NSG 211 - Immunity
Which WBC ingests invading microbes?
Phagocytes (Neutrophils and Macrophages)
Management of Pain Management in an Exaggerated Immune Response
Pharmacotherapy: NSAIDs, corticosteroids Hypothermia or hyperthermia treatments as appropriate Maintenance of mobility and physical activity
Active Immunity
A form of acquired immunity in which the body produces its own antibodies against disease-causing antigens.
When preparing a client for allergy testing, the nurse provides the client with which instruction? A. "Antihistamines should be discontinued 2 weeks before the test to avoid suppressing the test response." B. "It is okay to use your fluticasone propionate (Flonase) nasal spray before testing." C. "Aspirin in a low dose may be taken before testing." D. "You can take antihistamine nasal sprays before testing."
A. "Antihistamines should be discontinued 2 weeks before the test to avoid suppressing the test response." The nurse should tell the client that, "Antihistamines should be discontinued 2 weeks before the test to avoid suppressing the test response." Systemic glucocorticoids and antihistamines are discontinued 2 weeks before the test for this reason.Nasal sprays like fluticasone propionate (Flonase) to reduce mucous membrane swelling are permitted, except for sprays that contain an antihistamine. Allergists recommend that aspirin be withheld before testing.
___ form in the bone marrow and release antibodies that fight bacterial infections
B lymphocytes
What physical assessment findings does the nurse anticipate for a patient diagnosed with systemic lupus erythematosus (SLE)? (SATA) A. Weight Gain B. Abdominal Pain C. Discoid Lesions D. Inflames Red Rash E. Deep Vein Thrombosis
B. Abdominal Pain C. Discoid Lesions D. Inflamed Red Rash Typical physical findings in a patient diagnosed with SLE include abdominal pain, discoid lesions, and an inflamed red rash. Weight gain and deep vein thrombosis do not typically occur with SLE.
A client is being discharged from the hospital after an allergic reaction to environmental airborne allergens. Which instruction is most important for the nurse to include in this client's discharge teaching plan? A. Wash fruits and vegetables with mild soap and water before eating. B. Intermittent exposure to known allergens will produce immunity. C. Remove cloth drapes, carpeting, and upholstered furniture. D. Be cautious when eating unprocessed honey.
C. Remove cloth drapes, carpeting, and upholstered furniture. The most important discharge instruction to give this client is to remove cloth drapes, carpet, and upholstery in order to reduce airborne pollen, dust mites, and mold.Washing fruits and vegetables pertains to food allergies. Clients do not develop immunity to known allergens by direct intermittent exposure. Some common interventions include avoidance therapy, desensitization therapy, and symptomatic therapy. Honey is said to help some people with allergies to pollen only; it does not have an impact on airborne allergens.
Organ Rejection: Chronic Signs and Symptoms
Chronic inflammation and scarring -> smooth muscles of arteries overgrow and occlude Tissue replaced w/ fibrotic scar-like tissue. Function reduced Sx: lungs -> thickened small airways livers-> destroys bile ducts hearts-> accelerated graft atherosclerosis (AGA)
Hypersentivity Type IV
Delayed Hypersensitivity Reactions Cell-mediated
Management of Nutrition in an Immunosuppressed Patient
Multiple vitamin and mineral supplements Dietary supplements such as Ensure or equivalent Evaluation of weight and BMI
____ cells have direct cytotoxic effects on some non-self cells without first being sensitized.
Natural Killer Cells They conduct "seek and destroy" missions in the body to eliminate non-self cells. The NK cells are most effective in destroying unhealthy or abnormal self cells such as cancer cells and virally infected body cells
Immune Response to Hypersentivity Type I
+ IgE. Mast cell degranulation and histamine release. Anaphylaxis ( bv dilation, decr CO, bronchoconstriction) hypertension and respiratory distress secondary to massive histamine release
Treatment for Hypersentivity Type III
1. NSAIDS 2. Prednisone 3. DMARDS- Methotrexate/suppress immune system Symptom control
A ___ cell produces antibodies against sensitizing antigen.
Plasma Cells
HIV/AIDS Treatment: Pr-EP
Pre-exposure prophylaxis, For those at +risk- Truvada- 4 days until effective. On going assess of renal function and HIV#, contra for active HepB
Organ Rejection Function of Cyclosporines
Prevents activation of lymphocytes involved in transplant rejection side effects = *Nephrotoxic, HTN, tremor, CAD, hirsutism, gingival hyperplasia, opportunist infections, malignancies, hyperuricemia, *Hepatoxicity
Clinical Management of an Immunosuppressed Patient
Primary Prevention: vaccinations, Reduce high risk behavior, Diet, Exercise Secondary Prevention: HIV Screening
Examples of Hypersentivity Type III
Rheumatoid arthritis Systemic Lupus Erythematosus
These cells form in the thymus and other lymphatic tissue and attack cancer cells, viruses, and foreign substances...
T Lymphocytes
What is an antibody?
a blood protein produced in response to and counteracting a specific antigen
Organ Rejection Complications
*Corticosterioids leave the patient at greater risk for infection because it causes general immunosuppression *Oral agents must be taken for the life of the transplanted organ. *All are immunosuppressive to some degree, and the dosage is adjusted to each patient - these agents increases the risk for bacterial and fungal infections and for cancer development.
Systemic Lupus Erythematosus (SLE) Nursing Interventions
*When patients are taking steroids and/or immunosuppressants, stress the importance of avoiding large crowds and people who are ill. Teach patients to report any early sign of infection to their health care provider. Remind patients to take their medication early in the morning before breakfast because that is the time when the body's natural corticosteroid level is the lowest. *Teach patients to protect their skin to prevent an exacerbation of the disease. *Instruct patients to avoid prolonged exposure to sunlight and other forms of ultraviolet lighting, including certain types of fluorescent light. Remind them to wear long sleeves and a large-brimmed hat when outdoors. Patients should use sun-blocking agents with a sun protection factor (SPF) of 30 or higher on exposed skin surfaces. *Teach patients to practice proper skin care = use mild soap, dry skin by patting vs rubbing, apply lotion, avoid powder or other drying agents, use cosmetics that contain moisturizers, avoid direct sunlight, wear protective sun clothing, use SPF 30+, inspect skin daily for rashes *Two major differences between RA and SLE = teach patients to protect their skin & teach them to monitor body temp (fever is the major sign of exacerbation during which they can become ill)
Exaggerated Response Diagnostics/Testing
+eosinophils, IgE, Radioallergosorbent Test (RAST)
HIV/AIDS Complications
1. Potential for infection due to reduced IMMUNITY 2. Inadequate GAS EXCHANGE due to anemia, respiratory infection (P. jiroveci pneumonia [PCP], cytomegalovirus [CMV] pneumonitis), pulmonary Kaposi's sarcoma (KS), or anemia 3. Pain due to neuropathy, myelopathy, cancer, or infection 4. Inadequate NUTRITION due to increased metabolic need, nausea, vomiting, diarrhea, difficulty chewing or swallowing, or anorexia 5. Diarrhea due to infection, food intolerance, or drugs 6. Potential for reduced TISSUE INTEGRITY due to KS, infection, reduced NUTRITION, incontinence, immobility, hyperthermia, or cancer 7. Cognitive decline due to AIDS dementia complex (ADC), central nervous system infection, or cancer 8. Potential for psychosocial distress due to living with a life-threatening chronic disease that affects all aspects of life immune reconstitution inflammatory syndrome (IRIS)- short term therapy with corticosteroids
HIV/AIDS Signs & Symptoms
1. acute stage- flu-like symptoms (fever, sweats, HA, muscle aches), 2-4 weeks, often neg for ELISA 2. Chronic/clinically latent- virus +, T cells decr, can still fight infection 3. Swollen lymph nodes, hairy leukoplakia (white patch on tongue), oral candidiasis 4. AIDS (CD4 <200 OR opportunistic infections)- persistent fever, fatigue, weight loss, diarrhea, HIV# + significantly, 5. "AIDS-defining conditions": 10+ yrs · Recurrent bacterial pneumonia · Pneumocystis pneumonia · viral (Herpes) · Fungal infections (candidiasis of esophagus) Tumors: Kaposi sarcoma (skin lesions), primary lymphoma of brain
Systemic Lupus Erythematosus (SLE) Plaquenil
= In addition, the health care provider may prescribe the anti-malarial agent hydroxychloroquine for some patients. Hydroxychloroquine decreases the absorption of ultraviolet light by the skin and therefore decreases the risk for skin lesions. Teach patients to have frequent eye examinations (before starting the drug and every 6 months thereafter) if they are receiving hydroxychloroquine.
Exaggerated Response Antihistamines (Dipehenhydramine - Benandryl, Allerdryl)
= second-line drugs given IV or IM for angioedema and uticaria (HIVES)
Systemic Lupus Erythematosus (SLE) NSAIDs
>> 5 A's = Analgesic, Antipyretic, Anti-inflammatory, Antithrombotic, Arteriosus >> Bars = Bleeding, Asthma, Renal disease, Stomach (peptic ulcer or gastritis) >> with Acetaminophen may be used to treat joint and muscle pain and inflammation
In discharging a client diagnosed with acquired immune deficiency syndrome (AIDS), which statement by the nurse uses a nonjudgmental approach in discussing sexual practices and behaviors? A. "Have you had sex with men or women or both?" B. "I hope you use condoms to protect your partners." C. "You must tell me all of your partners' names, so I can let them know about possibly having AIDS." D. "You must tell me if you have a history of any sexually transmitted diseases because the public health department needs to know."
A. "Have you had sex with men or women or both?" The straightforward approach of asking the client about having sex with men or women is nonjudgmental and most appropriate."I hope you use..." is a judgmental statement. Naming partners is voluntary; also, assuming that more than one partner exists is judgmental and presumptuous. Asking for information in the name of the public health department is not straightforward, and the tone of this entire statement is judgmental. Judgmental statements to clients by healthcare providers (HCPs) can impede the collaborative relationship and communication between client and HCP.
The nurse is teaching a patient with a new diagnosis of systemic lupus erythematosus (SLE) about her disease. The nurse recognizes that the patient understands the information when making which statement? A. "I need to avoid getting infections because they will increase the immune response in my body, which can make my SLE worse." B. "I need to be sure to take all the available immunizations to keep me from getting sick." C. "Because of my SLE, my immune system is already diminished, so I need to avoid people with the flu." D. "As long as I take all my prescribed medications, I won't have to make any lifestyle changes as a result of my SLE."
A. "I need to avoid getting infections because they will increase the immune response in my body, which can make my SLE worse." SLE is a hyperimmunity problem. Pathogens trigger the immune response in the body, which can exacerbate the SLE. Immunizations trigger the immune response in the body to help create antibodies. In patients with autoimmune diseases such as SLE, immunizations can exacerbate the disease. SLE is not the result of immunosuppression. Lifestyle changes are required with most chronic illnesses such as SLE. Patients cannot depend on medications alone.
A client is receiving highly active antiretroviral therapy (HAART). Which statement by the client indicates a need for further teaching by the nurse? A. "With this treatment, I probably cannot spread this virus to others." B. "This treatment does not kill the virus." C. "This medication prevents the virus from replicating in my body." D. "Research has shown the effectiveness of this therapy if I do not forget to take any doses."
A. "With this treatment, I probably cannot spread this virus to others." HAART reduces viral load and improves CD4+ T-cell counts, but the client must still protect others from contact with his or her body fluids.HAART inhibits viral replication; it does not kill the virus. Remembering to take all doses of HAART is very important for preventing drug resistance.
Select all the organs from the following list that are part of the immune system. (SATA) A. Adenoids B. Appendix C. Bone marrow D. Gallbladder E. Liver F. Thyroid gland
A. Adenoids B. Appendix C. Bone marrow The lymphoid organs of the immune system are the adenoids, appendix, and bone marrow. Other organs of the immune system include the lymph nodes, thymus gland, tonsils, and spleen. The gallbladder, liver, and thyroid gland are not part of the immune system.
Parents rush their 7-year-old child to a free-standing emergency clinic because of the child's having been stung by bees and is having rapid, labored breathing. What is the priority action by the nurse when the child gets into the examining room? A. Administer oxygen using a nasal cannula. B. Obtain a complete health history from the parents. C. Place a tourniquet distal to the area where the bee stings are. D. Get the code cart located down the hall in the locked treatment room.
A. Administer oxygen using a nasal cannula. Initially, the nurse maintains an adequate airway by administering oxygen and assisting with aerosol treatments and intubation as necessary. A brief, focused health history is indicated related to the insect bites. In the case of an insect sting or injected medication, a tourniquet applied to the affected extremity just proximal to the site might help confine the allergen. The nurse should stay with the patient. Someone else can get the code cart.
Which factors are possible transmission routes for human immune deficiency virus (HIV)? (SATA) A. Breast-feeding B. Anal intercourse C. Mosquito bites D. Toileting facilities E. Oral sex
A. Breast-feeding B. Anal intercourse E. Oral sex HIV can be transmitted via breast milk from an infected mother to the child. Anal intercourse not only allows seminal fluid to make contact with the mucous membranes of the rectum, but it also tears the mucous membranes, making infection more likely. Oral sexual contact exposes the mucous membranes to infected semen or vaginal secretions.HIV is not spread by mosquito bites or by other insects. It is not transmitted by casual contact. Sharing toilet facilities does not cause transmission of HIV.
A client with a history of asthma is admitted to the clinic for allergy testing. During skin testing, the client develops shortness of breath and stridor and becomes hypotensive. What is the most appropriate drug for the nurse to give in this situation? A. Epinephrine (Adrenalin) B. Fexofenadine (Allegra) C. Cromolyn sodium (Nasalcrom) D. Zileuton (Zyflo)
A. Epinephrine (Adrenalin) The most appropriate drug for the nurse to give in this situation is epinephrine (Adrenalin). The client is experiencing an anaphylactic reaction, and epinephrine is a first-line sympathomimetic drug used to treat anaphylaxis.Fexofenadine (Allegra) is a nonsedating antihistamine and is not a first-line drug to treat anaphylaxis. Cromolyn sodium (Nasalcrom) is a mast cell-stabilizing drug used to prevent symptoms of allergic rhinitis. It is not useful during an acute episode. Zileuton (Zyflo) is a leukotriene antagonist also used to prevent symptoms of allergic rhinitis, but is also not useful during an acute episode.
A client recently diagnosed with human immune deficiency virus (HIV) is being treated for candidiasis. Which medication does the nurse anticipate the health care provider will prescribe for this client? A. Fluconazole (Diflucan) B. Trimethoprim/sulfamethoxazole (Bactrim) C. Rifampin (Rifadin) D. Acyclovir (Zovirax)
A. Fluconazole (Diflucan) Fluconazole (Diflucan) is indicated for opportunistic candidiasis infection related to HIV. Candidiasis is a fungal infection. Trimethoprim/sulfamethoxazole (Bactrim) is indicated for bacterial infections such as urinary tract infection. Rifampin (Rifadin) is used for treatment of tuberculosis. Acyclovir (Zovirax) is an antiviral agent.
A client is prescribed prednisone for treatment of a type I hypersensitivity reaction. The nurse plans to monitor the client for which adverse effects? (SATA) A. Fluid retention B. Gastric distress C. Hypotension D. Infection E. Osteoporosis
A. Fluid retention B. Gastric distress D. Infection E. Osteoporosis Prednisone is a corticosteroid that may cause fluid and sodium retention. It can cause gastric distress and irritation and usually is taken with food or an antacid. Prednisone decreases the immune response, increasing the susceptibility for infection. It can also cause osteoporosis. Hypertension (not hypotension) is an adverse effect of prednisone.
The nurse is caring for a patient experiencing an immune response. She assesses the patient for development of a hyperimmune response while knowing that cytotoxic T cells are responsible for which action? A. May kill healthy cells along with foreign antigens. B. Are the most prevalent type of T lymphocyte. C. Can suppress the immune response. D. Diminish dendritic cell function.
A. May kill healthy cells along with foreign antigens. Cytotoxic T lymphocytes can kill healthy tissue along with antigens. Suppressor T cells help to keep cytotoxic T cells in check. Helper T cells are the most prevalent type of T lymphocyte, not cytotoxic cells. Cytotoxic T lymphocytes do not suppress the immune response but are a factor in optimal immune functioning. Suppressor T lymphocytes help to suppress the function of cytotoxic cells. Dendritic cell function enhances cytotoxic T lymphocyte functioning.
What is a cardiovascular manifestation of systemic lupus erythematosus (SLE)? A. Pericarditis B. Pleural Effusion C. Interstitial Fibrosis D. Myocardial Fibrosis
A. Pericarditis Pericarditis is a cardiovascular manifestation of systemic lupus erythematosus (SLE). A pleural effusion is a pulmonary manifestation of systemic lupus erythematosus. Interstitial fibrosis is a pulmonary manifestation of systemic sclerosis. Myocardial fibrosis is a cardiovascular manifestation of systemic sclerosis.
Which member of the health care team demonstrates reducing the risk for infection for a client with acquired immune deficiency syndrome (AIDS)? A. The dietary worker hands the disposable meal trays to the LPN assigned to the client. B. The social worker encourages the client to verbalize about stressors at home. C. A member of the housekeeping staff thoroughly cleans and disinfects the hallways near the client's room. D. The health care provider orders vital signs, including temperature, every 8 hours.
A. The dietary worker hands the disposable meal trays to the LPN assigned to the client. The dietary worker giving the meal tray to the LPN limits the number of health care personnel entering the room, thus reducing the risk for infection.Verbalizing stressors does not reduce the risk for infection. Cleaning of bathrooms, not hallways, at least once daily by housekeeping staff reduces risk for infection. Vital signs, including temperature, should be taken every 4 hours to detect potential infection, but this does not reduce the risk of infection.
An adolescent female with systemic lupus erythematosus (SLE) is trying to learn how to live with her illness. What teaching by the nurse is priority? A. Use protection against the sun whenever she is outside, regardless of the season. B. Maintain a high-protein diet to maintain healthy skin integrity and muscle fibers. C. Plan her schedule so she gets at least 10 hours of solid, deep sleep each night. D. Keep a diary so she can document her thoughts and feelings as she adjusts.
A. Use protection against the sun whenever she is outside, regardless of the season. Using protection against the sun whenever she is outside, regardless of the season, is a must to avoid triggers that cause exacerbations. A high-protein diet is usually contraindicated, because it places stress on the kidneys because protein molecules are large. Sleep and rest are important with prevention of fatigue, rather than a specific number of hours' being asleep as the priority. Keeping a diary so she can document her thoughts and feelings as she adjusts is important, but the physiologic needs must be addressed before the psychological ones.
HIV/AIDS Prevention
Abstinence or monogamous relationships and safe sexual practices
Examples of Hypersentivity Type I
Allergic Rhinitis (hay fever) Latex Allergy
Passive Natural Immunity
Antibodies passed from mother to fetus via placenta or the infant thru colostrum and breast milk
Systemic Lupus Erythematosus (SLE) Pathophysiology
Antinuclear antibodies -> immune complexes -> inflammation, damage. Complexes invade organs directly or cause vasculitis ->deprives organ of blood. Usually some degree of kidney involvement. *Women 10x more likely to be effected *The disease also occurs among American Indians, Asian Americans, and Hispanics *Often develops between ages 20-40
The nursing instructor asks the student nurse to explain a type IV hypersensitivity reaction. Which statement by the student best describes type IV hypersensitivity? A. "It is a reaction of immunoglobulin G (IgG) with the host cell membrane or antigen." B. "The reaction of sensitized T cells with antigen and release of lymphokines activate macrophages and induce inflammation." C. "It results in release of mediators, especially histamine, because of the reaction of immunoglobulin E (IgE) antibody on mast cells." D. "An immune complex of antigen and antibodies is formed and deposited in the walls of blood vessels."
B. "The reaction of sensitized T cells with antigen and release of lymphokines activate macrophages and induce inflammation." The best statement by the student describing type IV hypersensitivity reaction is that the reaction of sensitized T cells with antigen and release of lymphokines is a delayed hypersensitivity reaction, as is seen with poison ivy (type IV hypersensitivity).A reaction of IgG with the host cell membrane or antigen describes a type II hypersensitivity reaction. A release of mediators, especially histamine, because of the reaction of IgE antibody on mast cells describes a type I hypersensitivity reaction. An immune complex of antigen and antibodies deposited in the walls of blood vessels describes a type III hypersensitivity reaction.
A patient presents to the clinic with observable edema and erythema of the left forearm. A brief history reveals no exposure to potential irritating agents. On palpation, the nurse finds the area very warm and tender. What is the most likely cause of the patient's symptoms? A. An allergic reaction B. A complement cascade C. IgE reactions D. Clonal diversity
B. A complement cascade A complement cascade is responsible for the dilation of blood vessels and leaking of fluid from the vascular system to the area of insult, resulting in the swelling and redness associated with an inflammatory response. An allergic reaction can cause edema and erythema, but the question does not provide enough information to determine the specific cause of the swelling and redness. IgE is a specific immunoglobulin associated with signs and symptoms of allergic rhinitis. Clonal diversity refers to the maturation process of cells.
A client diagnosed with human immune deficiency virus is concerned about getting opportunistic infections and asks the nurse how to prevent them. Which interventions does the nurse recommend to the client? A. Clean toothbrushes once a week. B. Bathe daily using an antimicrobial soap. C. Eat salad at least once a day. D. Wash dishes in cool water.
B. Bathe daily using an antimicrobial soap. Bathing daily and using an antimicrobial soap will help decrease the risk for opportunistic infections by reducing the number of bacteria found on the skin.Toothbrushes should be cleaned daily through the dishwasher or by rinsing in liquid laundry bleach. Salads and raw fruits and vegetables could be contaminated and should be avoided. Dishes should be washed in hot, soapy water or in a dishwasher.
Which factor indicates to the nurse the only similarity between discoid lupus erythematosus (DLE) and systemic lupus erythematosus (SLE)? A. Feeling tired and having a temperature that runs about 100° F (37.8° C) during the day B. Disfiguring and embarrassing rash C. Peripheral neuropathies and cranial nerve palsies D. High risk for renal inflammation
B. Disfiguring and embarrassing rash Skin lesions associated with disfiguring and embarrassing rash are common to SLE and DLE.
Which factor relates most directly to a diagnosis of primary immune deficiency? A. History of viral infection B. Full-term infant surfactant deficiency C. Contact with anthrax toxin D. Corticosteroid therapy
B. Full-term infant surfactant deficiency Genetic mutation causes surfactant deficiency; this is a primary immune deficiency. Primary immunodeficiencydiseases (PI) are a group of more than 250 rare, chronic disorders in which part of the body'simmunesystem is missing or functions improperly.Viral infection can cause a secondary immune deficiency. Anthrax and medical therapy are examples of a secondary immune deficiency.
The nurse is teaching a mother about the use of oral corticosteroids to her 8-year-old child. Instruction by the nurse is correct if which information is given? (SATA) A. Administer the medication on an empty stomach to promote absorption. B. Give the medication with milk or food to prevent stomach upset. C. Postpone the administration of live virus vaccines until the oral corticosteroids are no longer being taken. D. Give live virus vaccines when the dose of oral corticosteroids is being reduced. E. Keep the child away from anyone with colds and coughs.
B. Give the medication with milk or food to prevent stomach upset. C. Postpone the administration of live virus vaccines until the oral corticosteroids are no longer being taken. E. Keep the child away from anyone with colds and coughs. Corticosteroids should be given with milk or food to prevent stomach upset. Live virus vaccines should not be given while a child is receiving corticosteroids. Corticosteroids mask infection and decrease the child's resistance to infection so they need to be kept away from sick or potentially sick individuals. Corticosteroids should be given with milk or food to prevent stomach upset. Live virus vaccines should not be given while a child is receiving corticosteroids
Which postoperative kidney transplantation client does the nurse assess first for signs and symptoms of hyperacute rejection? A. Older adult with Parkinson disease receiving a donation from an identical twin B. Grand multipara female with a history of subsequent blood transfusions C. Middle-aged man with a 20-pack-year history D. Young adult with type 1 diabetes
B. Grand multipara female with a history of subsequent blood transfusions The grand multipara female with a history of subsequent blood transfusions should be assessed first because multiple pregnancies and blood transfusions greatly increase the risk of a hyperacute rejection. Hyperacute rejection occurs mostly in transplanted kidneys but is less common now with better HLA matching. Symptoms of rejection are apparent within minutes of attachment of the donated organ to the recipient's blood supply. The process usually cannot be stopped once it has started, and the rejected organ must be removed as soon as hyperacute rejection is diagnosed.The older adult with Parkinson disease receiving a donation from an identical twin has less chance of hyperacute rejection because his donor is an identical twin. Smoking places the middle-aged man with a 20-pack-year history at higher risk for postoperative respiratory difficulties, but not for hyperacute rejection. Type 1 diabetes requires close postoperative monitoring of blood sugar, but does not predispose the client to a hyperacute rejection.
The nurse is working with a teenager with systemic lupus erythematosus (SLE). What therapeutic management would the nurse expect to include during patient and family education? A. Foods that are high protein and low sodium B. Oral corticosteroids to control inflammation C. Gold salts to suppress the inflammatory process D. An exercise regimen to build up muscle strength and endurance
B. Oral corticosteroids to control inflammation Corticosteroids to control inflammation is the current primary mode of therapy. Gold salts are slow-acting anti-rheumatic agents used for those who do not respond to nonsteroidal anti-inflammatory drugs. Exercise should be done in moderation. A balanced diet without exceeding caloric expenditures is recommended.
A client who is human immune deficiency virus positive is experiencing anorexia and diarrhea. Which nursing actions does the nurse delegate to a nursing assistant? A. Collaborate with the client to select foods that are high in calories. B. Provide oral care to the client before meals to enhance appetite. C. Assess the perianal area every 8 hours for signs of skin breakdown. D. Discuss the need to avoid foods that are spicy or irritating.
B. Provide oral care to the client before meals to enhance appetite. Providing oral care is within the scope of practice of unlicensed personnel such as nursing assistants.Diet planning, assessment, and client teaching are higher-level actions that require more broad education and scope of practice, and would be done by licensed staff.
A client who is exposed to invading organisms recovers rapidly after the invasion without damage to healthy body cells. How has the immune response protected the client? A. Intact skin and mucous membranes B. Self-tolerance C. Inflammatory response against invading foreign proteins D. Antibody-antigen interaction
B. Self-tolerance Self-tolerance is the process of recognizing and distinguishing between the body's own healthy self cells and non-self proteins and cells. The presence of different proteins on cell membranes makes the process of self-tolerance possible.The body has some defenses to prevent organisms from gaining access to the internal environment, such as intact skin and mucous membranes; however, they are not perfect—invasion of the body's internal environment by organisms often occurs. Inflammation provides immediate protection against the effects of tissue injury and invading foreign proteins. The inflammatory response is immediate but short-term against injury or invading organisms; it does not provide true immunity. Seven steps, known as phagocytosis (See Figure 17-6), are needed to produce a specific antibody directed against a specific antigen. These steps are necessary whenever the person is exposed to that antigen.
These WBCs release vasoactive amines (heparin, histamine, serotonin, kinins, and leukotrienes) when activated by an allergen...
Basophils stimulate both general inflammation and the inflammation of allergic reactions
HIV/AIDS Transmission
Blood, semen, vaginal secretions @ all stages of disease 75 % sexual intercourse (male -> male most common in US, male -> female in resource limited settings) IV drug abuse Placenta, delivery, breastmilk + risk AA and hispanics
The nurse is teaching a client about cyclosporine (Sandimmune) therapy after liver transplantation. Which client statement indicates the need for further teaching? A. "I will be on this medicine for the rest of my life." B. "I must undergo regular kidney function tests." C. "I must regularly monitor my blood sugar." D. "My gums may become swollen because of this drug."
C. "I must regularly monitor my blood sugar." Further teaching is needed when the client says, "I must regularly monitor my blood sugar." Blood sugar is not affected by taking cyclosporine, so the client has no need to monitor blood sugar.The client must take cyclosporine for the rest of his or her life. (See chart 17-2) Kidney dysfunction is a side effect of cyclosporine, so regular monitoring is required. Swollen gums are a side effect of taking cyclosporine.
The nurse is conducting a health assessment interview with a client diagnosed with human immune deficiency virus (HIV). Which statement by the client does the nurse immediately address? A. "When I injected heroin, I was exposed to HIV." B. "I don't understand how the antiretroviral drugs work." C. "I remember to take my antiretroviral drugs almost every day." D. "My sex drive is weaker than it used to be since I started taking my antiretroviral medications."
C. "I remember to take my antiretroviral drugs almost every day." It is important that clients take these drugs consistently, because inconsistent use of antiretroviral medications can lead to unsuccessful therapy and the development of drug-resistant HIV strains. The nurse would immediately assess the reasons why the client does not take the medications daily and then would implement a plan to improve adherence.The nurse would assess whether the client is still injecting drugs and would make certain the client understands the risks for infection with another strain of HIV or other blood borne pathogens and the risk for spreading HIV, but this does not need to be addressed immediately. The nurse must provide further education about how the medications work and assess how the lack of knowledge or decreased libido influences compliance, but this does not need to be addressed immediately.
The nurse is instructing an unlicensed health care worker on the care of a client with human immune deficiency virus (HIV) who also has active genital herpes. Which statement by the health care worker indicates effective teaching of Standard Precautions? A. "I need to know my HIV status, so I must get tested before caring for any clients." B. "Putting on a gown and gloves will cover up the itchy sores on my elbows." C. "Washing my hands and putting on a gown and gloves is what I must do before starting care." D. "I will wash my hands before going into the room, and then will put on a gown and gloves only for direct contact with the client's genitals."
C. "Washing my hands and putting on a gown and gloves is what I must do before starting care." Standard Precautions include hand hygiene and whatever personal protective equipment (PPE) is necessary for the prevention of transmission of HIV and genital herpes.Knowing HIV status is important for preventing transmission of HIV, but is not part of the Standard Precaution Protocol. Health care workers with weeping dermatitis should not provide direct client care regardless of the use of a gown and gloves. Unlicensed health care workers cannot make the determination of what is required for PPE or Standard Precautions.
The nurse plans to assess a client with type I hypersensitivity for which clinical manifestation? A. Poison ivy B. Autoimmune hemolytic anemia C. Allergic asthma D. Rheumatoid arthritis
C. Allergic asthma Allergic asthma is a clinical manifestation of type I hypersensitivity.Poison ivy is a type IV delayed mechanism of hypersensitivity. Autoimmune hemolytic anemia is a type II cytotoxic mechanism of hypersensitivity. Rheumatoid arthritis is a type III immune complex-mediated mechanism of hypersensitivity.
Assessment findings reveal that a client admitted to the hospital has a contact type I hypersensitivity to latex. Which preventive nursing intervention is best in planning care for this client? A. Report the need for desensitization therapy. B. Convey the need for pharmacologic therapy to the health care provider. C. Communicate the need for avoidance therapy to the health care team. D. Discuss symptomatic therapy with the health care provider.
C. Communicate the need for avoidance therapy to the health care team. The best nursing action is to communicate the need for avoidance therapy to the health care team. Contact hypersensitivities can occur with latex, pollens, foods, and environmental proteins.Desensitization therapy is administered via allergy shots when allergens have been identified and cannot easily be avoided. Discussing the need for pharmacologic therapy might be indicated if signs of type I or type IV hypersensitivity exist, but this is not a preventive measure. Symptomatic therapy interventions such as an epinephrine pen, antihistamines, and corticosteroids are not preventive but are effective only after the hypersensitivity reaction has already occurred.
A client who is receiving an intravenous antibiotic begins to cough and states, "My throat feels like it is swelling." Which action does the nurse take next? A. Infuse normal saline at 200 mL/hr. B. Administer epinephrine (Adrenalin) 1:1000, 0.3 mL subcutaneously. C. Discontinue infusing the antibiotic. D. Give diphenhydramine (Benadryl) 100 mg IV.
C. Discontinue infusing the antibiotic. The nurse's first action should be to discontinue the antibiotic. The antibiotic is the most likely cause of the client's apparent anaphylactic reaction.Infusing normal saline and administering epinephrine and diphenhydramine may be indicated, but these are not the nurse's first action.
The school nurse is discussing prevention of human immunodeficiency virus (HIV) transmission with adolescents in a health class. What information is appropriate to include? A. The virus is easily transmitted. B. The virus is only transmitted through blood. C. Intravenous drug users should not share needles. D. Condoms should be used for homosexual sex.
C. Intravenous drug users should not share needles. HIV is spread through blood and body fluids. Intravenous needles that have been used should not be shared. They may be contaminated with the virus. Condoms should be used for both heterosexual and homosexual sex. The virus is not transmitted unless blood or body fluids directly contact non-intact skin or mucous membrane. If those conditions exist, then transmission is indeed "easy." Body fluids may also transmit the virus.
Organ Rejection Pathophysiology
Caused by general and specific immunity functions of a host directed against tissues and organs transplanted from other people. Host natural killer (NK) cells and cytotoxic/cytolytic T-cells are the major cells responsible for the destructive attacks on transplanted organs (grafts) leading to host rejection of these helpful tissues.
Management of Infection in an Immunosuppressed Patient
Clinical management of infection
____ cells contain soluble plasma proteins in the blood stream and are responsible for dilation, leakage (redness and swelling)
Complement Enhance Inflammation- stimulate mast cells to secrete histamine which +vascular permeability, attracts leukocytes (macrophage and neutrophils)
Hypersentivity Type II
Cytotoxic Reactions Tissue specific
The nurse is reviewing discharge teaching with a client who suffered an anaphylactic reaction to a bee sting. Which statement by the client indicates the need for further teaching? A. "I must wear a medical alert bracelet stating that I am allergic to bee stings." B. "I need to carry epinephrine with me." C. "My spouse must learn how to give me an injection." D. "I am immune to bee stings now that I have had a reaction."
D. "I am immune to bee stings now that I have had a reaction." More teaching is needed if the client states, "I am immune to bee stings now that I have had a reaction." No immunity develops after an anaphylactic reaction. In fact, the next reaction could be more severe.The client should carry epinephrine (EpiPen) at all times and always wear a medical alert bracelet that states all allergies. Someone (spouse, neighbor, or family member) must learn how to give the client an injection in case the client is unable to self-administer the injection.
What is the gastrointestinal sign of systemic lupus erythematosus? A. Ulcers B. Dysphagia C. Esophagitis D. Abdominal pain
D. Abdominal pain Abdominal pain, which occurs due to peritoneal involvement, is the gastrointestinal manifestation of systemic lupus erythematosus (SLE). Ulcers, dysphagia, and esophagitis are the gastrointestinal manifestations of systemic sclerosis.
An alert, middle-aged client is admitted to the emergency department with wheezing, difficulty breathing, angioedema, blood pressure of 70/52 mm Hg, and apical pulse of 122 beats/min and irregular. The nurse makes an immediate assessment using the "ABCs" for any client experiencing anaphylaxis. What nursing intervention is the immediate priority? A. Raise the lower extremities. B. Start intravenous (IV) administration of normal saline. C. Reassure the client that appropriate interventions are being instituted. D. Apply oxygen using a high-flow non-rebreather mask at 40% to 60%.
D. Apply oxygen using a high-flow non-rebreather mask at 40% to 60%. The most immediate priority is for the nurse to apply oxygen in order to provide adequate oxygenation for the client who is in respiratory distress. Assessing respiratory status is the most important assessment priority.Raising the lower extremities, starting an IV infusion, and reassuring the client are not the first priority for a client in respiratory distress.
Which statement best exemplifies a client's protection from cancer provided by cell-mediated immunity (CMI) after exposure to asbestos? A. Cytotoxic and cytolytic T cells destroy cells that contain the major histocompatibility complex of a processed antigen. B. Helper and inducer T cells recognize self cells versus non-self cells and secrete lymphokines that can enhance the activity of white blood cells. C. Suppressor T cells prevent hypersensitivity when a client is exposed to non-self cells or to proteins. D. Balance elicits protection when helper or inducer T cells outnumber suppressor T cells by a ratio of 2:1.
D. Balance elicits protection when helper or inducer T cells outnumber suppressor T cells by a ratio of 2:1. After exposure to asbestos, a client's protection from cancer depends on a balance between helper and inducer T cells and suppressor T cells. This balance occurs when helper and inducer T cells outnumber suppressor T cells by a ratio of 2:1.The activity of cytotoxic and cytolytic T cells is most effective against self cells infected by parasites. Overreactions can cause tissue damage if an imbalance exists between helper and inducer T cells. When suppressor T cells are increased, immune function is suppressed and the client is at risk for infection.
The nurse is reviewing the medical record of a client who is prescribed a decongestant. The nurse plans to contact the client's health care provider if the client has which condition? A. Cataracts B. Crohn's disease C. Diabetes mellitus D. Hypertension
D. Hypertension The health care professional should be notified if the client has hypertension because decongestants have actions similar to adrenergic drugs, causing vasoconstriction and increasing blood pressure.Decongestants are not contraindicated in clients with cataracts, Crohn's disease, or diabetes mellitus.
A child is being discharged home on a regimen of oral corticosteroids. What information is most important for the nurse to explain to the parents? A. Reduce the dosage as quickly as possible so dependence on the medication is avoided. B. Any new cuts should be washed with soap and water and then covered with a bandage. C. Increased appetite and energy are interpreted as a positive response to the medication. D. If the child becomes ill, notify the physician who ordered the medication immediately.
D. If the child becomes ill, notify the physician who ordered the medication immediately. If the child becomes ill, the physician who ordered the medication should be notified because of the increased stress. Supplemental glucocorticoids might be necessary during times of increased stress to prevent adrenal insufficiency. The dosage should be tapered to allow for a gradual return of adrenal function. Any new cuts should be washed with soap and water then covered with a bandage, but this is true for most children and is not specific to taking corticosteroids. Energy spurts do not indicate anything especially and increased appetite is common with this type of medication.
Which statement describes systemic lupus erythematosus (SLE)? A. It is nonfatal. B. It affects men more often than women. C. It is an acute, nonprogressive disorder. D. It is characterized by spontaneous remissions and exacerbations.
D. It is characterized by spontaneous remissions and exacerbations. SLE is characterized by spontaneous remissions and exacerbations. It is fatal, but patients with SLE can lead a productive life. It affects women 10 times more often than men. It is not an acute, progressive disorder, but it is a chronic, progressive disorder.
Which factor distinguishes a diagnosis of human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome (AIDS)? A. Viral load B. Course of treatment C. Duration of infection D. Number of CD4+ T-cells
D. Number of CD4+ T-cells Everyone who has AIDS has an HIV infection, but not everyone who has HIV has AIDS. The distinction is the number of CD4+ T-cells and whether any opportunistic infections have occurred. Viral load, course of treatment, and duration of infection are not distinguishing factors between HIV and AIDS diagnoses.
Which nursing action is most appropriate for the nurse working in an allergy clinic to delegate to a nursing assistant? A. Plan the schedule for desensitization therapy for a client with allergies. B. Monitor the client who has just received skin testing for signs of anaphylaxis. C. Educate a client with a latex allergy about other substances with cross-sensitivity to latex. D. Remind the client to stay at the clinic for 30 minutes after receiving intradermal allergy testing.
D. Remind the client to stay at the clinic for 30 minutes after receiving intradermal allergy testing. The most appropriate action for the allergy clinic nurse to delegate to a nursing assistant is to remind the client about safety policies. This is within the scope of practice of a nursing assistant.Planning care and assessing for complications require broader education and scope of practice and should be done by the registered nurse. Client education is a registered nursing responsibility, requiring broader education and scope of practice.
A client in the allergy clinic develops all of these clinical manifestations after receiving an intradermal injection of an allergen. Which symptom requires the most immediate action by the nurse? A. Anxiety B. Urticaria C. Pruritus D. Stridor
D. Stridor The symptom that requires the most immediate action by the nurse is stridor which indicates airway involvement and warrants immediate intervention, such as use of oxygen and administration of epinephrine. Maintaining the client's airway is the highest priority.Anxiety, urticaria, and pruritus may be symptoms of a reaction, but are not the nurse's highest priority when the client is in respiratory distress.
Organ Rejection Diagnostics/Testing
Diagnosis of acute rejection is made by laboratory tests that show impaired function of the donated organ and by biopsy of the donated organ. Biopsy
HIV/AIDS Diagnostics/Testing
ELISA (enzyme linked immunoSorbent Assay)- general antibody test, 21 days after exposure Western Blot test- HIV specific antibodies, 28 days after exposure Antibody/antigen test- recommended for screening Viral load test (during tx) RNA test • The most common HIV tests used for infants and children younger than 18 months are the HIV DNA polymerase chain reaction (PCR) and HIV RNA quantitative assays, which detect the presence of the virus itself. Lymphocyte # CD4/CD8 ratio
HIV/AIDS Treatment: HAART
Ensure that cART drugs are not missed, delayed, or administered in lower-than-prescribed doses in the inpatient setting. Teach patients the importance of taking the cART drugs exactly as prescribed to maintain their effectiveness. Even a few missed doses per month can promote drug resistance (remember the 90% rule). Highly Active AntiRetroviral Therapy (ART) - combo of meds (HIV regimen): slow HIV replication, does not kill
These WBCs are active against parasites and limit the inflammatory response...
Eosinophils they INCREASE during an allergic response because they contain granules that degrade the vasoactive chemicals released by other WBCs
Immune Response to Hypersentivity Type III
Excess antigens ->immune complexes ->lodged in small blood vessels (kidneys, skin, joints)->inflammation -> tissue/vessel damage Labs: IgG, CRP, ANA, RF, ESR
Cytokine tumor necrosis factor (TNF)
Facilitates acute inflammatory response to infectious bacteria
What virus attacks and destroys the human immune system?
HIV
Examples of Hypersentivity Type II
Hemolytic Anemias Immune thrombocytopenic purpura Hemolytic transfusion reactions Rh incompatibility
Which immunoglobulin binds to mast cells and basophils and is involved in allergic reactions?
IgE *Binds to mast cells and basophils -> binds to antigens ->mast releases histamine (allergic/anaphylactic reactions) and parasites s/sx- warmth, swelling, rhinitis, coughing, itching
Which immunoglobulin is the second-responder after B lymphocytes are sensitized and come out in FORCE!!!!?
IgG sends in the correct antibody to fight disease, specific, large molecule, develops over days to weeks. Will see if they've had it in the past, but not currently.MEMORY Most prevalent in serum; provides naturally acquired passive immunity; neutralizes bacterial toxins, participates in complement fixation and enhances phagocytosis?
Which immunoglobulin is the first antibody formed by a newly sensitized B-lymphocyte plasma cell?
IgM · First responder or "Medic", recognizes antigens, starts inflammatory response, sends messages back to spleen, bone marrow to build antibodies against this pathogen, it's the Messenger · You actively have the disease if IgM elevated
Hypersentivity Type III
Immune Complex Reactions Autoimmune
____ is the impaired ability to provide an immune response
Immunosuppression
Exaggerated Response Densensitization
Immunotherapy, also known as desensitization therapy or allergy shots, involves subcutaneous injections of very dilute solutions of the identified allergens. The doses increase steadily over 5 years. Appears to reduce allergic responses by competition - slowly produces more IgG that binds to allergens and does not produce allergic response // therefore IgG outnumbers IgE and binds to the allergen leaving none for IgE to bind to to cause allergy.
Treatment for Hypersentivity Type I
Labs: +eosinophils, IgE, RAST Avoidance therapy: environmental changes, pets Rx: decongestanst, antihistamines-diphenhydramine S/Sx: drowsiness, Corticosteroids- prednisone-, mast cell stabilizers, leukotriene antagonists, epinephrine
What is anaphylaxis?
Life threatening allergic reaction
These WBCs are found within the lymph nodes, they are phagocytes that destroy bacteria, cancer cells, and other foreign matter in the lymphatic stream.
Macrophages help stimulate immediate inflammatory responses and also stimulates the longer-lasting immune responses of Antibody Mediated Immunity and Cell Mediated Immunity - include phagocytosis, repair, antigen presenting/processing, and secretion of cytokines
Organ Rejection Nursing Interventions
Maintenance therapy is the continuous immunosuppression used after a solid organ transplant. The drugs used for routine therapy after solid organ transplantation are combinations of a calcineurin inhibitor, a corticosteroid, and an antiproliferative agent *Corticosteroids are general, Calcineurin inhibitors and antiproliferative agents are part of "selective immunosuppressant" therapy. These drugs more specifically target immunity components that are responsible for rejection. Rescue therapy is used to treat acute rejection episodes. The drug categories for this purpose are the monoclonal and polyclonal antibodies (see Chart 17-2). The drugs used for maintenance are often also used during rejection episodes at much higher dosages than for maintenance
These cells release chemicals (such as histamine) that promote inflammation...
Mast Cells differentiate and mature in tissues - involved in asthma/allergic reactions - release heparin - maintain and prolong allergic reactions
___ cells do not produce antibodies until next exposure to same antigen. They remain sensitized and ready for the next invasion of the same antigen.
Memory Cells
This WBC cell is an immature version of a macrophage and lives in the blood until it moves into the body tissue and turns into a macrophage...
Monocytes They release cytokines (make blood vessels leaky and attract granulocytes), only circulate in blood
This type of WBC engulfs invading microbes and contributes to the nonspecific defenses of the body against disease....
Neutrophils (granulocytes) -Only mature cells can do phagocytosis -The higher the # of mature neutrophils, the greater resistance to infection = measured by the absolute neutrophil count
Organ Rejection: Acute Signs and Symptoms
Occurs within 1 week to 3 months after transplantation 1. antibody mediated -> vasculitis w/in transplanted organ. Blood vessel necrosis -> organ destruction 2. Cellular: NK and cytotoxic T cells enter organ -> inflammatory response -> lysis of organ cells Sx vary depending on organ- tenderness, general symptoms of inflammation, vasculitis
Exaggerated Response Pathophysiology
Overactive immunity in response to antigen w/previous exposure + IgE production -> histamine -> acute inflammation *Cellular proteins draw more WBCs to area -> general inflammatory rx w/leukotriene and prostaglandins
Management of GI Dysfunction in an Immunosuppressed Patient
Pharmacologic treatment of diarrhea, candidiasis, and fluid and electrolyte loss
Management of Skin Disorders in an Immunosuppressed Patient
Pharmacologic treatment of skin rash
Management of Immunosuppression in an Exaggerated Immune Response
Pharmacotherapy: Corticosteroids, chemotherapeutic agents, NSAIDs, immunomodulators
HIV/AIDS Nursing Interventions
Place the patient in a private room whenever possible. • Use good handwashing technique or alcohol-based hand rubs before touching the patient or any of his or her belongings. • Ensure that the patient's room and bathroom are cleaned at least once each day. • Do not use supplies from common areas for neutropenic patients. For example, keep a dedicated box of disposable gloves in his or her room and do not share this box with any other patient. Provide single-use food products, individually wrapped gauze, and other individually wrapped items. • Limit the number of personnel entering the patient's room. • Monitor vital signs, including temperature, every 4 hours. • Inspect the patient's mouth at least every 8 hours. • Inspect the patient's skin and mucous membranes (especially the anal area) for the presence of fissures and abscesses at least every 8 hours. • Inspect open areas such as IV sites every 4 hours for signs of infection. • Change gauze-containing wound dressings daily. • Obtain specimens of all suspicious areas for culture (as specified by the agency) and promptly notify the primary health care provider. • Help the patient perform coughing and deep-breathing exercises. • Encourage activity at a level appropriate for the patient's current health status. • Keep frequently used equipment in the room for use with this patient only (e.g., blood pressure cuff, stethoscope, thermometer). • Limit visitors to healthy adults. • Use strict aseptic technique for all invasive procedures. • Avoid the use of indwelling urinary catheters. • Keep fresh flowers and potted plants out of the patient's room. • Teach the patient to eat a low-bacteria diet (e.g., avoiding raw fruits and vegetables; undercooked meat, eggs, and fish; pepper and paprika as seasonings sprinkled on food right before eating).
Examples of Hypersentivity Type IV
Positive Purified protein Derivative Contact dermatitis Poison Ivy skin rashes Insect sting rx Tissue Transplant rejection
Active Acquired Immunity
Protection developed by vaccination or immunization - the body is given small amounts of specific antigens and the immune system responds by actively making antibodies - LAST FOR MANY YEARS BUT BOOSTER SHOTS ARE REQUIRED TO RETAIN PROTECTION**
Testing for Immunosuppression
RBC WBC Fluorescent antinuclear antibody test C-reactive protein- determines general inflammation Erythrocyte sedimentation rate- monitor inflammatory diseases Allergy testing- skin test, IgE test ELISA (enzyme-linked immunosorbent assay)- determine blood levels of IgG subclasses and efficiency Western blot test- confirm presence of antibodies to HIV
Hypersentivity Type I
Rapid Hypersensitivity Reactions Atopic Allergy
Systemic Lupus Erythematosus (SLE) Psychosocial Assessment
Rash -disfiguring Social withdrawal Unpredictability of flare ups-> fear and anxiety ***fear they're going to die = let them know if managed effectively control is possible**
Systemic Lupus Erythematosus (SLE) Diagnostics/Testing
Rheumatoid factor Antinuclear antibody ESR Serum complement Immunoglobulins CBC ->pancytopenia Urine Tests DLE- skin biopsy
Treatment for Hypersentivity Type II
Run Normal Saline Discontinue offending treatment Plasmapheresis STAY WITH THE CLIENT FOR THE FIRST 15 MINUTES!
Systemic Lupus Erythematosus (SLE) Signs & Symptoms
Skin: "butterfly rash", alopecia, discoid lesions, mouth ulcers, fever, fatigue, anorexia, joint inflammation
Organ Rejection Function of Prograf (Tacrolimus)
Slows the growth of immune system cells responsible for autoimmune diseases side effects = Nephrotoxic, HTN, Hyperkalcemia, hypomag, hyperglycemia, opportunisitic infections, malignancies (basically electrolyte imbalances) \ Poor pregnancy and breastfeeding outcomes
Management of Anaphylaxis in an Exaggerated Immune Response
Support of airway, breathing, and circulation: Subcutaneous epinephrine if type 1 reaction; other bronchodilators; intubation and ventilator support, circulatory volume expanders, and vasopressors to maintain blood pressure and circulating volume
Organ Rejection Function of Corticosteroids (Prednisone & Prednisolone)
Suppress bone marrow production of all WBCs. Inhibit cytokine production -> generalized immunosuppression
Immune Response to Hypersentivity Type IV
T-cell is reactive (antibodies and complement not involved) Local collection of lymphocytes and macrophages ->edema, induration, ischemia, tissue damage
Exaggerated Response Nursing interventions
TIME IS CRITICAL *Immediately assess respiratory tatus and O2*Call Rapid Response*Ensure intubation and trach equip is ready*Apply O2 using a high-flow, nonbreather at 90%-100%*Immediate discontinue IV drug causing reaction. Change tubing and replace with NS *Start an IV if patient doesn't have on already, run NS*Prepare to admin Epinephrine IV or IM*Keep HOB elevated at 10degrees if hypotension present, if BP normal elevate 45*Raise feet and legs*Stay with patient*Reassure patient that appropriate interventions are being instituted
HIV/AIDS Pathophysiology
Targets CD4+ cells (T-helper cells, dendritic, macrophages) CD4 helps immune cells communicate Single stranded RNA retrovirus- enters host DNA, when immune cell activated, transcribes new HIV viruses
Passive immunity is ____.
Temporary Immunity in newborn babies is only temporary and starts to decrease after the first few weeks, or months.
Organ Transplant
Transplant rejection is caused by general and specific immunity functions of a host directed against tissues and organs transplanted from other people. Host natural killer (NK) cells and cytotoxic/cytolytic T-cells are the major cells responsible. Because the solid organ transplanted into the recipient (host) is seldom a perfectly identical match of human leukocyte antigens (HLAs) (unless the organ is obtained from an identical sibling) between the donated organ and the recipient host, the patient's immune system cells recognize a newly transplanted organ as non-self. Without intervention, the recipient's immune system starts immunologic actions that destroy these non-self cells, leading to rejection of the transplanted organ. Rejection can be hyper acute, acute, or chronic.
What are the clinical findings of immunosuppresion?
Vitals out of wack Weight loss Fatigue Impaired wound healing Infections Change in cognitive function r/t chronic inflammation Seizures
Passive Acquired Immunity
When adult is exposed to a serious disease for which he or she has little or no actively acquired immunity - antibodies are injected - used to prevent disease or death for patients exposed to tetanus, rabies, or poisonous snake bites
Active Natural Immunity
When antigen enters the body naturally without human assistance and the body responds by actively making antibodies against that antigen (ex: getting the Flu) - the invasion triggers antibody production - THIS IS THE MOST EFFECTIVE AND LONGEST LASTING**
Organ Rejection Function of Antiproliferatives
a substance used to inhibit something essential to DNA synthesis and prevent the spread of cells into surrounding tissue Some have additional immune suppressive actions. Side effects = Bone marrow suppression, thrombocytopenia, anemia, pancreatitis, hepatotoxicity, malignancies
What are the clinical findings of an exaggerated response?
an allergic response sneezing, watery eyes, nasal congestion Rashes, swelling, shock syndrome Autoimmune: organ function impairment
Passive Immunity
antibodies against antigen are transferred to a human after first being created in another human or animal - provides IMMEDIATE and SHORT protection
Immune Response to Hypersentivity Type II
autoantibodies directed at self cells w/foreign protein attached. Fever, chills, impending doom, F&E off, dark urine
Exaggerated Response Prevention
avoid known allergens, wear medical alert bracelet, carry EpiPen, alert HCP re specific allergies
Exaggerated Response Corticosteroids
broadly inhibit cytokine production in most leukocytes, resulting in generalized immunosuppression
Systemic Lupus Erythematosus (SLE)
is a chronic, progressive, inflammatory connective tissue disorder that can cause major body organs and systems to fail. Like RA, it is characterized by spontaneous remissions and exacerbations ("flare-ups"), and the onset may be acute or insidious (slow). The condition is potentially fatal, but most patients with SLE live many years after diagnosis and lead productive lives
Exaggerated Response Signs & Symptoms
nasal conjunctival mucosa, pruritis, erythema, inflammation Sudden severe abd cramping, diarrhea, urticaria (hives), angioedema
Signs of inflammation
redness, heat, swelling, pain, loss of function
What is Organ Rejection?
when the body recognizes an organ (after a transplant) as foreign and attacks it, leading to organ death
