Level I W2013

• first line: always on guard
• inflammatory response
• immediate maximal response
• not Ag specific, no memory

• second line: help when needed
• immune response
• lag time for maximal response
• Ag specific w/ memory

• non-specific, inflammation
• eosinophil
• neutrophil
• basophil

• immune response
• B lymphocytes
• T lymphocytes
• NK cells

• mast cells
• dendritic cells

<4000WBC

>10000WBC

• first responders
• infection, tissue damage, necrosis
• phagocytic
• defend against bacteria

• protect mucosal surfaces
• effective against fungus
• acute allergic/anaphylactic response
• release chemicals that promote inflammatory response - histamine, heparin, serotonin, cytokines

vasodilates, increases vascular permeability, increases migration of other WBC to site of infection

inhibits coagulation of blood

• Large amounts in GI & respiratory
• increase w/ allergic responses
• --IgE mediated responses
• React with products from basophils, mast cells, lymphocytes
• --releases histaminase
• Protects against allergy and parasites

• phagocytic
• present foreign invaders to lymphocytes
• increase w/ chronic inflammation & acute infections

• B-cells & T-cells: specific immunity
• B-cells - humoral immunity or AMI
• T-cells - cell mediated immunity
• Recognize foreign substances
• T & B cells develop memory cells
• increase w/ chronic & viral infections

• fixed in tissues: mucous membranes & connective tissue
• responsible for antigen presentation
• mast cells: histamine release
• dendritic: thread-like tentacles to capture Ag to present to B & T cells

attraction neutrophils to site through cytokine release

• cascade of lytic proteins that aid in pathogen destruction
• 1. facilitates lysis of cell membranes (cytolysis)
• 2. Help in attracting phagocytes to the antigen (chemotaxis)
• 3. Increase vascular permeability (anaphylaxis)
• 4. Make antigens more susceptible to phagocytosis (opsonization)

• released by cells when needed
• act as messengers between cell types
• mediate & regulate nonspecific & specific immunity
• stimulate hematopoeisis

• Interleukins - cancer killer
• Interferon - stimulates immmune of cancer patient and multiple sclerosis
• Tumor Necrosis factor: RA
• Colony-stimulating factor: neupogen - for neutropenia, erythropoietin - bone marrow production

• reaction at the vascular & cellular level
• helps prevent/limit entry of invader/injury
• causes: physical irritants, chemical irritants, microorganisms
• can have inflammation with infection
• Can't have infection without inflammation

• I: vascular response
• II: cellular response
• III: tissue repair/replacement

swelling, pain, heat, redness

movement of leukocytes through capillary wall

• anti-inflammatory, antipyretic
• action: inhibit formation of prostaglandin
• Types - aspirin, ibuprofen, naproxen, indomethicin, celecoxib
• S/Sx: bleeding, GI upset, monitor renal function, ringing in ears
• Warfarin potentiates effect
• Drink plenty of water

• acetaminophen:
• action - inhibits prostaglandin synthesis in CNS, adverse effects: thrombocytopenia, liver toxicity
• Nursing: monitor liver/kidney function, CBC, 3g/day, careful when taking with NSAIDS, antidote - acetylcysteine: mucomyst

• cortisone, hydrocortisone, methylprednisolone, prednisone, prednisolone, betamethasone, dexamethasone
• Prevents increased capillary permeability, suppresses cytokine release, suppresses prostaglandin production, decreases immune system

depression, mood changes, hypertension, thromboembolism, high blood cortisol, peptic ulceration, hyperglycemia, adrenal suppression, cushings appearance, weight changes, hypokalemia, GI upset: N/V, insomnia, hyperkalemia

• assess for adverse effects
• observe mental changes
• do not stop medication, must be tapered
• take with food or milk
• increase foods with K+
• monitor glucose levels
• avoid individuals with colds
• restrict Na+
• Monitor weight

• allergic response
• B-cells from bone marrow produce antibodies,
• Humoral AMI extra cellular response,
• which is immediate reaction

• Type I allergic
• Type II cytotoxic reaction
• Type III Immune complex such as in RA

• involve in Ag/Ab reactions
• circulate through lymph tissue until contact made with Ag
• transform into plasma cells - create & secrete Ag specific Ab = immunoglobulins
• IgD helps in B-cell differentiation
• Memory B-cells also produced

• primary immunity
• protection from gram- bacteria
• blood transfusions

• secondary immunity
• passes placental barrier
• passive immunity
• enhances phagocytosis
• provides sustained viral & bacterial immunity

• provides protection at mucosal level
• passes through breast milk
• important in viral & respiratory pathogens

assist in B-cell differentiation

• allergic reactions
• protection from parasites
• local or systemic

• initial exposure to antigen
• latent or lag time during antigen processing (48-72hrs)
• activated helper Tcells trigger Bcells to proliferate and differentiate
• antibody levels rise over period of 10-14days
• IgM major player

• subsequent exposure to antigen
• memory cells recognize antigen - antibody levels rise quickly ie booster immunizations
• IgG major player

• T-cells from thymus
• NK kill slowly in intracellular space
• delayed reaction
• protects against viruses, fungi, parasites, slow growing bacterial infections
• responsible for rejection of transplanted organs and tissues
• causes skin hypersensitivity reactions, survey for malignant cells

• differentiate in the thymus
• self vs. non-self or damaged/infected self cells
• regulate the immune response: essential for AMI
• produce & release cytokines that influence AMI & inflamation
• distinguish by surface proteins = CD antigens cluster of differentiation

• activated by Ag presenting cells
• function to help activate cytotoxic T cells & macrophages
• activate & stimulate Bcells
• do not attack & destroy directly

• effective against self cells infected by viruses, protozoa and tumors
• attaches to self, drills hole, inserts enzyme, releases and moves on
• autoimmunity may occur

• do not need previous sensitization
• lyse tumor cells, virally infected cells, and transplanted grafts
• surveyor of malignant cell changes

• Inflammation: defect in neutrophil function not #, leukocytosis may not occur
• Ab-mediated immunity: decline in natural antibodies, decreased response to antigens
• Cell-mediated immunity: thymic activity decreases, circulating T-lymphocytes decrease

• may have infection but not noted on CBC
• slight changes in VS: should be seriously evaluated
• Need immunizations & boosters
• stay away from people with colds
• skin, mucous membranes, resp & GU tracts increased risk for infections

• invasion of body by pathogenic antigen and the reaction of tissues to their presence and toxins
• etiology: primary infection, secondary infection that causes a problem due to compromised immune system, opportunistic infection - neutropenic phase precautions

• tacchycardia >90/min
• hypo/hyper thermia
• RR >20
• PaCO2 <32
• WBC <4000, >20000

Age, location of infecting organism, status of organ function, pregnancy/lactation, likelihood of resistance, provider preference

• allergy & anaophylaxis
• N/V & diarrhea
• bone marrow suppression
• hepatotoxicity & nephrotoxicity
• superinfections

• -cin, -mycin
• IM, IV
• bactericidal broad spectrum gram-
• adverse effects: ototoxicity, nephrotoxicity, neuromuscular blocking-respiratory paralysis
• Loop diuretic increases ototoxicity

• Peak & trough
• monitor hearing
• monitor renal function and I & O
• encourage hydration
• slow IV admin
• careful monitoring after anesthetics or muscle relaxants

• -cillin
• bactericidal broad spectrum for gram+
• Adverse effects: hypersensitivity, anaphylaxis, phlebitis at IV site, pseudomembranous collitis, serum sickness, superinfections

• ceph-
• bactericidal, use - septicemia, bone, joint, UTI, surgery
• Adverse effects: phlebitis, pain with IM injections, pseudomembranous colitis, nephrotoxicity, hepatotoxicity, bleeding tendencies, superinfections & serum sickness.
• 2-10% of those allergic to penicillin will be allergic to cephs

• assess for allergies to med
• monitor CBC, s/s bleeding
• admin slowly
• give deep IM ztrack
• assess GI status
• teach s/s of superinfections
• report signs of serum sickness: fever, skin reactions, joint pain, lymph node swelling

• -cycline
• action: broad spectrum bacteriostatic
• Use: chlamydia, mycoplasma, gonorrhea, spirochetes, acne, anthrax, penicillin allergies
• Adverse effects: photosensitivity, chelating to new teeth bone, teeth staining

• avoid use with pregnancy, children less than 8 and nursing women
• monitor CBC
• monitor for signs of hypersensitivity
• monitor signs of I & O
• avoid sun up to 3 days past last dose
• use sunscreen
• avoid taking with dairy products, antacids

• -mycin
• vacteriostatic, broad spectrum
• Use: allergy to penicillin
• adverse effects: hepatitis, ventricular arrhythmias
• Nursing: assess cardiac status, may need ECG, monitor for hepatotoxicity, do not give with antacids, take with full glass of water on empty stomach

• pale stool
• dark urine
• jaundice

• -oxacin
• bactericidal effect: broad spectrum gram- UTI & systemic infections
• Adverse effects: suprainfections, elevated BUN, creatinine, liver function tests, stevens-johnson syndrome, photosensitivity, achilles tendon rupture, rabdomyolysis: breakdown of muscle tissue, hypoglycemia

• use sunscreen, avoid sun
• monitor liver & kidney function
• admin with water before meals
• avoid antacids
• monitor for stevens johnson syndrome: fever, ulcerations, joint pain, bullae of skin >5mm(blister)

• sulf-
• bacteriostatic
• UTI, otitis media, vaginitis, eye
• Adverse effects: hypersensitivity, stevens-johnson syndrome, hemolytic reaction - fever, photosensitivity, neurologic effects

observe skin & mucous membranes, monitor temp, monitor I & O force fluids, monitor CBC, avoid direct sunlight, use sunscreen

• bactericidal
• use: life threatening infections: MRSA, MRSE & c-diff
• adverse effects: ototoxicity, nephrotoxicity, thrombophlebitis, red man syndrome, chills, fever, tacchycardia, itch(pruritus)
• Tx: anti-histamine

• admin in dilute solution over at least 60min
• monitor I & O & kidney function
• check BUN & creatinine during treatment
• monitor levels: peak and trough
• monitor hearing
• slow infusion if red man syndrome occurs
• give cautiously