Immunity Types and Immune Response Overview

Different Types of Immunity

• Active immunity develops when the immune system produces antibodies in response to an antigen entering the body. It develops over several weeks to months and is long-lasting.
• Passive immunity is temporary. It develops when antibodies are created by another human or animal and then transferred to a recipient. They do not independently develop antibodies.

Components of an Immune Response

• T cells are white blood cells (WBCs) playing a central role in the adaptive immune response, primarily through signaling and activating other immune cells. Types include helper T cells and cytotoxic T cells.
• Cytotoxic T cells, activated by helper T cells, destroy infected or cancerous cells by releasing toxins.
• Helper T cells recognize antigens and release cytokines to activate other immune cells, including cytotoxic T cells and B cells, to target the pathogen.
• B cells produce antibodies, proteins that bind to specific antigens on pathogens, marking them for destruction by other immune cells.

Immunosuppressants (Cyclosporine)

• Adverse effects include gingival hypertrophy, hirsutism, hypertension, hyperlipidemia, and nephrotoxicity.
• Patient teaching should emphasize using effective contraception, protective clothing, and sunscreen to decrease skin exposure and thus skin cancer risk.
• Nursing considerations include monitoring white blood cell (WBC) counts, as immunosuppressants can increase infection risk. Monitoring for organ rejection symptoms and kidney function (e.g., BUN/creatinine) is critical due to the narrow therapeutic range of cyclosporine.

MUGA Scan

• MUGA stands for mitigated acquisition scan, a noninvasive nuclear imaging test to assess the heart's structure and function.
• Cardiotoxic effects, such as heart failure, increase with cumulative lifetime doses above 550 milligrams per square meter.

Adverse Effects of Monoclonal Antibodies (Rituximab)

• Rituximab is used for non-Hodgkin's lymphoma, multiple myeloma, and chronic lymphocytic leukemia.
• Adverse effects include infusion reactions, rash, fever, fatigue, nausea, diarrhea, weight gain, bone marrow suppression, cough, increased ALT, hypotension, bronchospasm, and angioedema.

Multiple Myeloma

• Multiple myeloma is a disease where plasma cells excessively produce immunoglobulins, infiltrating the bone marrow.
• CRAB symptoms include elevated calcium levels (hypercalcemia), kidney problems, low red blood cell counts (anemia), and bone damage.
• Nursing considerations involve monitoring blood pressure, checking for signs of headache/seizures due to high hematocrit, and monitoring for thrombosis.

Patho of Different Blood Cancers

• Acute myeloid leukemia is a defect in stem cells, differentiating into all myeloid cell types—monocytes, granulocytes, erythrocytes, and platelets. It commonly affects older patients.
• Chronic myeloid leukemia involves a mutation in myeloid stem cells, leading to uncontrolled proliferation and the formation of the Philadelphia chromosome by the fusion of chromosomes 9 and 22.
• Acute lymphocytic leukemia arises from uncontrolled proliferation of immune cells from lymphoid stem cells. It predominantly affects children but outcomes vary with age.
• Chronic lymphocytic leukemia is a common malignancy in older adults arising from B lymphocytes, typically diagnosed in later adulthood.

HIV

• CD4 T cells are the target of HIV, a retrovirus.
• It replicates by converting RNA to DNA using reverse transcriptase.
• Associated metabolic disorders include hyperlipidemia, insulin resistance, bone disease, and renal disease, amongst others.
• Medications include antiretrovirals like Trimethoprim/Sulfamethoxazole and acyclovir,etc.

Zidovudine, Efavirenz, Saquinavir Mesylate, Enfuvirtide, Maraviroc, HAART

• Zidovudine is a nucleoside reverse transcriptase inhibitor that reduces HIV replication. This results in decreasing HIV manifestations.
• Efavirenz is a nonnucleoside reverse transcriptase inhibitor that stops HIV replication.
• Saquinavir inhibits HIV enzymes needed for replication
• Enfuvirtide blocks the attachment and entry of HIV into CD4T cells.
• Maraviroc binds to CCR5 on cell membranes inhibiting HIV entering lymphocytes,
• HAART is an aggressive treatment using three or more medications to reduce virus and increase CD4 counts, particularly Trimethoprim sulfamethoxazole.

Statins

• Statins are administered orally, with evening dosage recommended as cholesterol is synthesized during the night.
• Adverse effects include hepatotoxicity and myopathy.

Hep A and B vaccines

• Hep A is recommended for children and international travelers aged 2–18.
• Hep B is administered within 24 hours of birth and at 2 months with Tdap and HPV, with second dose at 16-18 years old

STEMI and NSTEMI protocols

• STEMI involves a complete blockage of a major coronary artery, causing significant muscle damage. Treatment includes thrombolytic therapy and percutaneous coronary intervention (PCI).
• NSTEMI involves a partial blockage. Treatment involves cath lab intervention with medications like aspirin, anticoagulants, beta-blockers, and ACE inhibitors.

Medications for MI and chest pain (MONA)

• Morphine, oxygen, nitroglycerin, and aspirin (MONA) are used during myocardial infarction (MI) and chest pain to relieve pain, improve oxygenation, dilate blood vessels, and reduce blood clots. The medications are administered by specific pathways and in a time-sensitive manner.

Hyperthyroidism, Hypothyroidism, Thyroid Storm

• Hyperthyroidism is characterized by a hypermetabolic state, including heat intolerance, weight loss, tachycardia, and nervousness.
• Hypothyroidism is marked by an underactive thyroid, causing cold intolerance, weight gain, lethargy, and constipation.
• Thyroid storm is a life-threatening acute exacerbation, often in untreated hyperthyroidism, characterized by extreme symptoms like tachycardia, hypertension, fever, and altered mental status.

Addison's Disease, Cushing's Disease

• Addison's disease is an adrenal insufficiency marked by hypotension, weakness, and hyperpigmentation. Treatment involves hydrocortisone.
• Cushing's disease involves elevated cortisol levels. Characterized by obesity, moon face, buffalo hump, thin skin, easy bruising, and susceptibility to infection. Treatment is with Ketoconazole

Endocrine Disorders, Lab Values

• TSH (thyroid-stimulating hormone), T3 (triiodothyronine), and T4 (thyroxine) are used to assess thyroid function. Elevated free T4 in hyperthyroidism, while decreased T4 and elevated TSH in hypothyroidism.

Prevention of Bacterial Meningitis, Encephalitis

• Bacterial meningitis is a severe infection of the membranes surrounding the brain, while encephalitis is inflammation affecting the brain tissue. Aseptic meningitis is caused by viral infections, while septic meningitis is caused by bacteria. Proper nursing care emphasizes assessing vital signs, protecting patients from injury related to unusual activity or altered LOC, monitoring electrolytes and urine output.

Lifestyle Changes for Hyperlipidemia

• Lifestyle changes for hyperlipidemia include eating a balanced diet, exercising regularly, and maintaining a healthy weight to control cholesterol and blood lipid levels.

Nursing Considerations for Benzos

• Benzos should be administered with caution, monitoring for adverse effects like respiratory depression, and excessive drowsiness. Interactions with other CNS depressants can increase these effects.

Ascites, Allopurinol

• Ascites is fluid accumulation in the peritoneal cavity, common in liver dysfunction. Treatment involves alleviating the fluid and maintaining electrolyte balance.
• Allopurinol is used to lower uric acid levels, reducing crystal formation. Administered orally or intravenously when a patient cannot swallow.

Proper Administration of Lactulose

• Lactulose is given orally or via NG tube in doses of 15-30 mL (depending on the patient's response), to increase stool frequency for ammonia excretion.

Electrolyte levels (Potassium, Sodium, Chloride)

• Electrolytes like potassium, sodium, and chloride must be monitored, as diarrhea caused by lactulose can disrupt their balance. Their normal ranges need to be closely monitored.

Renal Function Monitoring

• Monitoring BUN (blood urea nitrogen) and creatinine is essential to detect kidney issues that may arise as a complication of the presence of lactulose and other treatment factors.

This quiz covers the different types of immunity, including active and passive immunity, as well as the key components of the immune response such as T cells and B cells. Understand how these immune cells function and their roles in protecting the body against pathogens.