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Immune System
Nursing Anesthesia:Immune System
| Question | Answer |
|---|---|
| 3 functions of the immune system | Defense of foreign pathogens/infecttion, Homeostasis - helps clean blood, Surveillance for CA |
| Naturally Active Immunity | acquired through encounter live pathogen and have a primary immune response |
| Naturally Passive Immunity | mother's breastmilk, placenta (IgG) |
| Artifical Passive Immunity | Injection of gamma globulin |
| Artifical Acquired Immunity (artificial) | vaccination |
| B Cells made where? | made in bone marrow |
| T Cells made where? | made in thymus (Long-term immunity) |
| Humoral Immunity | B-Cells - Antibodies |
| IgG | only one to cross the placenta |
| IgA | breast milk and most body secretions |
| IgM | Involved in Primary immune response |
| IgD | on B-Cells |
| IgE | Involved allergies Remember IgE - Eosinophils which release histamine |
| Primary Immune Response (First Exposure) | the first contact witht the Antigen - activation of B-cells to Plasma that release Antibodies and Memory Cells |
| Secondary Antibody Response (Second Exposure) | Happens quicker, 1-2 days with 2nd encounter. |
| B Cellst turned into... | plasma cells -> antibodies |
| In cell- mediated immunity Primary T Cells against.... | INTRAcellular infections,viruses, tumors, tissue rejections |
| B Cells against... | Extracellular, found in body fluids,and indirectly become Plasma cells producing antibodies |
| The complement system (the Antigen-Antibody Interactions) | ChemotaxisDiapedsis - basically increase vasc. permeablityAgglutinationOpsonizationLysis |
| Opsonization | coated outside of cells, made it more suspectible to phagocytosis |
| Lysis | damaging the cell member, killing the cell |
| Chemotaxis | Attracting and keep phagocytes in the inflam area |
| T Lymphocytes (cytotoxic T Cells) | attack cells that they want to kill |
| Substances that help reconized self from non-self | MHC (Major histocompability complex)&HLA (Human Leukocyte Antigen) |
| Natural Killer Cells | Kill cells directly |
| Nonspecific Immunity includes... | Mechnical defenses/barriers, enzymes, inflammation, cellular response, species resistance |
| Reticuloendothelial Tissue | where your phagocytic cells wait and already action when needed. These include the blood, lymph, vessel lining, liver, spleen, bone marrow |
| Anaphylactoid | Occur in immediate hypersensitivity allergic reactions. Occurs in minutes. IgE attaches to mast cells; Chemical mediators (histamine,prostagladins,...) released |
| The most important activator of of inflammatory response | The Mast Cells |
| Chemical Mediators | Histamine, Serotonin, Prostaglandins |
| Kinins system involved | bradykinins - increased vasc. permeability |
| Effects of mediator: Histamine | Smooth muscle contraction; increased vascular permeability (edema); Vasodilation - vasoconstriction; Hypotension; Increased secretion of mucus; Itching |
| Anaphylactic Shock | Life threatening; Bronchial constriction; Vascular collapse; Edema, Hives, itching progress rapidly to shock |
| What happen in delay-reaction allery | repeated exposure, eventually sensitized T cells leading to skin inflammation & dermatitis |
| Ex of Type IV | contact dermatitis, microbial hypersensitivity reactions, transplant rejection |
| Four categories of Allergens | Inhalants, Contactants, Ingestants, Injectables |
| What should you assess for with Allergic Disorders? | Family allergies; past/present allergies; course of response (what happens?); Integumentary system; EENT, Resp: wheezing, stridor, sputum |
| Diagnostic Studies for Allergic Disorders | CBC with WBC differential |
| What is increased in allergic responses | eosinophils |
| RAST | Radioallergosorbent test |
| What does a RAST test? | blood sample - safer - less risk to paattient - not as reliable - expensive |
| Skin tests | Scratch/prick; Intracutaneous injecton (arms/back) Monitor closely and precautions must be taken |
| Anaphylaxis Treatment | ABC's: Airway, oxygen; Tourniquet to prevent spread (above site); Epinephrine or antihistamines for a lesser reaction; Treat shock - replace fluids and give vasoconstrictors |
| What should you do when giving antibiotics or blood products | observe carefully for s/s of a reaction - especially PCN & Cephalosporins; |
| Epinephrine | sympathomimetic - stimulates sympathetic nervous system; dilates bronchials and constricts veins |
| Diphenyhdramine - Benadryl | antihistamine |
| How is epi administered | SC or IV |
| How is Benadryl administered | IV, IM or PO |
| S/E of Antihistamines | Drowsiness/sedation; decreased coordination |
| How do antihistamines work | compete for H1 receptor sites with histamine; Don't prevent bronchospasms - WON'T HELP ANAPHYLATIC SHOCK |
| New Antihistamines do not | cross blood-brain barrier and have less CNS effects - don't cause as much drowsiness |
| New antihistamines include | Zyrtec, Hismanal, Claritin, Allegra |
| Sympathomimetic/decongestants | Epinephrine; Phenylephrine (Neo-Synephrine); Pseudoephedrine (Sudafed) |
| Corticosteroids | Nasal sprays for allergic rhinitis; Brief course of oral meds |
| Client teaching r/t drugs for allergies | rebound s/e of nasal sprays - if used too much it makes the problem worse; s/e esp r/t safety |
| Ex of Antipruritic Drugs | Topicals like calamine lotion, coal tar solutions camphor |
| Mast Cell Stabilizers | Inhibit release of histamines, leukotrienes, etc.,; nebulizers, nasal spral oral |
| Ex of Mast Cell Stabilizers | Cromolyn(Intal), Nedocromil (Tilade) |
| Immunotherapy is | allergy shots |
| When is immunotherapy indicated | for life threatening allergy (insect venom); used to control allergy when medications ineffective or allergen is unavoidable |
| Mechanism of action of immunotherapy | block levels of IgE with higher levels of IgG by introducing small amounts of antigen that stimulate IgG response (substituting one for another) |
| Nursing Mgmt for Allergy Shots | Observe pt for 20 min; watch for systemic reaction (potential-pruritis, urticaria, sneezing,etc.); given in controlled setting with emergecy equip, physician available |
| How should you administer an allergy shot | aspirate - don't want to give into blood stream |
| For anaphylaxix after an allergy shot | apply tourniquet above site |
| How and how often are allergy shots given | SubQ and Q week |
| How long does it usually take for allergy shots to be effective | 1-2 years |
| If having an anaphylaxis reaction to an allergy shot, you would administer... | epinephrine |
| A latex allergy is mostly a Type IV because.... | it is a contact dermatitis; usually a reaction to chemical; delayed reaction affects the skin only |
| A Type I Latex allergic reaction occurs | within minutes; ranges from skin redness to anaphylactic shock |
| Management of Latex Allergies | ID risk factors: asthma, other allergic reactions, HCW |
| Autoimmune Disorders are considered | Type II & III reactions |
| What happens in autoimmune disorders | inappropriate response to self-proteins; autoantibodies & autosensitized T cells |
| Autoimmune disorders tend to | cluster - usually have more than one |
| Examples of autoimmune disorders | autoimmune hemolytic anemia, Systemic lupus erythematosis, rheumatoid arthritis, scleroderma |
| HLA | Human Leukocyte Antigen System (tissue compatibility) |
| What does HLA do | used in matching donor tissue for transplantation; also a marker for genetic studies - relationship between autoimmune disorders and HLA types |
| Tx for autoimmune disorders include | Apheresis, Plasmapheresis, and Immunosuppressants |
| Apheresis | separation and removal of blood components |
| Plasmapheeresis (plasma exchange) | removal of plasma containing components causing disease |
| Immunodeficiency Disorders cause an impairment of | Phagocytosis, Humoral response, Cell-mediated response, Complement, and combined humoral and cell-mediated response (rem: the immune sys does not work) |
| Names of Primary Immunodeficiency Disorders | Hypogammaglobulinemia, Agammaglobulinemia, and Acquired hypogammaglobulinemia |
| Hypogammaglobulinemia | things you are born with - don't have enough of the protein to make antibodies; Defect; absence of one type (the boy in the bubble) |
| Agammaglobulinemia | Bruton's Disease |
| Acquired hypogammaglobulinemia | probably don't have enough - absence of plasma cells; recurrent infections |
| How do you treat acquired hypogammaglobulinemia | with gamma globulin/plasma transfusion |
| How is gamma globulin therapy administered | Previously given IM but now IV |
| What are examples when gamma globulin therapy is used | for rabies and Hep B exposure |
| S/E of gamma globulin therapy | flu-like symptoms, flank pain, chills, chest tightness, hypotension, slight temp increase, anaphylaxis with severe reactions |
| Nursing Mgmt of Gamma Globulin Tx | Baseline wt, VS before administration; Pretx with aspirin, Benadryl; Sometimes Prednisone; |
| How is Gamma Globulin infused | Slowly - no more than 3mL/min |
| What should you do if the patient is having s/e during administration of gamma globulin | slow the infusion rate - DO NOT Stop unless anaphylaxis |
| DiGeorge's Syndrome | lack of thymus/parathyroid development - absence of T cell function (hereditary) |
| Signs of DiGeorge's Syndrome | recurrent viral, fungal, protozoan infections; Hypocalcemic tetany (Calcium) |
| Tx of Hypocalcemic tetany | administration of calcium/VitaminD |
| Tx of DiGeorge's Syndrome | fetal thymic transplant in utero |
| Severe Combined Immunodeficiency Disease | B & T cell abnormalities;severe infections of all type |
| What is the onset of Severe Combined Immunodeficiency Disease | Within the first 2 years of life |
| What is the tx for Serve Combined Immunodeficiency Disease | Antibiotic therapy and protective isolation; Bone marrow transplant |
| What are the causes of Secondary Immunodeficiency Disorders | Drug-induces: antineoplastic agents, corticosteroids; stress; age; malnutrition; radiation; loss of lymph nodes, thymus or spleen via surgery; Hodgkins; Viruses |
| Graft -vs- Host Disease | Occurs with transfusion or transplant; graft rejects the host |
| What is the onset of graft vs. host for transplants | 7-30 days post transplant |
| What happens in Graft vs Host disease | Donor T cells attack host cells |
| What are the target organs of graft vs host | skin, liver, GI tract |
| What are some of the s/e of graft vs host | infection; interstitial pneumonitis |
| Mononucleosis | Benign, self-limiting |
| What are the usual age to get mono | 14-18 years |
| What can Mono lead to | Epstein Barr virus (EBV) |
| What is the incubation period for Mono | 4-8 weeks |
| What are the s/e of Mono during the prodromal phase: | HA, fatigue, chills, anorexia, puffy eyelids |
| What are the symptoms during the Acute phase of Mono | fever, painful lymph nodes, enlargement, sore throat |
| How do you Dx Mono | mono-spot test |
| How do you Tx Mono | Rest; treat symptoms |
| What occurs during Mono | Leukocytosis, increased lymphocytes and monocytes |
| Chronic Fatigue Syndrom occurs during what age | 25-45 |
| What viruses could cause Chronic Fatigue Syndrome | EBV, Herpesvirus, cytomegalovirus, ? cytokines |
| Chronic Fatigue Syndrome is often accompanied by | depression |
| Clincal manifestations of Chronic Fatigue Syndrome | overwhelming fatigue that is not r/t exertion; not alleviated by rest and affects life; Memory/concentration is impaired; sore throat, lymphadenopathy, muscle pain, joint pain, HA |
| Management of Chronic Fatigue Syndrome | Supportive Care, NSAID's, antidepressants, Klonopin for sleep; walking program; psychosocial support |
| Dx of Chronic Fatigue Syndrome | done by ruling out other disorders - no specific test |
Created by:
okrecota
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