Chapter 26 Immune System Flashcards
protects the body from substances and organisms that are considered foreign
Immune System
body produces special white blood cells called T cells that attack and destroy invaders
Cell mediated Immunity
B cell lymphocytes produce anti bodies that dissolve in plasma and lymph and wage war on invading organisms
Humoral immunity
abnormal immune response the body develops when person is previously exposed or sensitized to substance or allergen
generally produce no reaction or minor reaction
sensitive to allergen: can produce significant local ot systemic reaction
Allergic Reaction
extreme form of allergic reaction
involves one or multiple body systems
life threatening effects are greatest concern
Anaphylaxis
2 phase allergic reaction
pt’s symptoms improve and then reappear without exposure to the trigger
symptoms can resurface up to 8 or more hours after incident
Biphasic Reactions
symptoms that continue over time
time frame can be between 5 and 32hrs
Prolonged Reactions
body limits response to specific area after exposure to foreign substance
IE: swelling around an insect bite
Local Reaction
reaction through the body, possibly affecting multiple body systems
IE: person who is allergic to something develops swelling and hives all over the body
Systemic Reaction
Primary response: macrophages confront and engulf foreign substance
determine if they allowed in body
specific proteins, antibodies, match up with the antigen and inactivate it
body develops sensitivity
ability to recognize the antigen the next time it enters the body
reexposure to a foreign substance
Secondary Response
What produce’s the body’s chemical mediators. Contain granules filled with host of powerful substances ready to be released to fight invading antigens. Only released when foreign body detected.
Basophils and Mast Cells
Histamine release causes immediate vasodilation
presents as erythema our skin and hypotension
increase vascular permeability
results in edema, fluid secretion, and fluid loss
edema can present as urticaria
causes smooth muscle contraction
especially in Resp and GI systems
results in laryngospasm and bronchospasm
poss abdominal cramping
Decreases intropic (heart CONTRACTILITY) effects of the heart
coupled w/ vasodilation, can cause profound hypotension
coupled w/ hypoxia, can cause dysrhythmias
Leukotrines compound effects of histamine
causes coronary vasoconstriction
contributes to worsening cardiac condition and myocardial irritability
also associated w/ increased vascular permeability
increases hypoperfusion
Synergistic effect
Primary Survey:
Airway & Breathing
noisy airway can be early sign of impending airway occlusion
silent chest is ominous finding and requires immediate intervention
early intervention is key in these patients
MAINTAIN HIGH INDEX OF SUSPICION
Primary Survey:
Circulation
erythema, rashes, edema, moisture, pruritus (itching), and urticaria (hives)
Pallor and cyanosis may also be present
Check mucous membranes, nail beds, and palms in pt’s w/ dark skin
Weak, threat pulse
indicative of cardiovascular collaps
treat for shock prior to symptoms
make a transport decision as you are completing primary survey
History Taking For Allergic Reaction
Chief complaint
SAMPLE
OPQRST
History should be directed at this incident
Can ask about previous incidents and compare the severity to this incident
Home interventions?
IE: epi pen, albuterol inhaler
Exposure to antigen; known or unknown
Known IE: ate peanuts w/ peanut allergy
Unknown IE: new medications
If unknown cause, ask about less common causes
IE: exercise induced, recent sexual activity (seminal fluid allergy)
DO NOT DELAY TREATMENT TO FIND CAUSE
Assess Baseline Vital signs for allergic reaction
consider O2 admin during any level of allergic reaction/anaphylaxis
Rapid resp and pulse rates can indicate systemic shock
Fast pulse rates and hypotension are ominous signs
indicate systemic vascular collapse and shock
Cardiac Monitoring
assess for dysrhythimias associated w/ anaphylaxis
consider 12 lead
important in pt’s w/ cardiac and pulmonary PMHX
ETCO2
Levels may be elevated
”shark fin” waveform, indicating bronchoconstriction
Reassessment in allergic reaction
usually done enroute to ED
Be Vigilant
Pay special attention to any signs of airway compromise
increased work of breathing, Stridor, wheezing
Monitor anxiety levels
Observe skin for signs of shock
include: pallor, diaphoretic, flushing
Reobtain serial vital signs
Recheck interventions
Alert hospital, document ate status, interventions performed, and pt’s response to treatments
Allergic reactions divided into 2 groups
First Group: sign of allergic reaction but no resp distress
Treatment of choice= Diphenhydramine (Benadryl)
Second Group: Stable initially, are deteriorating, or have a hx of deterioration
Pt’s have anaphylaxis or potential to develop anaphylaxis.
process for providing emergency medical care to a patient who is experiencing an allergic reaction.
Must identify severity of reaction, first and foremost
Early Epinephrine is priority in care of pt w/ anaphylactic reaction
EARLY ADMINISTRATION OF WHAT SHOULD BE A PRIORITY IN ANAPHYLAXIS
Epinephrine -
IM is preferred route
If no response, IV/IO infusion is recommended
Some require more than 1 dose
Can be repeated every 5-15mins, PRN
IV infusion should be administered in conjunction w/ fluid bolus to support hemodynamic status as needed.
IV/IO Epi bolus only recommended for impending cardiovascular collapse
How does Epinephrine effect the the body for Anaphylaxis?
drug of choice because it stops the process of mast cell degranulation
immediate action
Reverses effects of chemical mediators
Alpha Adrenergic properties constrict blood vessels
reversing vasodilation and hypotension
beta 1 adrenergic effect: increase cardiac CONTRACTILITY, reversing depressing effect on the heart
increases cardiac contractions
beta 1 adrenegic effect cause bronchodilation, relieving bronchospasm in the lungs
2nd line drug to treat anaphylaxis
administer if urticaria or pruritus are present
Anti Histamine that blocks histamine-1 and histamine-2 receptor sites
does not prevent histamine release
blocks effect at H1 receptor sites
H2 blockers can be given orally or IV in conjunction w/ benadrly
IE: Pepcid and Tagamet
Inhaled beta adrenergic agent treatment for allergic reaction/anaphylaxis
Albuterol
consider if resp distress w/ wheezing is present
Epi (nebulized)
consider if resp distress w/ Stridor is present
Transport considerations for allergic reaction/anaphylaxis
20% of pt’s will have recurrence within 8hrs
make transport decision early
do not delay care trying to determine cause of reaction
immune system attacks own how tissue
Autoimmune Disorders
Autoimmune Disorder that the body perceives its own tissue and cells as dangerous invader and attacks that tissue.
o Can be chronic
o cause long term inflammation
o can result in death
Collagen Vascular Diseases
chronic, progressive, multi system autoimmune disease
immune complexes lodged in various parts of the body
cause inflammation, loss of tissue integrity, and permanent damage
Systemic Lupus Erythematosus
Slow Onset
Initial symptoms are mild & vague
Have periods of active symptoms
Periods of no symptoms
importance of patient education in the management of anaphylaxis and allergic reactions
Pt will need reassurance and emotional support.
Common stats on Lupus
More common in women than men
AA women 4x more likely to have lupus vs white
Lupus pt’s tend to die w/ kidney failure, infection, cardiovascular disease
Localized Scleroderma
changes usually only found in a few places on skin or muscles
rarely spread elsewhere
internal organs usually unaffected
rarely develop systemic scleroderma
Systemic Scleroderma
cause fibrotic changes to many parts of the body
· blood vessels, muscles, joint, skin, GI tract, lungs, kidney, heart, other internal organs
often have symptoms of Ryanaud phenomenon
· pain, blanching, cyanosis, redness of fingers/toes when stressed or exposed to cold
pt’s w/ dark skin notice changes in pigmentation in hands, arms, face
Common complaints Systemic Scleroderma
body aches/pains
· decreased joint motion
· decreased hand function
· Stiffness of lung, blood vessels can cause SOB, pulmonary fibrosis, and pulmonary hypertension
· cardiac involvement:
o lead to dysrhythmias and heart failure
· decrease blood flow to kidneys result in release of hormones and increase in BP
o triggers further reduction in renal blood flow
worsens kidney function
Organ Transplants:
Immune system can “reject” the organ
placed on medication to prevent immune system from attacking new organs
place pt at greater risk of infection
cause body’s self defense mechanism to not recognize other threats or to shut down portions of it’s function
increase risk of infection and sepsis
Heart Transplantation
May notice an increase in rate on ECG
d/t denervation of the vagus nerve
Chest pain is uncommon
denervated vagus nerve can’t produce angina like pain
Ischemia tend to present w/ signs of heart failure and dysrhythmias
Atropine is not indicated for bradycardia or heart blocks
Again, no vagus nerve
Sympathomimetic drugs tend to work well for these pt’s
Common signs of rejection: sepsis, pneumonia, dysrhythmias.
Assess for: fever, sob, hypoxia, hypotension, poorly controlled HTN, new dysrhythmia
Heart Transplantation
May notice an increase in rate on ECG
d/t denervation of the vagus nerve
Chest pain is uncommon
denervated vagus nerve can’t produce angina like pain
Ischemia tend to present w/ signs of heart failure and dysrhythmias
Atropine is not indicated for bradycardia or heart blocks
Again, no vagus nerve
Sympathomimetic drugs tend to work well for these pt’s
Common signs of rejection: sepsis, pneumonia, dysrhythmias.
Assess for: fever, sob, hypoxia, hypotension, poorly controlled HTN, new dysrhythmia
Liver Transplant
Second most common transplant
Rejection= loss of function, rapid deterioration of the pt and possibly death
Infection: Opportunistic infection is problem for these pt’s
Observe for: jaundice, tenderness over site
may have symptoms that are vague to complete fulminant hepatic failure
monitor for hyperkalemia from immunosuppressive drugs
Kidney Transplant
most common transplant in US
Infection is major concern
have tendency to develop Hep C and later liver disease
Rejection presents w/ fever, tenderness, swelling over implanted kidney
monitor for hypovolemia
hypotension is common
90% of these pt’s have HTN
ask about normal BP during assessment
Assessment should include: observation of site for infection, auscultation for development of bruit, eval for sign of infection
also ask if pt has had spleen removed
increase risks of infection progressing more rapidly
Lung Transplant
Can be performed along or in conjunction w/ heart transplant
3 types: bilateral, unilateral or lobar
single lung transplants: unequal lung sounds common finding
hemothorax early complication of transplant
Sign of rejection: cough, dyspnea, vomiting, fever, crackles, RHONCHI, and decrease in Oxygenation
infection present similarly and requires immediate intervention
Pancreas Transplant
Increased rate of complications, Lower survival rate
Most transplants performed on pt’s w/ diabetes
often performed in tandem w/ kidney transplant
Exocrine drain must be place
can be connected to intestine or bladder
When connected to bladder: monitor for urinary tract signs of infection and hematuria
Have chronic non anion gap acidosis
Bicarb produced drains directly into bladder for excretion
Pt takes oral bicarb supplements
At risk for dehydration and may present with orthostatic hypotension
Infection and rejection is common
Immune response problems include:
-Hypersensitivity
●Allergic reactions
●Anaphylaxis
●Biphasic allergic reactions
●Anaphylactoid reactions
●Collagen vascular diseases
●Transplantation-related disorders
Substance that produces allergic symptoms
Allergen
Protein produced by the body in response to an antigen
●
IgE antibody is the primary antibody responsible for allergic reactions.
Antibody
An allergic reaction that affects 2 or more systems, most commonly, respiratory and cardiovascular
OVER PROTECTION, HYPERSENSITIVITY, LOOKS OUT FOR OFFENDING INVADER AND MOUNTS AN ATTACK AGAINST IT
Anaphylaxis
●Inappropriate response to a substance body perceives as harmful
●Allergic reaction, anaphylaxis, biphasic reaction, prolonged reaction, anaphylactoid reaction
Hypersensitivity
Routes of Entry for Allergens
●Injection - Pierces the Skin
●Absorption - Absorbed through the skin
●Inhalation - Respiratory Tract
●Ingestion - GI tract
Anaphylactic Type Response, but does not involve IgE antibody mediation, can happen 1st time exposed to an allergen.
Anaphylactoid Reaction
Produce antibodies that dissolve in the plasma and lymph and wage war on invading organisms.
B Cell Lymphocytes
In Call-Mediated immunity (cellular immunity)….
The body produces special WBC’s called T cells that attack and destroy invaders.
The cells producing immunity are located where?
Lymph Nodes
Spleen
GI tract
Goal is to intercept foreign forces as they enter the body
primary antibody responsible for allergic reactions.
●IgE antibody
Histamine Antibody
Less than 1% of antibodies are IgE
Hypersensitivity
Inappropriate response to a substance body perceives as harmful
●Allergic reaction, anaphylaxis, biphasic reaction, prolonged reaction, anaphylactoid reaction
Biphasic Reaction
Pts symptoms resolve and then reappear later w/o exposure for a 2nd time
How much blood can you lose in what amount of time can you lose during anaphylaxis?
50%
10 Mins
