NCM112OFI

Marial J. Contiga BSN 3 – Laurente

PRELIM NOTES

Immune System White Blood Cell

Collection of organs, cells, tissues & molecules
that mediate the immune response. Protects the
body from outside invaders such as germs,
bacteria, viruses, fungi & toxins.

• WBC, RBC, platelets or lymphocytes from

bone marrow
• Lymphocytes produces antibodies.

Immune System key players in the immune system

made in the bone marrow & part of
Body’s specific response to foreign agent or
organism; resistance to diseases specifically the lymphatic system
infectious diseases.
▼
2 Types of Lymphocytes
move through blood & tissue
B Lymphocytes – will mature at the bone marrow
throughout the body, looking for
and responsible for production of hormones
foreign invaders such as bacteria,
T Lymphocytes – Migrate at the thymus and
destroy invading organisms. viruses, parasites & fungi
▼
Parts of Immune System launch an immune attack
• White Blood Cells
• Antibodies
• Complement System Antibodies
• Lymphatic System
• Spleen
An antibody is a protein produced by the immune
• Bone Marrow
system in response to the presence of an antigen.
• Thymus

Bone Marrow
Spongy tissue found inside bones produces RBC,
platelets, WBC, Lymphocytes are produced in the
marrow, & play an important part in the body's
immune system
 NCM112OFI
Marial J. Contiga BSN 3 – Laurente
PRELIM NOTES
help the body fight microbes or the
toxins (poisons) they produce. Lymphatic System
▼ • Lymphatic system is made up of: lymph
recognizing substances called nodes (lymph glands) – which trap microbes
• Lymph vessels carry lymph – colourless fluid
antigens on the surface of the that bathes the body's tissues & contains
microbe, or in the chemicals they WBC
• This is where lymphocytes will be flowing.
produce, mark the microbe or toxin • 3 Primary Functions:
as foreign. o Maintenance of fluid balance
o Facilitates absorption of dietary fats
▼ from GIT to bloodstream for
mark these antigens for metabolism & storage.
o Enhancement & facilitation of the
destruction. immune system.
many cells, proteins & chemicals
Spleen
are involved in this attack

•
Complement System
A blood-filtering organ that removes
microbes contains WBC destroys old,
Once the lymphocytes are activated, it will be damaged RBC.
activated. Made up of all small proteins, made by • Makes disease-fighting components of the
the liver. Capable of proliferation, they will form immune system (antibodies & lymphocytes)
cleavages. It will cause swelling and burst of
organism. Spleen
made up of small proteins
• Small gland in the lymphatic system that
found in the blood
makes & trains special WBC called T-cells --
▼ help immune system fight disease &
infection.
made by the liver
• Filters & monitors blood content. It produces
▼ the WBC called T-lymphocytes.

Help or complement the work

The Body’s Other Defenses Against Microbes:
of antibodies, phagocytic cells
• Skin - waterproof barrier secretes oil with
▼ bacteria-killing properties.
• Lungs - waterproof barrier secretes oil with
to clear pathogens from an
bacteria-killing properties
organism
 NCM112OFI
Marial J. Contiga BSN 3 – Laurente
PRELIM NOTES
• Digestive Tract - mucous lining contains NATURAL IMMUNITY
antibodies acid in the stomach can kill most First line of host defense
microbes.
• Other defenses - body fluids: skin oil, saliva, following antigen exposure,
tears contain anti-bacterial enzymes. The because it protects the host
constant flushing of the urinary tract & the
bowel without remembering prior
contact

➢ Cytokine – Small proteins control growth & ▼

activity of other immune system cells and Production of cytokines, other
blood cells. Help body‘s immune &
inflammation responses. effector molecules
➢ Acquired Immunity – The resistance that
▼
human acquires during life is known as
acquired immunity. Also known as adaptive Activate cells to control
immunity. It has a 2 type; (1) Active is the
pathogens or promote
resistance developed by an individual as a
result of an antigenic stimulus. (2) Passive is development of acquired
a resistance that is transmitted passively to a
immune response.
recipient in a ready-made form.

Types of Immunity Macrophages

Tissue-resident or infiltrated immune cells
Cell involved
critical for innate immunity, normal tissue
Monocytes, macrophages, dendrite cells
development, homeostasis, & repair of
Natural killer cells – basophils, eosinophils,
damaged tissue.
granulocytes
▼
Classified as to Function
Release cell mediator histamine,
1. Classically-activated (M1) macrophages,
bradykinin, prostaglandins
2. Wound-healing macrophages or
▼
alternatively-activated (M2)
phagocytosis
macrophages
3. Regulatory macrophages (Mregs).
 NCM112OFI
Marial J. Contiga BSN 3 – Laurente
PRELIM NOTES

Inflammatory Responce deals with antigens from

pathogens that are freely
Major function of natural immune system.
circulating, or outside the infected
cells.
▼
Antibodies produced by the B cells
will bind to antigens,
▼
neutralizing them, or causing lysis
(dissolution or destruction of cells
1. PHAGOCYTIC IMMUNE RESPONSE by a lysin) or phagocytosis
• Phagocytosis is a specific form of endocytosis
by which cells internalize solid matter, 3. CELLULAR IMMUNE RESPONSE
including microbial pathogens
• 3 main groups of phagocytes: • Cell-mediated immune responses involve the
o monocytes macrophages, granulocytes destruction of infected cells by cytotoxic T
dendritic cells cells, or the destruction of intracellular
• Dendritic cells pathogens by macrophages
o A special type of immune cell found • T cells part of the immune system & develop
in tissues, such as the skin, & boosts from stem cells in the bone marrow (migrate
immune responses by showing thymus for development)
antigens on its surface to other cells of
the immune system. Types of T Lymphocytes
2. HUMORAL IMMUNE RESPONSE
(ANTIBODY RESPONSE) 1. Effector T Cells

• Is mediated by antibody molecules secreted • Key players in steering the immune responses
by plasma cells to execute immune functions.
• T HELPER CELLS
o CD4+ - T HELPER CELLS
o CD8+ - CYOTOXIC CELLS
 NCM112OFI
Marial J. Contiga BSN 3 – Laurente
PRELIM NOTES
CD4 T lymphocytes 3. Memory T Cells
▼ • antigen-experienced cells that mediate a faster
Secrete cytokines & more potent response upon repeat
encounter with antigen.
▼
Attract/activate/coordinate
4. Null Lymphocytes
B cells, cytotoxic T cells, NK
• Destroy antigen already coated by antibody
cells, macrophages
▼
5. Natural Killer Cells
CD8 T lymphocytes – cytotoxic killer cells
Recognize infected, stressed
▼
cells
Directly attack antigen by
▼
▼
Secrete macrophage
Altering cell membrane - (Cell lysis
activating cytokine
disintegraton)
▼
▼
Killing these cells
Releasing cytolytic enzymes, cytokines
▼
Activate other lymphocytes, WBC
▼ Autoimmunity
DESTROYING ORGANISM
Is the failure of an organism in recognizing its
2. Suppressor T Cells own constituent parts as non self, which allows
an immune response against its own cells and
prevent hypersensitivity on exposure to non-self tissues. Any disease that results from such an
cells or proteins which help to prevent immune aberrant immune response is termed an
overreactions. autoimmune disease. Autoimmunity is often
caused by a lack of germ development of a target
▼
body and as such the immune response acts
Decrease B cell production at a healthy leve against its own cells and tissues.
 NCM112OFI
Marial J. Contiga BSN 3 – Laurente
PRELIM NOTES
2. IgA-15%
Anaphylaxis Appears in body fluids(blood, saliva, breast milk,
pulmonary, GI, vaginal secretions. Protects
Causes the immune system to release a flood of
against respiratory, GI, GUT infections. Prevents
chemicals that can cause shock
absorption of antigens from food. Passes thru
A clinical response to an immediate immunologic breast milk to neonate for protection.
reaction between a specific antigen & antibody
3. IgM-10%
▼
Appears in intravascular serum. Appears as the
Resulting from rapid release of IgE mediated first antibody produced in response to bacterial or
chemicals viral infections. Activate complement system

▼ 4. IgD-0.2%

Induce severe life threatening allergic reaction Appears in small amount in serum. Possibly
influences B lymphocytes
5. IgE – 0.004 %
Appears in serum. Takes part in allergic & some
hypersensitivity reactions, Combats parasitic
infections

B-cells produce antibodies to fight bacteria &

viruses.
▼
Y-shaped proteins specific to each pathogen
▼
Able to lock onto the surface of an invading cell
▼
Mark it for destruction by other immune cells
1. IgG -75%
Appears in serum & tissues. Assumes a major
role in blood-borne & tissue infection. Activates
complement system. Enhances phagocytosis.
Crosses placenta.
 NCM112OFI
Marial J. Contiga BSN 3 – Laurente
PRELIM NOTES
T cells (T lymphocytes) acts on histamine 1 (H1) and histamine 2 (H2)
receptors
▼
▼
Directly killing infected host cells
cause contraction of smooth muscles of the
▼ airway & GIT, increased vasopermeability &
Activating other immune cells, producing vasodilation, enhanced mucous production,
cytokines pruritus, cutaneous vasodilation, & gastric acid
secretion.
▼
& regulating the immune response.
Mast Cell
EOSINOPHIL CHEMOTACTIC FACTOR OF
ANAPHYLAXIS
Antigen
▼
An antigen is a substance that induces the AFFECT MOVEMENT OF EOSINOPHILS
formation of antibodies because it is recognized
by the immune system as a threat. (GRANULAR LEUKOCYTES)

Complete antigen ▼

One that both induces an immune response & TO THE SITE OF ALLERGEN
reacts with the products of it
PREFORMED IN THE MAST CELL &
ex. Animal dander, pollen
RELEASED IN DISRUPTED MAST CELL

Incomplete antigen or hapten

Platelet Activating Factor
Is unable to induce an immune response alone but
is able to react with the products of it, PLATELET –ACTIVATING FACTOR

e.g., antibodies ▼
INITIATING PLATELET AGGREGATION &
Chemical Mediators
& LEUKOCYTE INFILTRATION AT THE
SITES OF IMMEDIATE HYPERSENSITIVITY
Histamine
REACTIONS
A chemical created in the body released by WBC
▼
into the bloodstream when the immune system is
defending against a potential allergen CAUSE BRONCHOCONSTRICTION &
VASCULAR PERMEABILITY
 NCM112OFI
Marial J. Contiga BSN 3 – Laurente
PRELIM NOTES

Prostaglanding

Group of lipids made at sites of tissue damage or

infection that are involved in dealing with injury
& illness. Control processes such as
inflammation, blood flow, the formation of blood
clots & the induction of labour.

PRODUCE:
• Smooth Muscle Contraction
• Vasodilation
• Increased Capillary Permeability
• Fever, Pain in Allergic Responses
ARE PARTLY DUE TO PROSTAGLANDINS

Secondary Mediators
1. Leukotrines Management
Initiate inflammatory response cause smooth
MANAGEMENT
muscle contraction bronchial constriction mucus
secretions in airways ASSESS ABC
wheal, flare reactions of skin 100 -1000 x more CPR – CARDIAC ARREST
potent in causing bronchospasm than histamine
SUPPLEMENTAL O2
2. Bradykinin
EPINEPHRINE 1:1000 SQ, FF IV INFUSION
Cause increased vascular permeability
vasodilation hypotension contraction of smooth • causes constriction, or tightening, of the blood
muscles (bronchi) increased permeability in vessels – Decreases swelling, increase BP
capillaries causes edema stimulate nerve fibers antagonizes histamine by acting on effector
causing pain cells in a direction opposite of histamine.
• In the heart, it increases the rate and force of
3. Serotonin contraction – increasing cardiac output raising
Potent vasoconstrictor contraction of bronchial BP bronchodilator
smooth muscle
 NCM112OFI
Marial J. Contiga BSN 3 – Laurente
PRELIM NOTES
ANTIHISTAMINES
• Diphenhydramine — 25 to 50 mg
• IV over 5 minutes, may be
• Repeated every 4 to 6 hours PRN up
maximum dose of 400 mg/24H
CORTICOSTEROIDS
• IVFs normal saline, volume
• Expanders, vasopressorto
• Maintain BP, hemodynamic status
 NCM112OFI
Marial J. Contiga BSN 3 – Laurente
PRELIM NOTES

Rheumatoid Arthritis

• Chronic Inflammatory Disorder (extra-

articular disease)
• Linked to HLA-DRI &HLA-DA4
• Symmetric, progressive, causes joint
deformation
• It usually affects joints symmetrically (on
both sides equally), may initially begin in a
couple of joints only, and most frequently
Pannus is a membrane of granulation
attacks the wrists, hands, shoulders, knees,
elbows, ankles. tissue composed of mesenchyme- & bone
• Incidence: marrow-derived cells.
o 14 million people globally have RA
▼
(WHO 2021)
o 1.36 million adults in U.S. stimulates the release of IL-1, platelet- derived
(Rheumatology International, 2017) growth factor, prostaglandins, & substance P by
o Begin at any age, increases with age. macrophages,
onset highest among adults in their
60’S ▼
• Recent research prevalence increased with COLLAGENASE
age, body mass index, physical inactivity,
worsening physical & mental health. highest ▼
among adults who were unable to work, cause cartilage destruction & bone erosion
disabled, or had fair or poor self-rated health
 NCM112OFI
Marial J. Contiga BSN 3 – Laurente
PRELIM NOTES
Rheumatoid factor determine the presence of
abnormal antibodies seen in connective tissue
disease n; hegative positive titer > 1: 80 present
in 80% with ra

Management

Pharmacologic Therapy
•
Diagnostics SALICYLATES - ASPIRIN
• NSAID’s – VOLTAREN, DICLOFENAC,
• History IBUPROFEN
• PE • DMARD’s alter disease progression &
• Laboratory studies decrease or stop further tissue damage
• WBC COUNT • Non-biologic DMARD’s reduce
o MEASURES CIRCULATING proinflammatory cytokines (cell signalling
o LEUKOCYTES proteins), increase anti-inflammatory
o N: 4,500 – 11,000 CELLs/m cytokines
• HEMATOCRIT • Biologic DMARD’s – target a a certain cell or
• MEASURES THE SIZE CAPACITY, molecule within the immune system to treat
NUMBER OF CELLS PRESENT IN THE specific rheumatologic condition
BLOOD • DMARDS:
o MALE: 42% - 52% o HYDROXYCHLOROQUINE(PLAQ
o FEMALE: 35% - 47% UENIL)
o DECREASE IN CHRONIC o CHOROQUINE (ARALEN)
INFLAMMATION o MOA: Anti-inflammatory, inhibits
lysosomal enzymes
o Sulfasalazine (Azulfidine)
o Anti-inflammatory, reduces
lymphocyte response
• Gold containing compounds
o Aurothioglucose
Diagnostics o (Solganal)
o Gold sodium thiomalate
Measures the Rate RBC Settle out of o (Myochrysine)
o Auranofin (Ridaura)
Unclotted Blood in 1 hour
• MOA: inhibits T & B cell activity, suppress
• men < 50 yrs : < 15 mm/h synovitis during active stage of rheumatoid
• men > 50 yrs : < 20 mm/h disease.
• female < 50 yrs: < 25 mm/h
• Female > 50 yrs: < 30 mm/h
 NCM112OFI
Marial J. Contiga BSN 3 – Laurente
PRELIM NOTES
• Penicillamine (Depen) Anti-inflammatory
inhibits T cell function, impairs ntigen
presentation.
• Immunosuppressives
o Methotrexate ( Rheumatrex)
o Moa: immune suppression
• IMMUNODULATORS PYRIMIDINE
SYNTHESIS NHIBITOR
o Leflunomide: antiproliferative, anti-
inflammatory
• Cyclosporin (Neoral)
o Moa: immune suppression by
inhibiting T lymphocytes
• Corticosteroid Prednisone
o Moa: anti-inflammatory

Non Pharmacologic Pain Mgt

• Heat application to relieve pain, stiffness,

muscle spasm
• Warm baths, shower, warm moist compress
• Paraffin baths (dips) offer concentrated heat
• Therapeutic exercise
• Use of assistive devices for ambulation,
braces, splints
• Adequate rest and sleep
• Balance nutrition
NCM112OFI
Marial J. Contiga BSN 3 – Laurente
PRELIM NOTES