Med Surg - Immunity quiz

immunity

protection from illness or disease that is maintained by the body's physiologic defense mechanisms

inflammation

a nonspecific syndrome of normal tissue responses to cellular injury, allergy, or invasion by pathogens

innate immune system

the body's first line of general defense with which a person is born, nonspecific quick action; includes skin, cornea, and mucous membranes throughout the respiratory, GI, and genitourinary systems

adaptive immune system

responds to invading organisms; the body's second, specific response when exposed to microbes or chemicals

natural active immunity

production of one's own antibodies or T cells as a result of infection or natural exposure to antigen

artificial active immunity

vaccination

natural passive immunity

fetus obtains antibodies through placenta, colostrum, or breast milk

artificial passive immunity

occurs when the body is injected with antibodies that were created in the body of another person or animal

human leukocyte antigens (HLAs)

unique surface proteins specific to each person

HLAs determine

tissue type

HLAs are key for

recognition and self-tolerance

bone marrow produces

stem cells

WBC granulocytes

neutrophils, eosinophils, basophils, mast cells

WBC agranulocytes

monocytes, macrophages, lymphocytes

inflammatory leukocytes

neutrophil

macrophage

monocyte

eosinohil

basophil

antibody-mediated leukocyte

B lymphocyte

plasma cell

memory cell

cell-mediated immunity leukocyte

helper t cell

cytotoxic t cell

regulator t cell

NK cell

2 leukocytes that do phagocytosis

neutrophils

macrophages

eosinophil function

Releases vasoactive amines during allergic reactions and in response to parasite infestations

basophil function

Releases vasoactive amines during allergic reactions and in response to parasite infestations

NK cell function

destroy cancer cells, can also attack grafts and transplanted organs :(

when is immunity best?

20s and 30s and slowly declines with increasing age

age-related changes in inflammation

neutrophil function reduced

decreased leukocytosis

no fever during inflammatory episodes (bad)

age related changes in antibody-mediated immunity

B cells decrease

antibody response decreases

age-related change in cell mediated immunity

circulating T lymphocytes decrease; skin test for TB may show false negative

nursing implications for age-related changes

minor infections may be overlooked

educate on immunizations such as flu shots, pneumococcal, shingles

booster shots esp tetanus and pertussis

tissue mast cell function

they have binding sites for the stems of IgE molecules and are involved in allergic reactions; they respond to the inflammatory products released by T lymphocytes by maintaining and prolonging inflammation and allergic reactions

type I hypersensitivity

anaphylaxis

type II hypersensitivity

cytotoxic mediated; drug-induced hemolytic anemia, hemolytic transfusion reactions

type III hypersensitivity

immune complex; RA, SLE

type IV hypersensitivity

delayed-type; contact dermatitis, poison ivy, jewelry, insect sting, sarcoidosis

anaphylaxis nursing interventions

Stop the transfusion

ABCs

epinephrine

IV fluids

diphenhydramine

type II interventions

discontinue blood product

plasma filtration

monitor hemolytic crisis and kidney failure

type III interventions

treatment individualized to disease process

type IV interventions

symptomatic treatment

corticosteroids

angioedema can be caused by

ACEIs

anaphylaxis teaching

avoid known allergens whenever possible, to wear a medical alert bracelet, and to alert all health care personnel about specific allergies

carry anaphylaxis kit

anaphylaxis cues

respiratory compromise

swollen lips, mucosal tissue

low BP

severe GI symptoms

urticaria

systemic lupus erythematosus (SLE)

Over time the progressive loss of tissue integrity through excessive inflammation and overactive immunity leads to organ failure and death.

SLE triggers

viral infections, drugs, hormones, UV and sun exposure

SLE mostly affects

women and women of color

SLE musculoskeletal

Arthralgias and arthritis

Osteoporosis

SLE skin

Alopecia

Coin-shaped lesions (discoid rash)

Mucocutaneous lesions

Photosensitivity and rash development after sun exposure

BUTTERFLY RASH!!

SLE immune

• Chronic fatigue

• Generalized inflammation

• Increased number of infections

• Intermitted unexplained low-grade fever

SLE CV

• Pericarditis

• Raynaud phenomenon (hands that appear intermittently cyanotic, then may become red or pale when exposed to cold)

• Vasculitis

SLE renal

glomerulonephritis

Examine urine for cloudiness, the presence of obvious blood in the urine, and the appearance of foam (caused by protein in the urine)

SLE GI

esophagitis

SLE sensory

• Peripheral neuropathies

• Retinal vasculopathy

SLE hematologic

• Anemia

• Leukopenia

prednisone can cause

osteonecrosis

moon face

GI bleeding

increased susceptibility to colds and other infections

weight gain

SLE teaching

Teach the patient and family that regular medical monitoring, drugs, and healthy practices such as limiting sun exposure can prevent exacerbation of the disease and that life expectancy is normal for most people who adhere to treatment; long sleeves in sun, SPF 30

interventions for persistent pain in SLE

acetaminophen and NSAIDs

corticosteroids

proper rest

avoid stressful situations

low-impact activity

long sleeve shirts

managing fatigue interventions SLE

Suggest that patients make a list of activities they perform for home and recreation, and then identify which items "must" be done, which ones someone else can help with, and which ones perhaps are not necessary

SLE labs

decreased MCV, RBC

decreased WBC

increased plateles

increased eosinophils and monocytes

increased creatinine

increased ANA

IMPORTANT for corticosteroids

follow a tapering schedule, NEVER stop abruptly

outcomes showing SLE treatment is effective

• Adhere to meds

reduce incidence of complications associated with SLE

• Have pain managed at a level they deem acceptable

• Maintain energy to participate in activities important to them

• Experience longer periods of remission with low SLE activity

stage I HIV symptoms

fever, sore throat, rash, night sweats, chills, headache, and muscle aches, similar to those of any viral infection

AIDS diagnosis requires

adult has CD4 count less than 200 or certain OIs

if t cell counts improve after a stage III diagnosis

they will still be considered stage III

A client providing a health history to the nurse states, "I've been diagnosed with stage I HIV infection." Which assessment finding would the nurse anticipate?

A. Lymphocytopenia

B. Sore throat with myalgias

C. Overgrowth of Candida albicans in the mouth

D. CD4+ T-cell count 300 cells/mm3 (600-1500 cells/mm3)

B

how is HIV spread

sexually

parenterally - needles

perinatally - mother to baby

HIV teaching

safe sex

wear gloves

nurse precautions with HIV

standard precautions;

gloves and handwashing

clean needles with

bleach

PrEP drug

tenofovir/emtricitabine

if using PrEP drugs you have the possibility to acquire

drug resistance if you become infected

TasP

treatment as prevention; practice of taking HIV medication to prevent sexual transmission to others who are HIV negative

most common OIs in stage III

candidiasis, cryptococcosis, cytomegalovirus, M. avium complex, P. jirovecii pneumonia, toxoplasmosis, and tuberculosis

how to know if HIV treatment is working

higher CD4

lower viral load

less opportunistic infections

HIV labs

low WBCs

low CD4

high viral load

HIV nutrition teaching

avoid undercooked or raw meat and fish

HIV general teaching

avoid crowds

do not dig in garden or dirt or maintain house plants

stay out of litter box

take meds as prescribed

how to get patient to adhere to meds

med organizer

timers

The client on combination antiretroviral therapy calls the telehealth nurse to report forgetting to bring this medication on a vacation. Which teaching would the nurse provide, after the health care provider has sent an electronic prescription to a pharmacy at the client's current location?

A. "When you pick up the prescription, take today's next dose and continue forward as usual."

B. "After you get your medication you will need to take double doses of the drug for the next 2 days."

C. "As long as you pick up the drug and start taking it in the next 2 to 3 days, you will be fine."

D. "Before you can resume drug doses, you will need to find an urgent care center to have labs drawn for your viral load."

A

Epstein-Barr virus --> cancer

Burkitt lymphoma, B-cell lymphoma, nasopharyngeal carcinoma

Hep B --> cancer

Primary liver carcinoma

Hep C --> cancer

Primary liver carcinoma, possibly B-cell lymphomas

HPV --> cancer

Cervical carcinoma, vulvar carcinoma, penile carcinoma, other anogenital carcinomas, and head and neck carcinoma

Human lymphotropic virus type I --> cancer

Adult T-cell leukemia

HIV-1 --> cancer

Kaposi sarcoma; lymphomas

MS has a ____ onset

progessive, slow

MS signs

vision loss, muscle weakness

MS teaching

periods of rest

DO NOT go back to full on work schedule

Myasthenia gravis is ____ onset

fast

3 criteria for diagnosis of AIDS

Opportunistic infections

HIV diagnosis

CD4 less than 200

allergic rhinitis treatment

antihistamines

all cancer cells start out ___

normal

carcinogenesis

the process of changing a normal cell into a cancer cell

modifiable cancer risk factors

Smoking

UV exposure

Diet

Alcohol consumption

Sleep

Exercise

Screenings

nonmodifiable risk factors

Sex

Age

Race

genetics

Family history

Socioeconomic factors

Race at highest risk for cancer

African americans

CAUTION acronym

Changes in bowel or bladder

A sore/lesion that doesn't heal

Unusual bleeding or discharge

Thickening or lump in breast or elsewhere

Indigestion or difficulty swallowing

Obvious changes in wart or mole

Nagging cough or persistent hoarseness

primary prevention of cancer

avoidance of carcinogens (sun, smoking, PPE)

modifying associated factors (reducing alcohol, diet)

removal of at risk tissue

chemoprevention

vaccinations

chemoprevention example

use of tamoxifen to reduce the risk for breast cancer is an example

secondary prevention

screenings - colonoscopy, fecal occult test, mammogram, PAP smear

diet teaching for cancer

Avoid excessive intake of animal fat

Avoid nitrites (prepared lunch meats, sausage, bacon)

Minimize your intake of red meat.

Keep alcohol consumption to no more than 1 drink per day for females or 2 drinks per day for males

Eat more fiber and cruciferous vegetables, such as broccoli, cauliflower, brussels sprouts, and cabbage

Eat foods high in vitamin A (e.g., apricots, carrots, leafy green and yellow vegetables) and vitamin C (e.g., fresh fruits and vegetables, especially citrus fruits)

low white count teaching

Avoid litter

Wash perineal and armpits with antimicrobial soap twice a day

Don't share personal toiletries

No dirt

No fresh veggies or fruits

Don't drink anything that has sat for more than an hour

Take temp every day

thrombocytopenia

Decreased platelets

Increased risk for bleeding

malignant vs benign

Malignant - can metastasize, cancerous

Benign - can NOT metastasize

curative vs palliative measures

Curative - hoping to get rid of, go into remission

Chemotherapy

Radiation

Surgery to remove tumor

Breast cancer - hormone therapy along with mastectomy

Palliative - comfort