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Med Surg II > Immune Response, HIV/AIDS, Organ Transplant, Immunosuppressive Therapy > Flashcards

Immune Response, HIV/AIDS, Organ Transplant, Immunosuppressive Therapy Flashcards

1
Q

Immunity is the body’s ability to resist disease and serve what 3 functions?

A

Homeostasis
Defense
Surveillance

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2
Q

Organs of the immune system include:

A 
Lymph nodes (drain & filter dead cells and debris) 
Thymus gland (create and train T-cells) 
Bone marrow (produces RBCs, WBCs, and Platelets) 
Spleen (stores and filters blood)
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3
Q

Antigen (Function)

A

Substance that elicits an immune response
(An antigen is a substance that induces the formation of antibodies because it is recognized by the immune system as a threat)

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4
Q

Antigens (Other protein Types)

A

Polysaccharides
Lipoproteins
Nucleic acids
(most are composed of protein)

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5
Q 
Immunoglobulins/Antibodies 
IgA
IgG
IgM
IgE
IgD
A

IgA: respiratory tract, digestive system, saliva, tears, and breast milk
IgG: body fluids, and protects against bacterial and viral infections. IgG can take time to form after an infection or immunization.
IgM: located in blood and lymph fluid, first line antibodies the body makes when it gets a new infection
IgE: Normally found in small amounts in the blood. There may be higher amounts when the body overreacts to allergens or is fighting an infection from a parasite.
IgD: Least understood antibody, with only small amounts in the blood.

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6
Q

Types of Immunity: Innate

A

Present at birth

First-line defense against pathogens

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7
Q

Acquired Immunity

A 
Developed immunity (2nd line of defense) 
Active & Passive
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8
Q

Types of Acquired Speceifc Immunity: NATURAL

A

Active: Natural contact with antigen through actual infection (e.g. chickenpox, measles, mumps)
Passive: Transplacental and colostrum transfer from mother to child (e.g. maternal immunoglobulins passed to baby)

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9
Q

Types of Acquired Specific Immunity: ARTIFICIAL

A

Active: Immunization with antigen (e.g. vaccines for chickenpox, measles, mumps)
- Newer vaccines provide cell with a blueprint for making antigens rather than being entices
- COVID vaccine: a mRNA “blue print” forcing
Passive: Injection of serum with antibodies from one person to another person who does not have antibodies
- COVID: Monoclonal therapy

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10
Q

How does your immune system know which cells to attack and which cells are part of your own body

A

Immune system can recognize self with cell proteins (antigens)

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11
Q

Cells of Immune response: Mononuclear phagocytes

A

Capture, process, and present antigens to lymphocytes to initiate an immune response
Capture antigens by phagocytosis

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12
Q

Lymphocytes

A 
Made in bone marrow
Eventually migrate to peripheral organs 
Differentiate into B and T lymphocytes 
T Cytotoxic cells
T Helper cells
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13
Q

Types of Lymphocytes

A

T cells: 70%-80%
B cells: 10%-20%
2:1 Ratio
NK: Less than 10%

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14
Q

Dendritic Cells

A

Important in activating immune response

  • capture antigens at sites of contact with external environment
  • transport the antigen until it meets a T cell with specificity for that antigen
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15
Q

Cytokines

A
  • Soluble factors secreted by WBCs and a variety of other cells in body
  • Act as messengers between the cell types
  • Tell cells to change their proliferation, differentiation, secretion, or activity
  • Have a beneficial role in hematopoiesis and immune function
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16
Q

Cytokine Detrimental Effects

A
  • CHRONIC INFLAMMATION
  • AUTOIMMUNE DISEASE
  • SEPSIS
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17
Q

Cytokine Types

A 
Interluekins 
Interferons 
Tumor Necrosis Factor 
Colony-stimulating factor 
Erythropoietin
18
Q

Cell-Mediated Immunity

A

Immune response initiated through specific antigen recognition by T cells
Several cell types and factors are involved in cell-mediated immunity
- T cells
- Macrophages
- NK cells

19
Q

Cell-mediated Immunity (infections, pathogens)

A 
Immunity against pathogens that survive inside cells (viruses, some bacteria) 
Fungal infections 
Rejection of transplanted tissue 
Contact hypersensitivity reactions 
Tumor immunity
20
Q

Effects of aging on immune system

A

Immunosenescence

  • high incidence of cancer
  • greater susceptibility to infection
  • increased autoantibodies
  • lowered cell-mediated immunity
  • reduced proliferation response of T and B cells
  • reduced primary and secondary antibody responses
21
Q

Hypo immunity (Primary & Secondary)

A

Primary: inherited or otherwise present from birth
Secondary: caused by illness or treatment, steroids, transplant drugs, chemotherapy, HIV, age or poor health
- Characterized by severe, recurrent, difficult to treat infections

22
Q

HIV —> AIDS

A

Virus destroys CD4+ T cells resulting in a weakened immune system, making persons with HIV or AIDS at risk for many different types of infections
AIDS is the name used to describe a number of life-threatening infections and illnesses that happen with significant hypo-immunity

23
Q

Plan to end HIV

A

Diagnose HIV as early as possible
Treat HIV quickly and effectively
Protect people at risk
Respond quickly to clusters of new cases

24
Q

Transmission of HIV

A

Contact with certain body fluids:

  • blood, semen, vaginal secretions, and breast milk
  • unprotected sex with an HIV-infected partner is most common mode of transmission
  • greatest risk is for partner who receives semen - women are higher risk
  • traumatic penetration increases likelihood of transmission
  • sharing drug-using paraphernalia
  • puncture wounds cause work-related HIV transmission (needle sticks)
  • transmission of HIV to patients while in healthcare settings are rare
  • proper sterilization and disinfection procedures are required to prevent infection risks
  • removal of bioburden
25
Q

Pathophysiology of HIV

A

HIV is a ribonucleic acid virus
- called retroviruses because they replicate in a “backward” manner going from RNA to DNA
- CD4+ T cell is the target cell for HIV
Type of lymphocyte
HIV binds to cell through fusion
Normal range 800-1200 cells/microliter

26
Q

HIV immune problems

A

Immune problems start when CD4+ T cell count drop to less than 500 cells/microliter
SEVERE problems develop when less than 200 CD4+ cells/microliter (AIDS)
Insufficient immune response allows for opportunistic diseases
HIV positive will not always become AIDS

27
Q

Clinical Manifestations & Complications (ACUTE)

A 
Acute infection 
Mononucleosis-like symtpoms 
- fever, swollen lymph nodes, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and/or a diffuse rash (similar to COVID) 
Occurs about 2-4 weeks after infection 
Highly infectious
28
Q

Symptomatic & Asymptomatic Infection

A

Symptomatic: CD4+ T cells decline closer to 200 cells/microliter
HIV advances to a more active stage
Symptoms become worse: persistent fever, frequent night sweats, chronic diarrhea, recurrent headaches, severe fatigue.
Asymptomatic: left untreated, a diagnosis of AIDS is made about 10 years after initial HIV infection
- people are typically asymptomatic or have limited signs of infection
- high-risk behaviors may continue

29
Q

Stage 3: Final Phase (AIDS)

A

Diagnostic criteria is established by CDC

  • immune system severely compromised
  • infections, malignancies, wasting, HIV-related cognitive changes
30
Q

Lab studies: HIV

A

CD4 cells count: provides a marker of immune function-lower numbers are more active disease
Viral load: the lower the less active the disease (can still transmit but less symptomatic)
- decreased WBC counts, especially: lymphopenia & neutropenia (HARD TO FIGHT INFECTION)
- Low platelet counts (thrombocytopenia) normal 150,000-450,000
- Anemic

31
Q

Drug therapy & prevention

A 
Disease treatment: Antiretroviral therapy (ART) 
Decrease viral load
Maintain/increase CD4 counts 
- Abacavir, or ABC (Ziagen)
- Zidovudine, or ZDV (Retrovir) 
- Didanosine, or ddl (Viadex)
32
Q

HIV Prevention and Prophylaxis

A

Regular STD/HIV screening
Assess for risky sexual behaviors
Regular condom use with sexual activities
Limit sexual partners
Ask HCP about pre-exposure prophylaxis (PrEP)
- PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed
Do not use injected drugs or shared needles
Drug interaction: Herbal therapies (St. Johns Wart, Antacids, Proton pump inhibitors, supplements

33
Q

Collaborative Care

A

Do not make assumptions about who may be at risk
Candid conversation is important for effective management of HIV
Patient population more at risk for ANY infection?
Lifestyle oppurtunites and socio-economic status?
PPD test -> not enough WBCs to react to test (X-ray will diagnose TB)

34
Q

Delaying Disease Progression

A 
Promoting a healthy immune system 
Nutritional support 
Moderating or eliminating alcohol, tobacco, and drug use 
Keeping up to date with vaccinations 
Getting adequate rest and exercise 
Avoiding exposure to infectious agents 
Counseling and support groups
35
Q

Nursing Management: Planning

A

Goals for care are aimed at:

  • adherence with drug regimens
  • adopting a healthy lifestyle
  • protecting other from HIV
  • beneficial relationships
  • explore spiritual issues
  • coping with the disease and it’s treatment
36
Q

Acute Exacerbations

A

HIV infection

  • has no cure
  • continues for life
  • causes physical disability
  • impairs social, emotional, economic, and spiritual well-being
  • ultimately leads to death
37
Q

End-of-life Care

A

Patient comfort
Facilitating emotional and spiritual acceptance of finite nature of life
Helping significant others deal with loss
Maintaining safe environment

38
Q

Immunosuppressive therapy

A

Drug regimen
Lowers the bodies’ immune response. Most patients take immunosuppressant drugs after receiving an organ transplant.
Lymphocytes are the principal immune cells for the identification of the foreignness of the allograft and mediate graft damage (rejection)
Cell-to-cell combat

39
Q

Immunosuppressive therapy

A

Necessary after an organ is transplanted
Can also be treatment for idiopathic thrombocytopenia purpura (ITP), and other autoimmune or hyper immune diseases
Several medications and classes
Most patients require a corticosteroids
Most patients will complain of GI side effects

40
Q

Care of transplant patient

A

1 Cyclosporine (used to prevent organ rejection)

Taken with adjunct to other medications allowing the new organ to function normally
When caring for transplant patient:
- ASSESS for cyclosporine use
- CHECK the cyclosporine level
If the level is to low, organ rejection may occur
Optimal: 100-400 ng/mL
Daily levels when establishing dosing regimen.

41
Q

Nursing Care

A 
Neutropenic isolation 
Use sterile technqiue 
Life long therapy! 
Meds: 
- Prednisone 
- Tacrolimus (Prograf) 
- Cyclosporine (Neoral) (NO GRAPEFRUIT JUICE) 
- Mycophenolate Mofetil (CellCept) 
- Imuran (Azathioprine) 
- Rapamune (Rapamycin, Sirolimus)

Med Surg II (3 decks)

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