Immunity, Inflammation, and Hormonal Regulation

Signs of primary immunodeficiency

"SPUR"- severe, persistent, uncommon, recurring

SIADH (increased ADH)

- Holding on to fluids and not releasing (little output) - Change in LOC, decreased deep tendon reflexes, tachycardia, n/v/a, headache -Hyponatremia (water retention does not cause Na+ retention, but vice versa is true)

secondary immunodeficiency

-Gradual loss of immunity -Loss due to illness or treatment (medications)

DKA vs HHS

DKA : profound insulin ; Hyperglycemia HHS: sweating may be present, no acidosis

Primary prevention for immunity

Immunizations Avoid high-risk behaviors Adequate nutrition Exercise Infection control measures

hyperparathyroidism

Increase Callcium leveles Can cause: -renal calculi (kidney stones) -osteopoross -Hypercalcemia

Risk factors for hypothyroidism

Iodine-deficiency

acute inflammation

Minimal and short-lasting injury to tissue

signs and symptoms of diabetes insipidus

Polyuria, polydipsia Dehydration Clear urine

While caring for a patient preparing for a kidney transplant, the nurse knows that the patient understands teaching on immunosuppression when she makes which statement? a. "My body will treat the new kidney like my original kidney." b. "I will have to make sure that I avoid being around people." c. "The medications that I take will help prevent my body from attacking my new kidney." d. "My body will only have a problem with my new kidney if the donor is not directly related to me."

c.

local inflammation

confined to a specific area, redness heat swelling pain loss of function

Chronic inflammation

continuous injury or irritation to tissue May be caused by autoimmune disorders best to use diet and exercise for maintenance

Signs and symptoms of Inflammation

-Increased temp -Seizure -Coma -Increased WBC count -Redness, swelling, edema

Modifiable risk factors for alterations of immunity

-Stress -Tissue integrity -High RIsk behaviors and SUbstance abuse -Infection -Sleep -Malnutrition

Interventions for SIADH

Daily weight strict I&O Safety 1st Fluid restriction -VS monitoring -Furoseminde to inhibit ADH

The nurse is caring for a patient diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What is the nurse's best action? a. Encourage increased fluid and water intake b. Teach about risk for malignancies c. Monitor for changes in level of consciousness d. Assess labwork for potassium level changes

c.

The nurse is preparing to administer medications to a patient with rheumatoid arthritis (RA). The nurse should explain which goal of treatment to the patient? a. Eradicate the disease b. Enhance immune response c. Control inflammation d. Manage pain

c.

Aldosterone

"salt-retaining hormone" which promotes the retention of Na+ by the kidneys. Na+ retention promotes water retention, which promotes hypervolemia and increased BP -lack of aldosterone causes Na+ excretion and K+ retention -Attributes to FVE and edema

Hypercortisolism (Cushing's Syndrome)

- Moon face; Buffalo Hump -Truncal Weight Gain -weak muscles, osteoporosis -increased sodium and water retention -hypokalemia -Increased cortisol also means decreased inflammatory response -increased cortisol also means decreased WBC and increased glucose. (bacteria follows glucose) Caused by toomany corticosteroids or tumor secretions

How to assess changes in metabolism

-Changes in sleep pattern -Changes in urination/elimination -CHanges in appetite or eting -Weigh loss/weight gain -Increased Stress -Family history and risk factors -Vitals -Skin Hair and Nails -F&E

Signs and symptoms of SIADH

-FVE & Hyponatremia signs and symptoms -Nausea -Vomiting -Memory Issues -Confusion -weight gain

Assessments for alterations in immunity

-Family and Social history -History/frequency of infection -allergies -Medication history -Nutrition status/assessment -Weight changes -Sleep changes -Skin changes

Risks for alterations in Metabolism

-Hormone supplement therapy -Steroid Therapy -obesity and sedentary lifestyle -genetics, family history -Autoimmune responses -Age -Stress -brain injuries

Type 2 diabetes risk factors

-Hyperglycemia -Increased risk for infection -poor wound healing -HHS may be present after an infection

Hypocortisolism (addison's disease) (JFK)

-Hypoglycemia -Hyperpigmentation -HyperKalemia (lack of aldosterone causes Na+ excretion and K+ retention) -Weight loss -lack of energy -may be caused due to non-tapering of corticoids

Type 1 Diabetes interventions

-Monitor for hypokalemia (CARDIAC RHYTHM) -Monitor for DKA -Monitor for hypogylcemia (shaky, sweating, pallor, confusion) -BG checks hourly -Insulin -Hydration -BP and airway checks

Hypothyroidism/ Hashimoto's Disease (Oprah)

-Slowed down effects -Bradycardia -Hypothermia -Weight gain (decreased metabolism) -confusion -decreased BP

Type 1 diabetes mellitus

-absolute insulin deficiency r/t pancreatic beta cell destruction -Present at birth -autoimmune disorder

Type 2 diabetes interventions

-foot care -nutrition therapy -Rule of 15 (15g of simple sugars) -watch for increased HgbA1C levels.

hypoparathyroidsim

-hypocalcemia (trousseau's and chvostek's) -poor muscle contractility

Thyroid hormones

-regulates metabolism -Iodine-containing hormones that control the body's metabolic rate -secretes calcitonin, which inhibits/decreases serum calcium levels

Type 1 diabetes signs and symptoms

3 p's (polyuria, polydipsia, polyphagia) weight loss glucosuria Ketones in urine severe hyperglycemia DKA(metabolic acidosis)

The parents of a newborn question the nurse about the need for vaccinations: "Why does our baby need all those shots? He's so small, and they have to cause him pain." The nurse can explain to the parents that which of the following are true about vaccinations? (Select all that apply.) a. Are only required for infants b. Are part of primary prevention for system disorders c. Prevent the child from getting childhood diseases d. Help protect individuals and communities e. Are risk free f. Are recommended by the Centers for Disease Control and Prevention (CDC)

b, d, f

The nurse is caring for a patient who is being discharged home after a splenectomy. What information on immune function needs to be included in this patient's discharge planning? a. The mechanisms of the inflammatory response b. Basic infection control techniques c. The importance of wearing a face mask in public d. Limiting contact with the general population

b.

Which important teaching point should the nurse include in the plan of care for a patient diagnosed with Cushing disease? a. Daily weight using same scale b. Wash hands frequently c. Use exfoliating soaps when bathing d. Avoid yearly influenza vaccine

b. Washing hands is important because the patient's immune system is suppressed due to the excess glucocorticoid level. Daily weights are not indicated. Exfoliating soaps may damage thin skin. The patient should receive vaccinations due to being immunocompromised.

A patient who collects honey to earn supplemental income has developed a hypersensitivity to bee stings. Which statement, if made by the patient, would indicate a need for additional teaching? a. I need to find another way to earn extra money. b. I will get a prescription for epinephrine and learn to self-inject it. c. I will plan to take oral antihistamines daily before going to work. d.

c.

Glucagon function

increase blood glucose levels by telling the liver to release glucose from gycogen stores

Cellulitis signs and symptoms

localized area of inflammation -warmth -redness -edema -pain, tenderness -fever -gangrene possible if untreated

Cellulitis treatment

moist heat, immobilization, elevation, antibiotic therapy

systemic inflammation

no longer localized, can lead to septic shock

Insulin

regulates blood glucose levels, decreases blood glucose levels

R.I.C.E.

rest, ice, compression, elevation

Cortisol

stress hormone released by the adrenal glands -increased cortisol leads to increase risk of infection due to supressed immune system

Decreased Aldosterone

Causes dehydration and hypovolemia

The nurse is caring for a patient who was started on intravenous antibiotic therapy earlier in the shift. As the second dose is being infused, the patient reports feeling dizzy and having difficulty breathing and talking. The nurse notes that the patient's respirations are 26 breaths/min with a weak pulse of 112 beats/min. The nurse suspects that the patient is experiencing which condition? a. Suppressed immune response b. Hyperimmune response c. Allergic reaction d. Anaphylactic reaction

D. Anaphylaxis causes a change in vital signs.

Risk factors for SIADH

Head Injury Cancer Young with pneumonia or TB metabolic disorders -elderly at risk for hospitalization

Type 2 diabetes assessment

Hypergylcemia symptoms: 3p's ;blurred vision, fatigue -increased susceptibility to infecton -delayed wound healing -Hgb A1C greater than 6.5% Risk for HHS

Diabetes 2 diabetes

Insulin resistance (more gradual) inadequate insulin for bodily needs Obesity is a risk factor

Lifespan considerations for alterations in immunity

Pregnant Young (immature immune system) Older People (diminished/delayed hypersensitivity)

hyperthyroidism/ grave's disease

Sped up effects -Bulging Eyes -Goiter -Tachycardia -Increase metabolism -Weight loss -Increased Blood Pressure -Hyperthermia

Risk factors for Diabetes Insipidus

Brain injury or surgery Metabolic disorders

diabetes insipidus (decreased ADH)

antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect

Non-modifiable Risk factors for alterations of Immunity

chronic illnesses genetics Immunosupressed groups (cancer, transplants, HIV, lupus, chrohns)

Cellulitis

diffuse, acute infection of the skin's cellular or connective tissue marked by local heat, redness, pain, and swelling -often caused by staph or strep

primary immunodeficiency

genetic lack of immune response

Immunosupression

impaired ability to provide an immune response

1. The nurse assesses a patients surgical wound on the first postoperative day and notes redness and warmth around the incision. Which action by the nurse is most appropriate? a. Obtain wound cultures. b. Document the assessment. c. Notify the health care provider. d. Assess the wound every 2 hours.

ANS: B The incisional redness and warmth are indicators of the normal initial (inflammatory) stage of wound healing by primary intention. The nurse should document the wound appearance and continue to monitor the wound. Notification of the health care provider, assessment every 2 hours, and obtaining wound cultures are not indicated because the healing is progressing normally.

Following a parathyroidectomy, which electrolyte should the nurse most closely monitor? a. Potassium b. Sodium c. Magnesium d. Calcium

d.

Radioactive iodine is indicated for the treatment of hyperthyroidism. Which item should the nurse include in the plan of care? a. Isolation is required for 6-8 weeks. b. Continued thyroid monitoring is required. c. Thyroid replacement therapy is prescribed. d. An overnight hospital stay is required.

B.

Interventions for Inflammation

Underlying condition gets attention first RICE (q2-3H max) Crutches and other aids

Assessment for Inflammation

Vitals Skin: Warm, Red, Edema? History of injury, allergies Pain, swelling, fatigue Duration of Inflammation