HLAs (Human Leukocyte Antigens)
Marker to recognize self and non-self
Determine the tissue type of a person
an immediate, short term protective response against tissue injury & foreign proteins
The response may occur with or without infection
A response to tissue injury and invasion of organisms
Neutrophils and Macrophages
Basophils and Eosinophils
release chemicals, tissue response
Inflammatory response sequence
Stage 1 (vascular) constriction and hyperemia (increase blood flow) and edema
Stage 2 (cellular exudate) neutrophilia, pus
Stage 3 (tissue repair, and replacement)
specific immunity produced by B cells that produce antibodies that circulate in body fluids
Cell Mediated immunity
an immune response in which killer T cells attack antigen-bearing cells directly
Plasma, Interstitial fluid;crosses the placenta. Most dominant response in second exposure
Secretions; tears, saliva, breast milk, colostrum, mucous membranes and body surfaces
Plasma; antibodies to ABO blood antigens. Highest in initial exposure
Plasma; present on lymphocyte surface
Allergies, parasitic infections
Initial exposure--IgM predominates, some IgG 4-8 days
Subsequent exposure--IgG predominates, some IgM 1-3 days
Native immunity, Born with it
Natural Active Immunity
the body produces its own antibodies; long lasting immunity. Ex. from infection
Artificial Active Immunity
production of your own antibodies as a result of vaccination or immunization
Natural Passive Immunity
baby receives antibodies from its mother through the placenta and breast milk
Active Passive Immunity
Artificial, serum immune globulins/antibody injections
Cell Mediated Immunity
Involves WBCs, natural killer cells, & cytokines
Provides for self and nonself recognition
Critical role in preventing cancer development
Transplant rejection (a protective response)
Hypersensitivity or allergic reaction
an over-reaction against foreign antigens 4 types
1. rapid hypersensitivity (humoral)
2. cytotoxic/cytolytic reactions (humoral)
3. immune-complex reactions (humoral)
4. delayed hypersensitivity reactions (cellular)
Type 1 (Hypersensitivity reaction)
Rapid Hypersensitivity (Humoral)
Can be local or systemic
Allergens inhaled, ingested, contacted or injected
Reaction comes from within.
Reaction involves IgE, mast cells, chemical mediators.
Type 1 (Rapid Hypersensitivity) "atopic allergy"
Reactions involve IgE mast cells, chemical mediators
Labs: increased eosinophils, igE
Allergy testing--skin test, oral food challenges, avoidance therapy, environmental changes, drug therapies/patient education.....antihistamines (block h1/h2 receptors), sympathomimetic/decongestant drugs, corticosteriods, antipruritic meds (anti-itch), mast cell-stabilizing meds, leukotriene receptor antagonists
Anaphylactic Shock (type 1)
A severe, widespread acute hypersensitivity that occurs when an allergen is introduced to the bloodstream of an allergic individual. characterized by broncho-constriction, labored breathing, widespread vasodilation, circulatory shock, and sometimes sudden death. antihistamines are inadequate to counter this type of hypersensitivity, but epinephrine relieves the symptoms by dilating the bronchioles, increasing cardiac output, and restoring blood pressure.
Anaphylactic Shock (Medication, Mild response)
1:1,000, 0.2-0.5 ml SQ, repeat @ 20min/intervals
Anaphylactic Shock (Medication,Severe response)
1:10,000, 0.5 ml IV, @ 5-10min intervals
Type 2 (Hypersenstivity reaction)
Cytotoxic/Cytolytic Reactions (Humoral)
Production of autoantibodies--destroy own cells/tissue.
Antibody: IgA, IgM, complement often involved
Mediators: complement lysis (cell breakdown), macrophages
Examples:Transfusion reaction, Goodpasture syndrome, ITP, Grave's disease
Type 2 (Diagnostics)
Coombs blood test: hemolytic anemia, ABO incompatibility. Target underlying process
Type A blood
anti A and B antibodies.
Universal donor. Can only get o blood.
No antibodies. Universal receiver.
Type 3 (Hypersensitivity reaction)
Immune-Complex Reactions Humoral (Auto immune)
Involves antigen-antibody complexes.
IgM and IgG involved.
Mediators:Nurtophils, complement lysis
May involve localized or systemic inflammatory response, may be accute or chronic
Treatment:Target the cause of the manifestations
Type 4 (Hypersensitivity reaction)
Cell Mediated Response (Delayed Hypersens.)
Recognition and response of T lymphocytes to foreign antigen (external or internal)
Antibody and complement system are not involved.
Mediators: Cytokines, T cytotoxic cells, monocytes/macrophages, lysosomal enzymes
EX: allergic contact dermatitis, transplant rejection
Day old baby who is breastfeeding receives what type of Immunoglobulin?
Pt (first time infection) experiences highest level of what type of immunoglobulin?
Pt (repeat infection) experiances highest levels of what type of immunoglobulin?
Patient experiencing blood transfusion reaction experiances highest levels of what type of immunoglobulin?
Patient experiencing allergic reaction experiances highest levels of what type of immunoglobulin?
What type of reaction would a transfusion elicit?
What type of reaction would allergic rhinitis elicit?
What type of reaction would Rheumatoid arthritis elicit?
What type of reaction would contact dermatitis elicit?
Benign Tumor Cells
Continuous or inappropriate cell growth
Specific Morphology, small nuclear-to- cytoplasmic ratio. Tight adherence, No migration
Specific differentiated functions, Orderly growth, normal chromosomes
Rapid or continuous cell division, Large nuclear-to-cytoplasmic ratio, specific functions lost, loose adherence, migration, no contact inhibition, abnormal chromosomes
The creation of cancer/tumor formation and development
initation, Promotion, Progression , Metastasis
an act that sets in motion some course of events
ex:smoking, high fat diet, HTN, etc.
We intervene to decrease progression.
ex:smoking cessation, dietary consultation
process of moving forward, developing
(no contact inhibition)
spread of cancer cells beyond their original site in the body
decreased immunity & blood producing functions, altered GI structure and function, motor and sensory deficits, decreased respiratory function
tissue of origin ex: sarcoma=bone
cellular aspects,examination,study of tissue
Cannot be differentiated (cannot be assessed)
slight change, well differentiated, mild dysplasia
More abnormal, moderate differentation & dysplasia
Very abnormal, poorly differentiated; severe dysplasia
Immature and primitive, undifferentiated (no function), anaplasia
abnormal development or growth of cells, tissues, or organs
change in the structure of cells and in their orientation to each other
Location and degree of metastisis
Look @ the primary site, and see if it's spread
Based on chromosome # and appearance. number of sets of chromosomes
Doubling time and mitotic index
How fast it grows, develop treatment approach
Karnofsky Performance Scale
Used primarily in palliative care settings to assess functional abilities at the end of life
0=dead 100=doing good
Self exam, avoidance of known or potential carcinogens, modification of associated factors & remove "at risk" tissues, Chemoprevention (asprin/day), Vaccination
Regular screening, altering damaged genes, Genetic screening. detect and treat.
Seven Warning Signs of Cancer
C hange in bowel or bladder habits
A sore that does not heal
U nusual bleeding or discharge from body orifice
T hickening or a lump in the breast or elsewhere
I ndigestion or difficulty in swallowing
O bvious change in a wart or mole
N agging cough or hoarseness
Prevention, diagnosis, staging, and diagnostic plan, cure &/or control, supportive care, rehabilitation
radiation therapy administered at a distance from the body.
therapy using radioactive sources that are placed inside the body
Hormonal manipulation (Cancer mgt.)
Decrease the amount of hormone reaching hormone sensitive cells, alters the cancer cell ability to replicate, metastasize, differentiate
Agonists (medications) of hormone therapy
androgens, estrogen, progestin, LHRH
antiandrogens, and antiestrogens
Biologic Response Modifiers BRMs
substances produced by normal cells that block tumor growth or stimulate system to fight cancer
Ex: Cytokines, Interleukins, interferons
Modify cancer cell action & increase immune response
What med stimulates growth of WBC's?
What med stimulates growth of RBC's?
What med is given to stimulate platelet production?
shock that develops as the result of infection carried by the bloodstream, eventually causing dysfunction of multiple organ systems.
SIADH (syndrome of inappropriate anti-diuretic hormone)
this results from an excess of ADH (Antidiuretic Hormone). The POSTERIOR pituitary gland continues to release ADH, causing the kidneys to reabsorb excess water, which decreases urine output & increases fluid volume. Client will have hyponatremia, water retention, weight gain, concentrated urine, muscle cramps & weakness. The low osmolality of blood allows fluid to leak out of vessels & causes brain swelling.
Occurs most often in patients with bone metastasis
ManifestationsL fatigue, decreased appetite, N/V, altered elimination as well as fluid and electrolyte imbalance
Coll. Care: Hydration therapy, Drugs, Dialysis
Spinal Cord Compression
An oncologic emergency that is caused by a tumor pressing on the spinal cord, can cause various problems, including permanent paralysis if not treated properly. Caused by cancers of the lung, breast & prostate, which carry the greatest risk of metastasizing to the spinal cord.
Spinal Cord Compression
Early recognition and treatment, palliative, high-dose corticosteroids and radiation, surgery, back or neck braces to reduce pressure
Tumor Lysis Syndrome
oncologic emergency with rapid lysis of malignant cells, as the cells lyse, intracellular contents are released in blood which results in hyperkalemia, hyperphosphaemia, and hyperuricemia which puts the patient at risk for renal failure and cardiac function, early signs include n&v, anorexia, diarrhea, muscle weakness and cramping, later signs tetany, paresthesias, seizures, anuria, and cardiac arrest
Tumor Lysis Syndrome
Prevention, Hydration, Drug therapy. cell destruction quickly into blood stream.
Superior Vena Cava Syndrome
Compression/obstruction by tumor growth, painful -/+ life threatning emergency.
Signs include: edema, Stoke's sign, dyspnea, erythema, and epistazis
Superior Vena Cava Syndrome
S/S: edema, stokes sign, dyspnea, erythema, epistaxis (nose bleed) High-dose radiation therapy, Metal stent in vena cava
Gary ate my dead elephant.
vasoconstriction of peripheral blood vessels, relaxation of bronchial smooth muscle
mast cell stimulating meds
inhibit release of histamine
leukotriene receptor antagonist
block leukotriene, antiinflammatoryy
When would urticaria (hives) and transplant rejection?