Immunity

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Author:
tiffanydawnn
ID:
128583
Filename:
Immunity
Updated:
2012-01-22 22:22:03
Tags:
Altered Immunity
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Description:
Altered Immunity
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  1. nonspecific
    • innate immunity
    • 1st line
    • 2nd line
  2. specific
    • adaptive immunity
    • granulocytes increase
    • neutrophils - bacteria (shift to the left)
    • eosinophils - allergy (hypersensitivity), parasitic
    • lymphocytes - viral
  3. inflammation
    • blood/WBCs to local area
    • neutralize/destroy invader
    • initiate repair
    • s/s - heat, swelling, pain, redness
  4. chemical mediators
    • histamine - triggers inflammatory response (Benadryl)
    • leukotriene - allergies/asthma (Singular)
    • bradykinin - pain
    • complement - 20 proteins
    • prostaglandin - pain (Advil)
  5. histamines
    • released by mast cells (resp/GI)
    • s/s sneezing, itchiness, runny eyes, nasal congestion
    • H1 histamine - respiratory (Benadryl)
    • H2 histamine - stomach acid (Zantac)
  6. lymph system
    • spleen - destroys old RBC's
    • thymus - decrease as we age
    • bone marrow - produce blood cells
  7. myeloid line
    • -----reticulocyte (nucleus)
    • -----------erythrocyte (no nucleus)
    • -----leukocytes (neutro, eosino, baso, monocytes)
    • -----thrombocytes
  8. lymphoid line
    • -----lymphocytes
    • ---------plasma cells
    • ------------B cells (humural/antibodies/Type 1)
    • ------------T cells (cellular/viral/Type 4)
  9. self recognition
    • HLA - human leukocyte antigen - proteins on self cells
    • antigen - nonself
  10. humural
    • B-lymphocytes
    • mature in bone marrow
    • develop antibodies (immunoglobulins)
    • requires protein - need good diet, liver
    • first exposure causes antibodies to be created
  11. cellular
    • T-lymphocytes
    • mature in thymus
    • attacks antigen directly
  12. T-helper
    • CD4
    • "on swicth"
    • activate T and B cells (via cytokines)
    • attacked by HIV
    • must > 500 - s/b 500-1500
  13. T-suppress
    • "off switch"
    • deactivates T and B cells
  14. T-cytotoxic
    • CD8
    • attack and kill
  15. IgG
    • most abundant of all antibodies
    • neutralizes toxins
    • enhances phagocytosis
    • only antibody transferred from mom to fetus
  16. IgM
    first antibody released after exposure to antigen
  17. IgE
    • found on surface of basophils and mast cells
    • cause massive release of histamine when exposed to antigen
    • Type 1 hypersensitivity
  18. active immunity
    • you get the antigen and develop antibodies
    • natural - you get sick
    • artificial - you get a vaccine
  19. passive immunity
    • you get antibodies from somewhere else
    • natural - from mom
    • artificial - immunogloubin IV/IM
  20. abnormal immune responses
    • hyperresponsiveness - overreacts (allergies)
    • --autoimmunity - failure to recognize self - attacks self (more in females d/t estrogen)
    • --allergies
    • --transplant reactions
    • immunodeficiency
    • --AIDS (CD4 < 200)
    • --Cancer
  21. Type 1 hypersensitivity
    • allergies/anaphylaxis
    • immediate reaction
    • IgE mediated
    • antigen = allergen
    • chemical mediators: histamine, leukotrienes, prostaglandins
    • permeable capillary membranes (edema)
    • bronchoconstriction (airway - EPI)
    • vasodilation - (decreased BP, decreased cardiac output - EPI)
    • 1. Epi SQ or IV (must be slow)
    • 2. O2
    • 3. fluids (increase cardiac output)
    • 4. benadryl/zantac (block histamines)
    • 5. prednisone (block immune response)
  22. Type 2 hypersensitivity
    • tissue specific
    • transfusion reactions
    • hemolytic anemia - body breaks down RBCs (PCN, sulfa)
    • IgG or IgM mediated
    • remove problem to treat
    • airway (if issues)
    • limit hemolysis (stop transfusion)
    • give benadryl/prednisone
  23. Type 3 hypersensitivity
    • immune complex - combinations of antigens and antibodies that do not get cleared from circulation
    • ex: post strep glomerular nephritis, lupus
    • maintain kidney function
    • benadryl/prednisone
  24. Type 4 hypersensitivity
    • delayed reaction 48-72 hours
    • T-cell mediated
    • ex: contact dermatitis, PPD
    • benadryl/prednisone
  25. Allergy Diagnostics
    • allergy testing
    • complement assay - low = immune system problems
    • RAST - IgE blood test (allergies)
    • WBC/diff - increased eosinophils
    • Type and cross - prevent Type 2 reaction
    • immune complex assays - Type 3
    • Coombs - blood type
  26. **Pharm**
    • sympathomimetic agents - epi
    • mucolytics - expectorants - drink water
    • antihistamines - Benadryl
    • leukotriene inhibitors - Singulair
  27. allergy shots
    • small amounts of allergy to develop tolerance
    • monitor pt for a while - epi/albuterol nearby
  28. organ transplant
    • (Type 2 reaction possible)
    • skin
    • cornea
    • bone
    • kidney
    • lungs
    • heart
    • bone marrow
  29. transplant categories
    • isograft - donor and recipient identical twins
    • autograft - self-transplant
    • allograft - same species (different genotype and HLA)
    • xenograft - animal to human
  30. **prednisone**
    • hyperglycemia
    • osteoporosis
    • lipid redistribution (moon face/buffalo hump)
    • water/sodium retention
    • HTN
    • risk for infection
    • delayed wound healing
  31. donor criteria
    • brain dead
    • <70
    • no IV drug use
    • free of systemic disease
    • organ removed and preserved right after death
  32. organ rejection
    • host fights graft
    • s/s - fever, redness, inflammation, pain, labs
    • hyperacute - immediate - < 4 days - poor prognosis
    • acute - < 4 months - best prognosis
    • chronic - > 4 months - poor prognosis with chronic decline
  33. graft vs host disease
    • graft fights host
    • BMT complication
    • cellular immune response
    • Ab attacks liver, skin, GI
    • s/s: nausea, abd pain, DHR, rash, increased AST/ALT
    • acute GVHD - within 100 days
    • chronic GVHD - after 100 days
  34. pre-transplant
    • blood type/Rh factor
    • crossmatch
    • HLA histocompatibility
    • MLC assay - lymphocyte matching
    • Ultrasound/MRI
    • meds: antibiotics/antivirals to prevent infection (Bactrim, Acyclovir)
  35. post-transplant
    • Ultrasound/MRI
    • tissue biopsy - signs of rejection
    • corticosteroids/prednisone
    • Cyclosporine - anti-rejection med
    • --nephrotoxic - monitor BUN/Creat, K+
    • --no grapefruit juice
    • --monitor serum levels for toxicity
    • Imuran - anti-rejection med
    • --hepatotoxic - monitor ALT/AST
    • Cellcept - anti-rejection med
    • **monitor WBC - will run low (4-6)**
    • **watch for low grade fever - muted symptoms of infection - cannot mount inflammatory response**

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