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What is the definition of inflammation?
- Natural Immunity
- An immediate reaction to a tissue injury or invading organisms. Cannot be developed or transferred. Offers immediate short term protection
What are the s/s of inflammation? What is the difference between swelling and edema?
- Erythema, warmth, edema, pain, decreased function
- Swelling and edema are used interchangeably, but swelling is increased blood flow while edema is third spacing of fluids
What are the different kinds of histamine reactions?
- H1 receptors: skin, lungs
- H2 receptors: gut
Antihistamines: Diphenhydramine (Benadryl) and Cimetidine (Tagamet)
What is Anti-body mediated immunity?
- Involves antigen-antibody interactions
- Eliminates/destroys foreign proteins
- Antigen (pathogen): protein that stimulates antibody production
- Antibody: recognize and neutralize antigens
- When the Antigen enters the body, the body recognizes the foreign protein (unless immunocompromised), body becomes sensitized to the protein and antibodies are produced
- In autoimmune disease, body believes all proteins are foreign and treats them as antigens
What is the difference between passive and active immunity? How is each acquired?
- Active immunity: antigens enter the body and body makes antibodies against antigen. Occurs in chickenpox and MMR.
- -Natural- without human assistance, spread person to person
- -Artificial- by Immunization. Antigens are given to pt and then body makes antibodies. Does not cause disease and needs boosters
- Passive Immunity: antigens in Pt body created by person or animal
- -Natural- mother to fetus through placenta or BF
- -Artificial- ready made antibodies given to inactive disease (rabies, tetanus). Temporary
Describe the terms sensitized, desensitized, and hypersensitive when discussing reactions to antigens
- Sensitized: to respond to stimuli
- Desensitized: no longer sensitive
- Hypersensitive: extreme reaction to antigen
What is transplant rejection? What are the s/s of acute rejection and what is the treatment? What is the long term effect of chronic rejection?
- Acute or chronic
- Acute rejection occurs immediately or 1-3 mo after transplantation. Organ necrosis and inflammation. Only treatment is removing organ
- Chronic rejection is scarring over time that leads to decreased function of organ
- Immunosuppressants can be used to try and prevent rejection
What family of medications are used to prevent transplant rejection? Describe Cyclosporine
- Cyclosporine (Sandimmune):
- Used: to prevent or treat organ rejection
- Action: Inhibits the normal immune responses by inhibiting inter-leukin 2, a factor necessary for initiation of T-cell activity
- Contraindicated: for hypersensitivity
- Side/Adverse effects:n/v/d, HTN, tremors, hepatotoxicity, nephrotoxicity, hirsuitism, gingival hyperplasia, infection, seizures
- Route: PO/IV
- Dose: IV- 5-6 mg/kg/dose preop, 2-10mg/kg/dose divided until PO
- PO-14-18 mg/kg/dose preop, 5-15 mg/kg/dose 12-24hr postop, 3-10 mg/kg/day weekly maint
- Drug/Drug: many reactions
- Drug/Food: grapefruit juice increased absorb
- Nursing considerations: take same time ea day with meals, no grapefruit juice. Lifelong therapy with f/u appointments needed. Instruct on SE and dental hygiene. Teach s/s of infection and rejection. May need reverse isolation
What is HIV? When does it change to a diagnosis to AIDs?
- Human Immune Deficiency Virus
- Caused by virus that invades cells, injects genetic material into host's DNA in the CD4 + T-cell.
- Stage of HIV and AIDs depends on amount of CD4 + T-cells as well as opportunistic infections
- AIDs confirmed when <200cells/mm3 or less with opportunistic infection
What are the stages of HIV and AIDs?
- Stage 1: confirmed HIV CD4 + T lymphocytes >500 cells/mm3
- Stage 2: confirmed HIV 200-499 cells/mm3
- Stage 3: confirmed HIV <200 cells/mm3 or less with opportunistic infection (AIDs criteria)
- Stage 4: Confirmed HIV, no other info
How is HIV transmitted? What routes are most common?
- Sexual contact: mucus membranes and infectious disease. More common when rectum is involved. Female more likely to contract due to amount of muc mem.
- Parenteral: trans by needles, equip, blood. Decreased by autologous transfusions, needle exchange programs
- Perinatal: from placenta, maternal breast milk. If pregnant lady is HIV pos, continue treatment
How is HIV diagnosed? What is seroconversion?
- ELISA (Enzyme Linked Immunosrobent Assay): tests serum for HIV antibodies
- Western Blot: tests for 4 HIV Antigens
- Quantitative viral load testing: amount of HIV RNA in serum
- Lymphocyte counts: 5-10 thousand cells/mm3 is normal, AIDs <3,500 cells/mm3
- CD4 + T-cell: 500-1500 cells/mm3, AIDs <100
- Seroconversion: time lag between the infection and antibody production
What is PCP? What are the s/s?
- Pneumocystic Pneumonia
- Most common opportunistic infections for HIV
- Dry Cough
- Low Grade Fever
- Wt Loss
- Crackles in Lungs
What is toxoplasmosis? What are the s/s?
- One-celled parasite that reproduces only in cats, transmitted by eating undercooked meat or handling cat feces
- Decreased mental status
- Neuro deficits
What is cryptosporidium? What is the hallmark s/s?
- Microscopic parasite that causes diarrhea
- Intestinal Infection
- Electrolyte imbalances
- Severe wasting (assess for wt loss 5lb or more)
Describe Candida and why it's important for those who are immunocompromised
- Overgrowth of normal fungal flora
- Oral (stomatitis) or esophogitis
- Vaginal candida infection in women
- If its on the outside, its on the inside
What are the hallmark s/s of TB? What kind of precautions should be used?
- Cough, dyspnea, night sweats, weight loss, fever chills, anorexia
- May or may not have positive PPD (so immunocompromised it doesnt have a welt), so use Quantiferon gold test
- Airborne precautions until labs are negative
What is Karposi's Sarcoma? Why is it relevant for AIDS?
- Unique to AIDs towards the end of life
- Purple lesions (if on outside, on inside)
- Mouth, with or without candida, diagnosed with fine needle aspiration or biopsy
- GI tract- N/V/D, intestinal obstruction. Diagnosed by endoscopy
- Resp tract- fever, cough, hemoptysis, diagnosed by bronchoscopy
Describe AIDs Dementia
- Aids demetia complex (ADC)
- Late stage HIV
- Similar to other dementias, ranging from mild to severe
- Results from infected cells in the central nervous system
What kinds of medications are used for HIV/AIDs? Describe Zidovudine (Retrovir)
- Classification: antiretrovirals
- Use: HIV infection with other antiretrovirals. Reduction of transmission from mother to fetus
- Action: Prevents viral replication by inhibiting the enzyme DNA polymerase
- Contraindications: hypersensitivity, no breast feeding
- Side/Adverse effects: Seizures, hepatomegaly, pancreatitis, lactic acidosis, n/v/d, HA, weakness, abd pain, anemia, granulocytopenia
- Route: PO/IV
- Dose: IV- 1mg/kg over 1 hr, q 4hr until PO
- PO- 100 mg q4hr while awake or 200mg 3x daily or 300 mg 2x daily
- Nursing considerations: Teach on around the clock and consistent therapy. Encourage follow up visits. teach about SE and s/s of infection, hepatitis and pancreatitis. May use fall precautions because of dizziness. Monitor Labs and CBC for infection and anemia. Monitor for cushingoid symptoms. Keeps meds away from sun. Do not BF
What is anaphylaxis? What are the s/s?
- Systemic response that occurs rapidly and is life threatening
- S/S include:
- swelling of airway and bronchospasm
- Severe hypotension (shock)
- Dizziness, lightheadedness, syncope R/T Hypotension
- Individuals should carry epinephrine injections in case of emergency
- Classification: antihistamine, anti tuss
- Uses: relief of allergies and anaphylaxis. Mild night time sedation. Prevention of motion sickness
- Action: Antagonizes the histamine at H1 receptors, but does not deactivate histamine. Anticholinergic properties and CNS depressant
- Contraindications: hypersensitivity, acute asthma attack
- Side/Adverse effects: Drowsiness, anorexia, dry mouth, photosensitivity
- Route: PO, IV, IM, topical
- Dose: IM/IV- 25-50 mg q4hr PRN
- PO- 25-50 mg q4-6hr not to exceed 300 mg/day
- Nursing Considerations: fall risk (Esp older adults), admin 20 min before sleep or 30 min before travel, admin with meals or milk. Teach pt about safety and drowsiness, dry mouth and sleep hygiene techniques
- Classification: adrenergic, anti-asthmatic, bronchodilators, vasopressors
- Uses: management of reversible airway disease such as asthma or COPD. Management of severe allergic reactions.
- Actions: Effects both beta 1 and beta 2. Results in an accumulation of cAMP to inhibit release of mediators of immediate hypersensitivity reactions from mast cells
- Contraindications: Hypersensitivity, caution for cardiacs
- SE/AE: Nervousness, restlessness, HA, angina, HTN, tachycardia, N/V, hyperglycemia.
- Overdose: if toxicity occurs, beta blockers an supportive therapy used. BB may cause bronchospasm, use with caution
- Route: Subcut, IV, IM, Inhalan, Intracardiac, Intratracheal, Intraosseos
- Dose: many different doses. Subcut/IM- 0.1-0.5 mg for anaphylaxis
- Nursing considerations: Assess HR, BP, lung sounds prior to admin. Assess for hypersensitivity and monitor for paroxysmal bronchospasm. Monitor for increase in cardiac, assess E/F for hyperkalemia, hyperglycemia and lactic acid. Assess for toxicity