Level I W2013

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Author:
amelia.m.norton
ID:
204381
Filename:
Level I W2013
Updated:
2013-03-02 19:02:41
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Immunity inflammation
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Level I W2013 Immunity & inflammation
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  1. Innate/nonspecific
    • first line: always on guard
    • inflammatory response
    • immediate maximal response
    • not Ag specific, no memory
  2. Adaptive/specific
    • second line: help when needed
    • immune response
    • lag time for maximal response
    • Ag specific w/ memory
  3. Granulocytes
    • non-specific, inflammation
    • eosinophil
    • neutrophil
    • basophil
  4. Non-granulocytes
    • immune response
    • B lymphocytes
    • T lymphocytes
    • NK cells
  5. Fixed lymphocytes
    • mast cells
    • dendritic cells
  6. leukopenia
    <4000WBC
  7. leukocytosis
    >10000WBC
  8. Neutrophils
    • first responders
    • infection, tissue damage, necrosis
    • phagocytic
    • defend against bacteria
  9. Basophils
    • protect mucosal surfaces
    • effective against fungus
    • acute allergic/anaphylactic response
    • release chemicals that promote inflammatory response - histamine, heparin, serotonin, cytokines
  10. Heparin
    vasodilates, increases vascular permeability, increases migration of other WBC to site of infection
  11. Heparin
    inhibits coagulation of blood
  12. Eosinophils
    • Large amounts in GI & respiratory
    • increase w/ allergic responses
    • --IgE mediated responses
    • React with products from basophils, mast cells, lymphocytes
    • --releases histaminase
    • Protects against allergy and parasites
  13. Monocytes-immature
    Macrophages-mature
    • phagocytic
    • present foreign invaders to lymphocytes
    • increase w/ chronic inflammation & acute infections
  14. Lymphocytes
    • B-cells & T-cells: specific immunity
    • B-cells - humoral immunity or AMI
    • T-cells - cell mediated immunity
    • Recognize foreign substances
    • T & B cells develop memory cells
    • increase w/ chronic & viral infections
  15. Fixed Leukocytes
    -dendritic cells
    -mast cells
    • fixed in tissues: mucous membranes & connective tissue
    • responsible for antigen presentation
    • mast cells: histamine release
    • dendritic: thread-like tentacles to capture Ag to present to B & T cells
  16. Chemotaxis
    attraction neutrophils to site through cytokine release
  17. Complement
    • cascade of lytic proteins that aid in pathogen destruction
    • 1. facilitates lysis of cell membranes (cytolysis)
    • 2. Help in attracting phagocytes to the antigen (chemotaxis)
    • 3. Increase vascular permeability (anaphylaxis)
    • 4. Make antigens more susceptible to phagocytosis (opsonization)
  18. Cytokines
    • released by cells when needed
    • act as messengers between cell types
    • mediate & regulate nonspecific & specific immunity
    • stimulate hematopoeisis
  19. Cytokines as Medications
    • Interleukins - cancer killer
    • Interferon - stimulates immmune of cancer patient and multiple sclerosis
    • Tumor Necrosis factor: RA
    • Colony-stimulating factor: neupogen - for neutropenia, erythropoietin - bone marrow production
  20. Inflammation
    • reaction at the vascular & cellular level
    • helps prevent/limit entry of invader/injury
    • causes: physical irritants, chemical irritants, microorganisms
    • can have inflammation with infection
    • Can't have infection without inflammation
  21. 3 stages of inflammation
    • I: vascular response
    • II: cellular response
    • III: tissue repair/replacement
  22. Characteristics of Inflammation
    swelling, pain, heat, redness
  23. diapedesis
    movement of leukocytes through capillary wall
  24. NSAID meds
    • anti-inflammatory, antipyretic
    • action: inhibit formation of prostaglandin
    • Types - aspirin, ibuprofen, naproxen, indomethicin, celecoxib
    • S/Sx: bleeding, GI upset, monitor renal function, ringing in ears
    • Warfarin potentiates effect
    • Drink plenty of water
  25. Antipyretic
    • acetaminophen:
    • action - inhibits prostaglandin synthesis in CNS, adverse effects: thrombocytopenia, liver toxicity
    • Nursing: monitor liver/kidney function, CBC, 3g/day, careful when taking with NSAIDS, antidote - acetylcysteine: mucomyst
  26. Steroids
    • cortisone, hydrocortisone, methylprednisolone, prednisone, prednisolone, betamethasone, dexamethasone
    • Prevents increased capillary permeability, suppresses cytokine release, suppresses prostaglandin production, decreases immune system
  27. Coritcosteroid adverse effects
    depression, mood changes, hypertension, thromboembolism, high blood cortisol, peptic ulceration, hyperglycemia, adrenal suppression, cushings appearance, weight changes, hypokalemia, GI upset: N/V, insomnia, hyperkalemia
  28. Nursing Interventions w/ Corticosteroids
    • assess for adverse effects
    • observe mental changes
    • do not stop medication, must be tapered
    • take with food or milk
    • increase foods with K+
    • monitor glucose levels
    • avoid individuals with colds
    • restrict Na+
    • Monitor weight
  29. Antibody mediated
    Type I response
    • allergic response
    • B-cells from bone marrow produce antibodies,
    • Humoral AMI extra cellular response,
    • which is immediate reaction
  30. Three types of responses
    • Type I allergic
    • Type II cytotoxic reaction
    • Type III Immune complex such as in RA
  31. B-Cells: humoral immunity
    • involve in Ag/Ab reactions
    • circulate through lymph tissue until contact made with Ag
    • transform into plasma cells - create & secrete Ag specific Ab = immunoglobulins
    • IgD helps in B-cell differentiation
    • Memory B-cells also produced
  32. IgM 10%
    • primary immunity
    • protection from gram- bacteria
    • blood transfusions
  33. IgG 75%
    • secondary immunity
    • passes placental barrier
    • passive immunity
    • enhances phagocytosis
    • provides sustained viral & bacterial immunity
  34. IgA <15%
    • provides protection at mucosal level
    • passes through breast milk
    • important in viral & respiratory pathogens
  35. IgD
    assist in B-cell differentiation
  36. IgE
    • allergic reactions
    • protection from parasites
    • local or systemic
  37. Primary Humoral Immunity
    • initial exposure to antigen
    • latent or lag time during antigen processing (48-72hrs)
    • activated helper Tcells trigger Bcells to proliferate and differentiate
    • antibody levels rise over period of 10-14days
    • IgM major player
  38. Secondary humoral immunity
    • subsequent exposure to antigen
    • memory cells recognize antigen - antibody levels rise quickly ie booster immunizations
    • IgG major player
  39. Cell mediated
    • T-cells from thymus
    • NK kill slowly in intracellular space
    • delayed reaction
    • protects against viruses, fungi, parasites, slow growing bacterial infections
    • responsible for rejection of transplanted organs and tissues
    • causes skin hypersensitivity reactions, survey for malignant cells
  40. T-lymphocytes
    • differentiate in the thymus
    • self vs. non-self or damaged/infected self cells
    • regulate the immune response: essential for AMI
    • produce & release cytokines that influence AMI & inflamation
    • distinguish by surface proteins = CD antigens cluster of differentiation
  41. T-helper cells (CD4)
    • activated by Ag presenting cells
    • function to help activate cytotoxic T cells & macrophages
    • activate & stimulate Bcells
    • do not attack & destroy directly
  42. Regular Tcells
    Cytotoxic Tcells (CD8)
    • effective against self cells infected by viruses, protozoa and tumors
    • attaches to self, drills hole, inserts enzyme, releases and moves on
    • autoimmunity may occur
  43. Natural Killer cells
    • do not need previous sensitization
    • lyse tumor cells, virally infected cells, and transplanted grafts
    • surveyor of malignant cell changes
  44. Changes in immunity: elderly
    • Inflammation: defect in neutrophil function not #, leukocytosis may not occur
    • Ab-mediated immunity: decline in natural antibodies, decreased response to antigens
    • Cell-mediated immunity: thymic activity decreases, circulating T-lymphocytes decrease
  45. Nursing implications of elderly
    • may have infection but not noted on CBC
    • slight changes in VS: should be seriously evaluated
    • Need immunizations & boosters
    • stay away from people with colds
    • skin, mucous membranes, resp & GU tracts increased risk for infections
  46. Infections
    • invasion of body by pathogenic antigen and the reaction of tissues to their presence and toxins
    • etiology: primary infection, secondary infection that causes a problem due to compromised immune system, opportunistic infection - neutropenic phase precautions
  47. Sepsis S/Sx
    • tacchycardia >90/min
    • hypo/hyper thermia
    • RR >20
    • PaCO2 <32
    • WBC <4000, >20000
  48. Selection of antimicrobial
    Age, location of infecting organism, status of organ function, pregnancy/lactation, likelihood of resistance, provider preference
  49. Common side effects & Nursing interventions
    • allergy & anaophylaxis
    • N/V & diarrhea
    • bone marrow suppression
    • hepatotoxicity & nephrotoxicity
    • superinfections
  50. Aminoglycosides
    • -cin, -mycin
    • IM, IV
    • bactericidal broad spectrum gram-
    • adverse effects: ototoxicity, nephrotoxicity, neuromuscular blocking-respiratory paralysis
    • Loop diuretic increases ototoxicity
  51. Nursing Interventions Aminoglycosides
    • Peak & trough
    • monitor hearing
    • monitor renal function and I & O
    • encourage hydration
    • slow IV admin
    • careful monitoring after anesthetics or muscle relaxants
  52. Penicillin
    • -cillin
    • bactericidal broad spectrum for gram+
    • Adverse effects: hypersensitivity, anaphylaxis, phlebitis at IV site, pseudomembranous collitis, serum sickness, superinfections
  53. Cephalosporins 4 generations
    • ceph-
    • bactericidal, use - septicemia, bone, joint, UTI, surgery
    • Adverse effects: phlebitis, pain with IM injections, pseudomembranous colitis, nephrotoxicity, hepatotoxicity, bleeding tendencies, superinfections & serum sickness.
    • 2-10% of those allergic to penicillin will be allergic to cephs
  54. Nursing for cillins and cephs
    • assess for allergies to med
    • monitor CBC, s/s bleeding
    • admin slowly
    • give deep IM ztrack
    • assess GI status
    • teach s/s of superinfections
    • report signs of serum sickness: fever, skin reactions, joint pain, lymph node swelling
  55. Tetracyclines
    • -cycline
    • action: broad spectrum bacteriostatic
    • Use: chlamydia, mycoplasma, gonorrhea, spirochetes, acne, anthrax, penicillin allergies
    • Adverse effects: photosensitivity, chelating to new teeth bone, teeth staining
  56. Nursing Tetracyclines
    • avoid use with pregnancy, children less than 8 and nursing women
    • monitor CBC
    • monitor for signs of hypersensitivity
    • monitor signs of I & O
    • avoid sun up to 3 days past last dose
    • use sunscreen
    • avoid taking with dairy products, antacids
  57. Macrolides: erythromycin
    • -mycin
    • vacteriostatic, broad spectrum
    • Use: allergy to penicillin
    • adverse effects: hepatitis, ventricular arrhythmias
    • Nursing: assess cardiac status, may need ECG, monitor for hepatotoxicity, do not give with antacids, take with full glass of water on empty stomach
  58. Hepatotoxicity
    • pale stool
    • dark urine
    • jaundice
  59. Fluoroquinolones: ciprofloxacin
    • -oxacin
    • bactericidal effect: broad spectrum gram- UTI & systemic infections
    • Adverse effects: suprainfections, elevated BUN, creatinine, liver function tests, stevens-johnson syndrome, photosensitivity, achilles tendon rupture, rabdomyolysis: breakdown of muscle tissue, hypoglycemia
  60. Nursing Fluoroquinolones
    • use sunscreen, avoid sun
    • monitor liver & kidney function
    • admin with water before meals
    • avoid antacids
    • monitor for stevens johnson syndrome: fever, ulcerations, joint pain, bullae of skin >5mm(blister)
  61. Sulfonamides: sulfadiazine
    • sulf-
    • bacteriostatic
    • UTI, otitis media, vaginitis, eye
    • Adverse effects: hypersensitivity, stevens-johnson syndrome, hemolytic reaction - fever, photosensitivity, neurologic effects
  62. Nursing Sulfonamides
    observe skin & mucous membranes, monitor temp, monitor I & O force fluids, monitor CBC, avoid direct sunlight, use sunscreen
  63. Monobactams: vancomycin
    • bactericidal
    • use: life threatening infections: MRSA, MRSE & c-diff
    • adverse effects: ototoxicity, nephrotoxicity, thrombophlebitis, red man syndrome, chills, fever, tacchycardia, itch(pruritus)
    • Tx: anti-histamine
  64. Nursing vancomycin
    • admin in dilute solution over at least 60min
    • monitor I & O & kidney function
    • check BUN & creatinine during treatment
    • monitor levels: peak and trough
    • monitor hearing
    • slow infusion if red man syndrome occurs
    • give cautiously

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