NU 126 Exam 5 Part 1 Immune

HIV 2 - Which areas of the world are affected?

Africa and Southern Asia *rare*

Type III Hypersensitivity

Antigen Antibody Complexes deposit in BLOOD VESSEL walls causing INFLAMMATION and TISSUE damage

A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What option can the nurse discuss with the client? Sign a refusal of blood transfusion form so the client will not receive the transfusion. Bank autologous blood. Ask people to donate blood. Using volume expanders in case blood is needed.

BANK AUTOLOGOUS BLOOD

HIV Stage 3 - AIDS

*CD4 T count <200 or <14%*

HIV STAGE 1 - ACUTE

*CD4 T count >/500 mcl >29%* within 2 -4 wks after exposure FLU LIKE SYMPTOMS

Patients who have received blood or organ transplants before ________ are at risk for HIV/AIDS because those transfusions were not regulated back then.

1985

When do the Late phase reactions (secondary) IgE response occur?

8-12 hrs after exposure

Lymphocytopenia

abnormally low lymphocytes in the blood

Type III hypersensitivities are mediated by immune complexes that comprise?

an antibody (immunoglobulin) and an antigen

What do EIA tests identify?

antibodies specific for HIV indicates exposure or infection * precautions should still be taken because the person may not have created enough antibodies yet

Humoral Body Defense involves

antibody creation

Why are IgE antibodies considered Cytotropic antibodies?

because they bind to cell surfaces

Why do certain allergies tend to run in families?

because they have certain genes that cause the T-helper cells to be extra sensitive to certain allergens. - genetically linked

CD4 cells are created in ________________ and mature in the ___________.

bone marrow and mature in the thymus

T cells are produced in ____________ and mature in the ____________.

bone marrow and mature in the thymus

B cells mature in ___________________ and produce ________________.

bone marrow and produce antibodies

discordant couples

couples in which only one partner has HIV

What are immunodeficiency disorders caused by?

defect in phagocytic cells, b lymphocytes, t lymphocytes or the complement system

Five disorders of common, primary immunodeficiencies are ?

disorders of Humoral Immunity T cell defects combined B- and T cell defects Phagocytic disorders and Complement deficiencies

reverse transcriptase

enzyme that transforms single stranded RNA into DNA

The most prevalent cause of immunodeficiency worldwide is?

malnourishment

The diagnosis of anaphylaxis risk is determined by ?

prick and intradermal skin testing

The viral load test measures

the quantity of HIV RNA in the blood - predictor of HIV progression

atopic dermatitis

type I hypersensitivity inflammation of skin - itching, redness, skin lesions

Provirus

viral genetic material in the form of DNA that has BEEN INTEGRATED into the HOST GENOME.

Retrovirus

virus that carries genetic material in RNA and contains reverse transcriptase

At which point is HIV considered AIDS?

when Tcells/mm3 drop to <200

HIV Modes of Transmission

Blood Seminal Fluids Vaginal Secretions Amniotic Fluids Breast Milk

Serotonin

Bronchial smooth muscle contration

Epinephrine function as treatment for an anaphylactic reaction.

CONSTRICTS blood vessels

Type II Hypersensitivity is also known as?

Cytotoxic Hypersensitivity

What are some examples of CD4 cells?

Dendritic cells T helper Cells Macrophages

A client with AIDS is brought to the clinic by their family. The family tells the nurse the client has become forgetful, with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms?

HIV encephalopathy

Anaphylactic Rxn CM

IV site may be red or itchy Feelings of Apprehension LOC LOW BP Tachycardia

Whats an example of a Type II hypersensitivity?

Myasthenia Gravis

Type IV Hypersensitivity examples

OCCURS 24 to 72 hrs after exposure - RA - MS - Inflammatory Bowel Disease - Hashimoto - DM Type I

What comprises the (Primary) early phase reactions found in Ige Medicated cell response ?

Proteases (break up proteins) Eosinophils Histamine

A client in a late stage of acquired immunodeficiency syndrome (AIDS) shows signs of AIDS-related dementia. Which nursing diagnosis takes highest priority?

Risk for injury

Anaphylactic Shock

Severe - increased permiability of vessels and increased airway constriction - cant supply blood to vital organs

Type IV Hypersensitivity is mediated by?

T CELLS

Cellular Defense includes

T cells that can attack pathogens

CD4 cells

T- helper cells

CD8 cells

T-cytotoxic

What is required before testing for HIV?

The patient must know they are being tested and consent from the patient must be given !

Patient has gone through Anaphylactic Shock, what position should the patient be placed in?

Trendelenburg Position

Anaphylactic Shock is a ___________ Hypersensitivity Reaction.

Type I

Most allergic reactions are ______________ which are IgE mediated . There is an _____________ response.

Type I Hypersensitivity There is an immediate response, RXN within minutes

Whats the main difference between Type II and Type III hypersensitivities?

Type II involve antibodies binding to antigens on cell surfaces Type II involve immune complexes with soluble antigens

Serum Sickness (like a snake bite) is considered which type of hypersensitivity?

Type III

HIV 1 - which areas of the world are affected?

US and Worldwide

p24 antigen assay

quantifies the amount of HIV viral core protein in the clients serum

Which position is best for a closed angle glaucoma?

semi fowlers

If a person hears sound longer through air, but not at the normal 2:1 ratio, a __________ hearing loss is present

sensoneural

Rinne Test

to determine if a person hears sound better by air conduction or bone conduction.

Normally, sound produced by conduction through air (tuning fork adjacent to the external ear) is audible _____________________ as sound produced by conduction through bone (tuning fork on the mastoid process).

twice as long

Otoscope

used to examine ears

opthalmascope

used to examine the eyes

Postexposure prophylaxis (PEP) medications should be started within __________ after exposure, but no longer than __________, to offer any benefit. It must be taken for __________.

1 hour after exposure, but no longer than 72 hours, to offer any benefit. It must be taken for 4 weeks

A home care nurse is visiting a client with AIDS at home. During the visit, the nurse observes the caregiver providing care. Which of the following would alert the nurse to the need for additional teaching for the caregiver? A) Caregiver washes hands before and after providing care to the client. B) Caregiver cleans the client's anal area without wearing gloves C) Cargiver disposes of syringe and needle in a metal coffee can with lid. D) Caregiver uses a dilute bleach solution to clean up a urine spill.

B-To prevent the risk of HIV transmission, standard precautions should be used. Cleaning the client's anal area without wearing gloves indicates that the nurse needs to reinstruct the caregiver in measures related to standard precautions. Handwashing before and after client care, disposing of sharps in a puncture-resistant container, and cleaning up spills with a dilute bleach solution are appropriate measures.

Why are patients placed in the Trendelenburg Position during Anaphylaxis?

Because low BP

Which type of Ig antibodies are associated with Type II hypersensitivities?

IgG or IgM

Epniphephrine is given to someone going through a Type I Hypersensitivity, how serious must the reaction be?

The patient must be going through a SEVERE type of hypersensitivity reaction

If a person hears sound longer through bone, a ______________ hearing loss is present.

a conductive hearing loss is present

In closed angle glaucoma, you examine the eyes. What do you expect to find?

a non reactive pupil - greatly increased intraocular pressure around the iris prevents normal pupil response to light.

Someone with Menieres disease experiences dizziness. What is the best position to put them in?

any comfortable position is fine ---Dizziness in Meniere's disease does not result from poor circulation to the brain.

HIV stage 2 - CHRONIC

asymptomatic *CD4 T count 200-500 mcL* *14-28%*

Mydriatic eye drops cause the pupil to _____________, which can aid in the extraction of the cataract.

dilate

If someone has a GI issue they are at an ____________ risk for infection.

increased risk because GI secretions will also decrease

Clients with HIV should avoid large doses of iron and zinc because?

it can impair the functioning of the immune system

The two types of inherited B-cell deficiencies result from lack of differentiation of B cells into ___________________ and _________________ .

mature B Cells and plasma cells

When assisting the patient to interpret a negative HIV test result, the nurse informs the patient that the results mean which of the following? Antibodies to HIV are not present in his blood. He has not been infected with HIV. He is immune to HIV. Antibodies to HIV are present in his blood.

Antibodies to HIV are not present in the blood

The client is about to have a skin test for an allergic disorder. What critical instruction should the nurse give this client?

Avoid Antihistamines and cold preparations for 48 to 72 hrs before the test

A client visits the nurse complaining of diarrhea every time they eat. The client has AIDS and wants to know what they can do to stop having diarrhea. What should the nurse advise?

Avoid Residue, lactose, fat, and caffeine

A client has begun sensitivity testing to determine the allergen which caused an anaphylactic reaction 3 weeks ago. In scratch testing, which part of the body is more sensitive to allergens?

BACK

HIV targets _____________.

CD4 Cells

A client who is HIV positive is receiving highly active antiretroviral therapy (HAART) that includes a protease inhibitor (PI). The client comes to the clinic for a follow-up visit. Assessment reveals lipoatrophy of the face and arms. The client states, "I'm thinking the side effects of the drug are worse than the disease. Look what's happening to me." The nurse would most likely identify which nursing diagnosis as the priority? Deficient knowledge related to the effects of the disease Risk for infection related to the immune system dysfunction Disturbed body image related to loss of fat in the face and arms Risk for impaired liver function related to drug therapy effects

Disturbed body image related to loss of fat in the face and arms

A client presents at the clinic with an allergic disorder. The client asks the nurse what an "allergic disorder" means. What would be the nurse's best response? "It means you are very sensitive to something inside of yourself." "It is a hyperimmune response to something in the environment that is usually harmless." "It is a muted response to something in the environment." "It is a harmless reaction to something in the environment."

Its a HYPERIMMUNE RESPONSE to something in the environment that is usually harmless

In response to poison ivy, T cells release Proinflammatory cytokines which causes _______________________ and allows for more immune cells to come into the area which leads to ______________________ __________________ as well as systemic systems like a _______________________ .

LEAKY endothelial barriers Edema, Redness, Fever

In response to something like poison ivy, T cells release __________________.

Proinflammatory cytokines

What type of Hypersensitivity is Systemic Lupus Erythematosus

Type III

A positive PPD is an example of what type of hypersensitivity ?

Type IV

Contact dermatitis caused by poison IVY as an example of what type of hypersensitivity?

Type IV

Type I Hypersensitivity Symptoms

Urticoria Eczema Allergic Rhinitis Asthama Anaphylactic Shock

Telangiectasia

Vascular lesions caused by dilated blood vessels

The nurse practitioner reviews laboratory results requested to track HIV. Which of the following is a laboratory test that measures HIV RNA levels and is the best predictor of HIV disease progression?

Viral Load Test

Allergen

antigen that causes an allergic rxn

Type II Hypersensitivity involves antibody mediated destruction of __________________.

healthy cells - generally specific to one tissue or organ

Allergies

rxns to molecules (antigen) from outside your own body that most people dont react to. ex. foods, dander, mold, pollen, latex, lotions, soaps

Why do antigen-antibody complexes (TYPE III HYPERSENSITIVITY) embed themselves into the basement membrane of blood vessels?

small complex's are LESS IMMUNOGENIC they are LESS attracted to macrophages and so they dont get REMOVED from the bloodstream as quickly the complexes are also positively charged and the basement membranes are negative so they get attracted to each other that way

Which option should the nurse encourage to replace fluid and electrolyte losses in a client with AIDS? Liquids Gluten Sucrose Iron and zinc

LIQUIDDSS -

The period from infection with HIV to the development of antibodies to HIV is known as which of the following?

Primary Infection

CD4 cells function

helps immune system communicate

Leukotrienes

inflammation smooth muscle contraction recruit other immune cells even after the allergen is gone

Histamine is released by Mast cells in response to an allergen. What happens as a result of histamine release?

Bronchi Contract Dyspnea Blood vessel dilation increased permeability of blood vessel walls - which causes EDEMA and URTICARIA (hives)

Which is usually the most important consideration in the decision to initiate antiretroviral therapy? CD4+ counts HIV RNA Western blotting assay ELISA

CD4 COUNTS BECUASE THAT DETERMINES HOW FAR THE DISEASE HAS PROGRESSSEDD

EIA

Enzyme Immunoassay

Which blood test confirms the presence of antibodies to HIV?

Enzyme Linked Immunosorbent Assay (ELISA)

Nursing students are reviewing information about the different manifestations associated with AIDS. The students demonstrate understanding of these manifestations when they identify which of the following as the most common HIV-related malignancy?

Kaposi's Sarcoma

Secondary Cell response - Ige Mediated - includes which cells?

Leukotrienes Bradykinin Serotonin

A client with suspected HIV has had two positive enzyme-linked immunosorbent assay tests. What diagnostic test would be run next?

Western Blot Test

What test is used to confirm the Dx of HIV if a patient has a positive EIA ?

Western Blot test - blood test identifies antibodies to HIV

The Flu vaccine is an example of an _____________ immunity

active acquired

Immunoglobulins

any of a class of proteins present in the serum and cells of the immune system, that function as antibodies.

Lymphatic System Function

filtration of foreign substances circulation of lymphocytes

Primary Immunodeficiencies predispose people to three conditions _____________, ________________, and _______________.

frequent severe infections autoimmunity cancer

HIV attaches to the CD4 molecule with a protein called ?

gp120 (found on envelope of HIV cell)

Where do T Lymphocytes matures?

in the THYMUS

What type of blood pressure will you expect in an anaphylactic Response?

lowered blood pressure increased HR

Bradykinin

lowers BP

HIV is harbored within which type of cell?

lymphocyte

Tissue damage also occurs in Type IV hypersensitivities because the macrophages secrete __________________, complement components and ___________________.

lysosomal enzymes complement components and Reactive oxygen species

More than 50% of patients with common variable immunodeficiency develop the disorder of?

pernicious anemia

When does the primary IgE response occur ?

within minutes of exposure