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immune system
| Term | Definition |
|---|---|
| dyscrasia | Abnormal blood or bone marrow condition |
| myeloid | Pertaining to bone marrow |
| myelocyte | Immature WBC usually found in marrow; 1st maturation states of granulocytic leukocytes |
| malignancy | Virulent, tending to become worse & cause death |
| proginitor | Parent or ancestor, precursor cell, stem cell |
| Recombinant | Cell or organism that results from the recombination of genes within DNA molecule (genetic engineering) |
| concomintant | Designating 1 or more of 2 or more things occurring simultaneously |
| Clusters of Differentiation (CD) | CD antigens |
| immune system response | Diversity of ability to respond but with a specificity of action |
| immunodeficincy | Deficient response due to missing immune component in the process of cell-mediated or humoral immunity. Unable to resist or combat a potential infection |
| congenital or primary mmunodeficiency | born lacking a specific substance or function |
| acquired immunodeficiency | consequence of another disease, injury or other cause |
| bandaid theory | treat symptoms but not disease |
| non-specific defense | non-selective against any foreign substance anatomic & chemical barriers same response but varies with degree/extent dependent on relation of damage |
| specific defense | Unique substances, acquired ability Antibodies – cell mediated & humorally mediated |
| immune system function | defense:specific and non specific, memory, protection |
| inflammatory response: local manifestations | Redness, heat, swelling, pain & loss of function |
| inflammatory response: systemic manifestations | Fever, leukocytosis (shift to the right/left), elevated sed rate, anorexia, nausea, increased respiratory rate & pulse |
| types of immunity | natural and acquired |
| natural immunity | No prior contact but exists, can be R/T a species, race or genetic tendency,transfer via placenta,short lived |
| acquired immunity | implies development of immunity in a person ACTIVE: development of antibodies in response to an organism - long term PASSIVE: host receives antibodies to an antigen |
| antigen | Foreign substance that elicits an immune response – mostly protein in composition |
| haptens | Low molecular weight substances that can form complexes that are antigenic when combined with high molecular weight substances |
| common haptens | dust, animal dander, drugs, industrial chemicals,important in hypersensitivity reactions |
| components of the immune system | principle cells and lymphoid organs (thymus, bone marrow, spleen) |
| b lymphocytes | Bone marrow derived |
| T lymphacytes | Thymus dependent |
| cellular components | Mononuclear phagocytes Platelets |
| fluid factors | Circulating immunoglobulins Fibrins |
| complement proteins | Complement cascade pathways |
| acute-phase proteins | interleukins |
| interferon | Proteins made in response to viruses, bacteria or tumor cells |
| lymphatic system | Drainage pathway in body that facilitates immune system function |
| HLA antigen | Provides specific information relative to autoimmune & blood components |
| Thymus (central lymphatic system): function | differentiation & maturation of T lymphocytes essential for the cell-mediated immune response, secretes thymic hormones thymosin stable from birth until about age 25 gradually decreases thereafter |
| location of the Thymus | superior mediastinum behind the sternum |
| size parameters of Thymus | childhood, the gland is large, atrophies in the adult (fat infiltration) |
| bone marrow (central lymphatic system) | Sources: iliac crest, sternum |
| peripheral lymphatic system | tonsils, gut, genital, bronchial, skin associated, lymph nodes & spleen, found in the submucosa of respiratory, Peyer’s Patches intestinal lymph node tissues |
| lymphatics: lymph nodes | a. filtration, b. remove & destroy antigens circulating in blood & lymph,c. principal source of circulating lymphocytes which provide specific immune response |
| spleen | a.blood storage & platelets,b. filters & removes foreign material, c. worn out cells & cellular debris, d.white pulp: B & T lymphocytes,e.red pulp: erythrocytes |
| spleen location | LUQ |
| chemical mediators | Complement system, Prostaglandin & Leukotrines, Exudate formation |
| Epogen (Procrit) | boost erythropoietin production in the bone marrow |
| Neumega (Oprelvekin) | Increased platelet production |
| Leukine (Prokine) | Stimulate neutrophil action |
| BIOLOGICAL RESPONSE MODIFIERS | Agents that modify the relationship between host and tumor by altering the biological response of the host to tumor cells |
| ANC range | 2000-8000/mm |
| ethnic variable for ANC | black adult cam have a normal ANC as low as 1000/mm |
| ANC immunosuppression | can be classified as mild, moderate or severe |
| ANC neutropenia | Less than 1,000/mm leads to an increased incidence of infection |
| ANC responses | Determination of post nadir chemo ANC of 10,000/mm |
| dosage adjustments | Based on daily or 3 day consecutive evaluations |
| location of Neupogen | Stored in refrigerator Warm to room temperature |
| Neupogen compatibilty issues | Dedicated line. In all cases flush line before and after administration with D5W |
| Neupogen routes of administration | SubQ injection, Can be administered IVP over 1 minute, Intermittent infusion over 15-30 mins; can be diluted with D5W, Continuous infusion – single dose over 4 to 24 hours Hypersensitivity to E coli derived proteins |
| Neupogen precaution | May require albumin to protect absorption to plastics |
| Neupogen: Nursing Implications for pain | Premedicate with Tylenol, Rotation of sites Stimulation of marrow growth, Dose related bone pain requiring analgesics |
| Neupogen: Nursing Implications for allergic reactions | Itching & redness Swelling at injection site |
| Neupogen: client education for clinical signs | Report any signs of infection (fever) Allergic reaction |
| Neupogen: client education for self medication | Client can be taught to self medicate |
| current research findings validate this especially in the elderly population to boost immune response | zinc & selenium |
| LYMPHADENOPATHY: non-neoplastic | enlarged, flat & relatively soft |
| LYMPADENOPATHY: neoplastic | enlarged, irregular & rubbery hard |
| LYMPADENOPATHY: infectious | enlarged, variable degree of hardness, erythema, heat & pain |
| LYMPADENOPATHY: malignant | hard, discrete & non-tender |
| Diagnostic studies of the immune system: non-specific | WBC with differential, sed rate (ESR), Rheumatoid Factor (RF, C-reactive protein (CRP), total complement activity |
| Diagnostic studies of the immune system: specific | Protein electrophoresis, antibody screening tests autoantibody tests, ABO typing, skin tests, biopsy |
| Peripheral Blood Smear Morphology | RBC indices |
| WBC with differential | Identification of specific components of WBCs Examines immature vs. mature cells, Relative vs. absolute concentrations, Neutrophils: 1st line response, Bands or segs |
| eosoniphils | associated with allergic disorders |
| shift to the left | bacterial |
| shift to the right | viral |
| Neutropenia | Due to ineffective production, Abnormal distribution, Reduced survival, Combination mechanisms,Febrile neutropenia and Cyclic neutropenia |
| Erythrocyte Sedimentation Rate | Healthy elderly have increased rates |
| ESR | Nonspecific response to infection, inflammation, malignancies or collagen vascular disease. Increase in clumping of globulins or fibrinogens in blood |
| C Reactive Protein (CRP) | Abnormal glycoprotein produced by liver & excreted in bloodstream during the acute phase of inflammation, Iso-enzyme components released due to oxidative stress |
| Can have positive CRP tests with: | bacterial infections, acute conditions (RA, SLE & MI). Positive response seen during last ½ of pregnancy, with the use of oral contraceptives & IUDs |
| Total Complement Activity (CH50) | Helps to detect immunomediated disease & genetic complement deficiency Can be used to monitor the effectiveness of therapy |
| Total Complement Activity (CH50) Normal range: | 41 to 90 hemolytic units |
| Serum Protein Electrophoresis | Measures types of serum albumin & globulins 4 types of globulin = alpha 1, 2, beta and gamma Looked at in conjunction with total protein & albumin-globulin (A-G) ratio |
| antibody screening test | Sensitivity vs. specificity, ELISA, Western Blot |
| AutoAntibody tests | Rheumatoid Factor = nonspecific marker that may be present in a healthy subset of the population Renegade IgG or IgM Antinuclear antibodies = May be specifically associated with certain diseases |
| skin tests | Intradermal injections, Hypersensitivity reactions |
| skin biopsy | Pathology report, Encapsulated margins |
| LEUKEMOID REACTION | Increase in WBC in response to an allergy, inflammatory disease, infection, poison, hemorrhage, burn or severe physical stress. Condition is SELF limiting and usually doesn’t require treatment. |
| Bone Marrow diagnostic value | Clinical staging for treatment Response to therapy |
| Bone Marrow Site selection | hip/iliac crest |
| sternal tap | sternum: Aspiration and Bone Biopsy Pathology report/histology |
| sternal tap: client and nursing implications | Potential hemorrhage from site Pain associated with procedure |
| Protection from Infection | Protective Isolation Laminar airflow |
| Neutropenic Restrictions & Diet | Prophylaxis: Avoidance of gram negative bacteria, No fresh fruits or vegetables, No fresh flowers, No rectal temperatures, Soft toothbrush, Stool softeners & high fiber diet |
| NO BLACK PEPPER | Do not add after cooking or at the dinner table May add during the cooking process |
| Immunosuppression from treatment | Chemo induced neutropenia, Tumor lysis syndrome, Progression of disease |
| OPPORTUNISTIC INFECTIONS OF AIDS: Bacterial | MAC – Myobacterium Avium Complex |
| OPPORTUNISTIC INFECTIONS OF AIDS: Fungal | Candidasis Cryptococcus neoformans Histoplasmosis *PCP – Penumocystic Carinii Pneumonia |
| OPPORTUNISTIC INFECTIONS OF AIDS:Protozoal | Candidasis Cryptococcus neoformans Histoplasmosis *PCP – Penumocystic Carinii Pneumonia |
| OPPORTUNISTIC INFECTIONS OF AIDS: Viral | CMV – Cytomegalovirus HPV – Human Papilloma Virus OHL – Oral Hairy Leukoplakia HIV Encephalopathy or dementia |
| OPPORTUNISTIC INFECTIONS OF AIDS: R/T cancer | Kaposi’s sarcoma Hodgkin’s’ lymphoma Squamous cancer of the anus |
| OPPORTUNISTIC INFECTIONS OF AIDS: Wasting Syndrome | Defined syndrome related to greater than 10% weight loss |
| Mycobacterium Avium Complex (MAC) (bacterial): most common s/s | fever, diarrhea, weight loss & debilitation Occurs in 50% of clients with AIDS |
| Mycobacterium Avium Complex (MAC) (bacterial): treatment | Drug combination profile: Isoniazid (INH), Ethambutol & Rifampin |
| Mycobacterium Avium Complex (MAC) (bacterial): | Dissemination infection of multiple tissues & organs |
| Mycobacterium Avium Complex (MAC) (bacterial): diagnostics | usually diagnosed by blood cultures |
| Candidiasis (fungal): where does it present | Commonly present in mucous membranes of mouth, throat, esophagus & rectum Can have candidial proctitis |
| Candidiasis (fungal): S/S | White cottage cheese patches that can be scraped off, Dysphagia, rectal pain, pruritus & discharge, |
| Candidiasis (fungal): treatment | Medications: Nystatin (swish & swallow), CLOTRIMAZOLE –lozenge, FLUCONAZOLE –tablets, Vaginal creams / suppositories Temperature changes & spicy foods may aggravate, Disseminated form: treat with Amphotericin B |
| Cryptococcus Neoformans (fungal): | Usually presents as meningitis in HIV infected clients, Yeast like fungus found in pigeon droppings, nesting places, soil, fruit & fruit juices |
| Cryptococcus Neoformans (fungal): Diagnostics | found in CSF with staining, antigen testing in urine or serum titers |
| Cryptococcus Neoformans (fungal): treatment | Primary therapy: Amphotericin B |
| histoplasmosis (fungal): | Present in soil where bird & bat excrement collect, Pulmonary infection or disseminated disease |
| histoplasmosis (fungal): treatment | Medication: Diflucan or Sporanox, Amphotericin |
| Crytosporidium (Enterocolitis)(Protozoal): most common site | small intestines |
| Crytosporidium (Enterocolitis)(Protozoal): S/S | cramping abdominal pain & watery diarrhea Symptoms range from diarrhea to a cholera-like syndrome with wasting & electrolyte imbalances |
| Crytosporidium (Enterocolitis)(Protozoal): treatment | No effective treatment. Medication: Octreotide to reduce stool volume Death due to profound dehydration & F/E imbalances |
| Pneumocystic Carinii Pneumonia (PCP) Pneumocystis jiroveci (fungal): S/S | fever, SOB & dry non-productive cough |
| Pneumocystic Carinii Pneumonia (PCP) Pneumocystis jiroveci (fungal): What is it? | Common opportunistic infection Airborne transmission |
| Pneumocystic Carinii Pneumonia (PCP) Pneumocystis jiroveci (fungal): treatment | Medication: TMP- SMX Bactrim |
| Toxoplasmosis Gondii (protozoal): What is it? | Part of TORCH study group, 4 different types Found in cat excrement, ingestion of meats & vegetables containing cysts or oocytes Major cause of encephalitis in person with AIDS, Localized neurologic deficits |
| Toxoplasmosis Gondii (protozoal): diagnosis | brain biopsy, imaging, focal neurological deficit |
| Toxoplasmosis Gondii (protozoal): treatment | Medications: pyrimethamine (Daraprim acid), sulfadiazine, clindamycin, azithromycin |
| Cytomegalovirus (CMV) or Inclusion disease: viral | Part of TORCH study group, DNA virus that belongs to herpes group, Multiple transmission presentation- congenital or acquired, CMV retinitis, Common cause of enterocolitis in AIDS clients usually seen late in disease process |
| Cytomegalovirus (CMV) or Inclusion disease: viral | Medications: CMV immunoglobulins, antivirals |
| HIV Encephalopathy or Dementia: What is it? | Progressive loss or decline in cognitive, motor or behavioral function |
| HIV Encephalopathy or Dementia: treatment | Medication = AZT given to improve neurological functioning |
| Kaposi’s Sarcoma: What is it? | Vascular or lymphatic endothelial neoplasm Painless cutaneous lesions Pigmented nodules = reddish purple More common in males Discrete lesions that can be found all over the body |
| Kaposi’s Sarcoma: diagnosis | Diagnosed by biopsy *Now seeing them unrelated to HIV |
| Hodgkin’s Lymphoma: What is it? | B cell origin Peripheral lymphoma in 80% of cases Systemic presentation with extranodal disease Focal neurologic findings |
| Hodgkin’s Lymphoma: treatment | Chemotherapy, radiation and/or steroids |
| cervical cancer | Now an AIDS defining diagnosis in HIV+ females |
| squamous cancer of the anus | Associated presentation with HIV |
| Wasting Syndrome: what is it? | Unexplained loss of > 10% body weight is a common AIDS defining diagnosis Cycle of malnutrition & subsequent wasting that starts early in the disease process affecting entire body |
| Wasting Syndrome: S/S | GI, fatigue, constitutional symptoms, sensory or neurologic effects, anorexia |
| Wasting Syndrome: treatment | Prophylactic to assist with GI effects & taste alterations Therapeutic to stimulate appetite Medications to control diarrhea Supplementation: TPN or enteral feedings |
| Wasting Syndrome: Nursing Interventions | Boost calorie & protein intake, multivitamins nutrient rich foods, Small frequent meals, Counteract altered taste by using Sorbets as palate cleansers, High calorie high protein soft foods Avoid greasy high fat spicy foods Take liquids between meals |
| Wasting Syndrome:treatment | Megace = synthetic oral progesterone Adjuvant therapy to stimulate appetite Marinol = cannabis derivative as appetite stimulant Oxandrin = orexins (anabolic steroids |
| HIV Transmission | Parenteral Sexual Vertical or perinatal |
| Risk to pregnancy outcome | Fetal loss Prematurity Low birth weight (LBW) Infectious complications Effect of pregnancy on HIV does not hasten the course |
| HIV testimg infants and children | Congenital HIV manifests prior to 2 years of age & is a more severe form with poorer prognosis |
| HIV: Primary Prophylaxis | Aims to prevent or delay onset of symptoms of reactivated as well as newly acquired |
| HIV: Secondary Prophylaxis | Prevent or delay recurrent episodes of symptomatic infection |
| Latest CDC AIDS definition | CD4 count below 100/mm3 Pulmonary TB Recurrent pneumonia Invasive cervical cancer |
| CDC Recommendations for PCP & MAC: TMP-SMX (Bactrim) | Prophylaxis for PCP Both for Primary & Secondary Side benefit of preventing Toxoplasmosis Adverse effect: hematologic monitoring |
| HIV: Goal of antiretroviral therapy is to: | inhibit viral replication & (2) minimize development of resistant strains |
| HIV: Drug Categories: | Nucleoside analogs (Nucleoside reverse transcriptase inhibitors (Non-nucleoside reverse transcriptase inhibitors) Protease inhibitors Fusion inhibitors |
| Systemic Lupus Erythematosus (SLE): What is it? | Multi system autoimmune inflammatory condition characterized by a fluctuating, chronic course. Varies from mild to severe & maybe lethal |
| Systemic Lupus Erythematosus (SLE): presentation | Multiple organ involvement, joint symptoms, rash & + ANA test |
| Systemic Lupus Erythematosus (SLE): gender | Primarily affects women of child-bearing age |
| Systemic Lupus Erythematosus (SLE): hormonal effects | Effects of Estrogen, Oral contraceptive use can increase risk of flare ups Increased flare during pregnancy due to rising estrogen levels |
| Systemic Lupus Erythematosus (SLE): which ethnicity has a higher risk factor | Black, Hispanic, Asian & Native American greater than Caucasian |
| Types of Lupus | SLE, discoid, and drug induced |
| discoid Lupus | Skin rash without systemic disease |
| drug induced lupus | Occurs as a result to a response to various medications such as: hydralazine, dilantin, procainamide, isoniazid & penicillamine |
| SLE | systemic disease |
| most common presentation of SLE | Arthritis, Joint pain & swelling Aseptic necrosis can follow steroid therapy |
| dermatologic s/s of SLE | Butterfly rash, Photosensitivity, Unusual reaction to sunlight, Raynaud’s phenomenon, Discoid skin lesions |
| most common cause of death with SLE | Nephritis and/or renal failure, |
| other renal manifestations of SLE | HTN, Persistent proteinuria, Lupus glomerulonephritis |
| 2nd leading cause of death with SLE | Cardiac involvement, Pericarditis – 25% A fib and CAD |
| 3rd leading cause of death with SLE | CNS disease: Range from subtle changes to psychosis, seizures & strokes |
| Hematologic Manifestations with SLE | Hemolytic anemia, Leukopenia, Thrombocytopenia |
| SLE labs | >creatinine, >PT and >APTT, >Lactic dehydrogenase (LDH), <complement assay, Leukopenia & thrombocytopenia, |
| SLE management and treatment | Avoid complications, Monitor/treat renal disease, cardiac & CNS manifestations, rest, avoid UV light,Immunizations Prophylactic antibiotics for dental & invasive procedures, ASA or NSAIDS for arthritis |
| treatment for Blood dyscrasias (with SLE) | Replacement therapy IV gammaglobulin |
| Conservative Treatment: SLE | NSAIDS, Placquenil, Glucocorticoid treatment(Tapered dose/pulse dose IV pulse therapy, Alternate day scheduling Side effects of steroids) |
| Aggressive Treatment: SLE | Immunosuppressive agents: Chemotherapy regimens,Splenectomy (Maybe contraindicated if there is refractory thrombocytopenia, Treat with IV gammaglobulin), Plasmapheresis (Apheresis, Estrogenic hormones, IVIG (Immunoglobulins)) |
| Off Label Usage Azathioprine | Weight based Bone marrow suppression/liver toxicity Signs of infection CBC, platelets, liver function Pap test |
| Cyclophosphamide | Weight based Bone marrow suppression Malignancy Hemorrhagic cystitis Secondary infertility CBC & UA monthly Urine cytology/Pap test |
| Methotrexate |
Created by:
gemjema
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