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Krista/ 2 Advanced Physical Assessment and foundation of Nursing Anesthesia 2 > Immune System - Levi's lecture > Flashcards

Immune System - Levi's lecture Flashcards

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1
Q

When does your immune system begin to develop?

A

approx. 6 wks

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2
Q

What are some of the functions of the immune system?

A

Support
Protection
Vitalize Functions
Maintain Homeostasis

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3
Q

What are two types of Specific Immunity?

A

Innate

Acquired (adaptive)

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4
Q

Innate immunity has three ways of prohibiting or destroying bacteria. What are they?

A

Phagocytosis
Integumentary
Antibodies

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5
Q

What are the 2 branches of Acquired (adaptive) Immunity?

A
  • *Humoral (B-lymphocytes produced in bone marrow and plasma cells)
  • *Cell Mediated (T-lymphocytes produced in Thymus)
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6
Q

How is Acquired Immunity developed?

A

Resistance is developed after entrance of foreign pathogens into the body. T-lymphocytes produce antibodies and B-lymphocytes produce Immunoglobulins (Ig)

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7
Q

What are two ways of developing Non-specific immunity?

A
  • Vaccinations (can produce acquired immunity)

- Passive immunity (antibodies given to provide protection; breast feeding)

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8
Q

How is an allergic reaction started?

A

Foreign pathogen stimulates antibodies to attach to mast cells and basophils –> release of histamines

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9
Q

What is Anaphylaxis?

A

A systemic hypersensitivity that is IgE mediated.

Causes release of tissue mast cells and peripheral blood basophils.

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10
Q

Is anaphylaxis rapid or delayed in onset?

A

Rapid - can occur in seconds to 30 mins.

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11
Q

What is hypotension during anaphylaxis attributed to?

A

Increased capillary permeability which can cause a fluid shift up to 50%.

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12
Q

What is the difference between anaphylactic and anaphylactoid reactions?

A

Anaphylactoid reactions are Non-IgE mediated responses.
Looks the same as a anaphylactic reaction.
*May take greater amount of exposure to produce a reaction than anaphylactic

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13
Q

What are the 4 groups of hypersensitivity?

A

Type I. Anaphylaxis
Type II. autoimmune hemolytic anemia
Type III. Immune complex disease (SLE, Rheumatoid, Glomerulonephritis)
Type IV. Delayed (contact dermatitis, graft rejection)

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14
Q

Which drugs are the most commonly associated with allergic reactions?

A
  • Muscle relaxants (60%)
    - Rocuronium in females r/t cosmetics
  • Latex 15%
  • Antibiotics (5-10%)
  • Opioids (<5%)
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15
Q

How would you treat a non-life threatening allergic reaction?

A
  • Epinephrine
    • Adult 100-500 mcg SQ or IM q 10-15min
    • Child 10mcg/kg (500 max) q 15min x 2 then q 4 hr
  • Benadryl 1-2mg/kg or 25-50mg IV
  • Corticosteroid (questionable)
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16
Q

How would you treat a life threatening allergic reaction?

A
  • Epi 50-100 mcg IV
  • Cardiovascular support, CPR, pressors, fluids
  • 100% O2
  • Bronchodilators
  • H1 antihistamine (Benadryl)
  • H2 Blocker (Pepcid, Zantac)
  • Corticosteroid
17
Q

What are some common food allergies a person may have if they also have a latex allergy?

A

Bananas, Kiwi, Mangos

18
Q

What are the types of allergic reactions a person could have to latex?

A

Type I (anaphylaxis) or Type IV (Dermatitis)

19
Q

HIV/AIDS pts - _____% can have an abnormal EKG

_______% can have pericardial effusions

A

50% - EKG

25% - Pericardial effusion

20
Q

What are two major concerns with HIV/AIDS?

A
  • Infection to the pt

- Infection of the staff

21
Q

What types of infections are HIV/AIDS pt’s most susceptible?

A

Bacterial, Viral, Protozoal, Fungal

**PNUEMOCYSTIS CARINII or PC pneumonia (fungal pneumonia) is most common cause of AIDS related death

22
Q

What exposure places a healthcare worker at greatest risk of getting HIV/AIDS?

A
  • needle stick with open bore needle
    DO NOT RECAP THESE NEEDLES
    -small risk for infection after splash to mucous membranes
23
Q

what should you do after exposure to fluids from HIV/AIDS pts?

A
  • Wash and clean the area
  • Get immediate baseline test (you & pt)
  • Empirical treatment with 2 or more antiretrovirals (within 1-2 hrs or within 1-2 wks)
  • Seroconversion in 6-12 wks
  • Periodic testing for 6 months
24
Q

What are some common presenting symptoms of SLE?

A
  • polyarthritis and dermatitis
  • Malar rash (1/3 of pts)
  • Renal disease (>50%)
  • *Renal disease is most common cause of death
25
Q

What does SLE place these pts at high neurological risk for?

A

Seizures, stroke, dementia, neuropathy, psychosis

26
Q

What does SLE place these pts at high cardiac risk for?

A 
pericardial effusion (>50%)
**tamponade is rare
27
Q

What are some common meds used for treatment of SLE?

A

Corticosteroids
Antimalarials
Immunosuppresants

28
Q

What can cause exacerbation of symptoms in SLE?

A

Infection
Pregnancy
Surgical stress
Drugs - Over 80 different ones

29
Q

What kind of pulmonary issues can a pt with SLE have that would give us the biggest anesthesia concerns?

A 
Prone to Pleural effusion
Pneumonitis
Alveolar hemorrhage
Pulmonary HTN
***end result is a restrictive defect
30
Q

What kind of airway changes would lead to anesthesia concern for SLE pts?

A

Cricoarytenoid arthritis

recurrent laryngeal nerve palsy

31
Q

What might a pt with SLE need perioperatively to help prevent low blood pressure?

A

corticosteroids

32
Q

One of the medications a pt with SLE might be taking, Cyclophosphamide, inhibits plasma cholinesterase. What anesthetic concerns would this cause?

A

Inhibits plasma cholinesterase -Could prolong the action of Ester LA and Succs

33
Q

For HIV/AIDS pts, some meds can induce Cytochrome P450 system. What kind of anesthetic implications could this have?

A

It speeds up metabolism or other meds that require the CyP450 system could have a shorter duration of action.

34
Q

Anesthetic implications for scleroderma

A
  • May require fiber optic intubation
  • Bleeding with airway manipulation
  • Chronic HTN (therefore have hypovolemia)
  • GERD due to hypotonesis of LES
  • Pulmonary HTN (avoid acidosis, hypoxemia)
35
Q

What anesthesia technique may be preferred in Scleroderma pts?

A

Regional - offers advantage of peripheral vasodilation and post-op pain control

36
Q

What are some medication considerations when taking care of pts with RA?

A
  • may need steroid supplementation during surgery
  • could be taking Cyclophosphamide (plasma cholinesterase inhibitor)
  • platelet disfunction due to NSAID use
37
Q

What are some airway problems with pts with RA?

A

Cervical joints could be affected - neck extension may be limited. Could cause Atlantoaxial subluxation

  • small mouth opening due to temporomandibular joint issues
  • generalized swelling and edema to laryngeal area
  • Consider fiberoptic or glidescope intubation

Krista/ 2 Advanced Physical Assessment and foundation of Nursing Anesthesia 2 (8 decks)

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