Immunology
immune function is most efficient when people are in their
20-30 years and declines with age.
sexual transmission:
ABC: abstinence, be faithful and condoms. the risk for becoming infected from a partner who is HIV positive is always present. virus concentrates most heavily in the blood and semin although it is present in vaginal secretions. thus risk differs with gender, sexual act, and viral load of the infected partner. gender affects HIV transmission: vagina has more mucous membranes than the penis so easier to transmit from male to female than vice versa so always use a condom. sexual acts: anal intercourse is the highest risk. not olnly allows seminal fluid to make contact with the mucous membranes of the rectum but also tears the mucous membranes making infection more likely. so wear a condom. viral load: amount of virus present in the blood and fluid affects transmission. the higher the level the greater the risk for transmission. so use safe sex practices *new gels that contain an antiretroviral agent(tenofovir or raltegravir) can drop a womens exposure by 50%.
Table 20-1 differences in RA and OA
Characteristic RA OA onset: 35-45 older than 60 risk fact: autoimmune, triggers, aging, genetic, environmental obesity, trauma, job disease process: inflame degenerative disease pattern: bilateral, symm unilateral, multiple joints single joint up extrem. 1st. weight bearing systemic nonsystemic lab finding: elevated rheumatoid normal ESR factor, ESR. common drug therapy: NSAIDS, methotrexate. NSAIDS arava, cortices, acetamino biological response analgesics modifiers
cancers associated with a known viral origin
Epstein barr virus: burkitts lymphoma, nasopharyngeal carcinoma Hepatitis B virus: primary liver carcinoma Hepatitis C virus: primary liver carcinoma, vulvar carcinoma, and other anogenital carcinomas Human lymphotrophic virus type I: adult T cell leukemia human lyphotrophic virus type 2: hairy cell leukemia
phases of division
G1: first starting to divide S: DNA synthesis G2: cell makes important proteins that will be used after division is complete M: mitosis
grading tumors:
Gx: cannot be determined G1: tumor cells are well differentiated and closely resemble normal cells, low grade and slow growing G2: moderately differentiated and still retain some of the characteristics of normal cells G3: tumor cells are poorly differentiated but the tissue of orgin can be established, few normal charact. G4: tumor poorly differentiated and retain no normal call characteristics, tissue of origin is difficult and maybe impossible.
health care associated infection
HAI: infection acquired in the inpatient health care setting
Transplant rejection:
Hyperacute: begins immediately on trsnaplatation and is AMI response mostely in kidneys and apparent in minutes and organ is removed as soon as it is diagnosed. Acute rejection: in first 1-3 months after transplant. doesn't mean they will lose it. Chronic rejection: is not clear but is similar to chronic inflammation and scarring and Is major cause of death in patients who have survived 1 or more years after heart transplantation.
antibody classification:
IgA: most responsible for preventing infections in the upper and lower respiratory tracts, the GI tract, and the GI tract. IgD: co expressed with IgM, acts as a receptor on unsensitized B-lymphocytes. IgE: AMI and binds to mast cells anc auses their degranulation when an allergen(antigen) binds to IgE antigen recognition sites. IgG: providing sustained long term immunity, enhances phagocytosis, and CMI, and killer cells. IgM: actions of agglutination and precipitation, activates classic complement pathway.
three processes needed for human protection through immunity are:
Inflammation, antibody mediated immunity, and cell mediated immunity. each process uses different defensive actions and each influences or requires assistance from the other two processes.
Activity of selected cytokines:
Interleukin 1: induces fever, stimulates prostaglandins. Interleukin 2: enhances natural killer cell activity against cancer cells Interleukin 6: liver to produce fibrinogen and protein C, increases rate of bone marrow production or stem cells, increases sensitized b lymphocytes. Tumor necrosis factor(TNF): induces fever, involved in rheumatoid arthritis damage, acute inflammatory response to infections to infectious bacteria and sepsis, in graft rejection, muscle breakdown, cell death, stimulates delayed hypersensitivity reaction and allergy. Growth Factors: G-CSF: increases numbers and maturity of neutrophils GM-CSF: increase growth and maturation of myeloid stem cells Erythropoietin: increases growth and differentiation of erythroycytes. Thrombopoietin: increase growth and differentiation of platelets.
erythropoietin is the growth factor for
RBC's. when immature stem cells are exposed to erythropoietin they commit to the erythrocyte pathway and become mature RBCs.
MRSA
S. aureus found on the skin and perineum and in the nose of many people. acquired through oraganism entering into deep wounds, surgical incisions, lungs or bloodstream. direct contact and invades hospitalized patients through indwelling urinary catheters, vascular access devices and endo tubes can only be treated with vancomycin, and lenozolid(zyvox) can easily cause serious skin and soft tissue infections including abscesses, boils and blisters so teach to wash hands, hand sanitizers, avoiding close contact with infectious wounds, avoiding large crowds, contaminated surfaces and overall good hygiene.
hydration prevents and manages
TLS because it dilutes the serum potassium level and increases the kidney filtration and flow rates.
Staging of tumors:
TNM classification: Primary tumor(T) Tx: primary tumor cannot be assessed T0: no evidence of primary tumor Tis: carcinoma in situ T1-T4: increasing size and or local extent of the primary tumor Regional Lymph Nodes(N) Nx: cannot be assessed N0: no mets N1-N3: increasing involvement of nodes. Distant metastasis(M) Mx: cannot be assessed M0: no mets M1: distant mets
invasion occurs more often than does
actual disease or illness because of proper immune functioning
transmission based precautions
airborne: negative airflow rooms, enclosed booths with HEPA filtration or ultraviolet light for sputum induction procedures. keep doors closed. N95 respirator known for suspected TB, must wear N95 HEPA filter mask, transport the patient only for essential clinical reasons wearing a surgical mask. droplet: stay 3 feet away and wear surgical mask. examples such as pertussis, meningitis, mumps, influenza. private room if not may bunk with patient of same infection no others. mask required at all times when working within 3 feet transport same as airborne contact precautions: such as MRSA: private room may bunk with same infection but no others, wear gloves was hands with antimicrobial soap before leaving, wear gown, transport patents only in clinical reasons, dedicated equipment for this patient only or disinfect after use before taking from room. other examples are C. diff, pediculosis, scabies, ebola.
examples of inflammation caused by noninfectious invasion include:
allergic rhinitis, contact dermatitis, and other allergic reactions.
Desensitization therapy:
allergy shots. very dilute injection solution 1:100,000 of the allergen is compounded. A 0.05mL dose of this solution is injected subq. and increasing dose is given weekly or more often until the patient is receiving a 0,5mL dose and then is started on the lowest dose of the next higher concentration of allergen solution. and this is repeated with increasing concentrations until the patiens is receiving the maximum dose of the greatest concentration of usually 1:100. once a week for a year, then every other week the second year, and then every 3-4 weeks the 3rd year and treatment is about 5 years total. *works by injecting such a small amount IgE doesn't recognize it and doesn't cause allergy it will then bind with IgG which isn't associated with either mast or basal cells and then IgG will then remove the allergen from the body by precipitation. And then when the patient comes in contact with it IgG will bind to it and clear it from the body before IgE can bind to it and trigger an allergic reaction. its a competition game.
cyclins
allow cells to complete the cycle to form two new cells and when acitivated they allow a cell to leave G0 state and enter the cycle and then drive the cell to progress through mitosis. But suppressor genes regulate the amount of cclins present and ensure that cell division occurs only when it is needed.
biofilm
also called glycocalyx is a complex group of microorganisms that functions within a slimy gel coating on medical devices such as urinary catheters, orthopedic implants and enteral feeding tubes on parts of the body like teeth and tonsils and in chronic wounds these reservoirs become sources of infection for which antibiotics and disinfection are not effective. and antibiotic therapy may increase the growth of microbes within biofilms
Inflammation innate immunity:
also called innate native immunity or natural immunity, provides immediate protection against the effects of tissue injury and invading foreign proteins. this type of immunity cannot be developed or transferred form one person to another and is not an adaptive response to exposure or invasion by foreign proteins. Immediate but short term.
AMI antibody-mediated immunity:
also known as humoral immunity involves antigen antibody interactions to neutralize, eliminate or destroy foreign proteins. and are produced by sensitized b-lymphocytes(b-cells) which become sensitized to specific foreign protein(antigen) and produce antibodies directed specifically against that protein.
hypersensitivity or allergy is
an increased or excessive response to the presence of an antigen(foreign protein or allergen) signs are: itchy, watery eyes or sneezing to life threatening allergic asthma anaphylaxis, bronchoconstriction or circulatory collapse.
arthrocentesis is:
an invasive procedure that may be used for patients with joint swelling caused by excess synovial fluid(effusion). performed at bedside or in an office or clinic. local anesthetic and large gauge needle into the joint to aspirate a sample of fluid to relieve pressure. and fluid is analyzed for inflammatory cells and immune complexes. fluid from RA patients shows increased WBCs, cloudiness and volume. *after monitor the insertion site for bleeding or leakage of synovial fluid and notify HCP if these occur.
drugs to help prevent VTE:
anticoagulants such as warfarin, subcutaneous low molecular weight heparin(LMWH) such as lovenox, or factor Xa inhibitors.
pathogen
any microorganism capable of producing a disease
neoplasia
any new or continued cell growth not needed for normal development or replacement of dead and damaged tissues
AA and COX
arachidonic acid(AA) conversion of fatty acid into plasma membranes, Cyclooxygenase COX converts AA into many chemicals that are further processed into the substances that continue the inflame response in the tissue. many NSAID's stop this cascade by preventing COX from converting AA into inflammatory mediators.
pathogenic infections
are caused by virulent organisms and occur even among healthy people with normal immune systems
MHC or major histocompatibility complex
are major HLA that are determined by a set of genes called MHC.
lymphocyte counts
are performed as part of the CBC. normal WBC is 5000-10000. lymphocytes an absolute number of 1500-4500 and patients with aids often are leukopenic with a WBC count of less than 3500 and lymphopenic <1500 CD4 and CD8 counts and percentages are important and people with HIV usually have lower than normal number of CD$ and aids have fewer than 100 cells/mm when the normal is 500-1500. whereas the CD8 stays normal. normal ration is 2:1 but with HIV and AIDS ratio is low.
toxins
are protein molecules released by bacteria to affect host cells at a distant site
the products made by cells, such as cytokines, growth factors, and antibodies
are the weapons of the immune system
opportunistic infections:
are those caused by organisms that are present as part of the body's normal environment and are kept in check by normal immune function only when immune is depressed are these organisms capable of causing infections.
TSA: total shoulder arthroplasty
articulations: many joint surfaces hemiarthroplasty is a replacement of part of the joint typically the humeral component. general anesthesia sling applied to immobilize the joint until therapy begins.
care of the patien with sealed implants of radioactive sources:
assign to private room caution sign on door portable lead shields are used place them between the patient and the door keep door to patients room closed wear a dorsimeter film badge at all times while caring for patiens the badge offers no protection but measures a persons exposure to radiation. wear a lead apron while providing care. always keep arpon facing the source of radiation do not turn your back to the patient pregnant nurses should not care for these patients limit each visitor to 30min a day. and stay at least 6 feet from source never touch the source with bare hands if dislodged use a long handled forceps to retrieve it. deposit the radioactive source in the lead container kept in room save all dressings and bed linens in the patients room until after the radioactive source is removed. then dispose of dressings and linens in the usual manner. other equipment can be removed from room at any time without special precautions.
Heberdens nodes:
at the distal interphalangeal joints on the hands nodes may be painful and red
Bouchards nodes:
at the proximal interphalangeal joints on the hands nodes may be painful and red
prevention of infection:
avoid crowds do not share personal toiletries bath daily using antimicrobial soap and wash genitals and anal area twice a day clean toothbrush weekly wash hands avoid raw foods wash dishes always don't drink anything that's been sitting out over an hr take temp q day no litter boxes report signs of infection take all medications wear disposable gloves under gardening gloves wear a condom
dietary habits to reduce cancer risk:
avoid excessive animal fats avoit nitrites like lunch meats sausage and bacon minimize your intake of red meat keep alcohol to one to two a day eat bran, veggies, broccoli, cauliflower, Brussels sprouts and cabbage eat food high in vitamin a like apricots
bacteremia
bacteria in the bloodstream and surgical site infections: fragile skin of older patients and those receiving prolonged steroid therapy increases infection risk
treatment of type 2 cytotoxic reactions:
begins with discontinuing the offending drug or blood product. plasmapheresis filtration of the plasma to remove specific substances to remove autoantibodies.
both elisa and western blot are
blood based tests. test the bodies reponse to the virus
common defense mechanisms
body tissue phagocytosis inflammation immune systems
osteonecrosis:
bony necrosis secondary to lack of blood flow, usually from trauma or chronic steroid therapy.
common sites for metastasis for different cancer types:
breast: bone, lung, liver, and brain lung: brain bone liver lymph nodes, pancrease colorectal: liver lymph and adjacent structures prostate: bone like spine and legs, pelvic melanoma: GI, lymph, lung, brain primary brain: CNS
cancer classification:
by the type of tissue from which they arise, biologic behavior, anatomic site, and degree of differentiation. categories are solid and hematologic. solid: develop from specific tissue like breast and lung cancer. Hematologic: arise from blood cell forming tissue like leukemias and lymphomas.
supplements found to decrease inflammation and prevent bone loss
calcium but shouldn't be taken in excess for cause of kidney stones cold water fish and fish oil capsules containing omega 3. but don't take if taking anticoagulant therapy gamma-linolenic acid(GLA) an omega 6 found in the oils of certain plant seeds such as primrose and black currant.
protamine sulfate
can be given to offset all heparins.
HIV
can progress to AIDS which is the most common secondary immune deficiency disease in the world cause is the human immune deficiency virus and belongs to viruses called retroviruses. its only single stranded so it brings along reverse transcriptase to make it the same as the human DNA. but drugs like nucleoside analog reverse transcriptase inhibitors and non nucleoside reverse transcriptase inhibitors work to stop this process but HIV brings an enzyme called integrase and the drug class known as integrase inhibitors work to prevent this. the body becomes and HIV factory and CD4+ T-cell counts fall, viral numbers rise and without treatment the patient will die. everyone who has AIDS has HIV but not everyone who has HIV has AIDS. healthy adult usually has 800-1000 CD4+ T-cells per cubic millimeter of blood. the number is low in a person with HIV. first signs are fever night sweats chills headache and muscle aches, rash and sore throat giving ideas on mono or flu and then it goes away when on the inside a war is going on. and the patient is at risk for bacterial fungal and viral infections as well as cancers.
malignant cell growth
cancer is serious and without intervention leads to death
AIDS defining illness
candidiasis of bronchi, trachea or lungs, candidiasis of esophagus cervical cancer, invasive cryptococcosis cryptosporidiosis cytomegalovirus disease other than liver spleen or nodes cytomegalovirus rerinitis with loss of vision encephalopathy HIV related herpes simplex histoplasmosis isosporiasis Kaposi sarcoma lymphoid interstitial pneumonia lymphoma burkitt, immunoblatic primary of brain, mycobacterium tuberculosis pneumocystis pneumonia recurrent within 12 months progressive multifocal leukoencephalopathy salmonella septicemia toxoplasmosis of brain wasiting syndrome attributed to HIV
CAM therapies:
capsaicin products(burning only short time so use plastic gloves when applying and wash hands immediately). dietary supplements like glucosamine(decrease inflammation) and chondroitin(strengthen) to decrease pain and improve functional ability and may be taken orally or topically. *do not take glucosamine if you are prego/nursing, have high BP, monitor bleeding and blood sugar which can become increased, can cause headaches, rash, diarrhea, take dosage for weight,
Lysis:
cell membrane destruction
characteristics of normal and abnormal cells
character normal benign malignant division none/slow continuous rapid appear specific morph " anaplastic Nuclear/ cystoplasmic small " large differentiated many " some/none adherence tight " loose migratory no " yes growth well regulated expansion invasion chromo diploid " aneuploidy mitotic index low " high
agglutination:
clumping action that results from the antibody liking antigens together, forming large and small immune complexes
cancer assessment:
colorectal: changes in bowel habits, blood in stool, bladder: pain, blood, cloudy, frerquency or urgency prostate: hesitancy, size in urine stream, pain in back or legs, UTI skin: changes in moles or warts like color edges sensation leukemia: fatigue, bruising, bleeding tendency, infections, night sweats, unexplained fevers. lung: cough, hoarseness, smoking history, shortness of breath, activity tolerance, frothy or bloody sputum, pain in arms or chest, difficulty swallowing.
microorganisms are transmitted by several routes:
contact transmission direct or indirect droplet transmission airborne transmission
postexposure prophylaxis for occupational HIV exposure:
course is 28 days Basic PEP= two drugs: zidovudine plus lamivudine. or stavudine plus lamivudine or emtricitabine. or tenofovir plus lamivudine or emtricitabine. Expanded PEP= three or more drugs zidovudine plus lamivudine or emtricitabine plus lopinavir/ritonavir. or tenofovir plus lamivudine or emtricitabine plus lopinavir/ritonavir.
anthrax:
cutaneous: 1-7 days after contact, itching, edema, ulcerations, sloughing, lesions. Inhalations: 48hrs dyspnea, tachycardia, fever and respiratory failure.
thrombocytopenia
decreased platelets so monitor patients complete blood count and platelet count per policy.
drug therapy for AIDS:
doesn't stop it just slows it down. mixture of drugs to help called drug cocktails and is termed HAART NRTIs: retrovir, ddI, Videx, Epivir, 3tC, d4T, Zerit, renofovir, Emtriva, and abacavir. all fool reverse transcriptase into coping counterfeit bases for poor DNA replication. NNRTIs are HIV specific drugs work by inhibiting reverse transcriptase these suppress but do not kill virus and inclue nevirapine, delavirdine, sustiva, intelence but problems are interactions with other drugs and hypersensitivity reaction. PI's are HIV drugs that block the HIV protease enzyme, preventing viral replication and release of viral particles and include veracept, lopinavir/ritonavir, reyataz, lexiva, prezista, and aptivus. fusion inhibitors work by blocking the fusion of HIV with a host cell. and includes the drug fuzeon which is administered through subq. entry inhibitors are new type of anit-HIV drugs and current drug is maraviroc(selzentry. and works to prevent infection by blocking receptor on CD4 cells.
Sjogrens syndrome: triad of
dry eyes(KCSor sicca syndrome), dry mouth(xerstomia), dry vagina(in some cases) eyes feel gritty as if sand is in there. mouth is sticky membranes and eyes for redness or lack of tearing.
key features of RA
early: joint inflammation, systemic; low grade fever, fatigue, weakness, anorexia, and paresthesias. late: joint deformitites like swan neck or ulnar deviations, moderate to severe pain and morning stiffness(gel phenomenon). systemic; osteoporosis, sever fatigue, anemia, weight loss, subcutaneous nodules, peripheral neropathy, vasculitis, pericarditis, fibrotic lung disease, sjogrens syndrome, renal disease, feltys syndrome.
long term nonprogressors:
elite controllers are people been infected with AIDS for at least 10 years and show no symptoms and have cell counts within normal range and low or undetectable viral load.
bakers cysts
enlarged popliteal bursae behind the knee may occur and cause tissue compression and pain. and even tendon rupture.
joint effusions:
excess joint fluid with knees. may be able to move the fluid from the infrapatellar notch the area directly below the knee into the suprapatellar area which is area directly above the knee.
lupus erythematosus:
facial rash with the disease looks like a wolf, usually red. two types of lupus: discoid lupus erythematosus(DLE) and systemic(SLE). DLE only effects the skin. SLE is a chronic progressive disoreder tha can cause major body organs and systems to fail has remissions and exacerbations. it is potentially fatal but the survival rate is increasing. ANA's primarily affect the DNA and RNA as a result cause inflammation, damage and destruction and invade organs directly or cause vasculitis(vessel inflammation) which deprives the organs of arterial blood and oxygen. mostly attracted to the kidneys which can lead to death. mostly affects women and women of color more. occurs most often during the childbearing years 20-40years but can happen younger. genetics can play a role, contracting a virus. meds like pronestyle and hydralazine can cause lupus symptoms. signs: dry scaly raised rash on the face(butterfly rash) nonscarring and may increase with flareup and disappear when remission. discoid or coinlike lesions are the scarring lesions. alopecia, myalgia muscle pain, fever and fatigue in a flare, pneumonia or pleural effusions, pericarditis causing tachy, chest pain and myocardial ischemia, anemia, leukopenia, and thrombocytopenia, raynauds phenomenon which is when exposed to cold or stress the pts hands change color usually red, white and blue color changes and severe pain. limit sun exposure and do a skin biopsy to determine. CBC shows a pancytopenia a decrease of all cell types caused by direct attack of the blood cells or bone marrow by immune complexes. fever is main sign of flare up. drug therapy: acetaminophen, or NSAIDS for pain and myalgias, plaguenil decreases absorption of UV light by the skin but have frequent eye exams, MTX or Imuran for CNS lupus.
plague:
fever and chills productive cough, hemoptysis and headache, GI symptoms and rapidly progressive weakness.
C. Diff
flagyl and vancomycin to treat.
HIV Is found in and most often in 3 ways:
found in most body fluids including blood, semen, vaginal secretions, breast milk, amniotic fluid, urine, feces, saliva, tears, cerebrospinal fluid, lymph nodes, cervical cells, corneal tissue and brain tissue. most often transmitted by: sexual: genital, anal, or oral sex. parenteral: sharing needls or equipment perinatal: from the placenta, maternal blood and body fluids during birth or from breast milk from mother to child.
Inflammation:
functional change: defect in neutrophil function leading to neutrophil counts may be normal but activity is reduced or impaired increasing risk for infection. leukocytosis does not occur during episodes of infection leading to infection but not show expected changes in WBC counts. older adults may not have a fever during inflammatory or infectious episodes leading to not only a potential loss of protection through inflammation but also minor infections may be overlooked until the patient becomes severely infected.
Cell mediated immunity:
functional change: thymic activity decreases with aging and the number of circulating t lymphocytes decreases leading to skin tests for TB may be falsely negative, older patients are more at risk for bacterial and fungal infections especially on the skin and mucous membranes in respiratory tract and in the GI tract.
Antibody-mediated immunity:
functional change: total number of colony forming B-lymphocytes and the ability of these cells to mature into antibody secreating cells are diminished leading to older adults are less able to make new antibodies in response to the presence of new antigens, thus they should receive immunizations, such as flue shots, the pneumococcal vaccinations and the shingles vaccinations. decline in natural antibodies decreased response to antigens and reduction in the amount of time the antibody response is maintained leading to older adults not having sufficient antibodies present to provide protection when re exposed thus need to avoid people with viral infections and receive booster shots.
all antibodies are immunoglobulins, also called gamma globulins.
globulin is a protein that is globular rather than straight. also called gamma globulins because all free antibodies in the plasma separate out in the gamma fraction of plasma proteins during electrophoresis. 5 types are size, location, amount, function, and timing.
methods of infection control
hand hygiene PPE adequate staffing disinfection/sterilization patient placement and transport
Felty's syndrome
hepatosplenomegaly and leukopenia.
hypertrophy vs hyperplasia
hypertrophy is tissue to increase in size by enlarging each cell hyperplasia is tissue to incrase in size by increasing the number of cells
personal factors for cancer
immune function, advancing age, genetic risk like breast and prostate and ovarian. warning signs: changes in bowel or bladder habits a sore that doesn't heal unsual bleeding or discharge thickening or lump in breast or elsewhere indigestion or difficulty swallowing obvious change in wart or mole nagging cough or hoarseness
adaptive immunity:
immunity that a persons body learns to make or can receive as an adaptive response to invasion by organisms or foreign proteins. examples: AMI and occurs either naturally or artificially through active or passive response.
AIDS key features:
immunologic manifestations: low white blood cell counts, CD4/CD8 ratio <2, CD$ count <200, hypergammaglobulinemia, opportunistic infections, lymphadenopathy, fatigue. integumentary mani: dry skin, poor wound healing, skin lesions, night sweats, bleeding gums and petechiae. respiratory mani: cough and shortness of breath watch for dry cough and fever, dyspnea, tachypnea, low grad and persistent fever all usually signs of pneumocystis pneumonia or PCP. GI: diarrhea, weight loss, n/v CNS: confusion, dementia, headache, fever, visual changes, memory loss, personality changes, pain, seizures. malignancies: Kaposi's sarcoma, lymphomas, invasive cervical cancer, lung cancer, GI cancers, and anal cancer. endocrine complications: DM, elevated cholesterol, adrenal insufficiency, body shape changes, low testosterone, irregular menstrual cycles, decrease in muscle mass weight and change in libido, decrease in energy and increased in fatigue.
type 4 delayed reaction treatment:
in type 4 the response typically occurs hours to days after. treatment is to remove the offending antigen and patient is treated symptomatically. monitor the reaction site and sites distal to the reaction for circulation adequacy. only corticosteroids seem to help reduce the discomfort and help resolve the reaction more quickly.
vasculitis
inflammation of the blood vessels and major organs and body systems become ischemic and malfunction ischemic skin leasion that appear in groups as small, brownish spots, most commonly around the nail bed(periungual lesions).
Immune functions of specific leukocytes:
inflammation: neutrophil: nonspecific ingestion and phagocytosis of microorganisms and foreign protein. macrophage: nonspecific recognition of foreign proteins and microorganisms. Monocyte: destruction of bacteria and cellular debris matures into macrophage Eosinophil: weak phagocytic action, releases vasoactive amines during allergic reaction. Basophil: releases histamine and heparin in areas of tissue damage. Antibody-Mediated Immunity: b-lymphocyte: becomes sensitized to foreign cells and proteins Plasma cells: secretes immunoglobulins in response to the presence of a specific antigen Memory cell: remains sensitized to a specific antigen and can secrete increased amounts of immunoglobulins specific to the antigen in re-exposure. Cell-mediated immunity: Helper/T cell: enhances immune activity through secretion of various factors, cytokines, and lymphokines. Cytotoxic t-cells: selectively attacks and destroys non-self cells, including virally infected cells, grafts and transplanted organs. Natural killer cells: nonselectively attacks non-self cells, especially body cells that have undergone mutation and become malignant also attacks grafts and transplants.
antimicrobials act on susceptible pathogens by
inhibiting cell wall synthesis(penicillin) injuring the cytoplasmic membrane(antifungal agents) inhibiting biosynthesis or reproduction(erythromycin, tetracycline, and gentamicin) inhibiting nucleic acid synthesis(actinomycin)
parenteral transmission:
instruct injection drug users to clean their needles if sharing them with clear water first then bleach for 30-60 seconds and carry a small container with this solution whenever sharing.
Rheumatoid arthritis RA natural remissions and exacerbations
is a common connective tissue disease that can be the most destructive to the joints. chronic progressive, systemic inflammatory autoimmune disease process that affects primarily the synovial joints. systemic means this disease affects the body system, affecting many joints and other tissues. RFs are formed that attack healthy tissue, especially synovium and cause inflammation. the synovium then thickens and becomes hyperemic fluid accumulates in the joint space and a pannus forms which is vascular granulation tissue composed of inflammatory cells. and destroys bone eventually.
normal chromosomes(euploidy)
is a feature of most normal human cells these cells have 23 pairs of chromosomes, the correct number for human beings.
Sjogren's Syndrome:
is a group of problems that often appear with other autoimmune disorders. and include dry eyes(sicca syndrome), dry mucous membranes of the nose and mouth(xerostomia) and vaginal dryness. and this patient also has RA or firbromyalgia. there is no cure for SS. drugs that slow it are low dose chemotherapy with methotrexate or Cytoxan but both have serious long term s/e. use artificial tears and saliva can help. humidifiers, vaginal lubricants and moisturizers. Restasis for dry eyes, and Salagen for dry mouth. risks: women 35-45, viral infection is strongly suspected like Epstein barr virus and HIV type 1.
Immunity:
is an adaptive internal protection that results in long term resistance to the effects of invading microorganisms. this means response isn't automatic. the body has to learn to generate specific immune responses when it is infected by or exposed to specific organisms.
contact inhibition
is stopping of further rounds of cell division when the dividing cell is completely surrounded and touched by other cells.
specific morphology
is the feature in which each normal cell type has a distinct and recognizable appearance size and shape.
orderly and well regulated growth
is very important feature of normal cells they divide for only two reasons one to develop normal tissue and 2 to replace lost or damaged normal tissue. many spend their lives in the G0 state and do not divide rather than in the reproductive state.
examples of inflammation without infection
joint sprains, myocardial infarction and blister formation
types of rest for a joint:
local rest: immobilizing any unstable joint with a brace or splint. and cane used on the strong side of body. systemic rest: immobilizing the entire body like during a nap. *teach patients position joints in their functional positions. use small pillow under head or neck but avoid the use of other pillows, use large pillow under knees or head may result in flexion contractures. if needed elevate legs 8-12 inches to reduce back discomfort.
cancers associated with tobacco use:
lung, oral, pharyngeal laryngeal, esophagus, pancreatic, cervical, kidney, bladder, liver, stomach, myeloid leukemia
tissue macrophages:
lung: alveolar macro Connective: histiocyte Brain: microglial cell Liver: kupffer cell Peritoneum: peritoneal mac Bone: osteoclast Joint: synovial type A cells Kidney: mesangial cell
mgmt. of transplanted organ:
maintenance therapy is the continuous immunosuppression used after a solid organ transplant, durgs used for routine therapy are combinations of specific immunosuppressants such as cyclosporine, azathioprine, or mycophenolate and one of the corticosteroids such as prednisone. antibodies, basiliximab, or daclixumab are given IV within 2 hours before transplant surgery and within the first few days after surgery.
carcinogenesis/oncogenesis both terms for cancer development:
malignant transformation: changing normal cell into a cancer cell. occurring through the steps of initiation, promotion, progression and metastasis. initiation: change in gene expression caused by anything that can penetrate a cell, get into the nucleus and damage the DNA. leads to excessive cell division through DNA damage that results in either loss of suppressor gene function or enhancement of oncogene function. this is irreversible. not a health threat unless it can divide. if not it cannot form a tumor. but if it can cancer can develop from just one cancer cell. substances that change cell genes are carcinogens with chemical, physical or viruses. promotion: promoters are substances that promote or enhance growth of the initiated cancer cell. like insulin and estrogen can act as promoters and make altered cells divide more quickly shortening the latency period. progression: continued change of a cancer, making it more malignant over time. must get its own blood supply after 1cm diffusion for blood isn't sufficient. metastasis or secondary tumors occur. bloodborne mets tumor cell release into the blood is the most common spread. Lymphatic spread.
type 5 reaction treatment:
management focuses on removing enough of the responding stimulated tissue to return the function to normal. with graves disease, thyroid tissue is either surgically removed or destroyed with radiation.
immunocompetent
maximum protection against infection
differentiated function
means that every normal cell has at least one special function it perfomrs to contribute to the whole body function.
a small nuclear to cytoplasmic ratio
means that the nucleus of a normal cell dose not take up much space inside the cell.
benign(harmless)
moles or skin tages
immune system is influenced by many systems
nervous, endocrine and GI system and most cells come from the bone marrow and some mature in the bone marrow and others leave the bone marrow and mature in different body sites.
the purpose of inflammation and immunity is to provide protection by
neutralizing, eliminating or destroying organisms that invade the internal environment
RA drug and therapy
no cure DMARDS disease modifying antirheumatic drugs such as methotrexate(MTX) low once a week dose less than 25mg has become the mainstay treatment. slow acting taking 4-6 weeks to begin to control symptoms. decreases WBC and platelets bone marrow suppression occurs. risk for infection so avoid crowds and sick people. no alcohol, side effects are mouth sores and acute dyspnea from pneumonitis. strict birth control. discontinue 3 months before planned pregnancy. arava is a potent medication loading dose of 100mg daily for 3 days followed by 20mg daily thereafter. up to 3 months to kick in. side effects are hair loss, diarrhea, decreased WBC and platelets. no alcohol or pregnancy. plaquenil is another and the most serious side effect is retinal damage. report blurred vision or headache. eye examination every 6 months to detect changes in the cornea, lens, or retina. NSAIDS given with an H2 blocking agent. BRMS or TNF inhibitors are the newest form of DMARDS they neutralize the biologic activity of tumor necrosis factor. extremely expensive. not given to MS or TB patients. Enbrel: teach patient to report site reactions that can be painful. subcutaneously weekly dose. Humira: 40mg subq every 2 week with MTX or q week without MXT teach pt about site reaction *if drugs are taken in combination as a therapy draw regulary labs every 4-8 weeks to check CBC, serum creatinine and liver panel. *give acetaminophen and benadryle before the start of remicade and are often used at the time of reported infusion reactions. prednisone is given for their fast acting anti inflammatory and immunosuppressive effect prenisone may be given in high dose for short duration called pulse therapy or as a low chronic dose. *take calcium 1200-1500mg daily plus vit D 400mg to prevent osteoporosis. and DEXA scans'
self tolerance
non self proteins and cells include infected body cells, cancer cells, cells from other people, and invading organisms. and this recognizing self versus non self, which is necessary to prevent healthy body cells from being destroyed along with invaders
nonmigratory
normal cells do not wander throughout the body except blood cells.
benign tumor cells
normal cells growing in the wrong place or at the wrong time. examples are moles, uterine fibroid tumors, skin tags, endometriosis, nasal polyps.
tight adherence
normal cells make proteins that protrude from the membrans allowing cells to bind closely and tightly together like firbronectin
an older patient may not have a fever with infection but instead may experience an altered mental state.
obtain a sample of any drainage for culture and sensitivity to determine the offending organism and the antibiotics that may be needed for treatment.
secondary OA risk factor
occur less often. can result from other musculoskeletal conditions such as RA, trauma, certain heavy manual occupations, high intensity or repetitive stress to the joints, professional athletes.
inflammations from infections include:
otitis media, appendicitis, viral hepatitis.
fibromyalgia: chronic pain syndrome not an inflammatory disease.
pain stiffness and tenderness are located at specific sites in the back of the neck, upper chest, trunk, low back and extremities, also known as trigger points and can be palpated and pain is described as burning and gnawing. signs: GI, diarrhea constipation, urinary frequency, pelvic pain, chest pain, blurred vision and dry eyes, forgetfulness and concentration problems. irritated cause no relief from constant pain, IBS, treatment: tricyclic antidepressives, tramadol to help relive pain,
peripheral neuropathy associated with decreased circulation can cause footdrop and
paresthesias which is burning and tingling sensations usually in older adults
photodynamic therapy:
patient is sensitive to light for up to 12 weeks after the drug is injected. eyes and skin sensitive or 30-90 days. before: bring protective clothing, get someone to drive you, avoid leaving home for 1-3 months, voer all windos with light blocking shades, replace high watt lights with lower ones. after: effects last 1-3 months continue wearing protective clothing drink water don't start taking new drugs do exposure to sunlight slowly when no longer sensitive go to the doctor to get retina checked out
laboratory assessment for allergic response:
patient with severe seasonal alleric rhinitis may have an eosinophil count as high as 12% the normal being 1-2%. neutrophils remain normal between 55-70% unless there is an infection then they both increase. normal level of IgE: 39IU/mL this increases with allergies. RIST: is a test to determine specific allergies in the blood but is expensive. RAST: indicates the presence of an allergic reaction but does not indicate the specific allergen only the tendency to have allergic response. Skin testing: shows which specific allergen are the cause of most type 1 reactions. scratch or prick test can show an immediate reaction. only takes 15-20 minutes to show a positive wheal on the skin. use inside of forearm or the back, DC all antihistamines 4 weeks before and NSAIDs and aspirin, nasal spray is ok though. ROAT: is a testing done at home to test about certain hygiene or beauty products for contact dermatitis.
TKA: total knee replacement
performed when joint pain cannot be managed by conservative measures. may have a CPM machine after surgery to increase joint mobility like THA they need to shower the night before in antiseptic soap to decrase bacteria on the skin. intraoperative insertion of Adlea, a refined capsaicin product, derectly into the surgical joint opens C fiber receptors which causes extra calcium to enter the nerve cells causing numbness postop pain mgmt. is PNB peripheral nerve blockade which is local anesthetic injected into the femoral or sciatic nerve Continuous femoral nerve block check every 2-4 hours for performance pt should be able to plantar flex and dorsiflex the affected foot but feel no pain. signs that its getting into pts system: metallic taste, tinnitus, nervousness, slurred speech, bradycardia, hypotension, decreased respirations, seizures.)
electromyography helps confirm
peripheral neuropathy
diagnosis of AIDS requires:
person be HIV positive and have a CD4+ T-cell count less than 200 cells/mm or an opportunistic infection. and once diagnosed the person remains with AIDs even if treated.
care for a patient with myelosuppression and neutropenia:
place in private room good hand washing before touching anything ensure the patients room and bathroom are cleaned once a day do not use supplies from common areas limit number of health care personnel in room monitor vitals every 4hrs inspect mouth every 8 hours inspect skin and membranes esp anal area q8hrs inspect open area such as IV sites q4hrs change dressings daily assist in coughing and deep breathing encourage activity change IV tubing daily keep monitor equipment in patients room limit visitors monitor WBC count avoid indwelling catheters no flowers or plants avoid eating anything raw
treat necrostizing vasculitis with
prednisone
Gout: urate crystals deposit in the joints and other body tissues, causing inflammation.
primary is most common and results from one of several inborn errors of purine metabolism. uric acid is usually excreted by the kidneys but the production of uric acid exceeds the excretion of the kidneys, sodium urate is deposited in synovium and other tissues, resulting in inflammation. can be inherited through Xlinked trait. peak time is 40-50 years of age. 3 stages, asymptomatic which needs no treatment, gouty arthritis begins the acute stage and pt has pain and inflammation in one or more small joints usually great toe called podagra and ESR is usually increased. months and years pass before additional attacks occur. after repeated attacks deposits of crystals develp under the skin and within organs particularly in the renal system and the patient is then classified as having chronic tophaceous gout. secondary gout involves hyperuricemia(excessive uric acid in the blood) caused by another disease or factor. all ages. renal insufficiency, diuretic therapy, crash diets, and certain chemo agents decrease the normal excretion of uric acid and other waste products. treatment is to manage the underlying disorder. acute gout is with joint inflammation that is so painful and swollen to be touched or moved. check serum uric acid level a constant level of more than 6.5mg/dL is generally considered abnormal. urinary uric acid levels are also measured and if greater than 750mg/24hr makes the confirmation. chronic gout has tophi or deposits of sodium urate crystals and occur usually on the outer ear. other sites are arms and fingers near the joints. tophi are hard on palpation and are irregular in shape. breaks open and yellow, gritty substance is discharged, infection may result. other signs are renal stones, or dysfunction. treatment: colchicine or indomethacin along with a NSAID like ibuprogen for acute gout. IV colchicine works within 12 hours. oral medicaitons until inflammation subsides usually for 4-7days. chronic gout is treated with allopurinol or febuxostat to promote uric acid excretion. take these after meals and drink a glass of water with each dose. strict diet like avoiding organ meats, shellfish, oily fish with bones like sardines, limiting protein foods especially red and organ meats is sufficient, still others think that diet doesn't affect treatment. but it is well known that alcohol in excess and fad starvation diets can cause a gouty attack. and avoid all aspirin and diuretics.
treatment to reduce some cancers:
primary prevent: stop drinking and smoking Celebrex and aspirin for colon cancer, vitamin d and tamoxifen for breast cancer and use of lycopene to reduce the risk of prostate cancer. secondary prevention: yearly mams, exams, colonoscopy at age 50 and q 10 years, yearly fecal occult blood for adults of all ages, yearly PSA and DRE for men older than 50.
autoimmunity:
process where a person develops an inappropriate immune response that are directed against healthy normal cells and tissues. and the immune system fails to recognize certain body cells or tissues as self and thus triggers immune reactions. and associated with viral infections, cancer and some hematologic disorders. management is on the organ or organs affected. THERE IS NO CURE. anti inflammatory drugs and immunosuppressive drugs are commonly used along with symptomatic treatment.
exotoxins
produced and released by certain bacteria into the surrounding environment examples are tetanus, diphtheria, and E coli.
endotoxins
produced in the cell walls of certain bacteria and released only with cell lysis for example tyhoid and meningococcal diseases
apoptosis
programmed cell death
chemo induced peripheral neuropathy:
protect feet and other body areas right shoes fit so no blisters don't wear new shoes longer than 2 hours at a time avoid pointed toe shoes and heals higher than 2 inches inspect feet daily with mirror
nursing priority for patient with neutropenia
protecting them from infection within the health system and teaching the patient and family how to reduce infection in the home. total patient assessment including skin and mucuous membrane inspection, lung sounds, mouth assessment, and close inspection of venous access device insertion sites, should be performed every 8 hours by a RN.
human leukocyte antigens (HLA's)
proteins found on the surface of all body cells of that person and serve as a universal products code or cellular fingerprint for that person. will be foreign to another person or antigens which are proteins that stimulate an immune response.
sustained immunity(memory)
provides us with long lasting immunity to a specific antigen.
patients with indwelling urinary catheters are at high risk for
pyelonephritis and septicemia and current evidence shows that urease producing bacteria especially proteus mirabilis casue crystalline biofilms that create a crust that can block the catheter. use either silver alloy or antimicrobial coated catheters for short term less than 3 week use.
bleeding and managing anemia
q4hrs with vitals empty and measure bloody fluid from drain every shift and total amount of drainage is usually less than 50mL/8hr.
t cell brings the antigen into contact with the b cell so that the b cell can
recognize the antigen as non self
synovectomy
remove inflamed synovium may be needed for joints like the knee or elbow or TJA total joint arthroplasty may be indicated when all else fails.
transmission of infection in health care requires 3 factors
reservoir or source of infection susceptible hot with a portal of entry mode of transmission
Caplans syndrome
rheumatoid nodules in the lungs and pneumoconiosis
subcutaneous nodules
round movable nontender which appear on ulnar surface of the arm and finger or along the Achilles and may disappear and reappear at any time.
rhinorrhea
runny nose
anaphylaxis
signs: first of uneasiness, apprehension, weakness and impending doom anxious and frightened followed by itching and hives dyspnea, bronchospasms, wheezes, stridor, hypoxia, cyanosis, erythema and sometimes angioedema(diffuse swelling) of the eyes lips or tongue. the hives then merge to form large red blotches sometimes. loss of consciousness, incontinence, hyptonia, and absent DTR. then blood pressure drops 30% or lower than patients baseline of systolic. involve all blood vessels and bronchiolar smooth muscle causing widespread blood vessel dilation, decreased cardiac output and bronchoconstriction. major cause of fatal outcomes for anaphylaxis is a delay in the administration of epinephrine. carry epipen which is spring loaded injector that delivers 0.3mg of epinephrine per 2mL dose. inject dose into top of thigh with needle straight down can inject right through pants. keep in room temp place and away from light. drug should not be expired or discolored and cap should not be loose. s/e are pallor, muscle twitching, sweating, anxiety, insomnia, hypertension, headache, hyperglycemia. common agents that cause direct mast cell degranulation rather than IgE mediated anaphylaxis: DRUGS: antibiotics(penicillin, tetracycline) sulfonamides:bactrim and sptra, streptomycin, vancomycin, amphotericin B. adrenocorticotropic hormone, insulin, allergen extracts, muscle relaxants, hydrocortisone, vaccines, lidocaine, ACE inhibitors, ARBs, chemotherapy agents, whole blood, immune serum globulin, radiocontrast media, opiates. FOODS: peanuts, shellfish, eggs, legumes, nuts, berries, preservatives, bananas. OTHER: pollens, molds, latex INSECTS: bees, wasps, hornets, fire ants, snake venom. treatment: if IV drug stop it and but don't remove the IV access just change the IV tubing and hang normal saline. immediately assess respiratory status, airway, and oxygen saturation, call RRT, ensure intubation and tracheotomy equipment is ready, apply oxygen using high flow non rebreather mask at 90-100% Give epi 0.3-0.5mL IM or IV. this drug constricts blod vessels improves cardiac contraction and dilates the bronchioles and repeated every 5 minutes if needed. then elevate HOB 45 degrees or higher, raise feet and legs, stay with pt, reassure patient.
systemic sclerosis: also called scleroderma is an uncommon chronic inflammatory autoimmune connective tissue disease. means hardening of the skin. high mortality rate.
similar to SLE until a antibody test supports the diagnosis. the inflamed tissue in patients with SSc becomes fibrotic and then sclerotic(hard). renal problems lead to death. respiratory and hypertension are common. don't respond well to steroids or immunosuppressants used for lupus and die. classification for SSc are skin thickening on the trunk, face and rpximal and distal extremities, limited cutaneous SSc skin changes limited to face neck and distal extremities. often have CREST syndrome: calcinosis(calcium deposits), Raynauds phenomenon, esophageal dysmotility, sclerodactyly(fingers), Telangeictasia(spider like hemangiomas). other signs are GERD and hand and forearm edema, arthralgia(joint pain), stiffness, painless symmetric pittin gedema of hands and fingers, dysphagia, diarrheal stools, *give small easy to swallow foods and elevate head of bed for 1 hour after eating.
Precipitation:
similar to agglutination but has a larger response. larg antigen antibody complexes are formed and connot stay in suspension in the blood and they form a large precipitate, which then can be acted on and removed by neutrophils and macrophages.
AIIR
special air handling and ventilation systems in an airborne infection isolation room.
stages of HIV
stage 1: case definition any patient with confirmed HIV and a cell count greater than 500 or a cell percentage of 29% or greater. person at this stage has no AIDS-defining illness. stage 2: any patient with confirmed HIV infection and a cell count between 200-499 cells or a cell percentage between 14-28% and has no AIDS defining illnesses. stage 3: any patient with a confirmed HIV infection and a cell count of less than 200 or cell percentage of less than 14%. and AIDS defining illness. stage 4: confirmed HIV infection but no information regarding cell counts or percentage and AIDS defining illness is available.
steps needed to produce a specific antibody directed against a specific antigen whenever the person is exposed to that antigen:
steps are invasion, antigen recognition, lymphocyte sensitizations, antibody production and release, antigen-antibody binding, antibody-binding reactions, and sustained immunity or memory.
a major complication of THA is
subluxation or partial dislocation or total hip dislocation. when patient returns from PACU place him or her in a supine position with head slightly elevated. place pillow between the patients legs to prevent adduction beyond the midline of the body. avoid flexing the hips more than 90 degrees at all times. signs of hip dislocation: increased pain, shortening of affected leg and leg rotation. notify surgeon immediately.
lyme disease:
systemic infectious disease caused by the spirochete borrelia burgdorgeri bite from an infected deer tick early stage: flu like symptoms, erythema migrans(round or oval, flat or slightly raised rash) and pain and stiffness in the muscles and joints. bulls eye lesion. symptoms start in 3-30 days of bite. treat with antibiotic therapy such as doxycycline or amoxicillin. without treatment symptoms disappear in 4-5 weeks and the disease progresses to more serious stage 2. which occurs 2-12 weeks after bite and pt developes carditis with dysrhythmias, dyspnea, dizziness or palpitations as well as CNS disorders such as meningitis, facial paralysis and peripheral neuritis in this stage treat with IV antibiotics like ceftriaxone or cefotaxime for 30 days. and if still isn't treated or not found arthritis, chronic fatigue, memory/thinking problems can result and occurs months to years after bite. prevention of lyme disease: avoid heavily wooded areas, walk on trail, wear light colored clothing to spot ticks, use DEET on skin and clothes, wear long sleeved tops and pants and tuck shirt into your pants and pants into your socks and boots, wear closed shoes or boots and hat or cap, wash immediately after being in an infested area, pay attention when inspecting arms, legs and scalp, check pets, flush tick down toilet, then clean infected area with alcohol, wait 4-6 weeks after being bitten by a tick before being tested for lyme disease,
do not lift the patient
tell patient to stand on unaffected side and pivot
Lab results for RA
test norms abnorms rheumatoid fact negative positive ANA negative elevated in SLE, SSc, RA C3 55-120 decreased C4 20-50 decreased ESR male: up to 15mm/hr increased female: up to 20mm/hr SPEP 6.4-8.3g/dL albumin 3.5-5g/dL decreased alpha1 0.1-0.3 increased alpha2 0.6-1.0 beta 0.7-1.1 gamma 0.8-1.6g/dL increased HLA test none presence of
viral load testing:
tests the persons blood rather than the bodys response to the virus. these tests are quantitative and indicate the level or viral burden or viral load. useful in monitoring disease progression.
for temporary relief of pain in a single joint
the HCP will inject cortisone into it up to 4 times a year or once every 3 months.
sensitization occurs when
the b cell recognizes the antigen as non self and is now sensitized to this antigen and can only do this once so each b cell can be sensitized once to one type of antigen and remains to that specific antigen. and any cell produced by that specific b cell will be pre sensitized to that same specific antigen.
the bone marrow is the source of all blood cells including immune system cells
the bone marrow produces immature, undifferentiated cells called stem cells. stem cells are pluripotent meaning that each cell has more than one potential outcome and can become any one of many mature blood cells.
if inflammation is caused by infection
the end products of inflammation form pus which is then absorbed or exits the body through a break in the skin
the key process of inflammation is phagocytosis:
the engulfing and destruction of invaders and rids the body of debris after tissue injury. Neutrophils and macrophages are most efficient in this.
the presence of only one hot swollen painful joint out of proportion to other joints could mean
the joint is infected and pt needs to see HCP immediately and require immediate long term antibiotic treatment.
on inspection
the joint is often enlarged because of bony hypertrophy and feels hard on palpation, although not as common if inflammation is present it represents secondary synovitis.
ESR measures
the rate at which read blood cells fall through plasma the rate is most significantly affected by an increased number of acute phase reactants, which occurs with inflammation thus an elevated ESR (>20mm/hr) indicates inflammation or infection somewhere in the body. chronically elevated with inflammatory arthritis and other connective tissue diseases.
if either of iritis and scleritis occur
the sclera of one or both eyes is reddened and the pupils have an irregular shape
white blood cells (leukocytes or WBC) protect the body from the effects of invasions by organisms.
these cells are the immune system cells, the knights and soldiers protecting the castle inhabitants after invaders get through the castle wall.
treatment of type 3 immune complex reactions:
these circulating complexes form in the blood and lodge in small blood vessels and sites include kidneys, skin, joints, and other small blood vessels. and these trigger inflammation and tissue or vessel damage. treatment is based on the reaction. if serum sickness ccurs treatment is usually symptomatic antihistamines are given for itching and aspirin for arthralgias, prednisone is given if symptoms are severe.
classification of tumor by tissue of origin:
tissue of origin benign malignant epithelial glands Adenoma adenocarcinoma cartilage chondroma chondrosarcoma firbrous fibroma fibrosarcoma brain glioma blioblastoma blood vessel hemangioma hemangiosarcoma liver hepatoma hepatocarcinoma smooth musc leiomyoma leiomyosarcoma fat lipoma liposarcoma lympho non/hodgkins/burkitts melano melanoma meninges meningioma meningioma malignant nerve neuroma neurosarcoma bone osteoma osteosarcoma skeletal musc rhabdomyoma rhabdomyosarcoma squamous papilloma squamous cell carcinoma of skin, bladder, lungs cervix
surgical mgmt.: *always tell any future health care provider of a recent THA.
total joint arthroplasty(TJA) surgical creation of a joint. or total joint replacement(TJR) osteotomy(bone resection) to correct deformity THA( total hip arthroplasty or total hip replacement)(first time is referred to as primary, and if loosens then revision arthroplasty may be performed). *with obtaining labs before also get a cervical spine xray for general anesthesia incase of cervical spine disease that can lead to subluxation during intubation. *discontinue drugs that increase risk for DVT such as NSAIDS, vitamins C and E and HRT a week before. IV antibiotic like cephalosporin an hour before surgery. and placed under general or neuroaxial(epidural) anesthesia for lower extremity surgery. *get patient out of bed as soon as permitted to prevent complications
botulism:
toxin ingester results in dysphasia, and blurred or double vision, dry mouth, drooping eyelids. standard precautions no person to person spread.
communicable is
transmitted from person to person example is influenza or not communicable which is peritonitis
complement activation and fixation:
two classes of antibody that can activate the complement system are IgG and IgM.
examples of hypersensitivities
type 1: immediate: reaction of IgE antibody on mast cells with antigen, which results in release of mediators especially histamine causing things like hay fever, allergic asthma, anaphylaxis, allergy to latex, shellfish, drugs, peanuts, bee venom, allergic rhinitis. type 2: Cytotoxix: reaction of IgG with host cell membrane or antigen adsorbed by host cell membrane examples are autoimmune hemolytic anemia, goodpastures syndrome, and myasthenia gravis. type 3: Immune Complex-Mediated: fomraiton of immune complex of antigen and antibody which deposits in walls of blood vessels and results in complement release and inflammation examples are serum sickness, vasculitis, systemic lupus eryth, RA. Type 4: Delayed: reaction of sensitized t cells with antigen and release of lymphokines, which activates macrophages and induces inflammation examples are poison ivy, graft rejection, positive TB test, sarcoidosis. Type 5: stimulated: reaction of autoantibodies with normal cell surface receptors which stimulate a continual overreaction of the target cell examples are graves disease and b cell gammopathies.
IgA deficiency
upper resp infections, skin infections, urinary tract infections, vaginal infections, and diarrhea. it is major antibody in secretions so bacteria infections seen mostly in respiratory, GI and urogenital tracts. *never administer IVIG to this person!
shift to the left:
usually shows an increased number of immature neutrophils a few infections however such as malaria and infectious mono are associated with neutropenia(decreased neutrophils)
histamine
vasoactive amine a short acting biochemical causes capillary leak, nasal and conjunctival mucus secrtion, and itching(pruritus) often occurring with erythema(redness) and these symptoms last about 10 minutes after histamine is first released this is a primary phase of the reaction. In the secondary phase other proteins draw more white blood cells to the are and stimulate a more general inflammatory reaction through actions of leukotriene and prostaglandins and this occurs in addition to the allergic reaction stimulated by primary phase. *genetic inheritance to produce IgE response to an antigen.
drug therapy for allergy relief:
vasoconstrictors, antihistamines, mast cell stabilizers and drugs that inhibit the release or action of leukotrienes, decongestants. decongestants often contain ephedrine, phenylephrine, or pseudoephedrine. s/e include dry mouth, increased blood pressure, and sleep difficulties. consult with hcp before taking if you have high bp glaucoma and urinary retention. anithistamines block histamine from binding. Benadryl, chlorpheniramine which often induces sedation, clarinex, zyrtec and allegra are less sedating. corticosteroids decrease inflammation and immune responses by preventing the synthesis of mediators, nasal sprays can preven the symptoms of rhinitis. mast cell stabilizing drugs include nasal sprays such as nasalcrom that prevent mast cell membranes from opening when an allergen binds to IgE but not useful during an acute episode. Leukotriene modifiers for allergic rhinitis are zyflo which prevenst leukotriene synthesis.
sequence of inflammatory response:
warmth, redness, swelling, pain and decreased function.
skin protection during radiation therapy:
wash are gently each day with water or mild soap and water. use your hand rather than washcloth rinse soap thoroughly from your skin if ink or dye markings are present do not remove them dry irradiated are with patting motions rather than rubbing. use only powders, lotions and ointments or creams on your skin that are prescribed wear soft clothing avoid wearing belts or straps or clothing that binds avoid sun by wearing protective clothing and go outdoors in early morning or evening to avoid the intense sun stay under shaded areas. avoid heat exposure.
thrombocytopenia and anemia also from bone marrow suppression
when platelet count drops less than 50000 even small trauma can lead to prolonged bleeding with a count less than 20000 spontaneous and uncontrollable bleeding may occur. may require transfusion therapy take ESA's such as aranesp and epogen can prevent and improve anema. care to prevent bleedin: handle gently use lift sheet no injections or venipunctures if you have to use a small gauge needle apply firm pressure to needle stick site for 10 minutes or until the site no longer oozes blood apply ice to trauma areas test all urine and stool for presence of occult blood observe IV sites q4hrs do not give enemas or suppositories measure abdominal girth daily use electric shaver than a razor use soft tooth brush or sponges, dentures fit and do not rub don't blow nose or insert things into nose wear shoes with firm soles whenever walking keep pathways and walkways clear and uncluttered
lysozymes
which dissolve the cell walls of some bacteria are present in large qyantities in many body secretions, particularly in tears and nasal mucus.