Exam 4: Units 7 and 8 Flashcards
The body has 3 means of immune defenses
Phagocytic
Humoral/Antibody
Cell-mediated
4 stages of immune response
1) Recognition
2) Proliferation
3) Response
4) Effector
Stage of the immune response where Humoral or Cellular response is carried out
Response
Stage of the immune response where the immune system recognizes an antigen
Recognition
Stage of the immune response where T and B cells respond and proliferate
Proliferation
Stage of the immune response where the antigen is destroyed
Effector
This type of immunity has memory
Adaptive immunity
Leukocytosis is characterized by
WBC >10,000
Leukopenia is characterized by
WBC <4,000
Neutropenia is characterized by
Neutrophil count <2,000
All WBC percentages add up to
100%
5 types of WBC’s
“Never let monkeys eat bananas”
Neutrophil
Lymphocyte (B and T cells)
Monocytes
Eosinophils
Basophils
Innate immunity provides a ____ spectrum of defense
broad spectrum
With innate immunity, responses are
similar from one encounter to the next
Humoral immunity addresses problems ______ the cell
outside the cell (extracellular pathogens)
Cell-mediated immunity addresses problems _____ the cell
inside the cell
Humoral response occurs in the
blood stream
Humoral response is mediated by
B cells
B cells produce
antibodies
End result of humoral immunity
Memory B cells
cell-mediated response occurs in
the infected cell
cell-mediated response is mediated by
T cells
Role of killer T cells
directly destroy infected cells
End result of cell-mediated response
memory T cells
Antibodies prevent a virus or toxic protein from binding their target
Neutralization
A pathogen tagged by antibodies is consumed by a macrophage or neutrophil
Opsonization
Antibodies attached to the surface of pathogen cell activate the complement system
Complement activation
IgA antibodies found in
Mucosal Defense:
-Breastmilk
-Saliva
-Tears
-Mucous
IgA structure
Dimer
IgG structure
monomer
IgM structure
pentamer (and can be in monomer form)
IgE structure
monomer
IgA antibodies found in
FLUIDS of the body:
-Saliva
-Sweat
-Breast milk
these antibodies can fuse with the cell membrane of a B-cell lymphocyte and act as a receptor
IgD
IgM
Role of IgD antibodies
activates basophils and mast cells
IgE antibodies are prevalent in
allergies
helminth infections
how do the IgG antibodies provide passive immunity to the fetus
Cross placenta into the fetus
exposure to pathogen triggers antibody production
Active immunity
a person is given antibodies rather than having to produce them
passive immunity
vaccination is an example of
artificial active immunity
exposure to a sickness and needing to make your own antibodies is an example of
natural active immunity
breastfeeding is an example of
passive natural immunity
receiving antibodies through a blood transfusion is an example of
passive artificial immunity
4 stages of infection
Incubation
Prodromal
Illness
Convalescence
stage of infection where specific signs and symptoms of the disease present
Illness
stage of infection where symptoms diminish and host begins to recover
Convalescence
stage of infection where early signs and symptoms of an infection appears
Prodromal
stage of infection characterized by the time between exposure and symptom onset
Incubation
local signs of infection (think inflammation)
heat
redness
pain
swelling
loss of normal function at infection site
fever characterized by
temperature >38 C or 100.4 F
swollen lymph nodes
lymphadenopathy
Immune system attacks its own body/host
Autoimmunity
Body produces inappropriate/exaggerated responses to specific antigens
Hypersensitivity
*Includes allergies and transplant rejections
Overproduction of immunoglobulins
Gammopathies
Immune deficiency that’s generally congenital or inherited, resulting from improper development of immune cells/tissue
Primary
Immune deficiency acquired later in life described as an interference with an already-developed immune system
Secondary
Primary immune deficiencies are more common in
males than females
primary immune deficiencies are commonly diagnosed at this time of life
infancy
a main difference between primary and secondary immune deficiencies
Primary is diagnosed at/around birth, child is born with an altered immune system
Secondary is acquired later in life, an established immune system has been damaged
HIV is this kind of virus
retrovirus
HIV is transmitted through
blood and bodily fluids
cure for HIV
NO CURE!!
Treated with lifelong retroviral therapy
HIV primarily targets this kind of cell
CD4+ T-cell Lymphocytes
stage of HIV with the higher viral load
acute stage
3 stages of HIV
Acute
Chronic
AIDS
this kind of exposure is a greater risk of contracting HIV than an accidental needle stick
unprotected sex with HIV+ partner
HIV replicates by
integrating itself to host DNA and using reverse transcriptase to make more copies of itself
HIV is more seen in
males than females
type of HIV testing that detects antibodies, not HIV itself
antibody testing
type of HIV testing that detects antibodies and/or HIV virus
Antibody/Antigen
role of the viral load test
detects and quantifies HIV virus
role of gathering a CD4+ T-cell count
assessing immune function
during the acute phase of HIV, manifestations occur within
2-4 weeks after infection
s/s of HIV during the acute stage are similar to
the flu
the acute HIV stage is marked by
rapid rise in HIV viral load
decreased CD4+ cells
stage of HIV that is asymptomatic
chronic stage
these are produced during the chronic HIV stage
anti-HIV antibodies
=DOES NOT INDICATE IMMUNITY
these are destroyed in the chronic HIV stage
CD4+ cells
this increases in the chronic HIV stage
viral load
(begins to increase after a certain amount of time)
AIDS is an HIV stage characterized by
life-threatening opportunistic infections
without treatment during the AIDS stage, death occurs within
5 years
type of cancer that develops in the lungs and lymph nodes, usually presenting as red/purple/brown patches
Kaposi Sarcoma
3 areas of involvement with Kaposi sarcoma
skin
respiratory tract
mouth + gastrointestinal tract
Kaposi sarcoma is strongly associated with infection by
Human Herpesvirus 8 (HHV-8)
Memory rhyme for Kapso sarcoma
“Lesions start flat, get fat, and then mess with your breathing and shat”
pneumocystis jirovecci causes
pneumocystis pneumonia
pneumocystis jirovecii is this kind of infection
fungal
pneumocystis jirovecii infects this organ
lungs
pneumocystis jirovecii is transmitted via
airborne pathway
Dx of pneumocystis pneumonia in an HIV+ patient indicates
progression of HIV to AIDS
____ may be present in pneumocystis jirovecii/pneumonia
hypoxia - monitor pulse oximetry, gather ABG
prophylaxis against pneumocystis jirovecii is recommended for HIV+ patients with CD4+ counts at this level
<200 cells/mm3
this is considered an AIDS-defining condition, according to the CDC
candidiasis of the bronchi, trachea, esophagus, or lungs
white patches on the tongue, inner cheeks, throat with pain/difficulty swallowing
oral candidiasis (thrush)
this kind of candidiasis may cause difficulty/pain with swallowing, sternal pain, and weight loss
esophageal candidiasis
severe pain and difficulty with swallowing
odynophagia
this kind of candidiasis involves itching/discomfort and discharge of the vaginal area
vaginal candidiasis
condition characterized by involuntary weight loss of >10% baseline weight
wasting syndrome
nurse should encourage a patient with wasting syndrome to eat this many meals per day
6 small meals that are high in protein
severe neurological complication of HIV characterized by cognitive, motor, and behavioral impairments
HIV-associated dementia
the goal of ART therapy is to
lower the viral load/levels in plasma
Pre-exposure prophylaxis for AIDS
PrEP therapy
post-exposure prophylaxis for AIDS
PEP therapy
wasting syndrome AKA
cachexia
There is more _____ fluid in the body
intracellular fluid
movement of solutes from a higher to lower concentration
diffusion
movement of water from a dilute solution to a more concentrated solution
osmosis
the pressure a fluid exerts on a surface when its not moving
hydrostatic pressure
there is greater hydrostatic pressure _____ the blood vessel
inside the blood vessel
hydrostatic pressure and osmotic pressure act in a ______ manner
opposing manner
condition where too much fluid moves from the blood vessels into the intercellular spaces
third-spacing
this age range decompensates quickly
young children
2 CV-related s/s with fluid deficit
hypotension
tachycardia
dark urine
oliguria
respiratory rate will ______ with fluid deficit
increase
BUN will _____ with fluid deficit
increase
serum and urine osmolality will _____ with fluid deficitq
increase
if fluid volume deficit is due to water loss, Hgb and Hct will
be elevated
if fluid volume deficit is due to blood loss, Hgb and Hct will
be low
thirst response ______ with age
decreases
BUN/Specific Gravity will ______ with fluid overload
decrease
Hgb and Hct will _____ with fluid overload
decrease
excessive urine production
polyuria
in hypovolemic shock, place the patient in
trendelenburg position (feet elevated above the head)
In fluid volume overload, place the patient in
semi-fowler’s or high-fowler’s
monitor this with fluid volume deficit
urine output
normal range for sodium
135-145
monitor this with fluid overload
respiratory status
Na+ is in higher concentrations ____ the cell
outside the cell
K+ is in higher concentrations ____ the cell
inside the cell
hormone that increases H2O absorption from the urine
Anti-diuretic hormone (ADH)
hormone that retains sodium and excretes potassium
aldosterone
too much water relative to sodium, but total body water stays normal
euvolemic hyponatremia
loss of sodium accompanying a loss in water (sodium loss is greater)
hypovolemic hyponatremia
too much total body water resulting in hyponatremia
hypervolemic hyponatremia
s/s hyponatremia
“SALT LOSS”
S: Stupor/coma
A: Anorexia (n/v)
L: Lethargy
T: Tachycardia
L: Limp muscles
O: Orthostatic hypotension
S: Seizures/headache
S: Stomach cramping
2 IV fluids that should be administered to a pt with hyponatremia
Lactated Ringer’s
0.9% isotonic saline
If patient has _____, DON’T encourage salt substitutes since they are high in potassium
Chronic Kidney Disease (CKD)
sodium’s main function is to
help maintain electrical membrane excitability
kidney _____ may result in excessive electrolyte levels
kidney failure (kidney disease is different)
how would Addison’s disease contribute to hyponatremia
Addison’s = LOW Aldosterone = LOW Na+ levels
How would SIADH contribute to hyponatremia
Syndrome of Inappropriate ADH secretion = ^^ ADH
^^ ADH = ^^ water retention = Na+ dilution
how would Cushing’s contribute to hypernatremia
Cushing’s = ^^ cortisol = ^Na+, low K+
how would diabetes insipidus contribute to hypernatremia
DI increases urination = ^^ Na+ concentration
if a patient is hypervolemic with hyponatremia, the pulse and blood pressure will be
higher/bounding
a patient with hypovolemia and hyponatremia will have this HR and BP finding
tachycardia
hypotension
sodium imbalances can lead to
neuro changes
s/s hypernatremia
“FRIED SALT”
F: Flushed skin
R: Restlessness (changes in LOC)
I: Increased BP
E: Edema
D: Decreased urine output
S: Skin is dry
A: Agitation
L: Low-grade fever
T: Thirst
main role potassium
helps muscles contract (including myocardium)
“K+ing of action and contraction”
normal range for potassium
3.5-5.0
(a 5k is 3.5 miles)
overuse of _____ may result in hypokalemia
diuretics like furosemide (NOT potassium sparing diuretics)
potassium and ____ have in inverse relationship
sodium
how would Cushing’s Syndrome contribute to hypokalemia
Cushing’s = ^^ cortisol = ^^ Na+ = LOW K+
(inverse K+ and Na+)
how would hyperinsulinism contribute to hypokalemia
insulin moves K+ from ECF to ICF
(lowers serum levels)
L’s of hypokalemia (s/s)
Low K+ = Less contraction (weak muscles)
Lethargy
Leg cramps
Limp muscles
Low, shallow respirations
Lethal cardiac arrhythmias
Lots of urine
excessive urination
polyuria
a pt with hypokalemia will have an EKG showing a
flattened T wave
a nurse treating a patient with hypokalemia shouls administer a potassium supplement through this route if possible
orally if possible
should a nurse administer a potassium IV bolus?
NEVER - high risk of cardiac arrest
2 classes of medications that can contribute to hyperkalemia
ACE inhibitors
Potassium-sparing diuretics
How does diabetic Ketoacidosis (DKA) contribute to hyperkalemia?
There is an insulin deficiency = no K+ being brought into cells
s/s hyperkalemia
“MURDER”
^^K+ = tight and contracted muscles
M: Muscle cramps
U: Urine abnormalities (oliguria)
R: Respiratory distress
D: Decreased cardiac contractility (low HR and BP)
E: EKG (tall, peaked T-waves)
R: Reflexes (decreased deep tendon reflexes)
a patient with hyperkalemia will have an EKG showing
Tall, peaked T-waves
avoid using _____ in a patient with hyperkalemia
salt substitutes - they are high in K+
when treating a patient with hyperkalemia with IV fluids, choose ones with ____ or _____
dextrose or regular insulin
this class of medication may be given to a patient with hyperkalemia to excrete excess K+ through the renal system
loop diuretics (furosemide)
this may be given to a patient with hyperkalemia to excrete excess K+ through the feces
Sodium polystyrene sulfonate (Kayexalate)
low urine output
oliguria
most abundant electrolyte in the body
calcium
this is required for calcium absorption
vitamin D
how does PTH regulate calcium
PTH increases calcium concentrations in the blood
how does calcitonin regulate calcium
calcitonin decreases calcium concentration in the blood by bringing it to the bones
normal range for calcium
8.5-10.5
(OR 9-11)
main function of calcium
(3 strong B’s)
Bones
Beats (heart function)
Blood (clotting)
most prevalent cause of hypocalcemia
renal failure
calcium and _____ move the same (similar s/s, move same direction generally, etc.)
magnesium
calcium works inversely with this electrolyte
phosphorus/phosphate
a patient with hypocalcemia will exhibit positive findings for ______ and ______
Trousseau’s
Chvostek’s
carpal spasm caused by inflating a blood pressure cuff
Trousseau’s sign
twitchy contraction of facial muscles with a light tap over the facial nerve
Chvostek’s sign
s/s hypocalcemia
“CATS go numb”
C: Convulsions/seizures
A: Arrhythmias
T: Tetany
S: Spasms
+Numbness in fingers, face, and limbs
this supplement may be given to a patient with hypocalcemia to increase calcium absorption
vitamin D supplements
encephalitis may be found at calcium levels greater than
> 14
hypercalcemia may be life-threatening at levels
> 15
an overactive _____ may contribute to hypercalcemia
PTH = increase calcium in blood
the use of this class of medication may result in hypercalcemia
thiazide diuretics (hydrochlorithiazide)
how does kidney disease contribute to hypercalcemia
diseased kidneys are unable to excrete excess calcium from the body
how does bone cancer contribute to hypercalcemia
bone breakdown from the metastatic cancer releases calcium to the bloodstream
which two medications can be given to lower calcium levels
phosphorous/phosphate
calcitonin (decreases calcium conc. in blood)
kidney stones AKA
renal calculi
normal range for magnesium
1.3-2.1
main role of magnesium
keeps law and order in the muscles
nerve conduction, muscle contraction/relaxation
magnesium can stimulate the
parathyroid gland to release PTH = regulate calcium
(Mg and Ca work together!)
magnesium regularly resides _____ the cell
inside the cell
magnesium acts like a
sedative
think “calm and sedated”
magnesium and ____ rise and fall together!
magnesium and calcium
malabsorption through ____ or _____ may contribute to hypomagnesemia
celiac disease
crohn’s disease
s/s with hypomagnesemia are mainly
HIGH and NOT SEDATED!
3 main s/s with hypomagnesemia
muscle tetany
positive Trousseau’s
positive Chvostek’s
s/s with hypermagnesemia are mainly
LOW and SEDATED
normal urine output for adults is
at least 0.5 mL/kg/hour
acid-base blood pH range
7.25 - 7.35
when oxygen levels in the blood are low, this is released by the kidneys
erythropoietin
in response to low BP, this is released by the kidneys
renin (begins RAAS)
Sodium think
BRAIN
=sodium imbalances can lead to neuro changes
Potassium think
HEART
=potassium imbalances can cause cardiac dysrhythmias
Calcium think
BONES
=calcium imbalances can lead to an increased risk for pathologic fractures
Magnesium think
CALM and SEDATED
=magnesium acts like a sedative
3 lab assessments related to kidney function
BUN
Cr (creatinine)
GFR
slow, progressive, irreversible decrease in kidney function
chronic kidney disease (CKD)
____ or ____ can maintain life, but neither is a cure for CKD
dialysis or kidney transplantation
2 main risk factors for CKD
diabetes mellitus
HTN
GFR of stage 1 CKD
> 90 mL/min
GFR of stage 2 CKD
60-89 mL/min
GFR of stage 3a CKD
45-59 mL/min
GFR of stage 3b CKD
30-44 mL/min
GFR of stage 4 CKD
15-29 mL/min
GFR of stage 5 CKD
<15 mL/min
dialysis and renal transplant is considered at this stage of CKD
stage 4
edema in CKD is the result of
fluid retention as the kidneys are not filtering fluids
as substances accumulate in the body as a result of CKDm which 3 renal lab findings are expected
^ BUN
^ Creatinine
LOW GFR
3 expected urinalysis findings for someone with CKD
proteinuria
hematuria
WBC’s
HTN in CKD is due to
- sodium retention
- RAAS (low GFR is read as low BP by JG cells, beings RAAS)
2 electrolyte imbalances to watch for in a patient with CKD
hyperkalemia
hyperphosphatemia
in CKD, the loss of erythropoietin results in low Hct and Hgb - this results in
anemia
a patient in this stage of CKD is a candidate for dialysis
stage 5
role of digoxin in treating CKD
increases contractility and promotes cardiac output
role of sodium polystyrene (Kayexalate) in treating CKD
increases elimination of potassium
role of Epoetin alfa in treating CKD
stimulates production of RBC’s
role of ferrous sulfate in treating CKD
iron supplement
role of calcium carbonate in treating CKD
binds phosphate in food and stops its absorption
role of furosemide (loop diuretics) in treating CKD
excrete excess fluids
process where the dialyzer is used to process blood outside the body using a vascular access point
hemodialysis
how often is hemodialysis performed
2-3 times per week
process using the peritoneum to act as a natural filter to cleanse the blood
peritoneal dialysis
prior to hemodialysis, staff should assess fistula or graft for a
thrill/vibration
to assess fluid status of a patient undergoing dialysis, this should be taken
daily weight and vital signs
main concern with peritoneal dialysis
peritonitis - infection of the inside lining of the abdomen
the primary role of the nurse in the care of peritoneal dialysis clients is
facilitator
Foods high in sodium
Anything processed!
Foods high in potassium
“PB BAN”
P: Potatoes
B: Bananas
B: Beans
A: Avocados
N: Nuts
Foods high in calcium
“MILK”
M: Milk
I: Ice cream
L: Leafy greens
K: Kale
Foods high in magnesium
“BAGS”
B: Bananas
A: Avocados
G: Green leafy vegetables
S: Seeds
