Exam 4: Units 7 and 8 Flashcards by Kiana Pippin

The body has 3 means of immune defenses

Phagocytic
Humoral/Antibody
Cell-mediated

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4 stages of immune response

1) Recognition
2) Proliferation
3) Response
4) Effector

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Stage of the immune response where Humoral or Cellular response is carried out

Response

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Stage of the immune response where the immune system recognizes an antigen

Recognition

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Stage of the immune response where T and B cells respond and proliferate

Proliferation

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Stage of the immune response where the antigen is destroyed

Effector

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This type of immunity has memory

Adaptive immunity

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Leukocytosis is characterized by

WBC >10,000

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Leukopenia is characterized by

WBC <4,000

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Neutropenia is characterized by

Neutrophil count <2,000

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All WBC percentages add up to

100%

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5 types of WBC’s

“Never let monkeys eat bananas”

Neutrophil
Lymphocyte (B and T cells)
Monocytes
Eosinophils
Basophils

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Innate immunity provides a ____ spectrum of defense

broad spectrum

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With innate immunity, responses are

similar from one encounter to the next

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Humoral immunity addresses problems ______ the cell

outside the cell (extracellular pathogens)

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Cell-mediated immunity addresses problems _____ the cell

inside the cell

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Humoral response occurs in the

blood stream

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Humoral response is mediated by

B cells

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B cells produce

antibodies

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End result of humoral immunity

Memory B cells

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cell-mediated response occurs in

the infected cell

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cell-mediated response is mediated by

T cells

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Role of killer T cells

directly destroy infected cells

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End result of cell-mediated response

memory T cells

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Antibodies prevent a virus or toxic protein from binding their target

Neutralization

A pathogen tagged by antibodies is consumed by a macrophage or neutrophil

Opsonization

Antibodies attached to the surface of pathogen cell activate the complement system

Complement activation

IgA antibodies found in

Mucosal Defense: -Breastmilk -Saliva -Tears -Mucous

IgA structure

Dimer

IgG structure

monomer

IgM structure

pentamer (and can be in monomer form)

IgE structure

monomer

IgA antibodies found in

FLUIDS of the body: -Saliva -Sweat -Breast milk

these antibodies can fuse with the cell membrane of a B-cell lymphocyte and act as a receptor

IgD IgM

Role of IgD antibodies

activates basophils and mast cells

IgE antibodies are prevalent in

allergies helminth infections

how do the IgG antibodies provide passive immunity to the fetus

Cross placenta into the fetus

exposure to pathogen triggers antibody production

Active immunity

a person is given antibodies rather than having to produce them

passive immunity

vaccination is an example of

artificial active immunity

exposure to a sickness and needing to make your own antibodies is an example of

natural active immunity

breastfeeding is an example of

passive natural immunity

receiving antibodies through a blood transfusion is an example of

passive artificial immunity

4 stages of infection

Incubation Prodromal Illness Convalescence

stage of infection where specific signs and symptoms of the disease present

Illness

stage of infection where symptoms diminish and host begins to recover

Convalescence

stage of infection where early signs and symptoms of an infection appears

Prodromal

stage of infection characterized by the time between exposure and symptom onset

Incubation

local signs of infection (think inflammation)

heat redness pain swelling loss of normal function at infection site

fever characterized by

temperature >38 C or 100.4 F

swollen lymph nodes

lymphadenopathy

Immune system attacks its own body/host

Autoimmunity

Body produces inappropriate/exaggerated responses to specific antigens

Hypersensitivity *Includes allergies and transplant rejections

Overproduction of immunoglobulins

Gammopathies

Immune deficiency that's generally congenital or inherited, resulting from improper development of immune cells/tissue

Primary

Immune deficiency acquired later in life described as an interference with an already-developed immune system

Secondary

Primary immune deficiencies are more common in

males than females

primary immune deficiencies are commonly diagnosed at this time of life

infancy

a main difference between primary and secondary immune deficiencies

Primary is diagnosed at/around birth, child is born with an altered immune system Secondary is acquired later in life, an established immune system has been damaged

HIV is this kind of virus

retrovirus

HIV is transmitted through

blood and bodily fluids

cure for HIV

NO CURE!! Treated with lifelong retroviral therapy

HIV primarily targets this kind of cell

CD4+ T-cell Lymphocytes

stage of HIV with the higher viral load

acute stage

3 stages of HIV

Acute Chronic AIDS

this kind of exposure is a greater risk of contracting HIV than an accidental needle stick

unprotected sex with HIV+ partner

HIV replicates by

integrating itself to host DNA and using reverse transcriptase to make more copies of itself

HIV is more seen in

males than females

type of HIV testing that detects antibodies, not HIV itself

antibody testing

type of HIV testing that detects antibodies and/or HIV virus

Antibody/Antigen

role of the viral load test

detects and quantifies HIV virus

role of gathering a CD4+ T-cell count

assessing immune function

during the acute phase of HIV, manifestations occur within

2-4 weeks after infection

s/s of HIV during the acute stage are similar to

the flu

the acute HIV stage is marked by

rapid rise in HIV viral load decreased CD4+ cells

stage of HIV that is asymptomatic

chronic stage

these are produced during the chronic HIV stage

anti-HIV antibodies =DOES NOT INDICATE IMMUNITY

these are destroyed in the chronic HIV stage

CD4+ cells

this increases in the chronic HIV stage

viral load (begins to increase after a certain amount of time)

AIDS is an HIV stage characterized by

life-threatening opportunistic infections

without treatment during the AIDS stage, death occurs within

5 years

type of cancer that develops in the lungs and lymph nodes, usually presenting as red/purple/brown patches

Kaposi Sarcoma

3 areas of involvement with Kaposi sarcoma

skin respiratory tract mouth + gastrointestinal tract

Kaposi sarcoma is strongly associated with infection by

Human Herpesvirus 8 (HHV-8)

Memory rhyme for Kapso sarcoma

"Lesions start flat, get fat, and then mess with your breathing and shat"

pneumocystis jirovecci causes

pneumocystis pneumonia

pneumocystis jirovecii is this kind of infection

fungal

pneumocystis jirovecii infects this organ

lungs

pneumocystis jirovecii is transmitted via

airborne pathway

Dx of pneumocystis pneumonia in an HIV+ patient indicates

progression of HIV to AIDS

____ may be present in pneumocystis jirovecii/pneumonia

hypoxia - monitor pulse oximetry, gather ABG

prophylaxis against pneumocystis jirovecii is recommended for HIV+ patients with CD4+ counts at this level

<200 cells/mm3

this is considered an AIDS-defining condition, according to the CDC

candidiasis of the bronchi, trachea, esophagus, or lungs

white patches on the tongue, inner cheeks, throat with pain/difficulty swallowing

oral candidiasis (thrush)

this kind of candidiasis may cause difficulty/pain with swallowing, sternal pain, and weight loss

esophageal candidiasis

severe pain and difficulty with swallowing

odynophagia

this kind of candidiasis involves itching/discomfort and discharge of the vaginal area

vaginal candidiasis

condition characterized by involuntary weight loss of >10% baseline weight

wasting syndrome

nurse should encourage a patient with wasting syndrome to eat this many meals per day

6 small meals that are high in protein

severe neurological complication of HIV characterized by cognitive, motor, and behavioral impairments

HIV-associated dementia

the goal of ART therapy is to

lower the viral load/levels in plasma

Pre-exposure prophylaxis for AIDS

PrEP therapy

post-exposure prophylaxis for AIDS

PEP therapy

wasting syndrome AKA

cachexia

There is more _____ fluid in the body

intracellular fluid

movement of solutes from a higher to lower concentration

diffusion

movement of water from a dilute solution to a more concentrated solution

osmosis

the pressure a fluid exerts on a surface when its not moving

hydrostatic pressure

there is greater hydrostatic pressure _____ the blood vessel

inside the blood vessel

hydrostatic pressure and osmotic pressure act in a ______ manner

opposing manner

condition where too much fluid moves from the blood vessels into the intercellular spaces

third-spacing

this age range decompensates quickly

young children

2 CV-related s/s with fluid deficit

hypotension tachycardia

dark urine

oliguria

respiratory rate will ______ with fluid deficit

increase

BUN will _____ with fluid deficit

increase

serum and urine osmolality will _____ with fluid deficitq

increase

if fluid volume deficit is due to water loss, Hgb and Hct will

be elevated

if fluid volume deficit is due to blood loss, Hgb and Hct will

be low

thirst response ______ with age

decreases

BUN/Specific Gravity will ______ with fluid overload

decrease

Hgb and Hct will _____ with fluid overload

decrease

excessive urine production

polyuria

in hypovolemic shock, place the patient in

trendelenburg position (feet elevated above the head)

In fluid volume overload, place the patient in

semi-fowler's or high-fowler's

monitor this with fluid volume deficit

urine output

normal range for sodium

135-145

monitor this with fluid overload

respiratory status

Na+ is in higher concentrations ____ the cell

outside the cell

K+ is in higher concentrations ____ the cell

inside the cell

hormone that increases H2O absorption from the urine

Anti-diuretic hormone (ADH)

hormone that retains sodium and excretes potassium

aldosterone

too much water relative to sodium, but total body water stays normal

euvolemic hyponatremia

loss of sodium accompanying a loss in water (sodium loss is greater)

hypovolemic hyponatremia

too much total body water resulting in hyponatremia

hypervolemic hyponatremia

s/s hyponatremia "SALT LOSS"

S: Stupor/coma A: Anorexia (n/v) L: Lethargy T: Tachycardia L: Limp muscles O: Orthostatic hypotension S: Seizures/headache S: Stomach cramping

2 IV fluids that should be administered to a pt with hyponatremia

Lactated Ringer's 0.9% isotonic saline

If patient has _____, DON'T encourage salt substitutes since they are high in potassium

Chronic Kidney Disease (CKD)

sodium's main function is to

help maintain electrical membrane excitability

kidney _____ may result in excessive electrolyte levels

kidney failure (kidney disease is different)

how would Addison's disease contribute to hyponatremia

Addison's = LOW Aldosterone = LOW Na+ levels

How would SIADH contribute to hyponatremia

Syndrome of Inappropriate ADH secretion = ^^ ADH ^^ ADH = ^^ water retention = Na+ dilution

how would Cushing's contribute to hypernatremia

Cushing's = ^^ cortisol = ^Na+, low K+

how would diabetes insipidus contribute to hypernatremia

DI increases urination = ^^ Na+ concentration

if a patient is hypervolemic with hyponatremia, the pulse and blood pressure will be

higher/bounding

a patient with hypovolemia and hyponatremia will have this HR and BP finding

tachycardia hypotension

sodium imbalances can lead to

neuro changes

s/s hypernatremia "FRIED SALT"

F: Flushed skin R: Restlessness (changes in LOC) I: Increased BP E: Edema D: Decreased urine output S: Skin is dry A: Agitation L: Low-grade fever T: Thirst

main role potassium

helps muscles contract (including myocardium) "K+ing of action and contraction"

normal range for potassium

3.5-5.0 (a 5k is 3.5 miles)

overuse of _____ may result in hypokalemia

diuretics like furosemide (NOT potassium sparing diuretics)

potassium and ____ have in inverse relationship

sodium

how would Cushing's Syndrome contribute to hypokalemia

Cushing's = ^^ cortisol = ^^ Na+ = LOW K+ (inverse K+ and Na+)

how would hyperinsulinism contribute to hypokalemia

insulin moves K+ from ECF to ICF (lowers serum levels)

L's of hypokalemia (s/s) Low K+ = Less contraction (weak muscles)

Lethargy Leg cramps Limp muscles Low, shallow respirations Lethal cardiac arrhythmias Lots of urine

excessive urination

polyuria

a pt with hypokalemia will have an EKG showing a

flattened T wave

a nurse treating a patient with hypokalemia shouls administer a potassium supplement through this route if possible

orally if possible

should a nurse administer a potassium IV bolus?

NEVER - high risk of cardiac arrest

2 classes of medications that can contribute to hyperkalemia

ACE inhibitors Potassium-sparing diuretics

How does diabetic Ketoacidosis (DKA) contribute to hyperkalemia?

There is an insulin deficiency = no K+ being brought into cells

s/s hyperkalemia "MURDER" ^^K+ = tight and contracted muscles

M: Muscle cramps U: Urine abnormalities (oliguria) R: Respiratory distress D: Decreased cardiac contractility (low HR and BP) E: EKG (tall, peaked T-waves) R: Reflexes (decreased deep tendon reflexes)

a patient with hyperkalemia will have an EKG showing

Tall, peaked T-waves

avoid using _____ in a patient with hyperkalemia

salt substitutes - they are high in K+

when treating a patient with hyperkalemia with IV fluids, choose ones with ____ or _____

dextrose or regular insulin

this class of medication may be given to a patient with hyperkalemia to excrete excess K+ through the renal system

loop diuretics (furosemide)

this may be given to a patient with hyperkalemia to excrete excess K+ through the feces

Sodium polystyrene sulfonate (Kayexalate)

low urine output

oliguria

most abundant electrolyte in the body

calcium

this is required for calcium absorption

vitamin D

how does PTH regulate calcium

PTH increases calcium concentrations in the blood

how does calcitonin regulate calcium

calcitonin decreases calcium concentration in the blood by bringing it to the bones

normal range for calcium

8.5-10.5 (OR 9-11)

main function of calcium (3 strong B's)

Bones Beats (heart function) Blood (clotting)

most prevalent cause of hypocalcemia

renal failure

calcium and _____ move the same (similar s/s, move same direction generally, etc.)

magnesium

calcium works inversely with this electrolyte

phosphorus/phosphate

a patient with hypocalcemia will exhibit positive findings for ______ and ______

Trousseau's Chvostek's

carpal spasm caused by inflating a blood pressure cuff

Trousseau's sign

twitchy contraction of facial muscles with a light tap over the facial nerve

Chvostek's sign

s/s hypocalcemia "CATS go numb"

C: Convulsions/seizures A: Arrhythmias T: Tetany S: Spasms +Numbness in fingers, face, and limbs

this supplement may be given to a patient with hypocalcemia to increase calcium absorption

vitamin D supplements

encephalitis may be found at calcium levels greater than

>14

hypercalcemia may be life-threatening at levels

>15

an overactive _____ may contribute to hypercalcemia

PTH = increase calcium in blood

the use of this class of medication may result in hypercalcemia

thiazide diuretics (hydrochlorithiazide)

how does kidney disease contribute to hypercalcemia

diseased kidneys are unable to excrete excess calcium from the body

how does bone cancer contribute to hypercalcemia

bone breakdown from the metastatic cancer releases calcium to the bloodstream

which two medications can be given to lower calcium levels

phosphorous/phosphate calcitonin (decreases calcium conc. in blood)

kidney stones AKA

renal calculi

normal range for magnesium

1.3-2.1

main role of magnesium

keeps law and order in the muscles nerve conduction, muscle contraction/relaxation

magnesium can stimulate the

parathyroid gland to release PTH = regulate calcium (Mg and Ca work together!)

magnesium regularly resides _____ the cell

inside the cell

magnesium acts like a

sedative think "calm and sedated"

magnesium and ____ rise and fall together!

magnesium and calcium

malabsorption through ____ or _____ may contribute to hypomagnesemia

celiac disease crohn's disease

s/s with hypomagnesemia are mainly

HIGH and NOT SEDATED!

3 main s/s with hypomagnesemia

muscle tetany positive Trousseau's positive Chvostek's

s/s with hypermagnesemia are mainly

LOW and SEDATED

normal urine output for adults is

at least 0.5 mL/kg/hour

acid-base blood pH range

7.25 - 7.35

when oxygen levels in the blood are low, this is released by the kidneys

erythropoietin

in response to low BP, this is released by the kidneys

renin (begins RAAS)

Sodium think

BRAIN =sodium imbalances can lead to neuro changes

Potassium think

HEART =potassium imbalances can cause cardiac dysrhythmias

Calcium think

BONES =calcium imbalances can lead to an increased risk for pathologic fractures

Magnesium think

CALM and SEDATED =magnesium acts like a sedative

3 lab assessments related to kidney function

BUN Cr (creatinine) GFR

slow, progressive, irreversible decrease in kidney function

chronic kidney disease (CKD)

____ or ____ can maintain life, but neither is a cure for CKD

dialysis or kidney transplantation

2 main risk factors for CKD

diabetes mellitus HTN

GFR of stage 1 CKD

>90 mL/min

GFR of stage 2 CKD

60-89 mL/min

GFR of stage 3a CKD

45-59 mL/min

GFR of stage 3b CKD

30-44 mL/min

GFR of stage 4 CKD

15-29 mL/min

GFR of stage 5 CKD

<15 mL/min

dialysis and renal transplant is considered at this stage of CKD

stage 4

edema in CKD is the result of

fluid retention as the kidneys are not filtering fluids

as substances accumulate in the body as a result of CKDm which 3 renal lab findings are expected

^ BUN ^ Creatinine LOW GFR

3 expected urinalysis findings for someone with CKD

proteinuria hematuria WBC's

HTN in CKD is due to

- sodium retention - RAAS (low GFR is read as low BP by JG cells, beings RAAS)

2 electrolyte imbalances to watch for in a patient with CKD

hyperkalemia hyperphosphatemia

in CKD, the loss of erythropoietin results in low Hct and Hgb - this results in

anemia

a patient in this stage of CKD is a candidate for dialysis

stage 5

role of digoxin in treating CKD

increases contractility and promotes cardiac output

role of sodium polystyrene (Kayexalate) in treating CKD

increases elimination of potassium

role of Epoetin alfa in treating CKD

stimulates production of RBC's

role of ferrous sulfate in treating CKD

iron supplement

role of calcium carbonate in treating CKD

binds phosphate in food and stops its absorption

role of furosemide (loop diuretics) in treating CKD

excrete excess fluids

process where the dialyzer is used to process blood outside the body using a vascular access point

hemodialysis

how often is hemodialysis performed

2-3 times per week

process using the peritoneum to act as a natural filter to cleanse the blood

peritoneal dialysis

prior to hemodialysis, staff should assess fistula or graft for a

thrill/vibration

to assess fluid status of a patient undergoing dialysis, this should be taken

daily weight and vital signs

main concern with peritoneal dialysis

peritonitis - infection of the inside lining of the abdomen

the primary role of the nurse in the care of peritoneal dialysis clients is

facilitator

Foods high in sodium

Anything processed!

Foods high in potassium "PB BAN"

P: Potatoes B: Bananas B: Beans A: Avocados N: Nuts

Foods high in calcium "MILK"

M: Milk I: Ice cream L: Leafy greens K: Kale

Foods high in magnesium "BAGS"

B: Bananas A: Avocados G: Green leafy vegetables S: Seeds

Exam 4: Units 7 and 8 Flashcards

(244 cards)