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NURS2500 Patho/Pharma > Week 9: Infection and Immunity > Flashcards

Week 9: Infection and Immunity Flashcards

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1
Q

what is immunity?

A

Protection from illness or disease that is maintained by the body’s physiologic defense mechanisms.

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2
Q

what is this describing? Protection from illness or disease that is maintained by the body’s physiologic defense mechanisms.

A

immunity

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3
Q

true or false: Immunity Protects body from attacks from foreign antigens
■ Microorganisms: Bacteria, viruses, parasites, fungi
■ Pollens
■ Food
■ Venom (spider, bee, snake)
■ Vaccines
■ Transfusions
■ Transplanted tissue/organs

A

all true

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4
Q

is immunity accomplished through actions of the immune system?

A

yes

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5
Q

select all that is true regarding organs in the immune system:
Lymphoid organs spread throughout body
- spleen, thymus gland, bone marrow, adenoids tonsils, appendix

Lymphocytes are formed, grow mature and are released

Makes up the lymphatic system that along with blood connects the organs

A

all true

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6
Q

what falls under myeloid progenitors? where are they derived from?

A

■ Neutrophils,
■ Monocytes
■ Eosinophils
■ Basophils
■ Mast cells
from stem cells in bone marrow

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7
Q

what falls under lymphoid progenitors?

A

■ B lymphocytes – Secrete antibodies
■ Mature T lymphocytes
■ Natural killer (T lymphocytes) cells

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8
Q

what is the scope of immunity?

A

supressed (infection - normal - exaggerated (allergy)

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9
Q

true or false: physical barriers are epithelial cells, mucous membranes, saliva/tears/mucus
Innate immunity:
granulocytes, monocytes, proinflammatory hormones
acquire immunity

b and t cells

A

true

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10
Q

what is innate immunity and acquired immunity?

A

innate: (also referred to as natural or native): present at birth (Inflammation)

acquired:protection gained after birth through either active or passive immunity

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11
Q

what is active and passive immunity?
is this under innate or acquired?

A

acquired
active: body MAKES antibodies
natural active: Antigen enters the body and the body creates
antibodies to fight off the antigen (day to day)
artificial: Vaccination or immunization

passive: body given antibodies
natural: Passed from mother to the fetus through placenta or colostrum or breast milk
artificial: Specific transfusion such as immunoglobulins

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12
Q

what do T cells and B cells become ?

A

T cells - t regulatory cell, cytotoxic T cell, Memory T cell

B cell: Th cell to Memory Cell or Plasma cell - antibodies

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13
Q

what is antibody humeral mediated - adaptive immunity?

A

B-lymphocytes produce antibodies & with the help of T Lymphocytes, generate interactions for antibodies to neutralize, eliminate or destroy foreign antigens

Plasma & Memory B cells

Responsible for body’s response to invading bacteria and viruses

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14
Q

what is step 1-3 for antibody mediated response?

A
  1. invasion of body by new antigens in sufficient numbers to stimulate an immune response
  2. interaction of macrophages and helper/induced T cell in the processing and presenting of the antigen to the unsensitized “virgin” B-lymphocyte (B)
  3. sensitization of virgin B-lymphocyte to new antigen
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15
Q

what is step 4-7 of antibody mediated response?

A
  1. antibody production by the B lymphocyte. these antibodies are directed specifically against initiating antigen. antibodies are released from B lymphocyte and lost freely in blood and other fluids
  2. antibodies bind to antigen forming immune complex
  3. antibody binding causes cellular events and attracts other leukocytes to the complex, the interaction of other leukocytes along with cellular events results in neutralization destruction or elimination of antigen.
  4. when antigen is re exposed the sensitized lymphocytes and their progeny produce large quantities of antibody specific to antigen. also new virgin B lymphocytes become sensitized to the antigen and also begin antibody production
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16
Q

what are the five types of antibodies or immunoglobulins?

A

IgG
IgD
IgM
IgA
IgE

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17
Q

select all that is true regarding antibodies -

they are secreted by B lymphocytes

IgG –Largest amount of circulating antibodies – heavily expressed on 2nd+ exposures to antigen

IgD – Acts as a B-cell antigen receptor

IgM –First antibody produced from plasma cell with 1st exposure/
immune response

IgA – Secretory antibody that is present in high concentrations in the secretions of mucous membranes and the intestinal mucosa. Prevents infection in the upper and lower respiratory tracts, GI tract, and GU tract.

IgE – Associated with hypersensitivity reactions - forms a receptor on masts cells and basophils and triggers histamine release during allergic reactions

A

all true

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18
Q

select all that is true under cellular mediated - adaptive immunity:
T-lymphocytes
Major role in regulating antibody mediated immunity and innate immunity

Cytotoxic T cells
Destroy self cells infected by parasites

Helper T cells (CD4cells) - 75% of all T -Lymphocytes
Recognize self cells versus non self cells. When non self is identified, they secrete cytokines that enhance WBC activity

Regulator T cells
Prevent hypersensitivity and over reactions on exposure to non self cells.This prevents formation of antibodies against normal cells (process in autoimmune diseases). They secrete cytokines and have an overall inhibitory action on most cells.

Natural Killers
* Seek and destroy for unhealthy/abnormal self cells such as cancer/virally infected

A

all true

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19
Q

what are the four hypersensitivity reactions

A

Type I- IgE mediated or Atopic (Allergic)
B Type II- Cytotoxic- autoantibodies: Blood transfusion errors
C Type III-Immune Complex-mediated deposits in tissue: Autoimmune disorders
D Type IV- Delayed hypersensitivity: Contact dermatitis, insect stings

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20
Q

what are some age related differences found in infection/immunity?

A

In utero
* Immature
Infancy and childhood
* Matures and is supported by exposure to antigens and vaccinations
Advancing age
* Immunity and response decline with age,
* Diminished immune response and more serious complications * Lessened efficacy of vaccination
* Increased prevalence of autoimmune diseases

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21
Q

what are some risk factors for changes in immunity?

A

Age: Infants & elderly
Environmental exposure
Non-immunized
Chronic illness
Chronic drug therapy (corticosteroids, chemotherapy drugs)
Gender/Race/Ethnicity
High Risk Behaviors/Substance Abuse Genetics

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22
Q

what are some assessments done for infection/immunity?

A

■ History
Clinical findings
■ Suppressed Immune Function
■ Normal or abnormal VS
■ Weight loss
■ Generalized fatigue/malaise
■ Impaired wound healing
■ Opportunistic infections
■ Change in cognition or depression
Exaggerated Immune Function
■ Mild to severe
■ Normal to abnormal VS
Sneezing, watery eyes, nasal congestion to rashes, swelling, shock syndrome
Autoimmune disorders are often vague

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23
Q

what are some assessments done for infection/immunity?

A

Diagnostic Tests
■ Primary Tests
■ RBC, WBC
Screening Tests
■ C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)
Allergy Testing
■ Skin Test
■ Allergen-specific Immunoglobulin (IgE) blood test
■ Disease specific Testing

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24
Q

what falls under primary prevention, secondary prevention and collaborative intervention?

A

primary:
Vaccination
* Modify risk factors

Secondary:
Screening

Collaborative Intervention:
Suppressed
* Infection
* Gastrointestinal dysfunction: treatment of diarrhea, candidiasis, fluid and electrolyte balance * Skin disorders: treatment of skin rash
* Nutrition: Vitamins and supplements
* Exaggerated
* Immunosuppression
* Corticosteroids, Chemotherapy, NSAIDs
* Pain Management
* NSAIDs, corticosteroids
* Anaphylaxis

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25
what is a general definition of vaccination?
Introduction of foreign antigens to trigger immune response, allowing immune system to react more effectively the next time it is exposed to antigen
26
select all that is true regarding vaccinations? Effective vaccination, to confer long-term immunity to a disease, sometimes requires “boosters” or follow-up doses ■ Bacterial or Viral Vaccines -Killed vs Live Attenuated ■ Common adverse effects of vaccines - Redness, swelling at site of injection - Soreness, tenderness at site of injection - Fever ■ Contraindications - Immunocompromised patients – patients are unable to produce an active immune response - History or allergy/anaphylactic response to vaccine components (preservatives etc.) - Pregnancy – only inactivated vaccines are suitable during pregnancy
all true
27
Exaggerated immune response exemplar : allergic reaction Steps in a type I allergic reaction. GI, gastrointestinal ; IgE, immunoglobulin E.
B cell - The first time a person is exposed to an allergen Plasma cell - a large amount of IgE antibody is made Mast cell - These antibodies attach to mast cells Mast cell - The next time the person is exposed to allergen, it binds to the IgE antibodies that are attached to the mast cells. This triggers the release of chemical mediators from the mast cell
28
under these chemical mediators define the allergy reactions they may show: ( clinical manifestations of Type 1 hypersensitivity =reaction ) Intravascular compartment : skin: respiratory system : GI system :
Intravascular compartment : Anaphylactic shock skin: atopic dermatitis wheal- and- flare reaction angioedema respiratory system : rhinitis asthma GI system : nausea vomitting cramping pain diarrhea
29
Define if this is a true statement regarding anaphylaxis : conditions in which type 1 hypersensitivity reaction involves of all blood vessels and bronchiolar smooth muscle causing widespread blood vessel dilation, increased cardiac output, and bronchoconstriction within seconds to minutes after allergen exposure this is life threatening
false, everything else is true except increased cardiac output ( it decreases )
30
what could be occurring in anaphylaxis in : neurological skin respiratory cardiovascular gastro-intestinal
neurological : - headache -dizziness -paresthesia -feeling of impending doom Skin: -pruiritus -angioedema -erythema -urticaria Respiratory -coughing sensation of narrowed airway -wheezing -dyspnea, tachypnea -reparitory arrest -hoarseness Cardiovascular -hypotension -dysrhythmias -tachycardia -cardiac arrest Gastro intestinal -cramping,abdominal pain -nausea, vomitting, -diarrhea
31
Management of exaggerated immune response ( name the characteristics and the things we utilized) Anaphylaxis specific general allergic reaction
Anaphylaxis specific support airway , breathing, circulation epinephrine bronchodilators circulatory support ( blood pressure control) general allergic reaction immunosuppression pharmacotherapy corticosteroids nsaids
32
what connects with infections ( the concepts )
tissue integrity nutrition immunity stress inflammation
33
This is categorized by type of pathogen ( bacterial - viral - fungal- protozoa/parasitic ) along with mode of transmission, trajectory of illness, and body systems affected
infection
34
Location of infection can be what ?
localized or systemic and limited to specific area on the body - would be localized systemic - affect the entire body and can cause sepsis ( life threatening response of the body to infection and widespread inflammation )
35
infection can be acute or chronic , go more in depth on what this could mean in terms of infection
acute : lasting a few days or weeks chronic : typically longer than 12 weeks or uncurable
36
True or false. Infection can be communicable or non communicable. Example : influenza or peritonitis
true
37
what does communicable and non communicable mean ?
communicable - this is infectious such as tuberculosis non communicable- chronic disease such as a heart disease or cancer
38
name the different types of infections that can occur :
bacterial infections viral infections fungal infections parasitic or protozoa infections
39
what are the categories for infection process ?
HOST environment pathogen
40
name what undergoes infection process : Host Environment Pathogen
Host - acute illness -mechanical barriers -fever -phagocytes -stress -chronic illness Environment -sanitation -water quality -crowded living conditions -weather -air quality -seasons Pathogen -spore formation -pili -enzymes -flagella -slime layer -adhesions -encapsulations
41
Stages of infectious diseases
incubation prodromal illness convalescence
42
what does these terms mean ? incubation prodromal illness convalescence
incubation = entrance of pathogen, appearance of symptoms prodromal = onset of nonspecific symptoms to more specific symptoms ( spread risk) illness= patient manifests symptoms specific to the type of infection ( peak ) convalescence- acute symptoms disappear and body returns to the homeostasis, recovery occurs
43
risk factors for infection: ( think back to risk factors for impaired immunity)
natural immunity : congenital or acquired immune deficiencies ( suppressed)- chronic disease normal flora : alteration by antibiotic therapy age : infants and older adults hormonal factors : DM< steroids, adrenal insufficiency, stress
44
risk factors for infection : select all that is true ( think back to risk factors for impaired immunity) phagocytosis : neutropenia skin, mucus membranes : break in skin nutrition : malnutrition or dehydration environmental factors : tobacco or alcohol, inhalation of toxins medical interventions : endoscopy, catheters, lvs, steroids
all the above
45
what type of assessments are we utilizing or infection ?
history physical examination : local vs systemic signs diagnostic testing 1. laboratory tests 2.radiographic tests
46
why would we want to do a radiographic tests when assessing a patient with an infection?
help visualize certain body tissues to gain insight into the possibility of infection ( CXR/ABX, CT, MRI )
47
define the clinical manifestations of local infection
1) signs of inflammation : redness, pain, heat, swelling 2) exudate may be present 3) lymphadenopathy ( swollen and tender lymph nodes)
48
Clinical manifestations of systemic
fever fatigue headache anorexia and nausea malaise and myalgia ( ie. joint and muscle pain )
49
what is organ specific ( systemic signs) clinical manifestations
1. GI : vomiting or diarrhea 2. Resp: sneezing, coughing and difficulty breathing 3. GU : painful urination, frequency in urination
50
True or false. Infections that are severe, poorly responsive to therapy or untreated can lead from systemic infections also called as a what ? to multi system organ failure ( MSOF), also known as what ?
sepsis septic shock
51
clinical manifestations for infections that are severe are :
hypotension tachycardia tachypnea oliguria or anuria hypoxia hypercapnia seizures or coma
52
Lab values for infection : biochemistry what are we examining?
sodium - dehydration potassium- GI infection ( diarrhea/vomiting) creatinine- perfusion to kidneys ( hypovolemia) lactate ( sign of sepsis/msof)
53
what undergoes lab values for infection complete blood count
white blood cell count - elevated B and T lymphocytes, neutrophils, monocytes= bacterial or viral -elevate basophils/eosinophils = parasitic
54
what undergoes culture and sensitive in lab values for infection
urine,sputum, throat, blood, wounds, spinal fluid and equipment
55
What other lab values do we look for infection
ESR antibody tests : hepatitis, HIV
56
Methods of infection control and prevention
hand hygiene standard precautions transmission-based precautions - isolation precautions contact -mrsa -c.difficile droplet covid 19 airborne -tb
57
WE have to do this every single time we have a blood exposure, urine exposure, we have to protect ourselves regardless of what the patient has , what precaution are we using?
hand hygience
58
name the example we discussed in class for contact vs indirect contanct in terms of getting an infection
contact-= shaking someone hand indirect contact- taking a pen , and pen being contaminated
59
this is a larger molecule, travel about 3 feet ( can be contaminated by sneezing, or coughing ) what type of transmission is thibs?
droplet
60
smaller molecule ( last in the air for a long amount of time ) what type of transmission is this?
airborne
61
what are the different collaborative interventions we can utilize when we are dealing with a patient who happens to have an infection?
antimicrobial drug therapy fluids and electrolytes rest nutrition managing fever - treat cause
62
what would you do if a patient has an infection and we are using collaborative intervention as a approach ? ( hyperthermic and hypothermic patient )
if hyperthermic --> cooling ice packs, sponge bath, cooling blankets remove clothing antipyretics - may ask the fever therefore unless patient is uncomfortable, antipyretics not necessary all the time
63
infection control and prevention is a necessity in order to prevent infection
true
64
This is a late sign of an immunocompromise patients
hypothermic
65
Can these events occur within the infections of the following : skin infection - if you have a skin infection, you can no longer take care of themselves ( requires more assistance ) bacteremia - this is in your blood ( going more internal and systemic) cardiac output is going to change sepsis/msof/septic shock- not treating the patients with the right antibiotics , this circumstance can happen frequently
all the above is true
66
what type of infection do you suspect ? pus redness and red streaks around the cut ?
local infection
67
what type of medication can we take for an infection ?
antibacterial antiviral anti-fungal anti microbial ( antibiotic ) therapy
68
antibacterial therapy can be ....?
narrow or broad
69
classification of antimicrobial drugs susceptible organism can be...?
narrow spectrum : active against a few specific organisms broad spectrum : active against a wide variety of organisms
70
Classification of antimicrobial drugs mechanism of action , define if all is true : inhibit bacterial cell wall synthesis or activate enzymes that disrupt cell wall decrease cell membrane permeability causes non lethal inhibition of protein synthesis called bactericidal causes lethal inhibition of bacterial protein synthesis called bacteriostatic
true false ( it increases ) this is not bactericidal however it is a bacteriostatic this is not bacteriostatic however it is a bactericidal
71
Recall : Classification of antimicrobial drugs mechanism of action inhibit bacterial cell wall synthesis or activate enzymes that disrupt cell wall increases cell membrane permeability causes lethal inhibition of protein synthesis called bactericidal causes non lethal inhibition of bacterial protein synthesis called bacteriostatic what else can they perform ?
suppresses viral replication antimetabolites inhibit bacterial synthesis of DNA and RNA or disrupt DNA function
72
this is treating a bunch of different things ?
broad spectrum
73
this is treating what we want to achieve ( specific bacteria)
narrow spectrum
74
Special consideration : empiric and prophylactic therapy define what undergoes empiric
identify microorganism and drug it is susceptible to ( goal is narrow spectrum drugs ) broad spectrum used in emergency situations, however C & S must be collected prior to treatment ( culture and sensitivity )
75
Special consideration : empiric and prophylactic therapy define what undergoes prophylactic therapy
surgery bacterial endocarditis neutropenia other ( chronic issues)
76
before giving them this kind of therapy we have to give them a lot of antibiotics ( such as going into surgery ) recall : this is to prevent disease
prophylactic
77
this is a difficult infection ( must give them antibiotics before ) they are at risk for life threatening conditions, inflammation occurs in the lining of the heart chambers and heart valves.
bacterial endocarditis
78
what are the factors that modify drug of choice, route, or dosage
host defenses site of infection other ( such as allergic reaction )
79
A well functioning immune system works together with antimicrobial treatment in order to cure infection immunocompromised hosts require more rapid bactericidal which one of the factors that modify drug of choice, route or dosage
this undergoes host defenses
80
Factors that modify drug of choice, route, or dosage what undergoes site of infection
blood brain barrier foreign material ( prosthetics)
81
recall blood brain barrier what type of pharmacology concepts would you utilize
it would be a lipid soluble ( non ionize) drug therpahy
82
true or false. You can give an antibacterial therapy to a virus infection
false, you cannot
83
Define if these are true : misuse : treatment of viral infection - mumps, chicken pox, common cold do not respond to antimicrobials Improper dosage improper identification of organism improper cleansing of foreign material/exudate/necrosis
all true
84
Misuse of medication treatment of fever of unknown origin what is the only consideration we should utilize?
only consideration is in immunocompromised host
85
If we have a wound that is extremely infected ( we need a lot of care ) --> cannot leave wounds to expect it to be healed
true
86
antimicrobial resistance we must consider misuse factors along with nonadherance to completion of treatment
true
87
true or false.Antimicrobial resistance : organisms becomes less susceptible or sensitive to drug ( often from narrow spectrum )
this is false, it'ss usually often from broad spectrum
88
true or false.Patient responding to treatment is a sign that it is leading to complications. This could be an example of antimicrobial resistance.
false, patient usually does not respond to treatment leading to complications
89
true or false. antimicrobial resistance hospitals are sites of intensive antibiotic use : hospital associated infections are high
true
90
what is superinfections that undergoes antimicrobial resistance?
new infection that appears during the course of treatment for a primary infection - antibiotics eliminate normal flora allowing second infectious agent to flourish ( oral flush )
91
are the most common multi-drug resistant organisms ?
MRSA, C.difficile
92
Select all the antibacterials penincilins cephalosporins aminoglycosides tetracyclines macrolides sulfonamides fluroquinolones
all is true
93
DRUG CARD : PENICILLINS : PENICILLIN G ( this is a bactericidal and most common drug allergy )
MOA : weaken cell wall causing bacteria to take up excessive amounts of water and rupture broad and narrow spectrum side effects : super infections ( C.Diff) , nausea, vomiting, abdominal cramping contraindications : allergy, renal impairment, drug interactions with aminoglycosdies nursing considerations : assess allergies monitor kidney function ( creatinine and urine output) instruct to take full prescribed treatment ( drug resistance ) evaluate effects ( reduction in fever/pain inflammation )
94
DRUG CARD : CEPHALOSPORINS : CEFAZOLIN ( ANCEF)
MOA :bactericidal broad spectrum 5 generations ( classes ) with respect to antimicrobial spectrum contraindications - allergies ( 1% of penicillin allergies react to cephalosporins ), b bleeding disorder caution with anticoagulants/thrombolytics/antiplatelets/nsaid side effects : bleeding ( reduce prothrombin levels, ) superinfections ( C.diff) , diarrhea, abdominal cramping, alcohol intolerance nursing considerations : assess for allergies or history of bleeding disorders monitor INR instruct on no alcohol intake instruct to take full prescribed treatment ( drug resistance ) evaluate effects
95
DRUG CRAD : TETRACYCLINES : DOXYCYCLINE (very sensitive to light, protein synthesis inhibitors, often used for acne )
MOA : suppress bacterial growth ( bacteriostatic) broad spectrum side effects : epigastric burning, cramps, nausea, vomitting, diarrhea, superinfections ( C.diff/candida) teeth discoloration( binds to calcium ) hypoplasia of enamel hepatotoxicity photosensivity bleeding contrainidcations : under 8 years, liver or renal impairment , drug interactions with digoxin/anticoagulants/oral contraceptives, avoid mil products, calcium and iron supplements, magnesium,laxatives/antacids nursing considerations : assess allergies administer 1 hr before or 2 hrs ingestion of milk/supplments monitor creatinen/lfts/inr intrusct to take full prescirbe treatment ( drug resistance) evaluate effects ( reduction in fever /pain inflmmation )

NURS2500 Patho/Pharma (16 decks)

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