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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
inflammatory bowel disease priorities of care
decrease inflammatory response infection blood loss pain diarrhea imbalanced nutrition fatigue activity intolerance social isolation
26
inflammatory bowel disease nursing care
assess abdomen manage symptoms of disease: volume loss, electrolyte imbalance, pain administer drugs: immune modulators, 5 aminosalicylate based compounds nutritional support education
27
causes of thrombocytopenia
decreased production: meds, bone marrow injury, megaloblastic anemia increased destruction: immune-related increased utilization: idiopathic thrombocytopenia purpura distribution problems: splenomegaly
28
assessment of thrombocytopenia
bleeding gums GI bleeds petechiae or purpura abnormal vaginal bleeding epistaxis
29
nursing management of thrombocytopenia
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
immune mediated heparin induced thrombocytopenia type 1
transient decrease in platelets in patients on heparin therapy
31
immune mediated heparin induced thrombocytopenia type 2
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
complications of HIT type 2
thrombi formation CVA MI arterial occlusion DIC
33
HIT type 2 treatment
stop all heparin and initiate alternative anticoagulation use direct thrombin inhibitors lepirudin
34
DIC patho
endothelial damage -> microvascular thrombosis activation of intravascular coagulation -> platelet consumption, coagulation factors consumption, fibrinolysis -> impaired coagulation and bleeding = multi-organ ischemia or failure
35
DIC symptoms
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
DIC labs
prolonged PT and PTT increased fibrin degradation and d-dimer decreased clotting factors, fibrinogen levels, and platelets
37
DIC treatment
restore fluid and hemodynamic balance treat the cause transfuse platelets, FFPs, RBCs heparin drip coagulation inhibitor - antithrombin III
38
rheumatoid arthritis
systemic chronic, symmetrical, erosive inflammation of synovial tissue of joints progressive joint destruction, deformity, disability
39
rheumatoid arthritis patho
immune complexes deposited into synovial membrane that results in the destruction of articular cartilage
40
rheumatoid arthritis treatment
decrease pain with NSAIDs or disease modifying drugs (methotrexate, etc) occupational therapy physical therapy ROM, strength, endurance, heat
41
systemic lupus erythematosus (SLE) risk factors
15-40 yo women black, african american, hispanic/latine, asian american, alaska native, native hawaiian, pacific islander
42
SLE diagnostics
nonspecific fluorescent anti-nuclear antibody assay (ANA) anti Sm antibodies and anti-DNA
43
SLE
multisystem inflammatory disorder widespread damage to connective tissues, blood vessels, & mucous membranes will affect a major organ
44
SLE patho
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
SLE medical management
ASA NSAIDs glucocorticoids hydroxycloroquine immunosuppressants, methotrexate, azathioprine, mycophenalate cyclophosphamide used to treat glomerulonephritis dapsone manages cutaneous effects IV IgG manages thrombocytopenia
46
SLE nursing management
monitor for infection: meds and physiologic monitor for AKI and CKD prevent seizures maintain skin integrity maintain mobility: PT/OT
47
HIV
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
HIV/AIDS phases of infection
primary infection: flu like symptoms clinical latent infection early symptomatic HIV infection: large lymph nodes progression to AIDS
49
HIV pulmonary manifestations
pneumonia TB fever cough SOB valley fever fungal infections
50
HIV GI manifestations
chronic diarrhea oral candidiasis "wasting syndrome" protein-energy malnutrition syphilis infections
51
HIV malignancy manifestations
non-hodgkin's lymphoma Kaposi's sarcoma cervical cancer
52
HIV neurological manifestations
encephalopathy meningitis neuropathies dementia HIV-associated neurocognitive disorders (HAND)
53
HIV psychosocial manifestations
fear anxiety depression social isolation
54
HIV/AIDS pharm treatment
non-nucleoside reverse transcriptase inhibitors (NNRTI) nucleoside/nucleotide reverse transcriptase inhibitors (NRTI) protease inhibitors (PI) entry inhibitors (EI) antiretroviral agents
55
HIV NANDAs
ineffective breathing pattern impaired gas exchange infection altered thought processes fluid volume deficit electrolyte imbalance pain ineffective coping
56
multiple sclerosis
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
multiple sclerosis symptoms
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
multiple sclerosis treatment
disease modifying treatments: injections, oral meds slow disease activity by reducing number and severity of flare-ups steroids for flares
59
multiple sclerosis priorities of nursing care
fatigue impaired physical mobility impaired urinary and bowel elimination swallowing impaired cough reflex depression/coping/social isolation OT/PT
60
guillan barre syndrome
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
GBS s/s
ascending weakness that begins in the lower extremities diaphragm paralysis autonomic neuropathy: orthostatic hypotension, HTN, cardiac dysrythmias, paralytic ileus, urinary retention
62
GBS NANDAs
ineffective breathing pattern impaired mobility altered neurologic function nutritional deficit activity intolerance powerlessness anxiety fear
63
GBS priority nursing interventions
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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