TLO 1.3a Immune Flashcards
What is Innate immunity?
Nonspecific Immune Functions
Protective barriers triggered in response to antigen but NOT specific to that antigen
- chemical barriers (bactericides, enzymes in body secretions)
- inflammation (vasodilation, phagocytosis)
Phagocytosis
- Can occur along or with inflammatory process
- Neutrophils 1st phagocytes to respond
- Ingest antigen either survive or die
Increased capillary permeability and vasodilation
-redness and edema
Immune response effective= inflammation recedes
What is phagocytosis?
Can occur along or with inflammatory process
Neutrophils 1st phagocytes to respond
Ingest antigen either survive or die
What is Adaptive Immune Response?
Specific Immune Response
Antigen survives phagocyte, specific immune response is initiated
Two types
- humoral response
- cell mediated response
Lymphocytes function in both types of response
- types of leukocyte
- 2 types of lymphocytes are involved in immune response:
- B cells: promote humoral response
- T cells: promote cell mediated response
What are two types of Adaptive Immune Response?
Humoral response
Cell mediated response
What are the 2 types of lymphocytes involved in Adaptive Immune Response?
B cell: promote humoral response
T cell: promote cell mediated response
What does Humoral (antibody mediated) Response?
Immune response is produced by B lymphocytes (B cell)
B cells are activated by contact with antigen and by T cells
B cell is activated by specific antigen= proliferates into antibody producing plasma cells and memory cells
Memory cells retain antibody producing data for future encounter
B cell links to antigen and inactivates it
What is a Cell Mediated Response?
T cells initiate this response
T cells are antigen specific
T cell activates = produces antigen specific clones
Specific clones differentiate into cytotoxic, helper or suppressor cells
Effector and regulator T cells produce and release cytokines
What are the 5 immunoglobins and the total percentage?
IgG 75% IgA 10-15% IgM 5-10% IgD <1% IgE <0.1%
What is the significance of IgG?
75%
Most abundant, found in blood, lymph and intestines
Crosses placenta
Major antibody protecting against active bacteria, fungi and viruses
Binds to macrophages
Provides maternal antibody protection to infants
Longer/stronger response than other Ig
What is the significance of IgA?
10-15%
Provides local protection to mucous membranes
Especially important in antiviral protection
Appears in body secretions
Passes to neonate in breastmilk
Levels decrease with stress
What is the significance of IgM?
IgM
5-10%
Found in blood and lymph
Produced early in life
Response to blood transfusion reactions in ABO typing system
High concentration early in infection, decreases within about a week
Mediates cytotoxic response and activates complement
What is the significance of IgD?
<1%
Poorly understood, function unknown; found in blood, lymph, surfaces of B cells
What is the significance of IgE?
IgE
<0.1%
Leads to release of histamines= allergic response; elevation suggests allergy
Plays role in defense against parasites
What is the difference between Natural and Artificial PASSIVE IMMUNITY?
Passive
Natural
-acquired by transfer of maternal antibodies to the fetus or neonate via the placenta or breastmilk
-Ex: neonate initially protected again MMR if mother immune
Artificial
- acquired by administration of antibodies or antitoxins in immune globulin
- Ex: gamma globulin injected following Hep A exposure
What is the difference between Natural and Artificial
ACTIVE IMMUNITY?
Active
Natural
-acquired by infection with a pathogen, resulting in the production of antibodies
-Ex: chickenpox
Artificial
- acquired by immunization with antigen, such as attenuated live virus vaccines
- Ex: MMR, polio, DPT, hepatitis B vaccines
What is Allergic Reaction?
Immune response to an antigen= hypersensitivity reaction
Occurs with second exposure to antigen
Immediate (anaphylaxis, transfusion reaction) or delayed (contact dermatitis)
Most children with allergies r/t genetic link
What tests are performed to confirm allergen?
Increased serum IgE
Skin test
RAST (radioallergosorbent test)
Oral food challenge (food allergies)
What does histamine release causes (pathophysiology)?
Vasodilation and increased capillary permeability
Smooth muscle contraction
Bronchial constriction
Anaphylaxis treatment/nursing responsibilities?
Must begin immediately
911 or rapid response
Maintain patent airway- O2, prepare for intubation
Keep warm, lay flat, feet elevated (treats shock)
IV access
If reaction caused by insect bite, use tourniquet proximal to site, prevent spread of allergen
Administer meds
What are anaphylaxis medications?
Epinephrine: epi-pen, can give through clothing, hold to skin for 10 sec
Antihistamines: blocks histamine receptors
Corticosteroids: reduce local and systems inflammatory symptoms
Latex allergy s/s?
Hives Itching Wheezing Difficulty breathing Rhinorrhea/Rhinitis
Food to avoid when you have latex allergy?
High degree: bananas, avocados, chestnuts, kiwi
Moderate: apples, carrots, celery, papaya, potato, tomato, melons
Low: pear, mango, sweet pepper, peach, cayenne pepper
Undetermined: grapes, apricots, chickpeas
Two types of vaccines?
Live or Attenuated
Killed or Inactivated
What does a Live or Attenuated vaccines do?
Virulence diminished
Body produces antibodies
Causes immunity to be established
Ex: measles vaccine
What does a Killed or Inactivated vaccines do?
Pathogens made inactive by chemicals or heat
Allows body to produce antibodies but does not cause clinical disease
Tend to elicit limited immune response, requiring several doses
Ex: polio, pertussis
What is Viral Exanthems (rash)?
Unique organisms that contain DNA or RNA Can't reproduce on own Need a host cell to allow virus to duplicate Ex: Rubeola (measles) Rubella (3 day measles, German measles) Fifth's disease (erythema infectiosum) Varicella Zoster (chickenpox, shingles) Roseola Infantum
Define Exanthem?
Eruption or rash on the skin
Exanthem (wide spread rash) nursing responsibilities?
Assess history (onset, location, color, pattern, shape)
Vitals, lung sounds, physical assessment
Recent exposure to illnesses
Implement isolation
Rubeola (measles) CAUSATIVE AGENT? TRANSMISSION? IMMUNITY? INFECTIOUS PERIOD? SEASON? VACCINE?
RNA virus
Droplet contact or airborne (rare)
Natural disease or live attenuated vaccine
3-5 days prior to rash and 4-6 days after rash appears
Late winter and spring
2 doses MMR for full protection, given at 1 yr and 4-6 yr
Rubeola (measles) manifestations?
Respiratory s/s 10 days after exposure fever
Prodromal period: 3 C’s (cough, coryza(runny nose), conjunctivitis)
Koplik spots appear 2 days before rash (diagnostic)
Koplik spots blue/white spots with red base near molars and buccal mucosa, lasts 3 days, slough off
Next: deep red macular rash appears on face and neck, spreads down trunk and extremities, lasts 6-7 days.
Rubeola (measles) complications?
Secondary infections: otitis media, pneumonia, croup r/t respiratory involvement
CNS: encephalitis/brain death (rare)
Rubeola (measles) managment?
Symptom management
Isolation (droplet and airborne)
Vaccination (prevention)
Teach: risk of fever and febrile seizures 7-10 days after vaccination (slight risk)
Rubella (German measles, 3 day measles) CAUSATIVE AGENT? TRANSMISSION? IMMUNITY? INFECTIOUS PERIOD? SEASON? VACCINE?
RNA virus Airborne particles, direct contact with infectious droplets. Trans placental Natural disease or vaccine 7 days before s/s to 14 days after rash Late winter, early spring MMR 2 doses at 1 yr and 4-6 yr
Rubella (German and 3 day measles) manifestations
German and 3 day measles
Mild disease for children/adults
Rash develops after 14-16 day of exposure
Young child asymptomatic until rash presents
Older child: coryza, diarrhea, malaise, HA, sore throat, aches, eye pain, fever, nausea
Rash: pinkish maculopapular
Petechiae
Enlarge lymph nodes
Rubella (German and 3 day measles) complications?
German and 3 day measles mild arthralgias/arthritis in adults Self limiting mild thrombocytopenia Fetus has most risk when mother infected -intrauterine growth retardation -failure to thrive
Rubella (German and 3 day) management?
German and 3 day
Supportive and symptomatic
Disease is self limiting
No school or daycare 7 days after rash appears
Infants with congenital rubella considered infectious x1 yr or until nasal and urine cultures are negative repeatedly
MMR vaccine preventative
Erythema Infectiosum (fifth disease) CAUSATIVE AGENT? TRANSMISSION? IMMUNITY? INFECTIOUS PERIOD? SEASON? VACCINE?
Parvovirus B19
Airborne particles, resp droplets, blood, blood products, trans placental
Natural disease thought to provide antibodies
5-12 days from prodromal period until rash appears
Winter and spring
No vaccine
Erythema Infectiosum manifestations
Mild systemic disease
Mild HA, runny nose, fatigue, low grade fever before rash
Intense fiery red edematous rash on cheeks “slapped” look
Erythematous maculopapular rash on trunk and extremities develops 1-4 days after facial rash
Rash last 2-39 days fades with lacy appearance
Reappears when aggravated
Erythema Infectiosum complications
Generally none
Pregnant women risk for intrauterine infection and fetal death
Erythema Infectiosum management
Identify and notify pregnant women of exposure
Supportive care of symptoms
No vaccine: wash hands, cover mouth sneeze/cough, avoid sick people
Roseola Infantum (Examthem subitum) CAUSATIVE AGENT? TRANSMISSION? IMMUNITY? INFECTIOUS PERIOD? SEASON? VACCINE?
Human Herpes virus 6 Contact with secretions Unknown: from febrile period through 1st time rash appears Throughout the year, no pattern No vaccine
Roseola Infantum manifestations
Sudden high fever: 103-106
Malaise/irritability
Intermittent or constant fever for 3-5 days
Mild cough, runny nose, ad pain, HA, vomiting, diarrhea
Rash appears hours to 2 days after fever subsides
Rash: pink maculopapules or macules that blanch with pressure on neck and trunk, lasts 24-48 hours
Roseola Infantum complications
Uncommon
Febrile seizure may occur
Roseola Infantum management
Symptomatic
Teach fever management: no aspirin, use acetaminophen
Varicella-Zoster (chickenpox) CAUSATIVE AGENT? TRANSMISSION? IMMUNITY? INFECTIOUS PERIOD? SEASON? VACCINE?
Varicella zoster virus
Direct contact droplet, airborne particles
Natural disease, varicella vaccine
1-2 days before onset of rash until all rashes crusted over usually 5-7 days
Late winter through early spring
VAR 2 doses at 1 yr and 4-6yrs
Varicella Zoster manifestations
Rash: malaise, anorexia, slightly elevated temp
Rash develops on trunk and scalp followed by lesions
Lesions appear in crops over 3-4 days
Lesions teardrop shape with that become pustular and dry to develops a crust
Very contagious
Contagious until all lesions are crusted and dry
Varicella Zoster complications
Secondary bacterial infections of skin lesions
CNS: coma, convulsions, encephalitis, ataxia (rare)
Varicella pneumonia (adults generally)
Corneal problems if lesions involve the eye
Varicella Zoster therapeutic management
Symptomatic/supportive
Oatmeal baths, antihistamines to ease itching
Acetaminophen for fever NO aspirin
Hospitalization: strict airborne and contact isolation
Nurse assigned should not care for immunocompromised patients
Bag and label all contaminated materials before processing
Acyclovir IV if child is immunocompromised
Infectious Parotitis (mumps) CAUSATIVE AGENT? TRANSMISSION? IMMUNITY? INFECTIOUS PERIOD? SEASON? VACCINE?
Paramyxovirus
Airborne droplets, salivary secretions, possibly urine
Natural disease or live vaccine (MMR)
7 days before swelling of lymph nodes to 9 days after onset
Late winter and spring
MMR 2 doses, 1 yr and 4-6 yr
Infectious Parotitis (mumps) manifestations
Prodromal: fever, myalgia (pain in muscles), HA, malaise Parotid gland (gland by ears) swelling, classic clinical sign
Infectious Parotitis (mumps) complications
Aseptic Meningitis: nuchal (neck) rigidity, lethargy, vomiting
Salivary glands most affected but can involve other organs
Adolescent ovarian inflammation (female), testicle inflammation (boys)
Infectious Parotitis (mumps) therapeutic management
Symptomatic care: acetaminophen not aspirin for fever
Droplet precautions until 9 days after onset of swelling
Examine testes in boys (orchitis)
Hand hygiene to prevent transmission
Prevent with MMR vaccine
Poliomyelitis (Polio) CAUSATIVE AGENT? TRANSMISSION? IMMUNITY? INFECTIOUS PERIOD? SEASON? VACCINE?
Poliovirus found in throat and feces Fecal/oral or respiratory Shortly before and after onset of illness, shed in pharynx for 1 wk and weeks to months in feces Summer and fall IPV 4 doses at 2, 4, 6 mo and 4-6 yr
Poliomyelitis (polio) manifestations
Fever, malaise, nausea, HA, sore throat, generalized ab pain
Flaccid paralysis especially of lower extremities
Complications: Bulbar polio (cervical involvement) leads to inability to breathe
Poliomyelitis (polio) management
No specific treatment
Prevent through vaccination
PT helps maintain muscle integrity and prevent contractures
Mechanical ventilation
Pertussis (whopping cough) CAUSATIVE AGENT? TRANSMISSION? IMMUNITY? INFECTIOUS PERIOD? SEASON? VACCINE?
Bordetella pertussis
Direct contact with resp droplets from coughing
Bacteria or vaccine DTaP
1-4 weeks
Any season
Dtap 5 doses at 2, 4, 6, 18 mo and 4-6 yrs
Pertussis manifestation
Three stages
Catarrhal: 1-2 weeks
-URI (rhinorrhea, low grade fever, mild cough, lacrimation)
Paroxysmal: 2-4 weeks
- repetitive cough during single expiration followed by “whoop” on inspiration
- cough triggered by yawning, sneezing, eating
Convalescent: 1-2 weeks
-episodes of coughing, whooping and vomiting that decrease in frequency, lasts several months
Pertussis complications
Pneumonia (most common)
Atelectasis, pneumothorax
Hypoxemia leads to CNS involvement
Infants <6 mo, greater risk r/t no maternal immunity and may not be completely immunized
Pertussis therapeutic management
Vaccinate: DTaP
Antibiotics to pt and those in close contact
Infants/children exposed should continue with vaccination
Droplet precautions
Monitor resp status
Keep room quiet, calm (excitement triggers episodes)
Block care, monitor nutritional status
Diphtheria CAUSATIVE AGENT? TRANSMISSION? IMMUNITY? INFECTIOUS PERIOD? SEASON? VACCINE?
Corynebacterium diphtheria Contact with carrier or disease droplets Vaccine (DTaP) IM, passive immunity from maternal antibodies, natural disease process 2 wk-several months Fall and winter
Diphtheria manifestations
Common cold s/s initially Foul smelling mucopurulent discharge Thin gray membrane on tonsils and pharynx "Bull neck" or neck edema Respiratory compromise r/t narrowing of airway Complications: airway obstruction myocarditis, peripheral neuropathies
Diphtheria therapeutic management
Diphtheria antitoxin IV and antibiotics (PCN-G, E-mycin)
Vaccinate to prevent
Tetanus CAUSATIVE AGENT? TRANSMISSION? IMMUNITY? INFECTIOUS PERIOD? SEASON? VACCINE?
Clostridium tetani (bacterial)
Through broken skin with contaminated objects. Found in soil. Bacterial infection affects nervous system= muscle spasms
3-21 days
Vaccination (Tdap, DT)
Tetanus manifestations
HA Jaw cramping Sudden, involuntary muscle tightening (often stomach muscles) Painful muscle stiffness all over the body Trouble swallowing jerking or staring (seizures) Fever and sweating High blood pressure or fast heart rate
Tetanus complication
Laryngospasm
Fractures
Pneumonia (aspiration)
Breathing difficulty, possibly leading to death
Tetanus treatment
Immediate Human Tetanus Immune Globulin (TiG)
Antibiotics
Drugs to control muscle spasms
Hemophilus influenza B (HIB) CAUSATIVE AGENT? TRANSMISSION? IMMUNITY? VACCINE?
Type of bacteria, Type B causes Meningitis
Respiratory droplets (cough, sneeze)
At risk: Immunocompromised, younger than 5
Vaccine: 4 dose at 2, 4, 6 and 12-15 mo
OR
3 doses at 2, 4, and 12-15 mo
Vaccine SE: fever, redness and swelling at injection site
Pneumococcal Conjugate Vaccine (PCV13)
PREVENTION?
SIDE EFFECTS?
VACCINE?
Pneumococcal meningitis and pneumonia
Fussiness, sleepy, swelling at site, fever
4 doses at 2, 4, 6, and 12-15 mo
Given IM
Hepatitis B
VACCINE?
SIDE EFFECTS?
Protects against Hep B liver disease
3 doses at birth, 1-2 mo and 6-18 mo
Given IM
None or mild low temp, injection site soreness
