med/surg exam 4
Effects of Aging on Immune System
-Immunosenescence - ↑ Incidences of tumors - Greater susceptibility to infection - ↑ Autoantibodies - ↓ Cell-mediated immunity - Thymic involution - ↓ Delayed hypersensitivity reaction - ↓ IL-1 and IL-2 synthesis - ↓ Expression of IL-2 receptors - ↓ Proliferation response of T and B cells - ↓ Primary and secondary antibody responses
Brachytherapy
-Implantation of radioactive seed into prostate gland - Spares surrounding tissue - Placement guided by transrectal ultrasound -Best suited for early stages of disease - Irritative or obstructive urinary problems are common - May experience ED May be offered in combination with external beam radiation treatment for those with more advanced tumors
risk factors for prostate cancer
-Incidence rises markedly after age 50 - Median age at diagnosis is 67 years old - Highest incidence in Jamaican men of African descent - diet - obesity -genetic link
Gerontologic Considerations for HIV
-Increasing rates of HIV disease among older adults - Death rate from opportunistic infections reduced - People 60 and older are increasingly being infected
risk factors for cervical cancer
-Infection with high-risk strains of HPV - Immunosuppression - Low socioeconomic status - Chlamydia infection - Smoking
Causes of Thrombocytopenia
-Inherited - Acquired Immune thrombocytopenia purpura (ITP) - Thrombotic thrombocytopenia purpura (TTP) - Heparin-induced thrombocytopenia (HIT)
3 types of immunity
-Innate immunity -Active acquired immunity -Passive acquired immunity
Endometrial Cancer risk factors
-Major risk factor is exposure to estrogen Especially unopposed estrogen - Obesity is a risk factor Adipose cells store estrogen -Increasing age -Never being pregnant -Early menarche -Late menopause -Smoking -Diabetes mellitus -Personal or family history of colorectal cancer
Most useful screening tests detect HIV-specific antibodies/antigens in the blood =
-May take several weeks (newest generation test can show a positive 3 weeks after initial infection) - Screening tests can use blood or saliva - Rapid HIV-antibody tests can provide results before patient leaves the office but must be confirmed
Radiation Therapy External beam radiation
-Most widely used method of radiation for prostate cancer - Used to treat cancer confined to prostate and/or surrounding tissue - Side effects can be acute or delayed
Bacteria
-One-celled organisms - Normal flora - Enter the body & Grow inside human cells Secrete toxins that damage cells Staph, strep, chlamydia, E. Coli
fungi
-Organisms similar to plants - Usually localized but can be Systemic in immunocompromised individuals - Athletes foot, ringworm
what is PSA and what is the normal value
-PSA is a glycoprotein produced by prostate gland - Normal levels are within 0 to 4 ng/mL (0 to 4 mcg/L)
Thrombocytopenia Clinical Manifestations
-Patients are often asymptomatic - Most common symptom is mucosal or cutaneous bleeding - Petechiae - microhemorrhages - Purpura - bruise from numerous petechiae - Ecchymoses - larger lesions from hemorrhage
Chemotherapy for prostate cancer
-Primarily limited to treatment for those with hormone-resistant prostate cancer (HRPC) in late stages - Goal is mainly palliative
prostate cancer
-Prostate cancer is a malignant tumor of the prostate gland. - Prostate cancer is the most common cancer among men, excluding skin cancer, and is the second leading cause of cancer death in men (exceeded only by lung cancer).
Thrombocytopenia etiology and pathophysiology
-Reduction of platelets - Results in abnormal hemostasis - Prolonged or spontaneous bleeding - Primarily an acquired disorder - Commonly from ingestion of high doses of certain drugs
how endometrial cancer is tested
-Routine screening tests are not available - Most cases are diagnosed early due to postmenopausal bleeding - Endometrial biopsy is primary diagnostic test
protozoa
-Single celled organisms that live in soil or bodies of water - Amoebic dysentery, giardiasis
Antigens
-Substances the body recognizes as foreign that elicit an immune response - Most are composed of protein
Depending on the differentiation of the cells and the stage of cancer, treatment options for ovarian cancer include
-intraperitoneal and systemic chemotherapy, - intraperitoneal instillation of radioisotopes, - external abdominal and pelvic radiation therapy.
Drug Therapy - For treatment of advanced or metastatic prostate cancer
Chemotherapy Androgen deprivation therapy (ADT)
Passive acquired immunity implies that
the host receives antibodies to an antigen rather than synthesizing them. This may take place naturally through the transfer of immunoglobulins across the placental membrane from mother to fetus. Artificial passive acquired immunity occurs through injection with gamma globulin (serum antibodies). The benefit of this immunity is its immediate effect. Unfortunately, passive immunity is short-lived, because the person did not synthesize the antibodies and consequently does not retain memory cells for the antigen.
what is primary immune response
first exposure to antigen
Innate immunity involves
involves a nonspecific response, and neutrophils and monocytes are the primary white blood cells (WBCs) involved. Innate immunity is not antigen-specific so it can respond within minutes to an invading microorganism without prior exposure to that organism.
what is secondary immune response
subsequent exposure to same antigen
aids Nursing interventions can help the patient
(1) adhere to drug regimens (2) promote a healthy lifestyle that includes avoiding exposure to other sexually transmitted and blood-borne diseases (3) protect others from HIV (4) maintain or develop healthy and supportive relationships (5) maintain activities and productivity (6) explore spiritual issues (7) come to terms with issues related to disease, disability, and death (8) cope with symptoms caused by HIV and its treatments.
Endometrial CancerClinical Manifestations
*Early symptoms* - Abnormal uterine bleeding -Especially in postmenopausal women *Later symptoms* - Pain during urination - Pain during intercourse - Pain in pelvic area
how to avoid healthcare associated infections (HAI's)
*Hygiene* - Excellent hand hygiene - Use of appropriate PPE - Decontamination of equipment used for patient care *Follow CDC Guidelines* - Standard precautions -Transmission-based precautions *Vaccinations* - Vaccinations are administered to people across the lifespan;
Generalized Diagnostic Tests for infection
*Laboratory tests* - Complete Blood Count (with WBC differential) - Culture and sensitivity - C-reactive protein (CRP) - Erythrocyte sedimentation rate (ESR) - Serologic tests to detect specific antibodies or viruses *Radiographic studies* - X-rays - MRI - CAT - PET and indium scans
Pathophysiology of HIV
*RNA virus or Retrovirus* - Replicates "backwards" goes from RNA to DNA - Can only replicate once inside a living cell (it's a virus) *CD4 T cells are the target cell for HIV* - CD4 cell is a lymphocyte - HIV attaches to CD4 T cells then binds to a protein & enters the cell (fusion) - HIV destroys 1 billion CD4 cells every day eventually destruction exceeds new production of CD4 cells - Immune system compromised opportunistic infections develop
treatment for endometrial cancer
*Treatment* - Total hysterectomy - Bilateral salpingo-oophorectomy - Lymph node biopsies *Radiation* - For local or distant metastasis *Chemotherapy and hormonal therapy* - For advanced or recurrent disease
ART Therapy
- *Antiretroviral therapy (ART) consists of the combination of at least three antiretroviral (ARV) drugs to maximally suppress the HIV virus and stop the progression of HIV disease* - Ability to Adhere to drug regimen is important - Slow/Prevent disease progression -Opportunistic disease Increase in viral loads -ART is individualized
Immune Thrombocytopenic Purpura (ITP) Clinical syndrome manifests as
- Acute condition in children - Chronic condition in adults - Treated with multiple therapies
Prevention of HIV at work
- Adhere to precautions and safety measures to avoid exposure - Report all exposures for timely treatment and counseling - Post-exposure prophylaxis with combination ART can significantly decrease risk of infection
Tests used to determine location and extent of metastasis of prostate cancer
- Bone scan - CT scan - MRI using an endorectal probe - ↑ PAP (prostatic acid phosphatase) Especially if cancer has spread
Importance of CD4 & T Helper cells
- CD4 and T (helper) cells are white blood cells that are an important part of the human immune system - They are called helper cells because one of their main roles is to send signals to other types of immune cells, including CD8 killer cells, which then destroy the infectious particle.
Thrombotic Thrombocytopenic Purpura (TTP) caused by
- Caused by plasma enzyme deficiency - Primarily in previously healthy adults - Idiopathic or from drug toxicities *Medical emergency Bleeding and clotting occur simultaneously*
Slow growing androgen-dependent cancer Can spread by 3 routes =
- Direct extension - Through lymph system - Through bloodstream
Ovarian CancerClinical Manifestations
- Early ovarian cancer usually has no obvious symptoms. - Most clinical manifestations are vague and nonspecific. *These include pelvic or abdominal pain, bloating, urinary urgency or frequency, and difficulty eating or feeling full quickly*
Hypersensitivity altered immune response
- Exaggerated immune response / Disease /Autoimmune disorders / Asthma - Medication/ infusion related reactions
Gerontologic Considerations: Infections in older adults
- HAI's 2-3 times higher for older adults - Decreased immune function - Co-morbidities (diabetes, physical disabilities) - Central-line associated infections, surgical site infections, c.diff, MSRA, UTI's - 1/3 of HAI's are preventable - Atypical presentation of infections - Cognitive, behavioral changes, inability to perform ADL's are often seen before the emergence of fever, pain, changes in lab values
Viruses
- Infectious particles that consist of small amount of genetic material - Reproduce after releasing genetic material into the cell of another living organism Influenza, Herpes, Epstein-Barr, HIV
Normal Hemostasis
- Involves the vascular endothelium, platelets, and coagulation factors - Function together to stop hemorrhage and repair vascular injury - Disruption of any component may result in bleeding or thrombotic disorders
Immune Thrombocytopenic Purpura (ITP)
- Most common acquired thrombocytopenia - Syndrome of abnormal destruction of circulating platelets - Primarily an autoimmune disease
Ovarian CancerDiagnostic Studies
- No accurate screening test exists -Annual bimanual pelvic exam -Ovaries should not be palpable in postmenopausal women - Ovarian masses can be detected with abdominal or transvaginal ultrasound - Exploratory laparotomy can establish definitive diagnosis and stage of disease
Cervical CancerClinical Manifestations
- No symptoms in early stages - Eventually, unusual discharge, AUB, postcoital bleeding occurs Discharge initially thin and watery; becomes dark and foul smelling - Initially vaginal bleeding is spotty; becomes heavier and more frequent - Pain, weight loss, anemia, cachexia
AIDS is characterized by:
- Severe immune system suppression and CD4+ T-cell counts < 200 cells/μL - An opportunistic infection - An opportunistic cancer - Wasting syndrome (loss of 10% or more of ideal body mass) - AIDS dementia complex (ADC).
Immunocompromise altered immune responses
- Suppressed immune response / Disease / HIV - Medication/ Chemotherapy / Antibiotics - Abnormalities / Congenital neutropenia
Organs of Immune System
- The central lymphoid organs are the *thymus gland and bone marrow* - The peripheral lymphoid organs are the *lymph nodes; tonsils; spleen; and gut-, genital-, bronchial-, and skin-associated lymphoid tissues*
Initial treatment for all stages of ovarian cancer
- Total abdominal hysterectomy - Bilateral salpingo-oophorectomy - Omentectomy - Tumor debulking
Transmission of HIV
- Transmitted via: Contact with infected blood, semen, vaginal secretions, breast milk - Sexual intercourse with an infected partner - Exposure to HIV-infected blood or blood products - Perinatal transmission during pregnancy, at delivery or breast-feeding - HIV is not spread through casual contact *NOT Spread By: tears, saliva, urine, emesis, sputum, feces, sweat, respiratory droplets or enteric routes*
biopsy of prostate can be completed by
- Transrectal ultrasound procedure - MRI/ultrasound fusion biopsy
radical surgery for ovarian cancer usually involves
- removal of the uterus, ovaries, fallopian tubes, vagina, bladder, urethra, and pelvic lymph nodes. - In some situations, the descending colon, rectum, and anal canal may also be removed.
immune response to virus stages
- virus invades body and makes it way into cell to replicate self - macrophage recognize antigen on cell surface and digest it - T helper cell recognizes the antigen from the macrophage - T helper cells release cytokines, causing B cells to multiply and produce antibodies. - T cytotoxic cells and natural killer cells destroy infected body cells. - The antibodies bind to the virus and mark it for macrophage destruction. - Memory B and T cells remain behind to respond quickly if the same virus attacks again.
Thrombotic Thrombocytopenic Purpura (TTP)
-An uncommon syndrome with a variety of features that are not always present - Called TTP-HUS as it is most always associated with hemolytic-uremic syndrome - Associated with enhanced aggregation of platelets that form into microthrombi
Common physical problems for HIV
-Anxiety, fear, depression -Diarrhea -Peripheral neuropathy - Pain - Nausea/vomiting - Fatigue
Clinical Management for infections
-Appropriate Antimicrobial therapy - Rest and comfort measures - Nutritional support - Fluids - Disinfection of physical environment
Heparin-Induced Thrombocytopenia (HIT)
-Associated with increased use of heparin - Life-threatening - Two major responses to an immune-mediated response to heparin: - Platelet destruction - Vascular endothelial injury
risk factors for ovarian cancer
-At higher risk Women who have never been pregnant (nulliparity) - Increasing age - High-fat diet - Greater number of ovulatory cycles - HRT - Use of infertility drugs
HIV infection is preventable by=
-Avoid risky behaviors - Modify risky behaviors - Candid, culturally sensitive, language- appropriate, age-specific information and behavior change counseling
mild elevation of PSA can occur with=
-BPH -Recent ejaculation -Constipation -Acute or chronic prostatitis - After long bike rides
Vaccines against HPV
-Begin before 1st sexual contact Ages 11-12; as early as age 9 - Gardasil - types 6, 11, 16, 18 - Cervarix - types 16, 18 - Gardasil 9 - types 6, 11, 16, 18 plus 5 other types of HPV - *3 IM doses over 6-month period*
2 targeted therapy for ovarian cancer
-Bevaciumab For women with defective BRCA genes - Olaparib (Lynparza)
Ovarian Cancer Etiology
-Cause is unknown - Genetic link BRCA gene mutations - Family history Ovarian cancer, Breast or colon cancer - Personal history of breast or colon cancer and HNPCC
when are Cervical CancerDiagnostic Studies completed
-Cervical cancer screening at age 21 - 21-29 years old - every 3 years 30-65 years old - every 5 years - Abnormal Pap test should be followed with a colposcopy
complications after Cryosurgery (cryoablation)
-Damage to urethra - Urethrorectal fistula - Urethrocutaneous fistula - Tissue sloughing, ED, urinary incontinence, prostatitis, and hemorrhage can also occur
when does Heparin-Induced Thrombocytopenia (HIT) develop
-Develops 5-10 days after heparin therapy is started - Platelet count drops 50% from baseline - Venous thrombosis is major clinical problem - Arterial thrombosis can also develop - DVT and PE often result
Androgen deprivation therapy (ADT)
-Drug Therapy - For treatment of advanced or metastatic prostate cance - Primary therapeutic approach - Reduces levels of circulating androgens to reduce tumor growth - Can be used before surgery or radiation to reduce tumor size and in advanced disease
Surgical Therapy Radical prostatectomy
-Entire gland, seminal vesicles, and part of bladder neck are removed - Retroperineal lymph node dissection is done for men at high risk for metastasis - Not indicated for advanced disease stages
major complications after Radical prostatectomy
-Erectile dysfunction (ED) - Incontinence - Other complications include hemorrhage, urinary retention, infection, wound dehiscence, DVT, PE
when is PSA screening done
-Every 2 years - Especially for men ages 55-69 - When symptoms of prostatic hyperplasia are present, further diagnostic screening may be necessary (Table 54-2)
ovarian cancer Histologic grading
-Grade I - well-differentiated -Grade II - Moderately well- differentiated -Grade III - Poorly differentiated -Grade IV - Undifferentiated Poorer prognosis than other grades
Components of HIV cell
-HIV is surrounded by an envelope made up of proteins, including gp120. - HIV virus contains a core of viral RNA and proteins. - Like all viruses, HIV cannot replicate unless it is inside a living cell.
Cervical CancerDiagnostic Studies - PAP test
-Identifies changes in cervical cells - Obtained from cervix during pelvic exam
Active acquired immunity results from
the invasion of the body by foreign substances such as microorganisms and subsequent development of antibodies and sensitized lymphocytes. With each reinvasion of the microorganisms, the body responds more rapidly and vigorously to fight off the invader. Active acquired immunity may result naturally from a disease or artificially through immunization. Because antibodies are synthesized, immunity takes time to develop but is long-lasting.
Internal bleeding may manifest as
weakness, fainting, dizziness, tachycardia, abdominal pain, or hypotension
Thrombocytopenia Diagnostic Studies
-↓ Platelet count - Prolonged bleeding < 50,000/μL - Hemorrhage ↓ 20,000/μL - Peripheral blood smear - Medical history - Clinical examination - Lab parameter comparison
Clinical Manifestations and Complications of HIV
Acute Infection *Flulike symptoms Fever, swollen lymph nodes, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, or a diffuse rash* - Occurs about 2 to 4 weeks after infection Highly infectious - Asymptomatic Infection Symptoms are generally absent or vague - High risk behaviors may continue * Symptomatic Infection CD4+ T cells drop: 200 - 500 cells/μL.* - HIV Viral load increases HIV advances to a more active state—often about 10 years after initial infection, if left untreated
Labs used to monitor HIV Infection
CD4 T cell count - Adequate CD4 count is 800-1200 microliters - Viral load - The lower the viral load the less active the disease
immune response - homeostasis
Damaged cellular substances are digested and removed. Through this mechanism, the body's different cell types remain uniform and unchanged.
Normal Immune Response 3 functions
Defense Homeostasis Surveillance
what type of diet places men more at risk for prostate cancer
High red and processed meat intake High-fat dairy products Diet low in vegetables and fruits
2 medications used for BPH that may reduce chance of getting prostate cancer
Finasteride and dutasteride (used to treat BPH) may reduce the chance of getting cancer
name 2 types of Resistance tests can help determine new drug combinations for patients not responding to ART Therapy
Genotype assay Phenotype assay
Cervical CancerDiagnostic Studies - HPV test
HPV test - Identifies high-risk HPV types 16 and 18 -Cervical scrapings are tested for viral DNA or RNA
Antibodies
Immune globulins produced by lymphocytes in response to antigens
artificial active immunity
Immunization with antigen (e.g., vaccines for chickenpox, measles, mumps)
artificial passive immunity
Injection of serum with antibodies from one person (e.g., injection of hepatitis B immune globulin) to another person who does not have antibodies
prostate cancer Route of spread Direct extension
Involves seminal vesicles, urethral mucosa, bladder wall, and external sphincter
immune response - surveillance
Mutations continually arise in the body but are normally recognized as foreign cells and destroyed.
natural active immunity
Natural contact with antigen through actual infection (e.g., chickenpox, measles, mumps)
Symptoms of metastasis of prostate cancer
Pain in lumbosacral area that radiates down to hips or legs that is combine with urinary symptoms
End-of-Life Care for HIV
Patient comfort Helping patient & significant others deal dying Maintaining safe environment acceptance of life
Cryosurgery (cryoablation)
Surgical technique that destroys cancer cells by freezing the tissue Initial and second-line treatment after radiation therapy has failed
immune response - defense
The body protects against invasion by microorganisms and prevents the development of infection by attacking foreign antigens and pathogens.
cervix
The cervix is the lower third of the uterus that projects into the vagina and is comprised of glandular cells that line the uterine cavity and endocervical canal.
prostate cancer Route of spread Through bloodstream
To axial skeleton: pelvic bones, head of femur, lower lumbar spine, liver, and lungs
prostate cancer Route of spread Through lymph system
To regional lymph nodes
natural passive immunity
Trans-placental and colostrum transfer from mother to child (e.g., maternal immunoglobulins passed to baby)