Heme Flashcards
1
Q
Bone marrow function
A
Produces WBC (T + B cells)
2
Q
Lymphoid Tissues
A
Spleen and Lymph nodes
3
Q
Lymph Nodes
A
stores for white blood cells. They release when your body is getting sick
4
Q
Spleen
A
filters out old and injured RBC
5
Q
Natural/innate immunity
A
Defense against and resistance to infection
Inflammatory response
Physical barriers
o Gastric Acid, skin
Chemical Barriers
Cellular defenses
Immunoregulation
6
Q
Acquired Immunity
A
Learned immunity through exposure of vaccinations
7
Q
Active Acquired Immunity
A
actively gotten the illness and have created your own antibodies. Usually, you have these for a long time.
8
Q
Passive Immunity
A
temporary loan from a source outside of your body. This is an antibody from someone else that helps your body fight short term. It will not make its own antigens
Ex: Breast milk
9
Q
Phagocytic immune response:
A
o Comes through and gobbles up the invaders
o First line defense.
o Phagocytes attack invaders when they are found
o Macrophages and -phils
10
Q
Humoral or ANTIBODY response
A
o B-cells know who to call to fight it
o Second response
o Recognize something you have seen before
o Sees it and responds quickly
o Production of antibodies
11
Q
IgG
A
75%. Most important. Most prevalent. Found in blood and tissue. Activates the compliment system and calls the immune system buddies that it needs help. This is the one that we have seen a genetic deficiency with and it is bad. ENHANCES PHAGOCYTOSIS
12
Q
IgA
A
15%
Found in breast milk, salaiva, tears, and intestinal secretions
13
Q
Cellular response (T-Cells)
A
o Call the T cells to come in and kill it
o Cell mediated immunity
o T-cells come up and attack the invader
o Mature in the THYMUS
o They circulate alone in the blood stream. They look for the invaders and attack the invaders
These do NOT produce antibodies
14
Q
3 responses to invasions
A
Phagocytic immune response
Humoral or antibody immune response
Cellular immune response
15
Q
Bodily Response to Humoral Immunity
A
anaphylaxis
Hay fever
immune complex disease
bacterial and viral infections
16
Q
Bodily Response to Cellular immunity
A
Delayed hypersensitivity
Transplant surgery
graft vs. host disease
Tumor surveillance
17
Q
Fighter T cells (CD4 cells)
A
- Facilitates action of other types of T+B cells
- Simulate immune system
- Release cytokines
- Stimulate the immune system
- These get attacked by HIV
18
Q
CD8 cells
A
Directly attack and destroy the antigen
19
Q
Natural Killer Cells
A
- Destroy infected and stressed cells
- Secrete macrophage/cytokines
- ***This will trigger the inflammatory response!
o This is what gives us our signs and symptoms of infection
20
Q
Cytokines
A
Produced by lymphocytes and mediate reaction between cells
Enhance of phagocyte activity
Regulate lymphocyte and production of function
Triggers inflammatory response
Lymphnodes production
21
Q
Interleukins
A
type of cytokine that activates inflammation
22
Q
Colony Stimulating Factor
A
type of cytokines that turn up production in the bone marrow
23
Q
Interferons
A
Type of cytokine with antiviral properties
24
Q
Monoclonal antibodies
A
Made in lab to stimulate immune system
25
Tumor Necrosis Factor
Type of cytokine that induces endotoxic shock, growth factor for fibroblasts, narcotizes tumor cells
26
Cancer
abnormal cell growth. Cells ignore the growth regulation signals
27
Benign
tumor that is not cancerous
28
Malignant neoplasms
cancer cell growth
29
Tumor
abnormal tissue growth. cancerous or not cancerous
30
Metastasis
Spread of the cancer from the original site to another site
31
Carcinogens
Factors associated with cancer causation
32
Most common forms of cancer
Prostate and Breast because there is not much blood flow to that area
33
Carcinogen Examples
Viruses
Genetics (BRACA 1 and BRACA )
Lifestyle factors
Hormones changing
34
Primary prevention of Cancer
Reduce the risk before getting cancer
Vaccines
Not smoking
not going to a tanning bed
35
Secondary Prevention of Cancer
early detection and screening
Mammogram
going for skin checks
prostate exams
36
Tertiary Prevention of Cancer
After the diagnosis
Prevents some complications
treatment considered therapeutic to eradicate or arrest disease and prevent further complications
37
Oncogenes
Cells change into oncogenes and increase a persons risk of getting cancer
38
G0
Resting phase, no proliferation occurring
39
G1
RNA and protein synthesized
40
S
Synthesis of DNA and proteins of new chromosomes
41
G2
Preparation for cell division
42
M
Actual cell division (mitosis), producing 2 daughter cells
43
Cancer Pathophys
Go through the cell cycle much quicker and are less likely to enter into the G0 phase
44
Helpful tools to Diagnose Cancer
****Tissue biopsy
◦ Cytology results
◦ Lab results (hematological malignancies)
◦ CT, X-rays, MRI
45
Cancer Staging
determines the size, invasion, lymph node involvement, metastasis
46
Cancer Grading
Looking at the cell and determining how different the cells look compared to other cells. Higher the grade, poorer the prognosis
47
Stage 0
in situ: a bump that they can cut out. Very early
48
Stage 1
early invasion. No metastasis, no Lymph nodes involved
49
Stage 2
some spreading of the tumor and a LITTLE bit of lymph involvement (deeper in one spot)
50
Stage 3
Extensive local and lymphnode involvement
51
Stage 4
distant metastasis is the defining characteristic
52
Grade 1-2
well defined and don’t look crazy
53
Grade 3-4
very different than how they should. Poorly differentiated because you might not know where they came from if you didn’t have a comparison.
54
Prophylactic Surgery
preventing the chance (getting a mastectomy before you have the chance to get cancer)
55
Radiation
kills the rapidly dividing cells. It cannot decipher what is a good or bad cell, so it gets all of the rapidly dividing cells
We do these intermittently to catch the cells at different stages of the cells cycle life
56
Cells commonly affected by radiation
Bone marrow
Lymphatic tissue
Epithelium of GI
Hair follicles
Gonads
57
How to know how much radiation
BSA: body surface area when treating
Specific to the type of patient and the size of your patient
Ask patient to keep the same weight so that the chemo works accurately
58
External beam Radiation
source outside of the body. Shot with a laserbeam. Gets a direct hit for local tx. They make an individual garment for you that will allow the laser to target exactly where they need to
All tissue in pathway is affected
People can live their life
59
Internal radiation/Brachytherapy
the use of implants at treatment site. Pt.s have seeds that plug right into the tumor that releases radiation right to the tumor. Sealed source so it does not make the pt. radioactive.
Pt. is able to continue on with life
60
Common Tissues for internal radiation
Lung, thyroid, and prostate. Typically a more fibrous tissue.
61
Radioactive Isotope Radiation
liquid radiation that is injected or swallowed that is considered an UNSEALED source so that you are literally radioactive. Fluid is radioactive. Be careful when taking care of the patient
62
Radioactive Isotope Considerations
Patient is typically in the hospital
Visitors are restricted in visitation because of exposure
We see these in advance cases. This is a systemic treatment. Your entire body is radiating
Body fluid precautions
Itolation precautions
63
External Beam adverse Effects/considerations
burn where the laser is hitting the body at the entrance and the exit
No powder
no soap
no ointments or deodorant or perfumes
no shaving with razorblades
DONT WASH OFF THE MARKINGS
64
Radiation adverse effects
attacks bone marrow
fatigue
GI tract involvement (stomatitis and mucositis)
65
Radiation considerations
Watch CBC, bone marrow suppression, maintain nutrition
66
Antineoplastic Drugs
Work on rapidly dividing cells but they cannot distinguish between the good and the bad ones
67
Principles of Chemo
Disrupts reproduction of cells by altering biochemical processes
Destroys malignant cells without excess destruction of normal cells
Given in repeated doses or cycles
Functional assessment and other clearance tests done before drugs begin
WE want to catch the cells in the different phases that they are dividing
We need cardiac clearance, pulmonary clearance, etc.
68
Goals for Chemo
Cure
Control
Palliative
69
Routes for Chemo
IV, Tompical, Intra-arterial, intracavitary, intraperitoneal, intrachial, IM, SQ, PO
70
Chemo Adverse Effects on Blood
Leukemia
Anemia
Thrombocytopenia
May interrupt treatment schedules if levels are too low and blood needs to catch up
71
Chemo Adverse Effect Mucositis/Stomatitis
Oral, rectal, vaginal
These tissues get irritated and painful
Ulcers in the mouth
Ulcers in rectum or GI tract
Can effect entire GI tract: severe diarrhea
72
Doxorubicin
Cancer drug that is horrible for the heart (only once in a lifetime) and it needs to be preceded by Dexrazoxane to protect the heart
73
Cisplatin
Cytoxan
Horrible for the kidney--we need to rehydrate
74
5-FU (fluorouraci)
horrible chemo med for the liver
75
Nonspecific Biologic Response Modifiers
Stimulate the immune system generally
76
Monoclonal Antibodies
ex. trastuzumab
Destroy specific malignant cells and spare normal cells
77
Gene Therapy
Targeted therapies to make it so you only have a son or so that your daughter wont have the BRACA gene
78
What to watch with Chemo
Precautions r/t neutropenia, anemia, thrombocytopenia
79
What pt. should expect on chemo
fatigue
pain
nausea
(promote bland non-acidic foods)
80
Neutropenia
huge risk for infection
Fever is cardinal symptom!!! (38 is when we start getting worried)
Handwashing is crucial. Don’t touch anything
Staff wears a mask in the room and place on patient when patient is leaving the room
No fresh flowers or fruit or veggies, yogurt with active cultures
81
Med to help with neutropenia
Filgrastim (colony stimulating factor)
we will expect bone pain so give ACETAMINOPHEN
82
Thrombocytopenia
Common with Chemo
WE are looking for bruising or bleeding
WE don’t have many platelets
Don’t use razors or sharp toothbrushes. Avoid IM injections
May require platelet transfusion
83
Risk Factors for HIV
Health care workers
Geriatric population (55-64 years of age)
Drug abuse (with needles)
Mother to baby
84
HIV
retrovirus that attacks:
*Target cell - CD4 T lymphocytes
Monocytes
Dendritic cells
Brain microglia
85
Enzyme Immunoassay (ELISA)
Positive results indicate HIV virus because it tests for positive antibodies but that takes 2+weeks to show up
86
Antigen /Antibody Differentiation Tests
Used to confirm ELISA
Detects HIV virus right away
87
CD4+ T cells
Count measures overall immune function
Used in HIV Staging
88
HIV stage 0
* Period when the person becomes infected and when those antibodies are made
* First two weeks
Highly infectious during this period
* Fever
* Fatigue
* Lymphadenopathy
High viral load
89
HIV Stage 1
greater than 500 CD4 count
90
HIV stage 2
200-499 CD4 count
91
HIV stage 3
less than 200 CD4 count
92
Symptoms of HIV
Lack of energy
Weight loss
Fevers
N/V
Headache
Truncal rash
Ulcers of mouth, genitals, or both
Thrush
93
AIDS
Most advanced stage of HIV infection
94
AIDS Definition
low CD4 count (less than 200) AND an AIDS defining illness
95
AIDS defining illnesses
Pneumocystis Pneumonia
Mycobacterium avium complex
TB
Candidiasis (thrush)
Cancers
HIV encephalopathy
HIV wasting syndrome
96
Medical Prevention of PrEP
pre-exposure prophylaxis
Limits spread
Ex. Tenofovir and emtricitabine
97
Medical treatment of HIV
Mutates really rapidly so we have to use multiple drugs at the same time to combat the virus
98
ART
Antiretroviral therapy: treats HIV
99
HIV therapy adverse effect
Hepatotoxicity, nephrotoxicity, osteopenia, and increased risk of CVD and MI
100
Long term non-progressor
Person doing well and keeping the HIV under control
101
Long-term survivor
progressed to AIDS but they have not gone further than that
102
Nursing intervention for HIV
Only thing we can do is try to not let them progress
Increase caloric intake and fluids
Maintain comfort and safety
Prevent fatigue
Patient/family education on preventing further infections
103
Autoimmune Disorders
Immune system mistakes part of your body, like your joints or skin, as foreign. It releases
autoantibodies that attack healthy cells
104
Autoimmune Disorders Pathophys
B cells overproduce
◦ Systemic inflammation
◦ Can target 1 organ (DM1) or many organs (Lupus
105
Symptoms of Autoimmune Disorders
fatigue
◦ achy muscles & joints
◦ low-grade fever
◦ trouble concentrating/ brain fog
◦ numbness and tingling in the hands and feet
◦ hair loss
◦ skin rashes
106
Antinuclear antibodies
Lab testing autoantibodies that attack structures in the nucleus of cells. Different patterns
on the ANA are correlated with different disease
107
Erythrocyte sedimentation rate (ESR)
detects nonspecific inflammation in your body. An elevated (abnormally high) sed rate does suggest that
there is an ongoing inflammatory process in your body but does not indicate where or why
108
VDRL (Serum Syphilis test)
Systemic inflammation may cause false positive resu
109
Kidney Biopsy
May show antibody-antigen clumps blocking glomerulu
110
Lupus
Inflammatory autoimmune disease, multiple organ involvement
◦ Antibody-Antigen complexes trapped in capillaries
◦ Antibodies destroy host cell
111
Manifestations of Lupus
Chronic or acute states
◦ Fever
◦ Malaise
◦ Butterfly rash
◦ Joint & muscle pain
◦ Pericarditis, CP
◦ Nephritis
112
Medical Management of Lupus
Prevention of organ damage
◦ Prevent complications
◦ Renal failure
◦ CVA /MI
◦ Pain
◦ Life threatening in Acute stage
113
Drugs for Lupus
Immunosuppression
Corticosteroids
◦ Monoclonal Antibodies (MABs)
◦ Belimumab
◦ NSAIDS
114
Nursing Management for Lupus
Avoid sunlight
Infection prevention
Diet Restrictions
115
Sjogren’s Syndrome
Systemic autoimmune disease affecting lacrimal and salivary glands
116
Manifestations of Sjigren's Syndrome
Dry eyes
◦ Dry mouth
◦ Thick mucus
◦ Difficulty swallowing
◦ Skin rash
◦ Raynaud’s phenomenon
117
Drug Therapy for Sjigrens
Artificial tears
Biotene rinse
118
Diagnosis of Sjigrens
Ocular tests
Elevated ANA
119
General treatments for Autoimmune disorders
- Celecoxib
- Prednisone
- Adalimumab
- Methotrexate
120
Transplant Contraindications
Active systemic infection
Malignant disease
Active peptic ulcer disease
Active abuse of alcohol or other substances
Severe damage to other organ system
Severe psychiatric disease
Demonstrated non-compliance
Lack of support system
Lack of financial resources
121
Common problems with braindead people that we need to watch for in order to keep their organs verifiable
Hypotension
Shock
Electrolyte imbalances
Disseminated intravascular coagulation (DIC)
Loss of thermoregulation
122
Organ Viability (time per organ)
- Kidney 42-72 hours
- Heart: 4-5 hours
- Lung: 4-6 hours
123
Immunosuppressants used in transplant patients
Tacrolimus, Mycophenolate, and prednisone
124
Hyper acute rejection
right when they put the organ in the body the immune system attacks immediately
125
Acute rejection
1-3 months after the transplant the body rejects it
126
Chronic rejection
results from medication non-compliance. Cumulative damage over years
127
Signs/symptoms of rejection
o Fever
o Tenderness at graft site
o Fatigue
o Abnormal labs
128
Malignancy in Transplants
o Caused by the immune-deficient state
o We see a lot of blood cancers with transplants
