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rrd 3 Flashcards

mechs of defense: inflammation, immune fxn and disorders

1
Q

general description of body’s defenses

A

an interaction and coordination of responses to stressors

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2
Q

example of stressors

A
  • invasion by a foreign body, such as microbe, splinter, etc.
  • development of unnatural dangers, such as cancer cells
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3
Q

the immune system

A

the body’s defense systems in total (innate resistance and acquired immunity)

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4
Q

innate (natural) resistance

A

the defense mechanisms we are born with (1st and 2nd line of resistance)

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5
Q

1st line of resistance (first defense against invasion)

A
  • body’s physical/mechanical and biochemical barriers (and what can breach them)
  • immediate
  • non-specific
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6
Q

what does it mean for the 1st line of resistance to be immediate?

A

response occurs at the time of contact with a stressor

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7
Q

what does it mean for the 1st line of resistance to be non-specific?

A

the response process is the same, regardless of the type of stressor

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8
Q

2nd line of resistance (secondary defense against invasion)

A
  • inflammation
  • immediate
  • non-specific
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9
Q

innate category can also include states of _______ that are related to our species: human beings are ______ _______ to some infectious agents that cause illness in other species and vice versa.

A

resistance, naturally resistant

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10
Q

examples of resistance to infectious agents depending on species

A
  • canine distemper cannot be caught by humans
  • West Nile virus can infect birds, humans, horses, but not dogs or cats
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11
Q

acquired (adaptive) immunity is what line of defense?

A

3rd line of defense

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12
Q

acquired immunity

A
  • being able to resist certain diseases or conditions due to immunocyte involvement
  • delayed
  • specific
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13
Q

immunocytes are what kind of cells?

A

lymphocytes - B cells and T cells

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14
Q

what does it mean for acquired immunity to be delayed?

A

response occurs later than the time of contact with a stressor

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15
Q

what does it mean for acquired immunity to be specific?

A

different immunocytes respond to different types of stressors

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16
Q

the first line of defense includes what organs?

A
  • skin and its glands
  • membranes/glands of body openings
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17
Q

if a stressor breaches/breaks down the first line of defense, what happens?

A

2nd and 3rd lines of defense are next in line to defend us

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18
Q

examples of defensive roles of skin and its glands

A
  • protects more vulnerable areas underneath from simple environmental hazards
  • desquamation of skin
  • various glands in skin secrete sweat (antibacterial and antifungal properties)
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19
Q

what is desquamation of skin?

A

shedding of skin cells = bacteria shed too

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20
Q

sweat secretion from glands in skin

A
  • attack cell walls of certain bacteria
  • contribute to making the skin acidic (pH 3 to 5); inhospitable to most bacteria
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21
Q

stressors that can breach the 2st line of defense

A
  • lacerations
  • abrasions
  • punctures
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22
Q

list of membranes/glands of body openings

A
  • eyes’ defense
  • respiratory system defenses
  • gastrointestinal system defenses
  • genitourinary system defenses
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23
Q

eyes’ defense

A
  • tears
  • eyelashes
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24
Q

tears: ______ causes lacrimal glands to spread _____ over eyes and the _____ drains into lacrimal ducts, ______ the eye regularly.

A

blinking, tears, tears, washing

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25
Q

stressors that can breach eyes’ defense

A
  • dry eye syndrome
  • Sjogren’s syndrome
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26
Q

dry eye syndrome

A

manufacturing of tears slows down; happens to some degree to almost everyone as they age

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27
Q

Sjogren’s syndrome

A

autoimmune disease that dries up all lubricating fluids in the body

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28
Q

in resp system defenses, the ______ of mucus in ____ plus _____ traps bacteria (same with wax and hair in ears)

A

viscosity, nose, hair

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29
Q

in resp system defenses, ____ of cells in _____ can sweep away foreign bodies.

A

cilia, bronchi

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30
Q

cough reflex

A

if a foreign body is inhaled and reaches the carina, cough reflex stimulated

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31
Q

stressors that can breach the resp system defenses

A
  • cigarette smoking changes bronchial cells - no more cilia (metaplasia)
  • cough reflex suppression such as in head injury or stroke
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32
Q

gastrointestinal (GI) system defenses

A
  • saliva
  • stomach
  • gag reflex/vomiting
  • bowels
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33
Q

saliva contains?

A

protective enzymes

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34
Q

in the stomach. ____ destroys most microbes

A

HCl

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35
Q

gag reflex/vomiting

A

gets rid of injurious agents such as harmful bacteria

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36
Q

in the normal bowel are many ____ _____ - microbes that do not harm us but do keep out malicious microbes by competing for food

A

good flora

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37
Q

defecation

A
  • part of bowel defense
  • gets rid of injurious agents such as harmful bacteria
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38
Q

stressors that can breach gastrointestinal system defenses

A
  • Sjogren’s
  • anything that changes the bowel flora can leave us open to invading microbes
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39
Q

Sjogren’s with GI system

A

dries up saliva - less protection in mouth

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40
Q

example of something that might change bowel flora

A

antibiotics can wipe out bowel flora

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41
Q

genitourinary (GU) system defenses

A
  • flow of urine washes away microbes
  • vaginal secretions slightly acidic to kill bacteria
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42
Q

stressors that can breach GU system defenses

A
  • decreased urine flow, as in kidney stones or kidney failure
  • anything that changes vaginal acidity, such as douching
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43
Q

the second line of defense is?

A

a normal inflammatory process

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44
Q

inflammation is a state of _____ defense characterized by?

A
  • innate
  • being immediate and non-specific
  • expected manifestations such as a certain normal degree of SHEP (swelling, heat, erythema, pain)
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45
Q

SHEP is manifestations of (S&S of)?

A
  • swelling, heat, erythema (redness), pain
  • local inflammation
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46
Q

inflammation is a ______, important body mechanism that helps us defend against stressors, begin the _____ process, and calling the ____ line of defense as needed.

A

normal, healing, 3rd

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47
Q

inflammation is an _______ processes, but it is not _____.

A

uncomfortable, abnormal

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48
Q

what happens when the first line of defense, the skin, is breached (ie. a cut or laceration from a knife)?

A
  1. area becomes red and sore as normal inflammation takes place
  2. immediately, certain processes take place during inflammation (clot formation to stop bleeding)
  3. fibrin components are weaved together to form a scab to seal the breach
  4. less painful as it heals
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49
Q

what happens when a cut becomes infected?

A

inflammation increases and becomes more painful, but eventually it heals

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50
Q

what happens when you get an upper resp infection?

A

fever and aches (miserable, but get well)

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51
Q

a normal inflammatory process is usually?

A
  • acute
  • short-lived
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52
Q

a inflammatory process is only considered a disorder when?

A
  • gets out of control
    AND/OR
  • occurs inappropriately
    AND/OR
  • becomes chronic (lasts longer than 2 wks)
53
Q

examples of chronic inflammation

A
  • bacteria w/ cell walls that are resistant to breakdown by the phagocytes
  • irritants (chemicals, a retained splinter, or dust particles) that cause a prolonged inflammatory response
54
Q

purpose of inflammatory response

A

to facilitate shifting of substances from blood into injured/irritated tissue

55
Q

facilitating shifting of substances from blood to injured/irritated tissue allows?

A
  • clean up of the area, begin clotting process, and promote healing
  • stimulate and enhance immunocyte response (3rd line of defense) as needed
56
Q

inflammatory mediators

A

subset of biochemical mediators that act on the body

57
Q

components of the inflammatory response

A
  1. irritation/injury of tissue triggers leakiness in 3 ways (same response anywhere in the body)
  2. the neutrophils + macrophages phagocytize any dirt, debris, dying tissue, and/or microbes they might find in the tissue area
  3. if bacteria, viruses, or other microbes are part of the mix above, macrophages will have phagocytized and processed them and now need help from the 3rd line of defense (lymphocytes) to help kill microbes and create memory of the microbe
  4. clotting factors, platelets, and fibrin come together in various ways in the area to create healing, granulating tissue
58
Q

how is leakiness stimulated?

A
  • irritated/injured cells that make up the tissue undergo disruption of metabolic pathway
  • cell membrane loss of integrity and leakage of fluid + other substances from all injured cells in the area
  • mast cell degranulation occurs
  • HLP causes capillaries in area to swell up and “relax”, making capillary more permeable, then leaks plasma from the blood vessel into the tissue
59
Q

what is mast cell degranulation?

A
  • mast cells are specialized WBCs throughout any tissue area
  • when stimulated by an irritant or injury, they degranulate - leak chemical granules
60
Q

what are the chemical granules mast cells leak?

A

local inflammatory mediators - histamine, leukotrienes, prostaglandins (HLP)

61
Q

the HLP cause capillaries to swell up and “relax.” what is this called?

A

vasodilation

62
Q

the leaked plasma from the blood vessel that is going into tissue contains?

A

neutrophils, clotting factors, and fibrin

63
Q

if ___ inflammation is needed, the _____ inflammatory mediators come to the area via the bloodstream to pour fuel on the fire.

A

more, systemic

64
Q

what are the systemic inflammatory mediators called?

A

acute phase reactants

65
Q

examples of acute phase reactants

A
  • CRP (C-reactive protein)
  • complement
  • circulating prostaglandins
  • kinins
  • cytokines
  • clotting elements like factors
66
Q

the capillary swelling and cellular leaking that is part of the inflammatory process partly causes what?

A

S&S of swelling, heat, erythema, and pain
- swelling causes irritation to nerve endings in the area, leading to pain

67
Q

always think of _____ and ______ of capillaries and other blood vessels when thinking of inflammation. why?

A
  • vasodilation and leakiness
  • no matter where and under what circumstances inflammation is occurring, there is going to be some degree of vasodilation and increased capillariy permeability in the area
68
Q

neutrophils

A
  • phagocytic WBCs from the blood
  • circulating
  • kills microorganisms in blood and tissue
69
Q

macrophages

A
  • phagocytic cells in the tissue
  • start life as circulating monocytes and end up in the tissue as their home
  • permanent WBC of the tissue
70
Q

neutrophils

A
  • circulating phagocytes
  • kill microorganisms in blood and tissue
71
Q

lymphocytes

A
  • immunocytes
  • T-lymphocytes and B-lymphocytes
72
Q

exudate

A

a thick fluid that is a combination of plasma, phagocytes, dead tissue cells, bacteria, fibrin

73
Q

when there is little microbe involvement, the exudate is a ______ and is called?

A
  • clear gold color (color of plasma leaking out in the area)
  • serous exudate
74
Q

when there is little microbe involvement and there is also some blood, the exudate is called?

A

serosanguinous

75
Q

if there is more microbe and WBC involvement (infection), the exudate becomes?

A
  • thick, whitish or yellowish
  • purulent exudate or pus
76
Q

the memory of the microbe developed by the 3rd line of defense is also called?

A

immunity

77
Q

to involve the lymphocytes, the macrophages will?

A
  • secrete chemotactic substances to call immunocytes (usually T cell or CD4 lymphocytes) to come to the area via bloodstream
  • display remnants of the microbes on the cell membranes as a guide to the T-lymphocytes (“this is the enemy… create more defenses”)
78
Q

degranulation

A

breaking apart of mast cells with spillage of granules of biochemical mediators into tissue

79
Q

granuloma

A

a hunk of tissue that has been chronically inflamed and is now essentially just scar tissue

80
Q

granulating tissue

A

pink, healthy, healing tissue

81
Q

local internal examples of inflammatory response

A
  • appendix gets irritated by piece of food or microbe -> normal inflammation responds to the irritation -> appendicitis
  • pleuritis
  • thyroiditis
82
Q

inflammatory response can be ____ or ____.

A

local or systemic

83
Q

local external example of inflammatory response

A
  • laceration
  • abrasion to skin
84
Q

appendicitis becomes a ____ process because it is ultimately _____ to the body, but the initial _____ was a normal defense of the body

A

disease, harmful, inflammation

85
Q

thyroiditis

A

thyroid is inflamed bc of autoimmune attack

86
Q

pleuritis

A

inflammation of pleura when irritated by something like lung cancer cell

87
Q

systemic inflammatory response happens when _____ needs the extra help of the systemic _____ like more ____ and more ___ ____ ____.

A

body, cavalry, leukocytes (leukocytosis), acute phase reactants (often causing fever)

88
Q

normal systemic inflammatory response

A

basically the same as a local one, but w/o a specific focus

89
Q

any stressor which activates and involves a local inflammatory response can the cause the activation of?

A

a systemic inflammatory response

90
Q

example of normal inflammatory response associated with big toe

A
  1. localized injury with infection of big toe
  2. local inflammation is initiated
  3. local inflammatory mediators activate a systemic inflammatory response
91
Q

example of normal inflammatory response associated with bladder

A
  1. localized infection of the bladder
  2. local inflammation begins
  3. microbe(s) toxins enter blood stream (bacteremia)
  4. activates systemic inflammatory response (HLP + acute phase reactant, large #s of WBC)
92
Q

example of normal systemic inflammatory response when a traumatic injury occurs (ie car accident)

A
  1. local inflammation initiated
  2. local inflammatory mediators activate a systemic inflammatory response
93
Q

S&S of systemic inflammation

A
  • malaise, aches, pains
  • fever
  • CBC shows increased WBCs (leukocytosis)
  • elevated seurm CRP
94
Q

where does fever due to systemic inflammation come from?

A

from response to increased PGs and acute phase reactants

95
Q

purpose of fever

A

beneficial effect of directly killing some microorganisms

96
Q

deleterious effects of fever

A
  • fever dilate blood vessels -> too much vasodilation -> low BP
  • fever increases metabolic rate -> may cause decompensation in ill/debilitated/elderly patients
97
Q

heat ___ vessels, cold ____ vessels.

A

dilates, constricts

98
Q

leukocytes (WBCs) ____ in number as they are summoned to the areas of ____

A

increased, inflammation

99
Q

the WBC subtype that is usually most increased during inflammation is?

A

neutrophils (neutrophilia)

100
Q

example of a lab report showing leukocytosis and neutrophilia

A
  • total WBCs count: 15000 K/ul (norm is 5-10000)
  • percentage of neutrophils: 80% (norm 50-75%)
101
Q

why is the serum CRP elevated during systemic inflammation?

A

it is an acute phase reactant “fuel on fire”

102
Q

as inflammatory mediators ______, they will exert more chemotactic influence on WBCs

A

increase

103
Q

not enough inflammation due to?

A
  • quantitative/qualitative defects in phagocytic fxns
  • complement deficiencies
104
Q

quantitative defect in phagocytic functions

A
  • can be from chemotherapy
  • leukopenia (deficiency in WBCs)
  • specific deficiency in neutrophils (neutropenia)
105
Q

qualitative defects in phagocytic functions

A
  • chemotactic defects: won’t respond appropriately when summoned
  • impaired function (ex: phagocytes damaged by DM have decreased ability to fight microbes)
106
Q

complement deficiencies

A
  • grp of disorders that stem from a genetic defect in synthesis of complement proteins
  • patients who have defects in these have problems that are very similar to those seen in patients with antibody deficiencies
107
Q

anyone with not enough inflammation will be?

A

extra susceptible to infections

108
Q

if all goes well, inflammation is usually ____ and ______ - it gets the job done as efficiently as possible and goes away, paving the way for continued healing.

A

acute, short-lived

109
Q

abnormal inflammation

A

inflammation goes into overdrive and/or becomes chronic

110
Q

examples of abnormal inflammation

A
  • SIRS
  • sepsis
  • septic shock
  • chronic inflammation
111
Q

shock

A

low BP that causes s&s; usually lower than 80 or 90 systolic

112
Q

SIRS

A

systemic inflammatory response syndrome

113
Q

SIRS occurs when?

A
  • when a normal systemic inflammatory response goes into overdrive
  • normal braking system does not occur
  • wide spread systemic inflammation occurs in the entire body, not just in original injured or inflamed area
114
Q

the excessive systemic inflammation from SIRS contributes to?

A

widespread impaired tissue function and organ damage

115
Q

example of SIRS

A
  1. localized injury with big toe infection
  2. local inflammation initiated
  3. local inflammatory mediators activate a systemic response
  4. instead of healing, systemic inflammation goes into overdrive
  5. SIRS
  6. widespread tissue/organ damage
116
Q

SIRS S&S (2 or more needed)

A
  • unexplained change in mental status (confusion, not as awake and alert as normal)
  • fever of more than 100.4 F
  • increased HR
  • increased resp rate
  • abnormal WBC count
117
Q

normal temperature

A

98.6 F

118
Q

sepsis

A

occurs when there is a known or suspected infection and the person has SIRS

119
Q

example of sepsis

A
  1. localized injury with big toe infection
  2. local inflammation is initiated
  3. local inflammatory mediators activate
  4. inflammation overdrive
  5. S&S of SIRS
  6. sepsis
120
Q

early recognition of S&S of SIRS and identification of sepsis is key so appropriate treatment can be started early. mortality increases by ____ every hour that treatment is delayed.

A

10%

121
Q

septic shock

A

occurs when sepsis (infection + SIRS) is complicated by low BP

122
Q

in septic shock, ____ levels of systemic inflammatory mediators trigger widespread, extreme ____. ____ arterial vessel tone as arteries become ____ _____, _____.

A

high, vasodilation, no, too relaxed, floppy

123
Q

when vasodilation occurs during septic shock, blood pools where instead of being part of circulation?

A

in the periphery

124
Q

blood pooling in the periphery during septic shock causes what to the blood volume? what happens after?

A

low blood volume -> reduces amt of O2 being brought to tissues _ decreasing BP

125
Q

S&S of septic shock

A
  • SIRS S&S: change in mental status, fever, increased HR, increased resp rate, abnormal WBCs
  • low BP
  • ischemia to organs -> renal failure, resp failure, heart failure, or death
126
Q

differences between SIRS, sepsis, septic shock

A
  • SIRS: overdrive of widespread systemic inflammation w/ related S&S
  • Sepsis: SIRS + infection
  • Septic Shock: sepsis + low BP
127
Q

normal arteries have a certain ______ _____. the muscles in their walls constrict and dilate as body needs.

A

vasomotor tone

128
Q

chronic inflammation

A

last weeks or longer, regardless of cause

129
Q

inflammation can be prolonged to become _____, due to persistent what?

A
  • chronic
  • bacterial contamination, foreign objects, autoimmune processes

nurs pathophysiology (13 decks)

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