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immune system

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
Created by: gemjema