M7 Immunity Flashcards
SIRS
Systemic inflammatory response syndrome
Action of intrinsic immune factors
Can be triggered by infectious or non-infectious origin
Sepsis
Systemic due to infection inflammation aka, Severe SIRS,
Response is now systemic
When sepsis becomes severe it complicates the function of
organs
Septic shock
Systemic response S/S
Hypotension
Inadequate perfusion
SIRS cause types
Infectious or noninfectious
If infectious = sepsis
Patients at risk of septic shock
Immunocompromised
Infants
Elderly
SIRS/Sepsis Patho
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
To correct the sepsis hyperimmune response, the body produces anti-inflammatory substances that
Create a period of immune depression increasing risk of nosocomial infections
4 PRIMARY patho changes in sepsis/sirs
Myocardial depression
Vasodilation
3rd spacing (of plasma)
Microemboli
SIRS is identified by 2 or more symptoms of
Fever
Hypothermia
Tachycardia
Tachypnea
Leucocyte changes
To recap sepsis is
SIRS due to INFECTION
Inflammation =
if unchecked it will result in
Coagulation
reduction in blood to limbs and organs
Where does sepsis occur most often
In hospitalized people
The balance of what 2 systems determines sepsis outcome
Systemic inflammatory response SIRS
Counter anti-inflammatory response CARS
Common causes of SIRS
Infection
Trauma
Pancreatitis
Surgery
Wounds and devices that put people at risk of infections
Wounds
burns, ulcers
Devices
Catheters, drains, breathing tubes
S/S of SIRS/sepsis
breathing
urine
hr
gi
Hyperventilation
vUrine
^HR
N/V/D
Labs for SIRS/Sepsis
Blood
Urine
CBC
Monitoring procedures for SIRS/Sepsis
Vitals
Blood chemistry
ABGs
What organs to monitor for SIRS/Sepsis
Kidney
Liver
Visual scans for infection
Xray
CT
Ultrasound
Vasodilation with sepsis leads to what complications
drop in BP
increase in HR to compensate
crackles in lungs
hypoxemia due to lack of pressure
Hypoxemia with sepsis leads to what complications
lungs
a/b
rapid breathing to compensate
respiratory alkalosis
metabolic acidosis
SIRS CRITERIA
NEED 2 to diagnose
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
Skin indicators with SIRS/Sepsis
Cap refill greater than 3 sec
Mottling
Significant edema
Renal and hepatic labs with SIRS/Sepsis
^Bun
^Creatinine
^Urine specific gravity
^ALT AST
^Lactate
Nursing goals with SIRS/Sepsis
Normal tissue perfusion
Normal blood pressure
Normal organ function
Septic shock, how to monitor patients status
Vitals
Mental
Urine output
Hemodynamics (fluid excess of deficit)
How to treat sepsis low BP
Add fluids via IV
What to monitor for oxygenation with sepsis
PaO2 SpO2
MAP
CO
Hemoblobin
To assess fluid status with septic shock monitor
I&O
Daily weight
Diabetic sepsis lab to view
GLUCOSE
Shock indicator on the ECG
ST changes
MAP should be above
60
What to give with angina
Nitro
Vasogenic shock management drug classes
Antibiotics
Antihistamines
Epinephrine
Antiinflammatorys
HIV 101
Retrovirus
Destroys CD4 lymphocytes
HIV is carried in the
RNA
HIV stranded RNA MOA
serves as blueprint for host to produce destructive cells
What body liquids does HIV travel in
Semen
Vaginal secretions
CSF
Breast milk
Amniotic fluid
Saliva
Tears
Blood
When is Vomit urine or stool contaminated with HIV
If it has blood
CD4 T are also know as
Helper Ts
For HIV to replicate it involves what enzymes
Integrase
Protease
Transcriptase
What HIV med classes block interference with the Inegrace protease and transcriptase enzymes
NNRTI
NRTI
PI
B cells make HIV-specific antibodies resulting in
Activated T cells mounting an immune response
HIV CD4 T destruction exceeds body production resulting in
Impaired immune function
Normal T count
Problems start at what count
Severe immunocompromise at what count
1200-800
less than 500
less than 200
Age risk for HIV
13-24
over 50
Other risk factors for HIV
Socioeconomic status
Lifestyle
Environmental factors
Drugs
Other illnesses
Zoonotic diseases
Transmitted from animals to humans
HIV is one of em
HIV antibodies may not be detectable for
6 months
During this 6 month undetectable window can HIV still be trasmitted
YES
HIV diagnosis should be confirmed by how many method
At least 2
Since HIV is transmittable during the undetectable phase, this implication for healthcare workers means
BE CAREFUL
3 stages of HIV
Acute or primary
Clinical latency
AIDS
Acute/primary HIV
flu like symptoms at best
CD4 may fall rapidly
Clinical latency HIV
asymptomatic
HIV produces at low levels
May last 10 years if ART is administered
AIDS HIV stage
Acquired immunodeficiency syndrome
Immune failure
3y survival rate
T less than 200
Opportunistic for infections and secondary cancer
When is HIV most transmittable
Acute primary
and
AIDS
What becomes compromised with HIV
Defense barriers
Lymph system
Innate and adaptive immunity
Comprehensive history for HIV
Presence of risk factors
Known exposure
Current meds for hiv
Opportunistic infections
Secondary cancer
S/S of Initial or Primary infection with HIV
Flu like (fever, sore threat, N/V, headaches)
Stomach pain
Lymphadenopathy
Skin rash
S/S of AIDS
Malaise/fatigue
Night sweats
Weight loss
Oral lesions
Seizures
Neuropathy
Time between HIV and aids is smaller for
Children
Diagnostic tests for HIV
Rapid antibody
ELISA
Westernblot
RT-PCR
Panels that will be altered with HIV
CBC
Kidney
Liver
Fasting lipid
Fasting glucose
Viral load
Number of HIV particles in plasma
Undetectable viral load means
Load is less than detectable parameters
Does NOT mean pt is cured or that disease is untransmutable
Primary HIV prevention
Prevent manage and modify personal risk factors
Secondary HIV prevention
Screening and diagnosis for
HIV Co-infections
Opportunistic infections
Secondary cancers
HIV Co-infections
Hep B
Hep C
Tuberculosis
STDs
Tertiary HIV prevention
Infection prevention
Rest/exercise routines
Stress and anxiety control
Med regiment
Anti-HIV meds
Basic health practices with HIV
Avoid groups
Hand hygiene
Get immz
Good skin care and personal hygiene
HIV ART or HAART
Antiretroviral therapy
Minimum of 3 anti-HIV drugs from at least 2 different drug classes daily
Different HIV drug classes
NRTI
NNRTI
PI
Fusion inhibitors
CCR5 antagonists
Integrase inhibitors
NNRTIs
NRTIs
PIs
MOA
top 2 block transcriptase
3rd blocks protease
Fusion inhibitor meds MOA
block HIV from entering CD4
CCR5 antagonist meds MOA
CCR5 is a protein on CD4 cells needed for transmission
these meds block it
Integrase inhibitors MOA
HIV cant copy self
Collaborative HIV interventions
Usually late stages
Nutritional therapy
Oxygen therapy
Surgical HIV interventions
Chest tube
Lobectomy
Pneumonectomy
What organs can be transplanted
Kidney
Heart
Liver
Lungs
Pancreas
Stomach & Intestines
Allograft
Transplant from a non-identical donor
(not a twin)
Organ rejection involves both _ and _ immunity
Humoral
Cell mediated
Cell involved in organ rejection
T&B lymphocytes
Antibodies
Cytokines
Organ rejection can occur how quickly
or how long after
within 24 h
months or years
S/S of organ rejection
Inflammatory response (pain fever)
and
specific signs related to organ
if kidney - creatinine bun
if liver -ATL AST
To stop rejection of organ, pt will need
Immunosuppressant drugs
Hyperacute rejection
Minutes to hours
occurs due to existence of prior antibodies from blood transfusions or pregnancies
Acute rejection
Weeks or months
Lymphocytes that activate against donor antigens
Chronic rejection
Months to years after acute rejection
To prevent rejection, tissue typing is done prior
this process invovles
Human leukocyte antigen compatibility HLA
Percent reactive antibodies PRA
You want HLA
human leukocyte antigen compatibility to be
Identical
You want PRA
Percent relative antibodies to be
Not existent
You want no antibodies reacting to donors organ
PRAs are done how often
Monthly
Immunosuppressant drugs
Calcineurin inhibitors
Rapamycin inhibitors
Antiproliferative agents
Antibodies
Corticosteroids
Calcineurin 101
inhibits T lymphocytes and cytokines
side effects
nephrotoxicity, neurotoxicity, diabetes mellitus
Rapamycin 101
inhibits T & B cells
side effects
neutropenia, delayed wound healing
Antiproliferative agents 101
Suppress B&T
Poly and monoclonal antibodies for immunosuppressants
Block both humoral and cell mediated response
Used for acute rejection
Has multiple side effects
By using multiple drugs for immunosuppression at the same time…
Lower dosages can be used reducing risk of side effects
Immunosuppressants can also contribute to
Melanomas
Lymphomas
Other cancers
History before giving immunosupp
Acute and chronic infections
History of cancer
Lifestyle - poor nutrition, smoking
Nursing diagnosis for immunosupp
Ineffective med regimen
Risk of infection
Risk of injury
Social isolation
Priority nursing actions for post organ transplants
Correct admin of immunosuppressant
Monitor for rejection
Monitor for drug effect
Prevent infections
OTCs and herbals when on immunosupp
Not without permission
key to immunosupp admin
consistent manner regarding time/day/food or no food
Early signs of organ rejection
Not feeling well
Flu like symptoms
Pain and swelling at transplant site
Organ decline
To determine organ function it is important to show to which appts
Lab tests
For each immunosupp drug prescribed give teaching in what format
Written and verbal
What herbs suppress immune system
Ginseng
St Johns wort
what juice alters absorption of immunosupp
Grapefruit
To prevent infections while on immunosupp
Avoid exposure
Maintain healthy lifestyle
Take prophylactic antibiotics
Report infections
Risk of infection is determined by
ANC
Absolute neutrophil count
What is a low ANC
less than 1000
To prevent infections immunosupp patients are given prophylactic
Antibiotics
When ANC is below 1000, care for ALL lines and invasive procedures becomes
aseptic
Even a _ temp can indicate infection with immunossups
mild
Lifestyle things to avoid when on immunosups
Fresh fruit and veg
Live plants
Humidifiers
Due to increased risk for cancer with immunosupps do… use…
Routine screenings
Sun screen and protective clothing
