immune system 2

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Author:
Prittyrick
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308629
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immune system 2
Updated:
2015-09-28 21:16:00
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immunity
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  1. hypersensitivity
    • abnormal or excessive immune response to a stimulus/foriegn body
    • four types of hypersensitivity reactions
    • - types I, II, III, IV
    • allergic reaction are usually types 1 or type 4
    • chart p 1610 fig 53-2
  2. chart
    • type 1 (anaphylatic): <30 (20-30mins), IgE
    • binds to the mast cell or basophils
    • type 2: (cytotoxic): 5-12hr- blood issue
    • type 3: Immune complex 3-8hr
    • type 4: cancer
  3. causes and triggers of hypersensitivity
    • Skin: poison plants, animal scratches, pollen, latex
    • injection: bee sting
    • ingestion: meds, nuts and shellfish
    • inhalation: pollen, dust, mold and mildew, animal dander
  4. hypersensitivity type 1 (1st exposure)
    • Patho:
    • - antigen initially stimulates production of IgE antibodies
    • IgE antibodies bind to surface membranes of mast cell and basophils
  5. hypersensitivity type 1 (2nd exposure)
    • patho:
    • on subsequent exposure:
    • - allergens links with IgE antibody attaches to mast cells/basophils
    • - triggers degranulation of cells
    • - release of chemical mediators from granules in these cells (releasing of cytotoxic molecules
    • - the chemical mediators attack target organs
    • -- intravascular- anaphylaxis
    • -- skin- urticaria, atopic dermatitis
    • -- resp- rhinitis, asthma
    • -- GI- n/v/d, abd cramps
  6. chemical mediators in type 1
    • histamine: contraction of bronchial smooth muscle thus narrowing the air way, increa mucous secretion (anti histamine block receptor site)
    • leukotrienes: airway edema, smooth muscle contraction, incre cap permability
    • prostagladins: vasodilation, smooth muscle contraction, incre cap permability (headache)
    • kinins: bradykinase, increa vascular permability, stimulates secretion of mucous and nerve fibers
    • serotonin: vasocontrictor, stimulates smooth muscle contraction
    • platelet activating factor:
    • vasodilation, platelet aggregation, incre vascular permability
  7. Hypersensitivity Type 1 (2nd exposure)
    • IgE mediated response
    • less severe
    • wheal and flare reaction
    • atopic reaction
    • allergic rhinitis, asthma
    • atopic dermatitis
    • urticaria
    • angioedema
    • GI
  8. 2nd exposure
    • less severe
    • allergic rhinitis
    • asthma

    • severe
    • anaphylaxis
  9. Allergic Rhinitis
    (2nd exposure, less severe)
    • hay fever, seasonal allergic rhinitis
    • type 1 hypersensitivity
    • reaction to nasal mucousa with a specif antigen with production of IgE
    • nasal mucosa becomes thickened with edema, decre ciliary function, vasodilation, incre capill perm.
    • - histamine is major chemical mediator
    • - also prostagladins, leukotrienes (s/s sneezing, water eyes, swollen nasal congestion, nothing in chest)
  10. S/s of allergic rhinitis
    • sneezing, watery and itchy eyes and nose
    • nasal congestion/problem with smell
    • itching of throat ad palate, altered taste
    • dry irritating cough, hoarseness
    • headache, sinus pain, epitaxis
    • sore throat (post nasal drip), clogged ears and decreased sense of smell
    • puffiness under the eye, fatigue, irritiability
    • can cause: sleep disturbance, snoring
    • sore throat- warm salt water gurgle
  11. DX allergies
    • History and PE
    • Serum IgE
    • Eosinophil counts
    • skin test
    • - review 1612-1613
    • - nursing care/intervention
  12. Management of allergies
    • Pt education:
    • Avoidance of triggers:
    • - avoid house hold dust (less is best)
    • - avoid pollen
    • - avoid mold (dampness, draft)
    • - avoid pet allergens
    • - avoid smoke
    • - hygiene
    • - safety- meds cold meds cause vasocontriction which can lead to HTN. remember allergies cause vasocontrictio
  13. Medical management allergy
    • Antihistamines
    • - H1 receptors, blocks histamine binding
    • best: urtucaria, sneezing, excessive secretions ad mild congestion
    • s/e sedation, drowiness
    • often combined with decongestant
    • OTC
  14. Medical management 2 allergy
    • Corticosteriods
    • - intranasal preps- flonase, nasacort
    • - anti inflammatory effects
    • - infection, incr BS, incre BP (holds on to fluid)- no high sodium diet

    (saline nasal spray, nettie pot)

    • Leukotriene modifers (singular)
    • - block the synthesis of leukotrienes
    • - long term use
    • - s/e mild
  15. medical management 3 allergy
    allergy clinic
    • immunotherapy
    • - allergen disensitization
    • - treat igE mediated disease by injection of allergen extracts
    • - administration of gradually increasing doses of specific allergens (trying to give your body a reaction)
    • - s/e mild, risk for anaphylaxis
  16. Nx Dx for allergies
    • adaption/lifestyle changes
    • safety- meds
    • knowledge deficit- knowing the difference between allergies and a cold,do they know what they are allergic to.
  17. Asthma (2nd exposure, less severe)
    • Chronic inflammatory disease of the airways
    • - hyperresponsiveness of the airways
    • - mucosal edema
    • - mucus production
    • intermittent and reversible
    • common triggers
  18. Asthma patho
    • Reversible and diffuse airway inflammation-airway narrow (take home)
    • exposure to trigger/allergens- inflam cascade
    • mast cells release chemical mediators- incr inflam response
    • - vasodilate (inc blood flow), inc capillary perm
    • - bronchconstriction
    • - phagocytes: airway infiltrated with eosinophills lymphocutes, neutrophils
  19. asthma path cont
    • results:
    • vascular congestion
    • edema
    • thick tenacious mucus
    • bronchial muscle spasm/constriction
    • thickening of airway walls
    • inc bronchial hyperresponsiveness
    • Chronic inflammation- remolding- further airway narrowing
    • air can go in but it struggles to go out. - histamine causes inflamm and narrowing of airway
  20. Asthma classic s/s
    • cough with/out mucous production
    • - dyspnea
    • - wheezing
    • other s/s
    • chest tightness, use of accessory muscle
    • prolong expiration
    • diaphoresis, tachycardia cyanosis
    • hypoxemia
  21. Dx asthma
    • H/P
    • Peak flow- measure the expiration of air
    • chest x-ray
    • cbc w/diff- to check with infection
    • pulmonary function test
    • ABG's depending on severity- checking to see how it is perfusing the cells and tissues
  22. Nx Dx asthma
    • ineffective airway
    • impaired breathing pattern
    • impaired gas exchange
    • anxiety
    • knowledge deficit
  23. Nursing management asthma
    • maintain airway
    • - inc HOB
    • - Oxygen
    • Peak flow meter
    • - measure highest airflow during forced expiration
    • - correct usage
    • - give pt about dx state, progression of s/s
    • - adjunct to asthma management
    • IV access ) soften mucous 1/2 NS, NS (be careful bc of HF and HTN...NS has alot of salt)
    • reassure family
  24. treatment and drugs asthma
    • rescuer inhaler/SABA
    • quick relief, act quickly
    • relax bronchial smooth muscle and bronchodilator
    • use: stop exacerbation, exercise induced s/s
    • beta 2 stimulants
    • - first line
    • Anticholinegic
    • - choice of pt cannot tolerant SABA
  25. Tx of drugs asthma
    • proventil: inhaled SABA
    • - relief of acute symptoms, prev exercise induced asthma
    • - binds to beta 2 receptors: broncodilation
    • listen to pt lungs sounds after u give 15-20mins
    • Prednisone Glucocorticoid
    • - moderate/severe exacerbations
  26. Tx and drugs asthma 3
    • Flovent: inhaled steriods
    • - long term prevention
    • - reduces inflam
    • - rinse mouth, correct use (give water)

    • Salmeterol: long acting beta agonist (LABA)
    • - long term prevention, previous excerise induced
    • - stimulates beta 2- bronchodilation
  27. Tx and drugs asthma 4
    • Advair: combination med of LABA and long acting inhaled steriod
    • - salmetrol/fluticasone
    • - control of asthma s/s not acute use
    • - teaching: correct usage (review fundamental)
    • singular leukotiene Modifer
    • - inhibits actions of leukotrienes resp for inflam effects
    • - long term control/preventio, can be used with ICA fo persistent
    • asthma
    • - few side effects well tolerated
  28. Nx education to reduce ed visit
    asthma
    • avoid exposure to triggers/irritants: soaps, perfume, chemicals, pets
    • no smoking
    • remove carpeting
    • air filters/humidifer
    • hot water wash bedding, covers on bedding
    • cold induced: avoidance, scarfs
    • prompt intervention, colds URI
    • immunization, flu/pne shots

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