Adult Ii- Test 3- Immunity

Front 1

IgG

Back 1

2nd in immune response
Most common
crosses placenta

Front 2

IgA

Back 2

Lines mucous membranes and protects body surfaces

Front 3

IgM

Back 3

First in immune response
Forms antibodies to ABO blood antigens

Front 4

IgD

Back 4

Present in lymphocyte surface
Assists in differentiation of B lymphocytes

Front 5

IgE

Back 5

Causes symptoms of allergic reactions
Fixes to mast cells and basophils
Assists in defense against parasitic infections

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Type I reaction

Back 6

- IgE mediated reaction
- Anaphylactic reactions
- immediate, humoral

First exposure: IgE--> attaches to masts cells and basophils

2nd exposure: allergen --> links to IgE bound to mast cells --> release of chemical mediators/degranulation (histamine, serotonin, leukotrienes, eosinophil chemotactic factor of anaphylaxis, kinins, bradykinins)--> target tissues/organs--> allergy symptoms-->manifestation depend on if remains local or systemic --> smooth muscle contraction, increased vascular permeability, vasodilation, hypotension, increased mucus, and itching--> mediators are short acting and are reversible

Front 7

Histamine

Back 7

- within mast cells and basophils
- increases vascular permeability
- constricts smooth muscle
- stimulates irritant receptors

-->
- airway and larynx edema
- bronchial constriction
- urticaria
- angioedema
- pruritis
- N/V
- diarrhea
- shock

Front 8

Leukotrienes

Back 8

- constrict bronchial smooth muscles
- increase vascular permeability

-->
- bronchial constriction
- enhanced effect of histamine on smooth muscles

Front 9

Prostaglandins

Back 9

- vasodilation
- constrict smooth muscle

-->
- wheal and flare reaction on skin
- hypotension
- bronchospasm

Front 10

Platelet-activating factor

Back 10

- in mast cells
- aggregates platelets
- stimulates vasodilation

-->
- increased pulmonary artery pressure
- hypotension

Front 11

Kinins

Back 11

- stimulate slow, sustained smooth muscle contraction
- increased vascular permeability
- stimulate mucus secretion
- stimulate pain receptors

-->
- angioedema with painful swelling
- bronchial constriction

Front 12

Serotonin

Back 12

- from platelets
- increases vascular permeability
- stimulates smooth muscle contraction

-->
- mucosal edema
- bronchial constriction

Front 13

Anaphylatoxins

Back 13

- from compliment activation
- stimulate histamine release

-->
- same as histamine

Front 14

Type I Reaction examples

Back 14

Anaphylaxis
Atopic reactions (rhinitis, asthma, atopic dermatitis, angioedema)
IgE

Front 15

Type II Reaction

Back 15

IgG and IgM

antibodies--> antigen--> comeplemtn system --> cytolysis or enhanced phagocytosis of cells (rapid tissue damage)

common target cells include erythrocytes, platelets, and leukocytes

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Type II Reaction examples

Back 16

hemolytic transfusion reactions (AVO, Rh, autoimmune and drug hemolytic anemias)
Good pasture syndrome

Front 17

Type III Reaction

Back 17

secondary to antibody/antigen complex

Complex formed IgG or IgM --> deposit in tissue or small blood vessel --> fixation of complement and release of chemotactic factors--> inflammation and tissue destruction of area

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Type III Examples

Back 18

- kidneys, skin, joints, blood vessels, lungs
- SLE, RA, some acute golmerulonephritis

Front 19

Type IV Reactions

Back 19

no immunoglobulins
- T lymphocytes --> attack antigens and release cytokines--> some attract macrophages --> enzymes release--> tissue destruction

Also called a mediated immune response

* delayed reactions, takes 24-28h

Front 20

Type IV Reaction examples

Back 20

- Contact dermatitis
- hypersens to bacterial, fungal, viral infections (antigentic material released from TB--> reaction with T lymphocytes --> causing lung necrosis)
- transplant rejections
- some drug reactions

Front 21

Cellular immunodeficiency =

Back 21

less than 1200 /ug or 1.2 x10^9 /L

Front 22

Good test for determining various allergic reactions to foods and anaphylaxis

Back 22

RAST (radioallergosorbent) test

Front 23

Skin tests can not be performed on who?

Back 23

Pts that can't be removed from meds that suppress immune response

Otherwise they are good to determine specific allergies that are causing symptoms

Front 24

Positive skin test response

Back 24

wheal and flare
- size of reaction does not correlate with severity of allergy symptoms

*this test has increased chance of anaphylactic reaction
**Observe for itching and edema!!
*Should not be left alone!

Front 25

Cardinal principles for anaphylaxis treatment

Back 25

Speed in:
1. recognition of S/S
2. maintenance of patent airway
3. prevention of spread of allergen by using a tourniquet
4. Admin of drugs
5. treatment for shock

Front 26

Tx for mild anaphylaxis symptoms

Back 26

- 0.2-0.5 mL of epinephrine q 10-15 min
- IV infusion 0.5mL/kg IV every 2-5 min (for hypotension)
- Diphenhydramine (benadryl) for urticaria/angioedema- can also be given preventatively

Front 27

Tx for severe symptoms of anaphylaxis

Back 27

- IV epi, followed by adminstration of high-flow oxygen 100% via non-rebreather
- volume expanders, inotropes (Dopamine)- to maintain BP

Front 28

Latex-food syndrome

Back 28

- banana
- avocado
- chestnut
- kiwi
- tomato
- water chestnuts
- guava
- hazelnuts
- potatoes
- peaches
- grapes
- apricots

Front 29

High risk for latex allergy

Back 29

- long term exposure (healthcare workes, multiple surgeries, rubber manufaturers)
- asthma, hay fever, allergies
- latex-food syndrome

Front 30

Atopic reactions

Back 30

Type 1- sensitivity to environmental allergens
- allergic rhinitis
- asthma
-Atopic dermatitis (eczema)
- urticaria (hives)
- Angioedema

Front 31

Allergic rhinitis

Back 31

- year round or seasonal
- airbornse substances (pollens, dust, molds)
- target areas are conjuntivae, mucosa of upper respiratory tract

S/S- nasal discharge, sneezing, lacrimation, mucosal swelling of the airway, obstruction, pruritis around eyes, nose, throat, mouth

Front 32

Asthma

Back 32

Manifested with dyspnea, wheezing, coughing, chest tightness, thick sputum

Front 33

Atopic dermatitis

Back 33

Chronic inherited skin disorder
- caused by several environmental allergens
- skin lesions are generalized and involve vasodilation of blood vessels resulting in interstitital edema with vesicle formation

Front 34

Urticaria

Back 34

- characterized by transient wheals
- develops rapidly after exposure to allergen and may take minutes or hours
- Histamine--> vasodilation (erythema)--> transudation of fluid (wheal) and flaring
- Histamine is responsible for itching

Front 35

Angioedema

Back 35

- Localized cutaneous lesion involving deeper layers of skin and submucosa
- eyelids, lips, tongue, larynx, hands, feet, GI tract, genitalia
- swelling usually begins in the face then progresses to airways
- dilation and engorgement of capillaries secondary to release of histamine--> diffuse swelling
- lesions may burn, sting, itch, abdominal pain if in GI tract

Front 36

CBC with differential and allergies

Back 36

lymphocyte count < 1200 uL = cellular immunodeficiency

Eosinophils are increased with type 1 hypersens with IgE immunoglobulins

Front 37

RAST test

Back 37

Radioallergosorbent test

- invitro diagnostic test for IgE antibodies to specific allergens
- good for pts with history of severe anaphylactic reactions
- sputum, nasal, and bronchial secretions tested for eosinophils

Front 38

Skin tests

Back 38

- used to confirm specific pt with atropic disease after hx is suggestive of allergy
**CANNOT be performed on pts who cannot be removed from medications that suppress the histamine response or pts with food allergies

-cutaneous scratch or prick
- intracutaneous injection
- wheal and flare would be a positive
- a negative doesn't always mean negative

- increased risk of developing anaphylactic reaction--> observe site for itching and edema
**should not be left alone

Front 39

Plasmapheresis

Back 39

removal of plasma containing components causing or though to be causing disease

- used to treat SLE, CBS, myasthenia gravis, good pasture syndrome, RA, glomerulonephritis, and thrombocytopenic purpura

- plasma is removed and replaced by substitute fluids (salin, frash frozen plasma, albumin)
- removed immunomediators (such as IgG and can also remove inflammatory mediators)

Front 40

Human Leukocyte Antigen

Back 40

HLA
- major histocompatibility antigens
- primarily used in matching organs and tissues for transplants
- highly variable, different alleles, with many combinations

Front 41

Organs that can be transplanted together

Back 41

kidney and pancreas
kidney and liver
kidney and heart

Front 42

Cadaver transplant

Back 42

the longer it is cold the harder it is to get it to work

Front 43

Living transplant

Back 43

better cause it still has blood going through it
- want to maintain good perfusion
- live donors must meet certain criteria also

Front 44

how matching is one

Back 44

ABO and HLA, medical urgency, time on waiting list, geography

higher on list if under 19

Front 45

Crossmatch

Back 45

A positive crossmatch is an absolute contraindication to transplant!

- a positive match means that the recipient has cytotoxic antibodies to to the donor!

- you WANT A NEG!

Front 46

Hyperacute transplant rejection

Back 46

- antibody mediated humoral
- minutes to hours after transplant due to blood vessel destruction
- person had preexisting antibodies against transplanted tissue or organ
- remove organ ASAP
- kidney is most susceptible

Front 47

Acute transplant rejection

Back 47

- days to months after transplant, within the first 6 months
- mediated by recipients lymphocytes which have been activated against the donor tissue or organ
- another type occurs when anti0donor antibodies develop after transplantation
- requires long term use of immunosuppressants (higher doses at first which increases infection risk!)

Front 48

Chronic transplant rejection

Back 48

- occurs over months or to yers and is IRreversible
- unknow reasons or from repeated episodes of acute rejection
- transplanted organ is infiltrated with large numbers of T and B cells characteristic of an on-going, low-grade immune-mediated injury

--> results in fibrosis and scarring

Front 49

Transplant rejection manifestation in liover

Back 49

- loss of bile ducts

Front 50

Rejection manifestations in kidney

Back 50

fibrosis and glomerulopathy

Front 51

rejection manifestation in heart

Back 51

accelerated CAD

Front 52

rejection manifestations in lung

Back 52

bronchiolitis
- supportive therapy, retransplanted

Front 53

Immunosuppressive therapy concerns

Back 53

- Increased risk of infection
- Increased risk of malignancies
- Increased risk of toxicity
- side effects
- need suppression to prevent rejection but need immune response to prevent massive infection and malignancies

Front 54

Cyclosporine, tacrolimus

Back 54

- most effective immunosupressant
- need for life!
- do not cause bone marrow suppression or alterations in inflammatory response
- potentially nephrotoxic and don't mix with grapefruit juice

Front 55

Initial immunosupression

Back 55

triple therapy, one being a steroid so want to wean them off steroid as as soon as possible

Front 56

Monoclonal antobidies

Back 56

---mab

a flu-like syndrome may develop during the first few days of tx from cytokine release (fever, rigors, HA, myalgias, various GI disturbances)

Front 57

Graft versus Host disease (GVHD)

Back 57

- when immunocompentent pt is trasfused or transplanted with immuno-competent cells
- blood prducts from fetal thymust or fetal liver or bone
- graft rejects recipient
- 7-30 days onset
- little can be done to modify
- skin, GI liver ar target organs
- donor T cells attacking host cells
- palms of hands and soles of feet--> generalized erythema, pruritus, rash, desquamation
- liver-->jaundice to hepatic coma

Front 58

S/S of GVHD

Back 58

- rash
- jaundice
- hepatic coma
- watery diarrhea
- mild pruritus
- pain on pressure
- palms/soles
- N/V
- abdominal pain
- dark yellow urine

* be cautious if a pt receiving bone marrow transplant is experiencing a rash--> could be this!

tx is steroids and immunosuppressive agents (most effective in prevention!)
- radiate blood products before adminsitration

Front 59

Advantages of a live donor

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- better pt and graft survival rate regardles of HLA match
- immediate organ availaility
- immediate function (minimal cold time)
- opportunity to have recipient in best condition (elective surgery)

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Deceased donors

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- donors must be regularly healthy and declared brain dead
- brain dead donor must have effective cardiovascular function to preserve organs (dopamine to keep BP up, mech vet, etc.)
- age most suitable is 2-70

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Preop nursing teaching

Back 61

- educate on procedure and expected outcome
- including dialysis may be needed immediately after (kidney transplant)
- need for immunosuppressant drugs and infection prevention

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Postop nursing management of live donor

Back 62

Live Donor
- similar to post op laproscopic procedures
- monitor for renal function
- acknowledge "gift"

Front 63

Postop nursing management of kidney recipient

Back 63

- maintenance of fluid and electrolyte balance
- in ICU for 12-24 hours post transplant
- large volumes of urine may be produced soon after blood supply established (due to new kidney ability to filter BUN, surgical fluids, inhibition of concentration)
- watch venous pressure--> don't want a lot of BP fluctuation
- may have trouble concentrating urine
- avoid dehydration
* a sudden decrease in urine output is a cause for concern (could be dehydration, rejection, urine leack, obstruction)
- common obstruction is blood clot in catheter
- patency must be maintained (remains in bladder for 3-5 days to allow for anastomosis healing)

Front 64

Post operative teaching of kidney recipient

Back 64

- prevention and treatment of rejection, infection, complications of surgery, purpose and side effects of immunosuppression
- frequent blood tests and clinic visits to detect early rejection signs
- immunosuppressive therapy

Front 65

Chronic rejection...

Back 65

should be put back on transplant list

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Immunosuppressants and cardiovascular disease

Back 66

- increased incidence of atherosclerotic vascular disease
- immunosuppressants can worsen HTN and dyslipidemia

Front 67

most common secondary malignancies

Back 67

basal cell carcinoma of skin and lymphoma (nutrition, antioxidants)