health and illness 2: exam 4: Immunity

what is immunity

the normal physiologic response to microorganisms and proteins as well as conditions associated with an inadequate or excessive immune response

immune response photo

innate vs adaptive immunity

types of altered immunity

-immunocompromised/immunodeficient

-hypersensitive

immunocompromised/immunodeficient s/s

-report of frequent infections

-report of poor wound healing

-fatigue

-malaise

-weight loss

clinical findings of immunocompromised

-may appear poorly nourished or having wasting syndrome

-may have chronic wounds

-may have enlarged lymph nodes

-presence of opportunistic infections

4 classes of hypersensitivity

I: immediate

II: tissue specific

III: immune complex mediated

IV: delayed hypersensitivity/cell-mediated

what is I: immediate hypersensitivity

allergies or allergic rxn

what is II: tissue specific hypersensitivity

autoimmune hemolytic anemia

what is III: immune complex mediated hypersensitivity

lupus/RA

what is IV: delayed hypersensitivity/cell-mediated hypersensitivity

transplant rejection

what is antibody involvement in I: immediate hypersensitivity

IgE

what is antibody involvement in II: tissue specific hypersensitivity

IgG or IgM

what is antibody involvement in III: immune complex mediated hypersensitivity

IgG

what is antibody involvement in IV: delayed hypersensitivity/cell-mediated hypersensitivity

none (lymphocyte and macrophage)

what is leukopenia

low WBC count

causes of leukopenia

-autoimmune diseases

-medications (immunosuppressive, mental health meds, chemo)

-severe illness sepsis

-cancers

-lupus

-HIV/AIDs

-radiation therapy

what is leukocytosis

high WBC count

causes of leukocytosis

-infection

-inflammation

-leukemia

-extreme stress

-med side effects

what are WBC w/ differential labs

look at 5 types of WBCs

what are the WBCs in differential labs

-monocytes

-eosinophils

-neutrophils

-basophils

-lymphocytes

what are monocytes

4-13%

-fights infection and foreign substances

what are eosinophils

1-5%

-plays a role in allergic response and parasite infections

what are neutrophils

40-50%

-fights bacterial infections (left shift)

what are basophils

0.1-25

-plays a role in inflammatory conditions and allergy response

what are lymphocytes

20-40%

-fights viral infections (right shift)

what is the most prevalent inflammatory arthritis

rheumatoid arthritis

characteristics of RA

-course and severity variable

-chronic systemic autoimmune disorder

-abnormal, overactive functioning of immune system

-inflammation of CT

-primarily in joints

-chronic pain, alterations in body image

risk factors for RA

-female 3x more likely

-age 30-60 years

-genetic predisposition

-bacterial/viral infection (epstein barr virus)

-stress and smoking

-environmental factors

-older age

onset of RA

-usually insidious

-acute/precipitated by stressor

-may be preceded by systemic manifestations of inflammation

-polyarticular, symmetrical

-rate of development can fluctuate (symptoms come and go)

what are flare ups in RA

-can last days-months

-more common in winter than summer

stages of RA

manifestations of RA

-joint pain at rest and movement

-morning stiffness

-anorexia and weight loss

-swelling

-fever

-erythema

-lack of function

-deformities

-rheumatoid nodules (PIP)

dx labs for RA

-anti-CCP positive

-rheumatoid factor

-increased ESR

-increased CRP

-ANA

-elevated WBC

-CBC reveals anemia

dx procedures for RA

-xray

-radionuclide scans

-direct arthroscopy

-synovial fl aspirate

-synovial membrane biopsy

xray for RA

-soft tissue swelling

-erosion of joints

-osteoporosis adjacent progressing to bone-cyst formation

-narrowing of joint space

-subluxation

radionuclide scans for RA

identify inflamed synovium

direct arthroscopy for RA

visualization of area reveals bone irregularities/degeneration of joint

synovial fl aspirate for RA

-greater volume than normal

-cloudy, yellow appearance (inflammatory response, bleeding, degenerative waste products)

-elevated levels of WBCs/leukocytes

-decreased viscosity and complement (C3 and C4)

synovial membrane biopsy for RA

reveals inflammatory changes and development of pannus (inflamed synovial granulation tissue)

nursing dx for RA

-acute and chronic pain

-fatigue

-impaired physical mobility

-self care deficit

-disturbed body image

-ineffective coping

how do we reduce fatigue in RA

-assist with and encourage physical activity

-monitor for fatigue

-provide a safe environment

-monitor for med effectiveness

-encourage foods high in vitamins, protein, and iron

-eat small, frequent meals

nursing interventions for RA

-Place and monitor use of pillows, sandbags, trochanter rolls, splints, braces.

-Encourage frequent changes of position. Assist the patient to move in bed, supporting affected joints above and below, avoiding jerky movements.

-Recommend that patient take a warm bath or shower upon arising or at bedtime. Apply warm, moist compresses to affected joints several times a day. Monitor water temperature of compress, baths, and so on.

üProvide gentle massage.

-Discuss and provide safety needs such as raised chairs and toilet seat, use of handrails in the tub, shower and toilet, proper use of mobility aids and wheelchair safety.

-Encourage verbalization about concerns of disease process, future expectations.

-Encouraged a balanced diet, but make sure the patient understands that special diets won't cure RA. Stress the need for weight control.

pharm therapy for RA

-NSAIDs

-COX-2 enzyme blockers

-DMARDS

-corticosteroids

surgical management for RA

-reconstructive surgery

-synovectomy

-plasmapheresis

-arthroplasty

what is reconstructive surgery for RA

-indicated when pain cannot be relieved by conservative measures and the threat of loss of independence is eminent

what is synovectomy for RA

excision of synovial membrane

what is plasmapheresis for RA

-may be done for severe, life threatening exacerbation

-removes circulating antibodies from plasma, decreasing attacks on the clients tissues

pt hx for osteoarthritis

-C/O palpable bony joint enlargement

-morning stiffness (lasting <30 mins)

-pain

pt hx for RA

-pain duration >6 weeks

-morning stiffness >30 mins

-systemic symptoms (fatigue, anorexia)

physical exam for OA

-reduced ROM

-joint malalignment

-crepitus

physical exam for RA

-synovitis

-joint involvement, symmetrical

-joint destruction

-extra-articular manifestation

radiologic tests for OA

-presence of osteophytes

-joint space narrowing

radiologic tests for RA

-erosions on Xray or MRI

-synovitis noted by US or MRI

lab tests for OA

clear synovial fl

serology for RA

-ESR or CRP

-Anti-CCP

-rheumatoid factor

common types of juvenile arthritis

-oligoarticular JIA

-polyarticular (rheumatoid factor positive or negative) JIA

-psoriatic arthritis

-enthesitis-related arthritis

-systemic JIA

what is oligoarticular JIA

-juvenile idiopathic arthritis

-affects about 50% of children with JIA

-involved four or fewer joints

-large joints (knees, ankles, elbows) typically affected

-often seen in toddler years

-associated with an increased risk of eye inflammation

what is polyarticular (rheumatoid factor positive or negative) JIA

-30-40% of children with JIA affected

-affects 5 or more joints

-peak age of onset is toddler and adolescent years

-polyarticular disease can affect both the large and small joints (hands and feet)

what is psoriatic arthritis

-occurs in children who have a personal or family hx of psoriasis

-can develop swelling of an entire finger or toe= doctylitis

what is enthesitis-related arthritis

-occurs more in boys than girls

-begins in early adolscence

-often experience tenderness where tendons and ligaments attach to bone

-at risk for developing arthritis in lower back and spine

-at risk for eye disease

what is systemic JIA

-still's disease

-most serious

-least common

-10-15% of children with JIA

-joint inflammation and stiffness

-rash

-periodic fevers

-may cause inflammation of internal organs (heart, liver, spleen, lymph nodes)

risk factors for JIA

-immunogenic susceptibility

-environmental triggers

-genetic predisposition

s/s JIA

-joint swelling, redness, warmth

-pain worse in morning and after inactivity

-mobility limitations

-fever

-rash

-limp in the morning

-delayed growth

inflammatory markers of JIA

-ESR/CRP

-CBC

-ANA

-RF

xray of JIA

slit lamp eye examination- ocular manifestations

nursing dx of JIA

-acute pain

-impaired physical mobility

-disturbed body image

-self care deficit

-deficient knowledge

nursing interventions for JIA

-PT

-activity

-pain relief

-ROM

-emotional support

-health education

meds for JIA

-NSAIDs

-methotrexate

-corticosteroids

-etanercept

impact of JIA

-med appt

-school (handwriting/typing/opening items)

-socialization

-stigma

-self care

-healthy eating

-heat/cold tx

what is infection

the invasion and multiplication of microorganisms in body tissues, which may be unapparent or the result of local cellular injury caused by competitive metabolism, toxins, intracellular replication, or antigen-antibody response

contributing factors of infection

-immune defense

-virulence of microorganisms

-type of microorganism

types of pathogens

-bacteria

-viruses

-fungi

-parasites

what is the pathogen that most commonly causes infection

bacteria

what are viruses

nucleic acid, must enter living cells

what are fungi

yeasts, molds

what are parasties

protozoa, helminths, arthropods

what is the host part of infection

-acute illness

-mechanical barriers

-fever

-stress

-phagocytes

-biochemical barriers

-biochemical mediators

-chronic illness

environment part of infection

-sanitation

-water quality

-crowded living conditions

-weather

-air quality

-seasons

parasite part of infection

-encapsulation

-adhesions

-spore formation

-slime layer

-pili

-flagella

-enzymes

what is endemic infection

refers to the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area

what is epidemic infection

an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area

what is pandemic infection

epidemic that has spread over several countries or continents, usually affecting a large number of people

what are healthcare associated infection

-can develop during pts stay in the facility and/or manifest after discharge

-UTI most common

-antibiotic-resistant bacteria

what are antibiotic resistant bacteira

-MRSA

-VRE

-PRSP

-C diff

-ESBL

what are the pathogens that cause biologic threat infections

-anthrax

-small pox

-botulism

-pneumonic plague

-viral hemorrhagic fevers

what are the pediatric infections and communicable disease pathogens

-pertussis

-hep b

-varicella

-measles

-rubella

primary infection prevention

-handwashing

-immunizations

secondary infection prevention

screening

what is herd immunity

works to control the spread of disease within a population when a specific amount of that population (threshold) becomes immune to the disease through vaccination or infection and recovery

managing fever interventions

-eliminate underlying cause of fever (hyperthermia)

-destroy causative microorganisms

-drug therapy

-external cooling

-fl administration

consequence of uncontrolled infection

Once the body's compensatory mechanisms (e.g., vascular, renal, nervous, respiratory) are overcome, the following process occurs:

Septic shock --> Multisystem failure --> Death

consequence of uncontrolled infection chart

How do the eustachian tubes differ in kids?

eustachian tubes are shorter and more horizontal than adults

when do eustachian tubes peak

-first 2 years of life

-when children enter school (5-7 years)

eustachian tube anatomy: infant vs adult

bacterial causes of otitis media

-strep

-PNA

-H influenza

-M. cat

viral causes of OM

RSV, influenza

pathophysiology of OM

-bacterial infection

-viral

-allergies

-enlarged adnoids

risk factors for OM

-winter months

-daycare/schools

-smoker or livers with smoker

-cleft pallet

-down syndrome

-lack of immunizations

-bottle feeding lying down