufficiency, graft vs host dx

Neutropenia: neutrophils level low Leukemia: cancer of WBC- bone marrow

produces too many immature cells Cause: exposure to benzene, large dose of

radiation 2 types:▪ myelogenous-most often in adults▪ Lymphocytic-most often in kids 2-6 yrs old-

At risk for severe infection and bleeding s/s:infection, fever, nite sweats, low RBC ct,

fatigue, paleness, tachycardia, tachypnea, petechiae, purpura, epistaxsis, gingival bleed, melena (blood in stool), bone pain, weight loss, swollen lymph nodes

Tx: high dose chemo, therapy

Induction therapy-initial dose of chemo

Maintenance therapy- lower dose of chemo over 1-3 years

Intensification and consolidation therapy- bone marrow transplant(monitor for infection, bleeding)

Risk for injury r/t infection aeb thrombocytopenia and anemia. Goal absence of injury from infection, bleeding,

and inadequate oxygenation aeb normal body temperature, no bruising, or frank bleeding, pulse and respiratory, rates WNL

Fatigue Impaired oral mucous membranes Imbalanced nutrition<less than body

requirements Anxiety Ineffective therapeutic regimen

management

Thorough hand washing Encourage patient to shower everyday Discourage patients from eating fresh

fruit and veggies and dairy Possible transfusions Monitor for stomatitis Encourage patients and family to

express their feelings and ask questions

LUPUSS/S: Butterfly rash= characteristic

sign, malaise, anorexia, muscle pain, swollen joints, photosensitivity etc

DX: no one test definitely diagnoses SLE

Tx: No cure. Minimize symptoms, steroids, cytotoxic agents

Initial: lasts 4-8 weeks High levels in blood Flulike symptoms

Latent: inactive until a virus presents than replication begins Lasts 2-12 years Asymptomatic

Third stage=opportunistic infections 2-3 years Once CD4 Level below 200 it is considered AIDS

Opportunistic infections Pneumonia Herpes CMV retinitis Meningitis toxoplasmosis

Wasting Weight loss malnutrition

Cancer Kaposi’s sarcoma Non hodgkins Anal cancer Cervical cancer

Dementia From encephalitis

Flu like symptoms Fever Night sweats Swollen lymph nodes Headache Skin lesions that

don’t heal Sore throat Dyspnea Burning with

urination diarrhea

Fatigue Weight loss

Positive ELIZA testPositive Western Blot test

No cure Treat symptoms Prevent infections Encourage to eat balanced diet Exercise regularly Maintain good dental hygiene Smoking/illegal drug cessation Limit alcohol Minimize stress Practice safe sex

Early stages- usually treated outpatient

Late stages- more intensive in nature

Infection is the leading cause of death in those with HIV

Ineffective therapeutic regimenAnxiety Infection Impaired oral mucosa Imbalanced nutrition less than body

requirementsDisturbed thought processpain

Provide education Offer support group Encourage questions Encourage them to express self Anti infectives Medication education Encourage regular dental hygiene Have dietician see Appetite stimulants Saftey precautions Monitor pain

Estimated 53900 new cases diagnosed in 2002

Stages Low grade Intermediate grade High grade

The higher the grade the more aggressive Tx: chemo, bone marrow transplant, stem

cell transplant 5 year survival rate is 52%

Characterized by reed- sternberg cells in the lymph nodes

Highest occurance is in 20s and50sMen are more likely than women to

haveTx: radiation, chemo, bone marrow

transplant, stem cell transplantSurvival rates vary5 yr survival rate is 82%

Cancer of the plasma cells Most common over the age of 60 No known cause

Genetics and radiation exposure play a part s/s: bone pain, hyperuricemia (kidneys),

anemia, hypercalcemia, fractures, spinal cord compression

Diagnosis: radiographs, serum and urine protein electrophoresis, bone marrow biopsy

No known cure Tx: chemo and radiation to treat symptoms