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NURS2500 Patho/Pharma > Week 9: Infection and Immunity > Flashcards

Week 9: Infection and Immunity Flashcards

1
Q

what is immunity?

A

Protection from illness or disease that is maintained by the body’s physiologic defense mechanisms.

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2
Q

what is this describing? Protection from illness or disease that is maintained by the body’s physiologic defense mechanisms.

A

immunity

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3
Q

true or false: Immunity Protects body from attacks from foreign antigens
■ Microorganisms: Bacteria, viruses, parasites, fungi
■ Pollens
■ Food
■ Venom (spider, bee, snake)
■ Vaccines
■ Transfusions
■ Transplanted tissue/organs

A

all true

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4
Q

is immunity accomplished through actions of the immune system?

A

yes

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5
Q

select all that is true regarding organs in the immune system:
Lymphoid organs spread throughout body
- spleen, thymus gland, bone marrow, adenoids tonsils, appendix

Lymphocytes are formed, grow mature and are released

Makes up the lymphatic system that along with blood connects the organs

A

all true

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6
Q

what falls under myeloid progenitors? where are they derived from?

A

■ Neutrophils,
■ Monocytes
■ Eosinophils
■ Basophils
■ Mast cells
from stem cells in bone marrow

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7
Q

what falls under lymphoid progenitors?

A

■ B lymphocytes – Secrete antibodies
■ Mature T lymphocytes
■ Natural killer (T lymphocytes) cells

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8
Q

what is the scope of immunity?

A

supressed (infection - normal - exaggerated (allergy)

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9
Q

true or false: physical barriers are epithelial cells, mucous membranes, saliva/tears/mucus
Innate immunity:
granulocytes, monocytes, proinflammatory hormones
acquire immunity

b and t cells

A

true

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10
Q

what is innate immunity and acquired immunity?

A

innate: (also referred to as natural or native): present at birth (Inflammation)

acquired:protection gained after birth through either active or passive immunity

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11
Q

what is active and passive immunity?
is this under innate or acquired?

A

acquired
active: body MAKES antibodies
natural active: Antigen enters the body and the body creates
antibodies to fight off the antigen (day to day)
artificial: Vaccination or immunization

passive: body given antibodies
natural: Passed from mother to the fetus through placenta or colostrum or breast milk
artificial: Specific transfusion such as immunoglobulins

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12
Q

what do T cells and B cells become ?

A

T cells - t regulatory cell, cytotoxic T cell, Memory T cell

B cell: Th cell to Memory Cell or Plasma cell - antibodies

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13
Q

what is antibody humeral mediated - adaptive immunity?

A

B-lymphocytes produce antibodies & with the help of T Lymphocytes, generate interactions for antibodies to neutralize, eliminate or destroy foreign antigens

Plasma & Memory B cells

Responsible for body’s response to invading bacteria and viruses

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14
Q

what is step 1-3 for antibody mediated response?

A
  1. invasion of body by new antigens in sufficient numbers to stimulate an immune response
  2. interaction of macrophages and helper/induced T cell in the processing and presenting of the antigen to the unsensitized “virgin” B-lymphocyte (B)
  3. sensitization of virgin B-lymphocyte to new antigen
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15
Q

what is step 4-7 of antibody mediated response?

A
  1. antibody production by the B lymphocyte. these antibodies are directed specifically against initiating antigen. antibodies are released from B lymphocyte and lost freely in blood and other fluids
  2. antibodies bind to antigen forming immune complex
  3. antibody binding causes cellular events and attracts other leukocytes to the complex, the interaction of other leukocytes along with cellular events results in neutralization destruction or elimination of antigen.
  4. when antigen is re exposed the sensitized lymphocytes and their progeny produce large quantities of antibody specific to antigen. also new virgin B lymphocytes become sensitized to the antigen and also begin antibody production
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16
Q

what are the five types of antibodies or immunoglobulins?

A

IgG
IgD
IgM
IgA
IgE

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17
Q

select all that is true regarding antibodies -

they are secreted by B lymphocytes

IgG –Largest amount of circulating antibodies – heavily expressed on 2nd+ exposures to antigen

IgD – Acts as a B-cell antigen receptor

IgM –First antibody produced from plasma cell with 1st exposure/
immune response

IgA – Secretory antibody that is present in high concentrations in the secretions of mucous membranes and the intestinal mucosa. Prevents infection in the upper and lower respiratory tracts, GI tract, and GU tract.

IgE – Associated with hypersensitivity reactions - forms a receptor on masts cells and basophils and triggers histamine release during allergic reactions

A

all true

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18
Q

select all that is true under cellular mediated - adaptive immunity:
T-lymphocytes
Major role in regulating antibody mediated immunity and innate immunity

Cytotoxic T cells
Destroy self cells infected by parasites

Helper T cells (CD4cells) - 75% of all T -Lymphocytes
Recognize self cells versus non self cells. When non self is identified, they secrete cytokines that enhance WBC activity

Regulator T cells
Prevent hypersensitivity and over reactions on exposure to non self cells.This prevents formation of antibodies against normal cells (process in autoimmune diseases). They secrete cytokines and have an overall inhibitory action on most cells.

Natural Killers
* Seek and destroy for unhealthy/abnormal self cells such as cancer/virally infected

A

all true

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19
Q

what are the four hypersensitivity reactions

A

Type I- IgE mediated or Atopic (Allergic)
B Type II- Cytotoxic- autoantibodies: Blood transfusion errors
C Type III-Immune Complex-mediated deposits in tissue: Autoimmune disorders
D Type IV- Delayed hypersensitivity: Contact dermatitis, insect stings

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20
Q

what are some age related differences found in infection/immunity?

A

In utero
* Immature
Infancy and childhood
* Matures and is supported by exposure to antigens and vaccinations
Advancing age
* Immunity and response decline with age,
* Diminished immune response and more serious complications * Lessened efficacy of vaccination
* Increased prevalence of autoimmune diseases

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21
Q

what are some risk factors for changes in immunity?

A

Age: Infants & elderly
Environmental exposure
Non-immunized
Chronic illness
Chronic drug therapy (corticosteroids, chemotherapy drugs)
Gender/Race/Ethnicity
High Risk Behaviors/Substance Abuse Genetics

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22
Q

what are some assessments done for infection/immunity?

A

■ History
Clinical findings
■ Suppressed Immune Function
■ Normal or abnormal VS
■ Weight loss
■ Generalized fatigue/malaise
■ Impaired wound healing
■ Opportunistic infections
■ Change in cognition or depression
Exaggerated Immune Function
■ Mild to severe
■ Normal to abnormal VS
Sneezing, watery eyes, nasal congestion to rashes, swelling, shock syndrome
Autoimmune disorders are often vague

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23
Q

what are some assessments done for infection/immunity?

A

Diagnostic Tests
■ Primary Tests
■ RBC, WBC
Screening Tests
■ C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)
Allergy Testing
■ Skin Test
■ Allergen-specific Immunoglobulin (IgE) blood test
■ Disease specific Testing

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24
Q

what falls under primary prevention, secondary prevention and collaborative intervention?

A

primary:
Vaccination
* Modify risk factors

Secondary:
Screening

Collaborative Intervention:
Suppressed
* Infection
* Gastrointestinal dysfunction: treatment of diarrhea, candidiasis, fluid and electrolyte balance * Skin disorders: treatment of skin rash
* Nutrition: Vitamins and supplements
* Exaggerated
* Immunosuppression
* Corticosteroids, Chemotherapy, NSAIDs
* Pain Management
* NSAIDs, corticosteroids
* Anaphylaxis

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25
Q

what is a general definition of vaccination?

A

Introduction of foreign antigens to trigger immune response, allowing immune system to react more effectively the next time it is exposed to antigen

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26
Q

select all that is true regarding vaccinations?
Effective vaccination, to confer long-term immunity to a disease, sometimes requires “boosters” or follow-up doses
■ Bacterial or Viral Vaccines
-Killed vs Live Attenuated
■ Common adverse effects of vaccines
- Redness, swelling at site of injection
- Soreness, tenderness at site of injection
- Fever
■ Contraindications
- Immunocompromised patients – patients are unable to produce an active immune
response
- History or allergy/anaphylactic response to vaccine components (preservatives etc.)
- Pregnancy – only inactivated vaccines are suitable during pregnancy

A

all true

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27
Q

Exaggerated immune response exemplar : allergic reaction

Steps in a type I allergic reaction. GI, gastrointestinal ; IgE, immunoglobulin E.

A

B cell - The first time a person is exposed to an allergen

Plasma cell - a large amount of IgE antibody is made

Mast cell - These antibodies attach to mast cells

Mast cell - The next time the person is exposed to allergen, it binds to the IgE antibodies that are attached to the mast cells. This triggers the release of chemical mediators from the mast cell

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28
Q

under these chemical mediators define the allergy reactions they may show:
( clinical manifestations of Type 1 hypersensitivity =reaction )
Intravascular compartment :
skin:
respiratory system :
GI system :

A

Intravascular compartment : Anaphylactic shock

skin: atopic dermatitis
wheal- and- flare reaction
angioedema

respiratory system : rhinitis
asthma

GI system : nausea
vomitting
cramping pain
diarrhea

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29
Q

Define if this is a true statement regarding anaphylaxis :
conditions in which type 1 hypersensitivity reaction involves of all blood vessels and bronchiolar smooth muscle causing widespread blood vessel dilation, increased cardiac output, and bronchoconstriction within seconds to minutes after allergen exposure

this is life threatening

A

false, everything else is true except increased cardiac output ( it decreases )

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30
Q

what could be occurring in anaphylaxis
in :
neurological
skin
respiratory
cardiovascular
gastro-intestinal

A

neurological :
- headache
-dizziness
-paresthesia
-feeling of impending doom

Skin:
-pruiritus
-angioedema
-erythema
-urticaria

Respiratory
-coughing
sensation of narrowed airway
-wheezing
-dyspnea, tachypnea
-reparitory arrest
-hoarseness

Cardiovascular
-hypotension
-dysrhythmias
-tachycardia
-cardiac arrest

Gastro intestinal
-cramping,abdominal pain
-nausea, vomitting,
-diarrhea

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31
Q

Management of exaggerated immune response ( name the characteristics and the things we utilized)

Anaphylaxis specific

general allergic reaction

A

Anaphylaxis specific
support airway , breathing, circulation
epinephrine
bronchodilators
circulatory support ( blood pressure control)

general allergic reaction
immunosuppression
pharmacotherapy
corticosteroids
nsaids

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32
Q

what connects with infections ( the concepts )

A

tissue integrity
nutrition
immunity
stress
inflammation

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33
Q

This is categorized by type of pathogen ( bacterial - viral - fungal- protozoa/parasitic ) along with mode of transmission, trajectory of illness, and body systems affected

A

infection

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34
Q

Location of infection can be what ?

A

localized or systemic
and limited to specific area on the body - would be localized

systemic - affect the entire body and can cause sepsis ( life threatening response of the body to infection and widespread inflammation )

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35
Q

infection can be acute or chronic , go more in depth on what this could mean in terms of infection

A

acute : lasting a few days or weeks
chronic : typically longer than 12 weeks or uncurable

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36
Q

True or false. Infection can be communicable or non communicable. Example : influenza or peritonitis

A

true

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37
Q

what does communicable and non communicable mean ?

A

communicable - this is infectious such as tuberculosis
non communicable- chronic disease such as a heart disease or cancer

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38
Q

name the different types of infections that can occur :

A

bacterial infections
viral infections
fungal infections
parasitic or protozoa infections

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39
Q

what are the categories for infection process ?

A

HOST
environment
pathogen

40
Q

name what undergoes infection process :

Host
Environment
Pathogen

A

Host
- acute illness
-mechanical barriers
-fever
-phagocytes
-stress
-chronic illness

Environment
-sanitation
-water quality
-crowded living conditions
-weather
-air quality
-seasons

Pathogen
-spore formation
-pili
-enzymes
-flagella
-slime layer
-adhesions
-encapsulations

41
Q

Stages of infectious diseases

A

incubation
prodromal
illness
convalescence

42
Q

what does these terms mean ?
incubation
prodromal
illness
convalescence

A

incubation = entrance of pathogen, appearance of symptoms

prodromal = onset of nonspecific symptoms to more specific symptoms ( spread risk)

illness= patient manifests symptoms specific to the type of infection ( peak )

convalescence- acute symptoms disappear and body returns to the homeostasis, recovery occurs

43
Q

risk factors for infection:
( think back to risk factors for impaired immunity)

A

natural immunity : congenital or acquired immune
deficiencies ( suppressed)- chronic disease

normal flora : alteration by antibiotic therapy

age : infants and older adults

hormonal factors : DM< steroids, adrenal insufficiency, stress

44
Q

risk factors for infection : select all that is true
( think back to risk factors for impaired immunity)

phagocytosis : neutropenia
skin, mucus membranes : break in skin
nutrition : malnutrition or dehydration
environmental factors : tobacco or alcohol, inhalation of toxins
medical interventions : endoscopy, catheters, lvs, steroids

A

all the above

45
Q

what type of assessments are we utilizing or infection ?

A

history
physical examination : local vs systemic signs
diagnostic testing
1. laboratory tests
2.radiographic tests

46
Q

why would we want to do a radiographic tests when assessing a patient with an infection?

A

help visualize certain body tissues to gain insight into the possibility of infection ( CXR/ABX, CT, MRI )

47
Q

define the clinical manifestations of local infection

A

1) signs of inflammation : redness, pain, heat, swelling
2) exudate may be present
3) lymphadenopathy ( swollen and tender lymph nodes)

48
Q

Clinical manifestations of systemic

A

fever
fatigue
headache
anorexia and nausea
malaise and myalgia ( ie. joint and muscle pain )

49
Q

what is organ specific ( systemic signs) clinical manifestations

A
  1. GI : vomiting or diarrhea
  2. Resp: sneezing, coughing and difficulty breathing
  3. GU : painful urination, frequency in urination
50
Q

True or false. Infections that are severe, poorly responsive to therapy or untreated can lead from systemic infections also called as a what ? to multi system organ failure ( MSOF), also known as what ?

A

sepsis
septic shock

51
Q

clinical manifestations for infections that are severe are :

A

hypotension
tachycardia
tachypnea
oliguria or anuria
hypoxia
hypercapnia
seizures or coma

52
Q

Lab values for infection :
biochemistry
what are we examining?

A

sodium - dehydration
potassium- GI infection ( diarrhea/vomiting)
creatinine- perfusion to kidneys ( hypovolemia)
lactate ( sign of sepsis/msof)

53
Q

what undergoes lab values for infection
complete blood count

A

white blood cell count
- elevated B and T lymphocytes, neutrophils, monocytes= bacterial or viral
-elevate basophils/eosinophils = parasitic

54
Q

what undergoes culture and sensitive in lab values for infection

A

urine,sputum, throat, blood, wounds, spinal fluid
and equipment

55
Q

What other lab values do we look for infection

A

ESR
antibody tests : hepatitis, HIV

56
Q

Methods of infection control and prevention

A

hand hygiene
standard precautions
transmission-based precautions
- isolation precautions

contact
-mrsa
-c.difficile

droplet
covid 19

airborne
-tb

57
Q

WE have to do this every single time we have a blood exposure, urine exposure, we have to protect ourselves regardless of what the patient has , what precaution are we using?

A

hand hygience

58
Q

name the example we discussed in class for contact vs indirect contanct in terms of getting an infection

A

contact-= shaking someone hand
indirect contact- taking a pen , and pen being contaminated

59
Q

this is a larger molecule, travel about 3 feet ( can be contaminated by sneezing, or coughing ) what type of transmission is thibs?

A

droplet

60
Q

smaller molecule ( last in the air for a long amount of time ) what type of transmission is this?

A

airborne

61
Q

what are the different collaborative interventions we can utilize when we are dealing with a patient who happens to have an infection?

A

antimicrobial drug therapy
fluids and electrolytes
rest
nutrition
managing fever
- treat cause

62
Q

what would you do if a patient has an infection and we are using collaborative intervention as a approach ? ( hyperthermic and hypothermic patient )

A

if hyperthermic –> cooling ice packs, sponge bath, cooling blankets
remove clothing

antipyretics
- may ask the fever therefore unless patient is uncomfortable, antipyretics not necessary all the time

63
Q

infection control and prevention is a necessity in order to prevent infection

A

true

64
Q

This is a late sign of an immunocompromise patients

A

hypothermic

65
Q

Can these events occur within the infections of the following :
skin infection - if you have a skin infection, you can no longer take care of themselves ( requires more assistance )

bacteremia - this is in your blood ( going more internal and systemic) cardiac output is going to change

sepsis/msof/septic shock- not treating the patients with the right antibiotics , this circumstance can happen frequently

A

all the above is true

66
Q

what type of infection do you suspect ?
pus
redness and red streaks around the cut ?

A

local infection

67
Q

what type of medication can we take for an infection ?

A

antibacterial
antiviral
anti-fungal
anti microbial ( antibiotic ) therapy

68
Q

antibacterial therapy can be ….?

A

narrow or broad

69
Q

classification of antimicrobial drugs
susceptible organism can be…?

A

narrow spectrum : active against a few specific organisms
broad spectrum : active against a wide variety of organisms

70
Q

Classification of antimicrobial drugs
mechanism of action , define if all is true :

inhibit bacterial cell wall synthesis or activate enzymes that disrupt cell wall

decrease cell membrane permeability

causes non lethal inhibition of protein synthesis called bactericidal

causes lethal inhibition of bacterial protein synthesis called bacteriostatic

A

true
false ( it increases )
this is not bactericidal however it is a bacteriostatic
this is not bacteriostatic however it is a bactericidal

71
Q

Recall : Classification of antimicrobial drugs
mechanism of action

inhibit bacterial cell wall synthesis or activate enzymes that disrupt cell wall

increases cell membrane permeability

causes lethal inhibition of protein synthesis called bactericidal

causes non lethal inhibition of bacterial protein synthesis called bacteriostatic

what else can they perform ?

A

suppresses viral replication

antimetabolites

inhibit bacterial synthesis of DNA and RNA or disrupt DNA function

72
Q

this is treating a bunch of different things ?

A

broad spectrum

73
Q

this is treating what we want to achieve ( specific bacteria)

A

narrow spectrum

74
Q

Special consideration : empiric and prophylactic therapy

define what undergoes empiric

A

identify microorganism and drug it is susceptible to ( goal is narrow spectrum drugs )

broad spectrum used in emergency situations, however C & S must be collected prior to treatment
( culture and sensitivity )

75
Q

Special consideration : empiric and prophylactic therapy

define what undergoes prophylactic therapy

A

surgery
bacterial endocarditis
neutropenia
other ( chronic issues)

76
Q

before giving them this kind of therapy we have to give them a lot of antibiotics ( such as going into surgery )
recall : this is to prevent disease

A

prophylactic

77
Q

this is a difficult infection ( must give them antibiotics before ) they are at risk for life threatening conditions, inflammation occurs in the lining of the heart chambers and heart valves.

A

bacterial endocarditis

78
Q

what are the factors that modify drug of choice, route, or dosage

A

host defenses
site of infection
other ( such as allergic reaction )

79
Q

A well functioning immune system works together with antimicrobial treatment in order to cure infection

immunocompromised hosts require more rapid bactericidal

which one of the factors that modify drug of choice, route or dosage

A

this undergoes host defenses

80
Q

Factors that modify drug of choice, route, or dosage
what undergoes site of infection

A

blood brain barrier
foreign material ( prosthetics)

81
Q

recall blood brain barrier what type of pharmacology concepts would you utilize

A

it would be a lipid soluble ( non ionize) drug therpahy

82
Q

true or false. You can give an antibacterial therapy to a virus infection

A

false, you cannot

83
Q

Define if these are true :
misuse :
treatment of viral infection
- mumps, chicken pox, common cold do not respond to antimicrobials

Improper dosage
improper identification of organism
improper cleansing of foreign material/exudate/necrosis

A

all true

84
Q

Misuse of medication
treatment of fever of unknown origin
what is the only consideration we should utilize?

A

only consideration is in immunocompromised host

85
Q

If we have a wound that is extremely infected ( we need a lot of care ) –> cannot leave wounds to expect it to be healed

A

true

86
Q

antimicrobial resistance

we must consider misuse factors along with nonadherance to completion of treatment

A

true

87
Q

true or false.Antimicrobial resistance : organisms becomes less susceptible or sensitive to drug ( often from narrow spectrum )

A

this is false, it’ss usually often from broad spectrum

88
Q

true or false.Patient responding to treatment is a sign that it is leading to complications. This could be an example of antimicrobial resistance.

A

false, patient usually does not respond to treatment leading to complications

89
Q

true or false.
antimicrobial resistance
hospitals are sites of intensive antibiotic use : hospital associated infections are high

A

true

90
Q

what is superinfections that undergoes antimicrobial resistance?

A

new infection that appears during the course of treatment for a primary infection
- antibiotics eliminate normal flora allowing second infectious agent to flourish ( oral flush )

91
Q

are the most common multi-drug resistant organisms ?

A

MRSA, C.difficile

92
Q

Select all the antibacterials
penincilins
cephalosporins
aminoglycosides
tetracyclines
macrolides
sulfonamides
fluroquinolones

A

all is true

93
Q

DRUG CARD : PENICILLINS : PENICILLIN G
( this is a bactericidal and most common drug allergy )

A

MOA : weaken cell wall causing bacteria to take up excessive amounts of water and rupture

broad and narrow spectrum

side effects : super infections ( C.Diff) , nausea, vomiting, abdominal cramping

contraindications : allergy, renal impairment, drug interactions with aminoglycosdies

nursing considerations : assess allergies
monitor kidney function ( creatinine and urine output)
instruct to take full prescribed treatment ( drug resistance )
evaluate effects ( reduction in fever/pain inflammation )

94
Q

DRUG CARD : CEPHALOSPORINS : CEFAZOLIN ( ANCEF)

A

MOA :bactericidal
broad spectrum
5 generations ( classes ) with respect to antimicrobial spectrum
contraindications
- allergies ( 1% of penicillin allergies react to cephalosporins ), b
bleeding disorder
caution with anticoagulants/thrombolytics/antiplatelets/nsaid

side effects : bleeding ( reduce prothrombin levels, ) superinfections ( C.diff) , diarrhea, abdominal cramping, alcohol intolerance

nursing considerations : assess for allergies or history of bleeding disorders
monitor INR
instruct on no alcohol intake
instruct to take full prescribed treatment ( drug resistance )
evaluate effects

95
Q

DRUG CRAD : TETRACYCLINES : DOXYCYCLINE
(very sensitive to light, protein synthesis inhibitors, often used for acne )

A

MOA : suppress bacterial growth ( bacteriostatic)
broad spectrum

side effects :
epigastric burning, cramps, nausea, vomitting, diarrhea, superinfections ( C.diff/candida)
teeth discoloration( binds to calcium )
hypoplasia of enamel
hepatotoxicity
photosensivity
bleeding

contrainidcations : under 8 years, liver or renal impairment , drug interactions with digoxin/anticoagulants/oral contraceptives, avoid mil products, calcium and iron supplements, magnesium,laxatives/antacids

nursing considerations : assess allergies administer 1 hr before or 2 hrs ingestion of milk/supplments
monitor creatinen/lfts/inr
intrusct to take full prescirbe treatment ( drug resistance)

evaluate effects ( reduction in fever /pain inflmmation )

NURS2500 Patho/Pharma (16 decks)

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