Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
The Immune System John G. Summerville RN, MN Main reference used: Lewis unless other wise indicated. What organs are part of the immune response? • • • • • • • B____ M____ W___ L_______d tissue Th_____ gland S__________ L_____ nodes Tonsils (similar in gi, resp, reproductive) • L_____ What cells are involved with an immune response? • P______, Mo_________ [in the blood] • L______ __ and __, T cytotoxic cells, T Helper & T Suppressor cells, Natural Killer Cells [in the lymph system] • C_____ the chemical messengers which coordinate the response of the immune cells. Where do the blood cells come from? Where are the Lymph Nodes? What is Immunity? • Responding to _______ substances or _____ proteins. What is an antigen? • A substance ________________________ What are the types of immunity or How can immunity develop? Active Natural: Artificial: Passive Natural: Artificial: An example of A____ A_____ Immunity…immunizations T_____ or Clostridium Tetani = a gram positive, spore-forming, anaerobic bacterium Suppresses spinal and brain-stem u___ m____ n______ with a 50% mortality rate Develops as a result of p_______ wounds, human/animal bites, dirty needles, GSW's and other open wounds T_______ Clinical findings: Treatments: Tetanus I______ G____ (if NEVER immunized) [P_____ A_________________ _immunization] Tetanus t______ booster every 10 years [A_____ A_______ Immunization] What diagnostic tests can be done to the Immune system? • S Tests • Radio : a collection of lab procedures based on antigen-antibody reactions. • (ANA): identifies the presence of antibodies produced against the body's own cell nuclei. Helps diagnose autoimmune diseases. • C I Function Tests: T-cells and B-cell counts. • E : separates charged particles in a solution. Measures proteins, immunoglobulin, etc. EXPENSIVE! • E (E L Im Assay): a sensitive, quick look for antibodies to viral or bacterial infections. Can show antibodies to HIV, and is the first test done to see if there is HIV infection. How does the immune system respond to a ______? What is H_____ vs C___ M________ Immunity? What is the effect of A____on the Immune system? • Th___ ____creases in size and activity • ____crease in precursor T cells for response to new antigens…___________________ • _______________ What are the Types of Hypersensitivity Reactions? _____: A____ Response • Antibody - IgE • Mediator of injury – H________ What can Happen When you stop to smell the Roses? What tests are done to determine Type 1 allergies? • _________________ If you Get bit by a Fire Ant, What can happen and what symptoms can occur? Anaphylactic Response urticaria angioedema Erythema Treatments Local or Systemic Anaphylactic Response Local treatments Systemic Treatments Identify allergans and control them Quick Identification Stress Management Airway Maintenance Medications Control Allergen Antihistimines Decongestants Corticosteriods Mast Cell stabilizer Treatment for Shock Medications Epinephrine Plasma Expanders Fluids Dopamine Vasopressors Benedryl [diphenhydramine] • You can type here is you like Type _: C_____ Reaction • Antibody – IgG and IgM • Mediators of injury – Neutophils & Compliment • Example: A____He_____ Bl____ transfusion reaction – Blood reactions can be ___________________ What is the ABO Blood Type System? (there are 27 different systems) What is an Rh Factor? • Rh factor acts as __ ______ in Rh-negative persons, causing the production of a_______. • If Rh-positive blood is transfused into an Rhnegative person, the latter will gradually develop a______ called anti-Rh a________, that attach to the Rh-positive red blood cells, causing them to a________ (c_______) What are the kinds of Blood Products are available? • P___ R___ B__ C___ (PRBC’s) 300mls. (anemia & severe blood loss) • F____ RBC’s (reactions to WBC or blood proteins) • F____ F____ P____ (hypovolemia, clotting factors, replacement) • P_____ (low platelet levels) • A______ (plasma expander, shock, protein replacement) • C____________ (clotting factor replacement) What adverse reactions can occur with blood transfusions? • F______ most common adverse reaction (WBC, platelets, proteins) – Sudden f___r, c____s, a____y, flushing, muscle pain • A___ H___ (antibodies from host attack new RBCs and they b____) – Chills, fever, flushing, t______a, t_______a, hypo____, s___, c__ arrest, low b___p__, dark u___, renal f___, j___ • Mild Allergy (plasma proteins) • Ana_________ and Severe Allergy (plasma proteins) • S______ (bacteria) – Rapid fever, chills, vomiting, diarrhea, sever hypotension or shock • Circulatory O_______ (fast infusion for person) – Hyper________, headache, tachycardia, pul______ e_____, cough, dyspnea What Pre Treatments can be given? What are the safe Nursing practice steps for giving blood and managing adverse reactions? • • • • • • • • • • Verify correct b___ and patient Start blood on t___, end blood on time Vital signs _____ to giving Remain with patient _____ mins and observe for signs of a___ reaction S___ b___ for fever or other symptoms (more blood more reaction) D________ blood and IV tubing and s____ a Normal Saline Drip Frequent vital signs Assess & Respond to signs and symptoms Contact physician Collect b_____ and u____ sp_____ if needed Type ______________ Reactions • Antibody – IgG and IgM • Mediator of injury – Neutrophils and Complement • Example: ____________________ What is ‘Autoimmunity’ and what causes it? What are some Examples of Autoimmune Diseases • Systemic Diseases: ______________________, rheumatoid arthritis, scleroderma • Blood Diseases: Autoimmune hemolytic anemia, idiopathic, thrombocytopenia purpura • Heart: Rheumatic fever • Endocrine: Addison's disease, thyroiditis, Graves Disease, hypothyroidism • GI: Pernicious anemia, ulcerative colitis (Crohn's disease) • CNS: Multiple sclerosis, Guillain-Barre • Muscle: Myasthenias gravis Systemic Lupus Erythematosus 1 • Mostly a _______ disease • Characterized by periods of “_____" and “________" . • Immune system alterations: defective phagocytosis, deficient antibody production • Patho: deposit of a______- a_____ c_______ in the c______ tissue causing a generalized inflammatory response. SLE Diagnostic ‘Clues’ • The ‘great imitator’ is Hard to diagnose, because it may affect only one organ (such as skin or kidneys) or all body organs and mimics many other diseases. • Blood Tests – ____________________________ (ANA): 90% of people have positive ANA – Other auto________ tests (anti-DNA, anti-Sm, anti-RNP, anti-Ro [SSA], anti-La [SSB]) – Erythrocyte sedimentation rate (ESR) – Complement levels • Kidney Assessments – U_______ – K_____ b__________ • Skin biopsy S_________ L____ Erythematosus 2 • Symptoms: photo________ (almost 100%), fa____(81%), fe_____ (60%), chest pain (pericarditis 48% or pleuritis 50%), joint and muscle pain (50%), weight loss (40%), b______ r_____ across bridge of nose and cheeks (40%) • V________with r____ f_____ are common caused by a_________ of immune complexes within the blood vessel walls causing I________ within vessels. • Treatment: SLE Signs and Symptoms Type ______________________ Reaction • Antibody – None • Mediators of injury: Cytokines, T cytotoxic cells, Monocytes, macrophages, lysosomal enzymes. • Example: _______________ Organ Transplant • Organ donation is voluntary, families must ____________________. • U_________ An______ Gift Act – People can l_____ d_______ organs after death • Tell your family of your wishes for organ donation • All hospitals participate in organ procurement What organs can be transplanted? • How Big is the Need? – HHS Secretary Mike Leavitt announced that 26,984 Americans received an organ transplant last year [2004], setting a new national record. – http://www.unos.org/ • What is the need in Georgia? – http://www.lifelinkfound.org/gawait.asp HLA’s Self Antigens Anti________ and Tis________ • ___________ are responsible for recognizing and rejecting alien body tissues, or, more accurately, the ________________________. • There are more than 100 antigens on tissue cells in humans resulting in approximately 30,000,000 possible _______________________. • The chances of two unrelated people having the same HLA genotypes is ____________. Subsequently, ___________________ between organ donors and recipients are common. What test is done to determine if a Type 4 Hypersensitivity reaction is possible with an Organ Transplant? His_________________ • H___le________ a_________ (HLA type) • HLA-A, HLA-B, HLA-C, HLA-D,HLA-DR • Present on ____________ and platelets – Series of linked genes on the 6th chromosome – A genetic marker for self – Inherited from _____________ – Associated with some ____________ What are the Types of Host Organ Rejection (host cells attack transplant)? • ____________ occurs in minutes to hours, violent attack of the organ with no treatment and organ is lost. • ______________ occurs days to one week, antibody attack with no treatment and the organ is lost. • ____________ occurs after one week, (most common type) which does respond to immunosuppression drugs • _____________ a gradual deterioration or organ function as the result of acute rejection episodes. This causes scaring and infarction of blood vessels. What is it called when the transplanted organ attacks the host? G___ __ _____ Disease • When the organ or blood cells (____) _______________, hard to stop when it starts. • Occurs 7-30 days _______________ or blood transfusion • Patho: ______________________ host’s skin, liver, and GI tract • Signs: – H_____ and F________ erythema with pain or itching and s_________ of skin – ________ gives diarrhea, pain, bleeding, malabsorption – Liver attack shows J_________, mild to severe – Infections and pneumonia develop • Treatment: prevention is best with _______________________. Immuno___________ Disorder • ___________________ • Primary [Improperly formed = Genetics] • Secondary [caused by illness of disease] – ___________________ – Medications Immunosuppressive Medications • Calcineurin Inhibitors – Suppress interleukin 2 and stop T cell production [cyclosporines Sandimmune] • C______________ – Suppress cytokines and T cell activation [prednisone] • Mycophenolate Mofetil – Inhibits production T & B cells • Sirolimus – Suppresses B cell production of antibodies Immune System Destruction • Example: Human Immunodeficiency Virus What is the significance of HIV / Aids? • Who is most affected? • How Big is the Health Problem? How is HIV transmitted? • Contact with ________________________ • _____________________________ • ____________transmission is the most common. How does HIV damage the immune system? What are the changes in the Viral Load and CD4 Count over time? Phases of HIV to AIDS How is HIV diagnosed? • Blood testing for ___________ to HIV. • Enzyme-Linked Immunosorbent Assay (________) [antibodies that bind with HIV antigens] • History assessed for ___________ • E_____ is repeated if first E____ is _________ • W______ B____ (immunofluoresence assay IFA) is done if _______ positive ______ tests What are the signs and symptoms of HIV infection? • Initially flu like symptoms then _________ • __________ for a while….mean time for Aids to develop ____years. What are the clinical manifestations of _____? How is Acquired Immunodeficiency Syndrome (AIDS) Diagnosed? What are opportunistic infections? • Classic Examples… What groups of drugs are used to control the HIV? • Antiretroviral drug therapies (ART) • _____________ reverse transcriptase inhibitors (NNRTIs) • _____________ • ____________ reverse transcriptase inhibitors (NRTIs) • _______________________ • ___________________________ Treatment Protocol! • Combinations of Medications are recommended to prevent drug resistance • Balance with individual response How do we know the most current treatment guidelines? What are the general broad Nursing Goals with HIV AIDS?