Week 9: Infection and Immunity Flashcards
what is immunity?
Protection from illness or disease that is maintained by the body’s physiologic defense mechanisms.
what is this describing? Protection from illness or disease that is maintained by the body’s physiologic defense mechanisms.
immunity
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
all true
is immunity accomplished through actions of the immune system?
yes
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
all true
what falls under myeloid progenitors? where are they derived from?
■ Neutrophils,
■ Monocytes
■ Eosinophils
■ Basophils
■ Mast cells
from stem cells in bone marrow
what falls under lymphoid progenitors?
■ B lymphocytes – Secrete antibodies
■ Mature T lymphocytes
■ Natural killer (T lymphocytes) cells
what is the scope of immunity?
supressed (infection - normal - exaggerated (allergy)
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
true
what is innate immunity and acquired immunity?
innate: (also referred to as natural or native): present at birth (Inflammation)
acquired:protection gained after birth through either active or passive immunity
what is active and passive immunity?
is this under innate or acquired?
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
what do T cells and B cells become ?
T cells - t regulatory cell, cytotoxic T cell, Memory T cell
B cell: Th cell to Memory Cell or Plasma cell - antibodies
what is antibody humeral mediated - adaptive immunity?
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
what is step 1-3 for antibody mediated response?
- invasion of body by new antigens in sufficient numbers to stimulate an immune response
- interaction of macrophages and helper/induced T cell in the processing and presenting of the antigen to the unsensitized “virgin” B-lymphocyte (B)
- sensitization of virgin B-lymphocyte to new antigen
what is step 4-7 of antibody mediated response?
- 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
- antibodies bind to antigen forming immune complex
- 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.
- 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
what are the five types of antibodies or immunoglobulins?
IgG
IgD
IgM
IgA
IgE
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
all true
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
all true
what are the four hypersensitivity reactions
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
what are some age related differences found in infection/immunity?
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
what are some risk factors for changes in immunity?
Age: Infants & elderly
Environmental exposure
Non-immunized
Chronic illness
Chronic drug therapy (corticosteroids, chemotherapy drugs)
Gender/Race/Ethnicity
High Risk Behaviors/Substance Abuse Genetics
what are some assessments done for infection/immunity?
■ 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
what are some assessments done for infection/immunity?
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
what falls under primary prevention, secondary prevention and collaborative intervention?
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
what is a general definition of vaccination?
Introduction of foreign antigens to trigger immune response, allowing immune system to react more effectively the next time it is exposed to antigen
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
all true
Exaggerated immune response exemplar : allergic reaction
Steps in a type I allergic reaction. GI, gastrointestinal ; IgE, immunoglobulin E.
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
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 :
Intravascular compartment : Anaphylactic shock
skin: atopic dermatitis
wheal- and- flare reaction
angioedema
respiratory system : rhinitis
asthma
GI system : nausea
vomitting
cramping pain
diarrhea
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
false, everything else is true except increased cardiac output ( it decreases )
what could be occurring in anaphylaxis
in :
neurological
skin
respiratory
cardiovascular
gastro-intestinal
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
Management of exaggerated immune response ( name the characteristics and the things we utilized)
Anaphylaxis specific
general allergic reaction
Anaphylaxis specific
support airway , breathing, circulation
epinephrine
bronchodilators
circulatory support ( blood pressure control)
general allergic reaction
immunosuppression
pharmacotherapy
corticosteroids
nsaids
what connects with infections ( the concepts )
tissue integrity
nutrition
immunity
stress
inflammation
This is categorized by type of pathogen ( bacterial - viral - fungal- protozoa/parasitic ) along with mode of transmission, trajectory of illness, and body systems affected
infection
Location of infection can be what ?
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 )
infection can be acute or chronic , go more in depth on what this could mean in terms of infection
acute : lasting a few days or weeks
chronic : typically longer than 12 weeks or uncurable
True or false. Infection can be communicable or non communicable. Example : influenza or peritonitis
true
what does communicable and non communicable mean ?
communicable - this is infectious such as tuberculosis
non communicable- chronic disease such as a heart disease or cancer
name the different types of infections that can occur :
bacterial infections
viral infections
fungal infections
parasitic or protozoa infections
what are the categories for infection process ?
HOST
environment
pathogen
name what undergoes infection process :
Host
Environment
Pathogen
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
Stages of infectious diseases
incubation
prodromal
illness
convalescence
what does these terms mean ?
incubation
prodromal
illness
convalescence
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
risk factors for infection:
( think back to risk factors for impaired immunity)
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
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
all the above
what type of assessments are we utilizing or infection ?
history
physical examination : local vs systemic signs
diagnostic testing
1. laboratory tests
2.radiographic tests
why would we want to do a radiographic tests when assessing a patient with an infection?
help visualize certain body tissues to gain insight into the possibility of infection ( CXR/ABX, CT, MRI )
define the clinical manifestations of local infection
1) signs of inflammation : redness, pain, heat, swelling
2) exudate may be present
3) lymphadenopathy ( swollen and tender lymph nodes)
Clinical manifestations of systemic
fever
fatigue
headache
anorexia and nausea
malaise and myalgia ( ie. joint and muscle pain )
what is organ specific ( systemic signs) clinical manifestations
- GI : vomiting or diarrhea
- Resp: sneezing, coughing and difficulty breathing
- GU : painful urination, frequency in urination
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 ?
sepsis
septic shock
clinical manifestations for infections that are severe are :
hypotension
tachycardia
tachypnea
oliguria or anuria
hypoxia
hypercapnia
seizures or coma
Lab values for infection :
biochemistry
what are we examining?
sodium - dehydration
potassium- GI infection ( diarrhea/vomiting)
creatinine- perfusion to kidneys ( hypovolemia)
lactate ( sign of sepsis/msof)
what undergoes lab values for infection
complete blood count
white blood cell count
- elevated B and T lymphocytes, neutrophils, monocytes= bacterial or viral
-elevate basophils/eosinophils = parasitic
what undergoes culture and sensitive in lab values for infection
urine,sputum, throat, blood, wounds, spinal fluid
and equipment
What other lab values do we look for infection
ESR
antibody tests : hepatitis, HIV
Methods of infection control and prevention
hand hygiene
standard precautions
transmission-based precautions
- isolation precautions
contact
-mrsa
-c.difficile
droplet
covid 19
airborne
-tb
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?
hand hygience
name the example we discussed in class for contact vs indirect contanct in terms of getting an infection
contact-= shaking someone hand
indirect contact- taking a pen , and pen being contaminated
this is a larger molecule, travel about 3 feet ( can be contaminated by sneezing, or coughing ) what type of transmission is thibs?
droplet
smaller molecule ( last in the air for a long amount of time ) what type of transmission is this?
airborne
what are the different collaborative interventions we can utilize when we are dealing with a patient who happens to have an infection?
antimicrobial drug therapy
fluids and electrolytes
rest
nutrition
managing fever
- treat cause
what would you do if a patient has an infection and we are using collaborative intervention as a approach ? ( hyperthermic and hypothermic patient )
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
infection control and prevention is a necessity in order to prevent infection
true
This is a late sign of an immunocompromise patients
hypothermic
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
all the above is true
what type of infection do you suspect ?
pus
redness and red streaks around the cut ?
local infection
what type of medication can we take for an infection ?
antibacterial
antiviral
anti-fungal
anti microbial ( antibiotic ) therapy
antibacterial therapy can be ….?
narrow or broad
classification of antimicrobial drugs
susceptible organism can be…?
narrow spectrum : active against a few specific organisms
broad spectrum : active against a wide variety of organisms
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
true
false ( it increases )
this is not bactericidal however it is a bacteriostatic
this is not bacteriostatic however it is a bactericidal
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 ?
suppresses viral replication
antimetabolites
inhibit bacterial synthesis of DNA and RNA or disrupt DNA function
this is treating a bunch of different things ?
broad spectrum
this is treating what we want to achieve ( specific bacteria)
narrow spectrum
Special consideration : empiric and prophylactic therapy
define what undergoes empiric
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 )
Special consideration : empiric and prophylactic therapy
define what undergoes prophylactic therapy
surgery
bacterial endocarditis
neutropenia
other ( chronic issues)
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
prophylactic
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.
bacterial endocarditis
what are the factors that modify drug of choice, route, or dosage
host defenses
site of infection
other ( such as allergic reaction )
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
this undergoes host defenses
Factors that modify drug of choice, route, or dosage
what undergoes site of infection
blood brain barrier
foreign material ( prosthetics)
recall blood brain barrier what type of pharmacology concepts would you utilize
it would be a lipid soluble ( non ionize) drug therpahy
true or false. You can give an antibacterial therapy to a virus infection
false, you cannot
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
all true
Misuse of medication
treatment of fever of unknown origin
what is the only consideration we should utilize?
only consideration is in immunocompromised host
If we have a wound that is extremely infected ( we need a lot of care ) –> cannot leave wounds to expect it to be healed
true
antimicrobial resistance
we must consider misuse factors along with nonadherance to completion of treatment
true
true or false.Antimicrobial resistance : organisms becomes less susceptible or sensitive to drug ( often from narrow spectrum )
this is false, it’ss usually often from broad spectrum
true or false.Patient responding to treatment is a sign that it is leading to complications. This could be an example of antimicrobial resistance.
false, patient usually does not respond to treatment leading to complications
true or false.
antimicrobial resistance
hospitals are sites of intensive antibiotic use : hospital associated infections are high
true
what is superinfections that undergoes antimicrobial resistance?
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 )
are the most common multi-drug resistant organisms ?
MRSA, C.difficile
Select all the antibacterials
penincilins
cephalosporins
aminoglycosides
tetracyclines
macrolides
sulfonamides
fluroquinolones
all is true
DRUG CARD : PENICILLINS : PENICILLIN G
( this is a bactericidal and most common drug allergy )
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 )
DRUG CARD : CEPHALOSPORINS : CEFAZOLIN ( ANCEF)
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
DRUG CRAD : TETRACYCLINES : DOXYCYCLINE
(very sensitive to light, protein synthesis inhibitors, often used for acne )
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 )
