Immune System Flashcards
(119 cards)
1
Q
skin layers
A
- epidermis - outer
- dermis - 2nd layer, bulk of skin
- subcutaneous - attaches skin to underlying structures
2
Q
chemical mediators to cell injury
A
chem in the plasma that is activated by cell injury is called Hageman Factor (XII)
3
Q
Hageman Factor activates what?
A
- Kinin system
- Clotting cascade
- Plasminogen system - starts dissolution of clots
4
Q
Kinin system and role
A
Bradykinin role -
- local vasodilation
- stimulate nerve endings to cause pain
- causes release of arachidonic acid - > release of autocoids
5
Q
types of autocoids
A
- prostaglandins - stim or block inflammation
- leukotrienes - can cause vasodilation, increased capillary permeability. can also block these reactions
- thromboxanes - cause local vasoconstriction and facilitate platelet aggregation and blood coag
6
Q
order of inflammatory process
A
- rubor - red; increased blood flow (vasodilation)
- tumor - swelling; fluid leaks into tissues
- calor - heat
- dolor - pain; activated pain fibers
7
Q
tx for bee sting
A
ice
scrape out stinger
antihistamine if necessary (benedryl)
8
Q
tx for twisted ankle
A
R - rest
I - ice
C - compression
E - elevation
9
Q
tx for injection site
A
ice
10
Q
Bone marrow function
A
produces stem cell -> myelocytes, lymphocytes (both WBC)
myelocytes -> inflammatory and immune response
lymphocytes - T (mature in thymus - cell mediated) and B cells (bone - humoral)
11
Q
types of myeloid stem cells
A
granulocytes
monocytes
12
Q
types of granulocytes
A
neutrophils
mast cells
basophils
eosinophils
13
Q
types of monocytes
A
macrocytes = macrophages
14
Q
neutrophils action
A
60% of WBC
first to arrive, increase during infection (shift to L) - band cells increase
patrols tissues - squeeze out of capillaries
# increases during infection
short lived after phagocytosis
dead neutrophils make up pus
15
Q
basophils action
A
circulation
emit chem substance to initial and maintain immune inflammatory response - histamine and heparin
16
Q
mast cell action
A
incapable of circulation
found in resp, GI, skin
release chem mediator to stim inflammation and immune response
17
Q
macrophage character
A
larger than neutrophil
found in organs
made in bone marrow (monocytes), called macrophage when enter organ
long lived
initiate immune response as they DISPLAY ANTIGENS from pathogens
18
Q
antigen
A
substance with protein coat that causes immune system to produce antibodies
may be foreign substance
may be formed within body (bacterial toxins of tissue cells)
19
Q
lymphocyte products
A
T lymphocytes - helper T 4, suppressor T8, cytotoxic T cells
B lymphocytes - plasma cells and memory cells
20
Q
where is stem cell found
A
bone marrow
21
Q
where do B cells go after they mature
A
lymph nodes and spleen, also circulate in blood
22
Q
what is the purpose of t and b cells in circulation
A
come into contact with pathogens and each other
23
Q
when are helper T cells activated.
A
activated when they recognize an antigen for example macrophage membrane or infected cell
24
Q
what do t helper cells secrete
A
cytokines
25
what is action of T helper cells
secrete cytokine to help B cells divide and stimulate macrophages.
26
action of cytotoxic T cells (CD 8)
aka killer T cells
| kills body cells displaying antigen
27
action of T suppressor cells
suppresses immune system
28
action of memory T cells
remains in body. faster immune response when recognizes antigen again
29
function of plasma cells (B)
produce antibodies (Ig)
30
Memory Cells action
divide rapidly as soon as antigen is reintroduced
| pathogen can be destroyed before symptoms show
31
factors that affect immune system negatively
```
stress
anxiety
fear
social isolation
lifestyle choices
```
32
action of salicylates
inhibit synthesis of prostaglandins
| ie: ASA
33
NSAIDS action
blocks COX 1 and COX 2 (enzymes)
| inhibits synthesis of prostaglandins
34
steroidal anti inflammatory agents
prednisone (deltasone)
35
Key components of protection
1. skin, mucous - 1st line of defense
2. bone marrow - WBC
3. Lymphoid tissue - fight pathogens. includes tonsils
4. chem mediators - triggered by inflammatory reaction
5. Interleukins 1 - regulate growth and differentiation of lymphocytes
36
Aspirin properties
antipyretic
anti inflammatory
anticoag
analgesic
37
s/e of aspirin
```
GI upset/ulcer
Prolonged bleeding
anemia - Hb 14g/dl
hemorrhage
ototoxicity (tinnitus)
```
38
nursing interventions for aspirin
```
DO NOT GIVE before surgery
give with food/milk
monitor for bleeding
monitor Lv fx
prevent injury
DO NOT GIVE WITH OTHER FOOD DRUGS THAT PROLONG BLEEDING
```
39
with whom should you never use aspirin
children with viral infections (reyes syndrome)
clients with LV dysfx
clients in last trimester of pregnancy
40
NSAIDS Ibuprofen (Advil) actions
decrease inflammatory response without interfering with immune response of body's ability to fight infection
for mild to mod pain mgmt - RA, OA, gouty arthritis
dysmenorrhea
41
Advil interventions
Give with food - aggravates St lining
42
Gouty arthritis
deposits of needle like crystal of uric acid.
inflammation begins in big toe
tends to be chronic
43
what is action of celecoxib (celebrex)
inhibits synthesis of prostaglandins - blocks COX 1 COX 2 enzymes
44
name 2 propionic acids
feneprofen
| ibuprofen
45
name 3 acetic acids
diclofenac
etodolac
indomethacin - used for gout
46
fenamates (1)
mefenamic acid
47
c/i for NSAIDS
```
presence of allergy to NSAID or salicylate
CV dysfx or HTN
peptic ulcer or known GI bleeding
pregnancy, lactation
Caution with LV KD dysfx
```
48
indications for NSAIDS
s/s/ RA OA
mild to mod pain
primary dymenorrhea
fever reducer
49
NSAID a/r
GI upset
n/v, diarr
LV dysfx - prolonged bleeding
50
consideration for advil
give with food, milk
monitor for effectiveness
monitor LFT's - ALT, Ast, alkaline phosphotase, bilirubin, PT/ PTT
51
uricosurics are for?
tx gout
52
how does uricosuric work?
decrease reabsorption of and enhances excretion of uric acid
53
examples of uricosurics
allopurinol/zyloprim - chronic gout
colchicine - acute gout
probenecid
54
s/e of anti gout meds
altered urine pH -> more alkaline -> kd stone
| diarrhea - f/e imbalance, impaired skin integrity
55
nursing consideration for uricosurics
monitor uric acid level
encourage fluids unless c/i
teach client avoid high purine foods
56
which type of foods have purines
organ meat
shellfish
sardines
57
prednisone (deltasone) is an example of?
steroidal anti inflammatory
58
actions of steroidal anti inflammatory
used to decrease the inflammatory response and or suppress the immune system
59
indications for steroidal anti inflammatory
head trauma
asthma mgmt
addison's disease (deficient glucocorticoids)
organ transplant patients
60
s/e of prednisone
```
immunosuppressant - masks infection
increased appetite
weight gain
hyperglycemia
elevated BP
GI upset/ulcer
buffalo hump
moon face
Hirsutism
```
61
define hirsutism
hairy face and body esp in women
62
examples of steroid anti inflammatory agents
```
prednisone
decadron
solumedrol
solucortef
cortisone
```
63
consideration for prednisone
```
give at same time q day
give with food/milk
monitor bs
monitor for infection
do not d/c abruptly - taper
```
64
acetaminophen(tylenol) actions
acts directly on thermoregulatory cells of hypothalamus
thought to inhibit prostaglandin synthesis
used to treat pain and fever assoc with variety of conditions including flu.
prophylaxis of children getting DPT immunization
relieves musculoskeletal pain assoc with arthritis
65
examples of anti inflammatory agents
tylenol
gold compounds
anti arthritis drugs - solganal
66
peak time for tylenol
.5- 2 hours
67
tylenol a/r
h/a, hemolytic anemia, Kd dysfx, skin rash, fever, hepatotoxicity, increased bleeding
interactions - oral anticoags increase bleeding
68
action of gold compounds, indications
absorbed by macrophages, resulting in inhibition of phagocytosis
decreased tissue destruction
69
how long do gold compounds take to be effective
3-6 months
70
c/i for gold compounds
| a/r and interactions
c/i - allergy, diabetes, CHF, Kd Lv impairment
a/r - stomatitis, glossitis, gingivitis, bone marrow depression, dermatitis
interaction - penicillamine, antimalarials, cytotoxic drugs, immunosuppressive agents
71
other antiarthritis drugs
aurothioglucose (solanal)
etanercept (enbrel)
anakinra (kineret)
off label - choroquine (aralen) - antimalarial - used for long term RA; notify MD Of blurring vision
72
vaccine types
1. microbes that have been killed
2. microbes hat are alive but weak
3. bacterial toxins called toxoids modified to remove hazards
73
titer
presence of an antibody
| measure to assess effectiveness of vaccines
74
active immunity
immune system stimulated to produce antibodies due to exposure to antigen (vaccine)
75
passive immunity
obtained by directly administering antibodies to patient
| is only temporary
76
natural immunity
active - result of infection
| passive - transfer from mom to baby
77
artificial immunity
active - result of vaccine
| passive - injection of serum with antibodies
78
indications for vaccines
stim active immunity in people who are at risk
depends of exposure the person will have to pathogens
thought to provide lifelong immunity - sometimes needs booster
79
c/i for vaccines
```
immune deficiency
pregnancy
allergies to any part of vaccine
pt who received Ig or blood or blood products w/i last 3 months
presence of infection and fever
```
80
a/r of vaccines
fever, rash, malaise, chills, fretfullness, drowsiness, anorexia, vomiting, PAIN RED SWELLING AT INJECTION SITE
81
education for vaccines for adults
pneumonia x1 - can get booster if
82
immune sera definition
sera that contain antibodies to specific bacteria or viruses
83
types of immune sera
antitoxin
antivenom
spider or snake bites
84
indications for immune sera and toxins
provide passive immunity to a specific antigen or disease
used a prophylaxis against specific disease after exposure
may lessen the severity of disease
85
caution with immune sera and antitoxins
```
hx of severe rxn to any immune sera
cautions:
preg
coag defects
previous exposure to immune sera
rash
n/v
chills fever
```
86
allergic reaction to immune sera/ antitoxin
chest tightness, decreased BP, difficulty breathing
local reaction - swelling, tenderness, pain, musc stiff at site
monitor client >1 hr after injection
87
examples of impaired immune system
```
chronically ill - need immunizations
elderly - monitor infections, esp UTI
pt on immune suppressant therapy
pt on chemo
pt with disease that suppress immunity - HIV
```
88
immune stimulators - bio response modifiers action
used to energize the immune system when it is exhausted from fighting
prolonged invasion or needs
help fight specific pathogen or cancer cell
89
which cells help fight specific pathogen or cancer cell
interferons
interleukins
T/B/ modulators
90
immune suppressant actions
drugs used to block or suppress the actions of t cell and antibody production
used to prevent transplant rejection and treat autoimmune dz
91
which are used to prevent transplant rejection and tx autoimmune dz
t/b cell suppressors
monoclonal antibodies
steroids
92
types of immune modulators
interferons - act to prevent virus particles from replication
interleukins - stim immunity by increasing the activity of natural killer cells; aldesleukins (proleukin)
t/b cell modulators - ie: levamisole
93
action of t/b cell suppressors
block antibody production, inhibit suppressor and helper t cells
94
monoclonal antibody action
produced by a single clone of b cell that react with specific antigens
95
interferons definition
naturally occuring glycoproteins used for their ability to interfere with viral replication, suppress cell proliferation, enhance macrophage activity and increase cytotoxicity of lymphocytes for target cells
96
types of interferons
alfa - from leukocytes injected into wart
beta - from fibroblasts (connective tissue cells)
gamma - from fibroblasts and lymphocytes
97
action of interferon alfa 2b (intron A)
prevents virus particle from replicating inside other cells
stimulates interferon receptor sites on non invaded cells to produce antiviral proteins
inhibits tumor growth and replication
98
caution for interferon alfa
teratogenic
99
c/i for interferon alfa
| a/r
allergy, pregnancy, lactation
caution in cardiac, myelosuppression, CNS dysfx
a/r - lethargy, myalgia, arthalgia, anor, nausea, h/a, dizzy, bone marrow depression
100
interleukin definition
chemicals produced by t cells to communicate bet leukocytes (type of cytokine)
101
types of interleukin
aldesleukin (proleukin) - human, made by DNA tech using E Coli
Oprelvekin (neumeg) - newer
102
action indication of aldesleukin
increase # of natural killer cells and lymphocytes
activate cellular immunity and inhibit tumor growth
for specific Kd carcinoma and possible tx of AIDS and AIDS related disorder
103
indication for oprelvekin
prevention of severe thrombocytopenia after myelosuppressive chemo - stimulates growth of platelets
104
c/i for interleukin
known allergy to e coli products, pregnancy, lactation
caution with Kd Lv Ht impairment
a/r - lethargy, myalgia, arthalgia, fatigue, fever, resp difficulties, hypotension, bone marrow suppression
105
levmisole (ergamisol) action/indication
stimulates b cells to stim antibody formation, enhancing t cell activity
used for tx of duke's stage C colon cancer
peaks in 1.5-2 hrs. 1/2 life 16 hrs
106
c/i levamisole
a/r
interactions
allergy, pregnancy, lactation
use barrier protection
a/r - h/a dizzy, ataxia, n/v diarr
interaction - disulfiram type rxn, increased phenytoin level, ETOH
107
azathioprine action
prevents rejection in renal hemotransplants
| tx RA
108
cyclosporine action
suppresses rejection in variety of transplants
| tx RA and psoriasis
109
glatiramer acetate (copaxone) action
reduces # of relapses in MS adult pt
110
mycophenolate mofetil (cell cept) action
prevents rejection after Kd Ht transplant in adult
111
sirolimus (rapamune) action
prevents rejection after Kd transplant
112
Tacrolimus (Prograf) action
prevents rejection after LV transplant
113
cyclosporine
inhibits dna synthesis
c/i - allergy, preg, CNS & LV disease
interactions - monitor for toxicity due to multiple interactions
114
a/r cyclosporine
increased risk for infection and neoplasm development
LV toxicity
Kd toxicity and dysfx
Pulmonary edema
possible h/a, tremors, 2nd infections such as acne, GI upset, diarr, HTN
fatigue and flu like sx
115
interventions for cyclosporine
s/s of infection
teach pt avoid risk of infection (flowers, fresh fruit, raw febbies)
monitor i/o
teach about importance of LIFE LONG COMPLIANCY
116
anakinra (kineret) action
tx RA
block activity of interleukin 1
peak 3-7 hr
1/2 life 4-6
117
c/i for anakinra
a/r
interaction
allergy, preg, lact, Kd impairment
a/r - h/a, sinusitis, nausea, diarr
interaction - etanercept may cause severe, life threatening infection
118
muromonab CD3 (orthoklone OKT3) action
antibodies attach to specific receptors - antibody to T cells
119
c/i, a/r, interaction for muromonab CD3
c/i - allergy and fluid overload
a/r - pulm edema, fluid retention, flu like sx
interaction - severe immune suppression
