Immune System Flashcards
skin layers
- epidermis - outer
- dermis - 2nd layer, bulk of skin
- subcutaneous - attaches skin to underlying structures
chemical mediators to cell injury
chem in the plasma that is activated by cell injury is called Hageman Factor (XII)
Hageman Factor activates what?
- Kinin system
- Clotting cascade
- Plasminogen system - starts dissolution of clots
Kinin system and role
Bradykinin role -
- local vasodilation
- stimulate nerve endings to cause pain
- causes release of arachidonic acid - > release of autocoids
types of autocoids
- prostaglandins - stim or block inflammation
- leukotrienes - can cause vasodilation, increased capillary permeability. can also block these reactions
- thromboxanes - cause local vasoconstriction and facilitate platelet aggregation and blood coag
order of inflammatory process
- rubor - red; increased blood flow (vasodilation)
- tumor - swelling; fluid leaks into tissues
- calor - heat
- dolor - pain; activated pain fibers
tx for bee sting
ice
scrape out stinger
antihistamine if necessary (benedryl)
tx for twisted ankle
R - rest
I - ice
C - compression
E - elevation
tx for injection site
ice
Bone marrow function
produces stem cell -> myelocytes, lymphocytes (both WBC)
myelocytes -> inflammatory and immune response
lymphocytes - T (mature in thymus - cell mediated) and B cells (bone - humoral)
types of myeloid stem cells
granulocytes
monocytes
types of granulocytes
neutrophils
mast cells
basophils
eosinophils
types of monocytes
macrocytes = macrophages
neutrophils action
60% of WBC
first to arrive, increase during infection (shift to L) - band cells increase
patrols tissues - squeeze out of capillaries
# increases during infection
short lived after phagocytosis
dead neutrophils make up pus
basophils action
circulation
emit chem substance to initial and maintain immune inflammatory response - histamine and heparin
mast cell action
incapable of circulation
found in resp, GI, skin
release chem mediator to stim inflammation and immune response
macrophage character
larger than neutrophil
found in organs
made in bone marrow (monocytes), called macrophage when enter organ
long lived
initiate immune response as they DISPLAY ANTIGENS from pathogens
antigen
substance with protein coat that causes immune system to produce antibodies
may be foreign substance
may be formed within body (bacterial toxins of tissue cells)
lymphocyte products
T lymphocytes - helper T 4, suppressor T8, cytotoxic T cells
B lymphocytes - plasma cells and memory cells
where is stem cell found
bone marrow
where do B cells go after they mature
lymph nodes and spleen, also circulate in blood
what is the purpose of t and b cells in circulation
come into contact with pathogens and each other
when are helper T cells activated.
activated when they recognize an antigen for example macrophage membrane or infected cell
what do t helper cells secrete
cytokines
what is action of T helper cells
secrete cytokine to help B cells divide and stimulate macrophages.
action of cytotoxic T cells (CD 8)
aka killer T cells
kills body cells displaying antigen
action of T suppressor cells
suppresses immune system
action of memory T cells
remains in body. faster immune response when recognizes antigen again
function of plasma cells (B)
produce antibodies (Ig)
Memory Cells action
divide rapidly as soon as antigen is reintroduced
pathogen can be destroyed before symptoms show
factors that affect immune system negatively
stress anxiety fear social isolation lifestyle choices
action of salicylates
inhibit synthesis of prostaglandins
ie: ASA
NSAIDS action
blocks COX 1 and COX 2 (enzymes)
inhibits synthesis of prostaglandins
steroidal anti inflammatory agents
prednisone (deltasone)
Key components of protection
- skin, mucous - 1st line of defense
- bone marrow - WBC
- Lymphoid tissue - fight pathogens. includes tonsils
- chem mediators - triggered by inflammatory reaction
- Interleukins 1 - regulate growth and differentiation of lymphocytes
Aspirin properties
antipyretic
anti inflammatory
anticoag
analgesic
s/e of aspirin
GI upset/ulcer Prolonged bleeding anemia - Hb 14g/dl hemorrhage ototoxicity (tinnitus)
nursing interventions for aspirin
DO NOT GIVE before surgery give with food/milk monitor for bleeding monitor Lv fx prevent injury DO NOT GIVE WITH OTHER FOOD DRUGS THAT PROLONG BLEEDING
with whom should you never use aspirin
children with viral infections (reyes syndrome)
clients with LV dysfx
clients in last trimester of pregnancy
NSAIDS Ibuprofen (Advil) actions
decrease inflammatory response without interfering with immune response of body’s ability to fight infection
for mild to mod pain mgmt - RA, OA, gouty arthritis
dysmenorrhea
Advil interventions
Give with food - aggravates St lining
Gouty arthritis
deposits of needle like crystal of uric acid.
inflammation begins in big toe
tends to be chronic
what is action of celecoxib (celebrex)
inhibits synthesis of prostaglandins - blocks COX 1 COX 2 enzymes
name 2 propionic acids
feneprofen
ibuprofen
name 3 acetic acids
diclofenac
etodolac
indomethacin - used for gout
fenamates (1)
mefenamic acid
c/i for NSAIDS
presence of allergy to NSAID or salicylate CV dysfx or HTN peptic ulcer or known GI bleeding pregnancy, lactation Caution with LV KD dysfx
indications for NSAIDS
s/s/ RA OA
mild to mod pain
primary dymenorrhea
fever reducer
NSAID a/r
GI upset
n/v, diarr
LV dysfx - prolonged bleeding
consideration for advil
give with food, milk
monitor for effectiveness
monitor LFT’s - ALT, Ast, alkaline phosphotase, bilirubin, PT/ PTT
uricosurics are for?
tx gout
how does uricosuric work?
decrease reabsorption of and enhances excretion of uric acid
examples of uricosurics
allopurinol/zyloprim - chronic gout
colchicine - acute gout
probenecid
s/e of anti gout meds
altered urine pH -> more alkaline -> kd stone
diarrhea - f/e imbalance, impaired skin integrity
nursing consideration for uricosurics
monitor uric acid level
encourage fluids unless c/i
teach client avoid high purine foods
which type of foods have purines
organ meat
shellfish
sardines
prednisone (deltasone) is an example of?
steroidal anti inflammatory
actions of steroidal anti inflammatory
used to decrease the inflammatory response and or suppress the immune system
indications for steroidal anti inflammatory
head trauma
asthma mgmt
addison’s disease (deficient glucocorticoids)
organ transplant patients
s/e of prednisone
immunosuppressant - masks infection increased appetite weight gain hyperglycemia elevated BP GI upset/ulcer buffalo hump moon face Hirsutism
define hirsutism
hairy face and body esp in women
examples of steroid anti inflammatory agents
prednisone decadron solumedrol solucortef cortisone
consideration for prednisone
give at same time q day give with food/milk monitor bs monitor for infection do not d/c abruptly - taper
acetaminophen(tylenol) actions
acts directly on thermoregulatory cells of hypothalamus
thought to inhibit prostaglandin synthesis
used to treat pain and fever assoc with variety of conditions including flu.
prophylaxis of children getting DPT immunization
relieves musculoskeletal pain assoc with arthritis
examples of anti inflammatory agents
tylenol
gold compounds
anti arthritis drugs - solganal
peak time for tylenol
.5- 2 hours
tylenol a/r
h/a, hemolytic anemia, Kd dysfx, skin rash, fever, hepatotoxicity, increased bleeding
interactions - oral anticoags increase bleeding
action of gold compounds, indications
absorbed by macrophages, resulting in inhibition of phagocytosis
decreased tissue destruction
how long do gold compounds take to be effective
3-6 months
c/i for gold compounds
a/r and interactions
c/i - allergy, diabetes, CHF, Kd Lv impairment
a/r - stomatitis, glossitis, gingivitis, bone marrow depression, dermatitis
interaction - penicillamine, antimalarials, cytotoxic drugs, immunosuppressive agents
other antiarthritis drugs
aurothioglucose (solanal)
etanercept (enbrel)
anakinra (kineret)
off label - choroquine (aralen) - antimalarial - used for long term RA; notify MD Of blurring vision
vaccine types
- microbes that have been killed
- microbes hat are alive but weak
- bacterial toxins called toxoids modified to remove hazards
titer
presence of an antibody
measure to assess effectiveness of vaccines
active immunity
immune system stimulated to produce antibodies due to exposure to antigen (vaccine)
passive immunity
obtained by directly administering antibodies to patient
is only temporary
natural immunity
active - result of infection
passive - transfer from mom to baby
artificial immunity
active - result of vaccine
passive - injection of serum with antibodies
indications for vaccines
stim active immunity in people who are at risk
depends of exposure the person will have to pathogens
thought to provide lifelong immunity - sometimes needs booster
c/i for vaccines
immune deficiency pregnancy allergies to any part of vaccine pt who received Ig or blood or blood products w/i last 3 months presence of infection and fever
a/r of vaccines
fever, rash, malaise, chills, fretfullness, drowsiness, anorexia, vomiting, PAIN RED SWELLING AT INJECTION SITE
education for vaccines for adults
pneumonia x1 - can get booster if
immune sera definition
sera that contain antibodies to specific bacteria or viruses
types of immune sera
antitoxin
antivenom
spider or snake bites
indications for immune sera and toxins
provide passive immunity to a specific antigen or disease
used a prophylaxis against specific disease after exposure
may lessen the severity of disease
caution with immune sera and antitoxins
hx of severe rxn to any immune sera cautions: preg coag defects previous exposure to immune sera rash n/v chills fever
allergic reaction to immune sera/ antitoxin
chest tightness, decreased BP, difficulty breathing
local reaction - swelling, tenderness, pain, musc stiff at site
monitor client >1 hr after injection
examples of impaired immune system
chronically ill - need immunizations elderly - monitor infections, esp UTI pt on immune suppressant therapy pt on chemo pt with disease that suppress immunity - HIV
immune stimulators - bio response modifiers action
used to energize the immune system when it is exhausted from fighting
prolonged invasion or needs
help fight specific pathogen or cancer cell
which cells help fight specific pathogen or cancer cell
interferons
interleukins
T/B/ modulators
immune suppressant actions
drugs used to block or suppress the actions of t cell and antibody production
used to prevent transplant rejection and treat autoimmune dz
which are used to prevent transplant rejection and tx autoimmune dz
t/b cell suppressors
monoclonal antibodies
steroids
types of immune modulators
interferons - act to prevent virus particles from replication
interleukins - stim immunity by increasing the activity of natural killer cells; aldesleukins (proleukin)
t/b cell modulators - ie: levamisole
action of t/b cell suppressors
block antibody production, inhibit suppressor and helper t cells
monoclonal antibody action
produced by a single clone of b cell that react with specific antigens
interferons definition
naturally occuring glycoproteins used for their ability to interfere with viral replication, suppress cell proliferation, enhance macrophage activity and increase cytotoxicity of lymphocytes for target cells
types of interferons
alfa - from leukocytes injected into wart
beta - from fibroblasts (connective tissue cells)
gamma - from fibroblasts and lymphocytes
action of interferon alfa 2b (intron A)
prevents virus particle from replicating inside other cells
stimulates interferon receptor sites on non invaded cells to produce antiviral proteins
inhibits tumor growth and replication
caution for interferon alfa
teratogenic
c/i for interferon alfa
a/r
allergy, pregnancy, lactation
caution in cardiac, myelosuppression, CNS dysfx
a/r - lethargy, myalgia, arthalgia, anor, nausea, h/a, dizzy, bone marrow depression
interleukin definition
chemicals produced by t cells to communicate bet leukocytes (type of cytokine)
types of interleukin
aldesleukin (proleukin) - human, made by DNA tech using E Coli
Oprelvekin (neumeg) - newer
action indication of aldesleukin
increase # of natural killer cells and lymphocytes
activate cellular immunity and inhibit tumor growth
for specific Kd carcinoma and possible tx of AIDS and AIDS related disorder
indication for oprelvekin
prevention of severe thrombocytopenia after myelosuppressive chemo - stimulates growth of platelets
c/i for interleukin
known allergy to e coli products, pregnancy, lactation
caution with Kd Lv Ht impairment
a/r - lethargy, myalgia, arthalgia, fatigue, fever, resp difficulties, hypotension, bone marrow suppression
levmisole (ergamisol) action/indication
stimulates b cells to stim antibody formation, enhancing t cell activity
used for tx of duke’s stage C colon cancer
peaks in 1.5-2 hrs. 1/2 life 16 hrs
c/i levamisole
a/r
interactions
allergy, pregnancy, lactation
use barrier protection
a/r - h/a dizzy, ataxia, n/v diarr
interaction - disulfiram type rxn, increased phenytoin level, ETOH
azathioprine action
prevents rejection in renal hemotransplants
tx RA
cyclosporine action
suppresses rejection in variety of transplants
tx RA and psoriasis
glatiramer acetate (copaxone) action
reduces # of relapses in MS adult pt
mycophenolate mofetil (cell cept) action
prevents rejection after Kd Ht transplant in adult
sirolimus (rapamune) action
prevents rejection after Kd transplant
Tacrolimus (Prograf) action
prevents rejection after LV transplant
cyclosporine
inhibits dna synthesis
c/i - allergy, preg, CNS & LV disease
interactions - monitor for toxicity due to multiple interactions
a/r cyclosporine
increased risk for infection and neoplasm development
LV toxicity
Kd toxicity and dysfx
Pulmonary edema
possible h/a, tremors, 2nd infections such as acne, GI upset, diarr, HTN
fatigue and flu like sx
interventions for cyclosporine
s/s of infection
teach pt avoid risk of infection (flowers, fresh fruit, raw febbies)
monitor i/o
teach about importance of LIFE LONG COMPLIANCY
anakinra (kineret) action
tx RA
block activity of interleukin 1
peak 3-7 hr
1/2 life 4-6
c/i for anakinra
a/r
interaction
allergy, preg, lact, Kd impairment
a/r - h/a, sinusitis, nausea, diarr
interaction - etanercept may cause severe, life threatening infection
muromonab CD3 (orthoklone OKT3) action
antibodies attach to specific receptors - antibody to T cells
c/i, a/r, interaction for muromonab CD3
c/i - allergy and fluid overload
a/r - pulm edema, fluid retention, flu like sx
interaction - severe immune suppression
