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

Question 1

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

Answer 1

Homeostasis
Defense
Surveillance

Question 2

Organs of the immune system include:

Answer 2

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)

Question 3

Antigen (Function)

Answer 3

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)

Question 4

Antigens (Other protein Types)

Answer 4

Polysaccharides
Lipoproteins
Nucleic acids
(most are composed of protein)

Question 5

Immunoglobulins/Antibodies 
IgA
IgG
IgM
IgE
IgD

Answer 5

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.

Question 6

Types of Immunity: Innate

Answer 6

Present at birth

First-line defense against pathogens

Question 7

Acquired Immunity

Answer 7

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

Question 8

Types of Acquired Speceifc Immunity: NATURAL

Answer 8

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)

Question 9

Types of Acquired Specific Immunity: ARTIFICIAL

Answer 9

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

Question 10

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

Answer 10

Immune system can recognize self with cell proteins (antigens)

Question 11

Cells of Immune response: Mononuclear phagocytes

Answer 11

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

Question 12

Lymphocytes

Answer 12

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

Question 13

Types of Lymphocytes

Answer 13

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

Question 14

Dendritic Cells

Answer 14

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

Question 15

Cytokines

Answer 15

• 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

Question 16

Cytokine Detrimental Effects

Answer 16

• CHRONIC INFLAMMATION
• AUTOIMMUNE DISEASE
• SEPSIS

Question 17

Cytokine Types

Answer 17

Interluekins 
Interferons 
Tumor Necrosis Factor 
Colony-stimulating factor 
Erythropoietin

Question 18

Cell-Mediated Immunity

Answer 18

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

Question 19

Cell-mediated Immunity (infections, pathogens)

Answer 19

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

Question 20

Effects of aging on immune system

Answer 20

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

Question 21

Hypo immunity (Primary & Secondary)

Answer 21

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

Question 22

HIV —> AIDS

Answer 22

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

Question 23

Plan to end HIV

Answer 23

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

Question 24

Transmission of HIV

Answer 24

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

Question 25

Pathophysiology of HIV

Answer 25

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

Question 26

HIV immune problems

Answer 26

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

Question 27

Clinical Manifestations & Complications (ACUTE)

Answer 27

``` 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 ```

Question 28

Symptomatic & Asymptomatic Infection

Answer 28

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

Question 29

Stage 3: Final Phase (AIDS)

Answer 29

Diagnostic criteria is established by CDC - immune system severely compromised - infections, malignancies, wasting, HIV-related cognitive changes

Question 30

Lab studies: HIV

Answer 30

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

Question 31

Drug therapy & prevention

Answer 31

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

Question 32

HIV Prevention and Prophylaxis

Answer 32

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

Question 33

Collaborative Care

Answer 33

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)

Question 34

Delaying Disease Progression

Answer 34

``` 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 ```

Question 35

Nursing Management: Planning

Answer 35

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

Question 36

Acute Exacerbations

Answer 36

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

Question 37

End-of-life Care

Answer 37

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

Question 38

Immunosuppressive therapy

Answer 38

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

Question 39

Immunosuppressive therapy

Answer 39

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

Question 40

Care of transplant patient

Answer 40

#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.

Question 41

Nursing Care

Answer 41

``` 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) ```