Immunology

The client with rheumatoid arthritis reports GI irritation after taking piroxicam (Feldene). To prevent GI upset, the nurse should provide which instruction? 1. "Space the administration every 4 hours." 2. "Take piroxicam with food or an antacid." 3. "Use the drug for a short time only." 4. "Decrease the piroxicam dosage."

2. "Take piroxicam with food or an antacid." Taking piroxicam with food or an antacid decreases the risk of GI upset. The client may take the full piroxicam dosage once daily or may divide it in half and take a smaller dose every 12 hours; dosing every 4 hours isn't recommended. Because piroxicam may not produce therapeutic effects for 2 to 4 weeks, the client should take it for more than a short time. The client shouldn't adjust the dosage of piroxicam or any medication unless directed by a physician.

A client with thrombocytopenia, secondary to leukemia, develops epistaxis. The nurse should instruct the client to: 1. lie supine with his neck extended. 2. sit upright, leaning slightly forward. 3. blow his nose and then put lateral pressure on his nose. 4. hold his nose while bending forward at the waist.

2. sit upright, leaning slightly forward. Sitting upright and leaning slightly forward avoids increasing vascular pressure in the nose and helps the client avoid aspirating blood. Lying supine won't prevent aspiration of the blood. Nose blowing can dislodge any clotting that has occurred. Bending at the waist increases vascular pressure in the nose and promotes bleeding rather than halting it.

For a client with an exacerbation of rheumatoid arthritis, the physician prescribes the corticosteroid prednisone (Deltasone). When caring for this client, the nurse should monitor for which adverse drug reactions? 1. Increased weight, hypertension, and insomnia 2. Vaginal bleeding, jaundice, and inflammation 3. Stupor, breast lumps, and pain 4. Dyspnea, numbness, and headache

1. Increased weight, hypertension, and insomnia Prednisone can cause a wide range of adverse reactions, including increased weight caused by fluid retention, hypertension, insomnia, ecchymoses, suppressed inflammation, behavioral changes, and myopathy. However, it doesn't produce the signs and symptoms listed in options 2, 3, and 4.

The nurse is teaching a client who will be discharged soon how to change a sterile dressing on the right leg. During the teaching session, the nurse notices redness, swelling, and induration at the wound site. What do these signs suggest? 1. Infection 2. Dehiscence 3. Hemorrhage 4. Evisceration

1. Infection Infection produces such signs as redness, swelling, induration, warmth, and possibly drainage. Dehiscence, which refers to the separation of a wound, may cause unexplained fever and tachycardia, unusual wound pain, and prolonged paralytic ileus. Hemorrhage can result in increased pulse and respiratory rate, decreased blood pressure, restlessness, thirst, and cold, clammy skin. Evisceration produces visible protrusion of organs, usually through an incision.

immune response - T & B lymphocytes

1. Lymphocytes migrate to lymphoid tissue where they remain dormant until they need to form sensitized lymphocytes for cellular immunity or antibodies for humoral immunity. 2. Some B lymphocytes lie dormant until a specific antigen enters the body, at which time they greatly increase in number and are available for defense. 3. Types of T lymphocytes include helper/ inducer, suppressor, and cytotoxic/ cytolytic. 4. T and B lymphocytes are necessary for a normal immune response.

Which is the most numerous type of white blood cell (WBC)? 1. Neutrophil 2. Eosinophil 3. Basophil 4. Lymphocyte

1. Neutrophil Neutrophils are the most numerous of the WBCs, comprising about 65%. Lymphocytes are the second most abundant. Eosinophils account for about 2% while basophils are the least abundant.

interventions for the immunodeficient patient

1. Protect the client from infection. 2. Promote a balanced diet with adequate nutrition. 3. Use strict aseptic technique for all procedures. 4. Provide psychosocial care regarding lifestyle changes and role changes. 5. Instruct the client in measures to prevent infection. 6. Instruct the client to wear a Medic-Alert bracelet.

The nurse is assisting in planning care for a client with a diagnosis of immunodeficiency . The nurse would incorporate which of the following as a priority in the plan of care? 1. Protecting the client from infection 2. Providing emotional support to decrease fear 3. Encouraging discussion about lifestyle changes 4. Identifying factors that decreased the immune function

1. Protecting the client from infection The client with immunodeficiency has inadequate or absence of immune bodies and is at risk for infection. The priority nursing intervention would be to protect the client from infection. Options 2, 3, and 4 may be components of care but are not the priority.

Function of the Immune System

- The immune system provides protection against invasion by microorganisms from outside the body. - The immune system protects the body from internal threats and maintains the internal environment by removing dead or damaged cells.

Natural Immunity (innate)

- nonspecific - physical and chemical barriers ie. skin, oil secreting glands, perspiration (lysozyme), acidic environment (stomach), cilia - present at birth - specialized internal cells ie. compliment, neutrophils, macrophages, NK cells

A client who is receiving cyclosporine (Sandimmune) must practice good oral hygiene, including regular brushing and flossing of the teeth, to minimize gingival hyperplasia. Good oral hygiene also is essential to minimize gingival hyperplasia during long-term therapy with certain drugs. Which drug falls into this category? 1. procainamide (Pronestyl) 2. azathioprine (Imuran) 3. phenytoin (Dilantin) 4. allopurinol (Zyloprim)

3. phenytoin (Dilantin) Gingival hyperplasia may occur with long-term administration of phenytoin, an anticonvulsant. This adverse effect presumably is dose related. Frequent toothbrushing removes food particles and helps prevent infection; regular dental care and frequent gum massage also are recommended. Gingival hyperplasia isn't a reported adverse effect of procainamide, azathioprine, or allopurinol.

cellular response

A delayed response against slowly developing bacterial infections; also called delayed hypersensitivity. This type of response is active against slowly developing bacterial infections and is involved in autoimmune responses, some allergic reactions, and rejection of foreign cells.

5 major classes of immunoglobulins

IgG IgA IgM IgE IgD

acquired immunity

Immunity received passively from the mother's antibodies, animal serum, or antibodies produced in response to a disease. Immunization produces active acquired immunity.

agents with antioxidant properties

N-acetylcysteine (mucomyst) allopurinol (zyloprim) beta blockers ace inhibitors statins

Types of Specific Immunity

Natural & Acquired

nutrition and the immune system

PEM - protein energy malnutrition lack of micronutrients vitamin A & B6 deficiency is responsible for poor antibody response vitamin A maintains skin integrity zinc and vitamin C promote wound healing selenium and vitamin E promote NK cell function in elderly patients

myeloid stem cells develop into...

RBCs platelets macrophages polymorphonuclear granulocytes (neutrophils, eosinophils, basophils)

systemic autoimmune diseases

SLE (systemic lupus erythematosus) rheumatoid arthritis progressive systemic sclerosis (scleroderma)

3 main types of lupus

SLE (systemic lupus erythematosus) (70%) DLE (discoid lupus erythematosus) drug induced SLE (hydralazine, procainamide)

Scleroderma (systemic sclerosis)

Scleroderma is a chronic connective tissue disease similar to SLE that is characterized by inflammation, fibrosis, and sclerosis. This disorder affects the connective tissue throughout the body. It causes fibrotic changes involving the skin, synovial membranes, esophagus, heart, lungs, kidneys, and gastrointestinal tract. Treatment is directed toward forcing the disease into remission and slowing its progress.

Which of the following adverse effects should the nurse closely monitor in a patient who takes immunesuppressive drugs? a. respiratory or urinary infections b. depression, memory impairment, and coma c. heart failure, infusion reactions, and life-threatening infections d. rheumatoid arthritis

a. respiratory or urinary infections When taking drugs to suppress the immune system, the patient is vulnerable to an increased risk of infection, especially in the respiratory or urinary systems. Depression, memory impairment, and coma are dose-related effects of cytokines, a biologic response modifier. Heart failure, infusion reactions, and life-threatening infections are the possible adverse effects of taking infliximab, which minimizes inflammation. In addition, cytokines and infliximab are no immunosuppressive drugs. Moreover, immunisuppressive drugs are not known to cause rheumatoid arthritis.

Which of the following is a humoral response? a. delayed hypersensitivity b. anaphylaxis c. transplant rejection d. intracellular infections

b. anaphylaxis A humoral response includes anaphylaxis. Cellular responses include transplant rejection, intracellular infections, and delayed hypersensitivity.

Which of the following assessment should be completed if suspecting immune dysfunction in the neurosensory system? a. hematuria b. ataxia c. urinary frequency d. burning on urination

b. ataxia Ataxia should be assessed when suspecting immune dysfunction in the neurosensory system. Hematuria, discharge, and frequency and burning on urination are associated with the genitourinary system.

Which of the following is associated with impaired immunity relating to the aging patient? a. incidence of autoimmune disease decreases with age b. decreased renal function c. increased antibody production d. skin becomes thicker

b. decreased renal function Decrease renal circulation, filtration, absorption, and excretion contribute to the risk for UTIs. The antibody production decreases, skin becomes thinner, and the incidence of autoimmune disease increases with age.

Chronic illnesses may contribute to immune system impairment in various ways. Renal failure is associated with which of the following? a. altered production of white blood cells\ b. deficiency in circulating lymphocytes c. decreased bone marrow function d. increased incidence of infection

b. deficiency in circulating lymphocytes Renal failure is associated with a deficiency in circulating lymphocytes. Diabetes mellitus is associated with increased incidence of infection. Chemotherapy causes decreased bone marrow function. Leukemia is associated with altered production of white blood cells.

Proteins formed when cells are exposed to viral or foreign agent that are capable of activating other components of the immune system are referred to as a. antigens b. interferons c. antibodies d. complements

b. interferons Interferons are biologic response modifiers with nonspecific viricidal proteins. Antibodies are protein substances developed by the body in response to and interacting with a specific foreign substance. Antigens are substances that induce formation of antibodies. Complement refers to a series of enzymatic proteins in the serum that, when activated, destroy bacteria and other cells.

Which type of cells is capable of directly killing invading organisms and producing cytokines? a. null lymphocytes b. natural killer cells c. cytotoxic T cells d. memory cells

b. natural killer cells Natural killer cells defend against microorganisms and come type of malignant cells. Memory cells are responsible for recognizing antigens from previous exposure and mounting an immune response. Cytotoxic T cells attack the antigen directly by altering the cell membrane and causing cell lysis and by releasing cytolytic enzymes and cytokines.

Which of the following responses identifies a role of T lymphocytes? a. anaphylaxis b. transplant rejection c. allergic hay fever and asthma d. bacterial phagocytosis and lysis

b. transplant rejection Transplant rejection and graft-versus-host disease are cellular response roles of T cells. Anaphylaxis is a humoral response role of B-lymphocytes. Allergic hay fever and asthma are humoral response rolse of B-lymphocytes. Basterial phagocytosis and lysis are humoral response roles of B-lymphocytes.

Which of the following immunoglobulins assumes a major role in blood-borne and tissue infections? a. IgD b. IgM c. IgG d. IgA

c. IgG IgG assumes a major role in blood-borne and tissue infections. IgA protects against respiratory, GI, and genitourinary infections. IgM appears as the first immunoglobulin produced in response to bacterial and viral infections. IgD possibly influences B-lymphocyte differentiation.

During which stage of the immune response does the circulating lymphocyte containing the antigenic message return to the nearest lymph node? a. response b. effector c. proliferation d. recognition

c. proliferation Once in the node, the sensitized lymphocyte stimulates some of the resident dormant T and B lymphocytes to enlarge, divide, and proliferate. In the recognition state, the immune system distinguishes an invader as foreign, or non-self. In the response stage, the changed lymphocytes function either in a humoral or cellular fashion. In the effector stage, either the antibody of the humoral response of the cytotoxic T cell of the cellular response reaches and couples with the antigen on the surface of the foreign invader.

Cytokines

chemical messengers can be classified as lymphokines and monokines

GI manifestations of anaphylaxis

cramping abdominal pain nausea vomiting diarrhea

GMCSF - granulocyte macrophage colony stimulating factor

cytokine

Which of the following medication classifications are known to inhibit prostaglandin synthesis of release? a. Antibiotics (in large doses) b. Adrenal corticosteroids c. Antineoplastic agents d. Nonsteroidal anti-inflammatory drugs (NSAIDs) in large doses

d. Nonsteroidal anti-inflammatory drugs (NSAIDs) in large doses NSAIDs include aspirin and ibuprofen. Antibiotics in large doses are known to cause bone marrow suppression. Adrenal corticosteroids and antineoplastic agents are known to cause immunosuppression.

A client with systemic lupus erythematosus (SLE) has the classic rash of lesions on the cheeks and bridge of the nose. What term does the nurse use to describe this characteristic pattern? 1. Butterfly rash 2. Papular rash 3. Pustular rash 4. Bull's eye rash

1. Butterfly rash In the classic lupus rash, lesions appear on the cheeks and the bridge of the nose, creating a characteristic butterfly pattern. The rash may vary in severity from malar erythema to discoid lesions (plaque). Papular and pustular rashes aren't associated with SLE. The bull's eye rash is classic in client's with Lyme's disease.

The nurse practitioner assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? 1. Facial erythema, profuse proteinuria, pleuritis, fever, and weight loss 2. Pericarditis, photosensitivity, polyarthralgia, and painful mucous membrane ulcers 3. Weight gain, hypervigilance, hypothermia, and edema of the legs 4. Hypothermia, weight gain, lethargy, and edema of the arms

1. Facial erythema, profuse proteinuria, pleuritis, fever, and weight loss An autoimmune disorder characterized by chronic inflammation of the connective tissues, SLE causes fever, weight loss, malaise, fatigue, skin rashes, and polyarthralgia. Nearly half of clients with SLE have facial erythema, the classic butterfly rash. SLE also may cause profuse proteinuria (excretion of more than 0.5 g/day of protein), pleuritis, pericarditis, photosensitivity, and painless mucous membrane ulcers. Weight gain, hypervigilance, hypothermia, and edema of the legs and arms don't suggest SLE.

A client with suspected lymphoma is scheduled for lymphangiography. The nurse should inform the client that this procedure may cause which harmless, temporary change? 1. Purplish stools 2. Bluish urine 3. Redness of the upper part of the feet 4. Coldness of the soles

2. Bluish urine Lymphangiography may turn the urine blue temporarily; it doesn't alter stool color. For several months after the procedure, the upper part of the feet may appear blue, not red. Lymphangiography doesn't affect the soles.

The nurse is caring for a 32-year-old client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client? 1. Pallor, bradycardia, and reduced pulse pressure 2. Pallor, tachycardia, and a sore tongue 3. Sore tongue, dyspnea, and weight gain 4. Angina, double vision, and anorexia

2. Pallor, tachycardia, and a sore tongue Pallor, tachycardia, and a sore tongue are all characteristic findings in pernicious anemia. Other clinical manifestations include anorexia; weight loss; a smooth, beefy red tongue; a wide pulse pressure; palpitations; angina; weakness; fatigue; and paresthesia of the hands and feet. Bradycardia, reduced pulse pressure, weight gain, and double vision aren't characteristic findings in pernicious anemia.

A client with rheumatoid arthritis is being discharged with a prescription for aspirin (Ecotrin), 600 mg P.O. every 6 hours. The nurse should instruct the client to notify the physician if which adverse drug reaction occurs? 1. Dysuria 2. Tinnitus 3. Leg cramps 4. Constipation

2. Tinnitus The client with rheumatoid arthritis typically takes a relatively high dosage of aspirin for its anti-inflammatory effect. The nurse should instruct the client to report signs and symptoms of aspirin toxicity, such as tinnitus (ringing in the ears). The other options aren't associated with aspirin use or toxicity.

The nurse encourages a client with an immunologic disorder to eat a nutritionally balanced diet to promote optimal immunologic function. Autoimmunity has been linked to excessive ingestion of: 1. protein. 2. fat. 3. vitamin A. 4. zinc.

2. fat. A diet containing excessive fat seems to contribute to autoimmunity — overreaction of the body against constituents of its own tissues. Immune dysfunction has been linked to deficient — not excessive — intake of protein, vitamin A, and zinc.

The nurse is teaching a client with pernicious anemia who requires vitamin B12 replacement therapy. Which statement indicates that the client understands the treatment program? 1. "I'll swallow one vitamin B12 pill every morning for 2 weeks." 2. "I'll take a vitamin B12 pill once each month for life." 3. "I'll need an injection of vitamin B12 every month for life." 4. "I'll only need daily injections of vitamin B12 until my blood count improves."

3. "I'll need an injection of vitamin B12 every month for life." In pernicious anemia, the gastric mucosa doesn't secrete intrinsic factor, a protein necessary for vitamin B12 absorption. Without intrinsic factor, vitamin B12 replacements taken orally won't be absorbed; therefore, vitamin B12 must be administered through the I.M. or deep subcutaneous routes. Clients must take vitamin B12 each day for 2 weeks initially, then weekly for several months, then once each month for life.

The nurse is preparing a client with systemic lupus erythematosus (SLE) for discharge. Which instruction should the nurse include in the teaching plan? 1. "Exposure to sunlight will help control skin rashes." 2. "There are no activity limitations between flare-ups." 3. "Monitor your body temperature." 4. "Corticosteroids may be stopped when symptoms are relieved."

3. "Monitor your body temperature." Fever can signal an exacerbation and should be reported to the physician. Sunlight and other sources of ultraviolet light may precipitate severe skin reactions and exacerbate the disease. Fatigue can cause a flare-up of SLE. Clients should be encouraged to pace activities and plan rest periods. Corticosteroids must be gradually tapered because they can suppress the function of the adrenal gland. Abruptly stopping corticosteroids can cause adrenal insufficiency, a potentially life-threatening situation.

Which nonpharmacologic interventions should the nurse include in the care plan for a client who has moderate rheumatoid arthritis (RA)? 1. Massaging inflamed joints 2. Avoiding range-of-motion (ROM) exercises 3. Applying splints to inflamed joints 4. Using assistive devices at all times 5. Selecting clothing that has Velcro fasteners 6. Applying moist heat to joints

3. Applying splints to inflamed joints 5. Selecting clothing that has Velcro fasteners 6. Applying moist heat to joints Supportive, nonpharmacologic measures for the client with RA include applying splints to rest inflamed joints, using Velcro fasteners on clothes to aid in dressing, and applying moist heat to joints to relax muscles and relieve pain. Inflamed joints should never be massaged because doing so can aggravate inflammation. A physical therapy program, including ROM exercises and carefully individualized therapeutic exercises, prevents loss of joint function. Assistive devices should be used only when marked loss of ROM occurs.

A client is diagnosed with rheumatoid arthritis, an autoimmune disorder. When teaching the client and family about autoimmune disorders, the nurse should provide which information? 1. Clients with autoimmune disorders may have false-negative but not false-positive serologic tests. 2. Advanced medical intervention can cure most autoimmune disorders. 3. Autoimmune disorders include connective tissue (collagen) disorders. 4. Autoimmune disorders are distinctive, aiding differential diagnosis.

3. Autoimmune disorders include connective tissue (collagen) disorders. Connective tissue disorders are considered autoimmune disorders. Clients with autoimmune disorders may have either false-positive or false-negative serologic tests for syphilis. Other common laboratory findings in these clients include Coombs-positive hemolytic anemia, thrombocytopenia, leukopenia, immunoglobulin excesses or deficiencies, antinuclear antibodies, antibodies to deoxyribonucleic acid and ribonucleic acid, rheumatoid factors, elevated muscle enzymes, and changes in acute phase-reactive proteins. No cure exists for autoimmune disorders; treatment centers on controlling symptoms. Autoimmune disorders aren't distinctive; they share common features, making differential diagnosis difficult.

After an extensive diagnostic workup, a client is diagnosed with systemic lupus erythematosus (SLE). Which statement about the incidence of SLE is true? 1. SLE is most common in women between ages 45 and 60. 2. SLE affects more whites than blacks. 3. SLE tends to occur in families. 4. SLE is more common in underweight than overweight persons.

3. SLE tends to occur in families. SLE has a familial basis. Also, when one twin has the disease, the other twin has a 60% to 70% chance of developing it, suggesting a genetic predisposition. SLE strikes nearly 10 times as many women as men and is most common in women between ages 15 and 40. SLE affects more black women than white women; its incidence is about 1 in every 250 black women, compared to 1 in every 700 white women. Being overweight, not underweight, is thought to increase autoimmunity and thus heighten the risk for SLE and other autoimmune disorders.

The nurse is caring for a client with thrombocytopenia. What is the best way to protect this client? 1. Limit visits by family members. 2. Encourage the client to use a wheelchair. 3. Use the smallest needle possible for injections. 4. Maintain accurate fluid intake and output records.

3. Use the smallest needle possible for injections. Because thrombocytopenia alters coagulation, it poses a high risk of bleeding. To help prevent capillary bleeding, the nurse should use the smallest needle possible when administering injections. The nurse doesn't need to limit visits by family members because they don't pose any danger to the client. The nurse should provide comfort measures and maintain the client on bed rest; activities such as using a wheelchair can cause bleeding. The nurse records fluid intake and output to monitor hydration; however, this action doesn't protect the client from a complication of thrombocytopenia.

A client diagnosed with idiopathic thrombocytopenia purpura (ITP) needs a peripherally inserted central catheter placed. When explaining the catheter to the client, the nurse explains that one advantage of using a catheter is that it can be used: 1. to administer blood products and I.V. fluids only. 2. in clients with infections in the blood. 3. to accomplish long term access to central veins. 4. for 2 weeks without being replaced.

3. to accomplish long term access to central veins. A peripherally inserted central catheter provides long-term access (longer than 2 weeks) to central veins. It can be used to administer blood products, medications, I.V. fluids, and total parenteral nutrition (TPN). Moreover, the peripherally inserted central catheter can be used to obtain blood specimens. As with any other central venous catheter, this catheter shouldn't be inserted when systemic infection (infection in the blood) is present.

albumin (range)

3.2 - 4.5 g/dl

A client with idiopathic thrombocytopenic purpura (ITP), an autoimmune disorder, is admitted to an acute care facility. Concerned about hemorrhage, the nurse monitors the client's platelet count and observes closely for signs and symptoms of bleeding. The client is at greatest risk for cerebral hemorrhage when the platelet count falls below: 1. 135,000/μl. 2. 75,000/μl. 3. 20,000/μl. 4. 500/μl.

4. 500/μl. The client with ITP is at greatest risk for cerebral hemorrhage when the platelet count falls below 500/μl. A platelet count of 135,000/μl is normal and wouldn't occur in a client with ITP. Although platelet counts of 75,000/μl and 20,000/μl are below normal and increase the client's risk for bleeding, they don't increase the risk as much as a platelet count below 500/μl.

The physician orders tests to determine if a client has systemic lupus erythematosus (SLE). Which test result confirms an SLE diagnosis? 1. Increased total serum complement levels 2. Negative antinuclear antibody test 3. Negative lupus erythematosus cell test 4. An above-normal anti-deoxyribonucleic acid (DNA) test

4. An above-normal anti-deoxyribonucleic acid (DNA) test Laboratory results specific for SLE include an above-normal anti-DNA test, a positive antinuclear antibody test, and a positive lupus erythematosus cell test. Because the anti-DNA test rarely is positive in other diseases, this test is important in diagnosing SLE. (The anti-DNA antibody level may be depressed in clients who are in remission from SLE.) Decreased total serum complement levels indicate active SLE.

A client with rheumatoid arthritis is about to begin aspirin therapy to reduce inflammation. When teaching the client about aspirin, the nurse discusses adverse reactions to prolonged aspirin therapy. These include: 1. weight gain. 2. fine motor tremors. 3. respiratory acidosis. 4. bilateral hearing loss.

4. bilateral hearing loss. Prolonged use of aspirin and other salicylates sometimes causes bilateral hearing loss of 30 to 40 decibels. Usually, this adverse effect resolves within 2 weeks after the therapy is discontinued. Aspirin doesn't lead to weight gain or fine motor tremors. Large or toxic salicylate doses may cause respiratory alkalosis, not respiratory acidosis.

Types of Acquired Immunity

active & passive

assessment of immune system (factors)

age, gender, family hx, general health, past illness/hospitalization, allergies, occupation, current medications, recreational drug use, immunization status, screening tests, relationships, nutrition

acquired active immunity

antibodies are produced in response to acquiring a communicable disease (naturally) OR antibodies are produced in response to immunization (artificially)

hydroxychloroquine/Plaquenil

antimalarial used to treat SLE

medical interventions for SLE

aspirin & NSAIDs corticosteroids immunosuppressants antimalarials (hydroxychloroquine/Plaquenil) plasmapherisis BRMs (biologic response modifiers)

ITP (idiopathic thrombocytopenia purpura)

autoimmune disease of the blood

rheumatic fever

autoimmune disease of the heart

myasthenia gravis

autoimmune disease of the muscle

MS

autoimmune disease of the nervous system

guillain barre

autoimmune disease of the nervous system

scleroderma (systemic sclerosis)

chronic disease characterized by the formation of excess fibrous connective tissue and diffuse fibrosis of the skin and internal organs - can be localized or generalized (systemic)

SLE (systemic lupus erythematosus)

chronic inflammatory disease of connective tissue excessive B cell activation Immune complexes accumulate in circulating blood and become trapped in tissues (skin, brain, kidney, lungs, heart, joints) higher incidence in women more prevalent in African, Asian, Native American, Hispanic

immunocompromised

client's immune system is incompetent or unable to respond effectively

antioxidants

compounds that protect other compounds from free radicals ie. vitamin c, vitamin e, carotenoids, beta carotene, lycopene, selenium, zinc

INF - interferon

cytokine - first line of defense against viral infections (has anti-proliferative effect)

TNF - tumor necrosis factor

cytokine - involved in systemic inflammation

Interleukins

cytokines discovered after 1986

natural specific immunity

exists in individuals without prior contact with an antigen

assessment findings for SLE (sx)

fever fatigue joint pain skin rash (butterfly rash) anorexia weight loss photosensitivity

scleroderma (pathophys)

fibroblasts are stimulated to produce too much collagen excess collage forms thick connective tissue that builds up around cells of skin and blood vessels initially there's an inflammatory response, then skin undergoes fibrotic changes skin thickens and tightens (heart, lungs, kidneys, esophagus)

physical assessment of immune system

general appeance height/weight skin integrity wound inspection vital signs lymph node inspection/palpation joint inspection/palpation ROM

risk factors for SLE

genetic predisposition race sex hormones environmental factors virus/infection stress immunologic abnormalities

autoimmune diseases of the endocrine system

graves disease, hashimotos, type 1 DM

acquired passive immunity

host receives antibodies through transmission via placenta or breast feeding (naturally) OR host receives antibodies from injection of immune serum, gamma globulin (artificially)

free radicals

natural products of many cellular processes

anergy

no reaction to injected agent

GI autoimmune disease

pernicious anemia

diagnosis criteria of SLE

presence of 4 or more of following: facial erythema discoid rash hematological disorder photosensitivity oral or nasopharyngeal ulceration arthritis high levels of anti DNA antibodies positive ANA renal disorder serositis psychosis

Antimalarials (adverse effect)

retinal damage

suppressor T cells (T8orCD8)

turn the immune system off through feedback balance exists when T4 outnumber T8 2:1

diagnostics for immune system

wbc w/ diff serum protein albumin globulins protein electrophoresis antibody testing skin testing

inflammatory response

occurs in response to tissue injury as well as to the presence of non-self cells vessels dilate draw large numbers of phagocytes (neutrophils & macrophages) blood flow to affected area diminished

hypersensitivity

overreaction of the immune system

scleroderma sx

pain stiffness and muscle weakness thickened skin non-pitting swelling skin taut, shiny, hyperpigmented dysphagia decreased ROM contractures difficulty with ADLs arthralgias pulmonary cardiac GI renal

nursing interventions for SLE

patient education stress reduction medications prompt reporting of sx avoid exposure to sun - use sun screen

complements

plasma proteins which amplify immune response - also responsible for enhancing the initial steps of the inflammatory response

natural killer cells

prefer to destroy the body's own abnormal cells including cancerous and virally infected cells

skin manifestations of anaphylaxis

pruritus angioedema erythema urticaria

cell mediated response

recognition and killing of non-self and/or mutated self cells activation and regulation of immune responses cellular components: macrophages, T cells, NK cells T cells are primary component of cell mediated immunity

nursing interventions for immune function

reduce stress and depression promote sleep promote exercise (moderation - excessive exercise impairs immune response)

complication of SLE

renal failure

immunoglobulins

rid the body of antigens by either interfering with the antigens ability to adhere to cells or by activating the complement cascade

patient education (scleroderma)

scheduling activities strategies to prevent Raynaud's avoid chilling

Secondary/Peripheral Lymphoid Organs/Tissues

spleen, lymph nodes, tonsils, adenoids, appendix, peyers patch

Antigens

substances that illicit an immune response

corticosteroids (adverse effect)

suppress immune response moon face buffalo hump

The nurse provides home care instructions to a client with systemic lupus erythematous and tells the client about methods to manage fatigue. Which statement by the client indicates a need for further instructions? 1. "I should take hot baths because they are relaxing." 2. "I should sit whenever possible to conserve my energy." 3. "I should avoid long periods of rest because it causes joint stiffness." 4. "I should do some exercises, such as walking, when I am not fatigued."

1. "I should take hot baths because they are relaxing." To help reduce fatigue in the client with systemic lupus erythematosus, the nurse should instruct the client to sit whenever possible , avoid hot baths (because they exacerbate fatigue), schedule moderate low-impact exercises when not fatigued, and maintain a balanced diet. The client is instructed to avoid long periods of rest because it promotes joint stiffness.

A client is admitted to the facility with an exacerbation of her chronic systemic lupus erythematosus (SLE). She gets angry when her call bell isn't answered immediately. The most appropriate response to her would be: 1. "You seem angry. Would you like to talk about it?" 2. "Calm down. You know that stress will make your symptoms worse." 3. "Would you like to talk about the problem with the nursing supervisor?" 4. "I can see you're angry. I'll come back when you've calmed down."

1. "You seem angry. Would you like to talk about it?" Verbalizing the observed behavior is a therapeutic communication technique in which the nurse acknowledges what the client is feeling. Offering to listen to the client express her anger can help both the nurse and the client understand its cause and begin to deal with it. Although stress can exacerbate the symptoms of SLE, telling the client to calm down doesn't acknowledge her feelings. Offering to get the nursing supervisor also ignores the client's feelings. Ignoring the client's feelings suggests that the nurse has no interest in what the client has said.

Anaphylaxis

1. Anaphylaxis is a serious and immediate hypersensitivity reaction that releases histamine from the damaged cells. 2. Anaphylaxis can be systemic or cutaneous (localized).

Which white blood cells are involved in releasing histamine during an allergic reaction? 1. Basophils 2. Eosinophils 3. Monocytes 4. Neutrophils

1. Basophils Basophils are responsible for releasing histamine. Eosinophils' major function is phagocytosis of antigen-antibody complexes that are formed in allergic reactions. Monocytes and neutrophils are predominately phagocytic.

assessment of the immunodeficient patient

1. Factors that decrease immune function 2. Frequent infections 3. Nutritional status 4. Medication history, such as use of corticosteroids for long periods 5. History of alcohol or drug abuse

Assessment of the patient with a hypersensitive/allergic reaction

1. History of exposure to allergens 2. Itching, tearing, and burning of eyes and skin 3. Rashes 4. Nose twitching, nasal stuffiness

Interventions for the patient with hypersensitive/allergic reaction

1. Identification of the specific allergen 2. Management of the symptoms with antihistamines, anti-inflammatory agents, or corticosteroids 3. Ointments, creams, wet compresses, and soothing baths for local reactions 4. Desensitization programs may be recommended.

Actions to Take if a Client Develops Anaphylaxis

1. Quickly assess respiratory status and maintain a patent airway. 2. Call the physician or Rapid Response Team. 3. Administer oxygen. 4. Start an IV line and infuse normal saline. 5. Prepare to administer diphenhydramine (Benadryl) and epinephrine (adrenalin). 6. Document the event, actions taken, and the client's response. If the client experiences an anaphylactic reaction, the immediate action would be to assess the respiratory status quickly and maintain a patent airway. The physician or Rapid Response Team is called. In the meantime, the nurse stays with the client and monitors the client's vital signs and for signs of shock. An IV device is inserted if one is not already in place and normal saline is infused. The nurse then prepares for the administration of diphenhydramine and epinephrine and other medications as prescribed. The head of the bed is elevated if the client's blood pressure is normal. The client's feet and legs may be raised. The nurse documents the event, actions taken, and the client's response.

A client with a myocardial infarction is admitted to an acute care facility. During the admission history, the nurse learns that the client also has hypertension and progressive systemic sclerosis. For a client with this disease, the nurse is most likely to formulate which nursing diagnosis? 1. Risk for impaired skin integrity 2. Constipation 3. Ineffective thermoregulation 4. Risk for imbalanced nutrition: More than body requirements

1. Risk for impaired skin integrity Progressive systemic sclerosis is a connective tissue disease characterized by fibrosis and degenerative changes of the skin, synovial membranes, and digital arteries. Therefore, the nurse is most likely to formulate a nursing diagnosis of Risk for impaired skin integrity. Because clients with the disease are prone to diarrhea from GI tract hypermotility (caused by pathologic changes), Constipation is an unlikely nursing diagnosis. Progressive systemic sclerosis doesn't cause ineffective thermoregulation. GI hypermotility may lead to malabsorption, and esophageal dysfunction may cause dysphagia; these conditions put the client with the disease at risk for inadequate nutrition, making Risk for imbalanced nutrition: More than body requirements an improbable nursing diagnosis.

Antinuclear antibody (ANA) titer determination

1. The ANA titer determination is a blood test used for the differential diagnosis of rheumatic diseases and for the detection of antinucleoprotein factors and patterns associated with certain autoimmune diseases. 2. The test is positive at a titer of 1: 20 or 1: 40, depending on the laboratory. 3. A positive result does not necessarily confirm a disease. 4. The ANA titer is positive in most individuals diagnosed with systemic lupus erythematosus (SLE). 5. An ANA titer result can be false positive in a small proportion of the normal population.

Anti-dsDNA antibody test

1. The anti-dsDNA (double-stranded DNA) antibody test is a blood test done specifically to identify or differentiate DNA antibodies found in SLE. 2. The test supports a diagnosis, monitors disease activity and response to therapy, and establishes a prognosis for SLE. 3. Values a. Negative: Lower than 70 units by enzyme-linked immunosorbent assay (ELISA) b. Borderline: 70 to 200 units c. Positive: Higher than 200 units

After receiving a dose of penicillin, a client develops dyspnea and hypotension. The nurse suspects the client is experiencing anaphylactic shock. What should the nurse do first? 1. Page an anesthesiologist immediately and prepare to intubate the client. 2. Administer epinephrine, as prescribed, and prepare to intubate the client if necessary. 3. Administer the antidote for penicillin, as prescribed, and continue to monitor the client's vital signs. 4. Insert an indwelling urinary catheter and begin to infuse I.V. fluids as ordered.

2. Administer epinephrine, as prescribed, and prepare to intubate the client if necessary. To reverse anaphylactic shock, the nurse first should administer epinephrine, a potent bronchodilator as prescribed. The physician is likely to order additional medications, such as antihistamines and corticosteroids; if these medications don't relieve the respiratory compromise associated with anaphylaxis, the nurse should prepare to intubate the client. No antidote for penicillin exists; however, the nurse should continue to monitor the client's vital signs. A client who remains hypotensive may need fluid resuscitation and fluid intake and output monitoring; however, administering epinephrine is the first priority.

A client calls the nurse in the emergency department and tells the nurse that he was just stung by a bumble bee while gardening. The client is afraid of a severe reaction because the client's neighbor experienced such a reaction just 1 week ago. The appropriate nursing action is to: 1. Advise the client to soak the site in hydrogen peroxide. 2. Ask the client if he ever sustained a bee sting in the past. 3. Tell the client to call an ambulance for transport to the emergency department. 4. Tell the client not to worry about the sting unless difficulty with breathing occurs.

2. Ask the client if he ever sustained a bee sting in the past. In some types of allergies, a reaction occurs only on second and subsequent contacts with the allergen. The appropriate action, therefore, would be to ask the client if he ever experienced a bee sting in the past. Option 1 is not appropriate advice. Option 3 is unnecessary. The client should not be told "not to worry."

A client diagnosed with systemic lupus erythematosus (SLE) comes to the emergency department with severe back pain. She reports that she first felt pain after manually opening her garage door and that she is taking prednisone daily. What adverse effect of long-term corticosteroid therapy is most likely responsible for the pain? 1. Hypertension 2. Osteoporosis 3. Muscle wasting 4. Truncal obesity

2. Osteoporosis All of the options listed above are adverse effects of long-term corticosteroid therapy; however, osteoporosis frequently causes compression fractures of the spine. The other adverse effects aren't likely to cause severe back pain.

Which finding would the nurse identify as abnormal? 1. Red blood cells (RBCs): 4.9 million/μl 2. Platelets: 115,000/μl 3. White blood cells (WBCs): 7,000/μl 4. Hematocrit: 45%

2. Platelets: 115,000/μl Normal values are 150,000 to 300,000 platelets/μl; 5,000 to 10,000 WBCs/μl; 4.5 to 5.5 million RBCs/μl; and an average hematocrit of 45%.

During a routine checkup, the nurse evaluates a client with rheumatoid arthritis. To assess for the most obvious disease manifestations first, the nurse checks for: 1. muscle weakness. 2. joint abnormalities. 3. painful subcutaneous nodules. 4. gait disturbances.

2. joint abnormalities. Joint abnormalities are the most obvious manifestations of rheumatoid arthritis. A systemic disease, rheumatoid arthritis attacks all connective tissue. Nonarticular connective tissue, such as collagen in the lungs, heart, muscles, vessels, pleura, and tendons, may be involved diffusely. Vasculitis may affect the eyes, nervous system, and skin, causing thrombosis and ischemia. Although muscle weakness may occur from limited use of the joint where the muscle attaches, such weakness isn't the most obvious sign of rheumatoid arthritis; also, it occurs only after joint abnormalities arise. Subcutaneous nodules, although common in rheumatoid arthritis, are painless. The disease may cause gait disturbances, but these follow joint abnormalities.

Which immunoglobulin is specific to an allergic response? 1. IgA 2. IgB 3. IgE 4. IgG

3. IgE Immunoglobulin E (IgE) is involved with an allergic reaction. IgA combines with antigens and activates complement. IgB coats the surface of B lymphocytes. IgG is the principle immunoglobulin formed in response to most infectious agents.

A client takes prednisone (Deltasone), as prescribed, for rheumatoid arthritis. During follow-up visits, the nurse should assess the client for common adverse reactions to this drug, such as: 1. tetany and tremors. 2. anorexia and weight loss. 3. fluid retention and weight gain. 4. abdominal cramps and diarrhea.

3. fluid retention and weight gain. Common adverse reactions to prednisone and other steroids include sodium retention, fluid retention, and weight gain. Tetany and tremors are occasional adverse reactions to certain other drugs. Anorexia, abdominal cramps, and diarrhea are common adverse reactions to many drugs, but not to steroids.

During chemotherapy for lymphocytic leukemia, a client develops abdominal pain, fever, and "horse barn" smelling diarrhea. It would be most important for the nurse to advise the physician to order: 1. enzyme-linked immunosuppressant assay (ELISA) test. 2. electrolyte panel and hemogram. 3. stool for Clostridium difficile test. 4. flat plate X-ray of the abdomen.

3. stool for Clostridium difficile test. Immunosuppressed clients — for example, clients receiving chemotherapy, — are at risk for infection with C. difficile, which causes "horse barn" smelling diarrhea. Successful treatment begins with an accurate diagnosis, which includes a stool test. The ELISA test is diagnostic for human immunodeficiency virus (HIV) and isn't indicated in this case. An electrolyte panel and hemogram may be useful in the overall evaluation of a client but aren't diagnostic for specific causes of diarrhea. A flat plate of the abdomen may provide useful information about bowel function but isn't indicated in the case of "horse barn" smelling diarrhea.

For a client diagnosed with idiopathic thrombocytopenia purpura (ITP), which nursing intervention is appropriate? 1. Teaching coughing and deep-breathing techniques to help prevent infection 2. Administering platelets, as ordered, to maintain an adequate platelet count 3. Giving aspirin, as prescribed, to control body temperature 4. Administering stool softeners, as ordered, to prevent straining during defecation

4. Administering stool softeners, as ordered, to prevent straining during defecation The nurse should take measures to prevent bleeding because the client with ITP is at increased risk for bleeding. Straining at stool causes the Valsalva maneuver, which may raise intracranial pressure (ICP), thus increasing the risk for intracerebral bleeding. Therefore, the nurse should give stool softeners to prevent straining, which may result from constipation. Teaching coughing techniques would be inappropriate because coughing raises ICP. Platelets rarely are transfused prophylactically in clients with ITP because the cells are destroyed, providing little therapeutic benefit. Aspirin interferes with platelet function and is contraindicated in clients with ITP.

A client is receiving chemotherapy for cancer. The nurse reviews the client's laboratory report and notes that he has thrombocytopenia. To which nursing diagnosis should the nurse give the highest priority? 1. Activity intolerance 2. Impaired tissue integrity 3. Impaired oral mucous membranes 4. Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI

4. Ineffective tissue perfusion: Cerebral, cardiopulmonary, GI These are all appropriate nursing diagnoses for the client with thrombocytopenia. However, the risk of cerebral and GI hemorrhage and hypotension pose the greatest risk to the physiological integrity of the client.

A client is suspected of having systemic lupus erythematous. The nurse monitors the client , knowing that which of the following is one of the initial characteristic signs of systemic lupus erythematous? 1. Weight gain 2. Subnormal temperature 3. Elevated red blood cell count 4. Rash on the face across the bridge of the nose and on the cheeks

4. Rash on the face across the bridge of the nose and on the cheeks Skin lesions or rash on the face across the bridge of the nose and on the cheeks is an initial characteristic sign of systemic lupus erythematosus (SLE). Fever and weight loss may also occur. Anemia is most likely to occur later in SLE.

serum protein (range)

6 - 8 g/dl

NSAIDs (adverse effect)

GI irritation

Ibupforen (Motrin) has which effect on the immune system? a. neutropenia b. hemolytic anemia c. pancytopenia d. thrombocytopenia

a. neutropenia Motrin causes leukopenia and neutropenia. Phenylbutazone causes pancytopenia. Cefuroxime sodium (Ceftin) causes thrombocytopenia and hemolytic anemia.

humoral response

immediate response provides protection against acute, rapidly developing bacterial and viral infections B lymphocytes & complements B lymphocytes produce antibodies in response to foreign antigens B lymphocytes synthesize immunoglobulins

allergy

An abnormal, individual response to certain substances that normally do not trigger such an exaggerated reaction.

humoral response

An immediate response that provides protection against acute, rapidly developing bacterial and viral infections.

Types of hypersensitivity reactions

immediate, anaphylactic cytolytic, cytotoxic immune complex cell mediated, delayed

IgD

immunoglobulin bound to plasma membrane of B cells

IgA

immunoglobulin found in body secretions ie. colostrum

IgE

immunoglobulin mediator of allergies

IgM

immunoglobulin serves primarily to neutralize antigens and activate other immune proteins (complements)

immunosuppressants (adverse effect)

increased risk for infection

nursing diagnosis for SLE

increased risk for infection pain fear

helper T cells (T4orCD4)

initiate activation and maintenance of the immune response

medical management of scleroderma

Ca Channel blockers ACE inhibitors anti-inflammatory agents H2 histamine receptor antagonists tertracycline penicillamine (decrease skin thickening)\ PT dialysis

CREST syndrome

Calcinosis Raynaud's phenomenon Esophageal dysfunction Sclerodactyly Telangiectasia

HLAs

key feature for recognition and self tolerance

3 subtypes of scleroderma

limited (80%) diffuse sine

Preprocedure interventions for skin test

Discontinue systemic corticosteroids or antihistamine therapy 5 days before the test as prescribed. Obtain informed consent. Have resuscitation equipment available if skin testing is performed because the allergen may induce an anaphylactic reaction.

diagnostics for scleroderma

ESR gammaglobulin levels ANA skin bx nail fold capillary test

diagnostics for SLE

ESR, CRP (elevated) serum immunoglobulins (elevated) ANA (positive) anti DNA (positive) coombs (positive) serum compliment (low) UA (casts & protein) CBC (anemia, leukopenia, thrombocytopenia) EKG/Chest X-Ray (pericarditis, pleural effusion)

lymphoid stem cells develop into...

T lymphocytes B lymphocytes natural killer cells

immunodeficiency

The absence or inadequate production of immune bodies.

Skin testing

The administration of an allergen to the surface of the skin or into the dermis Administered by patch, scratch, or intradermal techniques

Primary/Central Lymphoid Organs/Tissues

Thymus & Bone Marrow

nursing focus for scleroderma

main skin integrity nutrition body image disturbance activity and rest continuous assessment of respiratory, cardiac, and renal function

4 main types of T cells

memory (CD3) helper (T4 or CD4) supressor (CD 8) killer

IgG

most prevalent immunoglobulin crosses the placenta

Immunocompetent

a client whose immune system is able to identify antigens and destroy or remove them

Systemic lupus erythematosus (SLE)

a. Chronic, progressive, systemic inflammatory disease that can cause major organs and systems to fail b. Connective tissue and fibrin deposits collect in blood vessels on collagen fibers and on organs. c. The deposits lead to necrosis and inflammation in blood vessels, lymph nodes, gastrointestinal tract, and pleura. d. No cure for the disease is known but remissions are frequently experienced by clients who manage their care well.

interventions for scleroderma

a. Encourage activity as tolerated. b. Maintain a constant room temperature. c. Provide small frequent meals, eliminating foods that stimulate gastric secretions, such as spicy foods, caffeine, and alcohol. d. Advise the client to sit up for 1 to 2 hours after meals if there is esophageal involvement. e. Provide supportive therapy as the major organs become affected. f. Administer corticosteroids as prescribed for inflammation. g. Provide emotional support and encourage the use of resources as necessary.

Which of the following is a nursing priority in caring for immunosuppressed patients? a. Following the agency guidelines for controlling infections b. Maintaining a serene atmosphere c. Ensuring a balanced and varied diet d. Uplifting the morale of such patients

a. Following the agency guidelines for controlling infections The nurse should follow the agency guidelines for controlling the infectious diseases or protecting the patient who is immunosuppressed. Patient teaching includes information about immunizations and instructions on drug therapy prescribed for disorders of the immune system. While ensuring an appropriate balanced diet and a serene atmosphere are also important, adhering to agency guidelines should be given priority. The morale of immunosuppressed patients does not require any special boost by the nurse.

Interventions for SLE

a. Monitor skin integrity and provide frequent oral care. b. Instruct the client to clean the skin with a mild soap, avoiding harsh and perfume substances. c. Assist with the use of ointments and creams for the rash as prescribed. d. Identify factors contributing to fatigue. e. Administer iron, folic acid, or vitamin supplements as prescribed if anemia occurs. f. Provide a high-vitamin and high-iron diet. g. Provide a high-protein diet if there is no evidence of kidney disease. h. Instruct in measures to conserve energy, such as pacing activities and balancing rest with exercise. i. Administer topical or systemic corticosteroids, salicylates, and nonsteroidal anti-inflammatory drugs as prescribed for pain and inflammation. j. Administer medications to decrease the inflammatory response as prescribed. k. Instruct the client to avoid exposure to sunlight and ultraviolet light. l. Monitor for proteinuria and red cell casts in the urine. m. Monitor for bruising, bleeding, and injury. n. Assist with plasmapheresis as prescribed to remove autoantibodies and immune complexes from the blood before organ damage occurs. o. Monitor for signs of organ involvement such as pleuritis, nephritis, pericarditis, coronary artery disease, hypertension, neuritis, anemia, and peritonitis. p. Note that lupus nephritis occurs early in the disease process. q. Provide supportive therapy as major organs become affected. r. Provide emotional support and encourage the client to verbalize feelings. s. Provide information regarding support groups and encourage the use of community resources.

Postprocedure interventions for skin test

a. Record the site, date, and time of the test. b. Record the date and time for follow-up site reading. c. Have client remain in waiting room or office for at least 30 minutes after the injection to monitor for adverse effects. d. Inspect the site for erythema, papules, vesicles, edema, and wheal e. Measure flare along with the wheal and document the size and other findings. f. Provide the client with a list of potential allergens, if identified.

Causes of SLE

a. The cause of SLE is unknown, but is believed to be a defect in immunological mechanisms, with a genetic origin. b. Precipitating factors include medications, stress, genetic factors, sunlight or ultraviolet light, and pregnancy. c. Discoid lupus erythematosus is possible with some medications but totally disappears after the medication is stopped; the only manifestation is the skin rash that occurs in lupus.

Which of the following statements accurately reflects current stem cell research? a. The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells. b. Stem cell transplantation can restore immune system functioning. c. Stem cell transplantation has been preformed in the laboratory only. d. Clinical trials are underway in patient with acquired immune deficiencies only.

a. The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells. The stem cell is known as a precursor cell that continually replenishes the body's entire supply of both red and white cells. Stem cells comprise only a small portion of all types of bone marrow cells. Research conducted with mouse models has demonstrated that once the immune system has been destroyed experimentally, it can be completely restored with the implantation of just a few purified stem cells. Stem cell transplantation has been carried out in human subjects with certain types of immune dysfunction such as severe combined immunodeficiency. Clinical trials are underway in patients with a variety of disorders with an autoimmune component including systems lupus erythematosus, rheumatoid arthritis, scleroderma, and multiple sclerosis.

2 types of immune system stem cells

myeloid and lymphoid

A patient undergoing a skin test has been intradermally injected with a disease-specific antigen on the inner forearm. The patient becomes anxious because the area begins to swell. Which of the following may be used to decrease anxiety in this patient? a. apply ice packs to reduce the swelling b. advise the patient to use prescribed analgesics c. gently rub the swollen area to accelerate the blood flow d. assure the patient that this is a normal reaction

d. assure the patient that this is a normal reaction The nurse should assure the patient that this a normal reaction. When disease-specific antigens are injected, the injection are swells as a result of the patient developing antibodies against the antigen that is introduced. The nurse should also keep in mind that the patient is not necessarily actively infectious if the test results are positive. Rubbing the area gently or even apply ice packs may only aggravate the swelling. The swollen area should be left open to heal by itself. The nurse should await the physician's instructions before advising the patient to use any prescribed analgesics.

Which of the following is an action of cytotoxic T cells? a. attack of foreign invaders (antigens) directly b. decreased B cell activity to a level at which the immune system is compatible with life c. production of circulating antibodies d. lyse cells infected with virus

d. lyse cells infected with virus Cytotoxic T cells play a role in graft rejection. B cells are lymphocytes important in producing circulating antibodies. Suppressor T cells are lymphocytes that decrease B-cell activity to a level at which the immune system is compatible with life. Helper T cells are lymphocytes that attack antigens directly.

Which type of immunity becomes active as a result of the infection of a specific microorganism? a. naturally acquired passive immunity b. artificially acquired active immunity c. artificially acquired passive immunity d. naturally acquired active immunity

d. naturally acquired active immunity Naturally acquired active immunity occurs as a result of an infection of a specific microorganism. Artificially acquired active immunity results from the administration of a killed of weakened microorganism or toxoid. Passive immunity develops when ready-made antibodies are given to a susceptible individual.

Which of the following is a process in which the antigen-antibody molecule is coated with a sticky substance that facilitates phagocytosis? a. agglutination b. apoptosis c. immunoregulation d. opsonization

d. opsonization In the process of opsonization, the antigen-antibody molecule is coated with a sticky substance that also facilitates phagocytosis. Apoptosis is programmed cell death that results from the digestion of DNA by endonucleases. Agglutination is the clumping effect occurring when an antibody acts as a cross-link between two antigens. Immunoregulation is a complex system of checks and balances that regulates or controls immune responses.

Which stage of the immune response occurs when the differentiated lymphocytes function in either a humoral or a cellular capacity? a. proliferation stage b. recognition stage c. effector stage d. response stage

d. response stage In the response stage, the differentiated lymphocytes function in either a humoral or a cellular capacity. Recognition of antigens as foreign or non-self, by the immune system is the initiating event in any immune response. In the proliferation stage, the circulating lymphocyte containing the antigenic message returns to the nearest lymph node. In the effector stage, wither the antibody of the humoral response of the cytotoxic TA cell of the cellular response reaches and connects with the antigen on the surface of the foreign invader.

A female patient who is 38 years of age has begun to suffer from rheumatoid arthritis. She is also being assessed for disorders of the immune system. She works as an aide at a facility that cares for children infected with AIDS. Which of the following is the most important factor related to this patient's assessment? a. diet b. home environment c. age d. use of other drugs

d. use of other drugs The nurse needs to review the patient's drug history. This data will help her to assess the patient's susceptibility to illness because certain past illnesses and drugs, such as corticosteroids, suppress the inflammatory and immune responses. The patient's age, home environment, and diet do not have any major implications during her assessment because they do not indicate her susceptibility to illness.

penicillamine (scleroderma)

decreases skin thickening

causes for scleroderma

environmental genetic

kidney autoimmune disease

glomerulonephritis

neurological manifestations of systemic anaphylaxis

headache dizziness paresthesia feeling of impending doom

respiratort manifestations of anaphylaxis

hoarseness coughing sensation of narrowed airway wheezing stridor dyspnea tachypnea respiratory arrest

cardiovascular manifestations of anaphylaxis

hypotension dysrhythmias tachycardia cardiac arrest