NUR 133 - Exam 3; Anna's Blueprint Flashcards
What are the function of Helper T-cells?
Back-up cells.
What are the function of Cytotoxic T-cells?
Kills directly.
What are the function of Memory T-cells?
Creates antibody.
What are the function of Suppressor T-cells?
Tells system when fight is over.
What are the components of Cellular Response?
- Helper T-cell
- Cytotoxic T-cell
- Memory T-cell
- Suppressor T-cells
What are the components of the Humoral Response?
- B-Lymphocytes
- Memory cells
- Plasma cells
- Antibodies
Which part of the immune system produces antibodies?
B-cells.
What are the types of immunity?
- Natural
- Acquired
- Active
- Passive
What is a natural type of immunity?
Non-specific response to any invader.
What is an acquired type of immunity?
Specific to a pre-exposed antigen.
What is an actively acquired immunity?
Vaccinations.
What is a passively acquired immunity?
Mom to newborn.
What are the 4 types of Leukocytes?
- Neutrophils
- Eosinophils
- Basophils
- Monocytes
What is the function of a Neutrophil?
- Power-house
- 1st responder
What is the function of a Basophil?
- Source of histamine
- Response with heparin
What is the function of a Monocyte?
- Contain macrophages and dendritic cells
- Phagocytosis
- Antigen presentation
- Cytokine production
What are signs of septic shock?
- Lactic Acid > 4
- Bands: Increased monocytes, decreased neutrophils
- Anaerobic metabolism (unable to compensate)
- Metabolic acidosis
- Breaking down ketones = lactic acid
- Agglutination - Clumping of RBCs
What is the treatment for septic shock?
- 100% oxygenation
- Vasodilate to create volume
- 0.9% NS
- B/P > 90
What is the function of an Eosinophil?
- Anti-allergy
- Any outside allergens get targeted by them
What is the entire Allergic Reaction Pathophysiology?
- Allergen triggers B-cell to produce IgE antibody
- Antibody attaches to mast cell
- Allergen reappears, binds to IgE, triggers mast cell to release histamine
- T-cell assists B-cell to secrete substances to destroy foreign bodies and stimulate macrophages
- Macrophages digest antigens and remove debris
What type of foreign bodies do B-cells target?
Bacteria.
What type of foreign bodies do T-cells target?
Viruses.
What happens when an individual gets a 2nd exposure to a foreign body?
- Bigger immune response
- No memory cells need to be created
What are increased serum IgE levels indicative of?
An allergic reaction.
What type of testing utilizes blood to determine allergies?
RAST test.
What is the biggest concern with distributive/circulatory shock?
Vasodilation with no volume.
What happens when mast cells release histamines?
Vasodilation which increase vascular permeability.
Which leukocyte releases heparin?
Basophils.
What supports a fever by increasing heat-generating effects?
Prostaglandin.
How soon does anaphylaxis occur?
Within the first 20 minutes.
What are the findings with anaphylaxis?
- Vasodilation
- Increased permeability
- Smooth muscle contraction
- Eosinophilia
What are the s&s of anaphylaxis?
- Flushing
- Urticaria
- Angioedema
- Hypotension
- Bronchoconstriction
- Stridor
- Wheezing
What is the treatment for anaphylaxis?
- Epinephrine 1:1000; .3-.5mg SQ
- Oxygenation
- 0.9% NS
- Anti-histamines
- Corticosteroids
- Auscultate lungs
What is the goal for treatment of anaphylaxis?
- Increase vascular permeability
- Vasodilation
What is Type I Hypersensitivity?
Anaphylaxis.
What is Type II Hypersensitivity?
Cytotoxic mistaken identity body turns against component of body.
What is Type III Hypersensitivity?
Immune Complex.
What is Type IV Hypersensitivity?
Delayed.
What are some examples of Type II Hypersensitivity?
- Pernicious anemia
- Transfusion reaction
- Thrombocytopenia
What are some examples of Type III Hypersensitivity?
- Nephritis
- Rheumatoid Arthritis
What are some s&s of Type III Hypersensitivity?
- Urticaria
- Joint pain
- Fever
- Rash
- Adenopathy (swollen glands)
How long until you see a Type IV Hypersensitivity reaction?
1-3 days.
What are some examples of Type IV Hypersensitivity?
- Contact dermatitis
- Hashimotos
- Sarcoidosis
What is a possible cause of Type IV Hypersensitivity?
Organ transplant.
Atopic Reaction details.
- Genetic
- Asthma, Rhinitis, Dermatitis
Non-atopic reaction details.
- No genetic component
- Latex
Early manifestations for x Reactions.
- Urticaria
- Swollen tongue
- No respiratory difficulty
Early manifestations for Anaphylaxis.
- Urticaria
- Stridor
- Swelling
- Wheezing
- Bronchoconstriction
Early manifestations for Anaphylactic Shock.
- Urticaria
- Stridor
- Swelling Airway
- Hypotension
- Wheezing
What do you do within the first 72 hours of exposure to HIV?
- Antiretroviral meds
- Prophylaxis
- T-cell identifies virus
What is Stage 0 for HIV?
- Early stage
- Inferred by lab test
What is Stage 1 for HIV?
- Acute stage
- Most contagious
- CD4 count of 500-1500
What is Stage 2 for HIV?
- Chronic stage
- HIV attacks and kills CD4 cells
- Increased symptoms
- CD4 count of 200-499
What is Stage 3 for HIV?
- AIDS
- Weak immunity - vulnerable to opportunistic infections
- CD4 count drops below 200
What are the manifestations of stage 0 HIV?
Can be asymptomatic.
What are the manifestations of stage 1 HIV?
- Flu-like symptoms
- Mouth sores
- Fatigue
- Skin rash
- SOB
- Cough
- Dyspnea
What are the manifestations of stage 2 HIV?
- Loss of appetite
- Nausea & vomiting
- Candidiasis
- Wasting syndrome
- Lymphomas
- Neuropathy
- Encephalopathy
What are the manifestations of stage 3 HIV?
- Karposi sarcoma
- Pneumonia
- Pneumocystis pneumonia
- TB
- Candidiasis
- Mouth ulcers
- Poor nutrition
- Low levels of protein
Karposi Sarcoma details.
- Purple, red, brown blotches
- Can turn into tumors
- Appears in stage 3 HIV aka AIDS
What are general interventions for HIV?
- No spicy foods
- Monitor wounds for infection/tunneling/necrosis
- Improve airway clearance (stridor is priority)
- Pulmonary therapy is priority in airway clearance care (cupping and deep breathing every 2 hrs)
- Monitor nutritional status
- Decrease social isolation
- Monitor adherence to meds
- CD4 < 200 refer to social worker/hospice care
- Fluids & electrolyte balance - dehydration monitoring
What is Brachytherapy?
Radiation through implanted internal port (i.e. prostate cancer care).
What is Myelosuppression?
Decreased cell production in bone marrow.
What is Neutropenia?
Abnormally low absolute neutrophil count (ANC).
What is primary prevention for cancers?
- Self-exams
- Sunscreen
What is secondary prevention for cancers?
- Screening/Skin assessments
- Diagnostics of lesions, etc.
What is tertiary prevention for cancers?
- Medications/Chemotherapy
- Preventing second component/side effect of cancer spreading
What do Tx, Nx, and Mx mean?
The concerned area cannot be measured.
What do T1-T4 refer to?
The size of the tumor from smaller to larger.
What does N0 mean in grading?
No cancer in nearby lymph nodes.
What does M0 mean in grading?
Cancer has not spread to other parts of body.
What does M1 mean in grading?
Cancer has spread to other parts of the body.
What are some typical pre-chemo meds?
- Steroids (boosts immune system)
- Zofran (for nausea and vomiting)
- Epoetin (Combat anemia/administer RBCs)
What do you assess in patients undergoing chemotherapy?
- Fluid & electrolyte
- Cognitive status
- Infection
- Nausea and vomiting
- Fatigue (give RBCs for anemia)
What is Graft vs. Host Disease?
It is the major cause of morbidity and mortality in clients who have had an allogeneic transplant.
What is hyperthermia indicative of with GVHD?
- 1st sign that patient is rejecting stem cell
- Perform a temperature check every hour for first 72 hours
What is infiltration?
Leakage of non-vesicant fluid.
What is extravasation?
Leakage of vesicant fluid.
What is the Cushing’s Triad?
- Hypertension
- Bradycardia
- Apnea
What are bleeding gums post-radiation a sign of?
Myelosuppression.
What are some s&s of leukopenia?
- Fever
- Pale
- Bleeding gums
What are Actinic Keratoses?
Pre-cancerous lesions on epidermis.
Which type of skin cancer is most common?
Squamous Cell Carcinoma.
Squamous Cell Carcinoma details.
- Rough, scaly lesions on epidermis
- Central ulceration and crusting
- Can metastasize
Basal Cell Carcinoma details.
- Small, waxy nodule on epidermis
- High rate of reoccurrence
- Erythema and ulcerations
Malignant Melanoma details.
- Irregular shape
- Borders multiple colors
- New/changed mole
- Can occur wherever pigment cells are (i.e. Melanosis in intestines)
- Rapid invasion and metastasis
What are the ABCDE’s of a total skin self-examination?
- A: Asymmetry
- B: Borders
- C: Color; lack of uniformity
- D: Diameter; width > 6mm
- E: Evolving
What else do you do in a TSSE?
- Body mapping
- Take pictures
- Moles monitored yearly
What is the main cause of laryngeal cancer and what is the first sign?
- Alcohol use/drinking
- 1st sign is hoarseness followed by dysphagia
What are the alarming s&s of laryngeal cancer?
- Stridor
- Dyspnea
- Globular sensation in throat
- Hemostasis
- Ineffective airway clearance
Why do you promote coughing with patients that have laryngeal cancer?
To break apart secretions.
What is the most common breast cancer?
Invasive Ductal Carcinoma.
What are the screening methods for breast cancer?
- Self-exam
- Clinical exam
- Mammography
Benign breast tumor details.
- Multiple/single
- Rubbery texture
- Mobile/slippery
- Regular borders
- Tenderness
- No retraction
- Change size quickly
Malignant breast tumor details.
- Unilateral
- Firm texture
- Irregular border
- Painless
- Retraction
- Grows constantly
Plan of care for patients with lymphedema.
- Constantly move arm
- No BP/Blood draws
- Elevation (promotes drainage)
- Drains & wound care
- Armband & mark room
- Compression sleeve
What is a priority aids treatment?
Comfort.
What is the 1st sign and med of anaphylactic reactions?
Stridor and epinephrine.
What are western blot and ELISA related to?
HIV testing.
What are the initial s&s of HIV?
- Night sweats
- Flu-like symptoms
- Sores
- Fatigue
What do you treat a simple allergic reaction with?
Diphenhydramine.
