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149 Cards in this Set
- Front
- Back
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The purpose of inflammation and immunity is to meet the human need for protection by _______, _______, or ______ organisms that invade the internal environment.
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neutralizing, eliminating, or destroying organisms
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What are Human Leukocyte Antigens (HLAs)?
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Proteins found on human cell membranes that serve as genetic markers to identify a self cell as a self cell
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Human Leukocyte Antigens provide a unique universal ___ ____ for each person
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product code
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Human Leukocyte Antigens determine the ____ ______ of a person
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tissue type
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What important immune system cells are found in bone marrow
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Stem Cells and leukocytes (WBCs)
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If a stem cell develops into a lymphoid progenitor cell will it work for immunity or inflammation?
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Immunity
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If a stem cell develops into a myeloid progenitor cell will it work for immunity or inflammation?
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inflammation
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Inflammation is "____ immunity"
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natural immunity
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_________ provides immediate protection against the effects of tissue injury and foreign proteins
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Inflammation
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__________ causes visible symptoms and can rid the body of harmful organisms. Tissue damage may result from excessive _______ response.
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Inflammation
inflammatory |
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Cell Types Involved in Inflammation (4)?
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Neutrophils
Macrophages Basophils Eosinophils |
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Is inflammation a specific or non specific body defense?
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non specific
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Sequence of Inflammatory Responses (5 steps)
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Warmth
Redness Swelling Pain Decreased function |
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neutrophils
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phagocytosis then dies
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macrophages
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can phagocytize over and over again
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basophils
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releases histamine and heparin
--> inflammation and bleeding |
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eosinophils
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for allergic reactions
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How many stages are involved in the inflammatory response?
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Stage I (Phase I, Phase II)
Stage II Stage III |
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Stage I of the inflammatory response
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Stage I (vascular)—change in blood vessels (caused by Basophils):
Phase I—constriction Phase II—hyperemia and edema |
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Stage II of the inflammatory response
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Stage II (cellular exudate)—neutrophilia, pus
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Stage III of the inflammatory response
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Stage III- tissue repair and replacement (start healing)
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_______ is a process that occurs in response to tissue injury and to the invasion of organisms.
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Infection
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What is the rule of infection/inflammation working together?
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Infection is usually accompanied by inflammation. However, inflammation can occur without infection.
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Does inflammation mean that an infection is present?
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Not always
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When does infection occur?
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When the bodies defense mechanisms are weaker than the invader.
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_______-______ interactions neutralize, eliminate, or destroy foreign proteins.
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Antigen-antibody
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___-cells dominate in Antibody-Mediated Immunity (AMI)
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B-Cells
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Agglutination
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Clumping of antigens & antibodies
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Innate immunity
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inflammation
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Passive natural immunity
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breatfeeding
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Active natural immunity
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acquiring an infection and making our own antibodies
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Passive artificial immunity
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antibody transfer- IgM, IgA
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Active artificial immunity
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immunization
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___-cells dominate in Cell-Mediated Immunity
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T Cells
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Cell-Mediated Immunity is also called _____ _____
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cellular immunity
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What type of immunity protects the body through the ability to differentiate “self” vs. “non-self” cells and get rid of “infected self” cells that may harm the body.
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Cell-Mediated Immunity (CMI)
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What immunity plays an important role in preventing cancer cell development and metastasis after exposure to carcinogens
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Cell-Mediated Immunity (CMI)
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What cells are involved in CMI? T-helper and T-killer (or Natural Killer) cells
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T-helper and T-killer cells
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T-Killer Cells are also referred to as...
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Natural Killer cells
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Lymphocytes consist of __ cells and ___ cells
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T Cells and B Cells
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2 Types of T Cells
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T-Helper Cells and T-Killer Cells
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T cells are names "T" because they move to this place where they mature
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Thymus
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Helper T Cells Job?
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Help by activating B Cells and killer T Cells
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Killer T Cells Job?
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Attack cells of the body infected by viruses and bacteria also cancer cells
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How do B-Cells activate and work?
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Helper T Cells activate B-Cells. Once activated, they make 2 types of cells- plasma cells and B memory cells.
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What role does the plasma cell play in immunity?
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Produces and antibodies to seek out intruders and help destroy them.
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How do antibodies work?
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They attach to foreign cells so that macrophages will eat them. Also, they neutralize toxins and incapacitate viruses.
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What role do Memory Cells play in immunity?
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These cells have a long lifespan and remember specific intruders. These cells react the next time the specific intruder invades the body.
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What is the complement system?
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a group of proteins that flow freely in the blood and are the first to contact the site of invasion.
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Managed Care
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Organized, high quality, cost effective system of healthcare that influences the selection and use of healthcare services of a population and is designed to control the cost while still maintaining the quality of that care.
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Case Management
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Coordinates an individual’s healthcare to maximize positive outcomes and contains costs. Focus on enhancing continuity of care and effectively using healthcare resources.
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Do case manager nurses give direct patient care?
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-Nurses who are case managers do not give direct care; rather they coordinate the care provided by others.
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Primary Healthcare
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Essential healthcare based on practical, scientifically sound, and socially acceptable methods and technology, made universally accessbile through the community’s full participation and at a cost the community can afford.
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Inpatient
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Is a person who enters a hospital and stays overnight for an indeterminate time (ranging from days to months).
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Outpatient
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Those individuals that do not require inpatient care can receive -treatment, care, and education on an outpatient basis.
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Primary Care Centers
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Delivery of healthcare services, including initial contact and ongoing care
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Ambulatory Care Centers and clinics
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convenient for people to walk into and receive care, offer walk in services, they are also open at times other than traditional office hours (urgent care, same day surg centers, etc
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Home health care
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Nurses provide care in the home, make assessments and provide physical care, administer medications, teach, support family members, collaborate with other healthcare providers to plan and provide patient care.
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Long term care
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Facilities for long-term care that provide healthcare and help with activities of daily living for people of any age who are physically or mentally unable to independently care for themselves.
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facilities that include transitional subacute care, assisted living facilities, intermediate and long-term care, nursing homes, retirement centers, and residential institutions for mentally and developmentally or physically disabled patients of all ages are all part of what kind of care?
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Long Term Care
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Daycare centers
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provide health related services and care to people who do not need to be in a healthcare institution but cannot be home alone.
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Mental Health Centers
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provide individual and group counseling, medications, and assistance with independent linving. Crisis centers provide information and services for victims of rape and abuce.
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Rural Health Centers
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located in geographically remote areas that have few healthcare providers. Many are run by APRN’s in collaboration with a physician who approves protocols for care
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Schools
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Nurses are a major source of health assessment, health education, and emergency care for the nation’s children.
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Industry
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may have their own ambulatory care clinic.
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Rehabilitation centers
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specialize in services for pts. Requiring physical or emotional rehabilitation and for treatment of chemical dependency.
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Respite care
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Caregivers are given a "break" from care. they can have up to 5 days off.
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Hospice services
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a program of palliative and supportive care services providing physical, psychological, social and spiritural care for dying persons, their families and other loved ones.
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Bereavement care
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continued for the family 1 year after the death of the pt. to help with the grieving process.
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Pallative Care
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is not restricted to end of life, it is focused on the relief of physical, mental and spiritural distress, & is provided by an interdisciplinary team.
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Parish nursing
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emphasizes holistic healthcare, health promotion, and disease-prevention activities within a faith community.
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Veterans administration and military agencies
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provide health care to Veterans and active members of the armed forces and their immediate families.
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Public Health service
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a federal health agency under the direction of the U.S. Department of Health and Human Services. Provides care for Native Am, Poor and uninsured, migrant workers, federal prisons, etc
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Public Health Agencies
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provide public health services at the local, county, state, or federal level.Prenatal care, well-child care, screening programs, education, and outreach into the community.
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Medicare
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Serves population > 75, people on dialysis, permanently disabled workers and dependents, pays based on DRGs, federally funded
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Medicaid
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Federally funded public assistance, any age with low incomes
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Health Maintenance Organizations
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group-managed care plan.patient does not have a choice about healthcare providers but receiveds all services from physicians who are associated with or are part of the HMO.
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Preferred Provider Organizations
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Pt.’s may seek outside the panel without referral by paying additional out of pocket expenses.
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Important trends in nursing
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increased focus on preventative care, more patient knowledge on health related issues, pts leaving hospital sicker and quicker, more need for home health care nurses, technology explosion, increased costs of healthcare
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*5 core competencies*
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communication
knowledge technical skills critical thinking values in clinical practice |
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When does discharge planning begin?
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Upon the patients admission
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What is medicare DRG?
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Diagnoses related groups- pays hospitals a fixed amount that is predetermined by the medical diagnoses or specific procedure rather than the actual cost
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What is the maximum hospital stay for CHF for medicare patients?
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7 days
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Antibodies are produced by....
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Plasma Cells (A type of B Cell)
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Each B Cell can be sensitized to how many types of antigen?
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Only 1
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Circulating antibodies can be transferred from one person to another to provide the receiving person with immediate immunity of ___ ______
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short duration
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What is inactivation/neutralization?
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process of making an antigen harmless without destroying it
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sustained immunity
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provides us with long lasting immunity to a specific antigen
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What is the most effective and longest lasting immunity?
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Natural active immunity
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What type of immunity is important in preventing the development of cancer and metastasis after exposure to carcinogens?
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Cell Mediated Immunity
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Osteoarthritis
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AKA degenerative joint disease.Progressive DETERIORATION and loss of CARTILAGE in one or more joints.
"Bone Spur", "Wear & Tear" |
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Osteoarthritis--> nodal/ non-nodal
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Mean with or without hand involvement
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Is Osteoarthritis an autoimmune/inflammatory disease?
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NO.
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Risk Factors for osteoarthritis
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aging, genetic changes, OBESITY, smoking, trauma, women > 50, Women more than men
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sites for osteoarthritis
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weight-bearing joints (hips knees), vertebral column, hands (nodal)
"Single joint" |
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Dx tests for osteoarthritis
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X-Ray, MRI, ESR, CRP
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Med Treatments for osteoarthritis
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Pain mgmt, surgery (TJR, THR, Osteotomy) NSAIDS
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Nursing assessment for osteoarthritis
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assess gait, pain,
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Patient Teaching for osteoarthritis
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home health care, weight control, lifestyle changes, risk for injury, body mechanics
restless leg syndrome? |
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Biggest Risk Factor for osteoarthritis?
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*Age and *more prevalent in women
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Rheumatoid Arthritis (RA)
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Chronic systemic inflammatory disorder leads to destruction of articular cartilage and ankylosis (fusion) of joints
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Is Rheumatoid Arthritis and autoimmune disease?
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YES- lots of inflammation
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Risk factors for Rheumatoid Arthritis
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30-45 y/o women, infectious organisms, genetics, stress, european americans
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Sites for Rheumatoid Arthritis
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Synovial joints, many tissues and organs
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Diagnostic tests for Rheumatoid Arthritis
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No single test for RA.
X-Ray, CT Scan, arthrocentesis, bone/joint scan, MRI, other labs |
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Medical Treatments for Rheumatoid Arthritis
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NSAIDS, immunosuppressives---> METHOTREXATE
Surgery |
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What to assess when looking for Rheumatoid Arthritis
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Deformaties, NODUALS, swelling, pain, fever, wt loss
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What to teach pts who have Rheumatoid Arthritis
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drug therapy, coping, balance activity/rest, swimming best on body,
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RA etiology is unclear but it is a combination of ___ and ____ factors
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genetic and environmental
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Early signs of Rheumatoid Arthritis
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joint stiffness, swelling, pain, migrating symptoms
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Late signs of Rheumatoid Arthritis
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Gel Phenomenon- morning stiffness, effusions- joint swelling with fluid, bakers cysts- enlarged popliteal bursae behing the knee
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Late Disease exacerbations
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subcutaneous nodules and skin lesions around the nail beds
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Lupus (SLE)
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chronic progressive, inflammatory disorder, connective tissue disorder
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Is Lupus an Autoimmune Disease?
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YES
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Which organs are the most afected by Lupus?
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The Kidneys- they will fail.
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Risk Factors for Lupus
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Genetic, environment, female
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Sites for Lupus
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Butterfly rash on face, immune system, connective tissue, kidneys, heart, CNS
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Dx test for Lupus
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Lupus test (CBC, ESR, ANA can accompany)
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MEdical Tx for Lupus
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topical meds, systemic meds, METHOTREXATE/ cortizone cream
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Things that nurses should assess with Lupus pts
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Fatigue, fever, pts may need kidney transplant
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Scleroderma
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Chronic inflammatory autoimmune connective tissue disease
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Is Scleroderma an autoimmune disease?
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YES
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Scleroderma diffuse
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skin thickening on trunk, face, and proximal/distal extremities
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Scleroderma limited
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thick skin limited to sites distal to elbows and knees but also face and neck
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Scleroderma Risk Factors
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Women, >40, coal miners, increased exposure to toxins
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Scleroderma sites
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Integumentary system, kidneys, GI
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Dx tests for Scleroderma
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skin biopsy, ESR CBC, Slotting factors
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Scleroderma med tx
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NSAIDS, steroids (for inflammation), immunosuppressants
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Teaching for pts with Scleroderma
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Avoid getting sick (immunocompromised), protect skin, psychosocial, speech therapy, coping skills, no smoking
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Scleroderma means...
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hardening of the skin
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Leading cause of death for both scleroderma and Lupus
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Renal failure/involvement
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Gout
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systemic disease in which URATE CRYSTALS deposit in JOINTS and other body tissues causing INFLAMMATION
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Gout AKA
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Gouty Arthritis
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Is Gout and autoimmune disease?
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NO
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Primary gout
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inborn errors of purine metabolism
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secondary gout
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hyperuricemia- caused by another disease or factor
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Dx tests for Gout
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serum uric acid (>8.5 mg/dL) and urinary uric acid levels, SYNOVIAL ASPIRATION, Renal Fx tests
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Risk Factors for Gout
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X-linked, family history, middle aged men, post menopausal women
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Treatments for gout
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Drug therapy, nutrition/diet *NO RED MEAT OR ORGANS, NO ALCOHOL, increase fluid intake
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Sites for Gout
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Joints- esp the big toe "Podagra," under skin- "Tophi," renal calculi//stones
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Drug Therapy for Gout
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Combination of colchicine and NSAIDS, allopurinol
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Fibromyalgia
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Brain Dysfunction (Thalamus & hypothalamus) chronic pain syndrome
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Is Fibromyalgia an autoimmune disorder?
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NO- not an inflammatory disease
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Risk Factors for Fibromyalgia
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Female 30-50 y/o, meds, trauma, lyme disease,
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Sites for Fibromyalgia
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"TRIGGER POINTS" Back of neck, upper chest, trunk, lower back, extremities
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Diagnosing Fibromyalgia
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Presence of pain in trigger points as well as ruling out other diseases/disorders
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Medical Treatments for Fibromyalgia
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CAM, Antidepressants, SSRIs, Physical Therapy
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What to assess with Fibromyalgia
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mild to severe fatigue, sleep disturbances, headaches, muscle tenderness, sensitivity to odors, bright lights
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What to teach for Fibromyalgia
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limit caffeine/alcohol, anything that will interfere with deep sleep, regular exercise
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