Med Surg Exam 4 study guide

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Innate (natural) immunity

Present at birth; not dependent on a specific immune response or previous contact with an infectious agent

Active Acquired immunity

Develops after birth as a result of the body's natural immune responses to antigens

Passive acquired immunity

temporary immunity, An injection of immune globulin or antiserum (made from human or animal blood) containing antibodies to a specific pathogen e.g. snakebite, rabies or exposure to hepatitis. Can also occur in an infant through ingestion of colostrum or receiving antibodies via the placenta. Antibodies that pass from mother to Baby

Autoimmune Diseases

Immune system reacts against and destroys its own tissues. T1DM, Rheumatoid arthritis, SLE, Graves Disease (body attacks itself)

1st line of defense

Skin and mucous membranes

2nd line of defense

phagocytosis and inflammation system

Cortisol

produced by adrenal cortex. Inflammatory response substance that releases histamine, stabilize lysosomal membranes and prevents influx of leukocytes. IMPEDES THE INFLAMMATORY RESPONSE. Hormone secreted by the Adrenal gland

inflammatory process

* Dilation of capillary beds increase blood flow and cause warmth and redness
* Increased permeability when fluid leaks out causing swelling
* Chemical Mediators with the release of prostaglandins, histamine and leukotrienes cause rash, pain and classic signs of inflammation

Bacteria

one celled microorganisms (not all cause disease)

Virus

small microorganisms that cause significant disease in humans, dependent on a host to reproduce. Have no cell wall. Cause significant disease in humans, most common is the Cold Virus (no effective vaccine for cold because to many strains
and constantly mutation).

Fungi

vegetable like organisms that exist by feeding on organic matter... Cause Athletes Foot and ringworm, candidiasis.

Rickettsiae:

come from rats and squirrels and transmitted to humans by fleas, and ticks, cause Rocky Mountain spotted fever, Typhus and Lyme Disease

Helminths

worms, parasites found in soil and water transmitted from hand and mouth: tapeworms, hookworms and pinworms

Protozoa

large group of one-celled organisms. Cause Malaria, dysnetery, giardiasis, sleeping sickness. Often spread by food or Water

Hand Washing

most effective and basic method of preventing cross-contamination. Running water, soap and friction for at least 15 sec

immunization and good hygiene

Prevention of Viral Infections

four signs of inflammation

heat, swelling, redness, & pain

common routes of infection
with helminths

worms, parasites found in soil and water transmitted from hand and mouth: tapeworms, hookworms and pinworms
fecal/ oral or through the skin

Community Acquired Infection

caused by day 2 day contact with the public. HIV, STD's, hep A, Salmonella and Strep. Contracted outside the healthcare facility

Hospital Acquired Infection

antibiotic resistant microorganisms, are more virulent: VRE and MRSA, UTI and pneumonia are most common nosocomial infections CDC has steps to prevent

adverse effect of antibiotic therapy

Candidiasis and yeast infections can occur when antibiotics destroy the normal flora

Common sites of nosocomial infections

wounds and procedure sites

Changes in a CBC count that indicate infection

increased WBC (shift to the left, WBC are above 60%)

S/S of Systemic Lupus Erythematosus.

butterfly rash Arthralgia: joint pain
Myalgia : muscle pain fever, anorexia, nausea, fatigue,*swelling of th kidneys, heart, and/ or lungs, resulting organ failure

Diagnostic test for SLE

ANA (antinuclear antibody), protien in urine, and elevated Sed Rate

Pt teaching for Decadron

Take with meals to prevent upset stomach because they inhibit prostaglandins (protect the stomach)
Drug should not be stopped abruptly because the body will not be producing steroids on there own and they will go into steriod crisis

Decadron

drug used to prevent rejection of transplanted organs

Stomatitis mouth care

* good oral care - no salt water or alcohol based mouthwash, use soft tooth brush
* NO lemon glycerine swabs
* use toothettes

Greatest risk factor for HIV Pt

Infection. We must prevent infection

Direct Contact

transfer of microorganisms directly. (STD's)

Indirect Contact

when pathogens are spread through droplets expelled during a sneeze or a cough or inanimate objects

Common Vehicle

through water, food, blood, or air currents contaminated with pathogens (Legionella)

Vectors

transported by a living organism such as a fly or mosquito

Fomites

any item that has been touched or cross-contaminated by the host, such as bed linen, side rails or hygiene items

Causative Agent

microorganisms that are present in sufficient number and virulence to damage human tissue

Reservoir

Human or animal tissue in which microorganisms can pool & multiply.

Portal of Exit

route by which the infectious agent leaves one host and travels to another. Nose and mouth are common portals

Mode of Transfer

mode in which a microorganism is transported to a host.

Portal of Entry

pathways into the host. Nose, mouth, open wounds, IV, catheters.

Suseptible Host

a person who can not fight a disease

Precautions for Immunosuppressed Patient

Private room, hand washing,
no fresh fruit and veges/ food must be thoughly cooked, no potted plants or fresh flowers

Nursing Dx for Lupus

Avoid the sun makes the rash worse, lots of rest for fatigue (schedule activities, balance btwn rest and activity)

Diagnostic test for Lupus

ANA (antinuclear antibody) positive may indicate disease, protein in urine, Sed Rate (elevated tells us inflammation)

Drugs used to treat Lupus

corticosteroids, antimalarial, NSAIDs

Causes of Neutropenia

Chemotherapy, autoimmune reaction, certain drugs, overwhelming infection

When to be aware of Pt allergies

Must be aware of a persons reaction when we are giving meds or when test are ordered because of Iodine (contrast media, shelfish)

Neutropenic Precautions

1) Hand washing (critical for all who come in contact with the patient)
2) Private room
3) Thoroughly cooked food, no raw fruits or vegetables
4) Equipment specific to that Pt's room
5) no flowers in standing water and no potted plants
6) Limit invasive procedures such as catheters and IV must be kept clean
7) Screen all visitors for illness

Complications of Bone Marrow Transplant

Infection Graft vs. Host Disease: T lymphocytes in the Transplanted bone marrow identify the Pt tissue as foreign and try to destroy the tissue

Patient teaching for SLE

* Know the names, dosage, schedule, and side effects of your drugs
* Avoid prolonged exposure to the sun and use sunscreen with SPF rating of > 15
* You can get additional information from the Lupus Foundation of America & American Lupus Society

Bacteria to avoid with immunocompromised Pt

E-coli from uncooked food
Pseudomonas auruginosa and Klebsiella

Cancer

abnormal growth of abnormal cells

Types of Cancer treatment

Surgery, Chemotherapy. Radiation, Biotherapy

alopecia

hair loss

carcinogen

cancer causing agent cigarettes, synthetic estrogens

biotherapy

Neupogin that stimulates the bone marrow to produce the blood cells and platelettes

antineoplastic

Chemical agent used to tx cancer : CHEMOTHERAPY

Benign

noncancerous tissue, can apply pressure and obstruct normal tissue

Malignant

Cancerous tissue

Fibroma

benign: fibrous connective tissue tumor

Lipoma

benign: fat tissue tumor

Leiomyomas

Benign: smooth muscle tissue tumor

Carcinoma

malignant: tissue of the skin, glands, lining of digestive, urinary tract

Sarcoma

Malignant: tissue of the bone, muscle other connective tissue

Melanoma

Malignant: pigment cells in the skin

Leukemia/ Lymphoma

Malignant: blood-forming tissue, lymphoid tissue, plasma cells and Bone marrow

Chemotherapy side effects

NVD, alopecia, bone marrow supression

Zofran

antiemetic cancer drug, Side effects are: constipation, diarrhea, headache

Reglan

antiemetic cancer drug. Side effects are: sedation, diarrhea, dizziness, EP symptoms

Leukemia complication

* Risk for Opportunistic Infections (infections from our own normal microbes)
* Bleeding (Thrombocytopenia) from low platelette counts
* Anemia causing fatigue, need to be taught energy saving techniques, allow periods of rest, coordinate care, limit visitors
* Dry mucous membranes/ Stomatitis
* Imbalanced nutrition from Tx and disease process : offer foods they like,

Radiation Precautions

1) patien in a private room that is lines with lead
2) Place sign on door indicating room is radiation area
3) Anyone who enters must take precautions. NO ONE under the age of 18 or pregnant women
4) Limit time in room and work as far from source as possible
5) Organize work efficiently. Care can be provided in a total of 30 minutes. Use portable lead shields.
6) Know that sealed sources can be dislodged accidentally. Check bedpans and linens for dislodged sources b4 disposal
DO NOT TOUCH AND SOURCE THAT COMES OUT OF THE PT's BODY WITH BARE HANDS

Antineoplastic Drug major side effects

The major systemic side effect of ANTINEOPLASTIC drugs are the same as those of radiation. Simultaneously irritate the lining of the digestive tract and stimulate the vomiting center of the brain.

Antineoplastic basic side effects

1) Bone marrow supression
2) Nausea and Vomiting
3) Alopecia

Antineoplastic Toxic effect

toxic on Heart, lungs, nerve tissue, kidneys and bladder

Adriamycin side effect

Toxic effects on the heart that may lead to heart failure, stomatitis (Cardiomyopathy)

Most common cancer in men

Prostate

Most common cancer in women

Breast

Body systems adversely affected by Chemotheray

Respiratory, Urinary, Skin, rapidly dividing cells of these systems are more sustible

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