Pathophysiology Exam 2 - Cardio, Immunity, Hematological Disorders

Bone Marrow

Origin of all immune cells; where immune cells develop

Thymus

Organ where T lymphocytes mature and become part of cell-mediated immunity

B lymphoctyes

Immune cells involved in humoral immunity and antibody production.

T lymphoctyes

Immune cells involved in cell-mediated immunity; include helper, cytotoxic, and memory T cells.

Hummoral Immunity

Immunity in which antibodies are produced to protect the body.

Cell mediated Immunity

Immunity in which lymphocytes attack non-self cells to protect the body.

igG

The most common immunoglobulin in the blood; can be transferred from mother to fetus across the placenta and through breast milk.

IgM

immunoglobulin that is the first to increase during an immune response.

IgA

Immunoglobulin found in tears, saliva, mucous membranes, and colostrum.

IgE

Immunoglobulin involved in allergic reactions; causes release of histamine and other chemicals, producing inflammation.

igD

Immunoglobulin attached to B cells that helps activate B cells.

Histamine

Chemical mediator involved in allergic and inflammatory reactions; its release can cause inflammation and the symptoms of anaphylaxis.

Antigen A

substance recognized by the immune system that can trigger a specific immune response.

Antibody

Protein produced as part of the immune response to help protect the body against an antigen.

Memory Cells

Immune cells that store information about an antigen so the body can respond to it again

Active Natural Immunity

Immunity developed after natural exposure to an antigen, causing the body to produce antibodies.

Active Artifical Immunity

Immunity Immunity produced after an antigen is intentionally introduced through immunization.

Passive Natural Immunity

Short-term protection received naturally when IgG passes from mother to fetus through the placenta or through breast milk.

Passive Artifical Immunity

Short-term protection produced by injecting antibodies into the body.

Titer test

measures levels of serum immunoglobulins.

Indirect Coombs Test

Test used to detect Rh blood incompatibility.

ELISA test

Test used to detect HIV antibodies and used for some other diseases.

MHC typing

Testing used for tissue matching before transplantation.

Transplant rejection

Immune response in which the body recognizes transplanted tissue as foreign and attacks it

Hyperacute rejection

Transplant rejection that occurs immediately after transplantation.

Acute Rejection

Transplant rejection that develops after several weeks.

Chronic Rejection

Late transplant rejection that occurs after months or years.

Immunosuppression

Reduction of the immune response to help prevent transplant rejection; increases the patient's risk for infection.

Hypersensitivity

An abnormal, exaggerated immune response to substances that normally would not cause such a response.

Type I Hypersensitivity

Immediate allergic reaction involving IgE, mast cells, and histamine; can cause itching, rash, inflammation, and anaphylaxis.

Type II hypersensitivity

Cytotoxic reaction in which an antigen on a cell membrane reacts with IgG or IgM, activating complement and causing cell destruction.

Type III hypersensitivity

Reaction caused by antigen-antibody complexes depositing in tissues and activating complement, resulting in inflammation and tissue injury.

Type IV hypersensitivity

Delayed immune reaction involving sensitized T lymphocytes; examples include contact dermatitis and transplant rejection.

Anaphylaxis

Severe, life-threatening systemic hypersensitivity reaction caused by release of histamine; can cause airway obstruction, decreased blood pressure, and severe hypoxia.

Signs of Anaphylaxis

Difficulty breathing, swollen tongue, flushing, rash, itching, weakness, dizziness, fainting, hives, and possible loss of consciousness.

Anaphylaxis Treatment

Immediate priority is maintaining a patent airway; emergency treatment includes epinephrine, oxygen, glucocorticoids, antihistamines, and stabilization of blood pressure.

Systemic Lupus Erythematosus (SLE)

Autoimmune disease in which the immune system attacks the body's own tissues, causing systemic inflammation and tissue damage.

SLE pathophysiology

Autoantibodies and immune complexes contribute to inflammation and tissue injury; multiple organs can be affected.

SLE Findings

May involve skin and other organs; laboratory findings may include positive ANA and anti-DNA antibodies, low complement, and increased ESR.

HIV

destroys helper T cells/CD4 lymphocytes, causing loss of immune response and increased susceptibility to secondary infections and cancer.

AIDS

Advanced active HIV infection characterized by marked clinical symptoms and multiple complications caused by severe immunodeficiency.

HIV-Positive vs AIDS HIV-positive

means the virus is present but there may be few or no clinical signs; AIDS is the active stage with marked symptoms and multiple complications.

HIV Pathophysiology

HIV destroys helper T cells → immune response decreases → susceptibility to opportunistic infections and cancer increases.

Opportunistic infections

Infections that occur more easily or become severe when the immune system is weakened.

Karposi Sacroma

Cancer associated with severe immune suppression; lesions can appear as purple or brown, nonitchy, painless patches that may become nodular.

HIV Testing

ELISA can detect HIV antibodies.

HIV treatment

Antiviral therapy can suppress development of symptomatic AIDS and prolong the time before active disease develops

HIV nursing priority

Protect the patient from infection, monitor for secondary infections and complications, and recognize signs of worsening immune suppression.

Hemaglobin

Protein in red blood cells that carries oxygen; problems with hemoglobin can reduce oxygen delivery to tissues.

Sickle Cell anemia

Hemoglobinopathy in which normal hemoglobin A is partly or completely replaced by abnormal hemoglobin S, causing red blood cells to sickle.

Sickle cell pathophysiology

Hemoglobin S causes RBCs to sickle; sickling is triggered by fever, dehydration, emotional/physical stress, or increased oxygen needs.

Sickle Cell crisis

Sickling episode that can cause pain in the abdomen and long bones, joint tenderness, and possibly dyspnea.

Sickle cell treatment

Hydration, oxygen, and prescribed analgesics; instructor notes specifically state to avoid meperidine because it may induce seizures.

Pernicious Anemia

Vitamin B12 deficiency, usually caused by autoimmune lack of intrinsic factor, resulting in impaired cell maturation and possible neurologic complications.

Pernicious Anemia Tests

Serum B12, Schilling's test, blood count, gastric analysis, and bone marrow biopsy.

Pernicious Anemia Treatment

Injectable vitamin B12.

Iron Deficiency Anemia

Depleted iron stores cause decreased iron available to manufacture hemoglobin in red blood cells.

Iron Deficiency Finding

Pallor, weakness, fatigue, irritability, and low hemoglobin and hematocrit.

Iron Deficiency Treatment

Iron supplements and iron-rich foods; liquid iron should be given through a straw because it can stain teeth.

Aplastic anemia

Bone marrow disorder in which development of blood cells is arrested, causing deficiency of RBCs and other formed blood elements.

Pancytopenia

Decrease in all major blood-cell types; in aplastic anemia this results from bone marrow failure.

Aplastic Anemia Findings

Pancytopenia, petechiae, purpura, pallor, weakness, fatigue, and tachycardia.

Aplastic Anemia Diagnosis

Bone marrow aspiration is used for definitive diagnosis.

Aplastic Anemia Treatment

Possible bone marrow transplant, immunosuppressive medications, colony-stimulating factors, corticosteroids, cyclosporine, and blood transfusions.

Hemophilia Bleeding disorder

caused by a deficiency of a clotting factor, resulting in impaired clot formation.

Hemophilia Findings

Bleeding, hematomas, and hemarthroses; bleeding into joints can cause joint pain and swelling.

Hemophilia Tests

Clotting studies and serum factor VIII levels; platelet count may remain normal.

Hemophilia Treatment

Clotting factor transfusions, recombinant clotting factors, desmopressin, and bleeding precautions.

DIC Disseminated intravascular coagulation;

widespread clotting uses up clotting factors, which can then cause serious bleeding.

DIC Pathophysiology

Widespread clot formation → clotting factors are consumed → the body loses the ability to clot normally → bleeding and possible organ damage.

DIC Complications

Tissue ischemia, bleeding, shock, and organ failure.

Neutropenia

Abnormally low neutrophil count, decreasing the body's ability to fight infection. Neutrophil concentration below 1,500 cells/mL

Neutropenia

Infection, medications, radiation, marrow cancers, spleen destruction, vitamin deficiency, and congenital conditions.

Neutropenia Treatment

Antibiotic therapy and hematopoietic growth factors.

Infectious Mononucleosis

EBV infection commonly spread by oral transmission; it infects B cells and is usually self-limiting.

Mononucleosis findings

Anorexia, malaise, chills, leukocytosis, fever, sore throat, and lymphadenopathy.

Mono treatment

Symptomatic and supportive care.

Hodgkin Lymphoma

Cancer of the lymphatic system characterized by Reed-Sternberg cells.

Hodgkin Lymphoma Findings

Painless enlarged lymph nodes, night sweats, pruritus, and splenomegaly.

Hodgkin Lymphoma Diagnosis

Imaging and lymph-node biopsy showing Reed-Sternberg cells; CBC may also be used.

Non-Hodgkin Lymphoma

Lymphatic cancer that can originate in B or T cells and is distinguished from Hodgkin lymphoma by the absence of Reed-Sternberg cells.

Non-Hodgkin Lymphoma Findings

May involve multiple lymph nodes throughout the body and can have widespread metastases; intestinal nodes and organs may be involved early.

Leukemia

Cancer of the leukocytes in which abnormal leukemic cells proliferate and crowd the bone marrow.

ALL Acute lymphoblastic leukemia;

most common leukemia, primarily affects children, responds well to therapy, and has a good prognosis.

AML Acute myeloid leukemia

primarily affects adults, responds fairly well to therapy, and has a reasonably good prognosis.

CLL Chronic lymphoid leukemia;

primarily affects adults, is slow-moving, responds poorly to therapy, but many patients live years after diagnosis.

CML Chronic myeloid leukemia;

primarily affects adults, and prognosis is improved by allogeneic bone marrow transplant.

Leukemia Pathophysiology

Leukemic-cell proliferation in the bone marrow suppresses normal blood-cell production → anemia + thrombocytopenia + lack of normal functional leukocytes.

Leukemia Findings

Leukopenia, anemia, thrombocytopenia, lymphadenopathy, joint swelling, bone pain, weight loss, anorexia, hepatomegaly, splenomegaly, and possible CNS dysfunction.

Leukemia Diagnosis

Medical history, physical examination, blood smears, complete blood count, and bone marrow biopsy.

Leukemia treatment

Chemotherapy and bone marrow transplant.

Leukemia complications

Rapid cell turnover can cause hyperuricemia, kidney stones, and kidney failure; disease progression can cause infection and hemorrhage.

Leukemia Priority

Overwhelming infection and hemorrhage are major causes of death, making infection and bleeding important nursing priorities.

von Willebrand Disease

Hereditary bleeding disorder caused by deficiency or defect of von Willebrand factor, producing increased bleeding from mucous membranes.

von Willebrand Findings

Epistaxis, gum bleeding, easy bruising, and excessive menstrual bleeding.

von Willebrand Treatment

Similar to hemophilia; clotting factors may be administered as prescribed.

Beta-Thalassemia Major

Severe autosomal recessive thalassemia caused by reduced production of globin chains needed to make hemoglobin.

Beta-Thalassemia Findings

Severe anemia and hepatosplenomegaly.

Beta-Thalassemia Treatment

Blood transfusions, monitoring for iron toxicity from repeated transfusions, and genetic counseling.

Multiple Myeloma

Cancer of plasma cells in which abnormal plasma cells crowd blood-forming cells in the bone marrow.