Immune Flashcards

Question

What are S/S of B-cell lymphoma or Hodgkin, Non-Hodgkin lymphoma? What does it typically indicate?

Answer 1

Weight loss, night sweats, fever Poor prognosis due to severe suppression of immune system, and now the need for chemotherapy

Answer 2

Progressive cognitive, behavioral, and motor function decline Probably directly related to the HIV infection HIV triggers release of toxins/lymphokines that result in cellular dysfunction, inflammation, and neurotransmitter interference Maintain client safety and initiate seizure precautions

Answer 3

Fungal infection that causes fever, headache, malaise, stiff neck, N/V, mental status changes, seizures by invading the brain tissue

Answer 4

IgE antibody action and a genetic predisposition atopic dermatitis, asthma, allergic rhinitis)

Answer 5

WBC Usually normal except with infection or inflammation Eosinophil count Elevated with an allergic reaction (bee sting, spider bite, etc.) IgE level High levels support a diagnosis of allergic disease Serum-specific IgE Test ( radioallergosorbent test- RAST) Takes blood of client to test if IgE is present to a specific allergen Skin tests (intradermal or scratch) Considered most accurate confirmation of allergy Emergency equipment must be readily available to treat anaphylaxis!!! Stop all antihistamines/corticosteroids 48 hrs. to 2 weeks prior to the test

Answer 6

Oxygen: if respiratory assistance needed due to shortness of breath or hypoxemia Epinephrine IM: for anaphylactic reactions such as swelling, wheezing, hypotension, vomiting combined with an urticarial rash Antihistamines: for urticarial rash or itching by blocking histamine effect Corticosteroids: to help reduce systemic inflammation in anaphylaxis *Adjunct therapy of antihistamines and corticosteroids are not in place of epinephrine*

Answer 7

Will reduce airway swelling and wheezing plus increase blood pressure

Answer 8

Seafood Peanuts and tree nuts Seeds Berries Eggs Wheat Milk Chocolate

Answer 9

Inflammation (redness, swelling and tenderness) Autoimmunity Degeneration and destruction of joints They primarily affect the joints (monoarticular or polyarticular), but also muscles, bone, ligament, tendons, and cartilage, sometime organs

Answer 10

Elevated serum rheumatoid factor (RF) Elevated ESR or CRP inflammatory markers Severity of disease varies Bilateral and symmetric Joint pain, redness, swelling and warmth to joints (inflamed) Joint stiffness, especially in the morning Lack of function gradually develops from deformities Deformities of hands and feet (late manifestation) Joints are “spongy” on palpation (filled with fluid) Typically, begins in small joints of hands and feet

Answer 11

Fever Weight loss Fatigue Anemia Lymph node enlargement Raynaud phenomenon of digits Chest pain from pleuritis or pericarditis Chest pain from angina (increased risk of CAD) Rheumatoid nodules Sjogren syndrome (10-15 % of clients with RA have Sjogren syndrome): Dry eyes and dry mucous membranes such as mouth, skin, and vagina

Answer 12

Rheumatoid factor (RF) antibody Diagnostic level is 1:40 to 1:60 (normal <1:20) High titers correlated with severe disease Other autoimmune diseases can have increased levels (creating diagnostic confusion) Erythrocyte sedimentation rate (ESR) Elevated ESR is associated with inflammation or infection >70 indicates severe inflammation C-reactive protein (CRP) May be done in place of ESR, or often both are prescribed Used to diagnose, monitor, or assess medication effectiveness >1.0 mg/dL indicates inflammation

Answer 13

NSAIDS DMARDS (disease modifying antirheumatic drugs, biologic vs non-biologic) Corticosteroids X-rays to determine the degree of join destruction Reconstructive surgery Arthroplasty such as hip, knee, shoulder replacements

Answer 14

Assist with and encourage physical activity Balance of rest and exercise Teach the client to monitor skin closely Provide referrals for OT and PT to maintain maximal function and ADLs Facilitate use of assistive devices Monitor for medication effectiveness Nutrition therapy High in vitamins, protein, and iron in mall, frequent meals Apply heat/cold to affected areas Balance rest/exercise Follow routine health screenings Report manifestations that can indicate RA exacerbation: fever, infection, pain upon inspiration, chest pain Express feelings regarding body image Use nonpharmacologic pain relief: hypnosis, acupuncture, imagery, music therapy, spiritual practices

Answer 15

methotrexate Bone marrow suppression Ulcerative stomatitis Liver toxicity Pregnancy category X 6 weeks for therapeutic effects Etanercept- similar: infliximab Given only by injection (subcutaneous or IV infusion) Can cause severe immunosuppression exposing client to cancer and infection Stevens-Johnson syndrome rashes can occur Avoid live vaccines due to immunosuppressed state TB skin test needed prior to many biologic agents

Answer 16

Exaggerated production of autoantibodies that attack many sites in the body. Varies in severity and progression Periods of exacerbations and remissions throughout life Genetic factors, increased risk if a parent or sibling has disease Immunologic factor Hormonal factor Environmental factor Exposure to medications can cause a flare-up of the disease Sulfa drugs, penicillin, or antibiotic drugs women African Americans

Answer 17

Systemic symptoms: Fever, fatigue, anemia, lymph node enlargement, Raynaud phenomenon, malaise, weight loss, anorexia Musculoskeletal symptoms: Joint swelling, tenderness, pain on movement, arthritis Skin manifestations: Butterfly-shaped rash across nose and cheeks Pericarditis:- most common cardiac condition. Also increased heart disease Renal involvement: Nephritis due to buildup of antibodies and immune complexes that damage nephrons, which can progress to renal failure CNS involvement: Psychosis, cognitive impairment, seizures, neuropathies, strokes

Answer 18

Antinuclear antibodies (positive in 95% of cases) ESR and CRP elevated Pancytopenia Anemia Thrombocytopenia Leukopenia

Answer 19

NSAIDs: reduce inflammation (Can worsen renal disease, HTN, HF, PUD, and fluid retention) Corticosteroids: used for flare-ups of SLE, usually short-term due to side-effects Monoclonal antibodies (belimumab/Benlysta): DMARD to suppress immune system Antimalarials (hydroxychloroquine): DMARD, remember eye check-ups annually Methotrexate: DMARD, suppresses immune system, monitor for fevers/infections, petechiae (low platelets), and signs of anemia (know the symptoms of bone marrow suppression which involves 3 cell lines)

Answer 20

Teach to avoid cold for hands/toes Pain management (pharmacologic and nonpharmacologic) Protect from sun exposure- sunscreen and protective hats/clothing Use mild protein shampoo and avoid harsh hair treatments Impaired skin integrity Use steroid creams for rash Cleanse skin with mild soap and inspect skin daily Apply lotion to dry skin Avoid powders, alcohol, or anything drying Pat skin dry rather than rubbing Report evidence of infection, peripheral edema, or periorbital edema immediately

Answer 21

Most common joint disorder Not considered an inflammatory arthritis Incidence increases with age (can affect any age) Not from autoimmunity of inflammation Limited to affected joint, no systemic symptoms By age 40, 90% of adults have some degenerative joint changes 85% of people over 65 years of age has radiographic changes indicating OA Articular cartilage breaks down leading to progressive damage of the bone Joint space narrows, develops bone spurs (osteophytes) Not considered a "normal part of aging" but aging is the biggest risk factor

Answer 22

Goals are to decrease pain and stiffness and maintain/improve joint mobility Acetaminophen is first line due to safety profile NSAIDs Corticosteroid injections Topical analgesics such as diclofenac gel Weight reduction Exercise (cardio and strength training) Orthotic devices (splints, braces, canes, walkers) Massage, yoga, acupuncture, TENS (research under way to determine effectiveness) OT and PT Surgery (osteotomy and arthroplasty)

Answer 23

The most common intermittent inflammatory arthritis Uric acid results from the breakdown of nucleic acids in cells (so think of which foods worsen condition) Hyperuricemia occurs (increased serum uric acid) causing uric acid crystals to deposit in joints and body tissues Risk factors Age Males are mainly affected until women reach menopause (estrogen was protective against gout before menopause) High BMI Postmenopausal women and adult males of any age Genetic predisposition High intake of purine rich foods (shellfish, organ meats) Alcohol ingestion Some chemotherapy agents since they destroy cells, and release nucleic acids Chronic renal failure, diabetes, hypertension and heart disease Medications such as hydrochlorothiazide diuretics

Answer 24

Acute inflammatory arthritis from uric acid crystals in joint Severe pain, redness, warmth, and swelling of the affected joint Most common in big toe joint, but also includes foot, ankle, knee Attacks can come suddenly, often at night Very painful when the swollen joint is touched or moved Appearance of tophi in soft tissues with chronic gout Most attacks will subside over 3-10 days with treatment Attacks come and go but result in gradual joint damage

Answer 25

NSAIDs: First-line therapy for acute attack Monitor for side-effects (renal injury, hypertension, edema, PUD, bleeding) Colchicine: Acute attack, when NSAIDs are not effective Decreases inflammation Explosive diarrhea limits use Corticosteroids: Oral prednisone or dexamethasone for acute attacks Not first-line due to assorted list of side-effects (important to know)

Answer 26

allopurinol Reduces uric acid production resulting in lower serum levels Side effects are rare, but can cause Stevens-Johnson syndrome and possible bone marrow suppression Renal toxicity (drink 2 L fluids a day), so maintain hydration Monitor uric acid levels Clients often take for life to reduce the acute attacks of gout Can also help reduce kidney stones if caused by uric acid stones

Answer 27

Restrict foods high in purines Organ meats (liver, kidneys), beer, sardines, shellfish, mushrooms, asparagus, gravy Limit intake of ETOH Avoid starvation diets, aspirin, and diuretics Limit physical or emotional stress Increase fluid intake Maintain normal body weight

Answer 28

Chronic pain syndrome Chronic fatigue- #1 problem and concern Generalized, widespread, bilateral musculoskeletal pain or tenderness Stiffness to muscles and joints Sleep disturbances Amplification of pain signals Predisposing factors to increased pain: anxiety, depression, physical trauma, emotional stress, insomnia, and viral infection

Answer 29

Medical Management NSAIDs Antidepressants (can help improve pain) Anticonvulsants such as pregabalin or gabapentin Treat insomnia with tricyclic antidepressant (amitriptyline) or trazadone Exercise, PT/OT Nursing Management Assess/monitor pain, mobility, and fatigue Support and encouragement Clients typically have had symptoms for extensive period and may feel that their symptoms have not been taken seriously Limit intake of caffeine, alcohol, and other substances that interfere with sleep Develop a sleep routine Engage in low-impact exercise daily Acupuncture, stress, management, tai chi, hypnosis can also be used

Answer 30

causative organism reservoir (a location that provides growth/survival of the organism) portal/mode of exit from the reservoir mode of transmission to host susceptible host portal/mode of entry

Answer 31

hand hygiene gloves proper handling of client equipment and linens environmental control prevention from sharps injuries

Answer 32

negative air pressure room private room keep door closed N-95 measles varicella herpes zoster TB My chicken has TB

Answer 33

standard plus face mask within 3-6 feet influenza menigitis mumps pertusis

Answer 34

standard plus private room gowns masks not needed, but you probably will want one C Diff MRSA

Answer 35

Easily colonizes on skin Individual serves as a reservoir for MRSA transmission to others Infection can spread to wounds or immunocompromised clients Treated with mupirocin ointment if not extensive or IV vancomycin if severe or systemic Admission screenings Contact isolation Clients regularly bathed with chlorhexidine gluconate solution to decrease microbial count on skin VRSA Vancomycin-resistant staphylococcus aureus With control of MRSA, the emergence of VRSA strains should decrease

Answer 36

VRE Normally found in the GI tract Admission screenings done Survives well on skin/hands and environmental objects 2nd most common source of HAIs in US Contact isolation

Answer 37

central line associated stream infection Femoral site aseptic dressing changes Aseptic caps on ports- port cleaning is essential prior to access! Clean with friction Bundles on temporary non-tunneled central lines Change clear dressings every 7 days

Answer 38

Decrease use of catheters Assess need daily No dependent loops in tubing Urometer must be kept off the floor Securement of device to avoid traction Peri care with soap and water at least twice daily

Answer 39

ventilator associated pneumonia HOB at 30 degrees Extubate as soon as possible Daily assessments to potentially extubate Oral care every two hours with chlorhexidine Endotracheal suctioning as needed (not every 2 hour if not needed)

Answer 40

12-15 months of age Repeat dosing at 4-6 years of age

Answer 41

pregnant and immunocompromised it's a live vaccine 60+ years

Answer 42

found in poultry, beef, pork diarrhea usually resolves, if severe ciprofloxacin cook and store meat appropriately separate kitchen supplies used to prepare meat Guillain-Barre

Answer 43

chicken eggs sprouts, fruits and vegetables

Answer 44

Most common aerobic organism colonizing the large bowel Part of normal flora Some strains of E. coli lead to severe diarrhea and rapid dehydration Ingestion of undercooked beef and vegetables that have been contaminated by animal wastewater Cook beef thoroughly until the juices run clear Bacterium lives in the intestines of cattle and can be introduced into the meat during slaughter May result in hemolytic uremic syndrome (HUS) form E.coli toxin

Answer 45

protozoa through contaminated food and drink, fecal-oral abd. pain, nausea, diarrhea, fever

Answer 46

Mild dehydration: 50 mL of oral rehydration salts (ORS) per 1kg of weight over 4 hours Moderate dehydration 100 mL/kg of ORS over 4 hours Severe dehydration IV replacement until hemodynamic and mental status return to normal Avoid anti-diarrheal medications for infectious diarrhea Bacteremia, hypovolemic shock/sepsis

Answer 47

Mild fever Rash Headache Conjunctivitis Joint/muscle pain Microcephaly and congenital abnormalities in infants of some women infected with Zika during pregnancy Guillain-Barre syndrome not traveling in endemic areas safe sex/abstinence with partners who have traveled

Answer 48

Usually a mild presentation HA Fever Persistent fatigue Caused by a mosquito bite Birds are the natural reservoir for the virus

Answer 49

Spread through direct contact with blood or body fluid, handling bats or wild animals hunted for food S/S High fever Muscle aches Fatigue Severe diarrhea Abdominal pain Vomiting 5% develop bleeding or hemorrhage Severe dehydration can lead to hemodynamic shock

Answer 50

Multisystem illness Includes pneumonia and respiratory symptoms Found in water sources man-made and naturally occurring Incidence increases during Summer and Fall months and growth occurs in plumbing systems Treated with antibiotics