Altered Immunity Study Guide

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Altered Immunity Study Guide
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2013-10-04 18:40:00
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N172 Altered Immunity
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N172 Altered Immunity
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  1. If you are immunoincompetent what sort of problems will you  have?
    system is incompetent or under responsive

    • severe infections
    • immunodeficiency disease
    • malignancies
  2. If you have immunohyperresponse issue, what sort of problems will you have?
    • allergies
    • auto-immune diseases
  3. WBC's involved in innate immunity
    • Neutrophils
    • Monocytes
  4. Active Acquired Immunity
    results from invasion of the body by a foreign object and development of antibodies.

    With each invasion the body responds quicker
  5. Passive Acquired Immunity
    results from person receiving antibodies to an antigen by an injection or from the mom across the placenta.
  6. Type I Hypersensitivity
    Anaphylaxis....mediated by IgE
  7. Describe Anaphylaxis
    this is any sort of an allergic response

    But it can be a severe and quick response to a specific allergen....bronchial constriction

    • edema
    • itchy
    • shock/death
  8. Atopic Type I Hypersensitivities
    Sensitive to environmental allergens

    • Allergic Rhinitis/hay fever
    • Asthma
    • Atopic Dermatitis
    • Urticarial
    • Angioedema
  9. Type II Hypersensitivities
    Involve IgG and IgM

    Cytotoxic and Cytolytic Reaction
  10. Describe Cytotoxic and Cytolytic Type II Hypersensitivity
    Involves erythrocytes, platelets and leukocytes

    • Seen when patient receives ABO incompatible blood from a donor causing agglutination (clumping)
    • Rh Imcompatability too
  11. Type III Hypersensitivity
    Involve IgG and IgM

    Associated with Auto-Immune Disorders

    tissue damage secondary to antigen-antibody complex
  12. Where do you typically see Type III Hypersensitivity Reactions occur? (Immune-Complex Reaction)
    • Kidney
    • Skin
    • Joints
    • Blood Vessels
    • Lungs
  13. Examples of Type III diseases
    • Lupus
    • Acute Glomerulonephritis
    • RA
  14. Type IV Hypersensitivity Reaction
    Delayed Hypersensitivity Reaction

    Reaction that occurs 24-48 hrs after contact

    When T lymphocytes attack antigens or release cytokines that attract macrophages and release enzymes that cause tissue destruction
  15. Examples of Type IV Delayed Hypersensitivity Reactions
    • Contact Dermititis:
    • Poison Ivy, Poison Oak

    • Microbial Hypersensitivity:
    • TB
    • Transplant Rejection
  16. Antigen responsible for Type I Anaphylaxis Hypersensitivity
    Exogenous pollen, food, drugs, dust
  17. Antigen responsible for Type II Cytotoxic Rxn
    Cell surface of RBC, basement membrane
  18. Antigen Responsible for Type III Immune-complex Hypersensitivity
    Extracellular, fungal, viral, bacterial
  19. Local Anaphylactic Response
    cause a localized cutaneous response, a pale wheal containing endematous fluid surrounded with a erythemous flare (mosquito bite)
  20. Systemic Anaphylactic Response
    • mediators are released systemically causing:
    • weak, rapid pulse
    • hypotension
    • dilated pupils
    • dyspnea/cyanosis
    • bronchial edema
    • angioedema

    **occurs within minutes and can be life threatening
  21. Urticaria
    Hives
  22. Angioedema
    swollen eyelids, lips, tongue larynx, hand, feet.

    Starts at the face and spreads
  23. Assessment for Type I Allergic Hypersensitivities
    • Patient health history-family history
    • Past and present allergies-Id them and get info about clinical manifestations
    • Physical exam of skin manifestations
  24. Diagnostic studies for Type I Allergic Hypersensitivities
    • CBC with differential (Increase of eosinophils)
    • Serology (ag and ab in blood)
    • RAST
    • Sputum, nasal and bronchial secretions (eosinophils)
    • Skin test
  25. What test is good to detect food and drug allergies?
    RAST
  26. Collaborative Care for Type I Allergy Hypersensitivity
    • Reduce exposure to allergens
    • Treat symptoms
    • Desensitize thru immunotherapy if needed
  27. If a person has anaphylaxis...what do I do?
    • Maintain patent airway: oxygen or intubation
    • Prevention of spread of allergen by a tourniquet (bee sting or bite)
    • Administer epinephrine, solumedrol and Benadryl
  28. Epinephrine does what for anaphylaxis
    • causes vasoconstriction for increase of BP
    • and dilates bronchioles to keep airway open
  29. What does Solumedrol do for anaphylaxis?
    decreases inflammation causing vasodilation for bronchioles to open
  30. Cardiovascular response to anaphylaxis
    • hypotension
    • arrhythmias
    • tachy
    • cardiac arrest
  31. Respiratory response to anaphylaxis
    • hoarse
    • coughing
    • wheezing/stridor
    • dyspnea/tachypnea
    • respiratory arrest
  32. Skin response to anaphylaxis
    • pruritis
    • angioedema
    • erythema
    • urticaria
  33. What do you teach a person who has had anaphylaxis reaction?
    Avoid allergens that cause systemic anaphylaxis
  34. Antibodies involved with Type II Cytotoxic and Cytolytic reactions....specific
    IgM-primary response to ABO blood antigen

    IgG-secondary immune response

    causing complement lysis and macrophages in the tissues
  35. What does Type II Hypersensitivity lead to?
    • Anemia
    • Bleeding-low platelets
    • Agranulocytosis....increased infections
  36. Autoimmunity
    cant differentiate self from non self proteins which leads to development of autoantibodies and auto-sensitized T cells causing tissue damage based on the self-antigen involved.
  37. Plasmapheresis
    the removal of plastma containing components causing the disease.  The plasma is replaced with normal saline or albumin.  Circulating antibodies and antigen-antibody complexes known to cause autoimmune disorders are removed as well as inflammatory mediators
  38. Systemic Type III Auto-Immune Hypersensitivity
    • Systemic Lupus
    • RA
    • Scleroderma (hardening of skin)
  39. Organ Specific Type III Auto Immune Hypersensitivity
    Blood, CNS, Muscle, Heart, Endocrine, GI, Kidney, Liver, Eye
  40. Who mostly gets Lupus?  When?
    Women during childbearing years....also cause flare ups
  41. Interventions for Acute Lupus Exacerbations
    • Document severity of symptoms and response to therapy
    • Monitor Fever
    • Joint inflammation, ROM limitations, pain, fatigue?
    • Any signs of hematological problems? (anemia/bleeding)
  42. If a persons on corticosteroids what do I need to watch closely?
    I&O...fluid retention and possible renal failure

    Protein and creatinine clearance
  43. Health promotion and teaching for a person with Lupus
    • Disease process...what do they know? Fill in rest
    • Drugs...side effects/schedule
    • Avoid stress
    • Pain and stress management
    • Avoid sick
    • Avoid skin drying agents, sun
    • Marital and Pregnancy counseling
  44. Mediators of injury for Type IV delayed Hypersensitivity reactions
    cytokines and T cytotoxic cells

    • NO ANTIBODIES!! 
    • Involves phagocytes, Cytotoxic T cells....cytokines are NOT always present
  45. With Type IV hypersensitivity what gets rid of the antigens?
    • T lymphocytes induce apoptosis
    • Macrophages and Natural Killer cells destroy the pathogen
  46. Type I Latex allergic rxn
    it's an immediate response to the rubber.

    • red skin
    • urticaria
    • rhinitis
    • conjunctivitis
    • asthma
    • anaphylactic shock
  47. Type IV Latex allergic rxn
    caused by the chemical used in manufacturing the latex gloves....a delayed reaction that occurs within 6-48 hrs.

    • dryness
    • pruritis
    • fissuring
    • cracking of skin
    • redness
    • swelling
    • crusty by 24-48 hrs.
  48. Goal of immunosuppressive therapy
    to suppress the immune response to prevent rejection of transplanted organ while maintaining sufficient immunity to prevent overwhelming infection and minimize side effects
  49. Example of 3 immunosuppressive drugs
    • Cell Cept
    • Solumedrol
    • Sandimmune-cyclosporine
  50. Primary immunodeficiency disorders
    immune cells are improperly developed or absent
  51. Secondary Immunodeficiency disorders
    deficiency is caused by an illness or treatment

    • Drug induced is most common (immunosuppressive drugs)
    • but also caused by....
    • stress response
    • malnutrition
    • radiation
    • surgical removal of lymph nodes, thymus or spleen
    • HIV (viral transmission)
  52. Describe gerontological considerations related to the immune response
    • decreased # of T lymphocytes
    • increased risk for tumors cuz less NK cells
    • increased risk for flus and pneumonia cuz shrinking thymus and decrease in t cell prod.
    • decline in effective immune response
  53. Dermatologic Manifestations of SLE
    • butterfly rash over the cheeks and bridge of nose
    • ulcerations of mouth
    • alopecia
  54. Musculoskeletal problems from SLE
    • polyarthralgia
    • arthritis that causes deformities in hands
  55. Cardiopulmonary problems from SLE
    • cardiac dysrhythmias as the disease advances
    • restrictive lung disease
  56. Renal problems seen with SLE
    • proteinuria
    • glomerulonephritis

    *Preserve renal function is goal!!*
  57. Nervous System problems seen with SLE
    • generalized or focal seizures
    • dementia
  58. Hematologic problems seen with SLE
    • anemia
    • mild leukopenia
    • thrombocytopenia
  59. Infections seen with SLE
    infections, pneumonia are common cuz of immunosuppressive effects and many anti inflammatory meds. 

    Treat fevers aggressively cuz can cause death
  60. If a person with  SLE needs a vaccination make sure it is
    not with a live virus
  61. Tests to confirm SLE
    • anti-double stranded DNA
    • anti-Smith antibodies
  62. Labs to confirm   SLE
    • CBC
    • UA
    • CXR
    • ECG
    • ANA
    • LE
    • ESR
    • CRP
  63. Maintenance drugs for SLE
    • NSAIDS for pain
    • Steroid sparing drugs for RA
    • Antimalarials to block autoantibodies
  64. Exacerbation drugs for SLE
    • Corticosteroids
    • Immunosuppressive drugs
  65. How is HIV transmitted
    • blood
    • semen
    • vaginal secretions
    • breast milk
  66. Variables in transmission of HIV
    • duration and frequency of contact
    • volume of fluid
    • virulence and concentration of organism
    • host immune status
  67. Patho of HIV
    • Has to be inside a living cell
    • virus goes from RNA to DNA with the help of reverse transciptase
    • strand copies itself and becomes a double stranded viral DNA
    • it enters the cells nucleus and its genome and it is now a permanent part of the cells genetic structure.....replicates again, and again, and again
  68. Viremia
    initial infection of HIV is a large amount of virus in the blood
  69. Why is the viral load in the initial stage of HIV low?
    Cuz the B cells are able to make HIV specific antibodies to reduce the viral load and the T cells are still able to mount a cellular immune response.
  70. CD4 T cells normal life span? when HIV positive?
    • 100 days
    • 2 days
  71. What causes the immune dysfunction in HIV positive people
    caused by damage/destruction of T helper cells and T lymphocytes
  72. What are the #s of CD4 T cells to maintain a healthy immune response?
    500....

    200-499 you will start to have immune problems

    under 200 sever problems
  73. Acute Phase of HIV
    • CD4 T >500
    • person will have flu like symptoms
    • GI problems
    • fever
    • fatigue
    • headache
    • malaise
    • rash
    • sore throat
    • aches
  74. Early Chronic Phase of HIV
    • CD4 T 200-499
    • patient unaware they have HIV
    • can last 10-12 yrs
    • very vague flu like symptoms
    • virus is replicating
  75. Intermediate Chronic Phase of HIV
    • CD4 T 200-499
    • Immunity is decreasing
    • Most common sign: THRUSH
    • PERSISTENT Fever
    • DRENCHING night sweats
    • CHRONIC diarrhea
    • RECURRENT headaches
    • SEVER fatigue
  76. Late Chronic Phase of HIV
    • IT IS NOW AIDS!!
    • CD4 T <200
    • Manifestations of life threatening opportunistic cancers, infections, wasting syndrome, dementia
  77. Opportunistic cancers
    • Invasive cervical
    • Karposis carcinoma
    • Lymphomas
  78. Opportunist Infections
    • #1 FUNGAL-thrush, oral hair leukoplakia, pneumocystitis jiroveci PNA
    • Viral- Herpes, shingles, Hep A & B
    • Bacterial-TB
    • Protazoal-Toxoplasmosis of brain
  79. What's wasting syndrome?
    loss of 10% or more of ideal body wt
  80. Abnormal labs in Late chronic stage of HIV....which is now AIDS
    • low WBC
    • low neutrophils
    • low platelets
    • low erythrocytes
    • abnormal LFT
  81. In order to dx a person with AIDS you must have... a CD4 T cell count of <200 plus one of these....
    • opportunistic cancer
    • opportunistic infection
    • wasting syndrome
    • dementia

    May have more than 1, but need at least 1.
  82. Enzyme Immunoassay (EIA)
    • detects serum antibodies that bind to HIV antigens.
    • if positive, test is repeated at 3 or 6 weeks, or 3 months

    If it is positive again, do a Western Blot of Immunofluorescence Assay
  83. If a person gets a false negative test for HIV with EIA....what do I do?
    check for risky behaviors and counsel to retest-early testing may have occurred
  84. Western Blot and Immunofluorescence Assay

    How do they work?
    WB-ID's antibodies in the serum after mixing with purified HIV antigens

    IFA-identifies the HIV in infected cells

    If either is + then HIV +
  85. Goal of drug therapy for HIV
    • decrease RNA levels
    • maintain/raise CD4T count >200
    • delay the development of HIV related symptoms and manifestations of opportunistic diseases
  86. Entry inhibitor drugs
    work by inhibiting the finding of HIV
  87. Reverse Transcriptase Inhibitors
    interfere with the ability of HIV to make a DNA copy
  88. Integrase Inhibitors
    prevents HIV from entering the viral genetic material into the host cell
  89. Protease Inhibitors
    prevents the protease enzyme from cutting HIV proteins in to appropriate lengths for replication
  90. Entry Inhibitor drug

    side effects
    Fuzeon

    • skin irritation at injection site
    • fatigue
    • nausea
    • insomnia
  91. Nucleoside Reverse Transcriptase Inhibitor (2)

    Side effects
    • AZT
    • Viramune
    • Viread

    • AZT-N/V, anemia, leukopenia, myopathy
    • Viramune-Steven Johnson, rash, hepatitis
    • Viread-N/V, vaginal irritation, renal impairment
  92. Integrase Inhibitor

    Side effects
    Isentress

    • hyperglycemia
    • hyperlipidemia
  93. Major problem with ART therapy
    • Resistance develops rapidly when taken alone or in inadequate doses
    • Its combo therapy and can have drug-drug interactions
    • Non compliance of dose and length of time
    • Keep up with f/u appt and labs
    • Expensive
  94. What med will you give somebody with Pneumocystitis jiroveci pneumonia and Toxoplasmosis and Mycobacterium avium complex?
    Antibiotics
  95. What med will you give a person with Varicella Zoster Virus?
    Immune globulins
  96. What med will you give a person with TB?
    Antituberculars
  97. What med will you give a person with pneumococcal pneumonia, influenza virus, Hep A and B?
    Vaccines
  98. What are your assessments for a person with HIV/Aids?
    • Risky behaviors
    • previous STD's
    • Hepatitis
    • TB
    • Foreign travel
    • frequen infections
  99. Planning goal for HIV/Aids pt.
    • Adherence to drug regimens
    • promotion of healthy life style
    • protect others from HIV
    • develop/maintain healthy and supportive relationships
    • maintain role fxn
    • come to terms with disease, disability, death
    • cope with symptoms of disease and drug therapy
  100. Safe Sex....
    abstinence

    Risk reducing-condoms
  101. Safe drug use
    don't use injectable drugs, do not share injection equipment with others, use sterile equipment through community need and syringe exchange programs

    Rick reducing-clean equipment before use with bleach
  102. Safe Perinatal activity
    if are HIV + use birth control and don't get prego

    Risk Reducing-treat with AZT before prego, during and after
  103. S/S HIV patients need to report immediately
    • change in LOC
    • headache with N/V
    • vision changes
    • persistent SOB related to activity and isn't relieved by a short rest period
    • N/V with abdominal pain
    • Vomiting blood
    • Yellow skin
    • pain in flank and unable to urinate for 6 hrs
    • blood in urine
    • new onset of weakness
    • chest pain
    • seizures
    • new rash or oral lesion accompanied by fever
    • depression/anxiety/hallucination/delusions
    • ideas to hurt self
  104. What are the side effects of long term ART
    • metabolic disorders...
    • bone disease
    • insulin resistance
    • cardiovascular disease
  105. Goodpasture Syndrome
    Type II Cytotoxic and Cytolytic Rxn

    disorder that involves lungs and kidneys resulting in hemorrhage and glomerulonephritis
  106. Local anaphylactic response
    hives
  107. The anaphylaxis cardinal principle is
    SPEED!!!

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