immune (class 5) Flashcards
external factors of immune system and aging
nutritional status, chemical exposure, UV radiation, and environmenal pollution
internal factors of immune system and aging
genetics, functioning of neurological and endocrine systems, chronic illnessess, variations on our anatomy and physiology
HIV (human immunodeficiency virus)
progresses to AIDS, final stage of HIV. retrovirus, spread by direct contact with infected blood and body fluids (blood semen, vaginal secretions, cerebrospinal fluid)
behavioral risk factors unprotected anal intercourse, heterosexual intercourse, injection drug use, needle and paraphemalia sharing, small occupational risk of health care providers.
manifestations of HIV
may be overlooked by HCP, asymptomatic to sever immunodeficiency, fever, sore throat, malaise, arthralgias and myalgias, headache, rash.
manifestations of aids
HIV progresses to aids: CD4-T cell count < 200 mcL, general malaise, fever, fatigue, night sweats, involuntary weight loss, skin dryness, rashes, diarrhea, oral lesions, candidiasis, gingival inflammation and ulcerations
HIV neurological effects
inflammatory, demyelinating, degenerative changes. HIV-associated neurocognitive disorders: complext neurologic manifestations of HIV, motor function and cognitive function affected.
HIV associated dementia: late comlication of HIV, fluctuating memory loss, confusion, apathy, diminished motor speed, lethargy, difficulty concentrating.
opportunistic infections associated with HIV
pneumocystis pneumonia: most common. tuberculosis: reactivation of prior infection, leading cause of death among those with HIV.
Other infections: toxoplasma gondii, cryptococcus neoformans, candida albicans.
secondary cancers to HIV
kaposi sarcoma (KS): seen in fewer than 1% due to antiretroviral therapy, herpes virus transmitted through sexual contact, vascular macules, papules, or violet lesions.
Lymphomas: malignancies of lymphoid tissue, late manifestations of HIV.
Cervical cancer: frequently develops in women with HIV, pap smear every 6 months.
other conditions
cardiovascular complications: coronary heart disease, dyslipidemia.
Hepatic complications: 90% of patients with HIV are also infected with HBV, ART may have negative effects on liver.
HIV-associated nephropathy: disproportionately affects african americans and hispanics/latinos. excessive protein in urine, nitrogen in blood. glomerular lesions.
diagnosis of HIV
HIV rapid antibody test.
enzyme-linked immunosorbent assay (ELISA), western blot antibody testing, HIV viral load testing, absolute CD4 lymphocyte count, HIV drug-resistance testing.
medications for treatment of HIV: antiretroviral therapy (ART)
expensive: wholesale 1931-3057 for a 30-day supply.
goals: suppress infection, prophylaxis of opportunistic infections and decrease symptoms.
medications for HIV: nucleoside reverse transcriptase inhibitors (NRTI)
mainstay of ART, inhibits action of viral reverse transcriptase, acts as chemical decoy: prevting RNA from being copied to DNA. nursing: allergic reaction, nausea, headache, peripheral neuropathy, anemia, neutropenia, assess CBC/chemistry for liver and pancreas involvemnet.
medications HIV: proease inhibitor
block function of protease. combined with other drugs; may be effective in eliminating virus. nursing: assess for liver & cardiovascular disease and diabetes, lipodystrophy, creatine clearance and flank pain, nausea, intestinal distress, headache, peripheral neuropathy common
medications HIV:nonnucleoside reverse transciptase inhibitors (NNRTI)
high incidence of cross-resistence to NRTI’s only one used at a time, risk for liver toxicity.
nursing: assess for hx liver disease, PO, assess for skin rash, kidney infection, anemia, and liver function
medications HIV: entry inhibitors
prevention of viral entry to host cells. injection 2x daily: expensive, candidate if resistant to ART.
Nursing: respiratory infection risk, cough, fever, URI, abdominal pain, dizzy, rash.
Medication HIV: HIV integrase strand transfer inhibitor
targets enzyme that integrates viral genetic material into human DNA. approved for patients resistant to ART.
Nursing: nausea, diarrhea, and headache.
leukemia
ratio of red to white blood cells is reversed: normal ration is 1 wcb for every 600-700 RBC.
Myeloblasts
granular leukocytes, neutrophils- most numerous, phagocytes, first to arrive at injured tissue.
eosinophils- allergic response and parasitc infection.
basophils- inflammatory response (histamine release)
monoblasts
monocytes- phagocytic cells, dispose of foreign and waste material.
macrophages- phagocytic cells, dispose of foreign and waste material.
lymphoblasts
lymphocytes-smallest WBC, important piece of immune syster.
B-cells- humoral response and antibody production
T-cells- part of cell mediated immune response.
leukemia pathophysiology
leukemia begins with malignant transformation of a single stem cell that multiplies slowly and differentiates abnormally.
cells do not function as mature WBCs and are ineffetive in the inflammatory and immune responses. leukemia results in sever anemia, infection, and bleeding.
FATAL without treatment
manifestations of leukemia
anemia: pallor, fatigue, tachycardia, malaise, lethargy, & dyspnea on exertion.
infection: fever, night sweats, oral ulcerations, and frequent or recurren respiratory, urinary, integumentary, and other infections.
bleeding: bruising, peechiae, bleeding gums, and bleeding within specific organs or tissues.
acute lymphoblastic leukemia (ALL)
malignant transformation of B cells, rapid onset, most common in children/young aduls.
chronic lymphocytic leukemia (CLL)
proliferation/accumulation of small abnormal mature lymphocytes in bone marrow, peripheral blood, body tissue.
acute myeloid (myeloblastic) leukemia (AML)
uncontrolled proliferation of myeloblasts and hyperplasia of bone marrow/spleen.
chronic myeloid leukemia (CML)
abnormal proliferation of all bone marrow elements
incidence & risk factors leukemia
diagnosed 10x more in adults than children. highest in US, canada, sweden, new zealand. men more.
RISK FACTORS: cigarette smoking, chemicals such as benzene, exposure to ionizing radiation.
CBC with differential
evaluates cell counts, hemoglobin and hematocrit levels, and the number, distribution, and morphology (size and shape) or WBC’s.
platelets
identifies thrombocytopenia secondary to leukemia and the risk of bleeding.
bone marrow examination
provides information about cells within the marrow, type of erythropoiesis, and maturity or erythropoietic and leukopoietic cells.
treatment & therapy:
chemotherapy: single or combination chemo.
Radiation therapy: damages cellular DNA so that cell cannot divide, multiply.
bone marrow transplant (BMT): often used in conjunction with or following chemotherapy or radiation, allogenic or autologous.
Hodgkin disease-
reed-sternberg cells; most curable cancer
Non-hodgkin lymphoma
T-cells, B-cells, or macrophages, more common than hodgkin disease.
hodgkin lymphome manifestations
painlessly enlarged lymph nodes in cervical or subclavicular region, persistent fever, night sweats, fatigue, malaise, weight loss, pruritus, anemia, enlarged spleen.
non-hodgkin lymphoma manifestations
painless lymphadenopathy localized or widespread, persistent fever, night sweats, fatigue, malaise, weight loss, abnormal pain, nausea, vomitting, headaches, altered mental status, seizures.
hodgkins disease pathophysiology
hodgkin lymphoma: develops in a single lymph node or chain of nodes, spreads to adjoining cells, reed-steinberg cells, immune system impairment, etiology unknown, contributing factors: epstein-barr virus, genetic factors
non-hodgkin lymphoma pathophysiology
does not contain reed-steinberg cells. etiology unknown, viral infections can play a role, EBV and HIV, genetics,
course of lymphoma
stage I: involvement of a single lymph node region or lymphoid structure.
stage II: involvement of 2 or more lymph node regions on the same side of the diaphragm.
stage III: involvement of lymph node regions or structures on both sides of the diaphragm.
stage IV: involvement of an extranodal site.
lymphoma treatment
chemotherapy: followed by radiation therapy. choice of drug combination depends on patients age, stage of disease.
immunotherapy: rituximab, alone or with cyclophosphamide, vincristine, and prednisone.
radiation therapy: may be primary treatment for early stage hodgkin..
stem cell transplant: autologous peripheral blood stem cell transplant (PBSCT)
complications of treatment: permanent sterility, secondary cancer is a late adverse effect.
multiple myeloma
malignancy: plasma cells multiply uncontrollably.
multiple myeloma pathophysiolgy
cells infiltrate bone marrow, lymph nodes, and spleen. affected bones are weakened, pathologic fractures
multiple myeloma incidence & risk factors
affects african americans nearly twice as often as caucasion americs, men more than women.
unknown cause.
multiple myeloma manifestations
bone pain, rapid bone destruction, hypercalcemia, manifestations of neurologic dysfunction, recurrent infections, renal failure- bence jones protein, pancytopenia
diagnosis multiple myeloma
c-ray reveal punched out lesions in bone.
bone marrow exam: increase immature plasma cells.
CBC: anemia with increase ESR
protein electrophoresis: increase IgG antibody
serum calcium, creatine, uric acid, and BUN levels: all elevated.
urinalysis: bence jones protein
staging multiple myeloma
based on hemoglobin, serum calcium levels, amount of abnormal protein present, and degree of bone involvement
multiple myeloma treatment
no cure. induction chemotherapy stem cell transplant maintenance chemotherapy combination chemotherapy localized radiation therapy plasma exchange therapy
