immunologic_disorders_chapter_31_and_32

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Quiz 12: Immunologic disorders Chapter 31 and 32 Function of the immune system: Body’s defense network against infection Recognizes, isolates and destroys pathogen. Anatomy and physiology of the immune system: Bone marrow Where are the WBCs primarily produced?> -produces red blood cells, white blood cells, platelets. -spongy center of the bones where the white blood (WBCs) are made. - WBC are produced primarily in the vertebrae, ribs, sternum, pelvis and long bones of the legs. Stem cells -aka progenitor cells -aka precursor cells -develop into WBC’s, RBCs, and platelets -located in the bone marrow and some circulate in the blood White blood cells (leukocytes) What occurs if dead WBCs build up faster than the - identify and destroy foreign antigens or proteins by ingesting them -life span is few hours to a few days If the dead WBC build up faster than the macrophages can the -pus forms
macrophages can clean them up? Types of wbcs function eosinophils -combat parasitic infections -associated w/ allergic reactions and other inflammatory processes. basophils -initiates a massive inflammatory response that quickly brings other WBCs to the site of infection -Work in conjunction with immunoglobulin (Ig) E who identifies a foreign antigen, and triggers basophils to release histamine from cell vesicles located in the basophils -Histamine is a potent vasodilator that increases blood circulation to the site quickly bringing other WBCs to the site of infection -found inside the cell when the basophils release histamine 2 things can occur: it can cause bronchoconstriction and vasodilation Mast cells: -store histamine in cell vesicles that can be released by IgE -has the same function as the basophils B lymphocytes responsible to - Manufacture antigen binding proteins called Immunoglobin on their cell membrane -When B cells Ig binds with an antigen, the B cells
produce antibodies. produce plasma and memory is stimulated to produce plasma cells and memory B cells -Plasma cells are antibody factories that produce large amounts of Ig -Memory B cells go into resting state but can be quickly reactivated to produce plasma cells and antibodies if exposed to the same antigen in the future -If the Ig is released either from B cells or plasma cells, it is called antibody. -can release the antibodies to fight infections neutrophils - fight bacterial infections -most abundant WBC -destroyed during phagocytosis t lymphocytes is made up of helper cells and cytotoxic cells= kill helper cells call on the other components of the immune system helper cells are the one greatly being attacked during an HIV infection -helper cells (CD4) secrete cytokines; the role of the cytokines is to call the rest of the immune system letting it know there is an infection. The helper cells call out the messenger the rest of the components in the immune system to go into that site and order to kill that microorganism. - Helper cells (CD4) - once they come in contact with foreign antigens, they secrete cytokines that activate the other components of the immune system to facilitate the body’s immune response; cells that are infected with HIV Cytotoxic cells (CD8); when come in contact with foreign antigens, they can directly destroy the invader.
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HIV loves to attack the helper cells Cytokines -a hormone that is secreted by the helper cells to signal other cells to go into site to take care of a foreign antigen - Examples of cytokines are interferon, interlukin, tumor necrosis factor, granulocyte macrophage colony-stimulating factor, granulocyte colony- stimulated factor and erythropoietin Thymus gland -located on the anterior area specifically on the upper chest below the thyroid. -lymphocytes (WBC) migrate from the bone marrow and go into the thymus gland once in the thymus gland the role of the thymus gland is to make the lymphocytes mature. -after puberty the T cells are enough for the entire life of this individual already so the amount of T cells has already maxed out so therefore the thymus gland knows its done with its job already produced enough of T cells for the person to use for their entire life so what happens to the thymus gland? It shrinks. Lymph, lymphatic, lymph nodes -When blood flows through the capillary bed to deliver oxygen and pick up carbon dioxide, not all the plasma returns to the veins to be recirculated -Lymphatic system is a network that collects the plasma left behind in the tissues and returns it to the venous system -Mixture of plasma and cells is called the lymph
fluid which is propelled along the lymphatic system by the normal contraction of skeletal muscles -One way valve in the lymphatic vessels prevent the lymph fluid from pooling in the periphery -Lymphatic vessels empty into the venous system through the right lymphatic duct of the right subclavian vein & the thoracic duct of the left subclavian vein - Lymphatic vessels can be damaged during surgery or following radiation therapy therefore, lymph fluid can build up in the tissues distal to the affected area resulting in lymphedema of the extremity -Lymph nodes are small patches of lymphatic tissue that filter microorganisms from the lymph fluid before it is returned to the blood stream -Lymph nodes are found in the cervical, axillary, inguinal (palpable) and intestinal (cannot be palpated but can be visualized on CT if they are larger than 2 cm) -Lymph nodes become swollen with infection and cancer -Lymph biopsy -vessel can be damaged if a patient goes under chemo or radiation
Liver -does not have their own WBC - filter the microorganisms from the blood so that macrophages can destroy them - when the blood goes in through the liver the liver notices there is a foreign antigen there and the macrophages comes to the liver to destroy the microorganisms. Spleen -has their own WBC - they house their own WBCs when the blood goes into the spleen, they don’t need to call the other components and the immune system. Once the blood goes into the spleen that contains the microorganism the resident inside the spleen which is the WBC kills them right away. -splenectomy when they remove the spleen it reduces the risk of the patient getting pneumonia. -it is always recommended when a patient is getting a splenectomy that the patient receives a pneumovax vaccine prior to the surgery so the body can produce their own antibodies so that when they are exposed to that virus or that microorganisms, they can easily fight it.
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types of immunoglobin I gM - first immunoglobulin to be secreted during primary immune response to an antigen I gG - secreted during secondary immune response -more specific to a particular antigen I gA Once the baby is born the baby immunes system is not strong enough to fight infection when they come out, so you need to give them a passive immunity which is through the mother’s milk, the first milk of the mother contains immunoglobin A - present in mucosal secretions and breast milk I gE -attaches to cell membranes of basophils and mast cells -triggers the cells to release histamine
Peyer patch: lymphoid tissue found in the small intestine. when you eat something, wrong there is a microorganism it goes into the intestine and the Peyer pathcr patch will catch the microorganism. Macrophages and both B and T lymphocytes found in the lymphoid tissue attach any foreign microorganisms that attempt to enter the blood stream and could cause infection Recap questions of what we just learned: What type of wbc fights against bacterial infections? Neutrophils Which type of WBC initiates the massive inflammatory response that brings out WBC to the site of the infection? Basophils Which type of CDC combats parasitic infection? Eosinophils
Basophils work with which immunoglobin in order to identify foreign antigens. Immunoglobin E (Ige) What is being released by the basophils that is a potent vasodilator? Histamine Which lymphocytes produce the antibodies? B lymphocytes Which type of WBC circulates in the bloodstream? Monocytes or macrophages What immunoglobin is being secreted during the secondary immune response? Immunoglobin g (igg) What is attached to the cell membrane of the basophils? Immunoglobin e (ige) What immunoglobin is being secreted during the primary immune response? Immunoglobin M (Igm) What immunoglobin is being secreted in the mucosal secretions and the mother’s milk? Immunoglobin A (iga)
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Which of the hormones is secreted by the helper cells (cd4) Cytokines Which organ shrinks after puberty? Thymus gland What can occur if lymphatic vessels are damaged during surgery or radiation therapy? Lymphedema Where are lymph nodes found? Cervical Axillary Inguinal Intestinal What does the term lymphadenopathy mean? Enlargement of the lymph nodes How can you identify if it is infection or cancer? Biopsy Immunoglobulin Secreted during secondary immune response to an antigen. igg
Attached to cell membranes of basophils. Ige Secreted during primary immune response to an antigen Igm Present in mucus and mother's milk • Iga Which hormones is secreted by the cytotoxic cell (CD4)? cytokines Which organ shrinks after puberty? Thymus gland Pooling of lymph fluid in the periphery is called? lymphedema Areas where lymph nodes are founds? Lymphadenopathy indicates? Cervical Axillary Inguinal
Intestinal Innate immunity: immunity that is present before exposure and is effective starting birth. Anatomy and physiologic barriers the skin and mucous membranes (first line of defense) secrete substances in the skin that inhibit the growth of pathogens or microorganisms that pass through the skin. Sweat glands: secretes lysozymes, lysozymes have a antimicrobial property which means If there is any microorganism when in the skin they secrete the sweat has lysozymes that kills the microorganisms. Gi tract: the acidity of the gi tract will kill the microorganisms. Have acidic environment which inhibits the growth of pathogens. Genitourinary system;; are kept acidic which inhibits the growth of many pathogenic organisms Respiratory and GI tracts: secretes Iga and phagocytes. What physiologic actions remove microorganisms from the body? -coughing and sneezing -peristalsis of the GI tract -emptying of the bladder -sloughing of dead skin cells
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Innate immunity: Inflammation: is a response to injury s/s: redness (rubor), tumor (swelling), calor (heat) and dolor (pain) Initial response to injury or infection by dilating the capillary bed and increasing the capillary permeability of the affected area. Brings the WBCs to the site and allows them to enter the tissue to attack microorganisms. Why would there be swelling in inflammation? -too much fluid in the inter\stial space Phagocytosis: process of ingesting and digesting invading pathogens, dead cells and cellular debris neutrophils, monocytes, and macrophages acquired immunity: specific to a particular pathogen and is activated only when needed. antibody mediated immunity. aimed primarily at invading microorganisms such as bacteria. initiated when the IgM on the surface of B lymphocytes detect a foreign antigen.
w/ T-helper cells, B lymphocytes secrete additional IgM and differentiate to produce antibody- secreting plasma cells and memory B cells antibodies do not destroy the pathogen; make the antigen readily recognizable to neutrophils, monocytes and macrophages which can phagocytose the pathogen. in the future, if the same pathogen tries to reenter the body, memory B cells are triggered to produce large amounts of Immunoglobin G the antibody will attach to the antigen to kill.
Passive acquired immunity: occurs when an antibody produced by one person, or an animal is transferred to another person. IgA antibodies in breast milk gamma globulin (contains IgG antibodies that help destroy hepatitis virus) what kind of immunity does the patient have when the person contacts a disease? Natural active immunity I give you a rabies immunoglobin because you were bitten by a dog, and you don’t know the status of rabies and when you go to the hospital and they you a rabies immunoglobin what kind of immunity is it? How long does antibodies last? last 1-2 months after antibodies have been received. Acquired immunity. Cell mediated immunity aimed primarily at intracellular defects caused by virus and cancer. responsible for delayed hypersensitivity to reactions and rejections of transplanted tissue cytotoxic cells secrete cytotoxic substances that destroy defective cells. transplanted tissue may be recognized as foreign and is attacked by cytotoxic cells.
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Tolerance: immune system must be able to recognize its own proteins and not mount an immune response against itself Autoimmune Disease Autoimmune disease: immune system identifies its own proteins as foreign and mounts a response to destroy these self-protein. occurs when a breakdown of tolerance takes place. Tolerance: Immune system must be able to recognize its own proteins and not mount an immune response. A utoimmune disease they do not recognize their own cells what does the body do, they create antibodies to fight their own self. What is the breakdown the tolerance it lead to which disorder? Autoimmune diseases Age related changes: Bone marrow less productive Immunologic function is not affected unless a person is usually stressed by trauma, chronic infection or treatment for cancer
nursing assessment of the immune system: health history: Reason for seeking care-frequent persistent infections, bleed for a long time when cut, bruises easily or has chronic infections. Past health history-cancer, prior treatment of cancer hiv infection, history of organ transplant, placement of indwelling venous access, medications like otc (nsaids and asprin) Diagnostic test and procedures: Blood test (cbc blood count); reports the total number of WBCs (5,000-10,000) per cubic millimeter. Ana: detects antibodies in the blood because the body will produce its own cells and destroys the center of the nucleus- it can tell you the patient has a autoimmune, it is not specific to one disorder HIV Viral load will tell you how much hiv you have; when you have an infection the viral load will be high Cell surface immunophenotyping: to see how much cd4 and cd8 you have. Hiv attacks cd4. Cd4 600- 1200 cells per cubic millimeter. The helper cells call upon the immune responses. Cultures of blood, urine, and stool to detect the infection: the cultures will tell you where the infection is. Skin test: to determine what kind of foods and material your allergic to.
Organ transplantation: Allograph; comes from the same species. Hyperacute withing 24 hours the body builds an antibody to attack the transplanted organ. Attack the blood vessels Acute within 6 months: they start the patient on immunosuppressant, so the body recognizes it is not a foreigner to the body. Chronic: it may happen after months or years after the transplanted organ and destroys the tissues and will eventually scar tissue will occur; fibrosis may occur; fibrosis is scaring. Tissue matching: to minimize the rejection; you give immunosuppressant, when you give a immunosuppressant the risk may be infection; Example of immunosuppressant: -steroid, methotrexate, tacrolimus, cyclosporine, azathioprine, mycophenolate organ transplantation immunosuppressant drugs: side effects
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Types of Calcineurin inhibitors cyclosporine, tacrolimus:> Adverse reactions of these medications: -Nephrotoxic -infection, -hepatotoxicity -lymphoma, -hypertension -rarely anaphylaxis -When taking cyclosporine or tacrolimus medications do not take it with grapefruit juice because it will inhibit the metabolism of cyclosporine and tacrolimus. - with an taking or administering oral solution mix with milk or apple juice or orange juice. Cytotoxic agents: prevent organ rejection: Types of cytotoxic agents: prevent organ rejection Cyclophosphamide, azathioprine, mycophenolate mofetil Adverse reactions: -bone marrow suppression: wbcs are low -neutropenia: decrease in neutrophils -thrombocytopenia: decrease in platelets -infection -gi disturbances -hair loss -reduced fertility
Organ transplantation Drugs: function Folate antagonist and antimetabolite: methotrexate> Monoclonal antibodies: such as belimumab rituximab -protects the patient from infection -suppress b and t lymphocytes production. -prevent rejection, non-Hodgkin lymphoma, sle, leukemia. -given to patients with non-Hodgkin lymphoma, sle, leukemia -may cause an anaphylactic reaction Tyrosine kinase inhibitors: Such as imatinib nilotinib - inhibits proliferation and promotes death of cancer cells, treat CML. Adverse reactions: -Neutropenia -anemia -thrombocytopenia Nausea diarrhea or constipation -myalgia -rash -edema -liver injury -fluid retention -pulmonary edema
-cardiac arrhythmias Hematopoietic stem cell transplantation: Restore hematologic and immunologic systems in patient with malignancies and receive chemotherapy and radiation because chemo and radiation can cause bone marrow suppression. Bone marrow transplant: during a bone marrow transplant they are going to access it through the posterior iliac crest. -used for patients who have a problem in their bone marrow production especially when they are born or have aplastic anemia - donated bone marrow is going to infuse in the iv of the recipients and go inside the bone. Different types of stem cell transplantation: Types: function:
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Allogenic: -used to treat leukemia because there is too much immature wbcs and because of that it’s not affected to fight against infections. What do they first do before the patient gets a bone marrow transplant is chemo and radiation why well first to kill the existing bone marrow they have because the bone marrow they have is not healthy why mix healthy bone marrow with unhealthy bone marrow. - using a hla is for finding a matched donor. It is collected from the iliac: may be from siblings the chance for it to be the same is 25%. -under anesthesia with repeated extractions of liquid marrow then reinfused in the patient to restore bone marrow function syngenic: -bone marrow transplant from twin sibling Autologous: -collecting the bone marrow and saving it for the future just in case after chemotherapy you
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develop a bone marrow suppression, we can give back whatever we collected before on your own and that will reduce the chance of rejection or a reaction -you harvest your own bone marrow and reuse it when needed. -In other words to harvests the patient's own bone marrow before chemotherapy and radiation therapy -used for lymphoma -not for those who have cancer or metastasize to bone. Peripheral blood stem cell transplant; -colony stimulating factors are administered to stimulate the bone marrow to produce large numbers of WBCs -in order to increase the production of wbs, rbs, and platelets.
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Apheresis: - is used to collect the peripheral stem -go the clinnc and insert a cathete bring all your blood to the machin remove the stem cells. - large bore of needle is placed i subclavian vein that allows simulta blood withdrawal and blood rein wherein the machine will centrifuge or the blood and separate it into WBC, RB plasma - stem cell of the WBC are removed an rest are returned to the patient -patient is treated with chemotherap radiation then peripheral stem cells ret patient -they re-engraft quickly and reducin duration of neutropenia and risk of infe -2-4 hours
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Complications of bone marrow transplantation and peripheral stem cell transplantation: • Infection - neutropenic • Thrombocytopenia -due to chemotherapy and radiation • Renal insufficiency – damaged with high doses of nephrotoxic drugs like cisplatin chemotherapy or the antibiotic gentamicin; if the blood flow to the kidneys are not maintained. • Hepatic veno-occlusive disease – damaged with high dose of chemotherapy and radiation; blood flow into and out of the liver can be obstructed, resulting in ischemia, ascites and increasing serum bilirubin. • Graft versus-host disease – found in allogenic; T lymphocytes in the transplanted bone marrow identify the patient’s tissue as foreign and try to destroy the patient’s tissues like epithelial cells of the skin, GI tract, biliary ducts, lymphoid system resulting in skin rash; green watery diarrhea, elevated liver enzymes. COMMON THERAPEUTIC MEASURES:
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• Nursing actions for the patient at risk for injury from infection: compromised host precautions • Private room – door open; compromised host precaution sign should be posted on the door. • Wash hands before touching the patient. • Monitor vital signs every 2 to 4 hours; notify physician if temperature is greater than 101 degrees Fahrenheit that may need change of antibiotics; may require two sets of blood culture, CXR, sputum culture, urine culture, wound culture and cultures of other sites suggestive of infection. • Invasive procedures should be kept to the minimum. • Careful attention to aseptic technique must be observed when performing phlebotomy, handling intravenous lines or performing other invasive procedures. • Designate a particular stethoscope and thermometer: you should use the patient’s own thermometer and stethoscope. • Masks are not required; staff with upper respiratory tract should not care for the patient. • Clean tabletops, equipment and the floor frequently with hospital-approved disinfectant, clean cloths and clean mops • Patient should wash his hands before and after eating, using the toilet and doing any self-care procedure; if possible, shower every day • Encourage to cough and deep breathe every 4 hours; mobility should be encouraged; smoking should be discouraged.
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• Only canned or cooked foods are served, raw fruits, raw vegetables, and milk products may not be served because of the risk of Escherichia coli, Pseudomonas aeruginosa, Klebsiella bacteria. • Tests, scans, appointments away from the patient’s room should be coordinated in advance to eliminate or minimize waiting time in common waiting areas. • Patient wear clean mask when outside the room, especially in heavily traveled public areas such as corridors, elevators, waiting room; new masks is used for each trip out of the room. • Flowers and plants should not be handled by the patient because of the possibility of Escherichia coli contamination of the water and soil. • No humidifiers with standing water should be used in patient’s room; if needed, change every day • Teach patient and family the underlying pathophysiology that puts the patient at risk for infection and about precautions to minimize the risk for infection. Disorders of the immune system: neutropenia -low neutrophils which increases the risk of infection.
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Causes of neutropenia: -decrease bone marrow production due to infiltration with malignant cells. -chemotherapy -Radiation therapy: -Certain drugs: Zidovudine: treatment and management of hiv-1 Clozapine : used for treatment resistant schizophrenia Signs and symptoms of neutropenia: - redness - swelling -pain ^These s/s may be absent because they do not have adequate number of wbc to mount an immunologic response. -fever is the only sign of infection Common sites of neutropenia: - lung (pneumonia) common site -blood (septicemia) -skin -urinary tract -gi tract (mucositis, esophagitis, perirectal lesions) Treatment; - by using antibiotics -minimize exposure to infectious agents by instituting compromised host precautions. -put the patient in compromised host precautions) protective isolation
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Recap brain quest: Patient with neutropenia is at risk for infection. True or false? True Best means to prevent infection for neutropenia? Hand hygiene or hand washing What kind of isolation/ precaution should a patient with neutropenia be instituted? Compromised host precautions. What are the ways of how to prevent infection in patient with neutropenia? Select all that apply. a.Serve fresh fruits and vegetables, soft boiled eggs. b. Use aseptic technique in any invasive procedures or dressing changes. c. Use a separate stethoscope and thermometer. d. Avoid sick visitors. e. Avoid crowds. f. Increase fluid intake from tap water. g. Minimize waiting time in the waiting area for any scheduled imaging. The 2 types of lymphoma Non-Hodgkin lymphoma - cancer if the lymph system
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CAUSE OF NON-HODGKIN LYMPHOMA: -VIRAL OR BACTERIAL INFECTION; AUTOIMMUNE DIESEASE; EXPOSURE TO TOXIC CHEMICALS. SIGNS AND SYMPTOMS OF NON- HODGKINS LYMPHOMA: classical SIGN: -PAINLESS ENLARGEMENT OF THE LYMPH NODES Secondary symptoms -FEVER - WEIGHT LOSS -ANOREXIA - NIGHT SWEATS -PRURITIS TREATMENT FOR NON- HODGKINS LYMPHOMA: -RADIATION AND CHEMOTHERAPY -IMMUNOTHERAPY HEMATOPOIETIC STEM CELL TRANSPLATATION WITH HIGH DOSE CHEMOTHERAY. HODGKIN Lymphoma: - a type of lymphoma characterized by reed Sternberg cells in lymph nodes.
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-the difference of Hodgkin’s lymphoma is that it is characterized by reed Sternberg cells and non-Hodgkin’s doesn’t. Causes of Hodgkin lymphoma: -viral infection -exposure to chemical agents Signs and symptoms of Hodgkin lymphoma: Classical sign: -painless lymph nodes enlargement -thrombocytopenia Hepatomegaly -splenomegaly -anemia -fever -weight loss -night sweats -pruritus’ -fatigue Treatment for Hodgkin’s lymphoma -surgery -radiation and chemotherapy -hematopoietic stem cell transplantation Recap brain QUEST questions: Which type of lymphoma has the presence of the reed Stemberg cells? Hodgkin’s lymphoma
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What are the classical signs of lymphoma? Painless enlargement of the lymph WHAT IS LYMPHOMA? CANCER OF THE LYMPH HEPATOMEGALY, SPLENOMEGALY, ANEMIA AND THROMBOCYTOPENIA ARE FOUND IN PATIENTS WITH HODGKINS LYMPHOMA. TRUE OR FALSE? TRUE WHAT ARE THE SIGNS AND SYMPTOMS OF NON- HODGKINS LYMPHOMA? SELECT ALL THAT APPLY. A. WEIGHT LOSS B. FEVER C.HEPATOMEGALY D. NIGHT SWEATS E. PRURITIS Disorders of the immune system: Leukemia: what is it? - cancer of the wbcs in which bone marrow produces too many immature wbcs Causes of leukemia: -unknown -exposure to large doses of ionizing radiation -exposure to chemicals Signs -fever
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and symptoms of leukemia: -night sweats -Fatigue -paleness -tachycardia -Tachypnea -petechiae: round spots that appear in the skin as a result of bleeding. -pupura: small blood vessels leak blood under the skin -epistaxis -gingival bleeding -melena menorrhagia: ^due to low platelet counts -weight loss -enlarged lymph nodes -bone pain due to crowding created by rapidly dividing leukemic cells in bone marrow
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Treatment of leukemia - acute leukemias; high dose chemotherapy (side effect infection and bleeding - stem cell transplant Side effects of chemotherapy: -nausea -vomiting -stomatitis -hair loss Treatment for acute leukemia: high dose of chemotherapy to destroy the diseased bone marrow and allow the body to regrow healthy bone marrow; side effect: infection and bleeding. Stem cell transplant Nursing assessment for leukemia: Infection is the leading cause of death: -monitor vital signs every 4 hrs (tachycardia, tachypnea, hypotension, fever -cough, note color and amount of sputum -inspect skin for reddened, swollen, painful or draining areas (no pus since low WBCs) -inspect mouth and pharynx for swelling, redness and pain -ask about pain or burning when urinating -look for signs of bleeding
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-note side effects of chemotherapy There are two types of leukemia: myelogenous and lymphocytic: acute or chronic: Chronic myelogenous leukemia (cml): - in adults -controlled by oral chemotherapy which is imatinib mesylate (Gleevec) -targets the leukemic cells (stops the action of protein of the leukemic cells) while sparing normal cells Chronic lymphocytic leukemia (Cll) - most common type of chronic leukemia in adults Acute lymphocytic leukemia (all) -most common in children -treat with chemotherapy ASAp Acute myelogenous leukemia (aml) -occurs most often in adults Recap brain quest: What is the patient at risk for post bone transplant and chemotherapy? Infection
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What is leukemia? cancer of the wbcs in which bone marrow produces too many immature wbcs. What is the leading cause of death of leukemia? Infection Which of the following are interventions for patients with leukemia? Select al that apply. A. Handwashing B. Inspect mouth and skin for any redness C. Place patient on respiratory isolation D. Use rectal thermometer to check temperature E. Avoid crowds F. Receive annual flu vaccine Why the patient with leukemia also has anemia and thrombocytopenia? There is overcrowding in bone marrow Most common type of leukemia in children All Stem cell collection is performed through apheresis. T or F true
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Patient receiving stem cell transplant will be prescribed with immunosuppressants to avoid rejection. Tor F true One of the nursing diagnoses for leukemia patient is potential for injury. Tor F true disorders of the immune system: Nursing Interventions: potential for injury related to infections, thrombocytopenia and anemia. -institute for compromised host precaution -good handwashing, shower every day - discourage eating from fresh fruits or vegetables and from drinking raw milk products -avoid uncooked foods because they contain bacteria Escherichia coli, Pseudomonas aeruginosa, and Klebsiella -platelet transfusion for those who are actively bleeding or platelets below 20,000 cells per cubic millimeter -RBC transfusion
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-Fatigue related to disease process and treatment– due to anemia, buildup of metabolic wastes as the leukemic cells are being destroyed and cleared from the body, disrupted sleep and psychologic stress of the disease -Impaired oral tissue integrity related to stomatitis– stomatitis due to side effect of chemotherapy -Inadequate nutrition related to nausea and vomiting– common side effect of chemotherapy -Anxiety related to the disease, treatment and uncertain outcome -Ineffective management of therapeutic regimen related to lack of knowledge about the disease process and treatment– patient must receive accurate and consistent information from all members of the health care team, nurses reinforce teachings
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Disorders of the immune system: Idiopathic thrombocytopenic pupura (itp) -antibody mediated autoimmune disorder in which IgG mistakenly helps destroy the patient's own platelets Clinical manifestations of Itp -bleeding Drugs that initiate itp: -drugs that initiate ITP: sulfonamide, thiazide diuretic, chlorpropamide, quinidine -HIV has increased risk of ITP Treatment for itp -steroids: used to suppress the immune system -IV immune globulin: used to give the patient antibodies instead of the patient using their own antibodies
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-splenectomy: the spleen is too activated -immunosuppressive therapy (azathioprine or cyclophosphamide) -monoclonal antibody rituximab w/ dexamethasone: used to stimulate the immune system to build antibodies to fight the antibodies your producing -thrombopoietin receptor agonist romiplostim and eltrombopag -NO platelet transfusion Disorders of the immune system Thrombotic Thrombocytopenic Purpura (TTP) -extensive blood clot formation and decreased blood flow to affected tissues
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-genetic -caused by antibodies that block the activity of an enzyme that is involved in blood clotting Factors that Triggered ttp: -pregnancy, HIV, lupus, medication (chemotherapy, ticlopidine, clopidogrel), surgery, stem cell transplant Signs and symptoms of ttp: -critically ill -fever -thrombocytopenia -hemolytic anemia -renal impairment -neurologic symptoms Treatment for ttp: -plasmapheresis (remove the antibodies that trigger TTP from the plasma; every day or every other day for several weeks until stabilizes) -blood is centrifuged in
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apheresis machine; patients own WBC, RBC, and platelets reinfused during treatment -steroid -vincristine -rituximab -cyclosporine A and/or splenectomy -platelet transfusions are contraindicated Recap brain quest questions: Is IT an autoimmune disorder? Yes or No yes Patient with IT are at risk for bleeding. T or F true
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Plasmapheresis is used in patients TTP. Tor F true Platelet transfusion is indicated for both IT and TP. Tor F false Interventions for patients with IT. Select all that apply. A. Use soft bristle toothbrush B. Use electric razor for shaving C. Remove throw rugs D. Avoid cluster in the hallway E. Decrease fluid intake and fiber in the diet Disorders of the immune system Systemic lupus erythematosus: -patient's immune system loses its ability to recognize itself and mounts an immune response against its own proteins What organs does sle affect? -skin, -joints -kidneys
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-CNS -cardiovascular -membranes lining body cavities -hematologic -immune system Causes of sle: WHO ARE AFFECTED? > -unknown -maybe genetic -environmental triggers -altered immune function • Women in childbearing age is usually affected. Cause of death for patients with sle: -infection -disease of cardiovascular, renal, pulmonary, and CNS Signs and symptoms of sle: -butterfly rash and photosensitivity -arthralgias, myalgias, joints are swollen, tender, stiff and painful w/ movement
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-oral ulcers -vasculitis -nephritis, pleuritis, pericarditis, leading to organ failure -inflammation of the retina, leading to sudden-onset blindness -renal disorder (proteinuria) -neurologic disorder (seizure, psychosis) -hematologic disorder (anemia, leukopenia, thrombocytopenia) -immunologic disorder -positive ANA Medical diagnosis for sle: -positive ANA test (not specific to SLE) -lupus erythromatosus preparation (LE prep)
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Treatment for sle: NO CURE -analgesics, NSAIDs -antimalarial agents (hydroxychloroquine or chloroquine); to reduce butterfly rash and joint pain -corticosteroids (prednisone; methylprednisolone); IV to achieve remission -topical corticosteroid (tacrolimus; pimecrolimus) -monoclonal antibodies (belimumab) -immunosuppressants (azathioprine, mycophenolate, mofetil, cyclophosphamide, methotrexate) Nursing interventions for sle: -avoid prolonged exposure to sun and use sunscreen w/ SPF greater than 15 to prevent skin rash and exacerbation of symptoms -provide supportive system
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-pharmacologic and non- pharmacologic pain management -fatigue due to low RBCs, chronic pain, disturbed sleep & psychological stress How many symptoms of sle need to be experienced by the patient to make a diagnosis? And what are those symptoms? -four symptoms -Characteristic rash -Discoid rash (red, scaly patches that cause scarring) -Photosensitivity with exposure to sunlight -Oral ulcers -Arthritis -Pleuritis or pericarditis -Renal disorder (proteinuria)
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-Neurologic disorder (seizure, psychosis) -Hematologic disorder (anemia, leukopenia, thrombocytopenia) -Immunologic disorder -Positive ANA (anti-nuclear antibody) Recap brain quest questions Classical sign for SLE.
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Molar rash Is SLE autoimmune? Yes or No yes Is there a cure for SLE? Yes or No no What are the signs and symptoms of SLE? Select all that apply. A. Joint pain B. Photosensitivity C. Oral ulcer D. Pericarditis E. Pleuritis F. Proteinuria G. Hematologic disorders H. Seizure The ANA result in patients with SLE will be negative. T or F false Which of the following medications are used for SLE. Select all that apply.
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A. Hydroxychloroquine to control the discoid lesion and rheumatic manifestations. B. Analgesic C. Steroid D. Antiviral E. Immunosuppressants F. Monoclonal antibodies
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