Class 16 review Flashcards
Innate immunity
Our first line of defence which is present at birth. These are white blood cells such as neutrophils and monocytes which are not specific to an antigen
Acquired immunity
This immune response is specific to the antigen that invades the body. Also known as acquired or adaptive specific immunity. Includes humoral immune response (b-lymphocytes) and cell mediated immune response (t-lymphocytes)
The two ways acquired immunity occurs:
Active acquired immunity
Passive immunity
Active acquired immunity definition
When the body develops its own antibodies in response to natural exposure to pathogen (eg chicken pox) or by immunization (eg Covid Vaccine)
Passive immunity definition
This occurs when antibodies are passed on from mother to fetus or when synthetically produced antibodies are given to host. This is provided when the host does not have time to mount active immunity and requires protection immediately (eg immunoglobulin given for hepatitis exposure) This type of immunity is short-lived because the body does not develop memory cells to the antigen
Immunoglobulins definition
Antibodies produced by plasma cells that differentiate from B-lymphocytes IgM IgG IgA IgE
Immunodeficiency definition
When the body cannot mount an immune response due to immune deficiency disease or malignancies
Immune-suppression definition
When the body’s immune response is suppressed by medication such as prednisone or chemotherapy
Neutropenia definition
When there is not enough neutrophils to mount that 1st line defence against pathogens. This is an adverse effect of chemotherapy
Neutropenic patient with fever are at high risk for …
Septicemia and death
Hypersensitivity definition
These are conditions where the immune system overreacts. There are four types of these reactions:I, II, III, IV
Hypersensitivity type I reactions
This is the response that occurs in allergies and anaphylaxis. In anaphylaxis, at least two body systems are involved in the response (eg neurological + respiratory + skin)
Hypersensitivity type II reactions
This occurs when the body’s T-cells and B-cells react to self-antigens and destroy host cells. This occurs in auto-immune disorders such as myasthenia graves, Good Pasture’s disease, and in hemolytic blood transfusion reactions
Hypersensitivity type III reactions
This reaction occurs when antigen-antibody complexes deposit in tissues and cause chronic inflammation/ destruction of the tissue. Examples include rheumatoid arthritis, acute glomerulonephritis
Hypersensitivity type IV reactions
This involves a delayed response to an antigen that has sensitized T lymphocytes, causing release of cytokines and macrophages that destroy tissues. Example of this is contact dermatitis and transplant rejection
Colony-stimulating factor prototype
filgrastim (Neupogen)
Adrenergic agonist (catecholamine) prototype
epinephrine (Adrenalin, Epi-Pen)
Anti-histamine prototype
Diphenhydramine (Benadryl)
Glucocorticoids prototype
prednisone
What are the first line of defence?
Innate, non-specific immunity. Includes PMN’s (neutrophils), macrophages, and natural killer cells (type of lymphocyte, no sensitizing, surveillance only)
What is short lived immunity?
Passive immunity
Antibodies transferred to host. Often mother to fetus or injection of immunoglobulin (antibodies)
What is long lasting immunity?
Acquired or adaptive specific immunity. Includes humoral immune response and cell mediated immune response
IgM
In blood, primary and early immune response
IgG
In blood, may enter tissue during inflammatory response, predominates the secondary and late immune response
IgA
Primarily released in mucus secretions and is particularly useful in defending the airways. Also found in breast milk
IgE
Forms a receptor on masts cells and basophils and triggers histamine release during allergic reactions
Cells in cell mediated immune response
T-lymphocytes
T cytotoxic (killer cell) (CD8 cells)
T helper cells (CD4 cells)
T-lymphocytes
From bone marrow, thymus
Major role in attacking infected cells, fighting intracellular viruses, tumour cells, fungi
T cytotoxic (killer) cells (CD8 cells)
Attach antigens on the cell membrane of foreign pathogens and release cytolytic substances that destroy the pathogen. Are antigen specific, produce memory T cytotoxic cells
T helper cells (CD4 cells)
Regulate T cytotoxic and B cell responses, produce cytokine messengers (overall, intensify immune response). Are antigen specific, produce memory T helper cells
When immunoglobulins are elevated, what sort of response is happening?
Humoral response
Characteristics of IgG
Is only immunoglobulin that crosses placenta
Is responsible for secondary immune response
Characteristics of IgA
Lines mucous membranes and protects body surfaces
Characteristics of IgM
Is responsible for primary response
Characteristics of IgD
Is present on lymphocyte surface
Assists in the differentiation of B lymphocytes
Characteristics of IgE
Causes symptoms of allergic reactions
Fixes to mast cells and basophils
Assists in defence against parasitic infections
Which of the following are TRUE in neutropenia?
a. WBC count <4.0
b. Clinical signs of infection are present
c. Neutrophil count <1.5
d. Treatment of an infection is based on culture and sensitivity
c. Neutrophil count <1.5
Neutropenia is low neutrophil count, low WBC is leukopenia
Signs of infection are not diminished if neutrophils are inadequate
Infection is treated empirically with broad spectrum antibiotic to prevent sepsis
Which of the following are involved in specific immune response? Select 2 that apply
a. IgM, IgG
b. Natural killer cells
c. Neutrophils
d. T-helper cells
a. IgM, IgG
d. T-helper cells
Specific immune response refer to antibodies and T-cells
Which response may alert the nurse that a possible anaphylactic reaction may be occurring after an IV infusion of penicillin?
a. hypertension
b. redness at the IV insertion site
c. angioedema and hoarseness
d. itching of the nose and sneezing
c. angioedema and hoarseness
Anaphylaxis results in hypotension, angioedema and hoarseness because of histamine release and vasodilation and bronchial constriction
Redness is a sign of inflammation. Itching and sneezing are a local histamine response
A patient who has recovered from the measles would have which of the following immunoglobulins in the bloodwork
a. IgA
b. IgE
c. IgM
d. IgG
d. IgG
IgA - acquired from breastmilk, not long lasting
IgE - allergic response related
IgM - released in acute early immune response when infection is ongoing (M = miserable)
IgG - response after acute phase when infection is resolved (G = gone) and following vaccination
Which of the following nursing interventions are indicated for the patient receiving a blood transfusion? Select 2 that apply
a. vital signs q4h
b. IV D5W as secondary line
c. vital signs baseline and q15min
d. IV NS as secondary line
c. vital signs baseline and q15min
d. IV NS as secondary line
Baseline vital signs and frequent monitoring is needed to detect reaction. NS is hung as secondary line to keep IV line open, to provide funds for vascular support for shock
Transfusion reactions
Occurs in the first 10-15 min or first 50cc of blood) Allergic: - facial flushing - hives Febrile: - fever - chills -anxiety - headache - tachycardia - tachypnea Hemolytic: - chest pain - low back pain - low BP - high RR
What is the treatment of neutropenia?
Broad spectrum antibiotics (in presence of fever, started STAT)
Neupogen (filgrastim)
Infection control practices
At home: no raw food, caution with cat litter, plants
Neupogen MOA
Prevents and reduces severity of neutropenia. Can be subcutaneous or IV
ABCDs of hypersensitivity reactions
A type I: atopic/ allergic
B type II: cytotoxic (antiBodies against the Body)
C type III: AB+Ag Complex deposits in the tissue
D type IV: Delayed hypersensitivity
Treatment of anaphylaxis
Epinephrine (IM, IV); may need repeat doses
Epinephrine MOA
Sympathomimetic (mimics SNS response)
Adrenergic agonist
-alpha receptors (heart, blood vessels)
- beta receptors (lungs)
Other acute transfusion reactions
Transfusion-related acute lung injury (TRALI) reaction
Massive (multi) blood transfusion reaction
Circulatory overload reaction
Sepsis reaction
What to monitor during blood transfusion
Frequent VS and urine output
S/S allergic reaction and hemolytic complications
Volume overload
Maintain a patient NS IV in case needed
Bacterial vaccines
- Inactivated bacterial exotoxins eg tetanus
- Killed bacteria eg pneumococcal
- Live attenuated bacteria - high response, but high risk
Viral vaccines
- live attenuated virus - high response but high risk
- killed virus
- recombinant - cultured vaccine; needs booster
- live viral vaccines produce high protection and longer immunity and production of IgAs, IgGs, and cellular immunity
- killed virus only produce IgGs
