Chapter 14 Med Surg
A patient is given lymphocyte immune globulin (Atgam) as an induction therapy before a liver transplant. What is the importance of administering this medication to the patient? Select all that apply.
Lymphocyte immune globulin is a polyclonal antibody used to severely immunosuppress an individual. This reduces the production of antibodies and thus helps in prevention of early organ rejection. Lymphocyte immune globulin inhibits leukocytosis. The drug does not provide passive immunity. Since it reduces antibody production, it increases the risk of an iatrogenic infection. Text Reference - p. 223
The nurse is comparing primary and secondary immune deficiencies. Which of these are potential causes of secondary immune deficiencies? Select all that apply. 1 Stress 2 Malnutrition 3 Job syndrome 4 Corticosteroid drugs 5 Graft-versus-host disease 6 Acquired immunodeficiency syndrome (AIDS)
1,2, 4, 6 Stress, malnutrition, corticosteroid drugs, and AIDS are causes of secondary immunodeficiency disorders. Job syndrome and graft-versus-host disease are causes of primary immunodeficiency disorders.
The nurse is alerted to possible anaphylactic shock immediately after a patient has received intramuscular iron dextran by the development of which of the following? Select all that apply. 1 Blisters at the injection site 2 Edema at the injection site 3 Itching at the injection site 4 Chest tightness 5 Itching of the nose and eyes 6 Sneezing
2, 3, 4 Symptoms of systemic anaphylactic shock include edema and itching at the site of exposure to the allergen, and chest tightness (dyspnea). Blisters at the injection site, itchiness of nose and eyes, and sneezing do not occur with anaphylaxis.
A patient is experiencing an acute rejection of a transplanted kidney. Which of these statements would help the nurse understand the course of events? Select all that apply. 1 A new transplant will be needed. 2 Repeated episodes of acute rejection can lead to chronic rejection. 3 Acute rejection can be treated with muromonab-CD3 (Orthoclone OKT3). 4 Corticosteroids are the most successful drugs used to treat acute rejection. 5 Acute rejection is common after a transplant and can be treated with drug therapy.
2, 3, 5 It is not uncommon to have at least one acute rejection episode, especially with organs from deceased donors. These episodes usually are reversible with additional immunosuppressive therapy that may include increased corticosteroid doses or polyclonal or monoclonal antibodies. Monoclonal antibodies, such as muromonab-CD3, are used for preventing and treating acute rejection episodes. Acute rejection is treatable and usually does not require a new transplant. Calcineurin inhibitors are the most effective immunosuppressants available to treat organ rejection.
The nurse recalls that immunodeficiency is defined as an inadequate response of the immune system to foreign bodies. In what conditions is immunodeficiency therapeutically induced in patients? Select all that apply. 1 Stress 2 Radiation 3 Chemotherapy 4 Organ transplantation 5 Autoimmune disorders
4, 5 Patients who have undergone organ transplants and patients having exacerbations or flare-ups of autoimmune disorders are given immunosuppressive drugs to clinically induce immunodeficiency or immunosuppression. This helps decrease the ill effects caused by the immune responses. Stress, chemotherapy, and radiation may trigger immunodeficiency.
The nurse is caring for a patient who had an exposure to poison ivy which initiated a cell-mediated immune response. The production of what type of cell is increased as a result of this response?
A cell-mediated immune response triggers the differentiation of T helper cells into T cytotoxic cells, which produce cytokines. IgE is an immunoglobulin and is produced during humoral immunity. Cell-mediated response does not affect the number of bacteria in the body. Macrophages are types of white blood cells (WBC) that identify and ingest antigens containing foreign material.
A patient is admitted to the hospital with allergic rhinitis. Which medications should be included in the treatment plan of the patient? Select all that apply
Antihistamines are the best drugs to treat allergic rhinitis. They act by competing with histamine for H1-receptor sites and thus block the effect of histamine. Mast cell-stabilizing drugs inhibit the release of histamines and are used in management of allergic rhinitis. If there is severe manifestation of allergic rhinitis, a brief course of oral corticosteroids is indicated. Antipruritic drugs are used for insect bites to protect the skin and provide relief from itching. The major sympathomimetic, epinephrine, is used in anaphylactic reaction. Minor sympathomimetic drugs are used to treat allergic rhinitis. Text Reference - p. 215
A concerned family member of a patient with atopic dermatitis asks the nurse about the disease. What will the nurse tell the relative? Select all that apply.
Atopic dermatitis is a chronic, inherited skin disorder. It is caused by several environmental allergens, which are difficult to identify. Although the patient has a positive skin test and elevated levels of IgE, it is not characterized by a localized wheal and flare. This is more indicative of a type I reaction. It is not associated with shortness of breath. Text Reference - p. 211
The nurse recognizes that a patient is demonstrating signs of a transplant rejection after a renal transplant. Which phenomenon is responsible for the rejection of donor organs and tissue?
Cell-mediated immunity involves various cells, including natural killer cells. The natural killer cells are responsible for identifying "self" and "non-self" tissues, which sometimes results in rejection of grafts and transplants. Innate immunity is present after birth. It involves a non-specific response through neutrophils and monocytes and is not responsible for graft rejections. Passive immunity results when antibodies are acquired by the body and not produced within. Humoral immunity involves immunoglobulin production and is responsible for allergic reactions.
What is the mode of action of cyclophosphamide (Cytoxan)?
Cyclophosphamide (Cytoxan) is a cytotoxic agent used as an immunosuppresant. It acts by cross-linking the DNA strands, which leads to cell injury followed by cell death. This action of cyclophosphamide decreases the number and activity of T-cells. Azathioprine (Imuran) blocks the synthesis of purine, thereby inhibiting B-cell and T-cell proliferation. Mycophenolate acid (Myfortic) acts by inhibiting purine synthesis. Belatacept (Nulojix) is a drug that inactivates T-cells.
Following a patch test, the patient experiences severe pruritus and erythema around the patch area. What are the most appropriate immediate nursing interventions? Select all that apply.
Following a patch test, if the patient experiences severe pruritus and erythema around the patch area, it indicates an anaphylactic reaction. To prevent it from becoming severe, the nurse should immediately remove the patch and apply antiinflammatory cream topically. A subcutaneous injection of epinephrine can also be given to decrease the severity of the reaction. Documenting and reporting are completed only once the patient is stable.
Which immunoglobulin passes from the mother to the child through the placenta?
IgG is the immunoglobin that crosses the mother's placental barrier and reaches the child. It is responsible for secondary immune responses. IgA is in the mother's breast milk, colostrum, and saliva. It lines the mucous membranes and protects body surfaces. IgD is on the surface of lymphocytes; it helps differentiate B-lymphocytes. IgE is in the child's plasma and interstitial fluid, and causes the symptoms of allergic reactions.
A nurse is performing a skin test on a patient with systemic lupus erythematosus. What are conditions that the nurse is likely to find during this test? Select all that apply.
Systemic lupus erythematosus is a type III hypersensitivity reaction in which erythema and edema appear within 3-8 hrs after performing a skin test. Wheal and flare appear in type I hypersensitivity reaction. Itching is present usually in atopic reactions. Skin lesions with bullae are seen during acute dermatitis. Text Reference - p. 209
Which questions are relevant for a nurse to ask while assessing a patient with seasonal allergies? Select all that apply.
Taking over-the-counter medicines can be a contributing factor of allergy. Information should be obtained about which over-the-counter medications have been taken by the patient. Often, the hair of pets can cause allergies. Many people are allergic to pets and pet dander. Therefore, it is important to ask the patient about any pets at home. A detection of the patient's family history of diabetes will not contribute in assessing allergy symptoms. The last date of the patient's menstruation period will not help the assessment of allergies. Also, exercising regularly is not related to allergies.
A patient develops an allergic rash on his arms and subsequent shortness of breath during the administration of intravenous gentamicin (Garamycin). What should be the immediate nursing intervention to ensure safety of the patient? Select all that apply.
The nurse should immediately stop the infusion because the patient may be susceptible to an allergic reaction. The nurse should stop the infusion of medicine and notify the health care provider. Decreasing the flow rate is not an appropriate action in this case. This could be an emergency situation, so reassessing after 15 minutes is not a wise thing to do. Instead, the nurse should continuously monitor the vital signs of the patient. Checking body temperature is not the priority. Text Reference - p. 210
A patient has been prescribed lymphocyte immune globulin (Atgam). The nurse understands that the drug may be associated with side effects like fever, joint pain, and tachycardia. Which measures should the nurse take to prevent the side effects when administering Atgam?
To reduce the side effects of lymphocyte immune globulin (Atgam), the nurse should administer the drug slowly over 4 to 6 hours and premedicate the patient with acetaminophen, diphenhydramine, and methylprednisolone. In addition, the patient should be closely monitored for adverse effects. Fever, arthralgias, and tachycardia are the common side effects caused by an allergic reaction to the foreign protein of the host animal. However, the side effects are not too severe to discontinue the use of the drug. The patient should be educated about prevention of infection as a general measure; however, prevention does not contribute to decreasing the symptoms.
The nurse differentiates between the types of hypersensitivity reactions and recognizes that which type is related to cell-mediated immunity?
Type IV is related to cell-mediated immunity. It is a delayed hypersensitivity reaction. Tissue damage occurs in delayed hypersensitivity reactions. It requires 24 to 48 hours for a response to occur. Type I, Type II, and Type III are immediate reactions and are a part of humoral immunity.
humoral activity--- cells involved: products: memory cells: protection: examples:
cells involved: B lymphocytes products: antibodies memory cells: present protection: bacteria, viruses, respiratory and GI pathogens examples: anaphylactic shock, atopic diseases, transfusion reaction, bacterial infections
cell-mediated activity--- cells involved: products: memory cells: protection: examples:
cells involved: T lymphocytes, macrophages products: sensitized T cells, cytokines memory cells: present protection: fungus, viruses, chronic infectious agents, tumor cells examples: tuberculosis, fungal infections, contact dermatitis, graft rejection, destruction of cancer cells
Immune responses serve the following 3 functions:
defense: The body protects against invasions by microorganisms and prevents the development of infection by attacking foreign antigens and pathogens homeostasis: damaged cellular substances are digested and removed. Through this mechanism, the body's different cell types remain uniform and unchanged surveillance: mutations continually arise in the body but are normally recognized as foreign cells and destroyed
types of immunity
innate immunity: present at birth, and its primary role is first-line defense against pathogens. this type of immunity involves a non specific response, and neutrophils and monocytes are the primary WBCs involved -- it is not antigen specific so it can respond within minutes to an invading microorganism without prior exposure to it acquired immunity: the development of immunity, either actively (invasion of body cells by foreign substances, development of antibodies occur and if reinvasion occurs the body responds more rapidly and vigorously - can happen naturally when you get disease or artificially through immunization) or passively (host receives antibodies to an antigen rather than synthesizing them. can happen naturally from transfer of immunoglobulins from mother to fetus, or through injection of gamma globulin and it has an immediate affect but is short lived because the person doesn't make the antibodies
immunity
the body's ability to resist disease