Immune Disorders: HIV / AIDS, Autoimmune Transplants Flashcards
risk factors for HIV (5)
- health care workers
- geriatric population (55 - 64 years of age)
- drug abuse (w needles)
- mother to baby
- oral sex on a man or women
what is HIV? (5)
- viruses are intracellular parasites
- retrovirus (brings RNA w it)
- infectious disease
- affects immune system
- belongs to a group of retroviruses (carry own genetic material in RNA)
what does HIV infect? (4)
- target cell - CD4 T lymphocytes
- monocytes
- dendritic cells
- brain microglia
early stages of HIV are known as
HIV
late stages of HIV are known as
AIDS
HIV infects / depletes T helper cells by first ____
attaching to the target cell membrane (T cells)
once HIV attaches & infects the T cells, it ___
infects other cells!!
in order to be diagnosed with HIV, what will a patient need to confirm diagnosis?
2 different positive diagnostic tests
describe the ELISA (enzyme immunoassay) diagnostic test
- what does it test for?
- what does a + test mean?
- how long do antibodies take to show after exposure?
- tests for antibodies
- positive results mean antibodies detected
- antibodies take about 2 weeks to show after exposure
Antigen / Antibody differentiation diagnostic tests
- what does it detect?
- used to confirm a positive result of which other test?
- Detects HIV virus
- Used to confirm ELISA
CD4+ T cell diagnostic test
- what does it count?
- what is it used for?
- Count measures overall immune function
- Used in HIV staging
Viral load diagnostic testing
- what does it measure?
- explain the number meaning
- Measures HIV RNA in blood & helps measure response to treatment
- The lower the viral blood, the longer survival time
HIV stage 0
- Period in which a person becomes infected & when antibodies are made
- Seroconversion (antibodies made)
HIV stage 1
- what is CD4+ count?
greater than or equal to 500 CD4+ T lymphocytes / mm3
HIV stage 2
- what is CD4+ count?
200 - 499 CD4+ T lymphocytes / mm3
HIV stage 3
- what is CD4+ count?
< 200 CD4+ T lymphocytes / mm3
describe early symptoms of HIV
- when do they disappear?
- is the patient highly infectious yet?
- Disappear in a week to month
- Highly infectious during this period (Fever, fatigue, lymphadenopathy)
- High viral load
describe later symptoms of HIV (8)
- lack of energy
- weight loss
- fevers / sweats
- N/V
- headache
- Truncal rash
- ulcers of mouth, genitals, or both
- thrush
how does the CDC define AIDS?
All HIV-infected people w < 200 CD4+ T cells and w one or more AIDS defining illnesses
what are considered AIDS defining illnesses? (4)
- Opportunistic infections
- Cancers
- HIV encephalopathy (AIDS dementia)
- HIV wasting syndrome (unexplained & uncontrollable weight loss, severe diarrhea, & fever)
pneumocystic pneumonia
fever, cough, hypoxia
Myobacterium avium complex
night sweats, weight loss, diarrhea
Tuberculosis
Hemoptysis, night sweats, weight loss
Candidiasis (Thrush)
white oral lesions, coated tongue
prevention of HIV / AIDS (4)
- PrEP (pre-exposure prophylaxis)
- Medicines can work to keep the virus from establishing a permanent infection
- Can help limit spread of virus to partners
- Tenofovir & emtricitabine
treatment of HIV
list adverse effects (4)
- Use combination therapy (ART)
- Helps prevent reproduction of the virus
- adverse effects to all HIV treatment regimens: Hepatotoxicity, nephrotoxicity, osteopenia, & increased risk of CVD & MI
how do antiviral drugs (ART) play a key role in interrupting the HIV process?
inhibiting, reducing, halting
what can lead to increased mortality / morbidity rates for HIV? (4)
- lower socioeconomic status
- lack of access
- limited AIDS experience
- physician w little experience in AIDS care
describe the difference between a long-term non-progressor w HIV & a long-term survivor w HIV
long-term non-progressor: immune system helps HIV stay under control
long-term survivor: progressed to AIDS but haven’t gone any further
nursing interventions for HIV (5) - which is most important?
assess mostly for progression of illness
1. assess for clinical manifestations
2. increase caloric intake & fluids
3. maintain comfort & safety
4. prevent fatigue
5. patient / family education on preventing further infections
describe autoimmune disorders
- what 3 things happen?
Immune system mistakes part of your body, like your joints or skin, as foreign. It releases autoantibodies that attack healthy cells.
1. B cells overproduce
2. systemic inflammation
3. can target 1 organ (DM1) or many organs (Lupus)
risk factors for autoimmune diseases (5)
- women more at risk than men
- hereditary
- diet
- environmental
- viruses
list symptoms of an autoimmune disorder (7)
- fatigue
- achy muscles & joints
- low-grade fever
- trouble concentrating / brain fog
- numbness & tingling in the hands & feet
- hair loss
- skin rashes
what makes it hard to diagnose an autoimmune disorder?
symptoms vary person to person!
describe the Antinuclear antibodies (ANA) lab
- what do they attack?
- how is an autoimmune disease diagnosed w this lab?
autoantibodies that attack structures in the nucleus of cells. Different patterns on the ANA are correlated w different diseases
describe the erythrocyte sedimentation rate (ESR) lab
- what does it detect?
- Detects nonspecific inflammation in your body. An elevated (abnormally high) sed rate doses suggest that there is an ongoing inflammatory process in your body but does not indicate where or why
- Usually first labs seen if a patient is suspected of having an autoimmune disease
VDRL (serum syphilis test)
- what can this diagnose?
- what can cause a false positive result?
- can diagnose an autoimmune disorder
- systemic inflammation may cause a false positive result
kidney biopsy
- what may this show to diagnose an autoimmune disorder?
May show antibody-antigen clumps blocking glomerulus
describe systemic lupus erythematosus (SLE)
- where are antibody-antigen complexes trapped?
- what do antibodies destroy?
Inflammatory autoimmune disease, multiple organ involvement
- Antibody-antigen complexes trapped in capillaries
- Antibodies destroy host cell
manifestations of lupus (7)
- Chronic or acute states (can go back & forth)
- Fever
- Malaise
- Butterfly rash
- Joint & muscle pain
- Pericarditis, CP
- Nephritis
medical management for lupus
- what to prevent?
- when can lupus be life-threatening?
- Prevention or organ damage
- Prevent complications (Renal failure, CVA / MI, pain)
Life threatening in acute stage
drug therapy for lupus (2 types)
- immunosuppression (Corticosteroids & Monoclonal antibodies (MABs) - Belimumab)
- NSAIDS
nursing management of lupus (4)
- emotional support
- avoid sun / UV light
- infection prevention
- diet recommendations (heart healthy, renal diet, low inflammation diet - low in processed foods)
describe Siogren’s syndrome
- Systemic autoimmune disease affecting lacrimal (tear ducts) & salivary glands
- Most common autoimmune disease
manifestations of Siogren’s syndrome (6)
- Dry eyes
- Dry mouth
- Thick mucus
- Difficulty swallowing
- Skin rash
- Raynaud’s phenomenon (at high risk)
how is Siogren’s syndrome diagnosed? (3)
- ocular & gland testing
- symptoms
- lab values: ANA (antinuclear antibody) elevated
medical management / symptom management of siogren’s syndrome (5)
- Mouth wash
- Eye drops
- Encourage fluid hydration
- Avoid alcohol & smoking
- Teach infection prevention
drug therapy used for siogren’s syndrome (2)
- artificial tears
- biotene rinse
nursing management of siogren’s syndrome (2)
- diet changes
- infection prevention
how many types of autoimmune diseases are there?
over 100
name other common types of autoimmune diseases (5)
- Inflammatory bowel disease (IBD)
- Multiple sclerosis (MS)
- Guillain-Barre syndrome
- Scleroderma
- Psoriasis
general treatment for autoimmune diseases (list the 4 drugs, their role, & an example med)
- anti inflammatory drugs - reduce pain & inflammation
Celecoxib (NSAIDS) - corticosteroids - reduce inflammation
prednisone - immune modulators: inhibit immune response
Adalimumab - Immunosuppressant drugs: inhibit immune response
Methotrexate
what is the #1 limitation to transplantation?
expensive cost for procedure plus 5 year post transplantation expenses & shortage of organ donors
what is the most significant limitation to transplantation?
shortage of organ donors
contraindications to transplant (9)
- Active systemic infection
- Malignant disease
- Active peptic ulcer disease (Lots of anti inflammatory meds given during transplant)
- Active abuse of alcohol or other substances
- Severe damage to other organ system
- Severe psychiatric disease (Treatment is so extensive)
- Demonstrated non-compliance
- Lack of support system
- Lack of financial resources
what is the criteria for receiving transplant?
Notify local Organ Procurement Organization (OPO)
- Urgency
- Blood type
- Recipient weight & height
- Stability
donation process for transplants
Documentation of brain death & family consent
“Sustained either irreversible cessation of circulatory & respiratory function or irreversible cessation of all functions of the brain, including the brain stem”
common problems w transplants (5)
- hypotension
- shock
- electrolyte imbalances
- disseminated intravascular coagulation (DIC)
- loss of thermoregulation
ideal transplant donor
brain death (otherwise healthy & infection-free)
what are the two most common types of transplants seen?
liver or kidney
list the time of viability for organ transplant for each of the following organs:
- kidney
- heart
- lung
- liver
- pancreas
- kidney: 48 - 72 hours
- heart: 4-5 hours
- lung: 4-6 hours
- liver: 24-30 hours
- pancreas: 24 hours
post-operative nursing care of transplant recipients (4)
- Recognition of life threatening clinical problems
- Preventing complications
- Promoting return to normal activities
- Recognition of the body’s natural defense system
list & describe the 3 types of rejection (complications of transplant recipients)
- Hyper-acute rejection (immune system attacks immediately)
- Acute rejection (seen 1-3 months after transplant)
- Chronic rejection (seen w medication noncompliance & cumulative damage over years)
signs / symptoms of graft rejection (4)
- fever
- graft tenderness
- fatigue
- abnormal labs
biggest risk factor for infection after a transplant
**Opportunistic infections 1-6 months after **
what is malignancy caused by in post-transplant patients?
caused by immuno-deficient state
what is a patient often screened after transplant?
development of cancer
