DECREASED IMMUNE RESPONSE: SUSCEPTIBILITY TO INFECTION

C Washington RN, MSNEd

Infection Host organism’s

response to a pathogen or disease causing substance

Infection Tissue destroying

microorganisms enter & multiply in the body

Invasion of the body by pathogenic organisms that multiply and produce injurious effects

Four types of microorganisms can enter the body & cause infection

Harmless Organisms Resident flora

-E Coli (intestine)

-Staph aureus (skin)

Colonization-microorganisms

become resident

flora

Intestinal flora help synthesize vitamin K

Harmful Actions of Microorganisms

# of organism present

Ability of organism to cause disease

Person’s immune system

Length of contact between person & organism

Climate for Infection Poor nutrition Stress Humidity Poor sanitation Crowded living conditions Pollution Dust Medications

Risk for InfectionInhalation

Opportunistic infections

Risk for Infection

Direct contact

Insect or animal bite

Ingestion

Controlling Microorganism Medical Asepsis Clean technique Limit #, growth, &

transmission of microorganisms

Handwashing Barrier techniques Environmental cleaning

Surgical Asepsis Sterile technique Completely free of

microorganisms

The Spread of Infection An elderly pt, admitted with a GI disorder, is on

bedrest and requires assistance with ADLs. Frequent uncontrolled diarrhea stools; the nurse

provided excellent care to maintain cleanliness & comfort.

After one episode of cleaning the pt & changing the bed linen, the nurse went over to a second pt to adjust foley cath tubing.

The nurse’s hands were not washed before assisting the second patient.

Breaking the Chain A patient assigned for morning care has

an open wound on her left lower leg. The wound is draining & when last

cultured, the organism MRSA was identified.

What steps would you take to break the chain of infection while changing the patients bed.

Nosocomial Infections

Drug Resistant Organisms Vancomycin-resistant enterococcus

(VRE)

Methicillin-resistant Staph aureus (MRSA)

Clostridium difficile (C Diff)

Nosocomial Infections Pneumonia

-Pseudomonas-Improper suctioning technique

Nosocomial Infections Bloodstream

-Staph aureus-Improper IV site care

Nosocomial Infections

Surgical Site-Enterococcus-Improper dsg

change

Nosocomial Infections Urinary Tract

-E Coli-Poor cath care

Preventing Nosocomial Infections

Transmission Based Precautions

Droplet precautions (pneumonia, meningitis)-Private room/mask <3 ft from pt

Transmission Based Precautions

Airborne precautions (measles, TB)-Private neg airflow room 6 air exchanges/hr

Transmission Based Precautions Contact

precautions-Direct (kissing, bathing, toughing)-Indirect (instruments, needles, dressing)

Transmission Based Precautions

Protective Precautions

What might you NOTICE (subjective & objective) if the patient has inadequate protection as a result of infection or infectious disease?

What should you ASSESS for a patient with inadequate protection as a result of infection or infectious disease?

How should you INTERVENE for a patient with inadequate protection as a result of infection or infectious disease?

What should you EVALUATE when a patient is being treated for an infection or infectious disease

2 days post-op below-the-knee amputation

Reports feeling hot and sweaty VS 100-98-30 156/88 What is your best action at this time

Adm from nursing home H/O Stroke MRSA urine Incontinent of urine & stool No private room available Semi private bed with older pt with

fractured leg

Immune Response  recognize foreign substances

neutralize, eliminate, or metabolize them with or without injury to the body's own tissues.

Functions of the Immune System

Defense: protection against antigens

Homeostasis: removal of worn out or damaged components (e.g., dead cells)

Surveillance: ability to perceive or destroy mutated cells or nonself cells.

Alterations in Immune Functioning

Immune Function: Defense

Hypofunction: Immunosuppression with increased susceptibility to infection (neutropenia, AIDS, immunosuppression

Hyperfunction: Inappropriate and abnormal response to external antigens; an allergy

Alterations in Immune Functioning

Immune function: Homeostasis

Hypofunction: No known effect

Hyperfunction: Abnormal response where antibodies react against normal tissues and cells; an autoimmune disease

Alterations in Immune Functioning

Immune function: Surveillance

Hypofunction: Inability of the immune system to perceive and respond to mutated cells, suspected mechanism in cancer

Hyperfunction: No known effect

Immune Response: Inflammation

Reaction of the tissues of the body to injury in order to destroy or dilute an injurious agent

prevent the spread of injury

promote repair of damaged tissue

Inflammatory Response: Cause

Physical irritants (e.g., trauma or a foreign body)

Chemical irritants (e.g., strong acids or alkalis)

Microorganisms (e.g., bacteria and viruses)

Inflammatory Response: Local

Pain Swelling Heat Redness impaired function

of part

*five cardinal signs of inflammation

Inflammatory Response: Systemic appear with

moderate to severe response

Fever Leukocytosis Chills

sweating Anorexia weight loss general malaise

Types of Immunity

Test Yourself A baby is born temporarily immune to

thediseases to which the mother is immune.

The nurse understands that this is an example of which type of immunity?

Test Yourself A mother brings her children into the

clinic & they are diagnosed with chicken pox

The mother had chicken pox as a child and is not concerned with contracting the disease when caring for her children

What type of immunity does this mother have?

Factors Influencing Immunity Age Sex Nutritional Status Stress Treatment Modalities

Nursing HistoryChief complaint Lack of energy Light-headedness Frequent infections Bruising Slow wound healing

Present illness Associated symptoms Location Radiation Intensity Duration Frequency Precipitating &

alleviating factors

Nursing HistoryPresent illness Prescription drugs Over the counter

drugs Herbal remedies Vitamins & nutritional

supplements Alternative therapies

Medical history Changes in overall

health Allergies Childhood diseases Recurrent infections Innumizations Rashes Visual disturbances

Nursing History

Medical history Fever Changes in

elimination h/o immune

disorders Menstural patterns

Family history Recurrent infections Allergies Cancer

Nursing HistorySocial history Work Exercise Diet Recreational drugs & alcohol Hobbies Stress Support systems Coping mechanisms

Physiologic Responses Immunologic Dysfunction

Urticaria Hives (wheals)

Physiologic Responses Immunologic Dysfunction

Angioedema Generalized swelling

Physiologic Responses Immunologic Dysfunction

Conjunctivitis Inflammation of membranes of

eyelids

Physiologic Responses Immunologic Dysfunction

Bronchoconstriction Swelling of airway

Physiologic Responses to Immunologic Dysfunction

Pruritis Associated with

erythema & urticaria

Hypotension

Physiologic Responses Immunologic Dysfunction

Leukocytopenia Abnormal decrease in WBCs

Physiologic Responses Immunologic Dysfunction

Hypersensitive Immune Responses Allergies Anaphylaxis Transfusion reactions Transplant rejection Latex allergy

Allergies Allergic disorders are the result of a

hypersensitivity (excessive reaction to a stimulus) of the immune system to allergens (a type of antigen commonly found in the environment).

Allergies A pt has allergic rhinitis. If the pt does not remain compliant with

the treatment regime, the patient is at risk for developing an infection

Such as Sinusitis

Anaphylaxis A systemic reaction to allergens and the

most serious type of allergic reaction.

Foods, drugs, hormones, insect bites, blood, and vaccines are all associated with anaphylactic reactions.

Anaphylaxis

Anaphylactic Reaction A patient is being given PCN via IVPB. Develops an anaphylactic reaction What would you do first? What symptom may the pt be

experiencing? What is the medication of choice for

anaphylaxis?

Transfusion Reactions Any client receiving blood products that

are homologous or from a donor may develop a transfusion reaction.

Five types: febrile nonhemolytic; allergic urticarial; delayed hemolytic; acute hemolytic; and anaphylactic.

Transplant Rejection Even with the use of immunosuppressive

medications, 10% to 15% of transplanted organs fail.

Latex Allergy Since 1987, when universal precautions

(now called Standard Precautions) were mandated, exposure to latex by health care workers has dramatically increased.

By June, 1996, 28 latex-related deaths had been reported to the FDA.

Latex in our lives A combination of

exposures to proteins found in latex products and certain foods may be the cause of a rise in latex allergies

Latex in our lives Assess for allergies to avocados, bananas,

kiwi or chestnuts for cross sensitivity to latex

Latex Allergies: Signs & Symptoms Contact dermitis Facial swelling Itching Hives Rhinitis eye symptoms

Bronchospasms generalized edema difficulty breathing cardiac arrest

Latex cart at bedside

Latex Allergy Precautions Mrs. Smith tells you she has allergic reactions

when she eats bananas, seafood, eggs Based on this information what would you

ask Mrs. Smith

What actions would you take?

Nursing DiagnosisIneffective

airwayClearance

(obstructed airway)

Facial edema Bronchospasms Laryngeal

edema

Decreased cardiac output

(Histamine release) Peripheral

vasodilation Increased capillary

permeability

Nursing DiagnosisRisk for Injury Hypersensitivity

responses high Blood

transfusions

Components of Immune Response

Located throughout the body

Organs include thymus, bone marrow, lymph nodes, spleen, tonsils, appendix, Peyer's patches of small intestine.

Components of Immune Response

Main cell types are WBCs (especially lymphocytes, plasma cells, and macrophages)

all originate from the same stem cell in bone marrow, then differentiate into separate types

Components of Immune Response

Granulocytes Eosinophils: increase with allergies and

parasites

Basophils: contain histamine and increase with allergy and anaphylaxis

Neutrophils: involved in phagocytosis

Components of Immune Response

Monocytes (macrophages) (e.g., histiocytes, Kupffer cells): involved in phagocytosis

Lymphocytes (T cells and B cells): involved

in cellular and humoral immunity

Immune System Response

Infection WBCs released from bone marrow into

blood

Bone marrow increases production of additional leukocytes

White Blood Cell Count & Differential

Leukocytes (WBC)

4,500 to 10,000 cell per cubic millimeter Transports themselves to site of

inflammatory or immune response Detect, attack, & destroy anything foriegn Locates damaged tissue & infection by

responding to chemicals released by other leukocytes & damaged tissue

WBC Leukocytosis WBC greater than

10,000/mm3 Infection or

inflammation Leukemia trauma or stress tissue necrosis

Leukopenia bone marrow depression overwhelming infection viral infection Immunosuppression autoimmune disease dietary deficiency

Differential WBCGranulocytes Play key role in protecting body from

harmful microorganisms during acute inflammation & infection-neutrophils-eosinophils-basophils

Neutrophils (55% to 70%)

Neutrophilia Acute infection Stress response Myelocytic

leukemia Inflammatory

disorders Metabolic

disorders

Neutropenia Bone marrow

depression Overwhelming

bacterial infection Viral infection Addison’s disease

Eosinophils (1% to 4%)Eosinophilia Parasitic infections Hypersensitivity

reactions Autoimmune

disorders

Eosinopenia Cushing’s

syndrome Autoimmune

disorders Stress Certain drugs

Basophils (0.5% to 1%)Basophilia

Hypersensitivity responses

Chronic myelogenous leukemia

Chickenpox/smallpox Splenectomy hypothyroidism

Basopenia Acute stress Hypersensitivity

reactions, hyperthyroidism

Monocytes (monos)Monocytosis Chronic inflammatory

disorders Tuberculosis Viral infections Leukemia Hodgkin’s disease Multiple myeloma

Monocytopenia Bone marrow

depression Corticosteroid

therapy

Lymphocytes (lymphs)Lymphocytosis Chronic bacterial

infection Viral infections Lymphocytic

leukemia

Lymphocytopenia Bone marrow

depression Immunodeficiency Leukemia Cushing’s disease Hodgkin’s disease Renal failure

Autoimmune Diseases Systemic lupus erythematosus Rheumatoid arthritis Myasthenia gravis Multiple Sclerosis AIDS

Systemic Lupus Erythematosus (SLE) A chronic, progressive, incurable

autoimmune disease affecting multiple body organs.

T cells attack the skin, kidneys, and other organs

Characterized by periods of remission and exacerbation.

Rheumatoid Arthritis A chronic, systemic autoimmune disease

characterized by joint stiffness

T cells attack the linings of joints

Myasthenia Gravis

Acquired Immune Deficiency Syndrome