Republic of the Philippines
UNIVERSITY OF EASTERN PHILIPPINES
University Town, Northern Samar
Web: http://uep.edu.ph Email: uepnsofficial@gmail.com
NCM 112
INFECTION, INFLAMMATORY, AND
IMMUNOLOGIC RESPONSE
(MODULE 3)
LOBERITA, DINO ERNESTO T.
BSN-3C
JEANETTE J. ROJO, RN, MAN
PROFESSOR
ACTIVITY:
Before proceeding to the abstraction, do this activity.
Adenoids: are a mass of soft tissue
behind the nasal cavity. Like lymph
nodes, adenoids are part of the
immune system and are made of
the same type of tissue (lymphoid
tissue). White blood cells circulate
through the adenoids and other
lymphoid tissue, reacting to foreign
invaders in the body. We all have
adenoids at birth and in childhood,
but as we head into adolescence
they start to shrink. By adulthood,
most people’s adenoids have
disappeared.
Tonsil: located in the back of our
throat where this helps fight
infection and disease. This contains
a lot of white blood cells, which kill
germs.
Thymus: is a small gland in the
lymphatic system that makes and
trains special white blood cells
called T-cells.
Bronchus-associated lymphoid
tissue: is a localized collection of
lymphocytes in the subepithelial
area of bronchi, analogous to gut-
associated lymphoid tissue.
Axillary lymph nodes: are a group of lymph nodes in the axilla and receive lymph from vessels that
drain the arm, the walls of the thorax, the breast and the upper walls of the abdomen.
Spleen: is a fist-sized organ in the upper left side of abdomen, it stores blood, filters blood by
removing cellular waste and getting rid of old or damaged blood cells, makes white blood cells and
antibodies, and maintains the levels of fluid in the body.
Intestine: main purpose is to digest food but it also produced various substances that carry
messages to other parts of the body, and plays an important role in fighting germs and regulating
the body’s water balance.
Peyer’s patches: plays an important role in immune surveillance of materials within digestive
system.
Appendix: may be a place for our body to store certain healthy types of gut bacteria that otherwise
could be altered or changed during an intestinal illness or with overuse of antibiotics.
Inguinal lymph nodes: helps the body to fight off infection, this forms a major drainage pathway for
legs, genitals, and pelvic region.
Bone marrow (B cells and T cells): forms a specialized stem cell connective tissue that fills the
cavities of most bones. Its major function is the formation of blood cells. (B cells – create antibodies;
T cells – focuses on specific foreign particles, T cells circulate until they encounter specific antigen).
EVALUATION:
CRITICAL THINKING EXERCISES:
1. A 70-year old woman is referred to the allergy and immunology clinic for evaluation of her
immune status. In addition to the eight medications she routinely takes, she has received several
courses of antibiotics in the previous months for recurrent infections. What diagnostic tests would
you expect to be ordered? What is the rationale for these? What further assessment data would
you want to obtain from this patient?
Recurrent infections are infections that last long and are too severe. Since, the patient
routinely takes eight medications and had received several courses of antibiotics in previous months
then, we have to suspect that it may be a sign of primary immunodeficiency disorder. Early diagnosis
is essential for referrals and initiation of appropriate therapy. The following laboratory tests are
used; antibody deficiencies, cellular (T-cell) defects, neutrophil disorders, and complement
deficiencies.
-Antibody deficiency: Screening tests may start with the measurement of immunoglobulin (Ig), or
antibody levels in the blood serum. These tests measure how well the immune system can make
antibodies against vaccines, as a marker of how well the antibody arm of defense is functioning.
-Cellular (T-cells) defects: Laboratory evaluation of cellular or T cell immunity focuses on determining
the numbers of different types of T cells and evaluating function of these cells. This includes
complete blood count (CBC) and differential to establish the total blood (absolute) lymphocyte
count. To determine if there are problems with the immune system or lymph nodes since low T-cell
count may indicate viral infections.
-Neutrophil function: The laboratory evaluation of neutrophil begins by obtaining a series of white
blood cell counts (WBC). To rule out certain diseases that are associated with abnormalities in the
structure of the neutrophil.
-Complement deficiency: The standard screening test for deficiencies in this system is the total
hemolytic complement assay or CH50. To provide additional testing that will identify the specific
complement component that is defective.
Among the laboratory tests, a complete blood cell count with manual differential should
always be analyzed first. Since, the client is 70-year-old, age should be considered, specifically there
is a need for age-matched normal ranges to be used for the antibody levels change as the person
ages. Moreover, for further assessment, family history and epidemiologic data about specific
infectious agents should be carefully assessed and considered as well.
2. A 38-year-old woman is hospitalized for a heart transplant, and immunosuppressant
medications are prescribed. Describe how her altered immune function would affect the care you
provide. Develop an evidence-based teaching plan for the patient and her family before hospital
discharge. Discuss the criteria used to assess the strength of the evidence for your teaching plan.
Immunosuppressant medications lower the body’s ability to reject a transplanted organ. But
drugs that suppresses the immune system are inevitably associated with increased risk of infection
and malignancy, cardiovascular disease and bone marrow suppression. Thus, principles of asepsis,
recognizing risk factors of infection and understanding the importance of proper nutrition, oral
hygiene, and skin care should be considered in a plan of care for a patient with altered immune
function. Before discharge, the patient and her family should be equipped with enough knowledge
regarding health management for patient on immunosuppressed therapy. The teaching plan should
encourage the patient and the family to be aware of avoiding close contact with people, getting up-
to-date vaccinations, performing good hygiene, seeking prompt medical attention if there are signs
and symptoms of minor illnesses, and following any dietary recommendations for their condition.
Effectivity of this health teaching would greatly depend on how the patient and his family would
handle and adhere to the said health teaching measures. So, the criteria that I would be using here is
a monitor plan as a follow up if they are likely to fully adhere and understand the information
taught.
3. A 24-year old woman is diagnosed with systemic lupus erythematosus (SLE), and corticosteroids
are prescribed. What nursing observations and assessments are indicated? Identify patient
teaching that is appropriate for the new diagnosis and prescription of steroids.
Systemic lupus erythematosus (SLE) is an autoimmune disorder that affects every organ in
the body. The following manifestations are observed: malar rash, discoid rash, photosensitivity, oral
ulcers, nonerosive arthritis, pleuritis or pericarditis, kidney disease, neurologic disease, hematologic
disorder, immunologic disorder, and positive antinuclear antibody. Aside from the general
assessment, SLE has special features in which the skin is inspected for erythematous rashes, areas of
hyperpigmentation or depigmentation may be noted, the patient should also be questioned about
skin changes specifically about photosensitivity to sunlight or artificial ultraviolet light, the scalp
should be inspected for alopecia, and mouth and throat for ulcerations. Moreover, it has
cardiovascular and neurologic assessment. For cardiovascular assessment, it includes auscultation
for pericardial friction rub, which may be possibly associated with myocarditis and accompanying
pleural effusions. Joint swelling, tenderness, warmth, pain on movement, stiffness, and edema may
be detected on physical examination. While neurologic assessment, is directed at identifying and
describing any central nervous system changes. The patient and family members are asked about
any behavioral changes, including manifestations of neurosis or psychosis.
Health management education should be emphasized to the patient about the importance
of continuing prescribed medications and addresses the changes and potential side effects that are
likely to occur with their use. Since, the usage of corticosteroid is associated with
immunosuppression, the patient should watch for signs and symptoms of infection. Moreover, they
should be aware that long-term use of corticosteroids increases the incidence of osteoporosis. So,
they need to have a bone mineral density test performed at diagnosis and prior to beginning steroid
use to determine a baseline status and then every 2 years thereafter. Calcium and Vitamin D
supplementation daily is encouraged, along with the benefits of weight-bearing activities to support
bone health.
Republic of the Philippines
UNIVERSITY OF EASTERN PHILIPPINES
University Town, Northern Samar
Web: http://uep.edu.ph Email: uepnsofficial@gmail.com
NCM 112
CELLULAR ABERRATION
(MODULE 3)
LOBERITA, DINO ERNESTO T.
BSN-3C
JEANETTE J. ROJO, RN, MAN
PROFESSOR
EVALUATION:
1. B
2. C
3. C
4. A
5. A
6. B
7. B
8. Growth and progression of the primary tumor. The first requirement for metastasis is rapid
growth of the primary tumor. Most tumors must reach 1 billion cells or 1 cm on size 1 cm
before metastasis is possible.
9. B
10. b
PART II: ESSAY
1. What must take place and be completed before metastasis to happen?
The first known step for metastasis to develop is rapid growth of the primary tumor. Most
tumor must reach 1 billion cells or 1cm before it is possible. Angiogenesis at the primary site is
also a necessary step for metastasis, because the release of angiogenetic factors by tumor cells is
necessary to stimulate new capillary formation. Local invasion is the next step for the metastasis
to happen to reach blood vessels or the lymphatic basement membrane. Detachment and
embolization, Arrest in distant organ capillary beds, and Extravasation are also a necessary for
metastasis to happen and lastly is the proliferation, once a tumor cell arrive in the extraction
tissue, a blood supply and nutrients must be acquired for continued growth. The new
environment may differ considerably from the original site. In general, more poorly
differentiated cancer cells are better able to adopt to foreign tissues and survive.
2. Differentiate normal cells from cancer cells.
There are a lot differences between normal cells and a cancer cells. In a simple explanation,
cancer cells grow without a signal that tells them to grow while normal cells only grows when
they receive such signals. Normal cells communicate with other cells via chemical producing with
the help of these signals, they decide when to communicate with other cells while a cancer cell
partially lose the ability to communicate whit other cells via chemical with other cells via
chemical signals. They lose the sensitivity to the antigrowth factors coming from surrounding
cells. A normal cell also maintains their relationships with the cells around them by sticking
together. This phenomenon called contact inhibitions, prevents unnecessary cell proliferation
and overgrowth while cancer cell loses their cellular contact and cell to cell interactions.
Unnecessary cell proliferation and overgrowth of the cells cannot be prevented. This
circumstance is called loss of contact inhibition.
