CCC EXAM 1

What is active immunity and when does it develop?

An adaptive process that allows the body to make antibodies in response to an antigen in the body – it develops over several weeks-months + long lasting

What is active natural?

Body produces antibodies in response to exposure to a pathogen

What is active artificial?

Vaccine is given

What is passive immunity and when does it develop?

Develops antibodies creased by human/animal and transferred to client (ex: mother to baby) and is temporary

What is passive natural?

Antibodies are passed by mother to fetus through placenta/breastmilk

What is passive artificial?

Antibodies in the form of immunoglobulins are given to an individual – exposure has already occurred

What are the 4 purposes of immunizations

Antibody production (antibodies have active immunity), eradication of infectious diseases, prevention of childhood and adult infectious disease (also prevents complications), and herd immunity (ULTIMATE PURPOSE)

What is the purpose of herd immunity?

To protect those that are more vulnerable to severe complications from these infections

2 points about herd immunity

It talks about the importance of widespread immunization coverage, and can protect those who haven’t gotten immunizations

What are contraindications and precautions of immunizations?

Anaphylactic reaction, moderate/severe illness (the general rule is a fever within 24 hrs), and immunocompromised

If you are immunocompromised, what type of immunization can you not have?

Live vaccines – such as MRA, MMR, and Varicella

What is important to do for your patients if you are giving an immunization?

Have emergency supplies ready (always prepare for the worst), vaccine information sheets (VIS – reviewed with each patient), educate the patients, and document (DATE, TIME, ROUTE, SITE, TYPE OF VACCINATION, MANUFACTURER, LOT #, AND EXPIRATION DATE) – always sign

Facts about vaccine information sheets

They are required by law (can be denied), available on CDC website, updated regularly, document (that you gave them the VIS)

What is the definition of immunity?

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

What is innate immunity?

A rapid immune response (no exposure needed)

What is adaptive immunity?

Where exposure is needed

What are risk factors of bad immunity?

Poor health/hygiene products, immunocompromised (chronic conditions or treatments), socioeconomic status (difficulty for resources), and age (over 65 and younger than 1)

What is neutropenia?

There the WBC count is below 2000 which means for a VERY high risk for infection

What do WBCs (leukocytes) do?

They stimulate inflammatory response and protect the body

What do neutrophils do?

They increase with infection and decrease with things like sepsis and chemo

What does the absolute neutrophil count (ANC) do?

It determines the patient’s severity of risk for infection: >1000 MEANS THAT NEUTROPENIA PRECAUTIONS ARE NEEDED

What happens during a left shift?

The body is trying to produce so many neutrophils at once which makes them premature (bands): body can’t keep up

What are lymphocytes?

T + B cells – cell mediated or humoral immunity – increases with bacterial/viral infections

What are monocytes?

They increase with chronic inflammation (ex: mono, TB) – decreased monocytes with corticoid steroid use, and aplastic anemia

What are eosinophils?

Active against infection and limit inflammatory response – increased with allergic reactions, and decrease with stress

What are basophils?

Stimulate inflammation and the response of allergy/hypersensitivity reactions – increase with leukemia, and decrease with allergy and stress

What are some examples of lab cultures

Stool, urine, blood – determines what the pathogen is

What are the clinical manifestations of neutropenia

Dependent on severity of immunocompromised state, pallor (pale/white skill appearance), fatigue, lethargy, fever (pay very close attention to)

What are the interventions to take with neutropenia?

Initiate precautions per policy, avoid crowds and ill individuals, monitor lab values (daily or based on symptoms), encourage good hygiene practices, and notify provider of any fevers or new symptoms

What are the parts of RA?

It is a systemic disease that can affect any connective tissue in the body, and it can affect any joint – inflammation of the connective tissue in diarthrodial (synovial) joints – caused by a combination of genetics and environmental factors (antigen) – WBCs attack synovial tissue which then synovial tissue becomes inflamed/thickened

Is RA an autoimmune disease?

Yes – the body is attacking itself

What an RA cause and limit?

It causes joint deformity and bone erosion. It limits ROM and function of those joints

What is RA?

It is a chronic, systemic autoimmune disease that has no cure

The goal during RA is to keep the patient in remission and exacerbation – EARLY DETECTION IS KEY

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What are the risk factors of RA?

Females, age (40-60), genetic predisposition, bacterial or viral infection, lifestyle factors (stress, obesity), environmental factors, and immune system dysfunction (another autoimmune dysfunction)

Clinical manifestations of RA?

Pain (rest or movement), morning joint stiffness, pleuritic pain (on inspiration), xerostomia (dry mouth), anorexia/weight loss, fatigue, paresthesis (hands/feet), lack of function (due to joint pain), subcutaneous nodules, fever, red eyes, and lymph node enlargement (chronic)

What are the RA diagnostic studies?

Laboratory studies, arthrocentesis, and x-rays

What happens to the RF test levels with RA?

Levels increase with active inflammation – other diseases can make this positive as well

What would the ESR and C-reactive protein (CRP) test show?

Active inflammation

Another test is antinuclear antibody (ANA)

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What would the antibodies to citrullinated peptide (anti-CCP) test show?

Positive in people early on before the symptoms start

What happens during the arthrocentesis test

The needle goes into the joint – it tests the synovial fluid

Stage 1 of RA description

The lining of the joint (synovium) becomes inflamed, thickened, and swollen with immune cells (lymphocytes) and protein buildup (fibrin)

Stage 2 of RA description

Inflammatory tissue known as pannus forms and spreads, directly attacking and wearing down the protective cartilage at the outer edges of the joint

Stage 3 of RA description

The cartilage is destroyed, causing the bone edges to erode, bone density to decrease, and surrounding tissue to swell significantly, leading to joint deformity

What are the types of deformities with RA?

Ulner drift and nodules (in hand and knuckles), boot near deformity (hand is cupping inward), halex valgus (food is curving outward), and swan neck deformity (mainly on wrist and knuckles)

RA appearance descriptions

Deformity, can’t straighten, not red

LOOK AT EXTRAARTICULAR MANIFESTATIONS OF RA IN POWERPOINT

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Nursing cares with RA

Encourage physical activity (assist PRN), avoid repetitive movements, heat/cold therapy (morning stiffness = hot shower, hand/find pain = heat, edema = cold), monitor for fatigue, monitor for medication effectiveness (decreased pain and increased mobility)

More nursing cares for RA

Provide a safe environment, PT/OT referrals, refer the patient to support groups, home health aide referral, encourage nonpharmacologic pain relief, teach about signs and symptoms of a flare up

What do disease-modifying antirheumatic drugs (DMARDs) do?

It is a slow progression and decreases the risk of joint erosion, and deformity: it suppresses the nervous system’s reaction

What are some examples of DMARDs?

Hydroxychloroquine, minocycline, sulfasalazine, etanercept, infliximab, methotrexate, cyclophosphamide, and azathioprine

What is the preferred drug for RA?

Methotrexate because it has a lower risk of toxicity and there are rare side effects of bone marrow suppression and hepatotoxicity

What should you monitor when taking DMARDs for RA?

An allergic reaction, WBC and platelet count, and liver function – CYTOTOXIC MEDS AN HAVE VERY SEVERE SIDE EFFECTS

Nutritional therapy for

Balance nutrition is important, corticosteroid therapy = weight gain

Therapeutic procedures for RA

Plasmapheresis (removes circulating antibodies – decreases the attacks on tissue, and used in severe, life-threatening exacerbations

What is a total joint arthroplasty?

A surgical repair/replacement (severe cases)

What is a synovectomy?

The removal of the synovial membrane – the synovial fluid is what is causing most of the issues and pain

Nursing implementation during acute intervention for RA

Alternating rest periods with activity, rest before becoming exhausted, avoid complete bedrest to prevent stiffness and immobility, and use a firm mattress to maintain good body alignment