34
Lesson Plans for
Immunologic Disorders
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 34.1:
2. List the data to be collected when assessing a patient with a disorder of the immune system.
3. Describe the tests and procedures used to diagnose disorders of the immune system and nursing
considerations for each.
Lesson 34.2:
5. Describe the pathophysiology, signs and symptoms, medical diagnosis, and medical treatment for
selected disorders of the immune system.
6. Assist in developing a nursing care plan for a patient with a disorder of the immune system.
CHAPTER TEACHING FOCUS
• In this chapter, the student will be introduced to the components of the immune system, including
innate immunity, acquired immunity, and tolerance.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
Concepts for nursing practice. St. Louis: Elsevier. The specific exemplars chosen and listed below for
each concept have been tailored specifically to correspond to the Linton textbook.
THEME: Homeostasis and Regulation
• Concept: Cellular Regulation
• Exemplar: Leukemia, p. 654
• Table 34-1: Diagnostic Tests and Procedures: Laboratory Studies to Evaluate the Immune System,
p. 649
• Table 34-2: Diagnostic Tests and Procedures: Diagnostic Tests and Procedures: Bone Marrow
Biopsy, p. 650
THEME: Protection and Movement
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CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Active acquired immunity occurs when a person __________.
a) manufactures antibodies in response to an infection or vaccination
b) receives immunity from another person
c) gains immunity by a vaccine
d) is never sick
2) White blood cells are produced by the __________.
a) bone marrow
b) lymphatic system
c) spleen and thymus
d) liver and pancreas
3) The most numerous white blood cells are the __________.
a) basophils
b) eosinophils
c) erythrocytes
d) neutrophils
4) The primary cells that become infected with HIV are the __________.
a) B cells
b) T cells
c) IgM
d) IgG
5) Colony-stimulating factors are administered to promote __________.
a) stronger macrophages
b) basophils resistant to inflammatory stress
c) bone marrow production of white blood cells
d) lymphatic production of B cells
6) A bone marrow transplant that uses a donor’s bone marrow is referred to as __________.
a) allogeneic
b) autologous
c) stem cell
d) sibling
7) Leukemia is a(n) __________.
a) low white blood cell count
b) elevated neutrophil count
c) lymph node malignancy
d) cancer of the white blood cells
8) The immunoglobulin associated with idiopathic thrombocytopenic purpura (ITP) is __________.
a) IgA
b) IgG
c) IgM
d) IgE
9) Systemic lupus erythematosus is an autoimmune disease in which __________.
a) the immune system mounts an immune response against its own proteins
b) the immune system causes excessive clot formation throughout the body
c) the immune system destroys the body’s platelets
d) a type I hypersensitivity reaction develops
10) The presence of Reed-Sternberg cells in the lymph nodes is characteristic of __________.
a) non-Hodgkin’s lymphoma
b) Hodgkin’s lymphoma
c) multiple myeloma
d) singular myeloma
Introduction to Medical-Surgical Nursing, 6th ed.
1) a
6) c
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: Where are white blood cells produced? What are the five major types of white blood cells?
Question: What is the main function of white blood cells?
4 Chapter 34Immunologic Disorders ____________________________________________________________
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 34.1
Instructor Preparation
Textbook Objectives Covered
2. List the data to be collected when assessing a patient with a disorder of the immune system.
3. Describe the tests and procedures used to diagnose disorders of the immune system and
nursing considerations for each.
Lesson Preparation Checklist
• Assemble materials and supplies needed for each lesson as indicated below.
• Prepare lecture from TEACH lecture slides available on Evolve.
• Student performance evaluation of all entry-level skills required for student comprehension of
principles underlying immunologic disorders, including:
• Anatomy and physiology of the immune system
• Age-related changes
• Nursing assessment of the immune system
• Disorders of the immune system
• Diagnostic tests and procedures
Materials and Supplies
• computer and PowerPoint
projector
Key Terms
• acquired immunity (p. 645)
• antibody (p. 643)
• antibody-mediated immunity
(p. 645)
• antigen (p. 642)
• immunity (p. 644)
• immunoglobulin (p. 643)
• innate immunity (p. 644)
• pathogen (p. 642)
• phagocytes (p. 645)
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 642–646)
REVIEW
• Figure 34-2: Maturation of cells constituting the hematologic and immune systems (p. 643)
• Figure 34-1: Diagram of the lymphatic system (p. 645)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1, 2, 3 (p. 661)
ANSWER – Study Guide
• Part IA: 1-8 (p. 205)
• Part IB: 1-5 (p. 206)
• Part IC: 1-7 (p. 206)
• Part ID: 1 (p. 206)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 34.1
2
READ – Textbook (pp. 646-648)
ANSWER – Text
• Review Questions for the NCLEX Examination: 5 (p. 661)
3
READ – Textbook (pp. 648–651)
REVIEW
• Box 34-2: Calculating Absolute Neutrophil Count from Complete Blood Count (p. 651)
• Table 34-1: Diagnostic Tests and Procedures: Laboratory Tests (p. 649)
• Table 34-2: Diagnostic Tests and Procedures: Special Procedures to Evaluate the Immune
System (p. 650)
ANSWER – Text
ANSWER – Study Guide
• Part IF: 1-5 (p. 206)
• Part IIK: 12, 13 (p. 209)
• Part IIL: 4 (p. 210)
6 Chapter 34Immunologic Disorders ____________________________________________________________
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LESSON 34.1
50-Minute Lesson Plan
Lecture Outline 20 minutes
Slide 1
Chapter 34
Immunologic Disorders
1
Slide 2
Anatomic Structures and Components
• Bone marrow
• Stem cells
• White blood cells (leukocytes)
• Neutrophils, monocytes and macrophages, eosinophils, basophils, mast cells, B
lymphocytes (B cells), T lymphocytes (T cells)
• Cytokines
• Eicosanoids
• Thymus
• Lymph, lymphatics, and lymph nodes
• Liver
TALKING POINTS:
• The bone marrow is the spongy center of the bones where the white blood cells (WBCs)
are made.
• The lymphatic system is a network of open-ended tubes—separate from the blood
circulation system—that collects the plasma left behind in the tissues and returns it to the
venous system.
• The spleen filters microorganisms from the blood.
• Early in life certain WBCs, called lymphocytes, migrate from the bone marrow where they
are produced to the thymus where they mature into T lymphocytes, or T cells.
elevation, WBC activation, and other physiologic processes involved in immunity.
Slide 3
Physiologic Functions: Innate Immunity
• Operational at all times, whether or not a pathogen is present
• Are immediately functional at birth
• Include anatomic and physiologic barriers, inflammatory response, and the ability of
certain cells to phagocytose foreign invaders
___________________________________________________________ Chapter 34Immunologic Disorders 7
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 34.1
Slide 4
Physiologic Functions: Barriers
• Skin and mucous membranes: a protective covering; secretes substances that inhibit
pathogen growth
• Sweat glands secrete lysozyme, antimicrobial enzyme
• Acidic gastrointestinal (GI) and genitourinary (GU) systems inhibit growth of
pathogenic organisms
• Secretions from the respiratory and gastrointestinal tracts contain the antibody IgA, as
well as phagocytes
• Surfaces colonized by normal bacterial flora; prevents pathogens from
Slide 5
Physiologic Functions: Inflammation
• Body initially responds to an injury or infection by dilating the capillary bed and increasing
the capillary permeability of the affected area
• Brings white blood cells to the site; allows them to enter the tissue to attack
microorganisms
• This multistep process is called inflammation and is recognized by rubor (redness), tumor
(swelling), calor (heat), and dolor (pain) at the site of injury or infection
Slide 6
Physiologic Functions: Phagocytosis
• The process of ingesting and digesting invading pathogens, dead cells, and cellular debris
Slide 7
Physiologic Functions: Acquired Immunity
• Specific to particular pathogen: activated only when needed
• Antibody-mediated
• Initiated when IgM immunoglobulins on B lymphocytes detect a foreign antigen
• Active: person synthesizes own antibodies in response to pathogen
• Passive: antibody produced by person or animal is transferred to another person
TALKING POINTS:
• When antibodies bind to an antigen, they do not actually destroy the pathogen, but they
make the antigen readily recognizable to neutrophils, monocytes, and macrophages,
Slide 8
Physiologic Functions: Acquired Immunity (cont.)
• Cell-mediated
• Aimed at intracellular defects caused by viruses and cancer
• Responsible for delayed hypersensitivity reactions and rejection of transplanted tissue
Physiologic Functions: Tolerance
• Immune system must recognize its own proteins
• Autoimmune diseases occur when there is a breakdown of tolerance; immune system
8 Chapter 34Immunologic Disorders ____________________________________________________________
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LESSON 34.1
Slide 10
Age-Related Changes
• Bone marrow becomes less productive
• Lymphatic tissue shrinks, resulting in fewer and smaller lymph nodes
• Immunologic function not affected unless a person is unusually stressed by trauma, a
chronic infection, or treatment for cancer
TALKING POINTS:
• Immunologic function is generally not affected unless a person is unusually stressed by
2
Slide 11
Chief Complaint and History of Present Illness
• Frequent or persistent infections, bleeds for a long time when cut, bruises easily, or has
chronic fatigue
Slide 12
Medical History
• Cancer or prior treatment for cancer, HIV infection, history of splenectomy, or an
indwelling venous access device, indicating that the patient needed long-term venous
access
• Medications patient is using or a recent change in medication may suggest an underlying
immunologic problem
• Ask about recent changes in medications and recent immunizations
Slide 13
Family History
• Note family history of immunologic disorders such as cancer
• Death of a family member at a young age for reasons other than trauma may indicate a
genetic immunologic disorder
Review of Systems
• Reddened, swollen, painful, warm areas
• Ask about fever, chills, or night sweats
TALKING POINTS:
• What is the primary symptom of an immunologic disorder?
• Night sweats can occur when the patient’s temperature rises at night but the patient does
not awaken until the temperature falls, causing sweating.
Slide 15
• Perception of health
Functional Assessment
• Occupation and hobbies
• Self-concept
• Activity and exercise
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 34.1
Slide 16
Physical Examination
• General survey
• Responsiveness, mood, expression, posture
• Carefully inspect and describe reddened, swollen, or painful areas
• Skin
• Note general color, texture, turgor, temperature, and integrity of the skin
• Palpate for swollen or painful areas
Slide 17
Physical Examination (cont.)
• Head and neck
• Enlarged, swollen, or draining areas
• Thorax
• The examiner with advanced skills may palpate the axilla for enlarged lymph nodes
• Lungs
• Document respiratory rate and effort; auscultate for wheezing, crackles, or rhonchi
• Palpate the groin for enlarged lymph nodes
Physical Examination (cont.)
• Heart and vascular system
3
Slide 19
Diagnostic Tests and Procedures
• Blood tests
• Complete blood cell (CBC) count
• Antinuclear antibody test
• Enzyme-linked immunosorbent assay and Western blot tests
TALKING POINTS:
• Physicians and nurses are primarily interested in the number of neutrophils because
these are the cells that fight bacterial infections.
10 Chapter 34Immunologic Disorders ____________________________________________________________
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LESSON 34.1
Slide 20
Question 1
• Which of the following is a true statement?
A. Lymphocytes are produced in the thymus.
B. Mature T lymphocytes are released into circulation after they have matured.
C. The thymus continues to grow until age 50.
D. The thymus is a lymphoid organ located above the spleen.
TALKING POINTS:
Slide 21
Question 2
• Which of the following statements are true about white blood cells?
A. When neutrophils enter tissue, they are called macrophages.
B. Macrophages can ingest many foreign antigens and survive months to years.
C. Monocytes combat parasitic infections.
D. Eosinophils can initiate a massive inflammatory response that quickly brings other
white blood cells to the site of infection.
TALKING POINTS:
___________________________________________________________ Chapter 34Immunologic Disorders 11
Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 34.1
Activities
Classroom Choose from below to make 30 minutes
Online
1
ASSESS BASELINE
• Have the class complete the Pretest. Collect
their work and use the results to guide how
you teach the class.
DISCUSS
• Discuss the major structures and
components of the immune system and their
functions.
PRACTICE
• Assign small groups of students one of the
following immune system components:
• B lymphocytes
• T lymphocytes
ASSESS BASELINE
• Post the Pretest and the Background
Assessment online and have your class
complete them. Use the results to guide how
you teach the class.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Ask students
to describe the similarities and distinctions
between innate and acquired immunity,
giving two examples of each type of
immunity.
2
DISCUSS
• Discuss the data that must be collected
through a health history and physical
assessment of a patient’s immune system.
PRACTICE
• Divide the class into groups, and assign
each group one of the following systems:
• Skin
• Neurologic
RESEARCH
• Ask students to research three herbal
medications that may adversely affect the
immune system. Students should list the
name of the herbal medications, with the
adverse effects on the immune system.
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LESSON 34.1
3
DISCUSS
• Identify the diagnostic tests and discuss the
purposes of these tests and procedures in
diagnosing a disorder of the immune
system.
PRACTICE
• Choose a laboratory test and call upon a
student. Ask the student to briefly describe
and patient teaching for each diagnostic test.
POST AND COMMENT
• Post the following discussion topic online
and have students comment. Ask students
to submit a patient/family teaching article
regarding skin teaching to an online
resource, such as Wikipedia or Web MD.
• Post the following discussion topic online
and have students comment. Ask students
to submit a video showing a nurse providing
Critical Thinking Question
Why does fatigue occur with both acute leukemia and systemic lupus erythematosus (SLE)?
Discussion Guidelines: Almost all patients with acute leukemia and SLE experience fatigue.
Instructor Notes/Student Feedback