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NCM 112: CARE OF CLIENT WITH INFLAMMATORY AND IMMUNOLOGIC

RESPONSE

TOPIC 1
Introduction to Concept of Immunity and Inflammation

Module Overview

This course deals with concepts, principles, theories and

techniques on immunity and inflammation in clinical practice,
education and research. The learners are expected to use the
concepts of immunity and inflammation to support the delivery of
health care.

Course Learning Outcomes

At the end of the lesson the students will be able to:
Relate the knowledge of physical, social, natural, and health sciences and
humanities in the nursing care of at risk and sick adult clients with problems
in infectious, inflammatory and immunologic disorders.

Pretest
Direction: Read each questions carefully. Write the letter of the correct
answer before each number. Use capital letters.

1. Immune system causes tissue damage as it fights off a perceived threat also known as
allergies.
a) hypersensitivity
b) autoimmune diseases
c) immunodeficiency
d) antibodies
2. The following are immune-deficiencies EXCEPT?
a) AIDS
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b) SCID Syndrome
c) Type I Diabetes
d) none of the above
3. Types of hypersensitivities are determined by their time course and whether ______ cell
are the principal element involved.
a) B
b) A
c) T
d) all of the above
4. The following are all autoimmune disease except:
a) myasthenia gravis
b) multiple sclerosis
c) anaphylaxis
d) rheumatoid arthritis
5. An inflammation-causing signal released by mast cell at the site of an infection is:
a) an interferon
b) lymphatic fluid
c) histamine
d) mucus

Module Content

To better understand the concept of Immunity and Inflammation, one

must understand the different terminologies uses in this concept:

 Disease
 a detectable alteration in normal tissue function.
 Asymptomatic or subclinical
 a condition or an infection caused by microorganism that produces no clinical
evidence of disease
 Infection
 an invasion of an organism's body tissues by disease-causing agents, their
multiplication, and the reaction of host tissues to the infectious agents and the
toxins they produce.
 Opportunistic Pathogen
 An infectious microorganism that is normally a commensal or does not harm its
host but can cause disease when the host's resistance is low.
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 Pathogenicity
 the ability to produce disease; thus, a pathogen is a microorganism that causes
disease.
 Resident flora
 The microorganisms that usually occupy a particular body site
 Virulence

the severity or harmfulness of a disease

IMMUNE SYSTEM

The immune system is made up of special organs, cells and chemicals that fight infection
(microbes). The immune system has different layers of organs that are responsible for
preventing and fighting infection that penetrates the human body. These are the following:

A. Basic structures of the immunologic system

1. The Lymphoid system

a. Lymphoid system consists of lymph nodes, spleen, thymus, tonsils, lymphoid
tissues (in mucosa and connective tissues) and bone marrow, a myeloid tissue
involved in blood cell formation
b. Organs and tissues include lymphocytes as part of their basic structure
c. Lymphoid organ consist of the lymph nodes, thymus, spleen and tonsils
d. Lymphoid tissues consist of lymphocytes and plasma cells
e. Lymphatic system consists of a communication network of vessels, lymph
nodes clusters, and circulating and resident lymphocytes that function as a
primary component in the immune system response
2. Central lymphoid organs
a. The thymus gland, which assists in T lymphocyte formation, is located in the
superior mediastinum behind the sternum
b. Bone marrow sources can be found in the iliac crest, the sternum and in bone
cavities throughout the body
3. Peripheral organs
a. Tonsils are a group of lymphoid tissue found in the palatine area of the
oropharynx in the mouth
b. Lymph nodes are found throughout the body and consist of a small rounded
mass of tissue from which the lymph fluid drains.
c. Mucosa-associated lymph tissue (MALT) consists of a grouping of lymph
tissue that is found in many organs of the body that work together to promote
an immune response; specific locators identify the source of the tissue; for
example; bronchial-associated lymph tissue(BALT), gut-associated lymph tissue
(GALT), skin-associated lymph tissue(SALT).
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d. The spleen is located in the left upper quadrant of the abdomen and is
composed of white and red pulp; the white pulp is composed of B and
Tlymphocytes; the red pulp is composed of erythrocytes
4. Mononuclear phagocyte system (MPS)
a. Monocytes are the largest component of the white blood cells (WBCs) and
have one nucleus and very little cytoplasm; they are considered to be
agranulocytes
b. Macrophages are considered to be mature cells of the MPS;ey they migrate
to different areas of the body, becoming specialized cells to perform their
function of defense
c. The MPS functions to protect the body by participating in the immune
response; it secretes chemical components and factors (enzymes, complement
proteins and interleukins

B. Basic Functions of the Immunologic System

1. Thymus gland
a. In childhood, the gland is large; with the aging, the gland atropies
because of fat infiltration
b. The thymus gland gives rise to the differentiation and maturation of
T lymphocytes, which are involved in cell-mediated immunity, a
part of the process of autoimmunity
c. It secretes thymic hormones such as thymosin; hormone level is stable
from birth to age 25 and then gradually decreases thereafter
2. Bone marrow
a. Bone marrow serves as a diagnostic predictor for immunologic,
hematologic, and oncologic disorders
b. It provides for analysis of chemical markers leading to the identification
of specific disease processes
c. It is the source of primary lymphoid action that helps to initiate,
maintain and provide for the immune response; marrow gives rise to
cellular components of blood and stores stem cells
d. Bone marrow gives rise to B lymphocytes and humorally mediated
response (Humural immunity that involve the production of antibodies,
specific substance produced in response to specific antigens
3. Spleen
a. The spleen is the site of destruction of RBCs as well as a storage site for
blood
b. It acts as a reservoir for B lymphocytes
c. It filters and removes foreign material, worn-out cells, and forms of
cellular debris
d. The spleen contains both red and white pulp tissues that help to
perform functions of RBC removal and B lymphocyte development into
mature plasma cells
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C. Normal Immune Response

1. Defense

a. The body provides for a communication network of protection that

involves both non- specific and specific forms of defense

b. Nonspecific defense relates to external reactions that include anatomic

and chemical barriers such as skin and mucous membranes; they are
considered non-selective, which means that they are activated against any
foreign substance that the body would encounter

c. Specific defense relates to internal physiological reactions of the body

that include both cell mediated and humorally mediated antibodies; they
are considered specific, which means that they are unique substances that
require activation

d. The body initiates its immune response in the presence of an antigen, a

protein substance that triggers antibody production

2. Homeostasis

a. The body seeks to maintain an immune balance where it can

successfully remove damaged cells

b. In homeostasis, there is a balanced response of ciriculating and

resident lymphocytes to maintain adequate protection

3. Surveilance
a. Surveilance is the ablity of the body to use memory and recognition in
order to maintain an immune response

b. The body will will remember the activation response even if the person
doesn’t remember the specific insult

Types of Immunity
1. Acquired Immunity

a. Acquired immunity is a long- term response in an organism that leads to the

development of antibodies that offer protection
 This can be accomplished by the individual developing antibodies in response
to having the disease process or by a response to artificial antigens as with the
administration of vaccine or toxiod
 This immunization response can be boosted and maintained via repeated
injections
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 Titer serum levels can be monitored in the client to indicate whether or not
immunity is present
b. Passive acquired immunity requires that the antibody be introduced to the
individual, either by maternal transfer (placenta and/ or colostrum) or immune serum
antibody injection, to promote a specific antigen response cells the one that releases
antibodies , proteins that cling to antigens and destroy them.

2. Natural Immunity
a. This type of immunity that exists in an individual is related to species, race, or
genetic trait
b. An individual is born with natural immunity
3. Humoral immunity

a. This involves the recognition of antigens by the B lymphocytes

b. B lymphocytes differentiate into plasma cells and memory cells

c. Memory cells lead to a more rapid response by remembering the original insult

d. Plasma cells secrete Immunoglobulins, a group of glycoproteins, each of which has

four polypeptide chains (two heavy and two light chains); the FAB fragment, which is
different in each immunoglobulin, denotes specific antigen binding sites

e. Immunoglobulins are identified as IgA, IgD, IgE, IgG and IgM

Types of Immunoglobulins

Class Location Characteristic

IgA Body secretions, tears, saliva, Lines mucous membranes
colostrum & breastmilk Protects body surfaces
IgD Plasma Present on lymphocytes
IgE Plasma Allergic/anaphylaxis
Interstitial fluids Bound to mast cells
Exocrine secretions
IgG Plasma Crosses placenta
Interstitial fluid Complement fixation
Secondary immune response
IgM Plasma Plasma Complement fixation
Primary immune response
Involve in ABO antigen
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4. Cell-mediated immunity

a. T lymphocytes are recognize a specific major histocompatiblity complex (MHC), a group

of proteins that play a role in autoimmune recognition and tissue rejection and binds to
them to elicit an immune response

b. Protein markers on the surface of the T-cell help to define specific function receptor
sites; these are called CD antigens or clusters of differentiation; CD markers serve as an
important prognostic indicator of immune function and are used in the diagnosis and
management of clients with human immunodeficiency virus (HIV) and acquired
immunodeficiency syndome (AIDS)

c. Humoral immunity is considered a long-term process whereby the T lymphocytes help to

protect the body against bacterial, viral and fungal infections

Other immune system participants:

a. Natural killer cell (Nut cell, NK cell) activity is present at birth, increases as one reaches
adulthood and decreases gradually in old age; null cells do not require prior sensitization
and are not considered T- or B lymphocytes

b. Cytokines ( also referred to as lymphokines and monokines) are soluble protein

mediators of the immune response; interleukins, tumor necrosis factor, and interferon are
examples of these chemical messengers, which have been used as treatment options in
boosting the immune response

c. Complement System

 This is a group of glycoproteins that are activated in sequential order and provide a
link to the humoral response

 IgG and IgM are responsible for activating the complement cascade; once this is
activated , it is said that the complement has been fixed or complement fixation
has taken place

 Complement assays are used in the diagnosis of immunodeficiencies and

autoimmune diseases

 There is a classic pathway and alternate pathway whereby the complement system
can be activated
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d. Biological response modifiers (BRMs)

 Are group of substances that can elicit, modify and restore the biological response
between an individual and tumor cell

 This is an area of key research in which scientists are looking at developing better
outcomes, thereby improving response and overall cure rates for immune
disorders

 Examples include:

1. Monoclonal antibodies- produced by a specific group of identical cells, that are

then used to treat tumors because of their specific targeting effect

2. Colony-stimulating factors- a group of proteins that stimulate growth of specific

hematological cells (red blood cells or white blood cells) to prevent or help reduce a client’s
adverse response to disease; these types of BRMs are used as treatment measures in a
variety of hematologic and immunologic diseases

Key Points
 Immunity
 Immune response
 Defense
 Immunoglobulin
 antibodies

A client’s immunization is up-to-date. What type of immunity does this provide to the client?
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Activity:
In your own words differentiate the types of immunity

1.
2.

External Resources
https://study.com/academy/lesson/what-is-immunity-definition-types.html
https://www.medicalnewstoday.com/articles/323653

(https://nursingcrib.com/nursing-notes-reviewer/stages-of-illness-behavior/)
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(https://bio.libretexts.org/Bookshelves/Microbiology/Book
%3A_Microbiology_(Boundless)/10%3A_Epidemiology/10.3%3A_Disease_Pattern)

https://medical-dictionary.thefreedictionary.com/prodromal+stage

Reference:

Medical Surgical Nursing: Clinical Management for Positive Outcomes, 8e (2 Vol Set)

Medical-Surgical Nursing - E-Book: Assessment and Management of Clinical

Reflection:
In 10 sentences, write your thoughts about this topic.