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Advanced Med-Surg > Immune function, HIV/AIDS > Flashcards

Immune function, HIV/AIDS Flashcards

1
Q

Increased or excessive response to an antigen to which the pt has been previously exposed.

A

Hypersensivities/allergies. Excessive reactions, inappropriate sites, inappropriate organ involvement.
Degree of reaction ranges from uncomfortable to life-threatening

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2
Q

What are the 4 types of hypersensitivity reactions?

A

Type 1: Immediate or Anaphylactic: IgE antibody- mediated
Type 2: Cytotoxic: Antigen-antibody reaction destroys cells
Type 3: Immune Complex: Antigen-antibody reaction causes inflammation
Type 4: Delayed: T-lymphocytes causes inflammation

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3
Q

This is the most common type of hypersensitivity.

A

Type 1: rapid hypersensitive reactions. Some reactions are localized, others are systemic. Could be a prolonged response and last up to 24 hours.

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4
Q

Allergen contact for type 1: rapid hypersensitivity reactions?

A

Inhaled: plant pollens, fungal spores, animal dander, house dust, grass, ragweed.
Ingested: foods, food additives, drugs
Injected: beed venom, drugs, biologic substances
Contacted: pollens, foods, environmental proteins

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5
Q

Type 1 allergens etiology?

A

Mast cells release histamine and other substances causing:
Vasodilation, increased vascular permeability, smooth muscle contraction and bronchial constriction, increased mucus gland secretion.

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6
Q

Labs for hypersensitivity? Allergy testing?

A

Increased eosinophil count, increased immunoglobulin E (IgE). Radio allergo-sorbent test (RAST)
Testing: pt preparation, procedure, follow-up care, emergency equipment.
Oral food challenges.

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7
Q

What may be involved in avoidance therapy for hypersensitivity?

A

Air-conditiong and air-cleaning units. Cloth drapes. Upholstered furniture. Carpeting. Pet-induced allergies.

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8
Q

These meds help to relieve symptoms of nasal stuffiness, runny nose, watery eyes, hives itching.
Relives congestion by reducing swelling, inflammation, mucous formation.

A

Antihistamines

Decongestants

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9
Q

These meds cause vasoconstriction of mucosal vessels.

Reduces release of histamine and other allergic response mediators.

A

Adrenergic agents

Mast cell stabilizers

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10
Q

Meds that impact the inflammatory cycle.

Bronchial smooth muscle relaxation

A

Leukotriene modifier

Bronchodilators

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11
Q

May involve all blood vessels and bronchiolar smooth muscle. Causes widespread blood dilation leading to decreased CO and bronchoconstriction. Life-threatening without immediate treatment.

A

Anaphylaxis.
Histamine causes capillary leak, mucosal edema, and excess mucus secretion.
Congestion, rhinorrhea, dyspnea, increasing respiratory distress with audible wheezing

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12
Q

Manifestations of anaphylaxis?

A

Feelings of apprehension and impending doom. Pruritus, urticaria, erythema, angioedema

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13
Q

Interventions of anaphylaxis?

A 
First assess respiratory function. Establish airway and start O2. Call EMS or RRT. CPR may be needed. Assess vitals. 
Give epinephrine (1:1000). 0.3 to 0.5 mg immediately, IV, IM, SQ. Obtain IV access and start normal saline. Antihistamines. Corticosteroids to treat bronchospasm. Vasopressor support.
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14
Q

Education for type 1 hypersensitivity reactions?

A

Medic alert bracelet, string kits, avoid exposure, clothing, repellants. Exercise caution when at risk drugs are being given. Emergent meds available, keep under pt. supervision. Check all pts for allergies, be aware of cross- sensitives. Avoidance of known triggers.

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15
Q

The body makes special antibodies directed against self-cellos that have some form or foreign protein attached to them. Clinical examples?

A

Type 2: cytotoxic reactions.

Hemolytic anemia, thrombocytopenia purpura, hemolytic transfusion reactions, goodpasture’s syndrome, myasthenia gravis

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16
Q

Rare autoimmune disorder. Attacks collagen in lungs and kidneys, leading to what? Treatment?

A

Goodpasture’s syndrome.
Dyspnea, hemoptysis, oliguria, weight gain, edema, HTN, and tachycardia.
High-dose corticosteroids, immunosuppressants, plasmapheresis.

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17
Q

Excess antigens cause immune complexes to form in the blood, which can lodge in small blood vessels Deposited complexes trigger inflammation, leading to tissue and/or vessel damage.

A

Type 2: hypersensitivity reactions.
Usual sites include the kidneys, skin, and joints. Rheumatoid arthritis, systemic lupus erythematosus, vasculitis, and serum sickness.

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18
Q

Treatment for type 3: hypersensitivity reactions?

A

Supportive care, healthy lifestyle. Immunosuppressive drugs such as prednisone and cehmotherapeutic agents (methotrexate). Disease-specific treatments.

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19
Q

Reactive cell is the t-lymphocye (T-cell) and monocytes/macrophages rather than antibodies. What do the local collection of lymphocytes and macrophages cause? Examples?

A

Edema, induration, ischemia, and tissue damage.
Positive purified protein derivative (PPD). Contact dermatitis, poison ivy, insect stings, transplant rejection, sarcoidosis.

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20
Q

Group of problems often within other autoimmune disorders. No cure. Insufficient tears leads inflammation and ulceration of the cornea, increasing infection.

A

Sjogren’s syndrome. Dry eyes and mucus membranes of the nose, mouth, and vagina.

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21
Q

Chronic, progressive inflammatory autoimmune disorder. Characterized by remissions and exacerbations. Diagnostic labs?

A

Systemic lupus erythematosus (SLE). Damage to body organs, mainly the kidneys. Major cause of death is renal failure.
Increased antinuclear antibody titer (ANA), pancytopenia, decreased serum complement. Iummunological testing similar to RA, newer tests being developed. Tests to monitor renal functions.

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22
Q

Clinical manifestations of systemic lupus erythematosus (SLE)?

A

Very individualized. Fever is a precursor to exacerbation. Butterfly rash, the classic. Polyarthritis, osteonecrosis, muscle atrophy, myalgia. Fatigue. Renal, pulmonary, cardiac neurological involvement. Raynaud’s phenomenon.

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23
Q

Treatment for SLE?

A

Goal is aggressive therapy. Topical cortisone creams for rash. Hydroxycholorquine (Plaquenil). Steroids. Immunosuppressive agents: cyclophosphamide (Cytoxan).

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24
Q

Patient education for SLE?

A

Monitor for temp increase: exacerbation. Skin protection, psychological support during exacerbations, counseling regarding pregnancy, medic alert bracelet. Health promotion activities.

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25
Q

The second most common secondary immune deficiency disease in the world. Identified in 1981. Serious worldwide epidemic.

A

Acquired immune deficiency syndrome: AIDS. Last and more serious stage of HIV infection. Diagnosis requires confirmed HIV+ status and CD4 cell count of <200 cells, or an AIDS- related opportunistic infection.
Once diagnosed, no reversal back to HIV+ is possible.

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26
Q

A virus that attacks the immune system. Retrovirus: intracellular parasite that never dies.

A

Human immunodeficiency virus (HIV).

Selectively infects and destroys CD4 t-cells. Immune response fails, opportunistic infections and/or cancers arise.

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27
Q

What are the differences between HIV and AIDS?

A

Distinction based on the number of CD4 cells and opportunistic infections. HIV is infectious and transmittable at all stages, especially in a recently infected person with a high viral load.

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28
Q

Risk categories for HIV infection?

A

Male to male sexual contact (MSM), injecting drug users, MSM who inject drugs, high-risk het contact, blood transfusion, hemophilia/coagulation disorders, perinatal transmission

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29
Q

What three conditions must be present for HIV transmission?

A

There must be an HIV source, there must be sufficient dose of the virus, there must be access to the bloodstream of another person. Most cases are transmitted through sexual contact and/or sharing needles. Education is the best for prevention.

30
Q

What three ways is HIV most often transmitted in?

A

Sexual: genital/anal/oral contact with exposure of mucus membranes to infected secretions.
Parenteral: Sharing of needles/equipment contaminated with HIV+ blood or contaminated blood products.
Perinatal: From the placenta/maternal blood and body fluids during birth/breast milk from HIV+ mother

31
Q

Safer sex practices for health promotion and maintenance of HIV?

A

Latex condom: genital and anal intercourse. Water-based lubricants. Condom/latex barrier (dental dam) over genitals/anus during sexual contact. latex gloves for finger/hand contact with vagina or rectum.

32
Q

Safer drug use and safer perinatal care for health promotion and maintenance of HIV?

A

Do not reuse needles. Proper cleaning of drug paraphernalia.
continue antiviral therapy. Treat babies at birth.

33
Q

Stage 1 of HIV, the primary infection, the early acute phase?

A

1-3 weeks after exposure. Flu-like symptoms or no symptoms at all. High viral load and highly infectious but HIV test may be negative due to lack of antibodies.

34
Q

Stage 2, the symptomatic HIV infection?

A

Alteration in immune system. CD4 200-499. Often present with diarrhea, fever, enlarged glands, oral infections, skin problems.

35
Q

Stage 3, AIDS?

A

CD4<200. Presence of one or more AIDS defining conditions.

36
Q

1st symptoms of the early acute stage, stage 1?

A

Fever, chills, night sweats, headache, muscle aches, rash, sore throat. Lasts 5-7 days. Can have severe symptoms, like encephalitis and seizures.

37
Q

Further explain the latent phase of HIV, the symptomatic part, stage 2?

A

Durability of the immune system determines how long the patient will be able to respond successfully to the virus. Average time is 10-11 years. Progressive decline in the immune system

38
Q

CD4 cell count for the latent phase, stage 2?

A

CD4 cell count decreases to about 80 cells/mm3/year as viral load increases.
CD4 cell count is <500 cells/mm3, increases the risk of an opportunistic infection.

39
Q

AIDS defining conditions of stage 3?

A

Bacterial infectons, multiple or recurrent. Candidiasis of bronchi, trachea, or lungs. Cytomegalovirus. Herpes simplex: chronic ulcers >1 month. Kaposi sarcoma. Mycobacterium avid complex. Mycobacterium tuberculosis. Pneumonia: recurrent. Wasting syndrome.

40
Q

Primary means of HV infection for healthcare workers?

A

Needle sticks/sharps injuries. The best prevention is the consistent use of Standard Precautions for all pts. HIV+ pts do not need contact or airborne isolation unless they have MRSA, VRE, CDT, or TB.

41
Q

HIV standard diagnostic tests?

A

HIV and syphilis serology, quantitative HIV RNA, CD4 count, CBC, chest x-ray, hepatitis serology and liver chemistry panel, PPD skin test.

42
Q

Lab assessments for HIV?

A

Decreased lymphocyte counts, leading to leukopenia.
Decreased CD4 t-cells. Normal count is 800-1000 cells/mm3. CD4 count of less than 500 increases infection risk.
CD4 t-cell count and CD8 t-cell percentage.

43
Q

How do folks with HIV work to avoid exposure to infections?

A

Handwashing, no sharing of toothbrush/toothpaste. Toothbrush through dishwasher daily. Avoid fresh fruits/veggis. No gardening/exposure to live plants or soil.

44
Q

Preventative healthcare for HIV?

A

Vaccinate early in the disease: Hep A, B. Pneumococcal vaccine, flu vaccine annually, tetanus q10 years. Shingles vaccine.

45
Q

HAART?

A

Highly active anti-retroviral therapy. Goals include increasing CD4 counts and decreasing viral load. Decreasing the risk of opportunistic injection. Prolonging the life of the patient.
Retro-viral therapy only inhibits viral replication and does not kill the virus. Pt will still be contagious while taking meds.

46
Q

What are the 5 types of antiretroviral drugs?

A

Reverse transcriptase inhibitors: NRTIs and NNRTs.

INSTIs, PI, fusion inhibitor, chemokine receptor 5

47
Q

Antiretroviral drug that prevents HIV infection by blocking a receptor on CD4 cells

A

Entry inhibitor: maraviroc (Selzentry)

Oral. Cough, dizziness, rash, decreased BP. Caution with CV risk factors. Monitor liver function.

48
Q

Antiretroviral drug that prevents HIV infection by preventing viral fusion with the host cell’s CD4 receptor.

A

Fusion inhibitor: enfuvirtide (Fuzeon).

Subq, BID. Teach injection technique and injection site rotation. About 20,000 bucks annually.

49
Q

Antiretrovirals that suppress viral replication.

A

Nuceloside analog reverse transcriptase inhibitors (NRTIs)
7 drugs in this class.
Emtricitabine/tenofovir (Truvavda). PrEP (pre-exposure prophylaxis) can reduce risk 92%. Does not replace condom use.

50
Q

Explain treatment with an NRTI for pre-exposure prophylaxis?

A 
Consider the nature and severity of the exposure, as well as the HIV status o the exposure source. No post-exposure prophylaxis. 2 NRTIs. Pt-based regimen. Within 1-2 hours. No more than 72 hours. Take for 28 days. Not always effective. 
Often zidovudine (Retrovir) and lamivudine (Epivir)
51
Q

Antiretrovirals that suppress viral replication. 5 drugs in this category.

A

NNRTIs.

Efavirenz (Sustiva) is the preferred HIV agent. Has a long half-life. Taken once daily only.

52
Q

Antiretrovirals that block an enzyme necessary for viral replication.

A

Integrase inhibitor, INSTI.

raltegravir (Isentress). Insomnia and HA most common side effects.

53
Q

Antiretrovirals that prevent viral replication and the release of irons. 9 in this category.

A

Protease inhibitors (PIs). Multiple interactions with other drugs. Must be given with greater than or equal to 1 NRTI or NNRTI

54
Q

Nursing considerations with antiretroviral meds for HIV?

A

Monitor labs. CBC, WBC, liver function tests. May increase ALT, AST, bilirubin, MCV, HDLs, total cholesterol, triglycerides.
Educate about side effects and ways to decrease the severity. Adherence and tolerability is the key. Need to take meds on regular schedule and not to miss doses. HIV virus can replicate and lead to drug resistance.

55
Q

Monitoring the response to antiretroviral therapy?

A

Increasing CD4 count. The goal for viral load testing to determine response to therapy is an undetectable viral load. Don’t do within two weeks of vaccinations or illness. usually 2 tests before deciding to change therapy.

56
Q

HIV-associated dementia complex (ADC). Refers to manifestations of CNS involvement.

A

AIDS dementia complex: HIV encephalopathy.

Due to infection of CNS with HIV virus. Occurs in about 70% with AIDS, ranges from barely noticeable to severe dementia.

57
Q

Involuntary weight loss of lean and fat mass.

A

AIDS wasting syndrome. Treated with anabolic steroids, growth hormone, Marinol, megace, and testosterone in men. Maintain the pt’s nutrition.

58
Q

Small purplish brown raised lesions that are usually not painful or itchy.

A

Kaposi’s sarcoma. 1-21% of patients with AIDS. Risk related to co-infection with human herpes virus-8.

59
Q

Opportunistic pneumonia. Pneumocystis jiroveci (PJP). Pneumocystis carinii pneumonia (PCP).

A

Tachypnea, cough, SOB, crackles, fever, fatigue, weight loss.
Trimethoprim/Sulfamethoxazole (Bactrim, Septra), dapsone (Aflosulfon), pentamidine (Pentacarinat), atovaquone (Mepron), steroids

60
Q

Opportunistic infection that us systemic and not contagious. Most common bacterial infection in AIDS. Treatment is usually multi-drug due to resistance issues.

A

Mycobacterium avium complex (MAC). Fever, weight losss, anemia, diarrhea, ab pain. clarithromycin (Biaxin) or azithromycin (Zithromax) w/ethambutol (Myambutol) or rifabutin (Mycobutin) or Cipro

61
Q

Opportunistic infection that affects the eyes, GI tract, and lungs.

A

Cytomegalovirus (CMV). Visual disturbances, fever, malaise, weight loss, diarrhea, ab bloating, fatigue.
ganciclovir (Cytovene). intraocular implants available. IV for GI distress.

62
Q

Opportunistic infection that usually presents as encephalitis with neurological deficits. Lifelong suppressive therapy after an episode.

A

Toxoplasmosis. Speech difficulty, visual changes, impaired gait, mental status changes.
pyrimethamine (Daraprim), sulfadiazine (Silvadene), leukovorin (Folinic acid)

63
Q

Opportunistic infection that usually presents as respiratory infection.

A

Histoplasmosis. Dyspnea, fever, cough, weight loss. Enlarged lymph nodes, spleen, and liver. Anemia. Progresses to widespread infection.
amphotericin-B (Fungizone) or ketoconazole (Nizoral)

64
Q

Opportunistic protozoal intestinal infection. Person-to-person, water, food, airborne exposure.

A

Cryptosporidiosis. Ab cramping, severe diarrhea, dehydration (lose 15-20 L/day).
Symptom control, hydration, diarrhea meds.

65
Q

Opportunistic cryptococcal meningitis.

A

Fever, headache, blurred vision, malaise, n/v, nuchal rigidity, confusion, focal neurological deficits, seizures.
Amphotericin-B (Fungizone) and flucytosine

66
Q

Opportunistic tuberculosis. Treated with a regimen involving three or more drugs.

A

Cough, dyspnea, chest pain, fever, chills, night sweats, weight loss, anorexia. May be pulmonary, CNS, bone, stomach, scrotal.
Positive skin test is treated with INH for 9-12 months.

67
Q

Opportunistic candidiasis of GI and reproductive tract. Greater than or equal to 75% of HIV+ pts.

A

Treat with nystatin (swish and swallow) or oral azoles.

68
Q

How do you treat anemia, leukopenia, neuropathy?

A

Anemia treated with erythropoietin.
Leukopenia with neupogen.
Neuropathy with Neurontin or similar meds.

69
Q

Nursing problems for HIV/AIDS?

A

Alteration in comfort, pain. Imbalanced nutrition, less than the body requirements. Potential for fluid imbalance, diarrhea. Impaired skin integrity, disturbed thought processes, chronic low self-esteem, social isolation, risk for infection.

70
Q

Goals of community-based care for the patient with HIV/AIDS?

A

Adhere to the prescribed drug regimen, practice safe sex at all times, remain free of opportunistic diseases, maintain a strong support system. Maintain maximal function, weight, self esteem, skin integrity, and orientation.

Advanced Med-Surg (11 decks)

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