Exam #1 Flashcards
What are three processes needed for immunity?
- Inflammation
- Cell mediated immunity- T cells
- Humoral immunity- Antibodies
Which immune process is lost in HIV?
Cell mediated immunity
Why is HIV a retrovirus?
-It replicates in a “backward” manner going from RNA to DNA.
What is the target cell for HIV?
-CD-4 T cell
What turns HIV RNA into HIV DNA?
-Reverse transcriptase
What enzyme matures the virus?
-Protease
What ways is HIV transmitted?
-Male to male sexual contact
-Heterosexual contact
-Injection drug use
-Perinatal
Contact with what bodily fluids can transmit HIV?
-Blood
-Semen
-Vaginal secretions
-Breastmilk
-Pregnancy
-US Blood supply
-Drug paraphernalia
What is PrEP?
-Pre exposure prophylaxis
-Strategy to reduce risk of sexually-acquired infection in high risk adults.
What drug is administered as PrEP?
-Truvada
What are 2 ways an RN can be exposed to HIV?
-Needlesticks
-Mucous membranes or no-intact skin
-Use standard precautions with all patients.
When should Post-Exposure Prophylaxis (PEP) be administered?
-As soon possible.
-Ideally within 2-36 hrs after exposure.
-Adhere to the full 28 day course.
What drugs are administered as PEP?
-Tenofovir combined with lamivudine or emtricitabine.
What are the different types of HIV tests?
-At- home test
-ELISA (enzyme-linked immunosorbent assay)
-Western blot
-Antigen/antibody test- Current gold standard
-Nucleic acid test (NATs)- tests for genetic material. Expensive
HIV progression is also monitored by?
-Viral load
-The lower the viral load the less active the disease
What is U=U?
-Undetectable=Untransmittable
-Undetectable for 6 months
-Teach to still use barriers
What is a normal CD4 T+?
-800-1200 cells/uL
-Stage 1
What is the CD4 count when immune problems arise?
-<500 cells/uL.
-Stage 2
What is the CD4 when symptoms worsen, viral load increases, and the is symptomatic infection?
-<200 cells/uL
-When a diagnosis of AIDS is made.
What does an Acute HIV infection (Stage 1) look like?
-Non specific- like mono
-Fever
-Nausea
-Malaise
-Swollen lymph nodes
-Headache
-Sore throat
-Muscle and joint pain
-Diarrhea
-Diffuse rash
When do these symptoms occur?
-2-3 weeks after infection
-Highly infectious
What is cART?
-Combination anti-retrovirus therapy
What is the example of cART discussed?
-BIKTARVY
What are the three drugs that make up BIKTARVY?
-Bectegravir
-Tenofovir Alafenamide
-Emtricitabine
-Taken at the same time everyday. 1 tablet a day regimen.
What are the goals of drug therapy?
-Decrease viral load
-Maintain/increase CD4 T counts
-Prevent HIV related symptoms and opportunistic diseases
-Delay disease progression
-Prevent HIV transmission
What are benefits of drug therapy adherence?
-Reduce viral load
-Prevent opportunistic disease
-Decreases/helps prevent resistance
What are challenges of drug therapy adherence?
-Lifelong commitment
-Schedule/ time/ memory
-Side effects/ interactions
-Decreased WBC count
-Low platelet counts
-Anemia
What are some examples of opportunistic infections?
-Cytomegalovirus retinitis
-Herpes simplex virus
-Varicella zoster virus- shingles
-Epstein-Barr virus
-Oral hairy leukoplakia
-Oral thrush
-Pneumocystis jiroveci pneumonia
-Kaposi’s sarcoma- Reddish brown lesions
-NHL B cell
What are clinical manifestations of wasting syndrome?
-Weight loss >10%
-Fever
-Chronic weakness
-Diarrhea
-Lasts longer than 30 days
What is some patient teaching related to infection prevention?
-Avoid crowds
-Stay away from undercooked eggs, meats
-Don’t handle litter boxes, turtles, snakes, or garden
-Use antimicrobial soaps
-Report if temp >100 F/ cough/ drainage/ cloudy urine
CANCER
What are some characteristics of benign tumors
-Slow growth
-Encapsulated
-Well differentiated
-No metastasis
-Lipoma
What are characteristics of malignant tumors
-Rapid, uncontrolled growth
-Loosely adhered
-Undifferentiated in structure, size, shape
-Divide indiscriminately
-Loss of contact inhibition- Disregard cell boundaries
-Divides continuously
-Metastasis (Invades tissue)
Proto-oncogenes
-Regulate normal cellular processes such as promoting growth.
-Genetic locks that keep cells functioning normally
-Mutations that alter their expression can activate to function as oncogenes
-With cancer protocol-oncogenes get turned into oncogenes.
Tumor suppressor genes
-Suppress growth
-Function to regulate cell growth
-Prevent cells from going through cell cycle
-Mutations make them inactive
-Result in loss of suppression of tumor growth
What is the main contributing factor of cancer?
-Age
What are carcinogens?
-Cancer-causing agents capable of producing cell mutation.
-Many are detoxified by protective enzymes and are excreted.
-Failure of protective mechanisms allows them to enter the cell’s nucleus and alter its DNA
Chemical carcinogenes
-Benzene
-Arsenic
-Formaldehyde
Radiation carcinogens
-Damage to DNA
What is the main source of UV exposure?
-The sun
Ultraviolet radiation
-Associated with melanoma, squamous and basal cell carcinoma.
Promotion stage of mutation
-Reversible proliferation of altered cells
Activities of promotion that are reversible
-Smoking
-Obesity
-Alcohol use
-Dietary fat
Patient teaching for promotion stage
-Teach about a healthy lifestyle
For disease to be clinically evident
-Tumor must reach a critical mass that can be detected
-Detectable= 1cm
Progression stage of mutation
-Increased growth rate of tumor
-Invasiveness
-Metastasis
-Spreads through blood and lymph
How does metastasis occur?
-Begins with rapid growth of primary tumor
-Develops its own blood supply
-Tumor cells can detach and invade surrounding tissue
-Most mobile cells do not survive
-Surviving tumor cells must create an environment conducive to growth and development.
Tumor angiogenesis
-Tumor develops its own blood supply
What are main sites of metastasis?
-Brain and cerebrospinal fluid
-Lung
-Liver
-Adrenals
-Bone- spine and femur
Cancer prevention: Primary
(These people do not have cancer)
-Avoid or reduce exposure to know or suspected carcinogens
-Eat a balanced diet
-Limit alcohol intake
-Exercise regularly
-Maintain a healthy weight
-Get adequate rest
-Eliminate, reduce, or cope with stress
-Have a regular health exam
-Be familiar with family history
Cancer prevention: secondary
(These people may have cancer. Trying to catch it early)
-Screening/Early detection
-Identify high risk groups
-Screening examinations
-Self-monitoring
-Diagnostics
-“CAUTION”
7 Warning signs of cancer: “CAUTION”
-Change in bowel or bladder habits
-A sore that does not heal
-Unusual bleeding or discharge
-Thickening or lump in the breast, testicle, or elsewhere
-Indigestion or difficulty swallowing
-Obvious change in the size, color, shape, or thickness of a wart, mole, or mouth sore.
-Nagging cough or hoarseness
-These changes last for weeks or months
Classification of cancer: Grading
-4 grades of abnormal cells
Cancer grading: Grade 1
-Cells differ slightly from normal cells and are well differentiated
Cancer grading: Grade II
-Cells are more abnormal and moderately different
Cancer grading: Grade III
-Cells are very abnormal and poorly differentiated
Cancer grading: Grade IV
-Cells are immature and primitive and undifferentiated.
Clinical staging of cancer: Stage I
-Tumor is limited to tissue of origin; localized tumor growth
Clinical staging of cancer: Stage II
-Limited to local spread
Clinical staging of cancer: Stage III
-Extensive local and regional spread
Clinical staging of cancer: Stage IV
-Metastasis
Clinical staging of cancer: Stage 0
-Cancer in situ
TNM staging of cancer
T=Tumor size
N=Lymph node status
M=Metastasis
TNM staging: Tumor
T1: 0-2 cm
T2: 2-5 cm
T3: >5 cm
T4: tumor has broken through skin or attached to chest wall
TNM staging: Nodes
N0: Surgeon can’t feel any nodes
N1: Surgeon can feel swollen nodes
N2: Nodes feel swollen and lumpy
N3: Swollen nodes located near collarbone
TNM staging: Metastasis
M0: Tested nodes are cancer free
M1: Tested nodes show cancer cells or micro metastasis
