Test 3: Immunity
Which option should the nurse encourage to replace fluid and electrolyte losses in a client with AIDS?
Liquids
Why is SLE known as "the great imitator"?
May affect many different body systems: Skin Musculoskeletal Cardiovascular Lungs Kidneys Central nervous system Red blood cells and platelets Mimics LOTS of other diseases
A nurse is collecting objective data for a client with AIDS. The nurse observes white plaques in the client's oral cavity, on the tongue, and buccal mucosa. What does this finding indicate?
Candidiasis Thrush
Why must you be careful with COX-2 inhibitors?
Cardiovascular issues Do not give with history of heart disease or recent MI
What is HIV 1?
Cause of most AIDs in US
What does phagocytic mean?
Cell eating
What is type 1 hypersensitivity?
Commonly called an "allergic reaction" Anaphylactic IgE (antibody) mediated reaction IgE binds to MAST CELLS causing them to release HISTAMINE
What is the diagnosis criteria of SLE?
Complete history and physical exam ANA - antinuclear antibody - positive in more than 95% Anti-DNA Anti-ds DNA Anti-sm CBC
What is type 2 hypersensitivity?
CYTOTOXIC Type Hypersensitivity IgG and IgM (antibody) involved in reaction Red blood cells involved = transfusion / hemolytic diesease Autoimmune involved = Graves disease / Myasthenia gravis Body gets confused and identifies a normal part of the body as foreign
What is the management of anaphylaxis?
Call rapid response AIRWAY!!!!!!!!!!!!!!!!!!! Epinephrine Antihistamines and corticosteroids IV fluids Vasopressors
What are T cells?
T lymphocytes Cell-mediated immunity Attack foreign cells directly
When obtaining a health history from a patient with possible abnormal immune function, what question would be a priority for the nurse to ask?
"Have you ever received a blood transfusion?" Exposure to foreign antigens may cause altered immune function
A nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan?
"Monitor your body temperature." REPORT FEVERS
The nurse is teaching a newly diagnosed client about systemic lupus erythematosus(SLE). What statement by the client indicates the teaching was successful?
"The belief is that it is an autoimmune disorder with an unknown trigger."
The nurse is teaching a client about rheumatic disease. What statement best helps to explain autoimmunity?
"Your symptoms are a result of your body attacking itself."
What are the different types of HIV tests?
-Antibody -Antigen/Antibody -Nucleic acid (RNA)
How is HIV 1 transmitted?
-Blood and blood products -Seminal fluid -Vaginal secretions -Mother-to-child: Amniotic fluid, breast milk -Not through casual contact
What is stage 3 of the HIV infection?
-CD4+ T-lymphocyte cell -below 200 cells/mm3 of blood -AIDS
What is stage 2 of the HIV infection?
-CD4+ T-lymphocyte cells -200 and 499 cells/mm3 -Viral load increased
What is the diagnostic criterial of RA?
-Morning stiffness lasting for 1hr for 6 wks -Arthritis with swelling or effusion of 3 or more joints for at least 6 wks -Arthritis of wrist, MCP, PIP joints for 6 wks -Symmetric arthritis -Rheumatoid nodules -Positive serum rheumatoid factor
What are lymphomas?
A general term for cancers that start in the lymph system Hodgkin and Non-Hodgkin (more common) Weight loss, night sweats, & fever
What is Pneumocystis Pneumonia (PCP)?
A serious infection caused by the fungus Pneumocystis jirovecii Most people who get PCP have a medical condition that weakens their immune system, like HIV/AIDS Initial symptoms: progressive dyspnea, fever, nonproductive cough, and chest discomfort If untreated, progresses to pulmonary impairment and respiratory failure Treatment: trimethoprim-sulfamethoxazole (TMP-SMZ)
What is an allergen?
A substance that causes an allergic reaction
What is Sjogren's syndrome?
A systemic autoimmune disease that affects exocrine galnds Causes a deficiency in saliva, tears, skin lubrication, and other exocrine secretions
What is a common lab in SLE?
ANA Antinuclear antibodies
What are cytotoxic T cells?
T lymphocytes that hunt down and destroy cells that have been tagged with a specific antigen
What are diagnostic tests of a patient with allergic disorders?
CBC: eosinophil count Total serum IgE or serum specific IgE formerly known as RAST Skin tests: prick, scratch, and intradermal
What is antiretroviral therapy?
ART Suppress HIV replication Reduce HIV - associated morbidity and prolong duration and quality of life Restore and preserve immunologic function Maximally and durably suppress plasma HIV viral load Prevent HIV transmission Combination of 3 drugs from 2 or more classes
What are variables that effect the immune system?
Age Nutrition History of infection Allergies Autoimmune disorders Cancer Chronic illness Surgery Medications Lifestyle choices
The nurse is educating a patient with allergic rhinitis about how the condition is induced. What should the nurse include in the education on this topic?
Airborne pollen or mold
What is a latex allergy?
Allergic reaction to natural rubber proteins Rhinitis Conjunctivitis Contact dermatitis Asthma Anaphylaxis Type 1 or 4 reaction
What is an allergy?
An inappropriate, often harmful response of the immune system to normally harmless substances
What are salicylates used for?
Anti inflammatory Analgesic Inhibit synthesis of prostaglandin, used to treat mild to moderate pain and fever
What are immunoglobulins?
Antibodies
What are dendritic cells?
Antigen-presenting cells They live under the skin and in mucosa and remember antigens they have killed
What is the management of allergic rhinitis?
Antihistamines Cetirizine (Zyrtec) Levocetirizine (Xzyal) Desloratidine (Clarinex) Loratidine (Claritin) Fexofenadine (Allegra) Side effects: dry mouth, blurred vision
What is IgM?
Appears in intravascular serum Responds to bacterial and viral infections
What us acquired or adaptive immunity?
B cells T cells
Which of the following cell types are involved in humoral immunity?
B lymphocytes
What are B cells?
B-lymphocytes Humoral immunity Release antibodies into the blood
A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client?
Bank autologous blood Donate your own!
Why is HIV called a retrovirus?
Because it carries its genetic material in the form of ribonucleic acid (RNA) rather than deoxyribonucleic acid (DNA)
What are leukotriene receptor antagonists?
Block the effect of leukotrienes Montelukast (Singulair) Side effects: Cold symptoms, GI upset, headache, fatigue, poor appetite
What is an allergic reaction?
Body encounters allergens that are types of antigens Body's defenses recognize antigens as foreign Series of events occurs in an attempt to render the invaders harmless, destroy them, and remove them from the body
What is Kaposi sarcoma?
Brownish pint to deep purple lesions Cutaneous lesions but may involve multiple organ systems Lesions cause discomfort, disfigurement, ulceration, and potential for infection
What are nasal spray corticosteroids?
Budesonide (Rhinocort) Fluticasone (Flonase) Mometasone (Nasonex) Triamcinolone(Nasacort) Side effects: unpleasant taste, nasal irritation, nosebleeds
A nurse is assessing a client with Kaposi's sarcoma. What initial sign does the nurse know to look for during assessment?
Deep purple cutaneous lesions
What is active acquired immunity?
Defenses developed by person's own body Lasts many years; may last a lifetime
What are Fusion Inhibitors?
Enfuvirtide (Fuzeon) Prevents the fusion of the virus with the human cellular membrane, which prevents the HIV-1 virus from entering the cell BLOCKS ATTACHING TO THE CELL
Which blood test confirms the presence of antibodies to HIV?
Enzyme immunoassay (EIA)
What are the hormonal factors of SLE?
Imbalance of estrogen Oral contraceptive use Early onset of menses Hormone replacement therapy Estrogen stimulates immune response
The nurse is administering injected allergens for "hyposensitization," which may produce harmful systemic reactions. Prior to administering these allergens, what medication should the nurse have at the bedside?
Epinephrine
What should an SLE patient be taught to ALWAYS report?
FEVER
What is natural or innate immunity?
FIRST LINE OF DEFENSE Physical barrier - skin Chem barrier - stomach acid / tears Phagocytic cells - Neutrophils / macrophages NK cells Dendritic cells
A nurse assesses a client in the health care provider's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)?
Facial erythema, pericarditis, pleuritis, fever, and weight loss
What are the systemic symptoms of SLE?
Fever Fatigue Skin rashes - Butterfly Joint pain and swelling
A client with lupus has had antineoplastic drugs prescribed. Why would the physician prescribe antineoplastic drugs for an autoimmune disorder?
For their immunosuppressant effects Drug therapy using anti-inflammatory and immunosuppressive agents is the mainstay for alleviating symptoms of SLE
What are leukocytes divided into?
Granulocytes Agranulocytes
What is the treatment of SLE?
Monoclonal antibodies: Belimumab (Benlysta) Rituximaub (Rituxan) NSAID's Antimalarials: Hydroxychloroquine (Plaquenil) Corticosteroids Immunosuppressive agents
What is graft vs host disease?
Most common after allogeneic stem cell transplantation Acute or chronic The graft must contain cells that are immunologically competent The recipient's cells must express antigens that are not present on donor cells The recipient must be immunologically compromised and incapable of mounting an effective immune response
What are NK cells?
Natural killer cells
Which granulocyte is the most abundant?
Neutrophils
What are granulocytes?
Neutrophils Eosinophils Basophils
A nursing instructor is giving a lecture on the immune system. The instructor's discussion on phagocytosis will include:
Neutrophils and monocytes
What is the treatment for EARLY RA?
Nonbiologic or biologic DMARD Begin within 3 months
What are negative HIV antibody results?
Not present in the blood at this time (not been infected with HIV or, the body has not yet produced antibodies) Continue taking precautions (does not mean that the patient is immune to the virus or not infected; it just means that the body may not have produced antibodies yet)
The nurse is talking to a group of community volunteers about food allergies. What are the foods that cause the most severe allergic reactions and result in the highest client death rates?
Nut Peanut and tree nut
What is the treatment of MOD RA (erosive)?
OT and PT along with medication
What is mycobacterium avium complex (MAC)?
Occur in clients with CD4 <50 cells/mm Fever, night sweats, weight loss, fatigue, diarrhea & abdominal pain Treatment: Clarithromycin with Ethambutol
What is hyperacute rejection?
Occurs almost immediately after transplantation Type III hypersensitivity reaction
What is chronic rejection?
Occurs over a long period T-cell generated cytokines stimulate fibrosis of graft tissue
What is an acute rejection?
Occurs within days to weeks after transplantation T lymphocytes respond to antigens in the graft tissue
A nurse is exposed to hepatitis C and receives a shot of gamma globulin. What type of immunity does this nurse have?
Passive immunity Passive immunity develops when ready-made antibodies are given to a susceptible person
What is the most common cause of anaphylaxis?
Penicillin
What does bone marrow consist of?
T and B cells Provide the environment for immune cell production and maturation
A client with human immunodeficiency virus (HIV) develops a nonproductive cough, shortness of breath, a fever of 101°F and an O2 saturation of 92%. What infection caused by Pneumocystis jiroveci does the nurse know could occur with this client?
Pneumocystis pneumonia
What happens if you have been exposed to HIV?
Post exposure prophylaxis (PEP) Antiretroviral medications within 72 hours of exposure 2 to 3 drugs prescribed for 28 days Testing ANTIBODY TEST Baseline 6 weeks 12 weeks 6 months If test is a antigen/antibody test Baseline 6 weeks 4 months CBC, renal & hepatic function test Baseline 2 weeks post exposure
What are oral corticosteroids?
Prednisolone (Prelone) Prednisone Methylprednisolone (Medrol) Side effects: increased appetite, mood changes, difficulty sleeping DO NOT STOP ABRUPTLY - can cause adrenal insufficiency
What corticosteroids are used for treatment in RA?
Prednisone Prednisolone Hydrocortisone Fast acting; onset in days Intra-articular injections are useful for joints unresponsive to NSAIDs
What are positive HIV antibody results?
Present in the blood (infected with the virus, and the body has produced antibodies) HIV can be transmitted to others Antibodies do not indicate immunity
What is the function of the thymus gland?
Programs T lymphocytes to become regulator or effector T cells
The nurse knows that a patient who presents with the symptom of "blanching of fingers on exposure to cold" would be assessed for what rheumatic disease?
Raynaud's phenomenon
What is the treatment of PERSISTENT RA (erosive)?
Reconstructive surgery if pain not controlled or threat of loss of independence
Which condition is associated with impaired immunity relating to the aging client?
Renal function decreases
What is immunity?
Resistance to disease or infection
What is type 4 hypersensitivity?
T cell mediated Delayed reaction Occurs 1-3 days after exposure to antigen Contact dermatitis + Hashimoto thyroiditis + sacroidosis
What are the chronic clinical manifestations of RA?
SYMMETRICAL inflammation of peripheral joints Pain + swelling Significant, often disabling morning stiffness Fatigue and malaise Weakness Fever Decreased ROM
What is the complement system?
Serum proteins produced by the liver that assist the immune system in destroying microbes
What are some risks associated with HIV?
Sharing needles Sex with infected individuals Infants born to/breastfed by HIV+ mothers People who received organ transplants / HIV infected blood / blood products
What are leukotrienes?
Signaling chemicals that mediate inflammation and some allergic reactions Bronchoconstrictors / congestion
What are disease modifying antirheumatic drugs (DMARDs)?
Slows the inflammatory response and the joint damage associated with it, reduce swelling and pain Decrease synovial inflammation and delay the destruction of cartilage and bone Gold standard Start early in disease - within 3 mnths of diagnosis More affordable Nonbiologic or Biologic
What are the precautions used for HIV patients?
Standard
What are corticosteroids?
Steroid hormones Suppress inflammation
What are helper T cells?
Stimulate the release of B cells and cytotoxic T cells
What is the clinical manifestation of juvenile RA?
Synovial inflammation Morning stiffness and joint pain Increased irritability, guarding of involved joint, refusal to walk, limping Fatigue, low grade fever, anorexia, weight loss, failure to grow Anemia
Which disorder is characterized by an increased autoantibody production?
Systemic lupus erythematosus (SLE)
What is passive acquired immunity?
Temporary Results from transfer of a source outside of the body
What are the precautions of allergic diagnostic tests?
Testing is not performed during periods of bronchospasm Emergency equipment must be readily available to treat anaphylaxis
A client on antiretroviral drug therapy informs the nurse about sometimes forgetting to take the medication for a few days. What should the nurse inform the client can occur when the medications are not taken as prescribed?
The client is risking the development of drug resistance and drug failure
What is an syngeneic transplant?
The donor and recipient are identical twins
What is an allogeneic transplant?
The donor and recipient are related or unrelated but share similar HLA types
What is an autologous transplant?
The donor and recipient are the same person Donate own blood
What is wasting syndrome?
The involuntary loss of more than 10% of body weight, plus more than 30 days of either diarrhea, or weakness and fever
What is transplantation?
The process of taking cells, tissues, or organs, called a graft, from one person and placing them into another person where they take over the normal function of the tissues replaced
What are suppressor T cells?
These inhibit activity of B-cells and other T cells when infection is under control
What is oral candidiasis?
Thrush May progress to esophagus and stomach Treatment with Mycelex troches or nystatin, ketoconazole
T-cell deficiency occurs when which gland fails to develop normally during embryogenesis?
Thymus
What type of hypersensitivity is SLE?
Type 3 Formation of autoantibodies and immune complexes
What is hematopoietic stem call transplant?
Used to treat many malignant and nonmalignant diseases Stem cells are harvested, processed, and reinfused Harvested from bone marrow, peripheral blood, or umbilical blood May be autologous, allogeneic, or syngeneic Administer chemo
What is an anaphylactic reaction characterized by?
Vasodilation Bronchoconstriction Increased capillary permeability Smooth muscle contraction Laryngeal stridor / edema Angioedema Hypotension Hives
What are tests that evaluate immune function?
WBC count / differential Bone marrow biopsy Humoral / cellular immunity test Phagocytic cell function test Complement component tests Hypersensitivity test Antigen / Antibody test HIV test
What are leukocytes?
White blood cells (WBCs)
A client is informed of having a low white blood cell count and that the client is at risk for the development of infections. The client asks, "Where do I make new white blood cells?" What is the best response by the nurse?
White blood cells are produced in the bone marrow
Who is affected more by RA?
Women 40-60 yrs old
Do HIV patients suffer from diarrhea bad bad poopy?
Yes Diarrhea related to HIV infection or enteric pathogens Octreotide acetate for severe chronic diarrhea
What are Nucleosides Reverse Transcriptase Inhibitors (NRTIs)?
abacavir (Ziagen) didanosine (Videx) emtricitabine (Emtriva) lamivudine (Epivir) stavudine (Zerit) tenofovir (Viread) zidovudine (Retrovir) Compete with the naturally occurring nucleosides within the cell that the virus would use to build the DNA chain INHIBIT REVERSE TRANSCRIPTASE
What are Protease Inhibitors?
atazanavir (Reyataz) darunavir (Prezista) fosamprenavir (Lexiva) indinavir (Crixivan) lopinavir/ritonavir (Kaletra) nelfinavir (Viracept) ritonavir (Norvir) saquinavir (Invirase) tipranavir (Aptivus) Protease is essential for the maturation of an infectious virus; without it an HIV particle is immature and noninfective INHIBIT PROTEASE
What are Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)?
delavirdine (Rescriptor) efavirenz (Sustiva) etravirine (Intelence) nevirapine (Viramune) rilpivirine (Edurant) Bind directly to HIV reverse transcriptase, blocking both RNA- and DNA-dependent DNA polymerase activities They prevent the transfer of information that would allow the virus to carry on the formation of viral DNA The virus is unable to take over the cell and reproduce INHIBIT REVERSE TRANSCRIPTASE
What are Integrase Strand Transfer Inhibitors?
dolutegravir (Tivicay) raltegravir (Isentress) These drugs inhibit the activity of the virus-specific enzyme integrase, an encoded enzyme needed for viral replication INHIBIT INTEGRASE
The nurse is reviewing various medications with a client that can be used to treat allergic disorders. What medication will the nurse identify as an intranasal corticosteroid?
fluticasone (Flonase)
A client is prescribed a disease-modifying antirheumatic drug that is successful in the treatment of rheumatoid arthritis but has side effects, including retinal eye changes. What medication will the nurse anticipate educating the client about?
hydroxychloroquine (Plaquenil) Antimalarial The DMARD hydroxychloroquine is associated with visual changes, GI upset, skin rash, headaches, photosensitivity, and bleaching of hair.
What are some NSAIDs?
ibuprofen (Motrin) naproxen (Naprosyn)
What are some salicylates?
•Aspirin (Bayer, etc.): Treats inflammatory conditions •Choline magnesium trisalicylate (Trilisate): Treats mild pain and fevers and arthritis •Choline Salicylate (Arthropan): Treats mild pain and fevers as well as arthritis
What is juvenile RA?
•Chronic inflammatory autoimmune disorder •Characterized by joint inflammation •Treatment similar to adults •Remission may last for years, months, lifetime •Affects joints and surrounding tissues •No cure
What are the systemic effects of RA?
•Fever •Fatigue •Anemia •Lymph node enlargement •Skeletal muscle atrophy •Rheumatoid nodules •Raynaud's phenomenon and Sjögren's syndrome
What is epinephrine?
Hormone (stress) mimic sympathetic Bronchodilation Increased heart rate Increased resp rate Increased blood pressure
What is HIV?
Human immunodeficiency virus
What is HLA?
Human leukocyte antigen
Which assessment suggests to the nurse that a client with systemic lupus erythematous is having renal involvement?
Hypertension
A client who is HIV positive is experiencing severe diarrhea. Which laboratory test result would the nurse expect to find?
Hypokalemia Electrolyte imbalances such as decreased sodium, potassium, calcium, magnesium, and chloride typically result from profuse diarrhea
What are CD4 Post-Attachment Inhibitors?
Ibalizumab-uiyk (Trogarzo) Bind to the CD4 receptor on a host CD4 cell - blocks HIV from attaching to the CCR5 and CXCR4 coreceptors and entering the cell BLOCKS ENTERING THE CELL
A client is being discharged from the hospital after being diagnosed with and treated for systemic lupus erythematosus (SLE). What would the nurse not say when teaching the client and family information about managing the disease?
If you have problems with a medication, you may stop it until your next physician visit
The nurse is discussing the new medication that a client will be taking for treatment of rheumatoid arthritis. Which disease-modifying antirheumatic drug (DMARD) will the nurse educate the client about?
Methotrexate
What are the IV corticosteroids?
Methylprednisolone (Solu-MEDROL)
What is the onset of juvenile RA?
-Recurrent fever (103 or higher) -May have salmon color rash (that come & go)
What is stage 1 of the HIV infection?
-Viral set point -Few or no symptoms -8 to 10 yrs
What is the life cycle of the HIV virus?
1) Virus binds CD4 cell 2) Virus fuses with the macrophage CD4 cell 3) Reverse transcription in the cytoplasm (HIV RNA converted to HIV DNA) 4) Incorporation of the DNA into the host DNA 5) Replication 6) Assembly 7) Budding
What are some disease modifying antirheumatic drugs (DMARDs)?
2 KINDS - ANTIMALARIALS AND IMMUNOSUPPRESSIVES ANTIMALARIALS = hydroxychloroquine (Plaquenil) chloroquine (Aralen) IMMUNOSUPPRESSIVES = Methotrexate (Rheumatrex)
A patient received epinephrine in response to an anaphylactic reaction at 10:00 AM. The nurse knows to observe the patient for a "rebound" reaction that may occur as early as:
2pm Rebound reactions can occur from 4 to 10 hours after an initial allergic reaction
The nurse is evaluating a client's complete blood cell count and differential along with the serum immunoglobulin E (IgE) concentration. Which result might indicate that the client has an allergic disorder?
High IgE concentration
A nurse is working in a dermatology clinic with clients who have allergies. What is the most important chemical mediator involved in the allergic response?
Histamine
Which body substance causes increased gastric secretion, dilation of capillaries, and constriction of the bronchial smooth muscle?
Histamine
What is the functions of chemical mediators in an allergic reaction?
Allergen triggers the B cell to make IgE antibody IgE antibody attaches to the mast cell When that allergen reappears, it binds to the IgE Then triggers the mast cell to release its chemicals
What is IgE?
Appears in serum Plays a role in allergic and hypersensitivity reactions Protects against parasitic infections
What is IgG?
Appears in serum and tissue Assumes major role in bloodborne and tissue infections
What intervention is a priority when treating a client with HIV/AIDS?
Assessing fluid and electrolyte balance
The nurse is teaching a client after a medication allergic reaction has occurred. What is the most important action for the nurse to teach the client to take to prevent anaphylaxis?
Avoid potential allergens
A home care nurse is visiting a client with acquired immune deficiency syndrome (AIDS) at home. During the visit, the nurse observes the caregiver providing care. What action by the caregiver would alert the nurse to the need for additional teaching?
Caregiver cleans the client's anal area without wearing gloves Standard precautions
The nurse is educating a client about the risks of stroke related to the new prescription for a COX-2 inhibitor and what symptoms to report. Which COX-2 inhibitor is the nurse educating the client about?
Celecoxib
What is a COX-2 inhibitor?
Celecoxib (Celebrex) Similar to an NSAID Inhibit only COX-2 enzymes, which are produced during inflammation
A client visits the employee health department because of mild itching and a rash on both hands. What will the employee health nurse focus on during the assessment interview?
Chemical and latex glove use Latex allergy
What is systemic Lupus Erythematosus (SLE)?
Chronic auto-immune inflammatory disease Can affect any organ system Characterized by remissions and exacerbations Primarily a disease of young women Familial - risk is low
What is Raynaud's phenomenon?
Chronic connective tissue disease that causes inflammation, fibroids, and sclerosis of the skin and vital organs Pain and color changes of the extremities when exposed to the cold
The nurse practitioner who is monitoring the patient's progression of HIV is aware that the most debilitating gastrointestinal condition found in up to 90% of all AIDS patients is:
Chronic diarrhea
What is Rhematoid Arthritis (RA)?
Chronic systemic autoimmune disorder Inflammation of connective tissues Primarily in joints
What are the environmental factors of SLE?
Cigarette smoke Ultraviolet rays Medications Viral infections Emotional stress Stress on the body
What is HIV 2?
Confined to West Africa
What is lymphoid tissue?
Connective tissue dominated by lymphocytes Spleen and lymph nodes Function to trap and process antigen and promote its interaction with mature immune cells
What is an inflammatory response?
Function of natural immune system Response to invading organisms or tissue injury Assisted by chemical mediators Facilitated by physical and chemical barriers
What is allergic rhinitis?
Hay fever / seasonal allergy Sneezing Nasal itching Conjunctivitis Type 1 reaction
What are chemical mediators?
Histamine Bradykinin Prostaglandins Assist in healing / immune response
What type of immunoglobulin does the nurse recognize that promotes the release of vasoactive chemicals such as histamine when a client is having an allergic reaction?
IgE
Which immunoglobulins are present in allergic reactions?
IgE
Which immunoglobulins are present in bacterial and viral infection?
IgG IgM
What is type 3 hypersensitivity?
Immune complex mediated Binding to free floating parts in body (blood or tissue) Local = vaccination reaction Systemic = serum sickness Autoimmune = Lupus / arthritis Joints + kidneys susceptible
A client with severe combined immunodeficiency is to receive a hematopoietic stem cell transplant. What would the nurse expect to be started?
Immunosuppressive agents
What is the treatment of ADVANCED RA (never relaxing)?
Immunosuppressive agents
The nurse is discussing life management with the client with rheumatoid arthritis in a health clinic. What assessment finding indicates the client is having difficulty implementing self-care?
Increased fatigue
What are the side effects of disease modifying antirheumatic drugs (DMARDs)?
Increased risk of serious immunosuppression (bone marrow suppression) and infection Fatigue, malaise, rashes, alopecia, ulcerative stomatitis, hepatic toxicity, severe bone marrow suppression, interstitial pneumonitis, chills, fever, anaphylaxis
What are Biologic agents for RA?
Infliximab (Remicade) Abatacept (Orencia) Tocilizumab (Actemra) Tofacitinib (Xeljanz) Used in moderate to severe RA Can be used alone or with methotrexate
During a routine checkup, a nurse assesses a client with acquired immunodeficiency syndrome (AIDS) for signs and symptoms of cancer. What is the most common AIDS-related cancer?
Kaposi's sarcoma
What are the contraindications of salicylates?
Known allergy Bleeding abnormalities Impaired renal function
How do you administer epinephrine?
Lateral thigh, inject hold for 10 sec, remove massage for 10 sec, call EMS, take epi needle with you to the hospital Usually given IV in hospital
How do you prevent HIV spread?
Latex condom use Pre-exposure prophylaxis (PrEP) HIV testing Needles exchanges Artificial insemination No breastfeeding LGBTQ youth at highest risk
A client asks the nurse how to identify rheumatoid nodules with rheumatoid arthritis. What characteristic will the nurse include?
Located over bony prominence
What are agranulocytes?
Lymphocytes Monocytes Macrophages
The nurse is aware that the phagocytic immune response, one of the body's responses to invasion, involves the ability of cells to ingest foreign particles. Which of the following engulfs and destroys invading agents?
Macrophages
What are CCR5 Antagonist?
Maraviroc (Selzentry) Blocks the receptor site on the cell membrane to which the HIV virus needs to interact to enter the cell BLOCKS ATTACHING TO THE CELL
What antiviral drugs are used to treat HIV?
•Nucleosides Reverse Transcriptase Inhibitors (NRTIs) •Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) •Protease Inhibitors •Integrase Strand Transfer Inhibitors •Fusion Inhibitors •CCR5 Antagonist •CD4 Post-Attachment Inhibitors
What are NSAIDs used for?
•Provide strong anti-inflammatory and analgesic effects •Sold over the counter, which may lead to abuse •Inhibit prostaglandin synthesis
What are the diagnostic tests of RA?
•Rheumatoid factors (RF) •CBC •Erythrocyte sedimentation rate •C-reactive protein •Anti-CCP (Antibodies to cyclic citrullinated peptide) •Examination of synovial fluid X-rays of affected joints
What are the treatments for RA?
•Salicylates •NSAIDs and COX-2 inhibitors •Disease-modifying antirheumatic drugs (DMARDs) •Biologic agents •Corticosteroids •Immunosuppressive agents