1H09.01 Explain the Structure of the Lymphatic System

Lymphatic System

1H09.01 Explain the structure of the lymphatic system.

A.  Lymph

1.  Straw-colored, similar to plasma

2.  Interstitial fluid – in spaces between cells

3.  Composed of H2O, lymphocytes, O2, digested nutrients, etc., but no red cells or proteins (too large)

B.  Lymph vessels

1.  Closely parallel veins

2.  Located in almost all tissues and organs that have blood vessels

3.  Thoracic duct – largest lymph vessel

C.  Lymph nodes

1.  Tiny, oval shaped, size of pinhead to size of almond

2.  Located alone or grouped

D.  Tonsils

1.  Get smaller as person gets older

2.  Located in throat

3.  Adenoids – tonsils on upper part of throat

E.  Spleen

1.  Sac-like mass of lymphatic tissue

2.  Upper left abdominal cavity, just below diaphragm

F.  Thymus – upper, anterior chest above the heart

1H09.02 Analyze the function of the lymphatic system.

A. Lymph – fluid that goes between capillary blood and tissues

1. Carries digested food, O2, and hormones to cells

2. Carries wastes back to capillaries for excretion

3. Since lymphatic system has no pump, skeletal muscle action squeezes lymph along

4. Lymph in tissues is interstitial fluid

B. Lymph vessels – transport excess tissue fluid back into circulatory system

1. Valves prevent backward flow

2. Lymph flows in only one direction – from body organs to heart

3. Closely parallel veins

4. Tissue lymph enter small lymph vessels which drain into larger lymph vessesl (lymphatics) into two main lymphatics – the thoracic duct and right lymphatic duct

C. Lymph nodes

1. Produce lymphocytes

2. Filter out harmful bacteria

3. If substance can’t be destroyed, node becomes inflamed

D. Tonsils

1. Lymph tissue that produces lymphocytes

2. They get smaller as a person gets older

E. Spleen

1. Produce lymphocytes and monocytes

2. Filter blood

3. Blood reservoir – stores large amounts of RBCs, contracts during vigorous exercise or loss of blood to release RBCs

4. Recycles old red cells – destroys and removes old or fragile RBCs

E. Thymus gland

1. Produces lymphocytes

2. Also considered an endocrine gland

F. Immunity – body’s ability to resist disease

1. Natural immunity – at birth, inherited and permanent

a. Unbroken skin

b. Mucus and tears

c. Blood phagocytes

d. Local inflammation

2. Acquired immunity – body’s reaction to invaders

a. Passive acquired immunity – from injecting antibodies, only lasts a few weeks

b. Active acquired immunity – lasts longer

i. Natural acquired immunity – result of recovering from disease, body manufactures own antibodies and person doesn’t get the disease again

ii. Artificial acquired immunity – from being vaccinated

3. Immunization – antigen injected into a person to stimulate production of antibodies

1H09.03 Discuss characteristics and treatment of common lymphatic disorders.

A. Tonsillitis

1.  In childhood, tonsils become infected and enlarged

2.  Difficulty swallowing

3.  Tonsillectomy in extreme cases

B. Lymphadenitis (adenitis)

4.  Swelling (enlargement) of lymph glands

5.  Occurs when infection present and body making WBCs to fight infection

B.  Hodgkin’s disease

1.  Cancer of lymph nodes

2.  Painless swelling of lymph node early symptom

3.  Rx – chemotheraphy and radiation

C.  Mononucleosis

1.  Caused by virus

2.  Young adults and children

3.  Spread by oral contact (kissing)

4.  Symptoms – lymphadenitis, fever, fatigue, á leukocytes

5.  Rx - bedrest

D.  Hypersensitivity

1.  Abnormal response to drug or allergen

2.  Antibodies made in response to foreign material (allergen) irritate certain body cells

3.  Allergen – antigen that causes allergic response (Examp. Ragweed, penicillin, bee stings, foods, etc.)

E.  Anaphylaxis (Anaphylactic shock)

1.  Severe or fatal allergic reaction

2.  Antigen-antibody response stimulates massive secretion of histamine

3.  Symptoms – breathing problems, headache, facial swelling, falling blood pressure, stomach cramps, vomiting

4.  Rx – Adrenaline

5.  Those prone should wear medic alert bracelet

F.  AIDS and HIV

1.  Acquired immunodeficiency syndrome

2.  Cause – HIV virus

3.  Three responses to HIV infection:

a. AIDS – full disorder

b. ARC – AIDS-related complex

c. Asymptomatic infection

4.  Screening test for HIV available

5.  AIDS victim subject to opportunistic infections (cancer, infections) that a healthy person would fight off but AIDS victim has compromised immune response

6.  Incubation period – 1 month to 12 years

7.  Rx and prevention – advances being made

8.  ARC – AIDS-related complex – HIV but not AIDS – less severe symptoms

9.  Transmission

a.  Sex with someone HIV positive

b.  Sharing needles with infected drug users

c.  At birth from infected mother

10.  Cannot be spread by casual contact, coughing, sneezing, shaking hands and sharing eating utensils

11.  Prevention – avoid risky behaviors and observe standard precautions

1H09.04 Apply standard precautions.

A. Standard precautions

1. Used in patient care setting when there is contact with blood or body fluids, mucous membrane or non-intact skin

2. Handwashing – single most effective way to prevent infection

a. Wash after touching body fluids, even if wearing gloves

b. Wash immediately after removing gloves and between patient contacts

c. Use soap and friction

d. Wash for a minimum of 10 seconds

3. Personal protective equipment

a. Gloves – when touching blood and body fluids

b. Mask, goggles, face shield, gown – when patient care activities can generate splashing or spray of blood, body fluids

4. Patient care equipment and linens

a. Handle with care

b. Don’t let it touch your clothing, clean or discard appropriately

B.  Occupational health and bloodbourne pathogens

1.  Beware of needles

2.  Never recap used needles

3.  Dispose of all needles and sharp objects in sharps container

4.  Use mouthpieces, resuscitation bags, or other ventilation devices as alternative to mouth-to-mouth resuscitation.

5.  A patient who contaminates the environment should be in a private room or relatively isolated area.

C.  The AIDS patient

1.  Sometimes treated as outcasts

2.  Healthcare worker should be supportive

3.  Use of gloves for normal patient contact is not necessary

Unit I: Lymphatic System

Terminology List

1.  acquired immunity

2.  adenoids

3.  active acquired immunity

4.  allergen

5.  anaphylaxis (anaphylactic shock)

6.  artificial acquired immunity

7.  hypersensitivity

8.  immunization

9.  incubation period

10.  interstitial fluid

11.  lymph

12.  lymph nodes

13.  lymph vessels

14.  lymphocytes

15.  natural immunity

16.  passive acquired immunity

17.  spleen

18.  standard precautions

19.  thoracic duct

20.  thymus

21.  tonsils

22.  vaccination

Disorders and Related Terminology

1.  adenitis

2.  AIDS/HIV

3.  ARC

4.  anaphylaxis (anaphylactic shock)

5.  Hodgkin’s disease

6.  hypersensitivity

7.  lymphadenitis

8.  mononucleosis

9.  opportunistic infections

10.  tonsillitis

11.  tonsillectomy

Functions:

1. LYMPH – fluid that goes between capillary blood and tissues.

2. LYMPH VESSELS – transport excess tissue fluid back into circulatory system.

3. LYMPH NODES – produce lymphocytes, filter out harmful bacteria.

4. SPLEEN – produces lymphocytes and monocytes, blood reservoir, recycles old red cells.

5. Thymus gland – produces T-LYMPHOCYTES

LYMPH

·  Straw-colored fluid (similar to plasma)

·  INTERSTITIAL FLUID or tissue fluid because it is in the spaces between cells

·  Composed of H2O, lymphocytes, some granulocytes, O2, digested nutrients, hormones, salts, CO2 and urea.

·  NO red blood cells or protein molecules (too large)

·  Carries digested food, O2 and hormones to cells

·  Carries wastes back to capillaries for excretion

·  Since the lymphatic system has no pump, skeletal muscle action squeezes lymph along

·  Valves prevent backward flow

LYMPH VESSELS

·  Closely parallel veins

·  Located in almost all tissues and organs that have blood vessels

·  Tissue lymph enters small lymph vessels which drain into larger vessels called lymphatics – they flow into one of two large, main lymphatics – the THORACIC DUCT and right lymphatic duct.

·  THORACIC DUCT gets lymph from left side of chest, head and neck, abdominal area and lower limbs à left subclavian vein à superior vena cava à heart.

·  Lymph flows only in one direction – from body organs to the heart.

LYMPH NODES

·  Tiny, oval shaped - size of pinhead to size of almond

·  Located alone or grouped

·  Site for lymph production and filter for screening out harmful substances

·  If substance can’t be destroyed, node becomes inflamed

TONSILS

Masses of lymphatic tissue that produce lymphocytes and filter bacteria – they get smaller in size as person gets older

·  ADENOIDS – tonsils on upper part of the throat

SPLEEN

·  Sac-like mass of lymphatic tissue

·  Upper left abdominal cavity, just below diaphragm

·  Forms lymphocytes and monocytes

·  Filters blood

·  Stores large amounts of RBCs – contracts during vigorous exercise or loss of blood, to release RBCs

·  Destroys or removes old or fragile RBCs

THYMUS GLAND

·  Upper, anterior thorax, above the heart

·  Thymus is also considered an endocrine gland

Immunity – the body’s ability to resist bacterial invasion and disease. 2 general types – natural and acquired.

NATURAL IMMUNITY – at birth, inherited and permanent. Includes:

·  Unbroken skin

·  Mucus and tears

·  Blood phagocytes

·  Local inflammation

ACQUIRED IMMUNITY – body’s reaction to invaders

PASSIVE ACQUIRED IMMUNITY

·  Acquired artificially by injecting antibodies to protect from a specific disease

·  Immediate immunity

·  Lasts 3-5 weeks

·  Used when someone exposed to measures, tetanus, infectious hepatitis

·  Mother provides newborn with some passive immunity

ACTIVE ACQUIRED IMMUNITY – lasts longer, two types

·  NATURAL ACQUIRED IMMUNITY – result of having had and recovered from a disease. For example, a child who had measles will usually not get it again – child’s body has manufactured antibodies.

·  ARTIFICIAL ACQUIRED IMMUNITY – comes from being vaccinated

IMMUNIZATION – artificial resistance to a particular infection by artificial means

·  Antigen injected into a person to stimulate production of antibodies

Disorders of the Lymphatic System

ADENITIS – swelling in the lymph glands

TONSILLITIS

·  In childhood, they may become infected, enlarged, and cause difficulty swallowing

·  Surgery done in extreme cases

LYMPHADENITIS – enlargement of the lymph nodes, occurs when infection is present and body is attempting to fight off the infection.

HODGKIN’S DISEASE – cancer of the lymph nodes, painless swelling of lymph nodes is early symptom. Rx – chemotherapy and radiation

INFECTIOUS MONONUCLEOSIS

·  Caused by virus

·  Frequently in young adults and children

·  Spread by oral contact (kissing)

·  Symptoms – enlarged lymph nodes, fever, physical and mental fatigue, á leukocytes

·  Rx – bedrest

HYPERSENSITIVITY

·  When the body’s immune system fails to protect itself against foreign material, and instead, the antibodies formed irritate certain body cells.

·  An abnormal response to a drug or allergen.

·  An ALLERGEN is an antigen that causes allergic responses. (Examples of allergens – ragweed, penicillin, bee stings, foods, etc.)

ANAPHYLAXIS

·  severe, sometimes fatal allergic reaction

·  Antigen-antibody reaction stimulates a massive secretion of histamine

·  Symptoms – breathing problems, headache, facial swelling, falling blood pressure, stomach cramps, and vomiting

·  Rx – adrenaline

AIDS/HIV

·  Acquired Immunodeficiency Syndrome

·  Caused by HTLV-III (human T-lymphotrophic virus type III) Commonly caused HIV or Human immunodeficiency virus.

·  Affects not only homosexual males but all populations

·  The patient with AIDS cannot fight off cancers and most infections.

·  Three responses to HIV infection:

1.  AIDS

2.  ARC (AIDS-related complex)

3.  Asymptomatic infection

·  Screening tests for HIV/AIDS are available

AIDS

·  Most severe type of HIV infection

·  Subject to OPPORTUNISTIC INFECTIONS – a healthy person would fight off these infections, but a person with AIDS has a compromised immune response.

·  Symptoms of AIDS

1.  Prolonged fatigue

2.  Persistent fevers or night sweats

3.  Persistent, unexplained cough

4.  Thick coating in throat or on tongue

5.  Easy bruising, unexplained bleeding

6.  Appearance of purple lesions on mucous membranes or skin that don’t go away

7.  Chronic diarrhea

8.  Shortness of breath

9.  Unexplained lymphadenopathy

10.  Unexplained weight loss, 10 pounds or more, in less than 2 months

Incubation period: 1 month to12 years

AIDS-RELATED COMPLEX (ARC)

Has HIV but not AIDS and develops other conditions such as:

·  Chronic diarrhea

·  Chronic lymphadenopathy

·  Unexplained weight loss

If life threatening opportunistic infections develop, then individual is said to have AIDS

ASYMPTOMATIC INFECTION - Has HIV but no symptoms.

High-Risk Groups for AIDS – EVERYONE who participates in risky behaviors.

Transmission by:

1.  Sex with someone who is HIV positive

2.  Sharing needles with infected IV drug users

3.  At birth from infected mother

Cannot be spread by:

1.  Casual contact

2.  Through air, feces, food, urine or water

3.  Coughing, sneezing, embracing, shaking hands and sharing eating utensils

Prevention:

1.  Avoid risky behaviors

2.  Standard precautions

STANDARD PRECAUTIONS

·  Guidelines to be used in patient care setting

·  Must be used when there is contact with blood, any body fluid (except sweat), mucous membranes and non-intact skin.

Handwashing – the single most effective way to prevent infection.

1.  Wash hands after touching body fluids, even if gloves are worn.

2.  Wash hands immediately after removing gloves, between patient contacts.

3.  Use a plain (non-antimicrobial) soap

4.  Wash for a minimum of 10 seconds

Gloves – worn when touching blood, body fluids, etc.

Mask, eye protection, face shield and gown – during patient care activities that may generate splashes or sprays of blood, body fluids, etc.

Patient care equipment and linens – handle with care, don’t let it touch your or clothing, clean or discard appropriately.

Occupational Health and Bloodbourne Pathogens

Beware of needles!

Never recap used needles.

Dispose of all needles and sharp objects in sharps container.

Use mouthpieces, resuscitation bags, or other ventilation devices as alternative to mouth-to-mouth resuscitation.

A patient who contaminates the environment should be in a private room or relatively isolated area.

The AIDS Patient

¨  Sometimes treated as outcasts

¨  Healthcare worker should be supportive

¨  Use of gloves for normal patient contact is not necessary

Summer 2005 I.16