Nurs 138: Immunity

Front 1

What is the function of tonsils and adenoids?

Back 1

Filters that filter debris and antigens entering the respiratory tract.

Front 2

What is the function of the lymph nodes?

Back 2

To filter debris and antigens and foster contact with T-lymphocytes

Front 3

What is the function of Peyer's Patches?

Back 3

To filter debris and antigens coming into the GI tract.

Front 4

What is the function of Bone marrow in immunity?

Back 4

The bone marrow holds the stem cells for Blymphocytes that mature to make B lymphocyte antibody producing plasma cells that bacteria, and viruses. They go out into the blood stream for humoral immunity.

Front 5

What is the function of the thymus?

Back 5

Contains cells that mature into T-lymphocytes that specifically fight viruses, parasites, fungi and foreign tissue and other antigens. Controls cell-mediated immunity

Front 6

What is the function of the spleen?

Back 6

Acts as a filter to remove debris, and antigens and to foster contact with t-lymphocytes.

Front 7

When is IgM produced in a child?

Back 7

Produced in utero around 20-24 wks. Increases as it helps fight infection.

Front 8

Which immunoglobulin is passed from the mother through the placenta and how long does it last in the child?

Back 8

IgG and it lasts for the child 6-9 mos old.

Front 9

Which immunoglobulin is passed through milk?

Back 9

IgA

Front 10

T/F

Back 10

Flora is established in an infant when they are born? F

Front 11

Which WBC are the first responders in inflammation process?

Back 11

neutrophils, then monocytes come in at 24 hours.

Front 12

What are agranulocytes?

Back 12

They are monocytes and macrophages. They don't have granules.

Front 13

What are platelets?

Back 13

They are blood clotters

Front 14

What are the components found in plasma.

Back 14

immunoglobulins, fibrinogen, clotting factors, and complement

Front 15

t/F the nervous system and immune system work together.

Back 15

T. Immune system manufactures some of the peptides that send messages to the brain. The brain is the traffic controller for the immune system.

Front 16

What is your innate defense in immunity?

Back 16

Either physical barriers or Inflammation. It is non-specific. and it is our 1st and 2nd lines of defense.

Front 17

What is your adaptive defense in immunity?

Back 17

It is your B and T lymphocytes which are made and matured in the bone marrow and thymus respectively, They are our 3rd line of defense. They are specific in their design and target. Both are able to make memory cells for secondary responses the next time body comes in contact with an antigen.

Front 18

What specific vitamins/function and minerals help the immune system?

Back 18

B-vitamins; energy, vitamin C helps with inflammation and healing, Vitamin E?, Vitamin D?, Vitamin K helps with clotting, and natural flora, ...zinc?

Front 19

What are NK cells?

Back 19

Natural Killer cells are like cytotoxic Tcells in that they are a special type of lymphoid cells that can identify protein changes on the surface of enemy cells (cancer, virus), they directly adhere to the target cell and killing by apoptosis.

Front 20

What is the function of the mast cell?

Back 20

Most important activator or trigger of the inflammatory response, are filled w/granules and are located in LCT close to blood vessels. Basophils function similarly to mast cells. Mast cells release their granules: histamine and chemotactic factors. Histamine is a vasoactive amine, it causes constriction of smooth muscle, yet causes vasodilation of venules increasing blood flow into circulation. Histamine also causes increases vasuclar permeability which can increase adherence of leukocytes to endothelium. Of course antihistamines would counteract this effect. Chemotactic factors diffuse from a site of inflammation forming a gradient which causes the directional movement of other cells(chemotaxis) toward the inflammation.

Front 21

What is the value of CD4 count that becomes a cause for concern?

Back 21

By the time the values reach 200 and below, the immune system is very weakened. Meaning you don't have enough to fight viruses and other antigens. HIV, a virus that needs a host to replicate, attaches itself to CD4 helper cells, it weakens and kills them so they aren't available to help kill other viruses or antigens that come into the body, eventually leading to AIDS.

Front 22

What are T-suppressor cell?

Back 22

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Front 23

What is opsonization?

Back 23

Opsinization: coating from the complement system that allows binding the phagocyte can cling and bind and do there job in phagocytosis.

Front 24

What is the first responder immunoglobulin and its function?

Back 24

IgM – IgM is produced in utero around 20-24 weeks of gestation;
largest in size; but not largest amount in abundance, which would be IgG. But it is the FIRST antibody produced during the initial response to antigen; and levels do increase in response to active infection.

Front 25

What is a toxoid? What is attenuated?

Back 25

A toxoid is a purified toxin that has been chemically detoxified without the loss of immunogenicity (example: diptheria and tetanus and other bacterias.). Most vaccines against viruses are attenuated or weakened (measles, mumps, rubella, varicella), so they continue to express appropriate antigens, but establish an easily controlled infections. By allowing a slight infection it appears to have longer lasting results. The exception to this is HepB which is a killed virus, so it wouldn't cause an infection at all. Attenuated viruses can have serious effects on someone who is immunocompromised.

Front 26

What is Active Natural Acquired immunity, Active Artificial Acquired immunity? What is Passive Natural Acquired, and Passive Artificial Acquired immunity?

Back 26

Active Natural: I had mumps; Active Artificial: I got my vaccinations; Passive Natural: I got my mother's milk: Passive Artificial: I have rabies and I need a dose of gamma globulin or specifically= Rabies immune globulin is a solution of globulins dried from the plasma or serum of selected adult human donors who have been immunized with rabies vaccine and have developed high titers of rabies antibody. It generally contains 10% to 18% of protein of which not less than 80% is monomeric immunoglobulin G.

Front 27

What is the function of IgD?

Back 27

IgD – sole purpose is antigen receptor on the surface of early B cells

Front 28

According to Alverson what are some dead or killed virus, bacteria vaccines?

Back 28

Polio and Pertussis. In book it talks about how polio used to be given live, but they had to change that because some people ended up w/polio even after it was attenuated. In the book it talks about how Pertussis was changed from killed whole cell to acellular, which would have some live w/out ability to replicate. .....FYI.

Front 29

What specific lymphocyte surface antigens are of specific importance in lab values?

Back 29

CD4 & CD8

Front 30

What are the specific lab tests that could be checked:

Back 30

CBC (wbc, stabs, segs), CRP, Allergy testing, MEGAD (IgM would be high), lymphocyte surface antigens (Cd4 & Cd8), and Titer tests.

Front 31

What are the three kinds of white blood cells and their sub-parts?

Back 31

Agranulocytes: moncytes and macrophages.
Granulocytes: basophils, eosinophils, neutrophils (1st responders)
lymphocytes

Front 32

What are the 4 category components that make up blood?

Back 32

WBC, RBC, Plasma and Platelets

Front 33

What are the components of plasma?

Back 33

Immunoglobulins, fibrinogen, clotting factors and complement

Front 34

The immune system works hand in hand with what system? and how?

Back 34

Works with the nervous system. Peptides send messages to the immune system and immune system makes some of the peptides. Brain is the traffic controller for the immune system.

Front 35

Name some factors that will affect the immune response.

Back 35

Things that can have a negative effect: 1) Age: The very young and very old have been shown to have reduced immune responses. Children undeveloped immune system and older is wearing out;
2) Genetic predisposition: allergies, lupus, family passes down weak gene links; 3) All forms of sugar interfere with the WBC’s ability to destroy bacteria: diabetics; 4) Chronic mental and emotional stress can reduce immune function; 5) Excessive thinness and obesity are associated with impaired immune responses; 6) Alcohol interferes with a variety of immune function. They just drink and don’t eat, and their liver is effected. 7) Hormones modulate immune response.

Things that have a good affect on immune system: 1) Multivitamins and minerals have been shown to boost immune function in the elderly: vitamin C & B12, Vitamin E fat soluble get K in your gut, ADEK are fat soluble and zinc. 2) Regular aerobic exercises have been shown to offset the effects of excess weight and weight-loss diets.3) Sleep & rest enhance the immune system. Body replenishes everything during sleep

Front 36

What is the vascular response in inflammation?

Back 36

Vascular response: chemotaxis: chemical sent out to get white blood cells to come: mast cells send out granules to get histamine to make prostaglandin come. Get smooth muscle contraction: blood vessels to dilate.

Front 37

What are immunoglobulins-describe them and their function.

Back 37

IgG – major antibody; crosses placenta lasts 6-9 months; most abundant because it behaves as a memory cell of previous antigens when its carried through the placenta.
IgA – found in mucosal epithelial cells, blood, and breast milk
IgM – largest in size; FIRST antibody produced during the initial response to antigen; increases in response to active infection: IgM will be elevated because it’s the first responder in infection.
IgD – sole purpose is antigen receptor on the surface of early B cells
IgE- mediators of allergic responses and in defense of parasitic infections

Front 38

What is anergy?

Back 38

Get anergy: because they don’t show inflammatory response to things. Example is TB, they might not show response to it, but have symptoms for TB. Example: UTI most common sign of dementia.

Front 39

What are some common diagnostic labs for immunology?

Back 39

Common laboratory and diagnostic tests; Serum Immunoglobulin levels (IgG, IgM, IgA, IgE)High IgM: infection, Lymphocyte surface antigens (CD4: Hiv into aids & CD8)
Serum antibody titer to antigens in vaccines received: MMR,CBC with differential; CRP: inflammation ESR:erythrocyte sedimentation rate for infection. Allergy skin testings; Radioallergosorbent test: titer: how much immune response you have in your body. Skin Tests to mumps, tuberculin, tetanus, candida

Front 40

What are the ways to prevent infection?

Back 40

Portal of Exit = how will you reduce the # of pathogens and prevent the pathogens from exiting?:wound, cough, fecal matter, urine, vomit

Mode of Transmission = what are the different modes of transferring pathogens? We’re the culprit: dirty hands, dirty equipment, dirty….stuff, reusing scopes, reusing needles.

Portal of Entry – How can pathogen enter a susceptible host? How will you prevent? Needles, open-toed shoe, improper skin prep for surgery, razors make cuts,
Asepsis is the absence of pathogenic organisms, i.e., sterile.SOMETHING STERILE
MEDICAL ASEPSIS: CLEAN TECHNIQUES: cleaning disenfecting.
Aseptic technique is the practice all healthcare provider implement to ensure that their clients are as free from pathogens as possible

Medical: CLEAN TECH: WASH HANDS DOWN. or surgical asepsis: SURG IS STERILE

Principles of Surgical Asepsis (P & P, p.669-670): ELIMINATE ALL: WASH HANDS UP. MICROORGANISISMS; STERILIZING. STERILE TO STERLIE: STERILE TO CLEAN IS NO LONGER STERILIE. 1” AROUND IS CONSIDERED CONTAMINATED OR BELOW WASTE, OR PUTTING ON PPE: PUT ELBOWS CLOSE TO YOU AND CLOSE HANDS. UNDER WASTE IS CONTAMINATED.

Front 41

What is the most important activator of the inflammatory response?

Back 41

The mast cell, which initiates inflammation by releasing biochemical mediators (histamine, chemotactic factors) from preformed cytoplasmic granules and synthesizing other mediators (prostagladins, leukotrienes) in response to a stimulus. Histamine is the major vasoactive amine released from mast cells. It causes constriction of vascular smooth mucles, dilation of capillaries and retraction of endothelial cells lining hte capillaries, which increases vascular permeability.

Front 42

What are droplet diseases and precautions?

Back 42

Droplet diseases are: influenza b, meningitis, pneumonia, scarlet fever, pharyngitis, pertussis, rubella, pneumonic plague, mumps, and diptheria. It includes droplet particles that are larger than or equal to 5 um. and are dispersed by coughing, sneezing, talking or suctioning. They are expelled into the air 3-6 ft. and require wearing of surgical mask, eye protective equipment, and using proper hand hygiene and gloves.

Front 43

What are airborne diseases and precautions?

Back 43

Tuberculosis, varicella, measles, and rubella. They are airborne particles, or particles wrapped in dust that are less than or = to 5 um. They can remain suspended in the air for an extended period of time. They require a specially equipped room with negative air flow and the air exchanges are exhausted directly outside. A HEPA filter mask is required and standard precaution wear if coming into contact w/ any bodily fluids.

Front 44

What are direct/indirect diseases and precautions?

Back 44

Clostridium difficile, E coli, Shigella, Hepatitis A, Herpes Simplex virus, cellulitis, and scabies. Gown, gloves, Eye protection are required. Direct transmission is germs from infected client directly onto health care workers compromised skin or mucous membranes. Indirect is germs from infected client on an inanimate object or THE HANDS OF HEALTHCARE WORKER. Hand hygiene is essential and alcohol sanitizer is NOT SUFFICIENT.

Front 45

What are the normal range for WBC count, and what are the normal ranges for each type of WBC?

Back 45

WBC=5-10K overall: With 55-70% of this being mature neutrophils, 0-4% stabs (bands), lymphocytes 20-40%, eosinophils 1-4%, and 0.5-1% basophils, and monocytes 4-8%.

Front 46

What is the normal range for RBC counts and what are the normal ranges for each category of RBC?

Back 46

Total RBC normal values are on average 4-6ish, Hgb is 12-18 (women can go as low as 12, but men are slightly higher), Hct 42 -52 with women on the lower end, and platelets 150-400K.

Front 47

Explain neutraphils, bands(stabs) and segs and left shift.

Back 47

Neutrophils are the first responders in inflammation accounting for 50-70% of WBC. Mature neutrophils are also called segmented (segs) or polys (polysegmented neutrophils because the nucleus is segmented into 2-5 lobes connected by strands. An immature netruophil is called a band (for the band appearance of the nucleus), and Although band cells are sometimes found in the peripheral circulation, the mature neutrophil is much more effective. If a person has an ongoing infection they may not have enough mature neutrophils and so the body will try and push out early neutrophils or bands (stabs), which means that a left shift has happened in the hematopoeis cycle of the neurtophil and they are only reaching the band stage (just after myelocyte stage) not quiet reaching maturity. You will also see monocytes in a higher percentage because they arrive after 24 hours of inflammation. Can find the amount of bands/segs to find percentage of left shift neutrophils.

Front 48

Important points about sterile objects are:

Back 48

If the sterile object touches a clean glove, the object is no longer sterile. If a sterile package is torn, punctured or WET, or open, it is considered UNSTERILE. If a sterile object is out of range of vision or held below waist it is contaminated. Avoid air currents around sterile area: No one should talk, laugh, sneeze or cough over a sterile field or when gathering and using sterile equipment. Capillary action can cause contamination: meaning if I place a sterile package on a bedside table that is wet or if I spill sterile solutions on the table and then through capillary action they leak into sterile wrap or kit, it is no longer sterile and I must get rid of the kit. Discard any sterile item that comes in contact with the 1" border.