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S4 2539 > M7 Immunity > Flashcards

M7 Immunity Flashcards

1
Q

SIRS
Systemic inflammatory response syndrome

A

Action of intrinsic immune factors

Can be triggered by infectious or non-infectious origin

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2
Q

Sepsis

A

Systemic due to infection inflammation aka, Severe SIRS,

Response is now systemic

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3
Q

When sepsis becomes severe it complicates the function of

A

organs

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4
Q

Septic shock
Systemic response S/S

A

Hypotension
Inadequate perfusion

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5
Q

SIRS cause types

A

Infectious or noninfectious
If infectious = sepsis

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6
Q

Patients at risk of septic shock

A

Immunocompromised
Infants
Elderly

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7
Q

SIRS/Sepsis Patho

A

Initial infection produces HUGE inflammatory response

Response exerts a harmful effect on Vascular, Coagulation and Immune systems

Immune systems becomes SO overwhelmed that is now works against the body

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8
Q

To correct the sepsis hyperimmune response, the body produces anti-inflammatory substances that

A

Create a period of immune depression increasing risk of nosocomial infections

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9
Q

4 PRIMARY patho changes in sepsis/sirs

A

Myocardial depression
Vasodilation
3rd spacing (of plasma)
Microemboli

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10
Q

SIRS is identified by 2 or more symptoms of

A

Fever
Hypothermia
Tachycardia
Tachypnea
Leucocyte changes

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11
Q

To recap sepsis is

A

SIRS due to INFECTION

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12
Q

Inflammation =

if unchecked it will result in

A

Coagulation

reduction in blood to limbs and organs

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13
Q

Where does sepsis occur most often

A

In hospitalized people

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14
Q

The balance of what 2 systems determines sepsis outcome

A

Systemic inflammatory response SIRS
Counter anti-inflammatory response CARS

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15
Q

Common causes of SIRS

A

Infection
Trauma
Pancreatitis
Surgery

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16
Q

Wounds and devices that put people at risk of infections

A

Wounds
burns, ulcers

Devices
Catheters, drains, breathing tubes

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17
Q

S/S of SIRS/sepsis

breathing
urine
hr
gi

A

Hyperventilation
vUrine
^HR
N/V/D

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18
Q

Labs for SIRS/Sepsis

A

Blood
Urine
CBC

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19
Q

Monitoring procedures for SIRS/Sepsis

A

Vitals
Blood chemistry
ABGs

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20
Q

What organs to monitor for SIRS/Sepsis

A

Kidney
Liver

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21
Q

Visual scans for infection

A

Xray
CT
Ultrasound

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22
Q

Vasodilation with sepsis leads to what complications

A

drop in BP
increase in HR to compensate
crackles in lungs
hypoxemia due to lack of pressure

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23
Q

Hypoxemia with sepsis leads to what complications

lungs
a/b

A

rapid breathing to compensate
respiratory alkalosis
metabolic acidosis

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24
Q

SIRS CRITERIA
NEED 2 to diagnose

A

Temp over 100.4 or under 96.8
HR over 90
Resp rate over 20
PaCO2 less than 32mmHg
WBC greater than 12000 or less than 4000

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25
Q

Skin indicators with SIRS/Sepsis

A

Cap refill greater than 3 sec
Mottling
Significant edema

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26
Q

Renal and hepatic labs with SIRS/Sepsis

A

^Bun
^Creatinine
^Urine specific gravity

^ALT AST
^Lactate

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27
Q

Nursing goals with SIRS/Sepsis

A

Normal tissue perfusion
Normal blood pressure
Normal organ function

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28
Q

Septic shock, how to monitor patients status

A

Vitals
Mental
Urine output
Hemodynamics (fluid excess of deficit)

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29
Q

How to treat sepsis low BP

A

Add fluids via IV

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30
Q

What to monitor for oxygenation with sepsis

A

PaO2 SpO2
MAP
CO
Hemoblobin

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31
Q

To assess fluid status with septic shock monitor

A

I&O
Daily weight

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32
Q

Diabetic sepsis lab to view

A

GLUCOSE

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33
Q

Shock indicator on the ECG

A

ST changes

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34
Q

MAP should be above

A

60

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35
Q

What to give with angina

A

Nitro

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36
Q

Vasogenic shock management drug classes

A

Antibiotics
Antihistamines
Epinephrine
Antiinflammatorys

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37
Q

HIV 101

A

Retrovirus
Destroys CD4 lymphocytes

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38
Q

HIV is carried in the

A

RNA

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39
Q

HIV stranded RNA MOA

A

serves as blueprint for host to produce destructive cells

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40
Q

What body liquids does HIV travel in

A

Semen
Vaginal secretions
CSF
Breast milk
Amniotic fluid
Saliva
Tears
Blood

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41
Q

When is Vomit urine or stool contaminated with HIV

A

If it has blood

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42
Q

CD4 T are also know as

A

Helper Ts

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43
Q

For HIV to replicate it involves what enzymes

A

Integrase
Protease
Transcriptase

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44
Q

What HIV med classes block interference with the Inegrace protease and transcriptase enzymes

A

NNRTI
NRTI
PI

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45
Q

B cells make HIV-specific antibodies resulting in

A

Activated T cells mounting an immune response

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46
Q

HIV CD4 T destruction exceeds body production resulting in

A

Impaired immune function

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47
Q

Normal T count
Problems start at what count
Severe immunocompromise at what count

A

1200-800
less than 500
less than 200

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48
Q

Age risk for HIV

A

13-24
over 50

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49
Q

Other risk factors for HIV

A

Socioeconomic status
Lifestyle
Environmental factors
Drugs
Other illnesses

50
Q

Zoonotic diseases

A

Transmitted from animals to humans
HIV is one of em

51
Q

HIV antibodies may not be detectable for

A

6 months

52
Q

During this 6 month undetectable window can HIV still be trasmitted

A

YES

53
Q

HIV diagnosis should be confirmed by how many method

A

At least 2

54
Q

Since HIV is transmittable during the undetectable phase, this implication for healthcare workers means

A

BE CAREFUL

55
Q

3 stages of HIV

A

Acute or primary
Clinical latency
AIDS

56
Q

Acute/primary HIV

A

flu like symptoms at best
CD4 may fall rapidly

57
Q

Clinical latency HIV

A

asymptomatic
HIV produces at low levels
May last 10 years if ART is administered

58
Q

AIDS HIV stage
Acquired immunodeficiency syndrome

A

Immune failure
3y survival rate
T less than 200

Opportunistic for infections and secondary cancer

59
Q

When is HIV most transmittable

A

Acute primary
and
AIDS

60
Q

What becomes compromised with HIV

A

Defense barriers
Lymph system
Innate and adaptive immunity

61
Q

Comprehensive history for HIV

A

Presence of risk factors
Known exposure
Current meds for hiv
Opportunistic infections
Secondary cancer

62
Q

S/S of Initial or Primary infection with HIV

A

Flu like (fever, sore threat, N/V, headaches)
Stomach pain
Lymphadenopathy
Skin rash

63
Q

S/S of AIDS

A

Malaise/fatigue
Night sweats
Weight loss
Oral lesions
Seizures
Neuropathy

64
Q

Time between HIV and aids is smaller for

A

Children

65
Q

Diagnostic tests for HIV

A

Rapid antibody
ELISA
Westernblot
RT-PCR

66
Q

Panels that will be altered with HIV

A

CBC
Kidney
Liver
Fasting lipid
Fasting glucose

67
Q

Viral load

A

Number of HIV particles in plasma

68
Q

Undetectable viral load means

A

Load is less than detectable parameters
Does NOT mean pt is cured or that disease is untransmutable

69
Q

Primary HIV prevention

A

Prevent manage and modify personal risk factors

70
Q

Secondary HIV prevention
Screening and diagnosis for

A

HIV Co-infections
Opportunistic infections
Secondary cancers

71
Q

HIV Co-infections

A

Hep B
Hep C
Tuberculosis
STDs

72
Q

Tertiary HIV prevention

A

Infection prevention
Rest/exercise routines
Stress and anxiety control
Med regiment
Anti-HIV meds

73
Q

Basic health practices with HIV

A

Avoid groups
Hand hygiene
Get immz
Good skin care and personal hygiene

74
Q

HIV ART or HAART
Antiretroviral therapy

A

Minimum of 3 anti-HIV drugs from at least 2 different drug classes daily

75
Q

Different HIV drug classes

A

NRTI
NNRTI
PI
Fusion inhibitors
CCR5 antagonists
Integrase inhibitors

76
Q

NNRTIs
NRTIs
PIs

MOA

A

top 2 block transcriptase
3rd blocks protease

77
Q

Fusion inhibitor meds MOA

A

block HIV from entering CD4

78
Q

CCR5 antagonist meds MOA

A

CCR5 is a protein on CD4 cells needed for transmission

these meds block it

79
Q

Integrase inhibitors MOA

A

HIV cant copy self

80
Q

Collaborative HIV interventions
Usually late stages

A

Nutritional therapy
Oxygen therapy

81
Q

Surgical HIV interventions

A

Chest tube
Lobectomy
Pneumonectomy

82
Q

What organs can be transplanted

A

Kidney
Heart
Liver
Lungs
Pancreas
Stomach & Intestines

83
Q

Allograft

A

Transplant from a non-identical donor
(not a twin)

84
Q

Organ rejection involves both _ and _ immunity

A

Humoral
Cell mediated

85
Q

Cell involved in organ rejection

A

T&B lymphocytes
Antibodies
Cytokines

86
Q

Organ rejection can occur how quickly
or how long after

A

within 24 h
months or years

87
Q

S/S of organ rejection

A

Inflammatory response (pain fever)
and
specific signs related to organ

if kidney - creatinine bun
if liver -ATL AST

88
Q

To stop rejection of organ, pt will need

A

Immunosuppressant drugs

89
Q

Hyperacute rejection

A

Minutes to hours

occurs due to existence of prior antibodies from blood transfusions or pregnancies

90
Q

Acute rejection

A

Weeks or months
Lymphocytes that activate against donor antigens

91
Q

Chronic rejection

A

Months to years after acute rejection

92
Q

To prevent rejection, tissue typing is done prior
this process invovles

A

Human leukocyte antigen compatibility HLA
Percent reactive antibodies PRA

93
Q

You want HLA
human leukocyte antigen compatibility to be

A

Identical

94
Q

You want PRA
Percent relative antibodies to be

A

Not existent
You want no antibodies reacting to donors organ

95
Q

PRAs are done how often

A

Monthly

96
Q

Immunosuppressant drugs

A

Calcineurin inhibitors
Rapamycin inhibitors
Antiproliferative agents

Antibodies
Corticosteroids

97
Q

Calcineurin 101

A

inhibits T lymphocytes and cytokines

side effects
nephrotoxicity, neurotoxicity, diabetes mellitus

98
Q

Rapamycin 101

A

inhibits T & B cells

side effects
neutropenia, delayed wound healing

99
Q

Antiproliferative agents 101

A

Suppress B&T

100
Q

Poly and monoclonal antibodies for immunosuppressants

A

Block both humoral and cell mediated response

Used for acute rejection

Has multiple side effects

101
Q

By using multiple drugs for immunosuppression at the same time…

A

Lower dosages can be used reducing risk of side effects

102
Q

Immunosuppressants can also contribute to

A

Melanomas
Lymphomas
Other cancers

103
Q

History before giving immunosupp

A

Acute and chronic infections
History of cancer
Lifestyle - poor nutrition, smoking

104
Q

Nursing diagnosis for immunosupp

A

Ineffective med regimen
Risk of infection
Risk of injury
Social isolation

105
Q

Priority nursing actions for post organ transplants

A

Correct admin of immunosuppressant
Monitor for rejection
Monitor for drug effect
Prevent infections

106
Q

OTCs and herbals when on immunosupp

A

Not without permission

107
Q

key to immunosupp admin

A

consistent manner regarding time/day/food or no food

108
Q

Early signs of organ rejection

A

Not feeling well
Flu like symptoms
Pain and swelling at transplant site
Organ decline

109
Q

To determine organ function it is important to show to which appts

A

Lab tests

110
Q

For each immunosupp drug prescribed give teaching in what format

A

Written and verbal

111
Q

What herbs suppress immune system

A

Ginseng
St Johns wort

112
Q

what juice alters absorption of immunosupp

A

Grapefruit

113
Q

To prevent infections while on immunosupp

A

Avoid exposure
Maintain healthy lifestyle
Take prophylactic antibiotics
Report infections

114
Q

Risk of infection is determined by

A

ANC
Absolute neutrophil count

115
Q

What is a low ANC

A

less than 1000

116
Q

To prevent infections immunosupp patients are given prophylactic

A

Antibiotics

117
Q

When ANC is below 1000, care for ALL lines and invasive procedures becomes

A

aseptic

118
Q

Even a _ temp can indicate infection with immunossups

A

mild

119
Q

Lifestyle things to avoid when on immunosups

A

Fresh fruit and veg
Live plants
Humidifiers

120
Q

Due to increased risk for cancer with immunosupps do… use…

A

Routine screenings
Sun screen and protective clothing

S4 2539 (11 decks)

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