Med surge Immune My notes
A client in stage 1 of HIV feels well and questions having the virus. Which response by the nurse is appropriate?
"There is an equal amount of virus and the cells to combat the virus in your body."
cytoxic T cells
(killer T cells) attack the antigen directly by altering the cell membrane, causing cell lysis (disintegration), and releasing cytolytic enzymes and cytokines
Stage 1 of HIV infection
*Acute Infection* -flu-like response to initial contact with the virus
Steps of HIV infection
1) HIV surface glycoprotien - gp120 - attaches to CD4 receptor on T-helper cells 2) Chemokine co-receptor aids in binding of gp120 ccr5/ cxcr4 3) Viral RNA converted into DNA with help from 3 enzymes - Reverse Transcriptase, Integrase, & Protease 4) DNA is inserted and integrated into the T-helper cell. protease matures new HIV virus Basically takes over cell = cell isn't a T-helper cell anymore, so T-helper cell values drop
IgA
15 percent, appears in breast milk, gi prostatic and vaginal secretions, prevents absorption of pathogens from food
A client is infected with human immunodeficiency virus (HIV) after sharing needles with another intravenous (IV) drug abuser. Upon infection with HIV, the immune system responds by making antibodies against the virus, usually within how many weeks after infection?
3 to 12 weeks
midrange
500-5000
high viral load
5000-10000
stage 3
<200
stage 2
<200-499
A client has had a kidney transplant performed for end-stage kidney disease. What type of immune response that T-cell lymphocytes perform is related to this type of surgery?
A cell-mediated response
What is the function of the thymus gland?
After birth, the thymus gland programs T lymphocytes to become regulator or effector T cells. The thymus gland becomes smaller during adolescence but retains some activity throughout the life cycle.
The spleen
An organ that is part of the lymphatic system; it produces lymphocytes, filters the blood, stores blood cells, and destroys old blood cells. Red pull is where old ones are destroyed/ white pulp contain lymphocytes
IgD
Attached to B cells Activates B cells
Which of the following cell types are involved in humoral immunity?
B lymphocyte
humoral
B lymphocyte cells (produces immunoglobulins gamde
Aids can also be aquired
By chemo therapy
Cytomegalovirus (CMV)
DNA virus that accounts for many respiratory, ophthalmic, and liver infections can cause blindness
HIV encephalopathy
Disease of the brain (dementia) caused by infection with the human immunodeficiency virus (HIV), which causes AIDS (acquired immunodeficiency syndrome).
hiv test
ELISA and Western Blot tests --> HIV diagnosed only after 2 or more positive ELISA tests are confirmed by positive Western Blot
Which blood test confirms the presence of antibodies to HIV?
Elisa
enzyme antibody
Elisa
Which blood test confirms the presence of antibodies to HIV?
Enzyme immunoassay (EIA)
A client with chronic renal failure has begun treatment with a colony-stimulating factor. What medication does the nurse anticipate administering to the client that will promote the production of blood cells?
Epoetin alfa (Epogen)
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?"
DiGeorge syndrome
Hypercalcemia, hypoparathyroidism
Nurse treatment
ID risk / help prevent transmission/ educate about disease/ arts/ monitor labs blood transfusion questions
proliferation stage
Lymphocytes stimulate some of the dormant T and B lymphocytes to enlarge, divide, and proliferate in the lymph nodes causing sore throat and swelling
What type of cytokine will attract neutrophils and monocytes to remove debris?
Lymphokines
More than 50% of individuals with this disease develop pernicious anemia:
More than 50% of clients with CVID develop pernicious anemia. Pernicious anemia is not associated with the other conditions.
NK cell
NK cells are a class of lymphocytes that recognize infected and stressed cells and respond by killing these cells and by secreting macrophage-activating cytokine. The helper T cells contribute to the differentiation of null and NK cells.
Which type of cells destroys antigens already coated with antibody?
NULL
The nurse is taking the health history of a newly admitted client. Which condition would place the client at risk for impaired immune function?
Organ transplantation requires immunosuppressive drugs, which cause impaired immune function.
The nurse completes a history and physical assessment on a client with acquired immune deficiency syndrome (AIDS) who was admitted to the hospital with respiratory complications. The nurse knows to assess for what common infection (80% occurrence) in persons with AIDS?
Pneumocystis pneumonia
pep
Post-exposure prophylaxis: can reduce the risk of HIV infection immediately AFTER exposure no more than 72 hrs
client is diagnosed with severe combined immunodeficiency (SCID). What would the nurse expect to integrate into the client's plan of care?
Preparation for bone marrow transplantation
The nurse is caring for a client recovering from a major burn. Burns affect the immune system by causing a loss of large amounts of which of the following?
Serum, which depletes the body's store of immunoglobulins
stage 2 of hiv
Stage 2 occurs when CD4+ T-lymphocyte cells decrease to between 200 and 499 cells/mm3 and had previously been referred to as the symptomatic stage.
A client who is has been HIV positive for 10 years has a CD4+T-lymphocyte count of 2600 cells/L. For which stage of the virus will the nurse provide care when the client is diagnosed with invasive cervical cancer?
Stage 3 because an opportunistic infection has occurred
stage 3 of hiv
Stage 3 is diagnosed when the count drops below 200 cells/mm3 and the person has AIDS.
cellular immunity
Stem cells migrate to thymus and produce T cells
T helper cells
T lymphocytes with CD4 receptors on their cell-surface membranes, which bind to antigens on antigen-presenting cells and produce interleukins, a type of cytokine. Presents ti to a B cell, T cells act alone and they destroy virus cells or cancer changed by mutation
What are the primary participants in the immune system
T- and B- cell lymphocytes
nucleic and p24
TEST FOR VIRUS DIRECTLY
A client is prescribed didanosine as part of a highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client?
Take half hour before or 2 h after meals
HIV 1 emmunoessay
Tests for both HIV-1 and HIV-2 antibodies
humoral response
The branch of acquired immunity that involves the activation of B cells and that leads to the production of antibodies, which defend against bacteria and viruses in body fluids.
When the body is invaded or attacked by bacteria, viruses, or other pathogens, it has three means of defense:
The phagocytic immune response The humoral or antibody immune response The cellular immune response
The nursing instructor is discussing the development of human immunodeficiency disease (HIV) with the students. What should the instructor inform the class about helper T cells?
They are activated on recognition of antigens and stimulate the rest of the immune system.
Which is a major manifestation of Wiskott-Aldrich syndrome?
Thrombocytopenia
Post exposure prophylaxis
Treatment administered to an individual after exposure to an infectious disease to prevent the disease
Epstein-Barr virus (EBV)
acute infection which causes sore throat, fever, fatigue, and enlarged lymph nodes; also called mononucleosis (white patches on tongue)
IRIS (Immune Reconstitution Inflammatory Syndrome)
an exaggerated inflammatory reaction to a disease-causing microorganism that sometimes occurs when the immune system begins to recover following treatment with antiretroviral (ARV) drugs ;; mycobacteria, fungi, herpes types: 1. "unmasking" = flare-up of an underlying, previously undiagnosed infection 2. "paradoxical" = worsening of a previously treated infection *can be life-threatening
3 types of test
antibody, antigen/antibody, nucleic acid
Which assessment should be completed if immune dysfunction is suspected in the neurosensory system?
ataxia
anti body test can be found in
blood , urine , saliva
A client is diagnosed with severe combined immunodeficiency (SCID). What would the nurse expect to integrate into the client's plan of care?
bone marrow transpl
infections a person with aids can get
candidiasis
even if cd4 increase
cannot be made less stage
Which is usually the most important consideration in the decision to initiate antiretroviral therapy?
cd4 ct
the complement system
circulating proteins that assist antibodies in the destruction of pathogens, made int he liver when an antibody connects to its antigen
prevention
dont drink water from foreign eat foods that are not raw or un pasteurized avoid risky activities keep vax up to date exposure to animal feces should be limited need to take art- helps immune strong
Protease inhibitors
ends invir
HIV/1-HIV-2 antigen/antibody combination immunoassay
ests for both virus (antigen) and antibody for both HIV-1 and HIV-2
IgE
for allergic reactions, and parasitic infections
HIV patients should avoid
fresh fruits everything should be thourughlt cookws
Cryptococcus neoformans
fungus that causes neurological disease fever, headache, malaise, stiff neck, nausea, vomiting, mental status changes, and seizures.
stage 1
greater than 500
supressor T cells
have the ability to decrease B-cell production, thereby keeping the immune response at a level that is compatible with health (e.g., sufficient to fight infection adequately without attacking the body's healthy tissues).
Testing preformed for people with
hepatitis, tb stds
Which of the following protective responses begin with the B lymphocytes?
humoral
uninfected T cells
in lymph nodes, and cell death occurs, this time pyroptosis due to inflammation , interluekin 1 betta , they get showered with interleukin one and all t ells cd4 gets destroyed, and end up in chronic inflamation (chain reaction)
A nurse is teaching the parents of an infant about primary immunodeficiencies. Which statement verifies that the parents understand the teaching?
infancy
A client has had a splenectomy after sustaining serious internal injuries in a motorcycle accident, including a ruptured spleen. Following removal of the spleen, the client will be susceptible to:
infections
A client is taking a corticosteroid for the treatment of systemic lupus erythematosus. When the nurse is providing instructions about the medication to the client, what priority information should be included?
infections
Proteins formed when cells are exposed to viral or foreign agents that are capable of activating other components of the immune system are referred to as
interferons
IgM
intravascular, first response to pathogen of viral and bacterial infections
cellular response
involves the T lymphocytes, which can turn into special cytotoxic (or killer) T cells that can attack the pathogens.
Interferons
is a nonspecific viricidal protein that is naturally produced by the body and capable of activating other components of the immune system.
Low HIV viral load
les that 75
highest reservoir of his
lymphatic system In GI
kaposi sarcoma
malignant, vascular, neoplastic growth characterized by cutaneous nodules. KS is caused by human herpesvirus-8 (HHV-8); affects eight times more men than women; and may spread through sexual contact. It involves the epithelial layer of blood and lymphatic vessels.
IgG antibodies
most abundant, crosses placenta, enhances phagocytosis
A 25-year-old client receives a knife wound to the leg in a hunting accident. Which type of immunity was compromised?
natural
Which immunity type becomes active as a result of infection by a specific microorganism?
naturally acquired active immunity
A client receiving antiretroviral therapy reports "not urinating enough." What is the nurse's bestaction?
nephron urea/ creatine
Mycobacterium avium complex (MAC)
opportunistic infection caused by mycobacterial organisms that commonly causes a respiratory illness but can also infect other body systems
Apoptosis
process of programmed cell death specific
compliment components
prostaglandins,leukotrines etc
B cells and T cells
respond to antigen, when they encounter specific antigen they bind in a lock and key manner
adenosine
reverse transcription inhibitor
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?
rsistance
Helper T cells (type of lymphocyte) there are 3
secrete cytokines that enhance immune response, which attract and activate B cells
Telangiectasia
skin lesion due to permanently enlarged and dilated blood vessels that are visible
What organ is considered lymphoid tissue?
spleen
prolonged chronic stage
stage 1
A client with AIDS is admitted to the hospital with severe diarrhea and dehydration. The physician suspects an infection with Cryptosporidium. What type of specimen should be collected to confirm this diagnosis?
stool
cellular
t lymphocyte (helper t - memoryt - cytoxic t)
phagocytic immune response
the immune system's first line of defense, involving white blood cells that have the ability to ingest foreign particles
bone marrow
the white blood cells (WBCs) involved in immunity are produced in the bone marrow
Kaposi sarcoma (KS)
type of skin cancer often seen in patients with AIDS; consists of brownish-purple papules that begin in skin and spread to internal organs <200
intergrase
valtagovir
