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The immune system is a complex system of cells and responses that recognises something as foreign and acts to remove it. For example microorganisms, foreign tissue, body cells -cancer.

FUNCTION

There are two different types of immunity: non-specific and specific.

These can be understood as lines of defence against invaders.

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Nonspecific Immunity.

First Line of Defence. Mechanical barriers, for example, intact skin and

mucous membrane. Chemical barriers. For example, saliva, tears. Reflexes, for example, coughing, sneezing, and

vomiting.

Second Line of Defence Inflammation and fever. Protective proteins that are produced in response to

viruses (interferon), and bacteria (complement protein ) Natural killer cells (lymphocytes). Phagocytes (special white cells that eat pathogens)

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Specific ImmunityThird Line of Defence.

Lymphocytes: T cells, B cells.

T cells are produced in the thymus. T cells account for 70% - 80% of all lymphocytes.

T cells attack antigens which are substances the body recognises as foreign.

B cells are produced in the bone marrow . B cells account for 20% - 30%. B cells secrete antigens.

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Immunity can be either:

Naturally acquired active immunity.For example, when the body is exposed to a disease and develops immunity through the action of T cells and B cells

Naturally acquired passive immunity is the immunity that is passed from mother to baby.

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Artificially acquired active immunity.

For example, when a person is vaccinated and develops long-term immunity against a disease through the development of antibodies against the disease.

Artificially acquired passive immunity. For example when the body is injected with

gamma globulin (antibodies) this sort of immunity is short-term as the body does not produce its own antibodies

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FUNCTION The function of the immune system is to

remove foreign substances and waste products from blood and lymph. (dead cells, bacteria, viruses, and cancer cells)

To fight disease and to maintains the balance of fluid in the tissues.

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THE LYMPHATIC SYSTEM.

The lymphatic system is closely connected to the circulatory system, it consists of an

additional set of vessels through which some of the tissue passes before reaching the large

veins and entering the blood.

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The lymphatic system is comprised of Lymphatic capillaries. Lymphatic vessels. Lymphatic nodes. Lymphatic tissue . Lymphatic ducts. Lymph nodes are found in the axilla in the

neck and in the groin. Lymphatic tissue is found in the spleen, the

tonsils and the thymus. It is in the lymphatic tissue the lymphocytes are formed

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Oedema of legs and feet

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NORMAL CHANGES ASSOCIATED WITH AGEING

The body’s ability to defend itself against disease generally diminishes with age due to decreased lymphocyte function, increased circulating antibodies and drugs that depress immunity

THE SIGNS OF INFECTION Localised: inflammation, redness, pain. Systemic: fever, malaise, raised white cell

count.

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COMMON HEALTH PROBLEMS ASSOCIATED WITH THE IMMUNE SYSTEM

Urinary Tract Infection (UTI)

An infection of the bladder resulting in urgency, frequency and burning on micturition.

UTIs may also cause an elderly resident to become confused.

The responsibility of the nursing assistant is to encourage fluids and observe for worsening symptoms.

Management:Urinary alkaliners. Antibiotics.

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Conjunctivitis

An infection of the conjunctiva in the eye causing redness, itching, swelling and pus.

It is the responsibility of the AIN to provide eye care as required and prior to the administration of eye drops or creame.

Management Topical antibiotic

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Thrush

An infection of the mucous membrane by a virus -candida albicans, causing, itching, a white ‘milk curd’ discharge and possibly swelling.

It is the responsibility of the AIN to keep the affected area clean - if it is vaginal thrush, perineal care as required and prior to the administration of medications.

Management Topical medication

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Oral thrush

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An allergy is the formation of antibodies to something not normally recognised as foreign.

These include hay fever, contact dermatitis and anaphylaxis.

The responsibilities of a nursing assistant in an allergic episode are to report any allergy to the registered nurse.

In the case of anaphylaxis, this can be a medical emergency.

Management Investigate underlying cause. Medication. Medical intervention if a severe form of

anaphylaxis.

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A condition whereby the body produces antibodies against itself.

For example rheumatoid arthritis

Management Medical investigationManagement depends on the disorderMedication

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Immune deficiencies are acquired or congenital. An example acquired immune deficiencies is

HIV/AIDS. Manifestations of HIV/AIDS are pneumonia, skin

disorders, cancer and dementia. The responsibility of the AIN is to provide

support and palliative care to the resident with HIV/AIDS

Management Treatment of symptoms as they arise. Medication Adequate hydration and nutrition.

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THE ENDOCRINE SYSTEM

FUNCTION The endocrine system comprises glands and

the hormones that are secreted by those glands directly into the bloodstream. Hormones regulate growth, blood sugar, metabolism, reproduction as well as various other functions, such as sleep rhythm

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STRUCTUREHormones Hormones are chemical substances secreted

by endocrine glands directly into the blood. Hormones are classified as proteins and

steroids. Hormones are aimed at receptors of target

organs. These receptors are located on the outer

surface of the cells of those organs. Hormone secretion is controlled by 3

mechanisms: negative feedback, biorhythms and the central nervous system

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Glands Glands are located throughout the body. The pituitary gland is the master gland and is

located in the brain behind the eyes at the base of the frontal lobe.

It is divided into 2 parts - the anterior and the posterior pituitary.

Each part secretes specific hormones that affect the action of other glands in the body

The hypothalamus lies above the pituitary. It releases hormones that either stimulate or inhibit the release of hormones by the anterior pituitary.

The pineal gland is located near the hypothalamus and houses our biologic clock

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The thyroid gland lies in the neck near the ‘Adams Apple’.

It produces a hormone that regulates growth and general metabolism.

The thymus lies in the chest above the xiphoidprocess and gets smaller after puberty, but it plays a part in the body’s immune system.

The parathyroids lie within the thyroid capsule. They produce a hormone that regulates, along

with one of the hormones of the thyroid gland, the level of phosphorus and calcium in the blood.

Calcium is important for many functions of the body, such as muscle contraction and conduction of nerve impulses

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The pancreas produces insulin and glucagon, which help regulate blood glucose levels.

Insulin acts to lower blood sugar level and glucagon acts to raise blood sugar level.

The adrenal glands lie on top of the kidneys and secrete hormones that help the body grow and adapt to stress

The ovaries in the female secrete oestrogen and progesterone.

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Summary of glands and their hormones

GLAND FUNCTIONAdrenal Regulates salt and water in the blood assists

body in coping with stress.

Pancreas Regulates blood glucose levels.

Ovaries Affect the formation of the ova and the

development of the female sex characteristics.

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Parathyroid Regulates the metabolism of calcium and

phosphates.

Pituitary Master gland. Testes Affect the formation of sperm and development

of male sex characteristicsThymus Aids in the formation of lymphocytes.

Thyroid Controls rate of body’s metabolism and

influences growth and development.

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NORMAL CHANGES ASSOCIATED WITH AGING

As the body ages there is a general decrease in the secretion of hormones.

This affects such things as metabolic rate, a disruption to circadian rhythm, an increase in the storage of fat.

Menopause occurs in women around the age of 50 years - menstruation stops and changes occur in breast tissue and in the reproductive organs.

Men do not lose their fertility but may lose their potency

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COMMON HEALTH PROBLEMS ASSOCIATED WITH THE ENDOCRINE SYSTEM.

Diabetes MellitusDiabetes mellitus is the most common

disorder of the endocrine system. It is due to the failure of the pancreas to secrete enough insulin for the metabolism of glucose. This causes glucose to build up in the blood and consequently the cells cannot perform their specific functions

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There are 2 main types of diabetes

Insulin Dependent Diabetes Mellitus (IDDM) (Type 1)

Non-Insulin Dependent Diabetes Mellitus (NIDDM) (Type 2)

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Presenting Problems

Increased thirst (polydipsia)Hunger.Weight loss. Irritability/confusion. Increased urine production (polyuria)Weakness.Halitosis.Delay in healing.

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Complications

Retinal damage. Kidney damage.Nerve damage. Circulatory disorders. Increased risk of infection.Diabetic ketoacidosis - a life-threatening

complication of diabetes that results in coma and death, if untreated

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Implications for Nursing Assistants

Be aware of the type of diabetes the resident has, as different types require different management.

Promote good foot care. Never trim the nails of someone who has diabetes as a ‘nick’ (cut) from scissors may cause an infection.

Encourage resident and their families/significant others in the selection of well-fitting shoes.

Encourage resident to wear stockings or socks.

Encourage resident to eat regularly. Encourage physical activity.

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Be aware of the signs of: Hypoglycaemia - bought on by exercise,vomiting too little food, and too muchinsulin.Headache.Light-headedness.Fainting.Sweating.Irritability.Double vision.Palpitations.Decreased consciousness.

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If this occurs, report change to registered nurse who will take measures to raise blood sugar level quickly by giving something sweet such as glucose, honey and orange juice and follow this up with a longer acting carbohydrate such as fruit or a biscuit or bread

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Hyperglycaemia - bought on by dehydration, too much sugar in the diet, a change in metabolic requirements.

Dehydration.Hypotension.Increased thirst.Increased urination.Lethargy that can lead to coma.

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If this occurs, notify the registered nurse immediately, as insulin needs to be administered

Management: AIM: to keep blood sugar level (BSL) between4 – 7.8 mmol/L

IDDM Insulin at least twice daily; the type of insulin

will depend on the resident’s BSL and the severity of the diabetes.

Frequent monitoring of BSL. Urinalysis for ketonuria. Maintenance of ideal weight. Exercise.

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NIDDM

Achieve ideal weight. Exercise.Oral hypoglycaemic agents which increase

the production of insulin by the pancreas, e.g. Diabex, Rastinon, Daonil

Diet

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Healthy Eating Guidelines.Wholemeal breads and cereals.More legumes, pulses, fruit and vegetables.Moderate amounts of lean meat and low fat

dairy products. Less alcohol.

Hyperthyroidism (Graves Disease) An over secretion of thyroid hormone causes

hyperthyroidism

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Presenting Problems Anxiety Agitation. Delirium. Bulging eyes. ‘goitre’ - bulging thyroid gland

Implications for Nursing Assistants

Generally try to provide restful environment. Help resident to relax as much as possible. Minimise stimulation. Diversional therapy. Encourage well-balanced diet. Avoid over-heating.

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ManagementMedications. Surgery.

Myxoedema Hypothyroidism is caused by an under

secretion of thyroid hormones A deficiency of iodineDefences for infection are weakened

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Presenting Problems

Slowed body metabolism. Lethargy, apathy.Generalised oedema. Intolerance to cold.Obesity.Dry skin. Constipation. Increase risk of infection.

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Implications for Nursing Assistants Encourage resident to be active and participate

in social interaction. Observe resident for signs of oedema. Provide warmth. Encourage resident to eat low-kilojoule foods. Encourage fluids so as to avoid constipation.

Management Hormone replacement therapy.