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Ch 2 - Patho - NURS 324
Terms in this set (166)
Name that condition!!!
- swollen lymph nodes
- nausea, vomiting, diarrhea
- cough and shortness of breath
- chronic fatigue
- rapid weight loss
- liver and spleen enlargement
- muscle myalgia
- sores and thrush in mouth
Why is HIV so deadly?
- It destroys Helper T (CD4) cells, which are in charge of enabling both Killer T (Cytotoxic) and B Cells to work
- Essentially, it shuts down any specific, 3rd line immune system response
What does it mean when someone says they have an Acquired Immune Disease?
They were both with a normal immune system, but it became ineffective due to exposure to a pathogen or chemical agent
What is the most common acquired immune disorder?
____ = "Boy in the Bubble disease" means ______
SCIDS = rare genetic disorder where there are a series of severe immune disorders all at once
Why do many children with SCIDS die?
Exposure to any normal environment presents enough pathogens to kill them because of their inability to fight it off with an immune system
Why don't children with SCIDS respond to medicine?
SCIDS affects both B and T cells, so they don't have any cells that could work with the medications, and they are unable to make any antibodies
What is the hallmark of immunodeficiency?
tendency to develop unusual or recurrent, severe infections
Immunodeficiency can be ___ or ____ and it makes a person ____
Can be congenital or acquired and makes a person more susceptible to diseases normally prevented by a healthy immune system
What does immunodeficiency increase the chances/rate of?
_____ = low or insufficient immune response
caused by a pathogen that does not normally produce an illness in healthy humans
Name that condition!!!
- excess Ab-Ag complexes
- butterfly rash
- usually misdiagnosed
Systemic Lupus Erythematosus (SLE)
SLE attacks ____, causing _____ (symptoms)
SLE attacks various parts of the body at different times, causing a mix of responses (chronic inflammatory disease)
SLE affects what tissues of body organs
connective tissues of body organs
1: SLE is more common in ____ ages ___ to ___
2: Asians are ______ likely
3: African Americans are ______ likely
1: more common in women 15-45
2: Asians = 3x higher risk
3: African Americans = 4x more likely
IBD attacks ____, causing ______ (symptoms)
IBD attacks intestinal lining
- rectal bleeding
- urgent bowel movements
- abdominal pain
- weight loss
MS attacks ____, causing _____ (symptoms)
MS attacks nerve cells
- muscle spasms
- coordination problems
Psoriasis/_____ _____ attacks ______ and _____ and causes ________ (symptoms)
Psoriasis/Psoriatic Arthritis attacks skin and the lining of the joints
- rough, red, scaly patches on the skin
What percentage of people also develop joint inflammation, swelling, and pain
What autoimmune disorder attacks joints?
What does this cause, and what happens if it's left untreated?
Rheumatoid Arthritis attacks joints
If left untreated = gradually causes permanent joint damage
Diabetes Mellitus is a common ____ that attacks and destroys _____
common autoimmune disorder than attacks and destroys insulin-producing cells in the pancreas
Autoimmune disorders can be exacerbated by ___
For autoimmune disorders...
1: Females and caucasians are at ___ risk
2: African Americans are at increased risk for _____
3: European Americans are at increased risk for ____
4: Native Americans are at increased risk for ____
5: Asian Americans are known for ______
1: Females and Caucasian = increased
2: African Americans = Peanut Allergy
3: European Americans = Hay Fever
4: Native Americans = Drug Allergies
5: Asian are at least risk for allergies
Explain what an autoimmune disorder is
when the body is unable to distinguish between self and non-self antigens, so it attacks itself
Graft vs Host Disease
can result from transplanted bone marrow that contains immunocompetent cells that attack the patient's immune system
Examples of type IV hypersensitivity
TB skin tests, transplant rejection, contact dermatitis
Which hypersensitivity has a delayed reaction? What does that mean?
Type 4 means it is a cell-mediated response
What is a cell-mediated response?
Cell-mediated response means that it is cause by Cytotoxic (Killer) T Cells, NOT antibodies from B cells
What are 2 hypersensitivity autoimmune response processes?
Systemis Lupus Erythematosis (SLE)
Rheumatoid Arthritis (RA)
Explain serum sickness
When a human is injected with non-human serums, he reacts. The immune complexes in blood deposit in tissues. Causes fever, enlarged lymph nodes, rash, and pain. Originally it came from a tetanus shot made from horses to humans.
Other than the glomeruli in your kidneys, what else can be damaged if strep is not treated quickly?
Mitral valve of the heart
Name that condition!!!
- elevated blood pressure
- facial or periorbital edema
- low grade fever
- weight gain (edema)
- elevated BP because kidneys are in charge of helping with blood pressure
- all the -uria things because the glomeruli are responsible for the filtering, and if they are inflammed or incompetent, they won't be able to keep those in the blood, meaning they will be forced through the glomerulus and into the tubules, ending up in the collecting duct and eventually in the urine
Name 2 post streptococcal sequelae/reactions.
acute rheumatic fever and acute glomerulonephritis
Why must streptococcal be treated so rapidly
must be treated quickly with antibiotics to ensure that there won't be a build up on Ab-Ag complexes
Why is Type 3 hypersensitivity dangerous?
Excess Ab-Ag complexes in the blood get stuck in the small blood vessels, which triggers the complement system and inflammation, resulting in damage to the tissues
____ - damage caused by overproduction of Ab-Ag complexes
Type 3 hypersensitivity
Explain why there is damage in a type 3 hypersensitivity reaction
It happens because there is an inadequate number of Suppressor/Regulator T cells in the immune system. This means that the immune system will continue to respond and there will be an overproduction of Ab-Ag complexes
The RhoGAM shot is an example of _____?
What does the RhoGAM shot do?
aids in erythroblastosis fetalis because it cleans up RH+ RBCs from the baby so that the mom doesn't develop acting/lasting immunity to Rh+ Cells and attack the babies
hemolytic disease of the newborn
When does erythroblastosis fetalis occur?
when the maternal Rh antibodies (RH -) cross the placenta and destroy the fetal erythrocytes because they are Rh +
In what hypersensitivity does lysis (rupture) occur? Why?
Type 2 because of the activation of the complement system (MAC Attack)
Which antibodies are involved in Type 2 Hypersensitivity reactions?
IgG and IgM
Type 2 hypersensitivity involves ___ and ___
Blood and Tissue
If someone is experiencing anaphylactic shock and doesn't get help quickly, what can happen?
Cardiac arrest or death
What are the CV and GI symptoms of anaphylactic shock?
CV = hypotension, dysrhythmia, angioedema
GI = severe cramps, nausea, diarrhea
What are the neuro and resp symptoms of anaphylactic shock?
Neuro = sensation of impending doom, anxiety, restlessness, seizures
Resp = difficulty breathing, hoarse voice, wheezing, stridor
Type 1 hypersensitivity can have both ___ and ___ reactions. Give examples of each
1: Mild = Allergic Rhinitis (Hay Fever - runny nose, sneezing, and itchy eyes)
2: Systemic = rapid and severe (latex reactions, bee stings, shellfish, nuts, and penicillin
Type 1 hypersensitivity is a ___ reaction and results from _____
rapid reaction that results from IgE antibodies
In order for hypersensitivity to occur, a person must ___
have previously come in contact with that pathogen
Immediate Reaction is to ____ and Delayed is to____
Immediate = Types 1-3 (B cells)
Delayed = Type 4 (T cells)
Type IV is an example of ____
Delayed Hypersensitivity is ____ mediated
What happens in immediate hypersensitivity? Why does it occur?
B-Cells (humoral immunity) reaction caused by Ag-Ab complexes
An adverse reaction to a transplant organ is an example of ____
What is the difference between autoimmunity and alloimmunity?
Auto = allergic response to your own cells
Allo = allergic response to beneficial tissue (adverse reaction to a transplant organ)
___ is an exaggerated response to normal, non-harmful, environmental agents
Why are normal inflammatory responses a good thing?
They rid the body of antigens and help resolve infections within a few days to decrease or eliminate potential damage to tissues
What are 2 indications for IVIG
1 = Supplement Immune System until it can protect someone (primary and acquired immunodeficiency, idiopathic thrompocytopenia to keep from bleeding to death, or bone marrow transplant and Graft vs Host disease)
2 = Block immune system when overreacting (neurological diseases caused by autoimmunity, acute flaccid myelitis, and kawasaki disease)
Acute Flaccid Myelitis
a sudden weakness or paralysis in limb(s) with decreased or absent reflexes (polio-like disease in children)
inflammation of blood vessels throughout the body in children (hence the strawberry tongue)
What adverse side effects can occur from IVIG? What does it depend on?
Depends on the infusion rate (Infusion-rate dependent)
What is IVIG? What are other names?
Intravenous Immunoglobulin, Serum, Gammaglobin
What are the cons of IVIG
Because the serum is coming from someone else, it doesn't lead to active immunity and there are many adverse side effects
What is passive immunity? Examples
short term immunity using antibodies produced outside the body = the body doesn't make the antibodies
Placenta giving baby IgG
Breast Milk giving baby IgA
If someone gets titers tested and they come back low for a specific pathogen, what do they need to do?
Get vaccinated so their body will produce more antibodies to that pathogen and increase their titer
What do scientists use to determine if someone is immune to a specific pathogen?
Titers = measure the level of antibodies in the blood plasma to determine immunity to a specific pathogen
Where are antibodies located?
Why would someone who already got a pathogen actually get it again
When the antigens on the pathogens change, the 3rd line of defense (specific immunity defense) doesn't recognize them, leading to a new immune response to make brand new antibodies for that particular strain
How long does active immunity last? Give examples
Depends on the pathogen
Tetanus = 10 years
Chickenpox = lifetime
What is active immunity?
the immunity that results from the production of antibodies by the immune system in response to the presence of an antigen.
How is active immunity acquired?
Your body gets the virus and then your body recognizes the virus and produces antibodies for that virus, whether that is from natural exposure (actually getting the pathogen), or artificial exposure (getting a vaccine)
Both active and passive immunity can be either ____ or ____ acquired
natural or artificial
Which cells remember antigens? What does that allow them to do?
Memory T Cells remember the antigen and this allows them to respond to that antigen when coming in contact with it again in the future
What is the function of the Suppressor/Regulatory T Cell?
Shuts down the immune system when it doesn't need to respond anymore
CD4 is another name for _____. What is the function?
CD4 = Helper T Cells
They help B-Cells make antibodies
Another name for Killer T Cells is _____. What do they attack
Cytotoxic T Cells
They attack cells infected by viruses
T cells are mostly active in ____ infections, but can also play a role in some ____ ones
Mostly active in viral infections, but can play a role in bacterial ones
What do T Cells do.use instead of antibodies?
They do the work themselves or produce cytokines
proteins secreted by cytotoxic T cells to aid in antigen destruction
Which antimicrobial factors do basophils and mast cells release?
BAF = B-Cell Activating Factor
Which antibodies/immunogens are scientists not really sure of the function? But what is it able to do?
Not sure of IgD function, but do know that it can bind to basophils and mast cells to activate them to release antimicrobial factors
What is the antibody/immunogen IgE involved in? How does it go about this?
Immediate allergic reactions
It bunds to the allergens and triggers histamine release from both mast cells and basophils
What 2 antibodies does the mom give the baby? Where are they given? How are they exchanged?
Placenta = IgG in utero
Breast Milk = IgA after birth
Which is the major antibody/immunogen found in fetal blood? How/Why?
IgG because mom's antibodies cross the placenta to give passive immunity to the baby until it develops its own
What antibody/immunogen is the MAIN defense against bacteria?
What are the pros and cons of IgG antibodies/immunogens?
Pro = most numerous and effective
Con = takes longer to produce
What percentage is IgG antibodies?
80-85% of plasma antibodies
Which antibody/immunogen is the first responder when pathogens enter the blood stream? What is the downfall of this?
Although it's the largest and 1st to respond, it's not as effective as IgG
Where is the antibody/immunogen IgA located? What is the role?
Bodily fluids, mucosal areas, breast milk
Prevents pathogens from...
- getting into the bloodstream
- colonizing in areas where the body is "open"
- in breast milk, it helps to provide infants with some immunity before they develop on their own
All antibodies are produced by what kinds of cells?
B Cells (humoral)
What is the purpose of antibodies binding to the antigens on viruses and bacterias
Prevents them from entering the cell and allows macrophages to target them and eat/destroy them
What is another word for antibodies (besides humors)
What is another word for antibodies in body fluid?
B cells ______
T Cells ______
B cells attack invaders
T Cells attack infected cells
What percentage of baby lymphocytes form in the bone marrow vs the thymus?
25 % in the bone marrow - become B cells
75% in the thymus - become T cells
What is cellular immunity made of?
What is the Humoral Immunity made of?
What happens when the 3rd line of defense detects a foreign antigen (what is the response)?
Responds be creating specific, tailor-made antibodies to kill only that one pathogen with those exact antibodies
What are the abbreviations for antigen and antibody?
Antigen = Ag
Antibody = Ab
Where are the antigens located that the 3rd line of defense responds to
Which line of defense if both self-regulating and self-limiting?
The 3rd line of defense is an ___-___ immune response
Which line of defense....
- develops over time
- uses a memory system
- distinguishes between both self vs non-self and specific pathogens
- is specific
Explain the difference between the roles of T and B Cells
- T cells mediate immunity by attacking already infected cells and carrying out phagocytosis
- B cells make the antibodies that tag the cells for T cells to attack
Which line of defense involves both T and B cells?
What do complement proteins do in order to destroy pathogens? (2 things)
1: Forms a Membrane Attack Complex (MAC Attack) that drives a hole through bacterial plasma that allows fluid to flow inside, eventually results in rupturing of the cell and lysis
2: Binds to microbes to form a rough outer layer coat that promotes phagocytosis
What is chemotaxis
attracting macrophages, monocytes, and neutrophils to an infected area
How do complement proteins change the blood vessels?
They cause vasodilation and increase the permeability of the blood vessels
What happens to those cells that are virally infected and send out interferons?
Because they are already infected and can't be helped or saved by the interferons they send out, Killer T cells will come and kill them off to prevent more spread of the infection
Explain the purpose of interferons
- They signal to the surrounding cells to help by binding to receptors on the uninfected plasma membranes, and once binded, the uninfected cell is able to produce an enzyme that doesn't allow viral replication, so when the virus enters that previously-warned, uninfected cell, it won't spread infection
What proteins are released by cells that are infected by a virus?
Along with fever, what else are interleukins responsible for?
They contribute to the general feeling of being ill
- body ache
- poor appetite
Name the 5 interleukins involved in fever production
Prostaglandin E2 (PGE2)
Explain the mechanism steps used by the body when someone gets a fever
1: Macrophages release cytokines/interleukins
2: Those chemical messages stimulate the hypothalamus
3: The hypothalamus increases body temperature
Is a WBC count of 7 increased, decreased, or okay?
Okay because the range is from 5-10
Is a band % of 11 increased, decreased, or okay
Very increased because the range is from 3-6
What are the normal ranges on blood work for...
1: WBC Count (x10^3)
2: Band %
3: Neutrophil/Seg %
1: WBC = 5-10
2: Band % = 3-6
3: Neut/Seg = 50-62
What does a left shift indicate? Why?
Serious bacterial infection because it shows that the mature WBC have already been used and your body is running out of fighters
Explain a "left shift"
An increased number of immature neutrophils (band neutrophils).
Which WBC is also important in killing some types of virally infected cells and cancer cells?
Which WBC is the 1st responder to bacterial infections?
Band cells are ...
What are monocytes
Which lymphocytes are slower to react, but live longer?
What are eosinophils responsible for?
Allergic Reactions and parasitic worms
Which kind of lymphocyte is special in regards to not having to have been exposed to a pathogen before?
What are the 4 types of WBC involved in the 2nd line of defense?
4: NK Cells
What line of defense are leukocytes/WBC involved in?
What's another word for WBC
What are 2 things that can lead to leukopenia?
1: Cancer (especially leukemia)
2: Drug treatments
What is leukopenia? Why is it dangerous?
Leukopenia = WBC/leukocytes are decreased in #
It's dangerous because it creates risk for infection because they make up the immune system, which wards off infections, so without an immune system, the body is unable to protect itself and destroy pathogens
What are 4 benefits of inflammation?
1: Limit and control tissue damage by preventing spread of inflammation into healthy tissue
2: Prevent and limit infection and further damage
3: Initiate adaptive immune response
4: Initiate healing
What is the systemic effect of an inflammatory response?
What are the local cardinal signs of inflammation?
- Swelling (edema)
- Decreased function at the site of infection
What are the 4 important contributors in the inflammatory response?
1: Pyrogens (cause fever)
2: Interferons (activate other immune cells)
3: Complement Proteins
4: Pro-Inflammatory Cytokines
Which cells release histamines?
mast cells and basophils
Why are histamines important?
They act as vasodilators, which makes it easier for WBC to respond to the site
What 3 symptoms do histamines cause?
What are the 3 roles of inflammation?
1: Fight invaders who get through the 1st line
2: WBC more from bloodstream into infected tissue
3: Mast cells release histamines and other cytokines
What is the main action of the 2nd line of defense immune system?
What are the 2 main types of Immune System Mechanisms
1: Nonspecific (1st and 2nd)
2: Specific (3rd)
Explain the role of skin acidity and sebum in the 1st line of defense
- Skin Acidity = inhibits bacterial growth
- Sebum = provides protective film over skin and inhibits pathogen growth
Explain the role of lysozymes, gastric acid, and saliva in the first line of defense
- Lysozymes = act as antimicrobials in tears, saliva, and sweat
- Gastric Acid = destroys bacteria and most toxins
- Saliva = dilutes the # of microbes
What are the 5 chemical barriers of the 1st line of defense
2: Gastric Acid
4: Skin Acidity
5: Sebum (skin oil)
Explain the role of urine and defecation/vomit in the 1st line of defense
- Urine = flushed microbes out of urethra
- Defecation and Vomit = expel microbes
Explain role of nose hairs in cilia in first line of defense
- Nose Hairs = filters air with microbes, dust, and pollutants
- Cilia (upper res) = traps and propels debris to throat
Explain the role of skin and mucus in the 1st line of defense
- Skin = periodic shedding removes microbes
- Mucus = traps microbes
What are the 6 physical barriers of the 1st line of defense?
1 = Skin
2 = Mucus and Mucus Membranes
3 = Hair
4 = Cilia
5 = Urine
6 = Defecation/Vomit
Which line of defense....
- can recognize self from nonself, but cannot distinguish between pathogens
- works faster, but not as well
- no priming or exposure needed to work
1st line of defense
What does the 3rd line of defense encompass?
Lymphocytes and antibodies
What does the 2nd line of defense encompass?
- Phagocytic WBC
- Antimicrobial Proteins
- Inflammatory Response
What does the 1st line of defense encompass?
Skin, Mucus and Mucus Membranes, and their secretions
2 types of nonspecific defense
1st line and 2nd line
When reviewing a patient's lab results, the physician comments that the results show a left shift. What does that mean?
The patient may have a serious infection
A 10 year old is stung by a bee while playing outside. He experiences a severe allergic reaction and has to go to the Emergency Department. This reaction is a result of ____
A hallmark symptom of most infectious diseases is ____
Which of the following immune cells are primarily targeted and destroyed by HIV?
Helper T Lymphocytes (CD4)
Systemic Inflammatory Response Syndrome (SIRS)
Non-normal exaggerated response to some stressor (burns, trauma or acute organ failure). May or may not involve infection
What are symptoms of SIRS
- Elevated Respirations
- Low BP
- Elevated WBC Count
What is the largest immunoglobulin
What is one of the most numerous and effective antibodies?
What makes the immune system last longer?
The more stable the pathogen and stronger the immune response
Which type of hypersensitivity can lead to anaphylactic shock?
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