Med Surg II Chapter 33-35 Study Guide

Immune System Disorders
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Terms in this set (...)

anergy
the inability to mount an immune response; commonly seen with AIDS and other immunosuppressive disorders
antibodies
chemical substances that destroy foreign agents in the body such as microorganisms
antigens
protein markers on cells that mark them as foreign to the body
artificially acquired active immunity
the administration of a killed or weakened microorganism or toxin in order to manufacture cells that will remember the substance and fight it the next time the body is exposed to it (ex: influenza vaccine)
immune response
a target-specific system of defense that primarily involves and lymphoid tissue
immunocompetence
the ability of the immune system to cooperatively protect a person from outside invaders and the body's own altered cells
naturally acquired active immunity
directly acquiring an infection and building antibodies against it so it can be fought the next time the body is exposed to it (ex: measles)
passive immunity
ready made antibodies given or passed on to a susceptible person that are short lived and will not recognize the antigen when the body is exposed to it again (ex: antibodies passed from the mother to the baby through the placenta or breast milk)
cell-mediated response
when T-cells survey proteins in the body, actively analyze the surface features, and respond to those that differ from the host by directly attacking the invading antigen
What is the function of the thymus?
it programs T-cells to become either regulator or effector cells
What is the function of the tonsils and adenoids?
they filter bacteria from the tissues and fluid
What is the function of lymphoid tissues in the body?
they play a role in immune responses and help prevent infection
active immunity
the body had to respond and work to build specific immunity based on exposure to an antigen
What is the primary blood test used to diagnose immune system disorders?
CBC with differential
Where are blood cells produced?
in the red bone marrow (RBCs) and yellow bone marrow (WBCs)
How does a TB skin test screening work?
if the person has been exposed to the TB virus, they will have antibodies (B memory cells) that will attack the small amount of injected fluid in the skin making it swollen and red (induration)
What is the role of natural killer (NK) cells ?
they are lymphocyte-like cells that circulate throughout the body looking for virus infected cells and cancer cells to attack and destroy
What is an allergic disorder/response?
it is characterized by a hyperimmune response to weak antigens that are usually harmless and would not cause an immune response
Why do allergic reactions usually not happen during the first exposure?
it does not produce a response because sensitization has not yet occurred in the body
What is sensitization?
the process by which cellular and chemical events occur after a second or subsequent exposure to an antigen
What should the nurse do when a patient states they are allergic to something?
1. Document the allergy
2. You can list specific stated reactions, but list it as an allergy
3. The physician can later reconcile and ask more questions if needed
4. Inform the patient to obtain and wear an allergy bracelet ASAP and check with EVERY medication administration
What are the symptoms of ingested food allergens?
abdominal cramping, vomiting, and diarrhea
How do corticosteroids work in the body to treat an allergic response?
they are anti-inflammatory hormones that block the synthesis of prostaglandins and leukotrienes
How are allergies typically treated?
1. Drug therapy such as diphenhydramine (mild reactions) or epinephrine (severe reactions)
2. Desensitiziation through weekly injections (must watch patient closely for reactions with initial dose and when increasing the dose)
What is skin prick allergy testing?
skin testing using extracts of various substances (antigens)
What patient teaching is important for a person having skin prick allergy testing performed?
avoid taking over-the-counter or prescribed antihistamines and cold medications for at least 48 -72 hours prior to the test
How are the symptoms of anaphylaxis (type I) managed?
1. Administer epinephrine ASAP!
2. Remove rings from swollen fingers
What is a delayed hypersensitivity response (type IV)?
an allergic reaction that may occur over several hours or days
How do you get a ring off a person's finger without damaging it when their hands are swollen?
try soap and oil first, and then do the string method if unsuccessful
What is an autoimmune disorder?
a disorder in which the killer T-cells and autoantibodies attack or destroy natural cells; the body attacks itself
How does being on an immunosuppressant medication affect receiving a vaccine?
there is an increased possibility of getting sick from the vaccine as the immune system is suppressed and doesn't have what it needs to fight off infection
What are colony stimulating factors?
agents that help stimulate the production of blood cells (epogen for RBCs and neupogen for WBCs)
What is the medical management for autoimmune disorders?
drug therapy such as corticosteroids (prednisone) and antineoplastics (chemo drugs) to lower the immune system response
What do autoimmune disorders put people at risk for?
infections
What are some important patient teachings points for people with autoimmune disorders?
1. Take medications even when in remission
2. Report symptoms of infection ASAP
3. Encourage a well-balanced diet
4. Supplements can sometimes help, but not necessarily
Why do clients with autoimmune disorders sometimes take chemotherapy drugs?
to lower the immune system response
What does it mean to have exacerbation and remission of autoimmune disorders, and why is it important to keep taking medications?
exacerbation (flare of symptoms) alternate with periods of remission (no symptoms) and the duration is completely unpredictable; medication should be taken even during remission to avoid acute exacerbation
How does HIV attack the body and why does it affect the immune system?
it impairs the ability of infected T4 cells to recognize foreign antigens and to stimulate B-cell lymphocytes to make antibodies

this will be a short answer question on the test
What opportunistic infections are patients with HIV/AIDS most susceptible to?
1. Candidiasis (yeast infection) - vaginitis is treated with nystatin, vaginal tablets, or suppositories
2. Cryptosporidiosis (protozoan) - diarrhea leads to dehydration and electrolyte embalance
What is the best way to prevent HIV/AIDS?
1. Use condoms with a spermicide such as Nonoxynol-9
2. Bank autologous blood (self-donated) or directed donor blood
What are the risk factors that increase a person's chance of contracting HIV/AIDS?
1. Unprotected sexual intercourse
2. Multiple partners
3. Sharing needles
4. Nonautologous blood transfusions
5. Infected mother to infant transmission via blood or breast milk
What should a healthcare worker do when stuck by a contaminated needle?
1. Report the incident to your supervisor immediately!
2. Practice safe sex until negative testing is confirmed for six consecutive months
3. ALWAYS practice safe handling of needles and sharp instruments
What is ADC?
AIDS dementia complex - irreversible degeneration of the brain that affects mood, cognition, and motor functions
When does HIV become AIDS?
1. When there is a marked decrease in the T4 cell count (normal range is 800-1,200)
2. The development of certain cancers or other opportunistic infections
What should the nurse always obtain prior to testing a client for HIV?
you MUST obtain consent
What is the goal of drug therapy when treating a client with AIDS?
to keep the CD4 cell count above 350/mm, which results in an undetectable viral load level
T-cells are created in the bone marrow and hang out in what lymphatic organ until they are stimulated to become either a regulator or effector?
thymus
Regulator T-cells become what?
either a helper T-cell or a suppressor T-cell
What is the function of helper T-cells?
they detect antigens and stimulate B-cells to make antibodies to the antigen (detective cells)
What is the function of suppressor T-cells?
they turn off the immune response
What is the function of effector T-cells?
they are killing cells that call in the troops of other nonspecific WBCs to seek and destroy
What is the function of plasma cells?
they create antibodies and are specific fighters
What is the function of memory cells?
they remember an antigen and are activated again when the body is reexposed to it
What are the bloodborne barriers of passive immunity?
1. Immunity passed from the placenta
2. Immunity passed from breast milk
3. Some vaccines
4. Generic cells such as monocytes, microphages, and macrophages

these barriers are only temporary and do not regenerate
What are the physical barriers of passive immunity?
1. Skin
2. Mucous membranes
3. Tears
4. Stomach acid
5. Fever/inflammation

these barriers regenerate