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Adults Exam 4 > Immune Disorders: HIV / AIDS, Autoimmune Transplants > Flashcards

Immune Disorders: HIV / AIDS, Autoimmune Transplants Flashcards

1
Q

risk factors for HIV (5)

A
  1. health care workers
  2. geriatric population (55 - 64 years of age)
  3. drug abuse (w needles)
  4. mother to baby
  5. oral sex on a man or women
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2
Q

what is HIV? (5)

A
  • 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)
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3
Q

what does HIV infect? (4)

A
  • target cell - CD4 T lymphocytes
  • monocytes
  • dendritic cells
  • brain microglia
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4
Q

early stages of HIV are known as

A

HIV

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5
Q

late stages of HIV are known as

A

AIDS

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6
Q

HIV infects / depletes T helper cells by first ____

A

attaching to the target cell membrane (T cells)

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7
Q

once HIV attaches & infects the T cells, it ___

A

infects other cells!!

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8
Q

in order to be diagnosed with HIV, what will a patient need to confirm diagnosis?

A

2 different positive diagnostic tests

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9
Q

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?

A
  • tests for antibodies
  • positive results mean antibodies detected
  • antibodies take about 2 weeks to show after exposure
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10
Q

Antigen / Antibody differentiation diagnostic tests
- what does it detect?
- used to confirm a positive result of which other test?

A
  • Detects HIV virus
  • Used to confirm ELISA
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11
Q

CD4+ T cell diagnostic test
- what does it count?
- what is it used for?

A
  • Count measures overall immune function
  • Used in HIV staging
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12
Q

Viral load diagnostic testing
- what does it measure?
- explain the number meaning

A
  • Measures HIV RNA in blood & helps measure response to treatment
  • The lower the viral blood, the longer survival time
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13
Q

HIV stage 0

A
  • Period in which a person becomes infected & when antibodies are made
  • Seroconversion (antibodies made)
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14
Q

HIV stage 1
- what is CD4+ count?

A

greater than or equal to 500 CD4+ T lymphocytes / mm3

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15
Q

HIV stage 2
- what is CD4+ count?

A

200 - 499 CD4+ T lymphocytes / mm3

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16
Q

HIV stage 3
- what is CD4+ count?

A

< 200 CD4+ T lymphocytes / mm3

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17
Q

describe early symptoms of HIV
- when do they disappear?
- is the patient highly infectious yet?

A
  • Disappear in a week to month
  • Highly infectious during this period (Fever, fatigue, lymphadenopathy)
  • High viral load
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18
Q

describe later symptoms of HIV (8)

A
  1. lack of energy
  2. weight loss
  3. fevers / sweats
  4. N/V
  5. headache
  6. Truncal rash
  7. ulcers of mouth, genitals, or both
  8. thrush
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19
Q

how does the CDC define AIDS?

A

All HIV-infected people w < 200 CD4+ T cells and w one or more AIDS defining illnesses

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20
Q

what are considered AIDS defining illnesses? (4)

A
  1. Opportunistic infections
  2. Cancers
  3. HIV encephalopathy (AIDS dementia)
  4. HIV wasting syndrome (unexplained & uncontrollable weight loss, severe diarrhea, & fever)
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21
Q

pneumocystic pneumonia

A

fever, cough, hypoxia

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22
Q

Myobacterium avium complex

A

night sweats, weight loss, diarrhea

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23
Q

Tuberculosis

A

Hemoptysis, night sweats, weight loss

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24
Q

Candidiasis (Thrush)

A

white oral lesions, coated tongue

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25
Q

prevention of HIV / AIDS (4)

A
  1. PrEP (pre-exposure prophylaxis)
  2. Medicines can work to keep the virus from establishing a permanent infection
  3. Can help limit spread of virus to partners
  4. Tenofovir & emtricitabine
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26
Q

treatment of HIV
list adverse effects (4)

A
  • 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
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27
Q

how do antiviral drugs (ART) play a key role in interrupting the HIV process?

A

inhibiting, reducing, halting

28
Q

what can lead to increased mortality / morbidity rates for HIV? (4)

A
  1. lower socioeconomic status
  2. lack of access
  3. limited AIDS experience
  4. physician w little experience in AIDS care
29
Q

describe the difference between a long-term non-progressor w HIV & a long-term survivor w HIV

A

long-term non-progressor: immune system helps HIV stay under control
long-term survivor: progressed to AIDS but haven’t gone any further

30
Q

nursing interventions for HIV (5) - which is most important?

A

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

31
Q

describe autoimmune disorders
- what 3 things happen?

A

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)

32
Q

risk factors for autoimmune diseases (5)

A
  1. women more at risk than men
  2. hereditary
  3. diet
  4. environmental
  5. viruses
33
Q

list symptoms of an autoimmune disorder (7)

A
  1. fatigue
  2. achy muscles & joints
  3. low-grade fever
  4. trouble concentrating / brain fog
  5. numbness & tingling in the hands & feet
  6. hair loss
  7. skin rashes
34
Q

what makes it hard to diagnose an autoimmune disorder?

A

symptoms vary person to person!

35
Q

describe the Antinuclear antibodies (ANA) lab
- what do they attack?
- how is an autoimmune disease diagnosed w this lab?

A

autoantibodies that attack structures in the nucleus of cells. Different patterns on the ANA are correlated w different diseases

36
Q

describe the erythrocyte sedimentation rate (ESR) lab
- what does it detect?

A
  • 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
37
Q

VDRL (serum syphilis test)
- what can this diagnose?
- what can cause a false positive result?

A
  • can diagnose an autoimmune disorder
  • systemic inflammation may cause a false positive result
38
Q

kidney biopsy
- what may this show to diagnose an autoimmune disorder?

A

May show antibody-antigen clumps blocking glomerulus

39
Q

describe systemic lupus erythematosus (SLE)
- where are antibody-antigen complexes trapped?
- what do antibodies destroy?

A

Inflammatory autoimmune disease, multiple organ involvement
- Antibody-antigen complexes trapped in capillaries
- Antibodies destroy host cell

40
Q

manifestations of lupus (7)

A
  1. Chronic or acute states (can go back & forth)
  2. Fever
  3. Malaise
  4. Butterfly rash
  5. Joint & muscle pain
  6. Pericarditis, CP
  7. Nephritis
41
Q

medical management for lupus
- what to prevent?
- when can lupus be life-threatening?

A
  • Prevention or organ damage
  • Prevent complications (Renal failure, CVA / MI, pain)
    Life threatening in acute stage
42
Q

drug therapy for lupus (2 types)

A
  1. immunosuppression (Corticosteroids & Monoclonal antibodies (MABs) - Belimumab)
  2. NSAIDS
43
Q

nursing management of lupus (4)

A
  1. emotional support
  2. avoid sun / UV light
  3. infection prevention
  4. diet recommendations (heart healthy, renal diet, low inflammation diet - low in processed foods)
44
Q

describe Siogren’s syndrome

A
  • Systemic autoimmune disease affecting lacrimal (tear ducts) & salivary glands
  • Most common autoimmune disease
45
Q

manifestations of Siogren’s syndrome (6)

A
  1. Dry eyes
  2. Dry mouth
  3. Thick mucus
  4. Difficulty swallowing
  5. Skin rash
  6. Raynaud’s phenomenon (at high risk)
46
Q

how is Siogren’s syndrome diagnosed? (3)

A
  1. ocular & gland testing
  2. symptoms
  3. lab values: ANA (antinuclear antibody) elevated
47
Q

medical management / symptom management of siogren’s syndrome (5)

A
  1. Mouth wash
  2. Eye drops
  3. Encourage fluid hydration
  4. Avoid alcohol & smoking
  5. Teach infection prevention
48
Q

drug therapy used for siogren’s syndrome (2)

A
  1. artificial tears
  2. biotene rinse
49
Q

nursing management of siogren’s syndrome (2)

A
  1. diet changes
  2. infection prevention
50
Q

how many types of autoimmune diseases are there?

A

over 100

51
Q

name other common types of autoimmune diseases (5)

A
  • Inflammatory bowel disease (IBD)
  • Multiple sclerosis (MS)
  • Guillain-Barre syndrome
  • Scleroderma
  • Psoriasis
52
Q

general treatment for autoimmune diseases (list the 4 drugs, their role, & an example med)

A
  1. anti inflammatory drugs - reduce pain & inflammation
    Celecoxib (NSAIDS)
  2. corticosteroids - reduce inflammation
    prednisone
  3. immune modulators: inhibit immune response
    Adalimumab
  4. Immunosuppressant drugs: inhibit immune response
    Methotrexate
53
Q

what is the #1 limitation to transplantation?

A

expensive cost for procedure plus 5 year post transplantation expenses & shortage of organ donors

54
Q

what is the most significant limitation to transplantation?

A

shortage of organ donors

55
Q

contraindications to transplant (9)

A
  1. Active systemic infection
  2. Malignant disease
  3. Active peptic ulcer disease (Lots of anti inflammatory meds given during transplant)
  4. Active abuse of alcohol or other substances
  5. Severe damage to other organ system
  6. Severe psychiatric disease (Treatment is so extensive)
  7. Demonstrated non-compliance
  8. Lack of support system
  9. Lack of financial resources
56
Q

what is the criteria for receiving transplant?

A

Notify local Organ Procurement Organization (OPO)
- Urgency
- Blood type
- Recipient weight & height
- Stability

57
Q

donation process for transplants

A

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”

58
Q

common problems w transplants (5)

A
  1. hypotension
  2. shock
  3. electrolyte imbalances
  4. disseminated intravascular coagulation (DIC)
  5. loss of thermoregulation
59
Q

ideal transplant donor

A

brain death (otherwise healthy & infection-free)

60
Q

what are the two most common types of transplants seen?

A

liver or kidney

61
Q

list the time of viability for organ transplant for each of the following organs:
- kidney
- heart
- lung
- liver
- pancreas

A
  • kidney: 48 - 72 hours
  • heart: 4-5 hours
  • lung: 4-6 hours
  • liver: 24-30 hours
  • pancreas: 24 hours
62
Q

post-operative nursing care of transplant recipients (4)

A
  1. Recognition of life threatening clinical problems
  2. Preventing complications
  3. Promoting return to normal activities
  4. Recognition of the body’s natural defense system
63
Q

list & describe the 3 types of rejection (complications of transplant recipients)

A
  1. Hyper-acute rejection (immune system attacks immediately)
  2. Acute rejection (seen 1-3 months after transplant)
  3. Chronic rejection (seen w medication noncompliance & cumulative damage over years)
64
Q

signs / symptoms of graft rejection (4)

A
  1. fever
  2. graft tenderness
  3. fatigue
  4. abnormal labs
65
Q

biggest risk factor for infection after a transplant

A

**Opportunistic infections 1-6 months after **

66
Q

what is malignancy caused by in post-transplant patients?

A

caused by immuno-deficient state

67
Q

what is a patient often screened after transplant?

A

development of cancer

Adults Exam 4 (5 decks)

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