NUR 2349 Exam 3 Possible study guide – Key Concepts

NUR 2349 Exam 3 Possible study guide – Key Concepts MODULE 6  What is Immunity? The normal physiologic response to microorganisms and proteins as well as conditions associated with an inadequate or excessive immune response.  Local signs of inflammation- pain, heat, redness, swelling, loss of function (severe)  B lymphocyte function in immune response (plasma cells, memory cells, Ig cells) Immunoglobulins are responsible for primary response to invading bacteria and viruses and provide the humoral immunity component of an immune response  What are the 3 types of T lymphocytes (T cells) 1. Helper T cells (CD4)- helps in functions, regulates most functions via the protein mediators, lymphokines. They direct and encourage other T cells to help activate B lymphocytes. 2. Cytotoxic T cells (killer cells): directly kill foreign antigens and may kill self-cells 3. Suppressor T cells: suppress the function of both helper and cytotoxic T cells in order to prevent hyperimmune responses  What is cell-mediated immunity? Immune response that involves the activation of phagocytes, antigen-specific cytotoxic T lymphocytes, and the release of various cytokines in response to an antigen.  What is primary immunodeficiency (PI) ? when the entire immune defense system is inadequate and the client is missing some or all of the components for a complete immune response  Secondary immunodeficiency (SI) develop for immunocompromised patients ex: MRSA, C-Diff  What are the 4 types of exaggerated immune responses? Type I: IgE-mediated or atopic "allergic" seasonal allergic rhinitis, bee stings Type II: tissue specific or cytotoxic Autoimmune thrombocytopenic purpura, Graves' disease Type III: Immune complex-mediated ystemic lupus erythematosus Type IV: cell-mediated or delayed hypersensitivity contact sensitivity to poison ivy and metals (jewelry)  Common diagnostic tests for Immune Function Primary testing: RBC & WBC count with differential, fluorescent antinuclear antibody, c-reactive proten (CRP),erythrocyte sedimentation (ESR), Disease-Specific testing: allergy testing genetic testing: Rheumatoid factors (RFs), Western blot test, organ function test, TORCH antibody panel  Pharmacotherapy for exaggerated immune response corticosteriods and NSAIDs for immunosuppression and pain management  What is an immunogen? A substance capable of inducing an immune response  Leukocytes WBC, originate from the bone marrow. spend most of their time in storage, in lymphoid tissues, or dispersed throughout the host tissues.  How does leukocytes get around? use blood mainly as a transport system to travel to areas of the body where they are needed  Six families of leukocytes that have distinct roles inthe body's defense  monocyte-macrophages, dendritic cells, mast cells, granulocytes, lymphocytes, and NK cells.  Monocytes (Macrophages aka EATERs) are leukocytes found in relatively small quantities in the blood, because most of them are either in the tissues or stored in the bone marrow. Fully differentiated stage is called a macrophage  phagocytosis"cell eating" (ex: white blood cells and amoeba)  Cytokines Affects the WAY other cells ACT (Cyto- "cell" and -kinein "move")  Chemokines Attract other leukocytes to the area to battle the invaders in a process called CHEMOTAXIS  Dendritic cells are essential in inducing and maintaining tolerance to BY PRODUCTS OF antigens, keeping the immune system from reacting to the body's antigens  Mast cells tend to live near the skin and connective of small blood vessels and contain granules with stored chemicals. When activated, they release substances within the granules (degranulate) that affect vascular permeability, particularly HISTAMINE.  Neutrophils A type of white blood cell that engulfs invading microbes and contributes to the nonspecific defenses of the body against disease. Actively involved in bacterial infections most abundant 40-70% 1st responder, dies and turns to pus Neutropenia Deficiency in neutrophils is called  Eosinophils defense against parasites & other microorganisms, role in IgE mediated allergic reactions ((redness))  Basophils are the final and most inscrutable granulocyte, appear effective against FUNGUS, role in inflammation  Natural Killer [NK] cells Lymphocyte that recognizes and destroys foreign cells responsible for immune surveillance and detection, subsequent destruction of abnormal tissue cells by releasing cytotoxins.  B lymphocytes [Mature in bone marrow or thymus] complete their differentiation process and become plasma cells, releasing ANTIBODIES  T lymphocytes [Mature in thymus (aka T-cells) cells that mature in the thymus and exist in four varieties, one of which kills antigen-bearing cells  Antibody Immune function of B cell Proteins produced by plasma cells that recognize and bind to a specific antigen  immunoglobulins (Ig) (antibodies) Y shaped with two recognition segments and one effector segment  agglutination Clumping of (foreign) cells; induced by cross-linking of antigen-antibody complexes.  PRIMARY LYMPHOID ORGANS Bone Marrow & Thymus Lymphocyte develope and mature  SECONDARY LYMPHOID TISSUE: the spleen, lymph nodes, and epithelial lymphoid tissues. they are strategically placed in the body so that invading pathogens will encounter them as early as possible, allowing the immune system to be activated before extensive damage can be done.  Innate immune system  Immunoglobulins-  G- Most abundant, found in all fluids and protects against bacterial/viral o Protects newborn(crosses placenta)  high concentrations found within mucous membranes; especially in resp passage and GI tract, as well as tears and saliva o Protects surface from invasion  M- first antibody made by body to fight infection; found in blood and lymph fluid o Natural antibodies, heavily in blood typing,  E- mainly with allergic reactions (overreacts to environment) found in lungs, skin and mucous membranes o Exocrine secretion. Energy, trigger release of histamine in mast and basophil  D- exists in small amounts in the blood, least understood  *Age related to immunity-suppressed immunity: Very old and very young are at greatest risks  Humoral-mediated immunity: refers to immunity that is mediated by B lymphocytes, plasma cells, and antibodies  Cell-mediated immunity: refers to immunity that is mediated by T lymphocytes.  Innate immunity- Present at birth, NON-specific response not considered antigen specific, provides immediate protection against effects of tissue injury and foreign proteins, CAUSE VISIBLE SYMPTOMS. o -Components: Tissue barrier; skin, respiratory and GI, mucosa. Cells: neutrophils, macrophages, NK cells. Plasma protein; complements  (Adaptive)Acquired immunity- after birth either passively or actively o -Antigen specific, develops after exposure, response slower than innate, MEMORY, Components: Cells, B and T lymphocytes=antibodies and cytokines  Actively Acquired Immunity: develops after the introduction of a foreign antigen  ACTIVE (ARTIFICIAL)- immunization  ACTIVE (NATURAL)- after introduction of pathogen (chickenpox)  Passively Acquired Immunity: occurs by introduction of antibodies either by artificial or natural routes  PASSIVE (ARTIFICIAL)- transfusion of immunoglobulin IgG  PASSIVE (NATURAL)- mother to fetus through placental blood, or breastfeeding  Optimal Immune Response: protects the body from invasion, removes dead/damaged cells, recognizes mutated cells (cancer)  What is altered Immunity? when immune responses are either suppressed or exaggerated  -Suppressed responses AKA immunocompromised or immunodeficiency  -Exaggerated responses AKA hypersensitive  Suppressed Immune Response (hypo) PRIMARILY: results from improperly developed cells of absence of cells SECONDARILY: loss of immune function from illness or treatment (chemo or autoimmune disease) this causes: risk for infection/ risk for cancer  Exaggerated Immune Response (hyper): allergic reactions, cytotoxic reaction, autoimmune reaction  What are the 3 lines of defense in an Optimal Immune Response  1. skin boundary: mucous membranes, natural microbial flora, and complement proteins  2. activities of phagocytes, natural killer T lymphocytes, granulocytes & macrophages  3. antibodies derived from B & T lymphocytes  Risk factors for Suppressed Immune Response very old/very young, non-immunized, environmental factors (poor nutrition, exposure) , chronic illness (HIV, COPD, Diabetes), genetics, high-risk behaviors & substance abuse, pregnancy  Risk factors for Exaggerated Immune Response: gender, race, ethnicity, genetics, environmental/medication exposure  What organs are involved with immune responses? AKA lymphoid organs, bone marrow, thymus gland, spleen, tonsils, adenoids, appendix lymphocytes are formed, grow, mature, & released from these organs.  Critical point of immune system: body must differentiate between self & non-self cells, when body fails to do so the immune system begins to attack host cells leading to autoimmune diseases and disorders such as Rheumatoid arthritis  Blood cells- all derive from within bone marrow in form of either. o Meyeloid= neutrophils, monocytes, eosonophils, basophils and mast cells o Lymphoid cells= B lymphocytes, (mature in thymus) T lymphocytes, Nature Killer cell  Substances lacking HLA are identified as nonself  Organ transplantation can affect immune function in several ways. Most transplanted organs will be attacked as nonself by the adaptive immune system. Immunosuppressive drugs are usually indicated throughout the rest of the patient’s life, putting the patient at risk for both acquired infections and opportunistic infections.  Heart transplant patients receive a double hit to the immune system because the thymus is usually removed along with the dysfunctional heart, and they receive immunosuppressive therapy  Neutropenia often occurs within 7 to 10 days after a block of chemotherapy is completed  The dendritic cell is the key to the activation of the immune system  Stress and social support can have a dramatic impact on immune function  Allergic diseases are common, affecting about 15–20% of the population  Atopy is an inherited tendency for hyperproduction of IgE antibodies to common environmental allergens Exemplars Multiple Sclerosis  Patho- a potentially disabling disease of the brain and spinal cord (CNS). The immune system attacks the protective sheath (myelin) that covers the nerve fiber and causes communication problems between the brain and the body. Can cause the nerves to deteriorate or become permanently damaged.  S/S- numbness or weakness, loss of vision, prolonged double vision, tingling or pain, electric shock sensation, tremor, unsteady gait, slurred speech, fatigue, dizziness, problems voiding. Complications: muscle stiffness, or spasms, epilepsy, mental changes, and depression  Diagnostics- no specific test. Blood test, spinal tap (banding, pattern indicates MS, in CSF), MRI (MRI + plaque in brain)  Medication & Treatment- corticosteroids, mitoxantrone (treats MS chemo type), Rebif/avonex (anti-inflammatory), azathioprine (immunosuppressant also treats RA, prevents organ rejection), Medrol (steroid, lower symptoms of cancer)  Educate- educate patient to exit using stronger sides, lift mechanism, firm high seats for posture, change position q 2hours  Systemic Lupus Erythematous (SLE)- originates in connective tissue, systemic  Patho- chronic inflammatory disease that has protein manifestations and follows a relapsing and remitting course. Characterized by an auto-antibody response to nuclear and cytoplasmic antigens.  S/S- “Butterfly rash across bridge of nose”, fatigue, joint pain, muscle pain, rash, fever, weight change, dry/ulcers in mouth, hair loss, anxiety, hematuria, water retention. Complications: blood problems, pleurisy, kidney damage/failure, bone death, carditis. Pregnancy and contraceptives can cause flare-ups  Diagnostics- CBC (WBC low), ANA (primary method to diagnose autoimmune diseases, systemic), UA (detect protein and blood), tissue biopsy. Use ELISA and to confirm use Western Blot test  Medication and Treatment- NSAID’s, anti-inflammatory, corticosteroids, antimalarial, immunosuppressant  Educate- sunscreen (30spf, avoid sun), use peroxide to swish mouth decrease mouth sores, rest (8-10hr/night), monitor weight, diet plan  AVOID SUNLIGHT, INFECTION, STRESS AND DRUGS, DIRECT TRIGGERS  HIV/AIDS- once progressed to (3rd stage) AIDS- life expectancy 5 years  Patho- HIV is a virus that attacks CD-4 cells (T cells), spread through bodily fluids, as body becomes immunocompromised HIV becomes AIDS (last stage of HIV) o Risky behaviors include: sharing needles, multiple sex partners, unprotected sex, work hazards, bodily fluids  S/S- late stag progression turns into AIDS o Early: flu-like symptoms, fever, chills, rash, fatigue o Late: delayed wound healing, lesions, weight loss, multiple infections  Diagnostics- general lab values, antibody test, (3-12 weeks), combination tests (2-6 weeks), nucleic acid test-NAT (7-28 days). Complications: pneumonia, TB, Kaposis Sarcoma (purple lesions), kidney disease, infection, DEATH  Medication & Treatment- no cure. Treat to manage symptoms, use at least 2+  NNRTI’s (antiretroviral) ex: efavirenz, etravirine,  NRTI’s (antiretroviral) ex: abacavir  Protease Inhibitor (antiretroviral) ex: darunavir  Educate- take meds as directed, avoid crowds, avoid fresh fruit &veggies, hand wash, safe sex,  Shingles  Patho- “herpes zoster” occurs because of a reactivation of chickenpox virus, which remains in the nerve cells of the body. Reactivates when host mechanisms fail to contain the virus- conditions range from stress to severe immunosuppression.  S/S- headache, sensitive to light, flu like symptoms, itching, tingling, pain certain areas. Band , strip small area (unilateral) of rash occurs a few days later turns into blisters. Feeling dizzy or weak, vision changes. Complications: vision loss (in/around eye), painful eye infections, POSTHERPETIC NEURARGIA, pain continues after cleared, nerve fibers are confused & exaggerated. If nerver fibers in the brain are affected it can cause brain inflammation, (encephalitis), facial paralysis or hearing/balance issues. Bacterial skin infections may develop.  Medication & Treatment- NO CURE. Drugs can speed up healing.  Antibiotics ex: acyclovir  Numbing agents ex: lidocaine (topical, spray, patch)  Corticosteroid injection and local anesthetics  Educate- All adults over 60 get vaccine. Children get varicella vaccine. Concepts someone received previous semester on Wed Group Review  *Fosamax drink with glass of water, sit up for 30 minutes  Neutrophils- are the most numerous granulocytes and thought to be the most important. Neutrophils are the third and final phagocytic cell in the immune system.  Neutropenia- be cautious for infection prevent infection. Neutropenic cautions  Leukocytosis 12,000  Leukopenia 4,000  Immunoglobulins  E-allergic reaction  G- most abundant, provides passive immunity  ATI immunizations, chapter 85  T lymphocytes react because they are your antibodies  Self vs Non-self- ???  Allergic reaction airway #1, but always stop medication  Cell-mediated immunity are not antibodies B lymphocytes  Hypoperfusion before hypoxia  Thymectomy- removal of thymus, immunodepression- infection, chronic illnesses more susceptible to pathogens. Nowhere for T cells to mature  Splenectomy- removal of spleen, immunodepression- be cautious of infections and aware Nursing 1 – Exam 3 – ATI concepts  Nursing discharge instructions patient w/ lupus = Wear sunscreen with protection of 30 or higher and use mild protein shampoo avoid dyes and permanents.  Transplant rejection is affected by the cellular response of the T-cells  High doses of glucocorticosteroids watch for compression fractures in back and neck  SLE (Lupus) originates in connective tissue and affects all organ systems  HIV primarily spread by contact of infected body fluids  HIV patient w/ phagocytic dysfunction, monitor for fungal or bacterial infections  Sign of Lupus = raised rash  A delayed hypersensitivity reaction would cause tissue damage, ischemia, edema at the site  Myasthenia gravis disease is a cytotoxic delayed hypersensitivity response  Autoimmune client monitor bleeding  Discontinue methotrexate 3 months before a planned pregnancy  Lupus – expected finding = facial rash  Hemolytic reaction to RBC transfusion = headache, low back pain, tachycardia, fever, and chills  AIDs patient w/ reduced CD4-T cells at risk for Candidiasis in the mouth  Fibromyalgia aggravated by lack of sleep  Oliguria (reduced urine output) is a sign of kidney transplant rejection  First signs of HIV are night sweats and flu like symptoms  Fibromyalgia does not cause joint inflammation  HIV patient, watch for CD4-T cells below 180 cells/mm. This = high risk for infection  Scleroderma leads to skin hardening and finger contractures  Antibody-mediated immunity (AMI) is mediated by antibodies produced my B-lymphocytes  Pt with anaphylactic reaction, check for wheezing  Urticaria (Hives)is a sign of allergic reaction of a blood transfusion  Cutaneous manifestation of Lupus = Butterfly rash on face  Suspected anaphylaxis nursing priority is to count reparatory rate  AIDs patients should clean soiled items with a 1:10 bleach ratio cleaner  A quantitative RNA assay measures viral load and the effectiveness of HIV treatment  The RAST test (used to confirm allergic reactions) measures Immunoglobulin E (IgE)  Immunoglobulin G (IgG) is the most abundant  Serum creatinine measures kidney function  After the ELISA test, a Western Blot analysis is done to confirm a HIV diagnosis  Kaposi’s sarcoma are AIDs related malignant skin lesions that are raised and purplish-brown  Drink 2 liters of water daily when taking methotrexate for RA  Splint incisions post op when performing coughing exercises  Immunocompromised patients should be taught to limit exposure to people recently immunized Module 7 Chain of Infection A reservoir is a source of infection: a place where pathogens survive and multiply. The human body is the most common reservoir for pathogens. Animals and insects are other living reservoirs. Nonliving reservoirs include soil, water, food, and environmental surfaces. Examples include contaminated water, garbage, soiled diapers, and wound dressings. For infection to spread, a pathogen must exit the reservoir. In the case of human or animal reservoirs, the most frequent portal of exit is through body fluids, including blood, mucus, saliva, breast milk, urine, feces, vomitus, semen, or other secretions. The body’s natural response to foreign materials, including pathogens, is to try to expel them. If you have a pathogen in the respiratory system, you cough and sneeze. If it is in the gastrointestinal system, you vomit or experience intestinal cramping and diarrhea. Microbes responsible for sexually transmitted infections can exit via semen, vaginal secretions, or blood that is present during sex. Mode of Transmission- Contact, either direct or indirect, is the most frequent mode of transmission of infection. Direct contact between two people usually involves touching, kissing, or sexual intercourse. Animals commonly transmit infection via scratching and biting as well. Indirect contact involves contact with a fomite, a contaminated object that transfers a pathogen. For example, suppose that while you are charting you begin to sneeze or cough. If you cover your nose and mouth with your hand and then resume charting, you may transmit pathogens to the pen, paper, and chart (or keyboard). Shoes, eyeglasses, stethoscopes, and other items we wear also commonly serve as fomites, as do contaminated needles. Some microbes can live only a few seconds on fomites; others can live for years. It depends on the type of microorganism and the environment. Droplet transmission occurs when the pathogen travels in water droplets expelled as an infected person exhales, coughs, sneezes, or talks. It may also occur during suctioning and oral care. The usual method of transmission is for the droplet to be inhaled or enter the eye of a susceptible person. Although droplets can travel only a few feet from the infectious person, within that distance they may readily contaminate fomites that then transmit the organism by contact. Airborne transmission occurs with much smaller organ- isms that can float considerable distances on air currents. Airborne pathogens can travel through heating and air conditioning systems to infect large numbers of people. Sweeping a floor or shaking out contaminated bed linens can stir up air- borne microorganisms and launch them on air currents—think of a flying magic carpet (of pathogens). The agents of measles and tuberculosis, as well as many fungal infections, are commonly transmitted in this manner. A vector is an organism that carries a pathogen to a susceptible host, typically by biting or stinging, creating another portal of entry into the body. The mosquito is a common vector for diseases, including malaria, yellow fever, and the West Nile virus. Ticks, fleas, mites, and other insects also carry various diseases. Portal of Entry- Pathogens can enter the body through various portals of entry. Normal body openings, such as the conj