NUR 203 Patho: Unit 3

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NUR 203 Patho: Unit 3
2010-06-02 17:14:35
Immunological Disorders

Immune Unit
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  1. Which antibody is found in great numbers in a patients with allergies?
  2. What disease most commonly occurs with HIV?
    Hepatitis C
  3. What does HIV primarily target?
    CD4 Lymphocytes
  4. What are the 4 signs & symptoms of Systemic Lupus erythematosus?
    • repeated miscarriages
    • hepatitis
    • pleural effusion
    • butterfly rash
  5. What are 3 signs & symptoms of Rheumatoid Arthritis?
    • morning stiffness
    • swollen joints
    • anorexia
  6. what blood levels should be drawn before & after IVIG administration?
    • Creatinine
    • BUN
  7. What test is used to confirm HIV?
    Western Blot
  8. What immunity/response are tuberculin skin tests an example of?
    T-cell mediated immune response
  9. How often should Peripheral venous cathetors be replaced?
    72-96 hours
  10. Which type of immunity occurs in response to vaccines?
    active immunity
  11. What 4 lab tests are used in the diagnoses of Rheumatoid Arthritis?
    • Hepatic Panel
    • Erythrocyte Sedimentation Rate
    • Antinuclear antibody Titers
    • C-Reactive Protein
  12. What 3 drugs cause drug induced systemic lupus erythematosus?
    • Isoniazid
    • Procainamide
    • Hydralazine
  13. What antibody is the most common in the body?
  14. IVIG is administered over how much time?
    2 to 4 hours
  15. T-Lymphocytes are produced and mature in what area of the body?
    the thymus
  16. Autoimmunity
    the normal protective immune response paradoxically turns against or attacks the body, leading to damage
  17. Hypersensitivity
    when the body produces inappropriate or exaggerated responses to specific antigens
  18. Primary Immune Deficiencies
    • deficiency results from improper development of immune cells or tissues
    • it is usually congenital or inherited
  19. Secondary Immune Deficiencies
    deficiency results from some interference with an already developed immune system usually acquired later in life
  20. WBC Count
  21. Neutrophil Count
  22. Eosinophil Count
  23. Basophil Count
  24. Lymphocyte Count
  25. Monocyte Count
  26. What do neutrophils do?
    They increase in response to a bacterial infection
  27. What is the function of Monocytes?
    they function as phagocytic cells that engulf, ingest & destroy numbers of foreign bodies or toxins
  28. What do Basophils & Eosinophils do?
    The increase as a response to an allergic reaction or a parasitic infection
  29. Acquired Immunity
    Acquired during life-not at birth. Usually a result of prior exposure to an antigen through immunization or by contracting a disease
  30. What do Lymphocytes do?
    they pla a major role in humoral & cell-mediated immune response
  31. What do lymphocytes consist of?
    • B-Cells
    • T-Cells
  32. What percent of lymphocytes are b-cells?
    10-20% of lymphocytes
  33. What percent of lymphocytes are t-cells?
    60-70% of lymphocytes
  34. B-Cells
    • important for producing a humoral response
    • during response they can transform themselves into plasma cells that maufacture antibodies
  35. T-Cells
    important for producing a cellular immune response
  36. Suppressor T-Cells
    Lymphocytes that decrease b-cell activity to a level at which the immune system is compatible with life
  37. Memory T-cells
    Remembers contact with an antigen & mounts an immune response when in contact again
  38. Helper T-Cells
    • Lymphocytes that attack foreign invaders (antigens) directly
    • Usually classified as CD4
  39. Cytotoxic T-Cells
    • Lymphocytes that lyse cells infected with a virus
    • plays a role in graft rejection
    • Usually classified as CD8
  40. CD4 T-Cell Count
  41. CD8 T-Cell Count
  42. B-Cell Count
  43. Natural Immunity
    • Rapid, non-specific immunity present at birth
    • Provides a broad spectrum defense against & resistance to infection
  44. What defense mechanism of determining "friend or "foe"?
    natural immunity
  45. What activates an immediate immune response or develops an acquired immune response?
    Natural Immunity
  46. What type of immunity produces an immune response to defend against re-exposure?
    acquired immunity
  47. What does acquired immunity rely on?
    the recognition of a specific foreign antigen
  48. 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
  49. 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
  50. What type of lymphocyte is responsible fore the cellular immune response?
  51. 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
  52. 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
  53. When is the humoral immune response activated?
    • anaphylaxis
    • allergic hay fever
    • asthma
    • immune complex disease
    • bacterial & some viral infections
  54. When is the cellular immune response activated?
    • transplant rejection
    • delayed hypersensitivity (TB rxn)
    • tumor surveillance on destruction
    • Viral, Fungal & parasitic infections
  55. 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
  56. What are antibodies?
    large proteins called immunoglobulins
  57. How many types of antibodies can the body produce?
    5 types
  58. IgG
    • appears in interstitial fluid
    • Major role in blood & tissue infections
    • Crosses the placenta
  59. IgA
    • appears in body fluids
    • protects against respiratory GI & GU infections
    • prevents absorptions of antigens from food
    • passess to newborn in breast milk
  60. IgM
    • in intravascular serum
    • first Ig produced in response to bacterial/viral infection
  61. IgD
    influences B-Cell differentiation
  62. IgE
    • takes part in allergic & hypersensitivity reactions
    • combats parasitic infections
  63. What are stem cells?
    blank cells that can be engineered to become various types of cells
  64. where are stem cells found in large quantities?
    • umbilical cord blood
    • aborted fetal tissue
  65. Deficiency/Excess of what nutrients impari the Immune System?
    • Protein
    • Copper
    • Iron
    • Zinc
  66. What Immunoglobulin mediates allergic reactions?
    IgE Antibodies
  67. Where is IgE mainly located?
    Respiratory & GI mucosa
  68. What does IgE do?
    Triggers mast cells to release chemical mediators such as histamine, serotonin & kinins
  69. What does the production of antigen specific IgE require?
    Active communication between macrophages, T-cells & b-cells
  70. 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
  71. Where are primary chemical mediators found?
    • Mast cells
    • Basophils
  72. What are primary chemicals mediators commonly referred to?
    immediate hypersensitivity response
  73. What are the 4 primary chemical mediators?
    • Histamine
    • Eosinophil chemotactic factor of anaphylaxis
    • Platelet aggregating factor
    • Prostaglandins
  74. Secondary Chemical Mediators
    inactive precursors that are formed or released in response to primary mediators
  75. What are 3 secondary chemical mediators?
    • leukotrienes
    • bradykinin
    • serotinin
  76. What is the most severe form of hypersensitivity?
    anaphylactic (type 1) hypersensitivity
  77. 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
  78. When does anayphylactic (type 1) hypersensitivity occur?
    typically occurs on re-exposure to an antigen
  79. 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
  80. What is cytotoxic (type 2) hypersensitivity associated with?
    • several disorders such as:
    • -myasthenia gravis
    • -goodpasture syndrome
    • -blood transfusion reaction
  81. 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
  82. Which hypersensitivity reaction are joints & kidneys particularly susceptible?
    Immune Complex Hypersensitivity (Type 3)
  83. When does Delayed-Type (type 4) hypersensitivty occur?
    24-72 horus after exposure
  84. What mediates delayed-type (type 4) hypersensitivity?
    sensitized t-cells
  85. anaphylaxis
    immediate reaction between a specific antigen and an antibody that results in rapid release of IgE
  86. What are the most common medications that can cause anaphylaxis?
    • penicillin
    • contrast dyes
    • IV anesthetics
    • NSAIDS
    • Opiods
  87. What are the most common foods that cause anaphylaxis?
    • peaches
    • shellfish
    • fish
    • milk
    • eggs
    • wheat
    • soy
  88. What are the signs & symptoms of Mild Anaphylaxis?
    • warmth
    • sensation of fullness in mouth & throat
    • Nasal congestion
    • puritis
    • sneezing
    • tearing of the eyes
    • periorbital edema
    • ** S/sx occur w/i 2 hrs
  89. what are the signs & symptoms of moderate anaphylaxis?
    • flushing
    • warmth
    • anxiety
    • itching
    • bronchospasm
    • dyspnea
    • cough
    • wheezing
  90. what are the signs & symptoms of severe anaphylaxis?
    • abrupt reaction with all previous signs & symptoms plus:
    • -cyanosis
    • -hypotension
    • -dysphagis
    • -nausea, vomiting, diarrhea
    • -seizures
    • -cardiac arrest
  91. What are teh 8 ways to manage anaphylaxis?
    • oxygen
    • epinephrine
    • antihistamines
    • intubation
    • corticosteroids
    • IV Fluids
    • Epi Pen
    • CPR
  92. What are the signs & symptoms of allergic Rhinitis?
    • clear watering nasal drainage
    • itching of throat
    • headache
    • hoarseness
    • dry cough
    • pain over sinuses
  93. What medications treat allergic rhinitis?
    • antihistamines
    • mast cell stabilzers
    • corticosteroids
  94. What type of hypersensitivity reaction is contact dermatitis?
    type 4 delayed hypersensitivity
  95. what type of hypersensitivty reaction is atopic dermatitis?
    type 1 immediate hypersensitivity
  96. what is the treatment of atopic dermatitis?
    • corticosteroids
    • antihistamines
    • immunosuppresive agents
  97. What are teh signs & symptoms of atopic dermitits?
    • itching
    • scratching
    • excessive dryness
    • inflammation & hyperreactivity of the skin
  98. What type of hypersensitivity reaction is dermatitis medicarmentosa?
    type 1 immediate hypersensitivity
  99. What type of hypersentivity reaction is a latex allergy?
    • type 1 immediate hypersensitivity *anaphylaxis*
    • Type 4 delayed hypersnsitivity
  100. Autoimmune Disease
    immune complexes build up & are deposited into synovial tissue or other organs, triggering inflammatory reaction (the body attacks itself)
  101. What are common autoimmune disorders?
    • rheumatoid arthritis
    • osteoarthritis
    • systemic lupus erythematous
    • scleroderma
  102. When is the Erythrocyte Sedimentation rate Increased?
    in conditions involving inflammation
  103. when is the hematocrit decreased?
    in chronic inflammation or anemia
  104. When is the RBC decreased?
    • Rhematoid Arthritis
    • Systemic Lupus Erythematous
  105. When is the WBC decreased?
    systemic lupus erythematus
  106. What diagnostic test is postive with many autoimmune disorders?
    antinuclear antibody (ANA)
  107. When is the rhematoid factor positive?
    • Rheumatoid arthritis
    • CTD
  108. What does a positive C-reactive protein indicate?
    active inflammation
  109. When are IgA, IgM & IgG levels increased?
    in people with autoimmune disorders
  110. What disease are human leukocyte antigen levels present?
    • In patients with:
    • -ankylosing spondylitis
    • -reiters syndrome
  111. Where does rheumatoid arthritis occurs?
    synovial tissue
  112. What does rheumatoid arthritis do?
    destroys cartlidge and bone resulting in loss of articular surface, joint motion, muscle elasticity & ctonractile power lost
  113. what is early rheumatoid arthritis mediation treatment?
    • salcylates
    • NSAIDS
    • Disease modifying antirhematic drugs (DMARDs) ex. Plaquenil, axulfidine
    • Immunosuppresives ex. methotrexate & cytoxan
  114. what is moderate rheumatoid arthritis medication treatment?
    immunomodulators ex. humira, enbrel, & remicade
  115. What is medication treatment for advanced/erosive rheumatoid arthritis?
    • corticosteroids
    • immunosuppressive
  116. What does rheumatoid arthritis frequently attack?
    • wrist
    • hands
    • elbows
    • shoulders
    • knees
    • ankles
  117. What are the signs & symptoms of rheumatoid arthritis?
    • edema
    • pain
    • swelling
    • warmth
    • erythema
    • joint stiffness in the morsning lasting more than 30 min.
    • bilateral & symmetrical
  118. What doea an x-ray show in rheumatoid arthritis patients?
    • Bony erosion
    • narrowed joint space
  119. What needs to be monitored with immunosuppresive therapy?
    • assess for:
    • -bone marrow suppression
    • -GI ulcerations
    • -Skin rashes
    • -alopecia
  120. What labs need to be done for rheumatoid arthritis client on immunosuppressive therapy?
    • CBC
    • Liver enzymes
    • Creatinine q 2-4 wks
  121. what is tested before administering immunomodulators?
    test for TB first
  122. What are patients at an increased risk for with remicade?
    • increased risk for infection
    • **withhold meds if fever exhists**
  123. How is remicade administered?
    IV over 2hrs or more
  124. How should Rheumatoid arthritis patients eat?
    small frequent meels high in protein, vitamins & iron
  125. What are 2 self-injectable immunomodulators?
    • humira
    • enbrel
  126. 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
  127. What are the vascular s/sx of systemic lupus erythmatous?
    • inflammation of arterioles
    • Purpric lesios on fingertips, elbow, toes, forearms & hands
  128. What are the musculoskeletal s/sx of systemic lupus erythemouts?
    • arthalgia
    • joint swelling
    • tenderness
    • pain on movement
    • morning stiffness
  129. What are the skin s/sx of systemic lupus erythematous?
    • polycystic lesions
    • chronic rash
    • butterfly rash on face
    • oral ulcers
  130. What are the renal system lupus erythematous complications?
    affects glomeruli resulting in renal failure
  131. What are the cardiovascular systemic lupus erythematous complications?
    • pericarditis
    • possible myocarditis with pleural effusions
  132. What neurological complications occur with systemic lupus erythematous?
    • wide spread neurological involvement
    • seizures
    • *psychosis
    • *Depression
  133. 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
  134. What are 5 mediations that can cause drug-induced System Lupus Erythematous?
    • apresoline
    • procainamide
    • thorazine
    • INH
    • Some Seizure Medications
  135. What are 3 types (categories) of SLE medications?
    • corticosteroids
    • antimalarial meds
    • immunosuppressive
  136. What is the window period for HIV sero-conversion?
    up to 12 weeks
  137. What diseases are caused by a T-Cell deficiency?
    thymus hypoplasia (DiGeorge syndrome)