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Accelerated Paramedic > Chapter 26 Immune System > Flashcards

Chapter 26 Immune System Flashcards

1
Q

protects the body from substances and organisms that are considered foreign

A

Immune System

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2
Q

body produces special white blood cells called T cells that attack and destroy invaders

A

Cell mediated Immunity

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3
Q

B cell lymphocytes produce anti bodies that dissolve in plasma and lymph and wage war on invading organisms

A

Humoral immunity

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4
Q

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

A

Allergic Reaction

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5
Q

extreme form of allergic reaction
involves one or multiple body systems
life threatening effects are greatest concern

A

Anaphylaxis

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6
Q

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

A

Biphasic Reactions

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7
Q

symptoms that continue over time
time frame can be between 5 and 32hrs

A

Prolonged Reactions

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8
Q

body limits response to specific area after exposure to foreign substance

IE: swelling around an insect bite

A

Local Reaction

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9
Q

reaction through the body, possibly affecting multiple body systems

IE: person who is allergic to something develops swelling and hives all over the body

A

Systemic Reaction

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10
Q

Primary response: macrophages confront and engulf foreign substance

A

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

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11
Q

reexposure to a foreign substance

A

Secondary Response

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12
Q

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.

A

Basophils and Mast Cells

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13
Q

Histamine release causes immediate vasodilation

A

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

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14
Q

Leukotrines compound effects of histamine

A

causes coronary vasoconstriction

contributes to worsening cardiac condition and myocardial irritability

also associated w/ increased vascular permeability

increases hypoperfusion

Synergistic effect

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15
Q

Primary Survey:
Airway & Breathing

A

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

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16
Q

Primary Survey:
Circulation

A

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

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17
Q

History Taking For Allergic Reaction

A

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

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18
Q

Assess Baseline Vital signs for allergic reaction

A

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

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19
Q

Reassessment in allergic reaction

A

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

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20
Q

Allergic reactions divided into 2 groups

A

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.

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21
Q

process for providing emergency medical care to a patient who is experiencing an allergic reaction.

A

Must identify severity of reaction, first and foremost
Early Epinephrine is priority in care of pt w/ anaphylactic reaction

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22
Q

EARLY ADMINISTRATION OF WHAT SHOULD BE A PRIORITY IN ANAPHYLAXIS

A

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

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23
Q

How does Epinephrine effect the the body for Anaphylaxis?

A

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

24
Q

2nd line drug to treat anaphylaxis

A

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

25
Q

Inhaled beta adrenergic agent treatment for allergic reaction/anaphylaxis

A

Albuterol
consider if resp distress w/ wheezing is present

Epi (nebulized)
consider if resp distress w/ Stridor is present

26
Q

Transport considerations for allergic reaction/anaphylaxis

A

20% of pt’s will have recurrence within 8hrs

make transport decision early

do not delay care trying to determine cause of reaction

27
Q

immune system attacks own how tissue

A

Autoimmune Disorders

28
Q

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

A

Collagen Vascular Diseases

29
Q

chronic, progressive, multi system autoimmune disease

immune complexes lodged in various parts of the body

cause inflammation, loss of tissue integrity, and permanent damage

A

Systemic Lupus Erythematosus

Slow Onset

Initial symptoms are mild & vague

Have periods of active symptoms

Periods of no symptoms

30
Q

importance of patient education in the management of anaphylaxis and allergic reactions

A

Pt will need reassurance and emotional support.

31
Q

Common stats on Lupus

A

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

32
Q

Localized Scleroderma

A

changes usually only found in a few places on skin or muscles

rarely spread elsewhere

internal organs usually unaffected

rarely develop systemic scleroderma

33
Q

Systemic Scleroderma

A

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

34
Q

Common complaints Systemic Scleroderma

A

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

35
Q

Organ Transplants:

A

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

36
Q

Heart Transplantation

A

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

37
Q

Heart Transplantation

A

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

38
Q

Liver Transplant

A

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

39
Q

Kidney Transplant

A

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

40
Q

Lung Transplant

A

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

41
Q

Pancreas Transplant

A

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

42
Q

Immune response problems include:

A

-Hypersensitivity
●Allergic reactions
●Anaphylaxis
●Biphasic allergic reactions
●Anaphylactoid reactions
●Collagen vascular diseases
●Transplantation-related disorders

43
Q

Substance that produces allergic symptoms

A

Allergen

44
Q

Protein produced by the body in response to an antigen
●
IgE antibody is the primary antibody responsible for allergic reactions.

A

Antibody

45
Q

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

A

Anaphylaxis

46
Q

●Inappropriate response to a substance body perceives as harmful

●Allergic reaction, anaphylaxis, biphasic reaction, prolonged reaction, anaphylactoid reaction

A

Hypersensitivity

47
Q

Routes of Entry for Allergens

A

●Injection - Pierces the Skin

●Absorption - Absorbed through the skin

●Inhalation - Respiratory Tract

●Ingestion - GI tract

48
Q

Anaphylactic Type Response, but does not involve IgE antibody mediation, can happen 1st time exposed to an allergen.

A

Anaphylactoid Reaction

49
Q

Produce antibodies that dissolve in the plasma and lymph and wage war on invading organisms.

A

B Cell Lymphocytes

50
Q

In Call-Mediated immunity (cellular immunity)….

A

The body produces special WBC’s called T cells that attack and destroy invaders.

51
Q

The cells producing immunity are located where?

A

Lymph Nodes

Spleen

GI tract

Goal is to intercept foreign forces as they enter the body

52
Q

primary antibody responsible for allergic reactions.

A

●IgE antibody

53
Q

Histamine Antibody

A

Less than 1% of antibodies are IgE

54
Q

Hypersensitivity

A

Inappropriate response to a substance body perceives as harmful

●Allergic reaction, anaphylaxis, biphasic reaction, prolonged reaction, anaphylactoid reaction

55
Q

Biphasic Reaction

A

Pts symptoms resolve and then reappear later w/o exposure for a 2nd time

56
Q

How much blood can you lose in what amount of time can you lose during anaphylaxis?

A

50%

10 Mins

Accelerated Paramedic (16 decks)

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