Immune system Flashcards
what produces WBCs, RBCs, B-lymphocytes
Bone marrow: produces a type of stem cell that is able to produce all types of blood cells. (RBC,WBC and platelets), which then differentiate into the cells of the hematologic and immune system. B lymphocytes are produced and mature in the BONE marrow and they play significant role in humoral response.
Where do T-lymphocytes reside until needed
The THYMUS gland, behind the sternum in the mediastium, is the place where T cells mature and are released into the blood stream.
What system do the tonsils and spleen belong to?
lymphatic system
Immune system Infants/young:
- Neonates are susceptible to infection due to an immature immune system.
- The thymus gland is largest during childhood and adolescence. After adolescence it begins to shrink in size and its production of T lymphocytes decreases.
Immune system Elderly
- Aging causes skin to become thin, less elastic, and more prone to injury. The skin is the first barrier to defense against pathogens.
- Decreased ciliary action in the respiratory tract and GI tract results in decreased removal of potentially harmful organisms.
- the presence of chronic diseases can decrease the immune response.
Inflammatory response
Recognition microorganisms or unknown antigens causes the body to immediately launch a defense because the tissue damage created by the invading microorganisms releases certain chemicals within the body. These chemical triggers, such as histamine , lead to the activation of the inflammatory response, which then, causes the blood and lymphatic systems to deliver certain WBC, lymphocytes, proteins , and other nutrients to the effected area. Trauma, pathogenic microorganisms, chemicals, or heat may cause injury to tissues inside or outside of the body. Redness, swelling, warmth, and tender to the touch. Blood flow is increased to the area by dilating the blood vessels/lymphatic vessels upstream of the injury, resulting in warmth and redness. The same substances also effect downstream vessels, causing vasoconstriction and swelling. If the effects of swelling are not quickly controlled, the edema can compress nerve endings surrounding injury leading to pain. - may be enough to kill the invading organisms by creating hostile environment. Protective proteins that are activated include the complement system.
Antigen
Foreign substance or component of cell that stimulates immune response
Antibody
Specific protein produced in the humoral response to bind with antigen
Innate
(natural) immunity is non specific. In humans when they are born, making them less susceptible to animal diseases. The body has the ability to recognize certain microorganisms as harmful, even without prior exposure
Cell-mediated response (weeks to produce antibodies)
Helper T Cells
Killer T Cells
Memory T Cells
Suppressor T Cells
Complement system
- Proteins produced in the LIVER that work with antibodies to help kill invaders
- Especially useful in viral infections
Immunity Key Points
B-Cells and T- Cells must work together for proper immunity
T-Cells provide defense against VIRAL infections
Immune response
-Proper response and invader is wiped out
-Improper response and
-Immune deficiency
-Autoimmune disease ( T-cells fault)
-Iatrogenic –treatment for one condition causes decreased immunity*
Alcohol consumption—decreases the effectiveness of B-cells to produce antibodies (2 drinks)
Immunization
- Contraindications
- Fever
- Pregnancy
- Decreased immunity
- Allergies
- Blood transfusions 6-8 weeks –prior
Nursing Key Points
- further investigate if pt has active infection without clinical signs
- If pt has recurrent infections or extreme infections from those organisms that typically do not cause much harm.
- Signs of shock? decreased BP, tachycardia, cold/clammy, diaphoretic
SIRS and Septic shock
ch45 pg 1037
Thymus
Gland located in the mediastinum, large in children, decreasing size in adults; site of maturation and proliferation of lymphocytes.
Lymphatic tissue
contains many lymphocytes; filters body fluids, removes foreign matter, immune response
Neutrophils (non specific)
WBC;for phagocytosis; non specific defense; active in inflammatory process
Basophils (mast cells) igE
WBC; bind immunoglobulin E; release histamine in anaphylaxis.
Eosinophils (allergic resp)
WBC; participate in allergic responses
monocytes
WBC: migrate from blood into body tissues to become macrophages
macrophages
phagocytosis; process and present antigens to lymphocytes for the immune response
Mast cells
Release chemical mediators such as histamine in connective tissue
B lymphocytes
Humoral immunity-activating cell becomes an antibody- producing plasma cell or or B memory cell.
T- Lymphocytes
WBC; cell mediated immunity. T cells respond to viruses on the surface of cells. T cells and macrophages produce
Memory T cells
Remember antigens and quickly stimulate an immune response upon re-exposure
Helper T cells
Activate B and T cells; control or limit the immune response.
First-line of defense
Skin, tears, earwax, mucus membranes, and urinary tract. All provide external barriers to prevent foreign microorganisms from entering the body.
Immune and Lymphatic systems
- Work together to defend against threats from multiple sources inside and out of the body.
CNS
Transports chemical messages that the body is under attack to the brain.
Complement system
works with the inflammatory response. Several of these protein enzymes, when sequentially activated, form a “ membrane attack complex” (MAC) that embeds itself into the cell membrane of the attacking microbe. This activation occurs when there is an exposure of complement binding sites on antibodies after they attach to antigens. This binding allows for a break in the cell wall allowing ions , such as salt, to enter the cell. the salt followed by water causes swelling and bursting of the microbe.
Immune response
The immune response is a remarkable series of complex chemical and mechanical activities that take place in the body. They include 1. Constant surveillance to detect entry of foreign agents (antigens) as soon as they gain access to body’s cells. @. immediate recognition of antigens as “non self” 3. The ability to distinguish one kind of foreign agent from another, and remember it it again if it enters the body at a later time. The thymus gland, lymphatic system, spleen, lymph nodes, bone marrow, peyers patches.
Deficiency of immune response
- Lack of appropriate response, immunodeficiency is present.
- Body produces an immune response to a “self” cell or tissue, causing autoimmune disease.
-Massive trauma
-Chronic illness
can inhibit immune response.
BOdy’s response to foreign substance has been detected and identified. the body responds in two general ways.
- It immediately produces a protein called ( an antibody). that is specifically designed to kill the antigen. The immediate response is called a HUmoral response.
- Cellular or cell mediated response. T lymphocytes,
Humoral
refers to any fluid of semifluid. there is also a delayed response that involves the use of sensitized lymphocytes to attack whole cells, such as bacteria, viruses, and malignant (cancer) cells.
Types of antigens
Bacteria, viruses, fungi, infectious microorganisms, toxins, non living matter, pollen, dust, chemicals, , some foods,
Primary Humoral response
Lymphocytic B cells are involved in humoral immunity and the production of antibodies. And the production of antibodies, they arise from stem cells in the bone marrow and undergo a maturation process that involves bone marrow stromal cells (Cells that contribute to the development of multiple tissues and blood cells)
Stromal cells
(Cells that contribute to the development of multiple tissues and blood cells) and their cytokines (messenger hormones). When mature, the B cells migrate to the lymph nodes. When the stimulated by an antigen, a B cell becomes a plasma cell that secrete immunoglobulins called antibodies in response to the specific antigen they encounter. This antibody mediated or Humoral immunity. Some of the antigen stimulated B cells become memory cells.
acquired immunity
Some of the antigen stimulated B cells become memory cells. This mechanism is the basis for acquired immunity. The memory cells cells reactivate the plasma cells to produce large quantities of the specific type of antibody needed to fight for the particular type of antigen, when the same antigen, when the same antigen enters the body a second time. It is an immediate and potent response, and antibodies continue for many months.
Immunoglobulins
when the body is exposed to harmful substances, the immune system produces antibodies, which are a type of proteins synthesized by plasma cells. these antibodies are called immunoglobulins.
Immunoglobulins (GAMED)
IgG
IgG: 75-85% ; blood plasma; Major antibody in primary and secondary immune responses; activates complement system; inactivates antigen; neutralizes toxins; crosses placenta to provide immunity for newborn; responsible for Rh reactions.
Immunoglobulins (GAMED)
IgA
IgA: 5-15%; Tears, Saliva; Mucus; breast milk; GI, Pulmonary, Prostatic, vaginal fluids; Protects mucus membranes on body surfaces; provides immunity for newborn; prevents antigens n food from being absorbed.
Immunoglobulins (GAMED)
IgM
IgM:5-10 %; Attached to B cells ; released into plasma during immune response. First Ig to respond to microbial invasion ; activates complement systems; causes antigens to clump together; responsible for transfusion reactions in the ABO blood typing system.
Immunoglobulins (GAMED)
IgE
IgE:0.5; Produced by plasma cells in mucous membranes and tonsils; Binds to mast cells and basophils, causing release of histamine; responsible for allergic reactions; helps fight parasitic reactions; helps fight off parasitic invasion.
Immunoglobulins (GAMED)
IgD
IgD: 0.2; Attached to B cells: Receptor sites for antigens on B cells; binding with antigen results in B cell activation.
Immunoglobulin attachment
Each immunoglobulin is able to attach to the kind of antigen for which it is made. The antibody’s ability to form a bond with its antigen, but it can sometimes result in damage to the bodies own cells. Antibodies are found in the serum of blood and in other body fluids and tissues, including tears, saliva, breast milk, spinal fluid, interstitial fluid, lymph nodes, the spleen and urine. An antibody can either destroy or inactivate its particular antigen by. 1. Mechanically harming it. 2. Activating a complement system or 3. Causing the release of chemicals that affect the environment of the antigen.
Toxin
If the antigen is a Toxin (poison) produced by a bacterial or viral cell, the antibody produced to fight it is an antitoxin. This antitoxin is capable of neutralizing the poisonous chemical of the antigen by covering the antigenic agent. An antitoxin is therefore a specific type of antibody that acts through the process of neutralization.
Macrolides (Mycin)
Pg. 740
USED FOR : Respiratory, GI, skin, soft tissue, STIs, bacterial infections. NURSING PROCESS: Administer at least 1 hr prior and 2 hrs after meals.
IM administration is generally not recommended. TEACHING/SAFETY: Gastric irritation, nausea, vomiting, diarrhea, abnormal taste. All mild effects and will resolve with continued use. Do not stop taking medications. DRUG INTERACTIONS : Birth control and many other numerous medication interactions.
Cephalosporins
Cefepine, ceftriaxone, cephalexin (-CEF)
USED FOR : for patients who are allergic to penecillins (WITH CAUTION) UTI, Resp/abd infection, bacteremia, meningitis, osteomyelitis
NURSING PROCESS: ABaseline vitals and CBC
ASSESS FOR ALLERGIES
Monitor I & Os
TEACHING/SAFETY: Oral care after admin
Take antacids and iron supplements 2 hours before or after to avoid inhibiting absorption. DRUG INTERACTION: Probenecid (toxicity) Alcohol Oral contraceptives
WARAFIN (increased anticoagulant effect)
Penicillins (cillin) 743 Amoxicillin Ampicillin Oxacillin Pen G
USED FOR :Bacterial Infections; UTI’s, Gonorrhea & Syphilis, Otis Media NURSING PROCESS:Monitor electrolytes, bowel function, assess infection, and s/s anaphylaxis TEACHING/SAFETY:Seizure precautions Notify Dr. if fever & diarrhea develop, do not take antidiarrheals consult with Dr. Signs of superinfection DRUG INTERACTION: Antacids Probenecid Methotrexate (serious toxicity) Warfarin Allopurinol
Quinilones ( floxacin)
Levofloxacin
ciprofloxacin
ROOT: floxacin
USED FOR :Broad spectrum antibiotics, UTI’s, skin and soft tissue infections, respiratory infections…Treats gram + and gram – and some anaerobes
NURSING PROCESS:Assess for infection, take vitals, assess allergies, review labs and cultures, and ensure patients are not pregnant.
TEACHING/SAFETY:Take as directed. Take 4 hours before or after iron ,zinc, and didanosine – lowers absorption. May cause drowsiness or dizziness
Can be taken with food.
Wear sunscreen – phototoxicity
Ototoxicity possibility
DRUG INTERACTION:Iron and zinc; Avoid NSAIDs
Avoid some heart medications
Theophylline can cause toxicity
Sulfonamides
Sulfadizine
Co-trimoxazole
Pg. 748
ROOT: SULF- AZOLE
USED FOR :UTI, otitis media, prevention of strep in patients allergic to penicillin, Traveler’s diarrhea, acute bronchitis, prevent pneumonia in immunocompromised pts.
NURSING PROCESS:Baseline vitals and CBC, ASSESS FOR ALLERGIES, Monitor I & Os
TEACHING/SAFETY: Drink plenty of water throughout the day to prevent crystal formation in urinary tract. Protection from sun/ u/v light, repeat labs if taken>14 days. Report tinnitus, headache, dizziness.
DRUG INTERACTION:
Oral hypoglycemic
Warfarin
Methotrexate
Phenytoin
ACE inhibitors
Tetracyclines (Demeclocycline (Declomacin) Doxycycline (Vibramycin) Minocycline (Minocin)
ROOT: Cycline
USED FOR :Pts with PCN allergies. Tx of certain venereal diseases, UTIs, Upper respiratory tract infections, PNA, and meningitis. Useful against skin (ACNE), rickettsial, micoplasmic infections
NURSING PROCESS: PO medications with exception of doxycycline, take medication 1 hr before or 2 hrs after eating a meal or having mild and dairy products as it inhibits absorption. Don’t give to children under 8. Do not use while breastfeeding as it can change the color of the infants teeth, use different birth control.
TEACHING/SAFETY: N/V, anorexia, ABD cramps, Diarrhea, photosensitivity, teeth coloring, loss of appetite
Take with full glass of water not milk. Take full prescription
Do not double the doses, take missed one as soon as possible.
DRUG INTERACTION: Antacids
Calcium, Iron, Cholesterol medication, Birth control pills,
PCN, Dairy products/mild
Antitubercular agents
isoniazid INH, (pg751)
rifampin Rifadin (pg 752)
USED FOR : Used to treat tuberculosis And a strain of meningitis. And influenza type B.
NURSING PROCESS:Assess lung sounds, character and amount of sputum
Monitor hepatic function due to extreme hepatotoxicity
Take on an empty stomach at least 1 hour before or 2 hours after meals with a full glass of water
TEACHING/SAFETY:Teach patients to notify if yellow skin and eyes occur (hepatotoxicity) anorexia, unusual tiredness, weakness occurs
Let them know that all of their bodily secretions can be tinged an orange color. Decreases oral contraceptives
DRUG INTERACTION:Carbamazepine
Theophilline
Phenytoin
All decrease absorption
Zyvox
oxazoldinones class
USED FOR :VRE and MSRA
+gram Microorganism
Community acquired pneumonia
NURSING PROCESS: Watch for vision function with tx over 3months
Monitor bowel function signs of pseudomembranous colitis
Obtain culture and sensitivity
Assess infection
TEACHING/SAFETY: Take as directed
Take full dose
Avoid lg. quantities of tyramine ex. (Chocolate, beer, coffee ,soda, yogurt)
Report diarrhea, bloody stool and adb. cramping
DRUG INTERACTION: MAO inhibitors, vasopressors, dopaminergic, SSRI’s, phenytoin, phenobarbital, meperidine, buspirone
Flagyl
ROOT: Dazole
USED FOR :Treatment of anaerobic infections(skin/skin structure, CNS, lower respiratory tract ,bone/joints, intrabdominal, septicemia, ) trichomonias, amebias, anti-biotic assoiated pseudomembranous cholitis. Topical Rx rosacea.
NURSING PROCESS:Assess wound and culture
Give with food to decrease GI upset. XR- on empty stomach 1hr before or 2 hrs after meals
Baseline assessment
Bowel activity; stool consistency
TEACHING/SAFETY: Urine may be red-dark brown , avoid alcohol, cough syrups; elixers x48hrs. Refrain from sexual contact
Watch fornumbness/tingling/hands and feet, Seizures, Can cross placenta and breast milk
DRUG INTERACTION: Alcohol, Disulfiram, oral anticoagulants
Concurrent corticosteroids
Vancomycin
ROOT: mycin
USED FOR : Gram (+) bacteria-strep, staph, c-diff, listeria-life threatening infections.
NURSING PROCESS: Assess hearing/renal function/allergies. Adjust dosage for renal impairment. Rapid administration causes severe hypotension. Assess IV site. Check for anaphylaxis.
TEACHING/SAFETY: Report changes in urination/hearing/secondary infections. Finish meds. Use secondary birth control.
DRUG INTERACTION:Use with skeletal muscle relaxants causes respiratory depression. Monitor concurrent oto/nephron toxic agent use.
Topical antifungals
Nystatin, meconozole
ROOT: ZOLE
USED FOR : Decrease skin irritation and resolution of variety cutaneous fungal infections: thrush, diaper rash, athletes foot, jock itch, ringworm, tinea versicolor, dandruff onychomycosis of fingernails and toes, yeast infections (nystatin)
NURSING PROCESS:Inspect involved areas frequently ; Cleanse area properly before applying; wear gloves/wash hands; apply small amount to cover affected area completely; avoid the use of occlusive wrappings or dressings unless directedNystatin oral sol: swish before swallowing- do not drink anything for about 20 min afterwards
TEACHING/SAFETY:report burning itching, local hypersensitivity reaction, redness, stinging; avoid the eyes; caution pts that some products may stain fabric, skin, or hair. Nystatin vaginal: do not use tampons during therapy
DRUG INTERACTION:Either not known or insignificant; some products contain alcohol or bisulfites and should be avoided in pts with known tolerance
B lymphocyte
That is specific for that bacterium or an antigen. The B lymphocyte becomes a plasma cell that secretes IgM (antibody) , which attacks the bacterium or antigen. After the particular bacterium or antigen is encountered for the first time, it takes 4-8 days for B lymphocyte to produce immunoglobulins that can attack.
Antigen-Antibody Response
is to provide protection against acute, rapidly developing bacterial and viral diseases. the antigen-antibody response is also involved in allergic and transfusion reactions.
Secondary cellular response
The second type of immunologic response of the body involves various interactions with antigens by T lymphocytes. . Unlike the humoral response, which takes place in the plasma, the cellular response involves whole cells called sensitized lymphocytes and occurs out in the tissues. They are said to be sensitized because they have been made sensitive to a specific antigen after their first contact with it.
Common fears of dying patient
- the unknown
- abandonment
- loss of relationships
- loss of experience in the future
- dependency or loss of independence
- pain
Kubler-Ross stages of dying
- Denial (This cant happen to me!)
- Anger (Why me!)
- Bargaining ( yes me, but)
- Depression (its me.. I give up)
- Acceptance ( I’m ready)
Immunoglobulins, and order B cells present them MADGE
Immunoglobulins, and order B cells present them MADGE
(character from the old dishwashing liquid commercial):
IgM
IgA
IgD
IgG
IgE
· Order of presentation by B cells (which is made first, IgD or IgM?) B cells
present IgM primarily, and then IgD.
Just remember why all of us are going through this pain…to become M.D’s. For a
B cell to be competent, it must get its MD.
· Finally, by the same rule, B cells must first release M then G
immunoglobulin on primary exposure.
Dendritic cell: function DENDRITIC CELL:
Disguised in host tissue (but still have same function!)
ECF ingestion
Nothing left to chance (ensures an immune response)
Derived from bone marrow
Regulates the immune response
Induces an immune response (makes it unique among antigen presenting
cells)
Transfers information from the ECF into the cell
Immune tolerance (increases it)
Co-ordinates the adaptive and innate immune systems
Captures and processes antigen
Expresses lymphocyte costimulatory molecules
Llong processes extend from cell (stellate shaped)
Lives in lymphoid tissue
Secretes cytokine to initiate immune response
Celiac sprue features CELIAC:
Cell-mediated autoimmune disease
European descent
Lymphocytes in Lamina propria/ Lymphoma risk
Intolerance of gluten (wheat)
Atrophy of villi in small intestine/ Abnormal D-xylose test
Childhood presentation
· Atrophied villi cause less absorption, so diarrhea, weight loss, less energy.
Immunoglobulins: which crosses the placenta
Immunoglobulins: which crosses the placenta IgG
crosses the placenta during Gestation.
Passive vs. active immunity
"Pay for Passive,
Active Ages":
Passive:Pay for a shot of antibodies for fast results following
exposure to Rabies, etc.
Active: Slow onset ("aging") and memory.Histamine: features HISTAMINE:
HCL production Inflammation Strong vasodilator Therapeutic vaue none Allergy Mast cells Neurotransmitter/ Narrow airways IgE
T and B cells: types When bacteria enter body, T-cell says
to B: “Help Me Catch Some!” B-cell replies: “My Pleasure!”:
· T-cell types: Helper Memory Cytotoxic Suppressor · B-cell types: Memory cell Plasma cell
Acute inflammation features SLIPR:
Swelling Loss of function Increased heat Pain Redness · "What a cute pair of slippers" can be used to tie acute inflammation to SLIPR.
Lupus signs and symptoms SOAP BRAIN:
Serositis [pleuritis, pericarditis] Oral ulcers Arthritis Photosensitivity Blood [all are low - anemia, leukopenia, thrombocytopenia] Renal [protein] ANA Immunologic [DS DNA, etc.] Neurologic [psych, seizures]
HLA-DR genetic predisposition immune disease examples HLA-DR:
Hashimoto's disease Leukemia/ Lupus Autoimmune adrenalitis/ Anemia (pernicious) Diabetes insipidous Rheumatoid arthritis
Complement cascade initiating items: alternative vs. classic
Classic: Combined Complexes.
Alternative: Activators Alone, or IgA.
· Complexes are made of Ab and Ag combined together.
· Examples of activators: endotoxin, microbial surface.
Corticosteroids: adverse side effects CUSHINGS BAD MD:
Cataracts Up all night (sleep disturbances) Suppression of HPA axis Hypertension/ buffalo Hump Infections Necrosis (avascular) Gain weight Striae Bone loss (osteoporosis) Acne Diabetes Myopathy, moon faces Depression and emotional changes
Cancer drugs: time of action between DNA->mRNA ABCDEF:
Alkylating agents Bleomycin Cisplastin Dactinomycin/ Doxorubicin Etoposide Flutamide and other steroids or their antagonists (eg tamoxifen, leuprolide)
TB ANTIBIOTICS
TB: antibiotics used STRIPE: STreptomycin Rifampicin Isoniazid Pyrizinamide Ethambutol
Tumors that metastasize to skin BLOCK:
Breast Lung Ovary Colon Kidney
Prognotic factors for cancer: general PROGNOSIS:
Presentation (time & course) Response to treatment Old (bad prog.) Good intervention (i.e. early) Non-compliance with treatment Order of differentiation (>1 cell type) Stage of disease Ill health Spread (diffuse)
Lung cancer: main sites for distant metastases BLAB:
Bone
Liver:lymph
Adrenals
Brain
Lung cancer: notorious consequences SPEECH:
Superior vena cava syndrome Paralysis of diaphragm (Phrenic nerve) Ectopic hormones Eaton-Lambert syndrome Clubbing Horner syndrome/ Hoarseness
TIGAN (Trimethobenzamide hydrochloride): indication TIGAN:
This Is Good Against Nausea
Mole: signs of trouble ABCDE:
Asymmetry Border irregular Colour irregular Diameter usually > 0.5cm Elevation irregular
Pituitary endocrine functions often affected by pituitary-associated
tumor “Go Look For the Adenoma Please”:
· Tropic hormones affected by growth tumor are: GnRH LSH FSH ACTH Prolactin function
Esophageal cancer: risk factors ABCDEF:
Achalasia Barret's esophagus Corrosive esophagitis Diverticuliis Esophageal web Familial
Colon carcinoma: aeitiology CRAPS:
Chronic ulcerative colitis Ratio of animal fat:fibre diet Adenomatous polyps Familial Polyposis Strong family history of colon cancer.
Oral cancer risks PATH LAB:
Plummer-vinson syndrome Alcohol Tobacco Human papilloma virus Leukoplakia Asbestos Bad oral hygiene
Lung cancer: presentation ABCDE:
Snowball turned to Avalanche Blood: hemoptysis Cough Distruption to airway in bronchus-->pneumonia whEEzing
Breast cancer: risk assessment “Risk can be assessed by
History ALONE”:
History (family, previous episode) Abortion/ Age (old) Late menopause Obesity Nulliparity Early menarche
Carcinomas having tendency to metastasize to bone “Particular
Tumours Love Killing Bone”:
Prostate Thyroid Lung Kidney Breast
Hodgkin’s lymphoma classification A:
Hodgkin’s lymphoma classification A: Asymptomatic
B: Bad
Hospice facets HOSPICE:
Home Outpatient Support groups Pain medication/ Physical needs Inpatient Counseling End-stage (terminal) illness/ Emotional needs
Healthy lifestyle modification DRAINS:
Diet Reduce weight Alcohol reduced Improve circulation (exercise) No other disease Smoking stopped
Placenta-crossing substances “WANT My Hot
Dog”:
Wastes Antibodies Nutrients Teratogens Microorganisms Hormones/ HIV Drugs
Pain history checklist DOCS ARE FIT:
Duration Onset Character Site Associatied symptoms Radiation Exacerbating and relieving factors Frequency Intensity Timing
Breast history checklist LMNOP:
Lump Mammary changes Nipple changes Other symptoms Patient risk factors
Cigarette smoke: major carcinogens PANT:
Polynuclear aromatic hydrocarbons Aromatic amines Nitrosamines Tar · Nicotine and Carbon monoxide are Non-Carcinogenic.
Neoplasm
New tissue growth
Benign
- Centralized
- Non metastasize
- Encapsulated ((fibrous capsule) that restricts the growth of , and spread of the neoplasm to other parts of the body) . But benign neoplasms can still impede the function of near by organs.
Malignant
- Traveled to other tissues
- can be transported by blood and body fluids
- entering new body cavity
- it is possible during surgery for free malignant cells to be directly transplanted from one organ to another, when gloves or instruments have these cells and serve as vehicles.
Prostate CA sites of metastasis
- bone esp spine and legs, pelvic lymph nodes
LABS TO CONFIRM
TNM STAGING
- T- primary TUMOR
- N- regional NODES
- Metastasis
- The number written beside each letter indicates how much the CA has metastasized
TNM —T
- T0- no evidence of primary tumor
- TIS- carcinoma in situ
- T1, T2,T3, T4 progressive in SIZE and INVOLVEMENT
TX- tumor cannot be assessed
TNM- N
N0- regional lymph node not demonstrably abnormal
N1,N2,N3- increasing degrees of demonstrable abnormality of lymph nodes
NX- regional lymph nodes cannot be assessed.
TNM-M
M0- No evidence of metastasis
M1,M2,M3- ascending degrees of distant metastasis, including metastasis to distant lymph nodes
M4- Multiple organ involvement
Causative factors CA
- AGE
- Genetics
- Immunocompromised
4.
PROMOTORS CA
Highten CA risk dont cause cancer
- ETOH
- Nitrate
- Chronic Irritation
Intrinsic factors CA
predisposing factors
- AGE
- SEX
- RACE
DIET AND CA
30% could be reduced with proper nutrition
Vitamin C cancer inhibitor
prevention of cancer
Screening -Mammogram 40 Sigmoidoscopy Q5y Age 50 Pelvic yearly, 40 q2years Testicular and breast exams
Cancer warning signals
0
Optimism in cancer treatment
66% of cancer patients are survivors
Neoplasm
Abnormal cell replication results in neoplasm ( new growth of tissue, or tumor)
Malignant
The cells of malignant (uncontrolled growth that can lead to death) growths are quite different from normal cells. cells that exhibit malignant growth are known as cancer. Cancerous growth changes a cells DNA makeup and function of cells that are replicated.; hence cancerous cells dont look or behave like normal cells.
Malignant cells
- Cell is large and irregular
- Doesn’t follow replication rules . Cant stop multiplying
- Offspring of CA cells proliferate in mass quantities and they grow more disorganized.4. Some CA cells take on a new shape so they no longer look like the original tissue.
4 their demand for the bodies nutrients depletes the supply of nourishment for normal cells.
Classifying of tumor/cancer
Tumors are classified according to the organs or tissue in which they first begin to grow; alternatively , tumors are classified according to the substances in which they are formed.
Suffix -oma
simply means TUMOR; the suffix -oma can designate any swelling , including a swelling in which there is a collection of fluids , as well as a swelling containing malignant cells. like HEMAt-oma bruise meaning blood swelling or collection of fluid.
Prognosis CA
DEPENDENT ON HOW MUCH MALIGNANt cells have attacked body tissues.
In Situ
a localized growth that remains in its original site. and has not yet released its cells. , even though the growth may have invaded underlying tissues. At this stage the disease is much more easily destroyed.
A regional/advanced malignancy
is one in which cells from the original malignancy have spread to the body area around the tumor, such as nearby lymph nodes. The spread has been limited by the body’s protective mechanisms. these cells may continue to grow, and multiply, and if the regional cancer is not successfully treated, malignant cells will eventually break away and spread throughout the body. This creates an advanced cancer that is often FATAL>
Causative factors CA
- All CA results from defects in the DNA of genes.
- Defects in DNA are either inherited, or caused by a mutation( permanent change in the DNA sequence of a gene) from chemicals or radiation.
Oncogenes
Mistakes in the instructions inside of a cell’s DNA, where by newly created cells are no longer normal. This new defected gene tells cells to multiply at a much higher rate. also, the defective coding prevents the abnormal cells from dying and being reabsorbed. The result is a tumor or a mass.
Tumor suppressor genes
are healthy, normal genes that control the growth of cells in the body. each persons body has the abillity to with stand the effects of carcinogens ( cancer causing agents), to mount a healthy immune response, and repair damaged DNA.
carcinogens ( cancer causing agents)
Certain chemicals, sources pf radiation, and viruses, hormones, inherited genes.
Asbestos, benzene, tobacco,ETOH, ionizing radiation, sun, Diethylsibestrrol, Estrogens, synthetic androgens, Vinyl chloride, aromatic amines, arsenic (inorganic), Chromium, Nickel dust, Chronic hep Bor C, Human T cell lymphotropic Virus type I, HPV, Phenacetin,Alkylting agents (used for chemo), cyclosporine( used to prevent transplant rejection)
AGe as a factor CA
- More susceptible
- immunocompetence ( or the ability for ones immune system to deal with foreign cells- bacterial, viral or malignant)
- 76% of CA happens in people 55 and older.
Chemical carcinogens CA
Occupations that deal with repeated exposure to dangerous carcinogens when handled or inhaled. Petrofluorocarbons (polychlorinated biphenyls or PCBs) and some pesticides DDT. these chemicals
1. Decrease immunocompetence
( Pitch, asphalt, crude parafin, petroleum products) smog, aniline dyes, Benzene in gasoline linked to leukemia.
Marlboro SMOKING
- known cause of CA in lung, esophageal, pancreatic, bladder, kidney.
- encourage those who smoke to stop.
- 90% of cancers in men and 79% in women linked to smoking
- Smoking and ETOH use together is the cause of other cancers.
Immunosuppressive drugs CA
- cause Non Hodgkin’s lymphoma
2. Synthetic estrogens linked to higher rates of endometrial CA
Promotors CA
not carcinogenic when found alone, but when they are in the body with a known carcinogen, cancer occurs faster. ETOH is such a substance. When ETOH and smoking are combine CA occurs at a faster rate. HEAD AND NECK CA
Causative factors CA
- chemical carcinogens
- Promotors
- chronic irritation
- radon gas
- viruses
- genetic predisposition
Chronic irritation CA
Long term irritation to skin and mucus membranes. Contributing factor to CA. there has to be a mole UV exposure
2. has a negative effect on the immune system decreasing immunity and making the person more susceptible to malignant cell growth.
Radon gas CA
higher incidence of malignancy
Viruses CA(ONCO Viruses) because of their abillity to cause CA.
Hepatitis B virus is carcinogenic for liver CA. Epstein barr virus causes burkitts lymphoma. Cases of adult T-cell leukemia and lymphoma are caused by human T cell lymphotrophic virus . HPV cervical/ throat CA.
CA cell transformation
After the cells transformation (change into something else) of a normal cell into a precancerous state, the malignant cell requires many conditions to be favorable to its multiplication and growth into a CA tumor. - this happens when virus introduces new DNA into a normal cell and transforms it into a malignant one Cell reproduction can be altered when viruses interact with carcinogens.
genetic predisposition
- Breast CA mom or sister b4 age 50
2. Gene markers, Colon, Breast, Prostate, Pancreatic,leukemia.
RACE CA
- Melanoma-
Intrinsic factors CA
- AGE
- Sex
- RACE
Predisposing factors for certain types of cancers. - STRESS
- DIET &nutrition
Prostate CA
- African American MALES
Cervical CA
- Black WOMEN
Breast CA
White WOMEN
Stress CA
- Considerable stress over long periods decreases immune system; making it less effective and riddling the body with invading organisms and decreases the bodies ability to destroy abnormal cells.
- Death of a partner increases likelihood of developing CA.
DIET CA
- 30% of CA could be reduced through proper nutrition and exercise. CA of breast, colon, endometrium, esophagus, rectum, uppermost abdomen, gallbladder,pancreas, liver, and kidney. all linked to excess weight and obesity. High fiber foods recommended over fatty foods.
Measures to prevent CA
- Diet and nutrition
Encourage normal weight. - ETOH moderation
- Environment -fertilizers, pesticides, industrial wastes, local water supplies, filtered or bottled H2o
Nutritional considerations CA
- eat varied diet balanced nutritional intake with exercise, maintain healthy weight.
- limit red meat, eat fish 2x week, increase omega 3. limit other fat particularly transfat.
- eat 5 or more servings fruit or veggies daily, containing betacarotene, tomatoes, onions, garlic, citrus, red&blue fruits, cabbage, broccoli, Brussels sprouts, kohlrabi, cauliflower, carrots, yellow squash, sweet potatoes, red grapes, berries, red chemicals.
- whole grains over processed or refined.
- moderate ETOH to less than 2 drinks daily for men, 1 women.
- Avoid smoked, salt cured, nitrate cured, and charred.
Avoiding ad limiting exposure to carcinogens
- Knowing which substances used in the household, yard, and areas of recreation and at the place of work are carcinogenic and using protective measures against them can decrease exposure.
- The use of protective clothing, gloves, and mask as appropriate when spraying pesticides or chemical cleaners or strippers greatly decreases exposure.
- being certain the area is well ventilated when using chemical cleaners.
- thoroughly washing hands and any exposed skin after using compounds containing carcinogens.
Describe the modes of transmission for HIV.
Standard precautions, blood, body fluids, tissue any break in skin or mucus membranes is an entry for hiv. Sexual men having sex with menMSM, heterosexual, bisexual, anal/vaginal intercourse. Blood products,
list the tests used to confirm the diagnosis of HIV.
Enzyme linked immunosorbent assay ELISA- normal value negative. HIV antibody screening test (positives must be confirmed with western blot) Antibody assays don’t confirm HIV in the earliest stages of the disease HIV antibody may be detected normally from 2 weeks to 6 months from the acute infection. False positive ELISA may be seen in the prescence of maternal antibodies.
Western blot: HIV ANTIBDY TEST
POLYMERASE CHAIN RXN (PCR) a quantitive measurement of cell proviral DNA/
IMMUNOFLUORESENT ANTIBODY ASSAY (IFA)
CD4 COUNT: normal 500-1500 values below 200 prompt treatment
SENTINEL INFECTIONS
opportunistic infections that indicate immunosupression. Oral thrush, recurrent yeast infections. symptoms appear much like flu: fever, fatigue, loss of appetite, diarrhea, fatigue, rashes, night sweats, swollen lymph glands, significant weight loss. pneumonia, memory or movement problems.
Discuss the presentation of at least one opportunistic infection that is viral, bacterial, fungal, and parasitic.
Herpes simplex 1 &2, cytomegalovirus(CMV)- TRANSMITTED BY CONTACT TO BODILY FLUIDS HANd t mouth contact can be passed to fetus. retina may cause blindness. GI tract causing abnormal cramps , diarrhea, weight loss and anorexia) Painful swallowing related to ulceration of esophagus and colitis, svere SOB, dyspnea on exertion, memory loss, muscle weakness, paralysis personality changes. , varicella zoster VSV SHINGLES. Mycobacterium Tuberculosis latent TB, ususally found in lungs but mTB is found in CNS, skin, bone, GI tract, liver, spleen. Mycobacterium avium MAC, respiratory/GI/bone marrow/circulatory system night sweats becomes an issue when CD4<100. fungal Cyrptococcosis found on pigeon droppings and in the soil. Histoplasmosis- ohio, missouri, Mississippi bat and bird droppings, coccidiodomycosis valley fever soil cutaneous rash, candidasis sore throat and taste perceptions. pneumocystic jiroveci. TOXOPLASMOSIS protozoan wild game, lamb, venison cats, CRYptosporidiosis parasite, large volume, foul smelling watery diarrhea.
•Identify the nursing diagnosis needed for a patient with AIDS.
Risk 4 infx elevated body temp impaired gas exchange impaired skin integrity imbalanced nutrition pain r/t pressure activity intolerance ineffective coping disturbed sensory percepton self care deficit
Explain wasting syndrome and nursing interventions
wasting malnutrition –assess patients ability to chew food, and swallow. Record I&O, administer antiemetics, assess availability of food , assess caretakers ability to meet patients nutritional needs. Administer dietary supplements as needed. Wasting syndrome is losing more than 10% in body weight along with at least 30 days of diarrhea or weakness accompanied by fever. strong correlation to progression of HIV , leads to death. decreased appetite, inability to absorb nutrients altered metabolism referral to nutritionist. small meals frequently, high calorie snacks, foods @ room temp, soften breads in milk prior to eating, non abrasive easy to swallow foods pasta, well cooked eggs, baked fish, soft cheese, pudding, ice cream, ice pops, AVOID: raw fruits and veggies unless thoroughly washed
spicy acidic or salty foods
excessivly hot foods
TEACHING HIV
nurses must assess risk behaviors & implement individualized POC teaching, understandable information that dispels myths and fears associated with becoming HIV infected. Reduces HIV #’s by education.
. Minorities highest risk- socioeconomic status – access to health care –health belifes – high cost HAART , don’t use spermicidal agents,
additional laboratory studys after HIV diagnosis
CD$, quantitative plasma HIV-RNA level (viral load) to see progression, DRUG resistance test (genotype mutations/ phenotype viral replication) - determine which ART will be the most effective). CBC assess for anemia, leukopenia, thrombocytopenia. ELECectrolytes, BUN, creatinine, Liver enzymes, Cholesterol, tryglycerides, STI, Toxoplasma gondii IGg - detects prior exposure if Dx complications and CNS difficulties when CD level <100. HEP ABC determine if vaccination is needed/
Kaposi sarcoma
mone of the most common causes of malignancies in hiv pos caused by herpes virus 8. discolored areasof skin, mouth, lungs, intestines. can range from pink, red,purple darkens over time. caused by the formation of many tiney blood vessels and cancer cells under the skin.
Lymphomas
Tumors of the tissues and cells in the lymphatic system. non hodgkins is the #1
Anasarca
generalized massive edema trunk and extremities, around eyes.
