Immune/HIV/transplants/ABGs/respiratory
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| Tonsils and adenoids (immune) | prevents infections of the throat when you are young, but not very beneficial when older.
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| Where do T-cells mature | Thymus
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| Where do B-cells mature | Bone Marrow
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| Self-tolerance (immune) | the ability of the immune system to distinguish host cells from foreign cells
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| 3 types of T-cells | T-helpers (activate B-cells), T-cytotoxic (phagocytosis), T-memory (acquired immune response for future infections)
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| 2 types of B-cells | B-plasma (produce antibodies to fight antigen), B-memory (acquired immune response for future infection)
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| NK cells | Natural Killers. Part of the innate immune response. Non-specific phagocytosis.
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| Neutrophils | Innate immune response; phagocytosis; first-responders to most infections
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| Eosinophils | parasitic infections and allergy response
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| Basophils | release chemotaxis to attract other WBC
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| Monocytes | innate immune response, phagocytosis, and antigen presenting cell to activate T-cells.
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| Human Leukocyte Antigens | cluster of 6 genetic markers used to identify which patients are good organ transplant matches
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| Stages of the innate immune response (non-specific response) | 1. Vascular response: blood vessels constrict to stop bleeding, then dilate to allow excess fluid to enter area and causes inflammation
2. Cellular response: blood thickens WBC enter the area and begin phagocytosis
3. Tissue Repair and Resolution
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| Adaptive: Antibody Mediated (Specific response) | B-cells come into contact with antigen and produce plasma and memory cells. Plasma cells produce antibodies to fight the antigen and memory cells create acquire immunity
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| Adaptive: Cell Mediated (Specific response) | T-cells come into contact with sleeper cell antigens and produce cytotoxic cells, T-helpers, and memory cells. Cytotoxic cells destroy the sleeper cells, helper cells stimulate the production of more T and B cells, memory cells produce acquired immunity
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| Type 1 immunoglobulin (IgE) | allergic reactions (peanut allergy), allergies (hay fever), anaphylaxis
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| Type 2 immunoglobulin (IgG/IgM) | Cytotoxic response attacks self-cells that have foreign proteins attached to them. Examples: hemolytic anemia (RBC destroyed too early), transfusion reactions, good pastures syndrome (attacks collagen in kidneys and lungs), thrombocytopenic purpura
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| Type 3 immunoglobulin (IgG/IgM) | trigger inflammation responses in kidneys, skin, joint, small vessels. Examples: rheumatoid arthritis, lupus, serum sickness
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| Type 4 immunoglobulin (T-cell mediated) | Delayed hypersensitivity reactions. Examples: latex allergies, poison ivy, TB skin test
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| Types of Immunoglobulin | immunoglobulin are antibodies that are produced by the B-plasma cells
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| Active Immunity | acquired through the disease or vaccinations
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| Natural immunity | acquired through getting the disease, placental, breast milk
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| Passive immunity | passed through breast milk or placental/ injection of antibodies
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| Artificial Immunity | passed through vaccinations
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| Anaphylaxis | Histamines causes vasodilation and increased capillary permeability, third spacing of fluid, and hypovolemic shock.
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| Autograph transplant | Transplant of your own tissues
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| Isograft transplant | Transplant between identical twins
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| Allograft transplant | Transplant between the same species
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| Xenograpft transplant | Transplant between different species
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| HLA histocompatibility test | Based on 6 genetic markers that determine transplant compatibility
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| Hyperacute tissue rejection | Occurs immediately-3 days after transplantation. More likely in patients with past transplants. Organ will be become soft and cyanotic due to decreased blood perfusion (Triggered by pre-formed antibodies)
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| Acute tissue rejection | Most common type. Occurs 4 day to 3 months after transplantation. Results in red and tenderness at site, fever, and organ failure. (Triggered by Cellular immune response)
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| Chronic tissue rejection | Occurs 4 months to years after transplantation. Results in slow progressive organ failure. (Triggered by the Antibody mediated immune response)
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| Graft versus host disease | Most commonly occurs with bone marrow transplant. Cell-mediated immune reaction where the body attacks its own host cells.
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| Symptoms of graft versus host disease | Bright red rash on palms of hands and soles of feet, bloody diarrhea, and abdominal pain.
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| Acute GVHD | Resolves within first 100 days
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| Chronic GVHD | Resolves after 100 days
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| Pre-transplantation medications | Antiviral and Antibiotic medications to prevent secondary infections
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| Post-transplantation medications | Corticosteroids, T-cell suppressors, Cytotoxic agents, and antilymphocyte globulin
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| Corticosteroid considerations (post-transplant) | Slow wound healing, hyperglycemia, mood changes, immune suppression, fluid retention
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| T-cell suppressing agent considerations (post-transplant) | Monitor BUN/Creatinine levels. This drug is renal toxic
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| Cytotoxic Agent considerations (post-transplant) | Monitor I&Os closely, risk for bleeding, and pulmonary fibrosis. This drug affects liver and kidneys
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| Antilymphocyte globulins considerations (post-transplant) | Given via IV through a central line or port immediately after a transplant. Pre-treat with Tylenol and Benadryl to reduce risk of serum sickness
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| HIV virus attacks which cells | CD4 T-cells
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| HIV is fought by which cells | B-plasma antibodies
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| HIV Acute Retroviral Syndrome | First 2-4 weeks after contracting HIV. Patient may present with flu-like symptoms and general malaise, but the viral antibodies are still undetectable by HIV tests
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| HIV diagnostic tests | ELISA (fast and cheap), Western Blot (more specific), Viral load test (looks at CD4 counts and progression of the disease)
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| HIV Seroconversion | Time at 5-6 weeks when the HIV antibodies are detectable by tests
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| Early Asymptomatic HIV infection | Patient may be asymptomatic or have vague symptoms, middle interval before HIV symptoms appear. CD4 counts are still above 500.
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| Early Symptomatic HIV Infection | Symptoms: herpes zoster, yeast infection, kaposis sarcoma, persistent lymphadenopathy (swollen lymph nodes)
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| Normal CD4 counts | Greater than 500
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| CD4 count for AIDS diagnoses | Less than 200 with opportunistic infections
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| What is the Ryan White Bill for HIV? | A federal fund to help HIV patients pay for treatment
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| HIV Treatment: Transcriptase Inhibitors | Interrupts DNA synthesis
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| HIV Treatment: Protease Inhibitors | Blocks movement of HIV virus. Side effects include HTN, insulin resistance, obesity, and skeletal wasting
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| HIV Treatment: Reverse Transcriptase Inhibitors | Interrupts RNA to DNA synthesis
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| HIV Treatment: Entry Inhibitors | Blocks entry of HIV virus into healthy cells
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| HIV Treatment: HAART Therapy | Combination anti-retroviral therapy that is highly active
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| Side effects of HIV HAART therapy | Atrophy if fat and muscle stores in the body, insulin resistance, changes in extremities, muscle wasting, HTN, and hyperlipidemia
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| How do hypotonic fluids affect cells | hypotonic fluids move fluid into the cells to make them bigger
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| How do hypertonic fluids affect cells | Hypertonic fluids move fluid out of the cells to make them shrink
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| Symptoms of fluid deficit | v blood pressure, ^ HR, v skin turgor, v urine output, edema
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| Symptoms of fluid excess | ^ BP, ^ HR, ^ respiratory effort, crackles, edema, normal urine output, weight gain
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| Normal Sodium | 135-145 (regulated by kidneys, helps control BP and muscle contraction)
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| Normal Potassium | 3.5-5.0 (regulates cardiac contraction)
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| normal Calcium | 8.5-10 (regulated by the parathyroid and dependent on albumin)
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| Normal Magnesium | 1.6-2.6
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| normal Phosphate | 2.5-4.5
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| Hyponatremia symptoms | Na+ <135; muscle cramps, weakness, fatigue, N/V/D, headache, depression, lethargy, changes in reflexes, dulled senses, and irritability
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| Hypernatremia symptoms | Na+ >145; extreme thirst, lethargy, weakness, irritability, seizures, coma, death. Flushing, restless, increased BP, edema, decreased urine output, low grade fever
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| Hypokalemia symptoms | K+ <3. 5; confusion, depression, changes in nerve impulse transmission, respiratory arrest, muscle cramps, paralysis, fatigue, polyuria, polydipsia, severe heart arrhythmias (U wave with ^ risk of V-tach/V-fib)
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| Treating hypokalemia | Administer oral or IV potassium chloride with magnesium (Mg helps with K+ absorption)
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| Hyperkalemia symptoms | Muscle cramps, bradycardia, weakness, tremors, peaked T-wave with widening QRS complex which can lead to CARDIAC STANDSTILL
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| Treating hyperkalemia | Kayexalate enema/oral K+ laxative, insulin/glucose tx, hemodialysis, stop K+ supple
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| Hypocalcemia symptoms | Tetany (muscle stuck), Chvostek's sign (cheek twitching), Trousseau's sign (BP cuff causes arm to contract), lung stridor, convulsion, seizures
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| Tetany | Muscle stuck in contraction (r/t hypocalcemia)
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| Chvostek's sign | Cheek muscles twitch when flicked (r/t hypokalemia)
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| Hypercalcemia symptoms | Weakness, fatigue, kidney stones, cardiac arrest, confusion, lethargy, polyuria, shorten QT complex, heart arrhythmias *potentiates the effects of Digoxin (causes bradycardia HR <60)
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| Treating hypercalcemia | IV hydration, Calcitonin (combats calcium), non-thiazide diuretics
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| Hypomagnesium symptoms | Changes in personality, nystagmus (eyes twitch), Babinski's sign, ^BP/HR, arrhythmia
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| Hypermagnesium symptoms | Confusion, lethargy, v BP, coma, cardiac arrest, arrhythmia
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| Hypophosphate symptoms | Tremors, bone pain, joint stiffness, bleeding disorders, seizures
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| Hyperphosphate symptoms | Weakness, N/V, dysphagia, tetany, v BP
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| Trousseau's sign | BP cuff on arm and arm will start to contract
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| Normal blood pH | 7.35 - 7.45
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| Normal paCO2 | 35-45 (regulated by lungs) Respiratory system
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| Normal paHCO3 | 22-26 (regulated by kidneys) Metabolic system
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| Metabolic Acidosis symptoms | Weakness, fatigue, LOC changes, bradycardia, arrhythmia, hyperkalemia, stupor, coma, *Kussmaul's respiration (rapid deep breathing to get rid of excess CO2)
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| Metabolic Alkalosis symptoms | Confusion, *hyperreflexia, tetany, dysarrhythmias, seizures, reps failure, hypokalemia
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| Respiratory Acidosis symptoms | Acute: Flushed skin, blurry vision, v LOC
Chronic: weakness, impaired memory, sleep disturbances, dull headache
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| Respiratory Alkalosis symptoms | Dizziness, palpations, dyspnea, chest tightness, anxiety, panic, tremors, tetany, seizures, loss of consciousness
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| Causes of Metabolic acidosis | DKA, renal failure, diarrhea (excess gastric acid)
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| Causes of Metabolic alkalosis | Excessive vomiting, GI suctioning, or too much bicarb (loss of gastric acid)
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| Causes of Respiratory acidosis | COPD, near drowning, suffocation, respiratory failure, lung diseases (retaining too much CO2)
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| Causes of respiratory alkalosis | Hyperventilation, anxiety (breathing off too much CO2)
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| Tidal Volume | The amount of air moved in and out of the lungs in one normal breath
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| Inspiratory volume | The amount of air that can forcibly be inhaled over tidal volume
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| Expiratory volume | The amount of air that can be exhaled forcibly over tidal volume
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| Residual volume | The value of air left in the lungs after a forced exhale
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| Vital capacity | The sum of TD, IV, and EV (about 4500mL)
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| WBC count that signals infection is present | >11,000
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| Normal pulse ox and COPD pulse ox | >90% and >88%
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| Pulmonary angiogram | Checks circulation pattern through lungs
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| Pulmonary V/Q scan | Injected dye/inhaled gasses to check ventilation and perfusion
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| Thoracentesis | Drains fluid from the pleural space to increase comfort
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| Pleuritis | Inflammation of the plural sac secondary to a lung infection or trauma
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| Plural effusion | Collection of fluid in the plural space. Dx with x ray, lungs sound diminished; tx underlying cause
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| Pneumothorax | Collection of air in the plural space., can be spontaneous (primary or secondary cause), Traumatic (open/closed/latrogenic), or Tension. Dx with chest x ray. Tx with chest tube
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| Symptoms of spontaneous/traumatic pneumothorax | Chest pain, dyspnea, SOB, tachypnea, tachycardia, diminished/absent lung sounds
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| Symptoms of tension pneumothorax | Life threatening: hypotension, shock, distended jugular veins, severe dyspnea, tachypnea, tachycardia, absent breath sounds, tracheal deviation
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| Hemothorax | Collection of blood in the plural space
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| Flail chest | 2 or more consecutive rib breaks result in free floating portions of rib. Tx with pain control
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| Inhalation injuries | Smoke (fire/chemical burns results in airway damage) and Near-drowning (asphyxiation/aspiration injuries)
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| Pulmonary Embolism prevention | teds, SCDs, heparin, Lovenox, mobility
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| Manifestations of pulmonary embolism | Sudden onset: dyspnea, SOB, chest pain, anxiety, cough, tachycardia, crackle, low-grade fever
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| Acute respiratory failure | Lungs are unable to meet demands of body (obstruction, COPD, PE, trauma, et.)
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| Symptoms of hypercapnia | dyspnea, respiratory depression, swelling of optic disc, tachycardia, DROWSINESS, respiratory acidosis
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| Symptoms of hypoxemia | dyspnea, tachypnea, RESTLESSNESS, tachycardia, metabolic acidosis
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