A 45-year-old man is admitted to the emergency department with a laceration on h

Question

A 45-year-old man is admitted to the emergency department with a laceration on his left arm. In collecting his history records, the nurse notes he has never had an immunization to tetanus. Due to the nature of the laceration, the patient needs to have immediate protection from tetanus to prevent possible exposure to the disease from the dirty laceration.

1. Compare and contrast active versus passive immunity.

2. If this patient needs immediate protection against the disease, what type of immunity will the nurse expect to give to the patient and why?

3. When this patient is given tetanus toxoid, the immunization utilized for protection against tetanus, he is given a substance that will cause an active immune response. Which two types of lymphocytes will be involved in this immune response, and how does each stimulate the immune response?

4. In 5 years, this same patient returns to the emergency room with another laceration. In obtaining the nursing history, you realize he has had all the required immunizations against tetanus. How will the concept of “memory cells” impact your understanding of what you need to do to protect the patient at his time?

Explanation / Answer

1)Active immunity involves your bodies direct response to an unknown pathogen. This response is the production of antibodies specific to the antigen of a particular pathogen. This type of immunity takes a while for the formation of antibiotics but, the response lasts for a long period of time and in some cases, where antibodies remain in the body as memory cells, immunity to certain diseases are life long eg herpes zoster. Conversely, passive immunity is an immune response which involves antibodies obtained from outside the body. An example of this is the antibodies a mother passes to her infant through her breastmilk. Immunity to the pathogens which these antibodies are specific to is therefore immediate, as no time is needed to create them. However, this immunity is not long term and may only last a few days. Passive and active immunity both have natural and artificial forms. So, for example the natural form of passive immunity is antibodies transferred in breast milk as mentioned, however an artificial form of passive immunity is the use of antidotes such as that for rabies where specific antibodies are injected into an infected individual. Additionally, the natural form of active immunity is the normal process of an individual contracting an infection and their immune system like the macrophages and white blood cells that defend against the infection , conversely the artificial form of active immunity is immunization, where an individual is deliberately exposed to a weakened form of a particular pathogen in order to elicit an immune response eg live or attenuated form of vaccination
2) For the above patient the nurse will have to use active form of Immunity especially with vaccinations of tetnus toxoid to prevent the patient from accquring disease through the clostridium tetni an anaerobic bacteria that cause infections .Clostridium tetnai enters the body through any cuts,lacerations or injuries .Toxoids are inactivated toxic compounds from micro-organisms in cases where these (rather than the micro-organism itself) cause illness, used prior to an encounter with the toxin of the micro-organism.other examples of toxoid vaccine are diphtheria vaccine

3)   The two lymphocytes involved in active immunity T cells (cytotoxic T cells, helper T cells, memory T cells, and suppressor T cells), B cells (memory B cells and plasma cells), and antigen-presenting cells (B cells, dendritic cells, and macrophages).
T cells function both through the release of substances into the blood, and by signalling B cells through contact. They have several different roles:
•   Signalling for growth and activation of B cells
•   Activation of cells that can ‘eat’ foreign substances
•   Stimulation of cytotoxic T cells during a viral infection
•   Signalling growth in cells, including other T cells, macrophages
T cells cannot detect foreign substances without assistance, and require a complex system to help them work. They need the help of cells called antigen presenting cells (APCs). These cells will eat the foreign substance, be it a bacteria, virus-infected cell or toxin, break it down, and present part of it to the T cell so that it can mount a response. APCs have a special type of molecule on their surface that allows them to communicate with helper T cells. Once a response is activated, lots and lots of T cells of different types are released into the blood stream. The released cells are responsible for the destruction of the foreign substance.
The majority of B cell activation takes place in the lymph nodes. Certain types of cells in the lymph nodes eat anything foreign and present them to B and T cells. Any B cell that shares a receptor for this substance will be activated and start to multiply. B cells can also be activated by helper T cells. After activation, active B cells migrate around the body and change into plasma cells.
4)   The nurse should not repeat the tetnus toxoid vaccine again as the immunity is present in the patients body for 10 years

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