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JohnO-1610-6

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Goodpasture's syndrome is an autoimmune disorder in which autoantibodies are made against the glomerular basement membrane and neutrophils
Best Practice for Prevention of Infection in an Immunocompromised Client
* Place the client in a private room when possible
* Use good handwashing technique before touching the client or any of his belongings
* Ensure that the client's room and bathroom are cleaned at least once each day
* Do not use supplies from common areas for immunosuppressed clients
* Limit the number of personnel entering the client's room
* Monitor vital signs every four hours
* Inspect the client's mouth at least every eight hours
* Inspect the client's skin and mucous membranes (especially the anal area) for presence of fissures and abscesses at least every eight hours
* Inspect open areas, such as IV sites, every four hours for manifestation of infection
* Change wound dressings daily
* Obtain specimens of all suspicious areas for culture, and promptly notify physician
* Assist the client in performing coughing and deep-breathing exercises
* Encourage activity at appropriate level for the client's current health status
* Change IV tubing daily
* Keep frequently used equipment in the room for use by the client only
* Limit visitors to healthy adults
* Use strict aseptic technique for invasive procedures
* Monitor the WBC count, especially the absolute neutrophil count (ANC), daily
* Avoid the use of indwelling urinary catheters
* Keep fresh flowers and potted plants out of the client's room
The initiating event for phagocytosis is
injury or invasion
CNS infections - how nosocomial might occur
* improper aseptic technique during dressing changes or during monitoring of intra cranial monitoring device
Bronchogenic carcinoma account for 90% of all cases of lung cancer. Usually develops in lower trachea or lower bronchi
Mycobacterium avium-intracellulare complex (MAC) is the most common bacterial infection associated with AIDS
Primary functions of B-lymphocytes
1) become sensitized to a specific antigen
2) produce antibodies directed specifically against that protein
UTI - how nosocomial infection might occur
* improper insertion of Urinary Catheter (use sterile technique when inserting urinary catheters)
* open and disconnecting drain system
* improper specimen collection techniques
* obstruction of drainage
* reflux of urine
* contaminated catheter or equipment
* improper handwashing techniques
SLE =
Systemic lupus erythematosus
Intervention Activities for The Client at Risk for Infection
1) Monitor for systemic and localized s/s of infection
2) Monitor vulnerability to infection
3) Monitor absolute granulocyte count, WBC, and differential results
4) Follow neutropenic precautions, as appropriate
5) Screen all visitors for communicable disease
6) Maintain asepsis for client at risk
7) Inspect skin and mucous membranes for redness, extreme warmth, or drainage
8) Obtain cultures, as needed
9) Promote sufficient nutritional intake
10) Monitor for change in energy level/malaise
11) Instruct client to take medications as prescribed
12) Teach client and family members how to avoid infections
Histamine constricts
the smooth muscles of the respiratory system and small veins
Types of nosocomial infections
1) Surgical wounds
2) Bloodstream infections
3) Pneumonia
4) UTI
5) Bone and Joint Infections
6) Cardiovascular system
7) CNS infections
8) GI System Infection
9) Skin and Soft Tissue
Drugs used to treat inflammation are generally classified as
steroidal or non-steroidal agents
Opportunistic infections =
caused by microorganisms that are continually present as part of the normal environment and are kept in check by normal immune function
Five Cardinal Manifestations of Inflammation
Warmth
Redness
Swelling
Pain
Decreased function
Skin and Soft Tissue
* improper skin care (dressing changes)
* patient risk factors such as poor nutrition, hydration, and immobility
Progressive systemic sclerosis (PSS) is one of a family of diseases often referred to as systemic scleroderma
If acetaminophen or topical agents are not successful in relieving pain, the analgesic drug class of choice is usually
non-steroidal anti-inflammatory drugs (NSAIDs)
Common NDx and Collaborative Problems
1) Risk for infection r/t immunodeficiency.
2) Impaired gas exchange r/t anemia, respirator infection or malignancy, anemia, fatigue, or pain
3) Acute pain or chronic pain r/t neuropathy, myelopathy, malignancy, or infection.
4) Imbalanced Nutrition - less than body requirements r/t high metabolic need, nausea and vomiting, diarrhea, difficulty chewing or swallowing, or anorexia
5) Diarrhea r/t infection, food intolerance, or medications
6) Impaired skin integrity r/t KS, infection, altered nutritional state, incontinence, immobility, hyperthermia, or malignancy
7) Disturbed thought processes r/t AIDS dementia complex, CNS infection, or malignancy
8) Situational low self-esteem to chronic low self-esteem r/t changes in body image, decreased self-esteem, or helplessness
9) Social isolation r/t stigma, virus transmissibility, infection control practices, or fear
Macrophages are important in
immediate inflammatory responses and can also stimulate the longer lasting immune responses associated with AMI and CMI
Bone and Joint Infections - how these might occur in a hospital
* improper aseptic technique during pin care or dressing care
As the tumor increases, fewer resources are available for normal cells
Pathogenic infections =
caused by virulent microorganism and occur even among people whose immune systems are functioning at an optimal level
Cell types involved in AMI
1) B-lymphocytes are the cells with the most direct role in AMI
2) Macrophages
3) T-lymphocytes
Surgical wounds -
how nosocomial infections might occur
* can happen from improper surgical technique
* improper self-preparation before surgery
* improper aseptic technique during dressing change
The mainstay drug of RA therapy is
Methotrexate
Additional NDx and collaborative problems
1) Activity intolerance r/t fatigue, discomfort, CNS defect, weakness, or anemia
2) Risk for injury r/t CNS defect, mental status changes, depression, or thrombocytopenia
3) Disturbed sensory perception (visual) r/t CMV retinitis or blindness
4) Disturbed sleep pattern r/t pain, discomfort anxiety, or depression
5) Ineffective coping r/t diagnosis of AIDS
6) Disabled family coping r/t the diagnosis of AIDS
7) Anticipatory grieving r/t potential loss of role and function or impending death
Allergens in immune system
Nursing process -
1) Report any allergies of patient or that patient describes or exhibits to the physician
2) Note drug allergies in large letters on front of chart and in the medical record
3) The patient should wear a special ID band
4) A person can have an allergic reaction to any drug
5) A reaction will occur more dramatically and more rapidly if the drug is administered parenterally
6) No drug ought to be given without first making sure the patient is not allergic to it
7) If there is any doubt, or if the patient has a history of allergies or asthma, the physician may do a skin test first
8) The nurse must always be prepared to deal with possible anaphylaxis
9) Patient education is a big part of the nurse's role
Cardiovascular system - how nosocomial infections might occur
* improper aseptic technique during dressing change or following cardiac surgery
Metastatic Cascade - divided into 3 stages
* Stage 1 - neoplastic cells from the primary tumor invades surrounding tissue and penetrate blood or lymph vessels
* Stage 2 - cancer cells migrate via the lymph or blood circulation or by direct extension. The lymphatic system provides the most common pathway for the initial spread of malignant cancer cells
- Blood vessels (both veins and arteries) carry cancer cells from the primary tumor to the capillary beds of the lungs, liver and bones
- Metastatic spread to distant organs and tissues is almost always the result of cells moving through the bloodstream (for example, from the lung to the brain)
- Direct extension of tumors to adjacent tissue also occurs. For example, a breast cancer may spread directly to the chest wall
- In body cavities, cells may spread by gravity. For example, cancer cells of the ovary are often found to have fallen onto and seeded the entire paritoneal cavity
* Stage 3 - cancer cells are established and proliferate at the secondary site
- although the exact mechanism of metastasis is unclear, the metastatic sites of many cancers are fairly predictable
- researchers have observed that certain tumors have for unknown reasons, an affinity for certain sites
- The most common sites are the liver, lungs, bones and brain
Sexual acts or practices that permit infected seminal fluid to come into contact with mucous membranes or nonintact skin are the most risky for sexual transmission of HIV
Sequence of Inflammatory Responses
1) Stage I (Vascular)
In stage I of the inflammatory response, the early effects involve changes at the blood vessel level
* Two Phases
- Phase I
- Constriction of arterioles and venules as a direct result of physical trauma to vascular smooth muscle
- lasts only a few seconds to minutes
- person may be unaware it is happening
- Phase II
- hyperemia - increased blood flow to the area
- edema formation (swelling) at the site of injury or invasion
The major leukocyte involved in stage I of the inflammatory response is the tissue macrophage.
2) Stage II (Cellular Exudate)
Stage II of inflammation is characterized by
* neutrophilia (increased number of circulating neutrophils)
* secretion of many factors into the interstitial fluid
* formation of exudate (pus)
Involves neutrophils, basophils, and eosinophils
3) Stage III (Tissue Repair and Replacement)
Stage III is completed last, though it begins at the time of injury and is critical to the ultimate function of the inflamed area
Bloodstream infections how nosocomial infections might occur
* improper skin prep of IV site
* failure to change IV site when inflammation appears
* contamination of IV fluid , needles, or catheters
* improper technique during the insertion of drug additives in the IV fluids
* improper care of peritoneal or hemodialysis shunts
* improper technique with adding stop cocks or adding or connecting tubing to IV fluids
* use of multiple lumen central venous catheters
Energy Conservation for the Client with Arthritis
1) Balance activity with rest; take one or two naps each day
2) Pace yourself; do not plan too much for one day
3) Set priorities; determine which activities are most important, and do them first
4) Delegate responsibility and tasks to your family and friends
5) Plan ahead to prevent last-minute rushing and stress
6) Learn your own activity tolerance and do not exceed it
Three process necessary for immunity and the cell types involved
1) Inflammation
2) Antibody-mediated immunity (AMI)
3) Cell-mediated immunity (CMI)
Cytokines
* Control the inducing and regulatory aspects of the CMI
* Small protein hormones produced by the various WBCs.
* Activity is similar to the action of other hormones
- one cell produces and secretes a cytokine
- this exerts its effects on other cells of the immune system
* Most cytokines are produces as needed, rather than stored
DLE =
Discoid lupus erythematosus
Clinical Category C
* Considered to have AIDS if any one of the following conditions that meet the CDC surveillance case definition for AIDS is present -
* Bronchial, tracheal, pulmonary, or esophageal candidiasis
* Invasive cervical cancer
* Disseminated or extrapulmonary cocidioidomycosis
* Chronic intestinal cryptosporidiosis
* Cytomeglovirus disease of other than liver, spleen, or lymph nodes
* Cytomegalovirus retinitis with vision loss
* HIV-related encephalopathy
* Herpes simplex (chronic, or bronchitis, pneumonitis, or esophagitis)
* Disseminated or extrapulmonary histoplasmosis
* Chronic intestinal isosporiasis
* Kaposi's sarcoma
* Lymphoma (Burkitt's, immunoblastic, or primary brain)
* Disseminated or extrapulmonary Mycobacterium avium-intracellulare complex or M kansasii
* Extrapulmonary Mycobacterium tuberculosis
* Pneumocystis carinii pneumonia
* Recurrent infectious pneumonia
* Progressive multifocal leukoencephalopathy
* Salmonella septicemia
* Toxoplasmosis (brain)
* Wasting syndrome
Eosinophils are not efficient phagocytes, although they can act against infestations of parasitic larvae
Skin and Soft Tissue - how nosocomial infections might occur
* improper skin care (dressing changes)
* patient risk factors such as poor nutrition, hydration, and immobility
* Stage 3 -
cancer cells are established and proliferate at the secondary site
- although the exact mechanism of metastasis is unclear, the metastatic sites of many cancers are fairly predictable
- researchers have observed that certain tumors have for unknown reasons, an affinity for certain sites
- The most common sites are the liver, lungs, bones and brain
Clinical Category B
* HIV positive
If one or more of the following conditions is present and is 1) attributed to HIV or is indicative of a deficiency in CMI OR 2) is complicated by HIV infection
* Bacterial endocarditis, meningitis, pneumonia, or sepsis
* Vulvovaginal candidiasis that is persistent for more than one month or poorly responsive to therapy
* Thrush
* Sever cervical dysplasia or carcinoma
* Constitutional symptoms, such as fever or diarrhea, lasting longer than one month
* Oral hairy leukoplakia
* Herpes zoster (shingles) involving at least two distinct episodes or more than one dermatome
* Idiopathic thrombocytopenic purpura
* Listeriosis
* Pulmonary Mycobacterium tuberculosis
* Nocardiosis
* Pelvic inflammatory disease
* Peripheral neuropathy
The bone marrow is the source of all blood cells, including immune system cells
GI System Infection - how nosocomial might occur
* contaminated food or water
* overuse of antibiotics (killing body's natural flora)
The client with Goodpasture's syndrome usually is not diagnosed until significant pulmonary and/or kidney problems are evident
Acquired or Secondary immunodeficiency =
one that occurs in a person haw has normally functioning immune system at birth but later becomes immunodeficient as a consequence of disease, injury, exposure to toxins, medical therapy, or unknown cause
Cell Types involved in inflammation
* Neutrophils
* Macrophages
* Eosinophils
* Basophils
The incidence of nosocomial infection would be decreased if nurses conscientiously practiced
good handwashing and aseptic technique
According to TNM classification cancers may be indicated as stage 0 for carcinomas in situ (without spread)
In general, the client with DJD uses heat instead of cold to reduce pain. A temperature just above body temperature is adequate to promote comfort
The cells of the immune system originate in
the bone marrow
Pneumonia - how nosocomial infections might occur
* may occur with improper technique during suctioning
* displacement of NG tube
* use of H2 blocker/antacids
* patient risk factors (such as immobility or decreased gas reflux
SLE is a chronic, progressive, inflammatory connective tissue disorder that can cause major body organs and systems to fail
The typical client with DJD is
a middle-aged or older woman who complains of joint pain and stiffness
Inflammation differs from AMI and CMI in two important ways
1) Inflammatory responses provide immediate but short-term protection against the effects of injury or foreign invaders rather than sustained, longterm immunity on repeated exposure to the same foreign invaders
2) Inflammation is a nonspecific body defense to invasion or injury and can be started quickly by almost any event
Nosocomial Infections Definition
an infection that develops in a healthcare setting; the infection was not present or incubating at the time of admission
Non-steroidal anti-inflammatory drugs may not exhibit anti-inflammatory effects for at least
1-2 weeks
Clinical Category A
* HIV positive
* EITHER asymptomatic, has lymphadenopathy, OR has acute (primary) HIV with accompanying illness or a history of acute infection
Self-tolerance =
the ability of the body to recognize self versus non-self cells
Cancer Pathophysiology
* Cancer is not one disease, it is many.
* Cancers comprise all diseases of cells that are altered or transformed in some way, but are able to multiply, grow and spread
Two Classifications of Lupus
1) Discoid lupus erythematosus (DLE)
2) Systemic lupus erythematosus (SLE)
AIDS is caused by the profound suppression of immune responses resulting from infection with HIV
Vascular Leak Syndrome =
the actions of kinins and serotonin which permit the plasma portion of the blood to leak into the interstitial space
Suppressor T-Cells
* Contain T8-lymphocyte antigen
* Prevent continuous overreactions (hypersensitivity reactions) to exposure to non-self cells or proteins
* Opposite action of helper/inducer T-cells; for optimal CMI function a balance between helper/inducer T-cell activity and suppressor T-cell activity must be maintained
Four Stages of Carcinogenesis
1) Initiation occurs when a carcinogen damages DNA
- Causes changes in the structure and function of the cell at the genetic or molecular level
2) Promotion occurs with additional assaults to the cells, resulting in further genetic damage
3) Progression occurs as the cells become increasingly malignant in appearance and behavior
4) Metastasis - these cells develop into an invasive cancer with metastases to distant parts of the body
The most important difference between retroviruses and other viruses is
a special complex of enzymes within the retrovirus called REVERSE TRANSCRIPTASE (RT)
Lysis =
cell membrane destruction
Syndromes associated with RA
1) Dry eyes
2) Dry mouth
3) Dry vagina
Nursing Dx (Allergies)
1) Diarrhea r/t allergy
2) Impaired skin integrity r/t pruritis
3) High risk for caregiver role strain r/t chronic disorder
4) Sleep pattern disturbance r/t pruritis and dyspnea
5) Fatigue r/t asthma
6) Altered growth and development r/t childhood asthma
7) Self-esteem disturbance r/t rash, itching, difficult breathing
8) Anxiety/fear r/t inability to breath
9) High risk for suffocation r/t airway obstruction
10) Altered thought processes r/t loss of consciousness
Rheumatic disease =
any disease or condition involving the musculoskeletal system
Non-Aspirin Salicylates
1) Produce a relatively lower incidence of GI upset
2) Not as specific in the treatment of inflammatory disorders
The major concern of the client with DJD is
pain control
Apply the concepts of universal precautions/body substance to isolation
* Universal Precautions are the same as Standard Precautions
* Treat everyone as though they are infected
* Glove when come in contact with body fluids
* Glove when break in skin on hands
* Gown during sterile technique or risk of clothing becoming soiled
* Mask/eye protection when chance of SPLATTERING
* Do not recap needles; might increase risk of poking oneself
The WBCs playing the most important role in CMI include
several specific T-lymphocyte subsets along with a special population of cells known as natural killer (NK) cells
The major and usually only manifestation of DLE is a
dry, scaly, raised rash on the face ("butterfly" rash) or upper body or individual round lesions that are sometime referred to as discoid lesions
A deficient response of the immune system resulting from a missing or damaged immune component is an
immunodeficiency
The inflammation-associated macrophage function is
phagocytosis
Artificial active immunity is a type of protection developed against serious illnesses for which
total avoidance is most desirable
EX - tetanus, diphtheria, measles, smallpox, mumps, rubella
Steroidal drugs are chemically r/t
cortisone, a hormonal agent secreted by the adrenal cortex
Four Themes that help people cope with DJD
1) Refusal to give up
2) Pragmatism toward treatment strategies
3) Staying in charge
4) Tangible caring by others
Infection is usually accompanied by inflammation; however
inflammation can occur without invasion by microorganisms
Natural Killer Cells (NK)
* Important in providing CMI
* Direct cytotoxic effects on target non-self cells
* Exert cytotoxic effects without first undergoing a period of sensitization.
* Most effective in destroying unhealthy or abnormal self cells
Gout, or gouty arthritis, is a systemic disease in which urate crystals deposit in the joints and other body tissues causing inflammation
The person with HIV infection can transmit the virus to others at all stages of disease
Macrophages arise from the committed _____ stem cells in the bone marrow and form the mononuclear-phagocyte system
myeloid
CMI helps provide protection to the body through its
highly developed ability to differentiate self from non-self
Non-steroidal drugs are synthetic compounds and not chemically r/t
substances produced in the body
HIV belongs to a special class of viruses known as
retroviruses
Functions of Macrophage
* involved in inflammation
* Nonspecific recognition of foreign proteins and microorganisms
* ingestion
* phagocytosis
Innate-native immunity is nonspecific and encompasses the
inflammatory responses
PSS is a chronic connective tissue disease characterized by inflammation, fibrosis, and sclerosis of the skin and vital organs
Risks for DJD
* Age
* Obesity
* Hormone Replacement Therapy (HRT)
* Trauma to the joints from excessive use
* Heavy manual labor-oriented types of work
* Certain athletics
* Lack of exercise
Explain how improper nursing actins can promote the spread of infections
* Handwashing
* Improper sterile technique
* Improper disposal of sharps
* Improper medication distribution
* Lack of communication
* Perpetuation of inadequate standards/precautions
* Catheter bag touching floor
Natural passive immunity -
when antibodies passed from the mother to the fetus via the placenta or to the infant through colostrum and breast milk
Patients and families erroneously believe that the patient has multiple cancers when the cancer cells metastasize to other sites
It is one cancer spread to other organs
Assessment Considerations for DJD
* HRT
* Occupation
* Nature of work
* History of trauma
* Weight history
* Exercise
* Sports involvement
Functions of Monocyte
* involved in inflammation
* Destruction of bacteria and cellular debris
* matures into macrophage
Hyperacute graft rejection begins immediately on
transplantation and is an antibody-mediated response
Primary gout is the most common type of gout and results from one of several inborn errors of purine metabolism
Primary or Congenital immunodeficiency =
one in which the immune malfunction is present from birth
Basophils have granules containing many chemicals (vasoactive amines) that act on blood vessels, including
heparin
histamine
serotonin
kinins
leukotrienes
Kinins cause vasodilation of
arterioles and, together with serotonin, increased capillary permeability
Chain of Infection
1) Reservoir
2) Pathogen
3) Immunity
4) Portal of Entry
5) Mode of transmission
6) Portal of exit
Sequence of Events Stimulating AMI
1) Invasion of the body by new antigens
2) Interaction of macrophage and T helper cell in the processing and presenting of the antigen to the unsensitized B-lymphocyte
3) Sensitization of the B-lymphocyte to the new antigen
4) Antibody production by the B-lymphocyte
5) Antibodies bind to the antigen forming an immune complex
6) Antibody binding causes cellular events and attracts other leukocytes to the complex
7) On re-exposure to the same antigen, the sensitized lymphocytes and their progeny produce large quantities of the antibody specific to the antigen
Artificial passive immunity -
deliberate injection of a person with antibodies that were produced in another person or animal
Phagosome (or phagolysosome) =
the name of the structure when the phagocyte's granule are inside the vacuole
Benign
1) Grows slowly
2) Grows by enlarging and expanding
3) Always remains localized
4) Never infiltrates surrounding tissues
5) Almost always contained in a fibrous capsule
6) Recurrence extremely unusual when surgically removed
7) Metastasis never occurs
8) Never harmful to the host unless located in an area where it compresses tissues or obstructs vital organs
9) Prognosis is very good
Common NDx for DJD
1) Chronic Pain relate to muscle spasm, cartilage deterioration, or joint inflammation
2) Impaired Physical Mobility r/t pain and muscle atrophy
3) Activity Intolerance r/t to pain and fatigue
4) Self-Care Deficit (partial) r/t pain, fatigue, and immobility
5) Disturbed Body Image r/t to he effects of loss of body function
6) Impaired Walking r/t joint pain
7) Ineffective Coping r/t chronic pain and decreased function
8) Imbalanced Nutrition - More than Body Requirement r/t decreased activity and mobility
Function of Natural killer cell
* involved in CMI
* nonselectively attacks non-self cells, especially body cells that have undergone mutation and become malignant
* attacks grafts and transplanted organs
Helper/Inducer T-Cells
* Contain T4 protein
* Efficient in recognizing self vs. non-self
_____ and _____ are the two major defense mechanisms protecting the immunocompetent person against diseases and other problems when the body is invaded by microorganisms
Inflammation
Immunity
Age is the strongest risk factor in the etiology of DJD
Function of Cytotoxic/cytolytic T-cell
* involved in CMI
* Selectively attacks and destroys non-self cells, including virally infected cells, grafts, and transplanted organs
CTD is the major focus of
rheumatology
* Stage 2 -
cancer cells migrate via the lymph or blood circulation or by direct extension. The lymphatic system provides the most common pathway for the initial spread of malignant cancer cells
- Blood vessels (both veins and arteries) carry cancer cells from the primary tumor to the capillary beds of the lungs, liver and bones
- Metastatic spread to distant organs and tissues is almost always the result of cells moving through the bloodstream (for example, from the lung to the brain)
- Direct extension of tumors to adjacent tissue also occurs. For example, a breast cancer may spread directly to the chest wall
- In body cavities, cells may spread by gravity. For example, cancer cells of the ovary are often found to have fallen onto and seeded the entire paritoneal cavity
Crepitus =
a continuous grating sensation caused by irregular cartilage, may be filet or heard as the joint is put through passive ROM
Neutrophils are the first internal line of defense against foreign invaders (especially bacteria) in blood and ECF
All antibodies are immunoglobulins,
also called gamma globulins
Secondary gout involves hyperuricemia (excessive uric acid in the blood) caused by another disease
Rheumatology =
the study of rheumatic disease
Function of Neutrophils
* involved in inflammation
* nonspecific ingestion and phagocytosis of microorganism and foreign protein
Antigen-Antibody Interactions
1) Exposure and Invasion
2) Antigen Recognition
3) Lymphocyte Sensitization
4) Antibody Production and Release
5) Antigen-Antibody Binding
6) Antibody Binding Reactions
The growth of metastatic tumors puts severe stress on the effected person, both physiologically and psychologically
Cell-Mediated Immunity (CMI)
Provided by committed lymphocyte stem cells that mature in the secondary lymphoid tissues of the thymus and pericortical areas of lymph nodes
Inflammatory responses help stimulate both AMI and CMI actions
Natural active immunity occurs when an antigen enters the body without human assistance and the body responds
by actively making antibodies against that antigen (eg chicken pox virus)
Type III - Immune Complex Reactions
In a type III reaction, soluble immune complexes are formed, usually with antigen excess
Active Immunity occurs when antigens enter the body and the body responds by
making specific antibodies against the antigen
Function of Memory cell
* involved in AMI
* Remains sensitized to a specific antigen and can secrete increased amounts of imgs (immunoglobulins) specific to the antigen
Antibody Binding Reactions
* Agglutination
* Lysis
* Complement Fixation
* Precipitation
* Inactivation-Neutralization
Gold Compounds (Chrysotherapy)
1) Used to reduce the progression of RA in both adults and juvenile types
2) Most useful before joint degeneration occurs
3) Must be absorbed IM because poorly absorbed by the oral route
4) Weekly injection for a period of almost six months initially
5) Ridaura is a gold compound which is administered orally; produces fewer side effects and better patient compliance
6) Gold compounds are believed to assist with the release of leukocyte enzymes
7) Between 25-50% of patients receiving parenteral gold therapy may develop side effects, about 10% experience severe toxicity
8) Blood dyscrasias (blood disorders)
Precipitation =
similar to agglutination, however antibody molecules bind more antigen to the point that an insoluble antigen-antibody complex is formed
Leukocytes associated with the inflammatory and infectious response are -
* Neutrophils
* Macrophages
* Eosinophils
* Basophils
Innate-native immunity (natural immunity) is
* a genetically determined characteristic of an individual, group, or species
* a person either has doesn't have this type of immunity
A client experiencing an anaphylactic reaction first complains of
feelings of uneasiness, apprehension, weakness, and impending doom
Acute graft rejection occurs within
1 week to 3 months after transplantation
Passive immunity =
* when antibodies against a specific antigen are in a person's body but were not created there
* the antibodies are transferred to the person's body after being made in the body of another person or animal
A malignant neoplasm that arises from blood vessels, lymphatic tissue or nerve tissue is called a
sarcoma
Two broad categories of immunity
1) Innate-native immunity
2) Acquired immunity
Identify individuals within the healthcare system who are at risk for developing infections
* Pt. (at risk of nosocomial)
* Environmental services / housekeeping
* Nurses, doctors, CNAs
* Visitors
* Admitting staff
* X-ray personnel
* Lab technicians
* Therapists
* Dental field
* Nursing students
* Respiratory therapist
Acquired Immunity is the immunity that every person's body makes (or may receive) as an adaptive response to invasion by foreign proteins
An adequate trial of at least two weeks ought be allotted before determination of the success or failure of therapy is determined
Agglutination =
clumping that results from an antibody molecule's having at least two antigen-binding sties
Functions of Eosinophil
* involved in inflammation
* weak phagocytic action
* releases vasoactive amines during allergic reactions
Cytotoxic/Cytolytic T-Cells
* Called TC-cells
* Have T8 protein
* Subset of suppressor cells.
* Function -
- allow person's immune system cells to recognize an infected self cell as abnormal
- binds to such cell
A type IV response typically occurs
hours to days after exposure
The primary clinical manifestation of many CTDs is
arthritis
Neutrophils belong to the class of WBC known as
GRANULOCYTES
DJD =
Degenerative joint disease
Cancer Staging - TNM Classification
* When a neoplastic growth is definitely diagnosed, it must be further defined in terms of its extent.
* This diagnostic process is called staging.
* Staging involves a systematic search for the characteristics of
- T = Primary tumor
- N = Involvement of lymph nodes
- M = Evidence of metastasis
Arthritis =
the inflammation of one or more joints
Mature neutrophils normally make up between _____ of the total WBC count
55-70%
CTD =
Connective Tissue Disease
Antihistamines compete with histamine at the histamine receptor site and essentially block it from binding to its receptor
AMI - Immunoglobulins (I-GAMED)
IgG = defense against invading foreign microorganisms (75%)
IgA = secretory protein on mucous membranes and outer body skin surfaces (first line of defense against invasion by microorganism) (less than 15%)
IgM = blood group marker (probably stimulates autoimmune diseases and responses) (10%)
IgE = mediates allergic and hypersensitivity reactions, protects against parasitic infections (less than 1%)
IgD = regulates lymphocyte activation and suppression (less than 1%)
Function of B-lymphocyte
* involved in AMI
* Becomes sensitized to foreign cells and proteins
Subclinical infection =
causes no apparent reaction in the host and thus elicits no detectable symptoms
A malignant neoplasm that arises from epithelial tissue is called a
carcinoma
Initiation
- Pure carcinogens initiate mutational changes in a cell's genes
Phagocytosis
* process by which leukocytes engulf invaders and destroy them with produced enzymes
* rids the body of debris and destroys foreign invaders
* neutrophils and macrophages perform phagocytosis most efficiently
Methods of Infection Control
* Handwashing
* Hygiene
* Sanitation
* Disinfection/sterilization
* Barriers (gloves)
PCM =
Protein-calorie malnutrition
Promotion
- Promoters are substances that promote or enhance initiated cell growth
Allergies Assessments
1) Patient family history
2) Perform a baseline assessment
3) Patient with an immune disorder will generally present with vague symptoms such as fatigue or dyspnea, frequent or recurrent infections, slow wound healing, joint pain or skin rashes
Immunity
resistance to infection; usually associated with the presence of antibodies or cells that act on specific microorganism
According to TNM classification (the accepted system of cancer staging today), cancers may be grouped into one of four stages (1 to 4)
G2 =
cell makes important proteins that will be used in actual cell division and in normal physiologic function after cell division is complete
Heparin inhibits
coagulation of blood an other protein-containing fluids
Pathogenicity =
ability to cause disease
Type IV Delayed Hypersensitivity Reactions
In a Type IV reaction, the reactive cell is the
T-lymphocyte
Chemotherapy
* A systemic intervention appropriate when
- disease is widespread
- risk of undetectable disease is high
- tumor cannot be resected and is resistant to RT
- may be used after surgery and/or when the patient is at high risk for recurrence
- used to eliminate any remaining submicroscopic cancer cells that are suspected to still be present
- the objective of chemotherapy is to destroy all malignant cells without excessive destruction of normal cells
Basophils cause the obvious signs and symptoms accompanying
inflammation
To prevent the spread of infection, break the
chain of infection at any point
Viruses -
* Includes Hep B, Hep C, Epstein-Barr Virus
Radiation Therapy (Nursing Interventions)
1) Provide emotional support
2) Provide education related to symptoms that do not develop until approximately 10 to 14 days into treatment and some do not subside until after several weeks after treatment
3) Management of side effects -
* Skin reactions
* Reactions
* Dry mouth
* Radiation caries
* Esophagitis
* Dysphagia
* Cystitis
* Alopecia
* Bone Marrow Suppression
4) Pain management
Complement activation and fixation is one mechanism of opsonization
and phagocytic adherence
Common NDx and Collaborative Problems for clients with infection or infectious disease
* Hyperthermia r/t an increased metabolic state
* Social isolation r/t effects of illness
* Risk for sepsis
* Risk for Septic shock
* Risk for Disseminated Intravascular Coagulation
Type II - Cytotoxic Reactions
In a type II (cytotoxic) reaction
the body makes special autoantibodies directed against self-cells or tissues that have some form of foreign protein attached to them
Types of RT
1) External beam radiation - delivery of radiation from a source placed at some distance from the site.
Administered by high-energy x-ray machine
Major advantage - the maximum effect of radiation occurs at tumor depth site in the body
2) Internal radiation - placement of specially prepared radioisotopes directly into or near the tumor itself or into the systemic circulation
Macrophages
* concentrated in liver and spleen
* immediate response to inflammation
* stimulate longer lasting immune response
* effective at trapping invading cells
General Characteristics of Antineoplastic Drugs
* Many drugs damage body cells (ie, they are cytotoxic)
* The drugs act during the cell's reproductive cycle
* Cytotoxic drugs are mot active against rapidly dividing cells, both normal and malignant
* Each drug dose kills a specific percentage of cells
* Antineoplastic drugs may induce drug-resistance malignant cells
* Most cytotoxic antineoplastic drugs are potential teratogens
* Most antineoplastic drugs are given orally or intravenously (IV); some are given topically, intrathecally, or by instillation into a body cavity
Salicylates
1) Chemically r/t salicylic acid
2) Aspirin (acetylsalicylic acid, ASA) has the most potent anti-inflammatory effects
3) Considered drug of choice for many chronic inflammatory disorder including all forms of arthritis
4) Least expensive
5) Readily available without a prescription
6) High doses are administered (3-5 g/day) for the anti-inflammatory effect
7) Most common adverse effects are gastric intolerance and occult bleeding
8) May prolong bleeding time
- People on aspirin bruise easily
M =
single cell splits apart into two cells (actual mitosis)
Function of Basophil
* involved in inflammation
* Releases histamine and heparin in areas of tissue damage
Clients receiving interleukins at therapeutic doses experience
generalized and sometimes severe inflammatory reactions
Plasmapheresis =
filtration of the plasma to remove specific substances
Two major types of internal radiation -
* Sealed-source RT -
- radioactive material is enclosed in a sealed container
- can be placed directly into a body cavity such as the uterus
- can be implanted directly into a tumor via needle, catheter, or seeds
Example - used with prostate cancer patients
* Unsealed-source RT -
- colloid suspensions that come into direct contact with body tissues
- can be administered intravenously, orally, or by direct instillation into a body cavity
Leukocytes Functions/Characteristics
1) Defend the body against disease organisms
2) They have the ability to push or squeeze through the capillary wall and rush to the threatened spot (i.e. move to sites of infection)
3) Find their way to foreign or damaged tissues by their attraction to certain chemical substances
4) Are colorless unless they are stained to be visible under the microscope
5) Leukocytosis means there is an increased number of WBCs
6) Leukopenia is a decrease in the number of WBCs
7) NL 5,000-10,000
8) Increase to 25,000 or higher indicates an infection
Colonization =
when microorganisms are pathogenic and present in the tissues of the host and not yet causing symptomatic disease
In situ =
without spread
Hyperplasia =
growth that causes tissue to increase in size by increasing the number of cells
Opsonization =
the coating of a target cell (antigen or foreign protein) in such a way to change the target cell's surface charge that makes it easier for phagocytic cells to stick to it
The antibody-mediated immune system produces antibodies directed against certain pathogens
The serum immunoglobulins can be separated into subtypes. In chronic inflammation, IgG is needed to combine with RF (Rheumatoid Factor); thus in RA the IgG value is typically elevated
Commitment involves
turning off specific early embryonic genes that controlled or regulated early rapid growth
Chemotaxins or leukotaxins are special chemical substances that can act as chemical magnets that attract
neutrophils and macrophages. Damaged tissues and blood vessels secrete chemotaxins
One tumor suppressor gene, p53, is present in virtually all normal tissues
The most common sites are
the liver, lungs, bones and brain
The hospice movement has demonstrated that there is still much that can be done for a patient and family, even when cure is no longer possible
Function of T-lymphocyte helper/inducer T-cell
* involved in CMI
* enhances immune activity through secretion of various factors, cytokines, and lymphokines
Exotoxins are produced and released by certain bacteria into
the surrounding environment
Excess dietary fats have a generalized _____ action on all aspects of immune function
suppressive
G1 =
cell is preparing for division by taking on extra nutrients, generating more energy, and making extra membrane
Recognition =
when the phagocytic cell sticks to the surface of the non-self target cell
The most definitive procedure for identification of a microorganism is
culture, or isolation of the pathogen by cultivation in tissue cultures or artificial media
The onset of RA is characterized by
synovitis, or inflammation of the synovial tissue in joints
In the last decade, scientist have made four major technological advances toward biotherapy
* a greater understanding of the complex cellular nature of the immune system
* progress in genetic engineering, enabling the development of biological agents
* advances in molecular biology
* improved laboratory and computer systems
Function of Plasma cell
* involved in AMI
* Secretes immunoglobulins in response to the presence of a specific antigen
Endotoxins are produced in the cells of certain bacteria and released only
with cell lysis
The latex agglutination test is sensitive but is not as specific for RA
Passive Artificial =
acquired by administration of antibodies or antitoxin in immune globulin Ex - Gamma Globulin injection following hepatitis A exposure
Neutrophils
* make up 55-70% WBC count
* Destroy and eliminate foreign invaders
Interferons are cell-produced substance that can protect noninfected cells from
viral infection and replication
Cancer Susceptibility
* Age - a factor because the person has had more years of exposure to carcinogens
* Gender - females have a generally lower risk of cancer incidence
* Hormonal Status - associated with increased risk in tissue that are responsive to hormones including breast, endometrium, prostate, ovary, thyroid, and testes
* Cultural - estimated that one fourth of cancer deaths in the US r/t diet
Neoplasia =
any new or continued cell growth not needed for normal development or replacement of dead and damaged tissues
Phagocytosis is the key mechanism for
the successful outcome of inflammation
Rhinorrhea =
runny nose
a thorough patient assessment is necessary before cytotoxic drugs can be administered - including
* physical assessment
* history of co-morbidity
* abnormal lab value
* severity and duration of side effects since previous treatment
* drug doses may have to be modified or delayed on the basis of this assessment
* patient's family education
* knowledge and skills related to allergic reactions (rare, however serious)
Eosinophils
* 1-2% of total WBC count
* Release enzymes to control or modulate the extent of inflammatory response
Nitrosoureas also interfere
with DNA replication and RNA synthesis and may inhibit essential enzymatic reactions of cancer cells
Radiation/Chemicals
Radiation -
* More than 80% of exposure to radiation is from natural sources
* Ultraviolet rays (sunlight, tanning beds)
* Radioactive minerals (radon gas, uranium)
Hypertrophy =
growth that causes tissue to increase in size by enlarging individual cells
Basophils
* rarest WEBC
* stored in bone marrow
* cause the obvious s/s of inflammation
Active immunity may last for years and is natural by infection or
artificial by injection of the agent itself (vaccine)
The most abundant amine is _____, a short-acting biochemical
histamine
S =
Because making on cell into two cells requires twice as much of everything, including DNA, the cell doubles its DNA content through DNA synthesis
High Risk Factors for AIDS
1) Male homosexual relations
2) Injecting drug users
3) Heterosexual relations with an HIV infected partners
4) Receivers of blood products prior to 1985
5) Children born to mother with HIV infection
Most complications of infection relate to
inadequate treatment
* Stage 1 -
neoplastic cells from the primary tumor invades surrounding tissue and penetrate blood or lymph vessels
Radiation Therapy
* More than 50% of patients with cancer receive RT at some pint during the course of their disease
* RT may be used as a primary, adjunct or palliative treatment
Manifestations of HIV infection range from mild abnormalities in the immune system without overt signs and symptoms to profound immunosuppression associated with various life threatening infections and malignancies
Virulence =
related to the frequency with which a pathogen causes disease (degree of communicability)
Cyclosporine is the most commonly used drug to
prevent organ transplant rejection and graft-versus-host disease
How Chemotherapy Works
* Chemotherapy directly or indirectly disrupts reproduction of cells by altering biochemical processes
* Only a percentage of cells are killed with each course of chemotherapy. Therefore, repeated doses must be used.
* A combination of drugs have consistently been far superior to single-agent therapy
* Drugs selected in combination must each be effective against the type of cancer being treated
* When combined, chemotherapeutic agents destroy more malignant cells and produce fewer side effects because each drug strikes the cancer cells at a different pint in the cell cycle
* The regimes are complex, cyclic, and individualized for the patient and the type of cancer
AIDS defined
the most serious form of continuum of illness associated with HIV
Reduction of percutaneous injuries (needle sticks) is of utmost importance to reduce
bloodborne pathogen transmission to health care personnel
Malignant
1) Usually grows rapidly
2) Grows by infiltrating surrounding tissues
3) Never contained in a capsule
4) Recurrence common following surgery because tumor cells spread into surrounding tissues
5) Metastasis very common
6) Always harmful to the host, causes death unless removed surgically or destroyed by radiation or chemotherapy
Characteristics of Early Embryonic Cells
* Demonstrate rapid and continuous cell division
* Show anaplastic morphology
* Have a large nuclear-cytoplasmic ratio
* Perform no differentiated functions
* Adhere loosely together
* Are unable to migrate
* Are not contact inhibited
The rate of HIV production is thought to be associated with the health status of the infected person
If the person is not fighting another infection, HIV reproduction may proceed slowly
Passive immunity is of short duration and either natural by transplacental transfer from the mother or
artificial by injection of antibodies (immune globulin)
Pathophysiology of Osteoarthritis
1) Inflammation and degeneration affects the cartilage, synovial fluid and bones
2) Obesity has been associated with OA of the knees
3) Joint traumas, sports activities, and occupations have been associated with risk factors
Things that must be reported
* AIDS
* STD
* Cholera
* Diphtheria
* Leprosy
* Hepatitis ABC
* Lyme Disease
* Malaria
* Mumps
* Polio
* Rabies
* Rocky Mountain Spotted Fever
* Rubella
* Typhoid Fever
* Tuberculosis
HIV reproduction appears to accelerate when the person is combating another infection and/or the immune system is stimulated
Antimicrobials act on susceptible pathogens by -
* Inhibiting cell wall synthesis (penicillins and cephalosporins)
* Injuring the cytoplasmic membrane (antifungal agents)
* Inhibiting biosynthesis, or reproduction (erythromycin, tetracycline, and gentamicin)
* Inhibit nucleic acid synthesis (actinomycin)
The change from normal to neoplastic cells is a process, not a single event.
Characteristics of Benign Cells
* Demonstrate continuous or inappropriate cell growth
* Show specific morphology
* Have a small nuclear-cytoplasmic ratio
* Perform differentiated functions
* Adhere tightly together
* Are nonmigratory
* Grow in an orderly manner
Clinical Manifestations AIDS
1) Widespread and can affect any organ system
2) Pneumocystis carinii pneumonia (PCP) is the initial manifestation in 60% of patients with AIDS
3) Without prophylactic therapy, PCP would develop in 80% of this population
4) First thought to be protozoan, now believed to be a fungus infection
5) Untreated, PCP eventually progresses to significant pulmonary impairment and, ultimately, respiratory failure
Direct Contact =
source and host have physical contact
Type V - Stimulatory Reactions
Results in a "turned-on" state for cell
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