NUR 203 Patho: Unit 3
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. What would you like to do?
Which antibody is found in great numbers in a patients with allergies?
What disease most commonly occurs with HIV?
What does HIV primarily target?
What are the 4 signs & symptoms of Systemic Lupus erythematosus?
- repeated miscarriages
- pleural effusion
- butterfly rash
What are 3 signs & symptoms of Rheumatoid Arthritis?
- morning stiffness
- swollen joints
what blood levels should be drawn before & after IVIG administration?
What test is used to confirm HIV?
What immunity/response are tuberculin skin tests an example of?
T-cell mediated immune response
How often should Peripheral venous cathetors be replaced?
Which type of immunity occurs in response to vaccines?
What 4 lab tests are used in the diagnoses of Rheumatoid Arthritis?
- Hepatic Panel
- Erythrocyte Sedimentation Rate
- Antinuclear antibody Titers
- C-Reactive Protein
What 3 drugs cause drug induced systemic lupus erythematosus?
What antibody is the most common in the body?
IVIG is administered over how much time?
2 to 4 hours
T-Lymphocytes are produced and mature in what area of the body?
the normal protective immune response paradoxically turns against or attacks the body, leading to damage
when the body produces inappropriate or exaggerated responses to specific antigens
Primary Immune Deficiencies
- deficiency results from improper development of immune cells or tissues
- it is usually congenital or inherited
Secondary Immune Deficiencies
deficiency results from some interference with an already developed immune system usually acquired later in life
What do neutrophils do?
They increase in response to a bacterial infection
What is the function of Monocytes?
they function as phagocytic cells that engulf, ingest & destroy numbers of foreign bodies or toxins
What do Basophils & Eosinophils do?
The increase as a response to an allergic reaction or a parasitic infection
Acquired during life-not at birth. Usually a result of prior exposure to an antigen through immunization or by contracting a disease
What do Lymphocytes do?
they pla a major role in humoral & cell-mediated immune response
What do lymphocytes consist of?
What percent of lymphocytes are b-cells?
10-20% of lymphocytes
What percent of lymphocytes are t-cells?
60-70% of lymphocytes
- important for producing a humoral response
- during response they can transform themselves into plasma cells that maufacture antibodies
important for producing a cellular immune response
Lymphocytes that decrease b-cell activity to a level at which the immune system is compatible with life
Remembers contact with an antigen & mounts an immune response when in contact again
- Lymphocytes that attack foreign invaders (antigens) directly
- Usually classified as CD4
- Lymphocytes that lyse cells infected with a virus
- plays a role in graft rejectionUsually classified as CD8
CD4 T-Cell Count
- Rapid, non-specific immunity present at birth
- Provides a broad spectrum defense against & resistance to infection
What defense mechanism of determining "friend or "foe"?
What activates an immediate immune response or develops an acquired immune response?
What type of immunity produces an immune response to defend against re-exposure?
What does acquired immunity rely on?
the recognition of a specific foreign antigen
what is the humoral response?
- response whre t-cells recognize foreign invader through the body
- t-cells report this to the lymph nodes
- characterized by the production of antibodies by b-cells in response to specific antigen
In humoral immune response, what are b-cell responsible for?
sending out specific clones for that invader and then making memory cells to recognize that invader, causing a stronger response
What type of lymphocyte is responsible fore the cellular immune response?
what do stem cells do in the cellular immune response?
they migrate from the bone marrow to the thymus gland wehre they develop into t-cells
what is the function of t-cells in the cellular immune response?
- attack foreign invaders directly rather than producing antibodies like b-cells
- take back information on invader to lymph nodes & develop various t-cells to defeat invader
When is the humoral immune response activated?
- allergic hay fever
- immune complex disease
- bacterial & some viral infections
When is the cellular immune response activated?
- transplant rejection
- delayed hypersensitivity (TB rxn)
- tumor surveillance on destruction
- Viral, Fungal & parasitic infections
What is the function of antibodies?
- get antigens to agglutinate in order to facilitate phagocytosis
- promote release of histamine
- get natural immune system to attack the invader
What are antibodies?
large proteins called immunoglobulins
How many types of antibodies can the body produce?
- appears in interstitial fluid
- Major role in blood & tissue infections
- Crosses the placenta
- appears in body fluids
- protects against respiratory GI & GU infectionsprevents absorptions of antigens from food
- passess to newborn in breast milk
- in intravascular serumfirst Ig produced in response to bacterial/viral infection
influences B-Cell differentiation
- takes part in allergic & hypersensitivity reactionscombats parasitic infections
What are stem cells?
blank cells that can be engineered to become various types of cells
where are stem cells found in large quantities?
- umbilical cord blood
- aborted fetal tissue
Deficiency/Excess of what nutrients impari the Immune System?
What Immunoglobulin mediates allergic reactions?
Where is IgE mainly located?
Respiratory & GI mucosa
What does IgE do?
Triggers mast cells to release chemical mediators such as histamine, serotonin & kinins
What does the production of antigen specific IgE require?
Active communication between macrophages, T-cells & b-cells
What is the 5 step process of IgE in an allergic reaction?
- 1.) allergin is absorbed through respiratory, GI tract or skin
- 2.) Macrophgae process antigen & presents it to t-cell
- 3.) T-cell influences b-cell
- 4.) B-cell mature into allergen specific IgE plasma cells
- 5.) IgE plasma cells synthesize & secrete antigen specific IgE antibodies
Where are primary chemical mediators found?
What are primary chemicals mediators commonly referred to?
immediate hypersensitivity response
What are the 4 primary chemical mediators?
- Eosinophil chemotactic factor of anaphylaxis
- Platelet aggregating factor
Secondary Chemical Mediators
inactive precursors that are formed or released in response to primary mediators
What are 3 secondary chemical mediators?
What is the most severe form of hypersensitivity?
anaphylactic (type 1) hypersensitivity
What are the signs & symptoms of anaphylactic (type 1) hypersensitivity?
they are determined by the amount of the allergen, mediator released, sensitivity of target organ & route
When does anayphylactic (type 1) hypersensitivity occur?
typically occurs on re-exposure to an antigen
When does cytotoxic (type 2) hypersensitivity occur?
- Occurs when system mistakenly identifies a normal constituent of the body as foreign
- Ex. Rh Hemolytic disease of the newborn
What is cytotoxic (type 2) hypersensitivity associated with?
- several disorders such as:
- -myasthenia gravis
- -goodpasture syndrome
- -blood transfusion reaction
What is immune complex (type 3) hypersensitivity?
- Reaction that involves immune complexes that are formed when antigens bind to antibodies
- Complexes are cleared from circulation by phagocytic action
Which hypersensitivity reaction are joints & kidneys particularly susceptible?
Immune Complex Hypersensitivity (Type 3)
When does Delayed-Type (type 4) hypersensitivty occur?
24-72 horus after exposure
What mediates delayed-type (type 4) hypersensitivity?
immediate reaction between a specific antigen and an antibody that results in rapid release of IgE
What are the most common medications that can cause anaphylaxis?
- contrast dyes
- IV anesthetics
What are the most common foods that cause anaphylaxis?
What are the signs & symptoms of Mild Anaphylaxis?
- sensation of fullness in mouth & throat
- Nasal congestion
- tearing of the eyes
- periorbital edema
- ** S/sx occur w/i 2 hrs
what are the signs & symptoms of moderate anaphylaxis?
what are the signs & symptoms of severe anaphylaxis?
- abrupt reaction with all previous signs & symptoms plus:
- -nausea, vomiting, diarrhea
- -cardiac arrest
What are teh 8 ways to manage anaphylaxis?
- IV Fluids
- Epi Pen
What are the signs & symptoms of allergic Rhinitis?
- clear watering nasal drainage
- itching of throat
- dry cough
- pain over sinuses
What medications treat allergic rhinitis?
- mast cell stabilzers
What type of hypersensitivity reaction is contact dermatitis?
type 4 delayed hypersensitivity
what type of hypersensitivty reaction is atopic dermatitis?
type 1 immediate hypersensitivity
what is the treatment of atopic dermatitis?
- immunosuppresive agents
What are teh signs & symptoms of atopic dermitits?
- excessive dryness
- inflammation & hyperreactivity of the skin
What type of hypersensitivity reaction is dermatitis medicarmentosa?
type 1 immediate hypersensitivity
What type of hypersentivity reaction is a latex allergy?
- type 1 immediate hypersensitivity *anaphylaxis*
- Type 4 delayed hypersnsitivity
immune complexes build up & are deposited into synovial tissue or other organs, triggering inflammatory reaction (the body attacks itself)
What are common autoimmune disorders?
- rheumatoid arthritis
- systemic lupus erythematous
When is the Erythrocyte Sedimentation rate Increased?
in conditions involving inflammation
when is the hematocrit decreased?
in chronic inflammation or anemia
When is the RBC decreased?
- Rhematoid Arthritis
- Systemic Lupus Erythematous
When is the WBC decreased?
systemic lupus erythematus
What diagnostic test is postive with many autoimmune disorders?
antinuclear antibody (ANA)
When is the rhematoid factor positive?
What does a positive C-reactive protein indicate?
When are IgA, IgM & IgG levels increased?
in people with autoimmune disorders
What disease are human leukocyte antigen levels present?
- In patients with:
- -ankylosing spondylitis
- -reiters syndrome
Where does rheumatoid arthritis occurs?
What does rheumatoid arthritis do?
destroys cartlidge and bone resulting in loss of articular surface, joint motion, muscle elasticity & ctonractile power lost
what is early rheumatoid arthritis mediation treatment?
- Disease modifying antirhematic drugs (DMARDs) ex. Plaquenil, axulfidine
- Immunosuppresives ex. methotrexate & cytoxan
what is moderate rheumatoid arthritis medication treatment?
immunomodulators ex. humira, enbrel, & remicade
What is medication treatment for advanced/erosive rheumatoid arthritis?
What does rheumatoid arthritis frequently attack?
What are the signs & symptoms of rheumatoid arthritis?
- joint stiffness in the morsning lasting more than 30 min.
- bilateral & symmetrical
What doea an x-ray show in rheumatoid arthritis patients?
- Bony erosion
- narrowed joint space
What needs to be monitored with immunosuppresive therapy?
- assess for:
- -bone marrow suppression
- -GI ulcerations
- -Skin rashes
What labs need to be done for rheumatoid arthritis client on immunosuppressive therapy?
- Liver enzymes
- Creatinine q 2-4 wks
what is tested before administering immunomodulators?
test for TB first
What are patients at an increased risk for with remicade?
- increased risk for infection
- **withhold meds if fever exhists**
How is remicade administered?
IV over 2hrs or more
How should Rheumatoid arthritis patients eat?
small frequent meels high in protein, vitamins & iron
What are 2 self-injectable immunomodulators?
Systemic Lupus Erythematous
- increaed autoantibody result from t-cell suppression leading to immune complex depostion & tissue damage
- inflammation stimulates antigens, which stimulate additional antibodies & reptition of cycle
What are the vascular s/sx of systemic lupus erythmatous?
- inflammation of arterioles
- Purpric lesios on fingertips, elbow, toes, forearms & hands
What are the musculoskeletal s/sx of systemic lupus erythemouts?
- joint swelling
- pain on movement
- morning stiffness
What are the skin s/sx of systemic lupus erythematous?
- polycystic lesions
- chronic rash
- butterfly rash on face
- oral ulcers
What are the renal system lupus erythematous complications?
affects glomeruli resulting in renal failure
What are the cardiovascular systemic lupus erythematous complications?
- possible myocarditis with pleural effusions
What neurological complications occur with systemic lupus erythematous?
- wide spread neurological involvement
What diagnostic test are done for systemic lupus erythematous?
- positive ANA
- CBC to assess for anemia, thrombocytopenia, leukocytosis/leukopenia
- serum creatine & urinalysis to assess kidney damage
What are 5 mediations that can cause drug-induced System Lupus Erythematous?
- Some Seizure Medications
What are 3 types (categories) of SLE medications?
- antimalarial meds
What is the window period for HIV sero-conversion?
up to 12 weeks
What diseases are caused by a T-Cell deficiency?
thymus hypoplasia (DiGeorge syndrome)
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