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NURS 470 > Hematology Immunology > Flashcards

Hematology Immunology Flashcards

1
Q

immunosenescence

A

process of immune dysfunction that occurs with age

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2
Q

granulocytes

A

eosinophil
basophil
neutrophil

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3
Q

lymphocytes

A

B lymphocyte
T lymphocyte
natural killer cell

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4
Q

B lymphocytes

A

mature in marrow to make antibodies
interact with T helper cells to make specific immunoglobulins on their cellular membrane
signal and respond with cytokines and interleukins

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5
Q

T lymphocytes

A

made in marrow and mature in thymus
cytotoxic t cells: kill viruses, foreign cells or tissues
active in children to learn and kill new exposures
middle life: maintain immunity through memory and controlling cancer cells
elderly: significant decline = more infections and cancer

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6
Q

neutrophils

A

most abundant
first responders
kill and digest bacteria

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7
Q

basophils

A

surveillance, help identify cancer cells
release histamine, cytokines, helps to differentiate lymphocytes and stimulate IgE
associated with allergy response

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8
Q

eosinophils

A

respond and congregate at places of inflammation
allergic responses and parasitic infections

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9
Q

immunoglobulin A

A

mucosa, respiratory and GI tracts, saliva, tears

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10
Q

immunoglobulin G

A

most abundant
found in all body fluids
protects against bacterial and viral infections

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11
Q

immunoglobulin M

A

found in blood and lymph made to fight new infections

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12
Q

immunoglobulin E

A

allergic reactions
found in lungs, skin, mucosa

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13
Q

immunoglobulin D

A

least understood
found in small amounts in blood

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14
Q

type 1 hypersensitivity responses

A

requires repeated exposures
mast cells release mediators: histamine, leukotrines, platelet aggregating factor, prostaglandins, recruit neutrophils and eosinophils

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15
Q

effect of release of histamine

A

capillary dilation (vascular permeability)
bronchoconstriction
mucous secretion

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16
Q

effect of release of leukotrines

A

smooth muscle contraction
vascular permeability
platelet activation

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17
Q

anaphylaxis symptoms

A

systemic response
urticaria, hives
vomiting
bronchoconstriction
edema
hypotension

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18
Q

type 2 hypersensitivity response

A

cytotoxic
transfusion incompatibility, drug induced hemolytic anemia

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19
Q

type 3 hypersensitivity response

A

immune complex mediated
transplant rejection
systemic lupus erythematosus

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20
Q

type 4 hypersensitivity response

A

delayed response of T lymphocytes
graft vs host, rheumatoid arthritis, type 1 diabetes

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21
Q

treatment of hypersensitivity response

A

epinephrine: decrease histamine response
antihistamine 1 and 2 blockers
glucocorticoids: anti-inflammatory and immunosuppressive
beta 2 agonists
T-lymphocyte suppression: chemotherapeutics

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22
Q

NANDAs for hypersensitivity responses

A

fluid volume deficit
decreased cardiac output (anaphylaxis)
impaired gas exchange (asthma)
infection
impaired skin integrity

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23
Q

crohn’s disease

A

occur anywhere in the GI tract
transmural and cobblestone
can greatly affect nutrition
tissue is inflamed
fistulas and infection common
often preceded by a bacterial infection with an overly aggressive T-cell response to enteric bacteria

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24
Q

ulcerative collitis

A

found in large bowel and rectum
can cause significant bleeding and pain
inflammation can cause thickening of the mucosa and absecesses

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25
Q

inflammatory bowel disease priorities of care

A

decrease inflammatory response
infection
blood loss
pain
diarrhea
imbalanced nutrition
fatigue
activity intolerance
social isolation

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26
Q

inflammatory bowel disease nursing care

A

assess abdomen
manage symptoms of disease: volume loss, electrolyte imbalance, pain
administer drugs: immune modulators, 5 aminosalicylate based compounds
nutritional support
education

27
Q

causes of thrombocytopenia

A

decreased production: meds, bone marrow injury, megaloblastic anemia
increased destruction: immune-related
increased utilization: idiopathic thrombocytopenia purpura
distribution problems: splenomegaly

28
Q

assessment of thrombocytopenia

A

bleeding gums
GI bleeds
petechiae or purpura
abnormal vaginal bleeding
epistaxis

29
Q

nursing management of thrombocytopenia

A

BLEEDING PRECAUTIONS
soft toothbrush
electric razor
no contact sports
limit alcohol
no NSAIDs
increase intake of dark leafy vegetables
infuse platelets
fall risk/no skid socks

30
Q

immune mediated heparin induced thrombocytopenia type 1

A

transient decrease in platelets in patients on heparin therapy

31
Q

immune mediated heparin induced thrombocytopenia type 2

A

immune mediated complication of heparin therapy which involves decreased platelets and thrombi formation
onset 5-14 days after initiation of heparin therapy
platelet are 50,000-80,000 or drop 50& from baseline

32
Q

complications of HIT type 2

A

thrombi formation
CVA
MI
arterial occlusion
DIC

33
Q

HIT type 2 treatment

A

stop all heparin and initiate alternative anticoagulation
use direct thrombin inhibitors
lepirudin

34
Q

DIC patho

A

endothelial damage -> microvascular thrombosis
activation of intravascular coagulation -> platelet consumption, coagulation factors consumption, fibrinolysis -> impaired coagulation and bleeding

= multi-organ ischemia or failure

35
Q

DIC symptoms

A

bleeding-related: petechiae, ecchymosis, scleral bleeding, oozing from IV lines/arterial lines, injured tissues & internal bleeding
micro-emboli: ischemia to fingers, toes, nose, ears
thrombus formation: ischemic organs and organ dysfunction
altered LOC, tachycardia, hypotension, dyspnea, tachypnea, cyanosis, hypoxemia, ARDS, kidney injury

36
Q

DIC labs

A

prolonged PT and PTT
increased fibrin degradation and d-dimer
decreased clotting factors, fibrinogen levels, and platelets

37
Q

DIC treatment

A

restore fluid and hemodynamic balance
treat the cause
transfuse platelets, FFPs, RBCs
heparin drip
coagulation inhibitor - antithrombin III

38
Q

rheumatoid arthritis

A

systemic
chronic, symmetrical, erosive inflammation of synovial tissue of joints
progressive joint destruction, deformity, disability

39
Q

rheumatoid arthritis patho

A

immune complexes deposited into synovial membrane that results in the destruction of articular cartilage

40
Q

rheumatoid arthritis treatment

A

decrease pain with NSAIDs or disease modifying drugs (methotrexate, etc)
occupational therapy
physical therapy
ROM, strength, endurance, heat

41
Q

systemic lupus erythematosus (SLE) risk factors

A

15-40 yo
women
black, african american, hispanic/latine, asian american, alaska native, native hawaiian, pacific islander

42
Q

SLE diagnostics

A

nonspecific fluorescent anti-nuclear antibody assay (ANA)
anti Sm antibodies and anti-DNA

43
Q

SLE

A

multisystem inflammatory disorder
widespread damage to connective tissues, blood vessels, & mucous membranes
will affect a major organ

44
Q

SLE patho

A

skin: immune complex deposition, vasculitis
GI: vasculitis leading to mucous membrane ulcers, organ infarction, necrosis
musculoskeletal: increased fibrin deposits at synovial surfaces, inflammation of arterioles, venules, tendon sheaths, muscle fibrosis
pulmonary: pleural inflammation, pulmonary HTN
cardiovascular: vasculitis, inflammation & scarring AV & SA nodes, pericardial sac inflammation
renal: lupus nephritis leading to glomerulonephritis
neuro: peripheral and central neuropathies

45
Q

SLE medical management

A

ASA
NSAIDs
glucocorticoids
hydroxycloroquine
immunosuppressants, methotrexate, azathioprine, mycophenalate
cyclophosphamide used to treat glomerulonephritis
dapsone manages cutaneous effects
IV IgG manages thrombocytopenia

46
Q

SLE nursing management

A

monitor for infection: meds and physiologic
monitor for AKI and CKD
prevent seizures
maintain skin integrity
maintain mobility: PT/OT

47
Q

HIV

A

infects the RNA of the killer T cells, duplicates, and kills the killer T cells -> pt is now vulnerable to infection and cancers
spread through sex, blood, sharing IV needles

48
Q

HIV/AIDS phases of infection

A

primary infection: flu like symptoms
clinical latent infection
early symptomatic HIV infection: large lymph nodes
progression to AIDS

49
Q

HIV pulmonary manifestations

A

pneumonia
TB
fever
cough
SOB
valley fever
fungal infections

50
Q

HIV GI manifestations

A

chronic diarrhea
oral candidiasis
“wasting syndrome”
protein-energy malnutrition
syphilis infections

51
Q

HIV malignancy manifestations

A

non-hodgkin’s lymphoma
Kaposi’s sarcoma
cervical cancer

52
Q

HIV neurological manifestations

A

encephalopathy
meningitis
neuropathies
dementia
HIV-associated neurocognitive disorders (HAND)

53
Q

HIV psychosocial manifestations

A

fear
anxiety
depression
social isolation

54
Q

HIV/AIDS pharm treatment

A

non-nucleoside reverse transcriptase inhibitors (NNRTI)
nucleoside/nucleotide reverse transcriptase inhibitors (NRTI)
protease inhibitors (PI)
entry inhibitors (EI)
antiretroviral agents

55
Q

HIV NANDAs

A

ineffective breathing pattern
impaired gas exchange
infection
altered thought processes
fluid volume deficit
electrolyte imbalance
pain
ineffective coping

56
Q

multiple sclerosis

A

chronic demyelinating neurologic disease
immune mediated demyelination is triggered by viral infection
activate T cells to initiate inflammatory response
macrophages enter brain and cause demyelination and destruction of oligodendrocytes

57
Q

multiple sclerosis symptoms

A

tinnitus, loss of hearing
nystagmus, diplopia, blurred vision
dysarthria, dysphagia
urinary retention, spastic bladder, constipation
weakness may progress to paralysis, muscle spasticity, ataxia, vertigo

58
Q

multiple sclerosis treatment

A

disease modifying treatments: injections, oral meds
slow disease activity by reducing number and severity of flare-ups
steroids for flares

59
Q

multiple sclerosis priorities of nursing care

A

fatigue
impaired physical mobility
impaired urinary and bowel elimination
swallowing
impaired cough reflex
depression/coping/social isolation
OT/PT

60
Q

guillan barre syndrome

A

demyelinating neuropathy
immune mediated response involving IgG attacking the nerve cells of the PNS
triggered by viral or bacterial infection 1-3 weeks prior to onset of sx
may take 2-48 weeks to recover

61
Q

GBS s/s

A

ascending weakness that begins in the lower extremities
diaphragm paralysis
autonomic neuropathy: orthostatic hypotension, HTN, cardiac dysrythmias, paralytic ileus, urinary retention

62
Q

GBS NANDAs

A

ineffective breathing pattern
impaired mobility
altered neurologic function
nutritional deficit
activity intolerance
powerlessness
anxiety
fear

63
Q

GBS priority nursing interventions

A

definitive airway (ETT, vent)
monitor for complications or progression of neuro deficits
passive ROM
plasmapheresis
IVIG
control of BP
pain control
nutrition
emotional support

NURS 470 (28 decks)

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