Exam 1 - Immune Disorders

how can autoimmune deficiency be acquired

medical treatment (chemo)

HIV

prevention and early detection of HIV are the key to helping patients live a full and happy life

antiretroviral therapy (ART)

viral treatment for HIV (and other viruses)

ELISA

allows early dx of the infection before the onset of symptoms

what fluids are HIV type 1 transmitted in

Blood

Seminal fluid

Vaginal secretions

Amniotic fluid

Breast milk

should you share toothbrushes if you have HIV

no

what should HIV patients take

take ART(antiretroviral therapy) regularly

how to reduce risk of transmission of HIV to providers

Hand hygiene

PPE

Soiled equipment

Patient placement (put them in a single pt room)

post exposure prophylaxis for Healthcare providers

- Antiretroviral medications ASAP

- No more than 72 hours after possible HIV exposure

- 0.3% risk of becoming HIV infected with needle stick involved HIV-infected blood

helper T cell

aka CD4 cell --> "hey there's a problem over here"

help triger the immune cells to start working

what kind of virus is HIV

retrovirus (carries genetic material in the form of RNA)

HIV-1 vs HIV-2

Closely related forms

HIV-2 is slower course of illness

how is HIV related to CD4+ receptors

When an affected CD4+ cell is activated by HIV, it begins to produce new copies of RNA and viral proteins -->

This can infect other CD4+ cells

t/f HIV Mutates quickly at a relatively constant rate

true

HIV stage 0

- what period

- test +/-?

- initial symptoms

- Period from infection with HIV to development of HIV-specific antibodies

- Initially test NEGATIVE on antibody blood test BUT THEY ARE INFECTED AND HIGHLY CONTAGIOUS

- sx: nonspecific viral illness w fever, fatigue, rash for 1-2 weeks

after what time period can antibodies be detected for HIV

after 2-3 weeks, by this time HIV-1 is very established in the host

what happens to CD4+ T cells in the host during HIV stage 0

destruction of CD4+ T cells --> dramatic drop in cell counts

HIV stage 1

Amount of virus in the body subsides --> "Viral set point" which varies greatly between patients

-->Untreated, this set point can last years

Chronic stage persists

Can HIV patients go back in stages

no. once they reach a stage they can't go back

in stage 1 of HIV, the chronic stage persists. what does this mean?

- Immune system cannot eliminate the virus

- Average 8-10 years before a major HIV-related complication develops

- Pt feels well w few related symptoms

HIV stage 2 (cell count and other name for this stage)

- CD4+ t-lymphocyte counts decrease to between 200-499 cells/mm3

- “symptomatic stage”

HIV stage 3 (cell count and other details)

- CD4+ count drops below 200 cells/mm3

- Person has AIDS

HIV stage unknown

no info on CD4+ T cell count

HIV symptoms

range from none to generalized fatigue/rash

later stages = variety of sx r/t immunosuppressed state

HIV tests

Antibody tests

antigen/antibody tests

Nucleic acid (RNA) tests

what is the main lab indicator of immune function

CD4+ count

ART goals (for HIV)

Goals:

- Reduce HIV-associated morbidity, prolong duration and quality of life

- Restore and preserve immunologic function

- Suppress plasma HIV viral load

- Prevent HIV transmission

HIV treatment complications

- Hepatotoxicity, nephrotoxicity, osteopenia, cardiovascular disease, MI

- Fat redistribution syndrome

- Facial wasting

HIV complications and comorbidities

- Pancreatitis

- Hepatitis

- Pneumocystis Pneumonia

- Tuberculosis

- Candidiasis (Oral, vaginal)

- HIV wasting syndrome

- Skin conditions: Kaposi Sarcoma, Herpes zoster and herpes simplex virus

- AIDS-related lymphomas

- Peripheral neuropathy

- HIV encephalopathy

HIV supportive care

Nutritional support

Oxygen Therapy

Relaxation therapy

Psychological support

Social resources

rheumatic diseases encompass...

Autoimmune

Degenerative

Inflammatory

Systemic conditions

rheumatic disease affects what in the body

joints, muscles, and soft tissues

T and B cells are called

antibodies nope

antibody

a substance produced by the body that destroys or inactivates an antigen that has entered the body

explain inflammation

1. The antigen stimulus activates antibodies (T and B cells)

2. Immunoglobulin antibodies form immune complexes

3. Phagocytosis

4. Attracts other WBCs to area

5. Prostaglandins try to modify the inflammation --> Produce enzymes to break down collagen

6. Edema in the joint

7. Pannus formation occurs (thick/inflamed layer)

8. Destruction of join cartilage and erosion of bone

a hallmark of inflammatory rheumatic disease is _________

autoimmunity

autoimmunity inflammation mainly occurs in what part of the body

the joints

autoimmunity is linked to what genes

human leukocyte antigen (HLA) genes

degeneration stage

inflammation occurs as a secondary process --> can cause cartilage failure and increased mechanical stress on bone ends

rheumatic disease clinical manifestations

Joint swelling

Limited movement

Stiffness

Weakness

Fatigue

rheumatic disease assessment

Evolution of symptoms

Family history

Complete PMH and family history

Functional assessment

--> Gait, posture, general musculoskeletal size & structure

--> Gross deformities

--> Abnormalities in movement

--> Symmetry

- Serum tests

- Imaging (xray, ct, mri, arthrography)

when assessing for rheumatic disease, what serum labs would you get

Creatinine

Erythrocyte count

ESR

Hematocrit

WBC

Uric Acid

CRP (c-reactive protein)

ANA (Antinuclear Antibody tests)

Rheumatoid Factor

rheumatic disease pharmacological therapy goal

control inflammation

what pharmacological therapy is used for rheumatic disease

Salicylates (analgesics like aspirin)

NSAIDs

Disease-modifying antirheumatic drugs (DMARDs) (Can suppress the autoimmune response, alter disease progression, stop or decrease tissue damage on joints, cartilage and organs) --dont need to know specifics

Corticosteroids (often used during flares)

KNOW TABLE 34-2

THE SPECIFIC ONES HIGHLIGHTED IN THE LECTURE WILL BE THE ONES SHE IS ASKING MOST

rheumatic disease nonpharmacologic medical management

Heat application

Paraffin baths

Theraapeutic exercises

Ongoing activity

focus on causes of each ABG abnormality (each disturbance)

practice ABG interpretation

rheumatoid arthritis

autoimmune reaction reaction occurs in synovial tissue --> breaks down collagen, causes edema, proliferation of synovial

rheumatoid arthritis clinical manifestations

Symmetrical joint pain

Morning stiffness lasting longer than 1 hour

Swelilng of joints

Erythema

Lack of function

Palpation of joint is spongy or boggy tissue

Onset is acute

**Bilateral and symmetric is the key

rheumatoid arthritis physical assessment reveals

Bilateral and symmetrical stiffness, tenderness, swelling in joints

diagnostics for RA

Labs:

- Rheumatoid factor (RF)

- Antibodies to cyclic citrullinated peptide (anti-CCP)

- ESR

- CRP

- CBC

Imaging:

- X-ray

- Ultrasound

- MRI

what other diseases should be ruled out when assessing for RA (like make sure they don't also have these diseases)

TB test, hepatitis test

rheumatoid arthritis medical management

GOAL PREVENT INFLAMMATION AND SLOW/PREVENT JOINT DAMAGE

Nonbiologic or biologic DMARDs

Corticosteroids

NSAIDs

Opioid analgesics

Nonpharmacological pain management

RA nursing management

Assessment of symptoms, tolerance

Assess for sleep disturbance

Assess for mobility

Education when necessary

systemic lupus erythematosus

Inflammatory, autoimmune disorder

Affects many organs in body

Body's immune system inaccurately recognizes one or more components of cell's nucleus as foreign

Antigen-antibody complexes get "trapped" in capillaries

Antibodies act to destroy the host cells

Systemic Lupus Erythematosus Clinical Manifestations

Fever

Fatigue

Skin rashes

Join pain and swelling

Mucocutaneous, musculoskeletal, renal, nervous, cardiovascular and respiratory system involvement

Systemic Lupus Erythematosus blood tests for dx

ANA (Antinuclear Antibody Test, + in 95% of lupus pts)

anti-DNA(antibody that develops against a pt own DNA)

CBC

how to medically manage SLE in the acute disease form

- Control the exacerbation to limit organ involvement

- Slow progression

other ways to medically manage SLE

pain management

nonspecific immunosuppresion

- Monoclonal antibody (block the cytokines)

- Corticosteroids

- Antimalarial medication

- Immunosuppressive agents

systemic lupus erythematosus nursing management

Assessment of physical symptoms

Assessment of sleep

Daily management tips

Access to resources

-->Support groups, social support, medical support

Nicotine cessation

what is the most common form of inflammatory arthritis

gout

gout incidence increases with....

age, BMI, alcohol consumption, HTN, diuretic use

linked to consumption of fructose rich beverages (SODA)

GOUT PRESENTS WITH

Hyperuricemia (increased urine uric acid)

Uric acid affected by diet, medications, overproduction in body, inadequate secretion by kidneys

Hyperuricemia can cause urate crystal deposition in joint space

Macrophages in joint space phagocytize urate crystals

Inflammation occurs

Exacerbated by presence of free fatty acids

Accumulations of urate crystals

gout clinical manifestations(how they look!)

PAIN, REDNESS, SWELLING AT THE JOINT. CAN BE ISOLATED TO A SPECIFIC LOCATION

- Acute gouty arthritis

- Tophi (large, swollen uric acid crystal deposits in tissues)

- Gouty nephropathy

- Uric acid urinary calculi

- Metatarsophalangeal joint of big toe-common affected joint

- Patient awakes with severe pain, redness, swelling and warmth of joint

- Cyclical episodes

gout medical management

Colchicine (reduces pain/swelling)

NSAIDs

Corticosteroid

Uric acid lowering therapy

Lifestyle management (avoid purine rich foods, weight loss, decrease alcohol consumption)

gout nursing management

Encourage verbal and written communication of plan

Encourage diet regimen

Maintain normal body weight

Medication adherence, limit alcohol

in what 2 ways is immune deficiency acquired?

1. medical treatment (chemo)

2. infection from pathogens (HIV)

what is an opportunistic infection?

illnesses caused by pathogens—bacteria, viruses, fungi, or parasites—that take advantage of weakened immune systems

these infections rarely cause disease in healthy people but can be severe or fatal in immunocompromised individuals

what is antiretroviral therapy (ART)?

the daily, lifelong treatment for HIV using a combination of medications that suppresses the virus, allows for immune system recovery (CD4 cells), and prevents transmission. While not a cure, it reduces the viral load to undetectable levels, enabling people with HIV to live long, healthy lives

what is ELISA (Enzyme-Linked Immunosorbent Assay)?

screening blood test used to detect HIV infection

can detect:

HIV antibodies (made by the body in response to HIV)

HIV antigen (p24) — an early part of the virus itself, allowing for early detection of HIV before symptom onset

what is HIV (Human Immunodeficiency Virus)?

- virus that enters the body and attacks the immune system—specifically CD4+ (T-helper) cells

- weakens the immune system over time

- makes it harder to fight infections

- treatable with antiretroviral therapy (ART)

- retrovirus (carries genetic material in the form of RNA)

- mutates quickly at a relatively constant rate

what is AIDS (Acquired Immunodeficiency Syndrome)?

AIDS = the result of uncontrolled HIV

the advanced stage of HIV infection, not a separate disease

When HIV becomes AIDS: A person is diagnosed with AIDS when:

- CD4 count < 200 cells/mm³, OR

- They develop opportunistic infections or cancers (like PCP pneumonia, Kaposi sarcoma)

What it means:

- Severe immune suppression

- High risk for life-threatening infections

how is HIV transmitted?

body fluids: blood, seminal fluid, vaginal secretions, amniotic fluid, breast milk

what should you teach patients about HIV prevention?

- abstinence

- correct and consistent use of condoms (must use latex male condoms)

- avoid anal intercourse or manual-anal intercourse (risk of fissures)

- eliminate reuse of needles and other equipment in IV drug use

- do not share razors, toothbrushes (cause microtears)

what should you teach HIV positive patients about preventing transmission?

- take ART regularly

- inform all sexual partners and drug-using partners of HIV status and avoid unprotected sex with other HIV + people

- discuss reproductive education (pregnancy)

how can HIV transmission to health care providers be prevented?

- standard precautions

- post-exposure prophylaxis for HCP: anti-retroviral medications ASAP (no more than 72 hours after possible HIV exposure)

how does HIV infect CD4+ cells?

- CD4+ cell is activated by infection and begins to produce new copies of RNA and viral proteins

- our CD4+ cells infect each other

- our CD4+ cells are reduced which weakens our immune response, leading to immunocompromise

what 5 things are the stages of HIV infection based on?

1. clinical hx

2. physical exam

3. lab evidence

4. signs & symptoms

5. associated infections and malignancies