Unit 3A - Chapters 18, 21, 22

immunity

the body's ability to resist infection and disease

innate immunity

provides first and second lines of defense; biochemical and mechanical barriers

inflammatory response

initiated to prevent and/or limit infection, clean out the debris of dead cells, and initiate tissue healing

adaptive immunity

immunity that occurs by natural exposure; infection, transfer of maternal antibodies, or artificial exposure; vaccination; or infusion of immune serum globulin

competent

a ____ immune system is able to ward off the penetration of any foreign microbes or proliferation of abnormal or malignant cells

incompetent

an ____ immune system is when there is a failure that can lead to allergies, infections, cancer, autoimmune conditions, or immunodeficiency disorders

thymus

a soft organ located within the chest cavity near the heart; large in childhood and decreases in size in adulthood; where T-cell development takes place

bone marrow

where B- and T-lymphocyte formation and differentiation of B cells and T cells occur

spleen

located in LUQ; filters old or damaged RBCs, stores blood, houses lymphocytes and macrophages, and filters unwanted debris like a lymph node

lymph nodes

small glandular structures that house macrophages, lymphocytes, and monocytes that actively filter and phagocytize microorganisms and other invading particles from circulating lymphatic fluid

lymphatic system

network of vessels that transports excess interstitial fluid that has not been reabsorbed back in to the bloodstream, helping to maintain fluid balance

tonsils, adenoids, and peyer's patches

additional lymphoid tissues located in close proximity to mucosal surfaces within the body and provide another means of protection against invading microorganisms

neutrophils

immature WBCs; innate immune response/inflammation; phagocytosis

eosinophils

phagocytosis in parasitic infections, allergens; associated with allergic reactions

basophils

release histamine, heparin when stimulated during early inflammatory response

lymphocytes

active in humoral and cell-mediated responses; coordinate adaptive immune responses

cellular-mediated response

mediated by t-cells

humoral-mediated response

mediated by b-cells

history

a comprehensive patient ____ includes: current problem, past medical and surgical history, immunization history, family history, and social history

CBC with differential

evaluates individual leukocyte counts

CRP and ESR

inflammatory markers; elevated in infection and inflammation

decrease

immune competence may ____ as the immune system changes and weakens with age; increased infection risk, increased risk of malignancy, and increased autoimmune disorders

drug resistant organism

DRO

contact transmission

occurs when a person or object comes in contact with a pathogen; most common

airborne transmission

occurs when pathogens are carried through the air

vehicle transmission

indirect mode of transmission that occurs when a disease-carrying agent touches a person's body or is ingested

vector-borne transmission

indirect mode of transmission that occurs when a vector, an organism that transmits a pathogen, bites or infects a person

nosocomial infection

hospital acquired infection

community-acquired infection

infection acquired in the community, not in a hospital

methicillin-resistant staphylococcus aureus

MRSA

nares

the most common site of colonization of MRSA

risk

factors increasing ____ for colonization of MRSA include immunosuppression, prolonged hospitalizations, surgical wounds, intravenous sites, recent use of antibiotics, and being in close proximity to healthcare workers, patients or family members who are MRSA colonized

S. aureus

clinical manifestations of ______ commonly include minor skin infections, including pimples, abscesses, sties, and impetigo

MRSA

clinical manifestations of _____ are more serious including pneumonia, skin and soft tissue infections, surgical-site infections, and bloodstream infections

vancomycin-resistant enterococci

VRE

enterococci

_____ are bacteria that normally live in the GI tract and the female genital tract; also in the soil, water, and food

VRE

increased use of vancomycin has resulted in an increased incidence of ____

enterococci

_____ commonly cause UTIs, peritonitis (intra-abdominal and pelvic wound infections), and bacteremias; thus, clinical manifestations vary depending on the site of infection

clostridioides difficile

C. diff

C. diff

the most common cause of antibiotic-associated diarrhea in the US

C. diff

_____ bacteria causes an inflammation of the colon and life-threatening diarrhea and colitis mostly in people who have had both recent medical care and antibiotics

risk factors

____ ____ for C. diff include antimicrobials, duration of hospitalization, immunocompromising conditions, chemotherapy, NG tubes severe underlying illness, use of acid suppressing medications

H2 blockers and PPIs

_____ and ____ are acid suppressing medications that increase the risk for development of C. diff infection

disinfectants

Clostridioides difficile spores are resistant to many types of ____, heat and dryness

oral-fecal

C. diff spores are transmitted via the _____-_____ route

hands

the ____ of healthcare workers are the primary source by which C. diff is spread during outbreaks

C. diff

the most common manifestation of _____ is loose, watery stools ( >3 stools in 24 hours) and may have occult blood or mucous; other manifestations include abdominal pain and cramping

complications

____ of C. diff include hypovolemia, electrolyte imbalances, skin breakdown, sepsis, and death

acinetobacter baumannii

resistant to more than 3 classes of antibiotics; rarely occurs outside of healthcare setting, and healthy people rarely get serious infections from this organism

risk factors

____ ____ for A. baumannii include recent surgery, central venous catheters, tracheostomy, and mechanical ventilation

respiratory tract

A. baumannii colonizes the ____ ____; ventilator-associated pneumonia and bloodstream infections

transmission

____ of A. baumannii commonly occurs through contaminated skin, body fluids, equipment, or the environment; outbreaks are often traced back to common-source contamination: respiratory care equipment, wound care procedures, humidifiers, and patient care items

carbapenem-resistant enterobacteriaceae

CRE

50%

_____ of people who develop bloodstream infections with CRE will die

klebsiella and e. coli

enterobacteriaceae normally found inn intestines; typically harmless if contained, but if spread outside the intestine, they can cause serious infections such as UTIs, bloodstream infections, wound infections, pneumonia, and meningitis

direct contact

CRE are usually spread through ____ ____ with infected or colonized people, particularly contact with skin, wounds, or stool

manifestations

_____ of CRE depend on the location of the infection; bloodstream, pneumonia, wound infections, meningitis, or UTIs; fever, chills, and signs of sepsis if the infection has not been successfully controlled

carbapenem

CRE are strains of bacteria that are resistant to ____, a class of antibiotics typically used as a last resort for treating severe infections when other antibiotics have failed

mortality

because of CREs have become resistant to nearly all available antibiotics, ____ is high

prevention

the best treatment of MDROs begins with _____, hand hygiene

contact-isolation

patients in healthcare settings who are either colonized or infected with MDROs are placed on _____-_____ precautions to help reduce patient-to-patient spread of the organism within the hospital; gowns, gloves

vancomycin

the most commonly used medication for the treatment of infections caused by MRSA is ____; IV or orally

probiotics

_____ (live bacteria and yeasts) are another treatment that is used supplementally; have effectively reduced the incidence of simple antibiotic-associated diarrhea

fecal transplant

transfer of stool from a healthy donor into the gastrointestinal tract of a recipient; C.diff treatment

bleach

surfaces and equipment must be cleaned with _____ after used on a patient with C. diff

human immunodeficiency virus

HIV

acquired immune deficiency syndrome

AIDS

progressive

HIV is a _____ illness; once someone is classified in more severe state, they cannot be reclassified into a less severe state

risky behaviors

no vaccine is available to prevent HIV/AIDS; biggest teaching is to eliminate ____ _____

CD4

in HIV there is chronic, persistent destruction of infection fighting cells, the _____ cells

opportunistic infection

if the HIV infection is untreated, the individual eventually dies, usually from an ____ ____

inflammatory reaction

when a person is first infected with HIV, the virus causes an ____ ____

RNA

Once HIV is inside the cell, viral ____ is changed to viral DNA using the enzyme reverse transcriptase

DNA

after RNA to DNA conversion, the viral _____ is now in charge of cell reproduction and produces new viral proteins

viral load

the quantifiable measurement of HIV in the blood

2

once a person becomes symptomatic, the average time to develop AIDS is approximately ____ years

AIDS

an HIV-infected individual has ____ when the CD4 count is less than 200 cell/mcL or when diagnosed with one or more AIDS-defining illnesses

AIDS-defining

commonly occurring _____-____ illnesses in US are Pneumocystis pneumonia, Mycobacterium avium complex, toxoplasmosis, esophageal candidiasis, and recurrent bacterial pneumonia

HIV/AIDS

clinical manifestations observed in patients with _____ are most often r/t impaired immune function and typically reflect the OIs that occur as a result of HIV disease; fever, cough, weakness, N/V, diarrhea, dysphagia, forgetfulness, skin lesions, SOB, dyspnea, headache, vision changes, pain, night sweats, lymphadenopathy

deterioration

clinical manifestations indicating a _____ in HIV/AIDS patient include: new cough, increased fatigue, temp > 102, night sweats, new onset headache, new onset visual blurring, recent changes in mental status, new skin lesions, new onset of diarrhea, weight loss greater than 10% of previously recorded weight

kaposi's sarcoma

skin lesions associated with HIV/AIDS; hallmark sign

antiretroviral therapy

ART

ART

interferes with the ability of HIV to reproduce itself; 6 classes of medications available in US

2-3

individuals on ART are prescribed ____-____ medications from at least 2 different classes to reduce risk of resistance to medication; life-long therapy

live viruses

immunizations with ____ ____ are generally contraindicated in HIV infected individuals with CD4 count of less than 200; household members as well

sexually transmitted disease

HIV is most commonly a ____ ____ ____ , although many individuals contract the disease via IV drug use; sharing injection equipment, blood transfusion, occupation exposure, pregnant/breastfeeding mothers

infective endocarditis

VRE is the 3rd most common cause of ____ ____; no agent approved to treat

flagyl

if vancomycin doesn't work to treat C. Diff, IV _____ may be used