Immune responses And Transplantation Flashcards
What does immunity mean?
Is the body ability to resist disease
What are the 3 functions immunity serves for?
Defense
protect against foreign invasion
Homeostasis
remove damanged substances
Surveillance
looking for and destroying foreign cells
What are antigens?
And it’s present in what?
Substances that elicits an immune response
Present in every cell
What are antigens composed of?
Protein
Antigens are unique to everyone and it allows the body to what?
Be able to recognized self
An antigen is a substance that induces the formation of what?
Antibodies
What is an antibodies?
It’s produced by lymphocytes in response to exposure to antigen
There are two types of immunity what are they?
Innate and acquired
What is innate immunity ? (2)
Present at birth
First line defense against pathogens
What is acquired immunity (3)
Developed immunity
Active
passive
There are two types of innate specific immunity
Active Vs passive
What is it?
Active
- natural contact with antigen through actual infection
Passive
- transplacental & colostrum transfer from mother to child
What is an example of innate active immunity?
Chicken pox, measles & mumps
What is an example of innate passive immunity?
Breastfeeding
There are two types of acquired specific immunity ( artificial )
Active vs passive
Active
- immunization with an antigen
Passive
- injection of serous with antibodies from one person to another person who does not have antibodies
What is an example of acquired artificial active immunity?
Vaccine of chickenpox, measles and mumps
What is an example of acquired artificial passive immunity?
Injection of hepatitis B immune globulin
What is the 2 organs our central ( primary ) lymphoid ?
Thymus gland
Bone marrow
What is the thymus gland involved in?
Differentiation & maturation of T lymphocytes
What happens to the thymus when we age? And why is this important?
It shrinks when we age
Older population have a higher risk of thyroid cancer
What is the function of our bone marrow?
Production of
RBCS, WBCS, platelets
What are the 3 peripheral lymphoid organs?
Lymph nodes
Tonsils
Spleen
What’s a splenectomy ?
Why is it important when talking about immunity, that you be careful with these patients?
Removal spleen
For the rest of their lives, they will always have a higher risk of infection
Lymphoid tissues are associated with what 4 things?
Bronchi
Gut
Genitals
Skin
Viral invasion 7 steps
Elaborate the procreate of a virus invading our body
- Virus invades the body & replicates in cells
- Macrophages digests the virus, displays pieces of the virus ( antigens ) on its surface
- T helper cells recognized antigens, binds to the macrophages.
Stimulates production of cytokines by the macrophages and interleukin-2 and interferon by T cells.
These cytokines are intracellular messengers that provide communication among the cells
- Cytokines communicate with other cells, causing more increase of T cells and Triggers B cells to multiply and provide antibodies
- T cytotoxic cells and natural killer cells destroy infected body cells
- Antibodies bind to the virus and mark it for macrophage destruction
- Memory B and T cells remain behind to respond quickly if the same virus attacks again
What is mononuclear phagocytes?
Monocytes & macrophages
Monocytes & macrophages capture, process, and present antigens to lymphocytes to initiate an immune response
Monocytes & macrophages capture antigens by what process?
Phagocytosis
What are lymphocytes?
Produced in the bone marrow, migrate to peripheral organs
Lymphocytes are differentiated into what 2 lymphocytes ?
Describe each
B
- plasma cells when activated, produced antibodies
( immunoglobulins )
T
- Migrate to thymus, become cytotoxic cells or T helper cells
Lymphocytes, B and T cells are the what type of liners?
Front or back when infection?
Front
T cells provide what?
And live? for how long?
Immunity to virus, tumor cells, fungi
Live months to years
This is why you won’t ever get covid a second time within the same month cause of these cells
T cytotoxic cells
What is the function?
Specific to different antigens they act as?
Attack antigens, release cytotoxins to destroy pathogens.
Specific to different antigens, some act as memory cells
T helper cells function?
Involved in cell mediated immunity & humoral antibody response
What is the natural killer cells function?
Recognize and kill tumor cells, virus infected cells and transplanted grafts
Natural killer cells
Help with?
They are what type of cells?
Significant role in what?
Cell mediated immunity
Large cells that do not require prior sensitization
Significant role in malignancy surveillance
Natural killer cells are known to be the what type of cells ?
Dumb ones
Your transplant patients will be immunocompromised and we purposely do that & give them Immunosuppression medication, why?
so their body doesn’t attack their brand new organ
And if they don’t, their natural killer cells will attack the new organ
What is the function of dendritic cells?
Important in activating immune response
What are the two functions of cytokines?
Acts as messengers between the cell types
Have a beneficial role in hematopoiesis and immune function
What are the 5 cytokines ?
Interleukines - immunomodulatory
Interferons - antiviral & immunomodulatory
Tumor necrosis factor
Colony - stimulating factors - affect growth of blood cells
Erythropoietin
- stimulates RBC growth
What are the 5 classes of immune globulins?
IgG
IGA
IgM
IgE
IgD
What the 5 important roles in cell mediated immunity? ( the immunoglobulins )
Immunity against pathogens that survive inside cells
( viruses, some bacteria )
Fungal infections
Rejection of transplanted tissues
Contact hypersensitivity reactions
Tumor immunity
Effects of aging on immune system
Elderly Patients have higher incidences of cancer because
The primary impact of aging on the immune function is on T cells, which are important immune surveillance and tumor immunity
( shrink thymus -> T cells less )
What other 4 things of aging should we look out for in immunity?
Greater susceptibility to infection
Increase autoantibodies
( more prone to attack good cells within their body )
Lowered cell mediated immunity
Thymus shrinks with age
What is hypersensitivity reactions mean?
How many types are there?
It can what two reactions?
People coming in with some form of allergic reactions
4
Immediate or delayed
What immunoglobulin is In charged of allergic reactions?
IgE
Type 1 igE
The first exposure to allergen causes what ____ antibodies to form and attach to ___?
IgE
Mast cells
What does subsequent exposures mean for type 1 igE ( allergic reactions?)
Causes mast cells to release chemical mediators
( histamines, leukotrienes, prostaglandins )
Subsequent exposures to allergic reactions leads to what?
The more you are exposed to that allergic reaction, the worse it’s going to become
In which where even oral medications are not going to help control that hypersensitivity reaction
Type 1 IgE release causes what? (6)
Smooth muscle contraction
Increase vascular permeability
Vasodilation
Hypotension
Increase mucous production
Itching
Instead of giving a patient oral antihistamines, we are going to end up giving them what for type 1 igE?
Epi-pen
Epi-pen is what?
Short acting & reversible effects
Epi pen does what?
Vasoconstriction
Type 1 igE
Anaphylaxis - means what?
Severe reaction
Occurs within minutes & life
threatening
Anaphylaxis TYPE 1 igE
Have an atopic reaction
Which type of symptoms will they have ^^ (5)
Allergic rhinitis
Asthma
Atropic dermatitis
( inflammation of skin )
Angioedema
( life threatening; edema of airway)
Urticaria
( itchy skin )
Is Angioedema a life threatening emergency?
Why?
Which it’s always important to assess?
Yes
Edema of your airway
Their airway then intervene !
Different types of reactions we will see are ? (3)
Type 1 IGE
Wheal & flare
( mosquito bite & allergy testing )
Urticaria
( hives )
Angioedema
( airway obstruction, involves face, hands, feet, gi tract, genitalia )
Type 2 of hypersensitivity reaction
Cytotoxic & Cytolytic
Which is what immunoglobins & does what?
IgG and igM directly binds to antigen on cell surface
Cellular destruction results
When thinking of cytotoxic & cytolytic type 2 hypersensitivity reactions, you want to think what?
Why?
Blood transfusions
Causes hemolytic destruction
Type 2 cytotoxic & cytolytic
Hemolytic transfusion reactions (3)
Goodpasture syndrome
( farmer coming into the emergency room, respiratory distress from being exposed to pesticide )
Graves disease
Cytomegalovirus
Type 3 immune complex reactions
What is it?
It can be happen when/where? (3)
Associated with what?
Tissues damage results from antigen and antibody complexes
( IgG or igM binding with antigens )
Local, systemic immediate or delayed
Autoimmune disease
( SLE, RA, CMV )
What are the common sites for type 3 immune complex reactions? (5)
Kidneys
Skin
Joints
Vessels
Lungs
Type 4 delayed hypersensitive reaction
What is it/happens when?
What are T lymphocytes doing?
Macrophages are doing& causes?
Examples of this? (4)
Cell mediated immune response, 24-48 hours post exposure
Attack antigens or release cytokines
Macrophages and macrophage released enzymes cause tissue destruction
Metals, position ivy, medications, PPD
Allergic disorders
We want to ask what?
We might even ask them to do what test?
History and physical exam
Skin test
Allergic disorders
Will have what elevated?
Immunodeficiency is present if lymphocytes is less than what?
Eosinophils (IGE)
1200
Allergic disorders
How would we preform Treatment ? (3)
Environmental control
Medication
Immunotherapy
Anaphylaxis
What are the steps to help (4)
What are we administrating?? (6)
Recognize reactions - stop trigger
( clean their mouth or remove )
Airway support
Prevent of spread when possible
( cleaning everything )
Administration of O2, IV Access, epinephrine, nebulizer albuterol( vasodilator ) , Diphenhydramine, steroids ( inflammation )
If not treating anaphylaxis, it can lead to what?
So we must prepare for what?
Shock??
Intubation & Tracheostomy
Latex allergy can be what two types of reaction?
We want to prevent it how?
What syndrome?
1 or 2
Asking for allergic
Latex food syndrome
What is an organ transplant ?
Surgical procedure where healthy organ is removed from a donor and placed into a recipient
For organ transplant, patients are placed on what type of medications?
Immunosuppressants
Nurses should always monitor the risk of what for organ transplants??
Rejection
What’s the treatment of a patient with acute rejection of an organ transplant? (2)
Additional immunosuppressants
Decrease exposure to infection
( viral pneumonia, graft versus host disease, burns )
What is standard precautions?
Hand hygienes & gloves
( Acquired by contact blood, body fluids, non intact skin, rashes, mucous membranes )
contact precautions
What you wear?
It’s what type of contact?
Examples ?
Gloves, hand hygiene, gown
( masks and eye protection if you want )
Direct or indirect contact with patient environment & objects
C.DIFF & MRSA.
Droplet precautions
Examples on what is droplet ?
Patient is placed in what type of room?
What would we wear?
Example of droplet infection
Sneezing, coughing, talking, close contact with patient breathing
Individualized rooms
Mask, clean hands,eye protection, gown
Influenza
Airborne precautions
What do you wear?
What are examples of airborne?
What type of room you want these patients in?
Gloves, gown, eye mask , N95 respirator mask
TB, anthrax, measles, chickenpox
Negative pressure room
( air is sucked inwards )
What is a nursing bundle?
Simple sets of evidence based practices that, when implemented collectively, improve the reliability of their delivery and improve patient outcomes
Foley catheter patients
( prevent infection from occurring ; groups of activities as a nurse are acquired to do )
Central line
Associated bloodstream infection ( CLABSI )
These are commonly used in?
It’s the most common what?
ICUS, dialysis units, intraoperatively, and with oncology patients
HAI from central line ( PICC )
Implementation of central line insertion and maintenance bundles reduces the incidence of CLABSIS (5)
Daily review of central line
Prompt removal of unnecessary lines
Disinfection prior to manipulation of the line
Daily chlorhexidine washes
Disinfect catheter hubs, ports, connectors
Bundle for the prevention of catheter associated urinary tract infections ( CAUTI )
It’s the most common what?
You want to do 4 things?
Most common HAI
Avoid use of urinary catheters
Aseptic technique
Daily assessment
Keep drainage bag below the level of patient bladder
Bundle of the prevention of ventilator associated pneumonia ( VAP )
What do you want to do as a nurse to help ? (3)
Elevate HOB 30-45 degree
Daily assessment to wheene VAP
Daily oral care with chlorhexidine
