NR I 283: I Pathophysiology IExam I2 IReview
(Chapters I6,7, I13, I8, Iand I10)
Chapter I 6: IInfection I & I Chapter I 7: IImmunology
◈ I I B I cells I - I HUMORAL I IMMUNITY
➥ I Created Iin Ibone Imarrow, Imature I in Ibone Imarrow
○ Proceeds Ito Ithe Ispleen Ior Ilymphoid Itissue
➥ I Creates IImmunity
○ production Iof I antibodies Ior I immunoglobulins
○ After Iexposure Ito Iantigens, Iand Iwith Ithe Iassistance Iof IT Ilymphocytes, Ithey
IbecomeIantibody-producing I plasma Icells. I B I lymphocytes I act I primarily I against
I bacteria Iand Iviruses Ithat Iare Ioutside Ibody Icells. IB-memory Icells Ithat Iprovide Ifor
Irepeated Iproduction Iof Iantibodies Ialso Iform Iin Ihumoral Iimmune Iresponses.
➥ I Usually Iin Iblood Iand Ilymphs
➥ I I I IAntibodies I - I immunoglobulins
○ IgG I- Imost Icommon Iand Iplentiful
➢ Can Icreate Iantibodies Iagainst Ifungus, Ibacteria, Ietc.
○ IgA
➢ Found Iin Itears, Isaliva, Icolostrum
○ IgM
➢ Has Ito Ido Iwith Iyour Iblood I- IABO
○ IgD
➢ Activates IB Icells
○ IgE
➢ Allergies, IEosinophils
T ICells
➥ ICreated Iin IBone IMarrow, Imature Iin IThymus
➥ I I I Creates I CELL-MEDIATED I immunity
○ develops Iwhen IT Ilymphocytes Iwith Iprotein Ireceptors Ion Ithe Icell Isurface Irecognize
antigens Ion Ithe Isurface Iof Itarget Icells Iand Idirectly Idestroy Ithe Iinvading Iantigens
○ These Ispecially Iprogrammed IT Icells Ithen Ireproduce, Icreating Ian I“army” Ito
IbattleIt he Iinvader, Iand Ithey Ialso Iactivate Iother IT Iand IB Ilymphocytes. I T Icells Iare
Iprimarily I effective I against I virus-infected Icells, Ifungal I and I protozoal
Iinfections, Icancer Icells, Iand Iforeign Icells Isuch Ias Itransplants
➥ I ILymph I nodes
➥ I Usually Iin Icells
➥ I I Memory I cells
➥ I Different Itypes Iof Iimmunity
○ Natural Iactive I:Chicken Ipox
○ Artificial IActive I: IVaccine IChickenpox
○ Natural Ipassive: IPregnant Imom Ihad Ichicken Ipox
○ Artificial I Passive: I rattlesnake I bite I- I serum
○ Innate Iimmunity I: Iborn Ithat Iway
◈ I I I Humoral I Immunity
➥ Antibodies Iare Iproduced Ito I protect Ithe I body
◈I I Memory I Cells
➥ I Normally Ithe Iimmune Isystem Iignores I“self” Icells, Idemonstrating Itolerance. IWhen Ithe
immune Isystem Irecognizes Ia Ispecific Inon–self-antigen Ias Iforeign, Iit Idevelops Ia Ispecific
Iresponse Ito I that I particular I antigen I and I stores Ithat I particular Iresponse I in I its
I memoryIc ells Ifor Ifuture Ireference Iif Ithe Iantigen Ireappears Iin Ithe Ibody
, ➥ IFor Iexample, Ilymphoid Itissue Iin Ithe Ipharynx, Isuch Ias Itonsils Iand Iadenoids, Ican
IcaptureIa ntigens Iin Imaterial Ithat Iis Iinhaled Ior Iingested Iand Iprocess Ithe Iimmune Iresponse.
INote Ithat Ia Iperson Imust Ihave Ibeen Iexposed Ito Ithe Ispecific Iforeign Iantigen Iand Imust Ihave
developed Ispecific Iimmunity Ito Iit I(such Ias Iantibodies) Ibefore Ithis Idefense Iis Ieffective.
IThisIr esponse Iis Iusually Irepeated Ieach Itime Ithe Iperson Iis Iexposed Ito Ia Iparticular Isubstance
I(antigen) Ibecause Ithe Iimmune Isystem Ihas Imemory Icells. IImmune Iresponses Ithat Ioccur
Iafter Ithe Ifirst Iintroduction Iof Ithe Iantigen Iare Iusually Imore Irapid Iand Iintense Ithan Ithe
IinitialIr esponse.
◈ I I I Antibodies
➥ I I IAntibodies Iare Ia I specific Iclass Iof I proteins Itermed I immunoglobulins
➥ I I IEach Ihas Ia Iunique I sequence Iof Iamino Iacids I (variable I portion, I which I binds I to Iantigen)
attached Ito Ia Icommon Ibase I(constant Iregion Ithat Iattaches Ito Imacrophages)
➥ I I I IgG I - I most I common I and I plentiful
○ Can Icreate Iantibodies Iagainst Ifungus, Ibacteria, Ietc.
➥ I IgM
○ first Ito Iincrease Iin Ithe Iimmune Iresponse; Iactivates Icomplement; Iforms Inatural
antibodies
● is Iinvolved Iin Iblood IABO Itype Iincompatibility Ireaction
➥
I IgA ○ Found Iin Itears, Isaliva, Icolostrum I(liquid Ithat Iappears Ibefore Ibreast Imilk)
➥ I I IIgE ○ Allergies, IEosinophils
➥ I IgD
○ Activates IB Icells
◈ I I I Antigens
➥ I I I Foreign I substance, Imicrobes I or Icomponent I of Icell I that I stimulates I immune I response; I non-
self Iantigen
◈ I I Culture Iand I Sensitivity
➥I I Culture
○ test Ito Ifind Igerms I(such Ias Ibacteria Ior Ia Ifungus) Ithat Ican Icause Ian Iinfection.
➥I I Sensitivity
○ test Ichecks Ito Isee Iwhat Ikind Iof Imedicine, Isuch Ias Ian Iantibiotic, Iwill Iwork Ibest Ito
treat Ithe Iillness Ior Iinfection.
➥ I A Iculture Iand Isensitivity Itest Imay Ibe Idone Ion Imany Idifferent Ibody Ifluids, Isuch Ias Iurine,
mucus, Iblood, Ipus, Isaliva, Ibreast Imilk, Ispinal Ifluid, Ior Idischarge Ifrom Ithe Ivagina Ior Ipenis.
◈ I I Titer
➥ Measures I levels I of I serum I immunoglobulins
➥I I A Inursing Istudent Ihas Ito Iprovide I her I immunization I record?
○ TITER
◈ IHypersensitivities-Types Iand ICategories Iand Idefinition
➥ Type I 1 I - Iallergic I reactions
○ Common
➢ Caused Iby Iallergen
➢ skin Irashes
➢ hay Ifever
○ Causative I mechanism
➢ Exposure Ito Iallergen
, ➢ Development Iof IIgEs
➢ Mast Icells
○ Complications
➢ Anaphylaxis
○ Reactions
➢ Hay Ifever
◆ Nasal Imucosa
➢ Food Iallergies
◆ Digestive Itract Imucosa
➢ Atopic I dermatitis I / I eczema
◆ Skin
➢ Asthma
◆ Bronchial Imucosa
➥ I I I Type I 2 I - I Cytotoxic I Hypersensitivity, I Antibody
○ Antigen Iis Ipresent Ion Icell Imembrane
➢ May Ibe Inormal Ibody I component I or Iexogenous
○ Blood Itype Ireaction
○ Circulating IIgGs Ireact Iwith Iantigen
➢ Destruction Iby Iphagocytosis Ior Icytolytic Ienzymes
○ Example: Iresponse Ito Iincompatible Iblood Itransfusion
➥I IType I3 I- IImmune IComplex IHypersensitivity
○ Antigen Icombined I with I antibody
➢ Forms Iimmune Icomplexes, Ideposited Iin Itissue
➢ Activation Iof Icomplement Isystem
➢ Autoimmune Idiseases
○ Process Icauses Iinflammation Iand Itissue Idestruction
○ Examples: IGlomerulonephritis Iand IRheumatoid Iarthritis
➥I I Type I 4 I- I Cell IMediated I or IDelayed IHypersensitivity
○ Delayed Iresponse Iby Isensitized IT Ilymphocytes
○ Released Iof Ilymphokines
○ Inflammatory Iresponse
○ Destruction Iof Iantigen
○ Examples: ITuberculin Itest, Icontact Idermatitis, IAllergic Iskin Irash, I poison Iivy
◈I I S/S I of I Anaphylactic I Shock
➥ I I I I Severe, I life-threatening
➥ I I I Systemic I hypersensitivity I reaction
➥ I I I Decreased Iblood I pressure I caused Iby I release I of I histamine
➥ I I I Airway I obstruction
➥ I Severe Ihypoxia
➥ I Can Ibe Icaused Iby:
○ Latex Imaterial
○ Insect Istings
○ Nuts Ior Ishellfish: Ivarious Idrugs
➥ I Signs Iand Isymptoms
○ Generalized Iitching Ior Itingling, Iespecially Iin Ioral Icavity
○ Decreased IBP
○ Coughing, Idifficulty Ibreathing, Ifeeling Iweak, Idizzy, Ifainting, Isense
IofIf ear/panic, Ihives I(urticaria)
○ Edema Iaround Ieyes, Ilips, Itongue, Ihands, Ifeet
○ Collapse Iwith Iloss Iof Iconsciousness
➥I I Treatment
○ Requires Ifirst Iaid Iresponse
➢ Epipen
➢ 911
○ Treatment Iin Iemergency Idepartment
➢ Epinephrine, IGlucocorticoids, IAntihistamines, IOxygen
➢ Stabilize IBP
(Chapters I6,7, I13, I8, Iand I10)
Chapter I 6: IInfection I & I Chapter I 7: IImmunology
◈ I I B I cells I - I HUMORAL I IMMUNITY
➥ I Created Iin Ibone Imarrow, Imature I in Ibone Imarrow
○ Proceeds Ito Ithe Ispleen Ior Ilymphoid Itissue
➥ I Creates IImmunity
○ production Iof I antibodies Ior I immunoglobulins
○ After Iexposure Ito Iantigens, Iand Iwith Ithe Iassistance Iof IT Ilymphocytes, Ithey
IbecomeIantibody-producing I plasma Icells. I B I lymphocytes I act I primarily I against
I bacteria Iand Iviruses Ithat Iare Ioutside Ibody Icells. IB-memory Icells Ithat Iprovide Ifor
Irepeated Iproduction Iof Iantibodies Ialso Iform Iin Ihumoral Iimmune Iresponses.
➥ I Usually Iin Iblood Iand Ilymphs
➥ I I I IAntibodies I - I immunoglobulins
○ IgG I- Imost Icommon Iand Iplentiful
➢ Can Icreate Iantibodies Iagainst Ifungus, Ibacteria, Ietc.
○ IgA
➢ Found Iin Itears, Isaliva, Icolostrum
○ IgM
➢ Has Ito Ido Iwith Iyour Iblood I- IABO
○ IgD
➢ Activates IB Icells
○ IgE
➢ Allergies, IEosinophils
T ICells
➥ ICreated Iin IBone IMarrow, Imature Iin IThymus
➥ I I I Creates I CELL-MEDIATED I immunity
○ develops Iwhen IT Ilymphocytes Iwith Iprotein Ireceptors Ion Ithe Icell Isurface Irecognize
antigens Ion Ithe Isurface Iof Itarget Icells Iand Idirectly Idestroy Ithe Iinvading Iantigens
○ These Ispecially Iprogrammed IT Icells Ithen Ireproduce, Icreating Ian I“army” Ito
IbattleIt he Iinvader, Iand Ithey Ialso Iactivate Iother IT Iand IB Ilymphocytes. I T Icells Iare
Iprimarily I effective I against I virus-infected Icells, Ifungal I and I protozoal
Iinfections, Icancer Icells, Iand Iforeign Icells Isuch Ias Itransplants
➥ I ILymph I nodes
➥ I Usually Iin Icells
➥ I I Memory I cells
➥ I Different Itypes Iof Iimmunity
○ Natural Iactive I:Chicken Ipox
○ Artificial IActive I: IVaccine IChickenpox
○ Natural Ipassive: IPregnant Imom Ihad Ichicken Ipox
○ Artificial I Passive: I rattlesnake I bite I- I serum
○ Innate Iimmunity I: Iborn Ithat Iway
◈ I I I Humoral I Immunity
➥ Antibodies Iare Iproduced Ito I protect Ithe I body
◈I I Memory I Cells
➥ I Normally Ithe Iimmune Isystem Iignores I“self” Icells, Idemonstrating Itolerance. IWhen Ithe
immune Isystem Irecognizes Ia Ispecific Inon–self-antigen Ias Iforeign, Iit Idevelops Ia Ispecific
Iresponse Ito I that I particular I antigen I and I stores Ithat I particular Iresponse I in I its
I memoryIc ells Ifor Ifuture Ireference Iif Ithe Iantigen Ireappears Iin Ithe Ibody
, ➥ IFor Iexample, Ilymphoid Itissue Iin Ithe Ipharynx, Isuch Ias Itonsils Iand Iadenoids, Ican
IcaptureIa ntigens Iin Imaterial Ithat Iis Iinhaled Ior Iingested Iand Iprocess Ithe Iimmune Iresponse.
INote Ithat Ia Iperson Imust Ihave Ibeen Iexposed Ito Ithe Ispecific Iforeign Iantigen Iand Imust Ihave
developed Ispecific Iimmunity Ito Iit I(such Ias Iantibodies) Ibefore Ithis Idefense Iis Ieffective.
IThisIr esponse Iis Iusually Irepeated Ieach Itime Ithe Iperson Iis Iexposed Ito Ia Iparticular Isubstance
I(antigen) Ibecause Ithe Iimmune Isystem Ihas Imemory Icells. IImmune Iresponses Ithat Ioccur
Iafter Ithe Ifirst Iintroduction Iof Ithe Iantigen Iare Iusually Imore Irapid Iand Iintense Ithan Ithe
IinitialIr esponse.
◈ I I I Antibodies
➥ I I IAntibodies Iare Ia I specific Iclass Iof I proteins Itermed I immunoglobulins
➥ I I IEach Ihas Ia Iunique I sequence Iof Iamino Iacids I (variable I portion, I which I binds I to Iantigen)
attached Ito Ia Icommon Ibase I(constant Iregion Ithat Iattaches Ito Imacrophages)
➥ I I I IgG I - I most I common I and I plentiful
○ Can Icreate Iantibodies Iagainst Ifungus, Ibacteria, Ietc.
➥ I IgM
○ first Ito Iincrease Iin Ithe Iimmune Iresponse; Iactivates Icomplement; Iforms Inatural
antibodies
● is Iinvolved Iin Iblood IABO Itype Iincompatibility Ireaction
➥
I IgA ○ Found Iin Itears, Isaliva, Icolostrum I(liquid Ithat Iappears Ibefore Ibreast Imilk)
➥ I I IIgE ○ Allergies, IEosinophils
➥ I IgD
○ Activates IB Icells
◈ I I I Antigens
➥ I I I Foreign I substance, Imicrobes I or Icomponent I of Icell I that I stimulates I immune I response; I non-
self Iantigen
◈ I I Culture Iand I Sensitivity
➥I I Culture
○ test Ito Ifind Igerms I(such Ias Ibacteria Ior Ia Ifungus) Ithat Ican Icause Ian Iinfection.
➥I I Sensitivity
○ test Ichecks Ito Isee Iwhat Ikind Iof Imedicine, Isuch Ias Ian Iantibiotic, Iwill Iwork Ibest Ito
treat Ithe Iillness Ior Iinfection.
➥ I A Iculture Iand Isensitivity Itest Imay Ibe Idone Ion Imany Idifferent Ibody Ifluids, Isuch Ias Iurine,
mucus, Iblood, Ipus, Isaliva, Ibreast Imilk, Ispinal Ifluid, Ior Idischarge Ifrom Ithe Ivagina Ior Ipenis.
◈ I I Titer
➥ Measures I levels I of I serum I immunoglobulins
➥I I A Inursing Istudent Ihas Ito Iprovide I her I immunization I record?
○ TITER
◈ IHypersensitivities-Types Iand ICategories Iand Idefinition
➥ Type I 1 I - Iallergic I reactions
○ Common
➢ Caused Iby Iallergen
➢ skin Irashes
➢ hay Ifever
○ Causative I mechanism
➢ Exposure Ito Iallergen
, ➢ Development Iof IIgEs
➢ Mast Icells
○ Complications
➢ Anaphylaxis
○ Reactions
➢ Hay Ifever
◆ Nasal Imucosa
➢ Food Iallergies
◆ Digestive Itract Imucosa
➢ Atopic I dermatitis I / I eczema
◆ Skin
➢ Asthma
◆ Bronchial Imucosa
➥ I I I Type I 2 I - I Cytotoxic I Hypersensitivity, I Antibody
○ Antigen Iis Ipresent Ion Icell Imembrane
➢ May Ibe Inormal Ibody I component I or Iexogenous
○ Blood Itype Ireaction
○ Circulating IIgGs Ireact Iwith Iantigen
➢ Destruction Iby Iphagocytosis Ior Icytolytic Ienzymes
○ Example: Iresponse Ito Iincompatible Iblood Itransfusion
➥I IType I3 I- IImmune IComplex IHypersensitivity
○ Antigen Icombined I with I antibody
➢ Forms Iimmune Icomplexes, Ideposited Iin Itissue
➢ Activation Iof Icomplement Isystem
➢ Autoimmune Idiseases
○ Process Icauses Iinflammation Iand Itissue Idestruction
○ Examples: IGlomerulonephritis Iand IRheumatoid Iarthritis
➥I I Type I 4 I- I Cell IMediated I or IDelayed IHypersensitivity
○ Delayed Iresponse Iby Isensitized IT Ilymphocytes
○ Released Iof Ilymphokines
○ Inflammatory Iresponse
○ Destruction Iof Iantigen
○ Examples: ITuberculin Itest, Icontact Idermatitis, IAllergic Iskin Irash, I poison Iivy
◈I I S/S I of I Anaphylactic I Shock
➥ I I I I Severe, I life-threatening
➥ I I I Systemic I hypersensitivity I reaction
➥ I I I Decreased Iblood I pressure I caused Iby I release I of I histamine
➥ I I I Airway I obstruction
➥ I Severe Ihypoxia
➥ I Can Ibe Icaused Iby:
○ Latex Imaterial
○ Insect Istings
○ Nuts Ior Ishellfish: Ivarious Idrugs
➥ I Signs Iand Isymptoms
○ Generalized Iitching Ior Itingling, Iespecially Iin Ioral Icavity
○ Decreased IBP
○ Coughing, Idifficulty Ibreathing, Ifeeling Iweak, Idizzy, Ifainting, Isense
IofIf ear/panic, Ihives I(urticaria)
○ Edema Iaround Ieyes, Ilips, Itongue, Ihands, Ifeet
○ Collapse Iwith Iloss Iof Iconsciousness
➥I I Treatment
○ Requires Ifirst Iaid Iresponse
➢ Epipen
➢ 911
○ Treatment Iin Iemergency Idepartment
➢ Epinephrine, IGlucocorticoids, IAntihistamines, IOxygen
➢ Stabilize IBP
