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What is a type 1 hypersensitivity reaction
- allergic reaction
- governed by IgE immunoglobulin
- histamine is released
- occurs as a positive reaction to a scratch test
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what bodily changes are caused with the release of histamine
- vasodilation
- changes in vascular permeability
- increased mucous production
- contraction of various smooth muscles
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what is allergic rhinitis
- aka hay fever
- type 1 hypersensitivity reaction
- SnS: sneezing, nasal itching, runny nose, itchy red eyes, dark circles under eyes
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what is atopic dermatitis
- aka eczema
- type 1 inflammatory skin response
- causes pruritus, edema and extremely dry skin followed by eruptions of tiny vesicles
-
therapeutic measures for atopic dermatitis (eczema)
- lukewarm soaks followed by application of emollients and oil-in-water lubricants (alpha keri oil)
- topical corticosteroids
- wear cotton clothing
- humidification in winter to prevent dryness
-
type 1 hypersensitivity reactions
- allergic rhinitis
- anaphylaxis
- urticaria
- atopic dermatitis (eczema)
- angioedema
-
what is a common side effect of ace inhibitors
angioedema
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pts with certain underlying conditions are sususceptible to urticaria; what are these conditions
- lupus erythematosus
- lymphoma
- hyperthyroidism
- cancer
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what is angioedema
- form of urticaria
- affects submucosal and subcutaneious tissues
- painless and minimally pruritic
- dermal erythematous and sucbcutaneous eruptions
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what is a type 2 hypersensitivity reaction
- destruction of a cell or substance with an antigen attached to its membrane
- sensed by IgG or IgM
-
hemolytic transfusion reaction
- RBC lysis because of incompatible antigens; ABO or RH
- cellular debris occludes blood vessels
-
signs and symptoms of hemolytic transfusion reaction
- sudden onset of low back or chest pain
- hypotension
- chills
- tachycardia
- tachypnea
- wheezing
- dyspnea
- urticaria
- anxiety
-
type 3 hypersensitive reactions
- autoimmue reactions
- serum sickness
- red edematous skin lesions
- hemorrhage
- necrosis
-
serum sickness
- type 3 hypersensitivity reaction
- usually occurs after given penicillin or sulfonamide
- occurs 7 - 10 days after exposure
-
type 4 hypersensitivity reaction
- delayed reaction by a T lymphocyte
- contact dermatitis
- transplant rejection
-
contact dermatitis
- type 4 hypersensitivity reaction
- T lymphocytes destroy foreign body
- poison ivy
- tb test
- latex allergy
- transplant rejection
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pernicious anemia
- antibodies destroy gastric parietal cells
- causes decreased production of intrinsic factor
- pt develops b12 deficiency
- causes decreased rbc production
-
signs and symptoms of pernicious anemia
- increasing weakness
- loss of apppetite
- glossitis (inflammation or infection of tongue)
- tingling in extremities (peripheral neuropathy)
- confusion
- irritabiltity
-
are immunosuppressive drugs required for life after an organ transplant
- yes
- pt at high risk for infection
-
idiopathic autoimmune hemolytic anemia
- antibodies lyse or agglutinate (clump) RBCs
- mild fatigue
- pallor
- severe hypotension
- dyspnea
- palpitations
- jaundice
-
treatment for idiopathic autoimmune hemolytic anemia
- folic acid to increase RBC production
- spleenectomy to stop RBC destruction
-
hashimotos thyroiditis
- autoantibodies bind with hormone receptor sites on the thyroid and causes hyperthyroidism
- eventually other autoantibodies destroyt thyroid cells causing hypothyroidism
-
signs and symptoms of hyperthyroidism
- restlessness
- tremors
- chest pain
- increased appetite
- diarrhea
- moist skin
- heat intolerance
- weight loss
-
signs and symptoms of hypothyroidism
- bradycardia
- hypotension
- dyspnea
- anorexia
- constipation
- dry skin
- weight gain
- facial puffiness
- cold sensitivity
- slowing of mental process
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signs and symptoms of discoid lupus
patchy, crusty, sharply defined skin plaques; occur on face or sun exposed areas
-
how does lupus affect the skin
- butterfly rash
- photosensitivity
- mucosal ulcers
- alopecia
- pain
- pruritis
- bruising
-
how does lupus affect the musculoskeletal system
-
how does lupus affect the blood
- anemia
- leukocytopenia
- eleveated ESR
- thrombocytopenia
- false positive VDRL
-
how does lupus affect the heart
- pericarditis
- myocarditis
- myocardial infarction
- vasculitis
- pleurisy
- vlavular heart disease
-
how does lupus affect the renal system
- renal failure
- uti
- fluid and electrolyte imbalance
-
how does lupus affect the central nervous system
- cranial neuropathies
- cognitive impairment
- mental changes
- seizures
-
how does lupus affect the GI system
- anorexia
- ascites
- pancreatitis
- intestinal vasculitis
-
how does lupus affect the eyes
- conjunctivitis
- dry eyes
- glaucoma
- cataracts
- retinal pigmentation
-
lupus treatments
- NSAIDs (motrin, indocin, naprosyn)
- immunosuppressants (imuran, sandimmune, rheumatrex)
- corticosteroids (decadron, solu-medrol, solu-cortef, deltasone)
- antimalarials (aralen, paquenil)
- intravenous immunoglobulin
-
ankylosing spondylitis
- inflammatory disease of the spine and sacroiliac area
- may cause spinal fusion
- positive test for HLA B27 antigen related to the disease
-
signs and symptoms of ankylosing spondylitis
- lower back stiffness and pain; worse in morning
- normal curvature of lower back flattens
- upper back curvature increases
-
hypogammaglobulinemia
- deficiency of one or more immunoglubulin
- increased chance of infection
- infant asymptomatic until 6 months; maternal immunoglubulins gone
-
humoral immunity
involves B cells
-
cell-mediated immunity
involves T cells
-
chain of infection
- reservoir
- causative agent
- mode of transmission
- portal of entry
- susceptible host
- portal of exite
-
how does direct contact transmission occur
- touching, kissin, sexual contact,
- droplet spray into eyes or mucous membrane; sneezing, coughing spitting, singing, talking
- biting
-
name some diseases spread through contact transmission
- influenza
- stds
- c. diff.
- conjunctivitis
- herpes
- impetigo
- pediculosis
-
droplet spread is usually limited to what distance
3 feet
-
how does indirect contact transmission occur
- spread by contaminated object; vehicleborne
- spread by infectious organism; vectorborne
-
Can conjunctivitis, trichonosis, HIV and hepatitis A, B, C, D and E be spread by indirect contact?
yes
-
airborne contact
- particles float in air for a long time and may travel long distances
- may be inhaled or deposited on mucous membrane of susceptible host
-
are measles, chickenpox and tuberculosis transmitted by airborne transmission
yes
-
is chickenpox transmitted through direct, indirect and airborne transmission
yes
-
steps in the inflammatory response
- vascular: local vasodilation increases blood flow, creates redness and heat
- inflammatory exudate: swelling caused by plasma entering tissue
- phagocytosis and purulent exudate: destruction of pathogens creates pus
-
manifestation of localized infection
pain, redness, swelling and warmth at site
-
manifestation of generalized infection
- headache
- malaise
- muscle aches
- fever
- anorexia
- hypotension
- mental confusion
- tachycardia
- shock
-
naturally acquired passive immunity
baby acquires immunity through breast milk
-
artificially acquired passive immunity
- injection of antibodies from an outside source
- hep B injection
-
what 3 things happen to our immune system as we get older
- less efficient immune response
- increased perception of body's tissue as foreign
- malignant cells not destroyed as quickly (higher chance of cancer)
-
community acquired infection
pt has infection before admitted to hospital
-
which areas within a hospital have an increased number of nosocomial infections
- icu
- neonatal
- dialysis
- oncology
- burn unit
-
iatrogenic infection
- caused by treatment given to pt
- immunosupressants to reduce organ rejection increase risk of infection
-
what must be done when transporting a pt under airborne precautions
provide pt with surgical mask
-
do pts with influenza recquire droplet precautions
- yes
- must maintain distance of 3 ft from pt
- wear mask upon entering pt room
- surgical mask when transporting pt
-
if a pt has severe sepsis which drug may be given
drotrecogin
-
which drug is used to treat MRSA
vancomycin hydrochloride
-
which drug is used to treat VRE
- synercid (quinupristin/dalfopristin)
- zyvox (linezolid)
-
ampicillin, cephalosporins and clindamycin are known to have which side effect
diarrhea
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effect of reverse transcriptase
- forces human cell to produce new dna from viral rna
- human cells are tricked into creating more viral particles
-
initial stage of hiv
- lasts 4 - 8 weeks
- high levels in blood
- acute retroviral syndrome: generalized flulike symptoms
-
retrovirus
RNA is made into DNA not vice versa
-
latent stage of hiv infection
- lasts 2 to 12 years
- virus is inactive
- high levels in lymph nodes but low in blood
- pt asymptomatic
- cd4 cells decline
-
third stage of hiv infection
- lasts 2 - 3 years
- pt gets opportunistic infections
- cd4 cells usually below 500
- blood viral levels increase
- AIDS when cd4 < 200
- usually die within 1 year
-
how is hiv transmitted
- blood
- vaginal secretions
- semen
- fetal transmission
- breast milk
-
how is perinatal transmission of hiv prevented
- antiretroviral therapy during pregnancy, labor and delivery (zidovudine [AZT, retrovir])
- infant given zidovudine for 6 weeks
-
first action that should be taken if accidentally exposed to hiv
wash site with soap and water immediately
-
medications given post accidental exposure to hiv
- zidovudine and lamivudine
- or combivir
-
AIDS is diagnosed when the cd4 count is below which number
200
-
AIDS wasting syndrome
- loss of more than 10% of baseline body weight
- chronic weakness or fever, or chronic diarrhea longer than 30 days
-
common opportunistic infections associated with aids
- candida albicans
- cytomegalovirus
- pneumocystis jioveci pneumonia
- tuberculosis
- viral infections
- kaposi's sarcoma
-
candida albicans
- common opportunistic infection associated with AIDS
- 80% of pts develop it
- oral or esophageal pain
- dysphagia
- yellow-white plaques in mouth and throat
-
cytomegalovirus
- opportunistic infection associated with AIDS
- usually affects eyes
- may cause vision impairment or blindness
- transmitted through bodily fluids and blood through unprotected sex
-
pneumocystis jiroveci pneumonia
- common opportunistic infection associated with AIDS
- fungal
- acquired by inhalation
- shortness of breath, non productive cough and fever
- second leading cause of death in AIDS pts
- treated with bactrim, dapsone, clindamycin and pentamidine
-
HIV testing pattern
- ELISA test
- if positive, repeat ELISA
- second positive, Western Blot Test
- if all positive, HIV diagnosed
-
purpose of genotyping in hiv pts
measures resistance to current antiviral treatments
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