Immunology Pathophysiology and Pharmacology Book PDF

29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle Immunology Pathophysiology and Pharmacology Book Site: Federation University Moodle Printed by: Dajou Buloba...

29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle Immunology Pathophysiology and Pharmacology Book Site: Federation University Moodle Printed by: Dajou Buloba NURBN 2027 SEM2 2024: Nursing Context 7: Date: Tuesday, 29 October 2024, 1:52 PM Course: Pathophysiology and Pharmacology Applied to Person- Centered Nursing Practice B Combined 001 Book: Immunology Pathophysiology and Pharmacology Book Table of contents 1. Introduction 2. Scenario 3. Overview of the Immune System 3.1. The immune response 3.2. Humoral Immune Response 3.3. Cell Mediated Immunity 4. Hypersensitivity reactions 4.1. Blood Transfusion Reaction 4.2. Transplantation rejection 5. Pharmacologic management of allergic reactionsReaction 5.1. Medications to treat allergic reactions 6. Cancer 6.1. Medical management of cancer https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 1/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle 1. Introduction  Learning Objectives Upon completion of the week 's content and with further reading you will be able to 1. 1. Differentiate between allergy, autoimmunity and alloimmunity reactions. Give an example of each 2. Describe the hypersensitivity reactions type 1, type 2, type 3 and type 4. Discuss the the pathophysiology and clinical manifestations. (Examples for each are Type 1 anaphylaxis, Type 2 Graves disease, Type 3 Rheumatoid arthritis, type 4 Type 1 Diabetes Mellitus. 3. Describe the difference between humoral immune response and cell mediated immunity 4. Pharmacology Describe the class, mode of action, side effects, contraindications and nursing considerations of 1. Anti-histamine 2. IM adrenaline 3. Hydrocortisone 5. Discuss the Pathophysiology of cancer 6. Describe the use, purpose and effect of Chemotherapy  Alignment to Assessment Information in this Week will assist in the successful completion of Assessment Task : Practical Exam  Time Allocation Reading through this book and completing all associated activities is expected to take approximately 4-6 hours and must be done PRIOR to attending any scheduled synchronous class. https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 2/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle 2. Scenario  Activity - Scenario Complete the scenario to prepare for the pathopthysiology book: https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 3/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle 3. Overview of the Immune System Immunity denotes a series of events that takes place in the body to provide protection to our body. Even when our immune system is functioning normally; the person may still experience infections if they are exposed to a sufficient number of pathogens (micro- organisms) or a virulent strain of microorganisms. While our immunity strives to return our body to homeostasis; sometimes the immune system is insufficient or inappropriate. In appropriate immune response may be 1. Exaggerated against antigen (a toxin or foreign substance that induces an immune response and causes the release of antibodies; commonly known as allergy 2. Directed against transplanted foreign tissues such as organ transplants or blood transfusions 3. Misdirected against the body's own cells what is known as autoimmunity 4. Insufficient to protect the host such as a acquired immune deficiency disease. Innate immunity Also called natural or non-specific immunity, provides general or non specific protection that is present at birth and protects the body by providing a natural barrier, activating cells that limit and destroy the ability of foreign substances to enter and spread. This immunity does not need to identify what the specific pathogen is to get activated. It consists of two levels of protection 1. Skin and mucous membranes which form a physical barrier creating a first line of defence to prevent foreign bodies from penetrating. This is mainly conducted by the epithelial cells which line the cavities and body surfaces which secrete substances intended to trap and destroy the pathogens such as mucus, sweat, saliva and earwax. a range of non-pathogenic bacteria called the normal bacterial flora also contribute to our innate immunity. 2. A range of cells, chemicals and processes that are activated if a foreign body breaks the first line of defence or of their is cell injury. This forms the body's second line of defence. The cellular components are: Phagocytes which consist of neutrophils and monocytes (two types of white blood cells) , originate in the bone marrow. Neutrophils are first responders and move rapidly to the cite of the infection to initiate phagocytosis. Monocytes are an immature form of white blood cells that become macrophages when they migrate to the site of infection. These supplement and replace neutrophils. Watch this video to understand how phagocytosis takes place Phagocytosis Animation https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 4/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle Natural Killer cells their main function is to recognise and eliminate cells infected with viruses and abnormal host cells specifically cancer cells. They are derived from a type of white blood cells called the lymphocytes. These cells have the ability to kill cells that are abnormal and have receptors that allow them to recognise differences between tumor/infected cells and normal cells. Chemical mediators that enable the immune and inflammatory cells to function more efficiently and assist in their coordination. These chemical mediators include: Cytokines which are small proteins that are crucial in controlling the growth and activity of other immune system cells and blood cells. When released, they signal the immune system to do its job. Cytokines affect the growth of all blood cells and other cells that help the body's immune and inflammation responses. Interferons a family of cytokines responsible for protecting cells against viral infection. Interferon alpha and beta induce the production of antiviral proteins while interferon gamma enhances the inflammatory response by increasing the activity of macrophages ; it also facilitate the development of acquired immunity against viral antigens. Adaptive immunity Adaptive immunity, often called immune response, is the 3rd barrier to foreign (non-self) substances called antigens. It is specific against microorganisms and has memory so it can provide permanent or long term protection. Being able to remember specific foreign substances is important because it accelerates the immune response when the same foreign substance is encountered thereafter. Key difference to innate immunity is that it is slower and very highly specific. Lets look at how the body differentiates between normal and foreign cells. Antigens: Each cell in the body can be identified as self. These cells are not normally attacked by the immune system The cells in the body contain a marker consisting of proteins. The immune system recognises non self cells via antigens which determine if an immune response should be initiated. To be antigenic, part of the foreign molecule must be recognised by the immune system and become bound to an antibody or to specific receptors on a lymphocyte in a lock and key manner. The degree to which an antigen is immunogenic depends on 1. the foreignness to the host 2. adequate size 3. adequate chemical complexity 4. being present in sufficient quantities Watch these videos to understand how a primary and secondary immune response develop in the body as a result of recognising the antigen PRIMARY IMMUNE RESPONSE AND SECONDARY IMMUNE RESPONSE Humoral immunity produces antigen-specific antibodies and is primarily driven by B cells. Cell-mediated immunity on the other hand does not depend on antibodies for its adaptive immune functions and is primarily driven by mature T cells, macrophages and the release of cytokines in response to an antigen. https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 5/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle Watch the video to enable the understanding of the difference between the humoral immune response and cell mediated immunity HUMORAL IMMUNITY vs CELL MEDIATED IMMUNITY https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 6/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle 3.1. The immune response This section explores how an immune response begins. The antigen is central to this process because its presence triggers the activation of B and T cells to differentiate into their respective cells subsets. this generally occurs in the lymphoid organs where an antigen selectively reacts with a B or T cells. Under the control of cytokines, the selected B cells differentiate and proliferate into plasma cells that produce antibodies and selected T cells that can attack cellular targets. The B and T memory cells will respond quicker should the body have an exposure to the same antigen. Hence, the immune response id divided into two phases 1. The primary response characterised by the release of IgM antibodies followed by IgG against the same antigen. This serves to "prime" the body's immune system. 2. The secondary response characterised by a more rapid and larger production of antibodies than the primary response. the rapidity is due to memory B and T cells that do not require further differentiation. IgG production is increased significantly making it the predominant antibody in this phase. https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 7/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle 3.2. Humoral Immune Response As we have mentioned before, the primary function of the B cell differentiation is to 1) produce plasma cells that secrete antibodies in response to antigens 2) produce memory cells that accelerate the immunity when the antigen is re encountered. Here we explain further the types and effects of antibodies. Antibodies Also called immunoglobulins (Ig) are proteins found in body fluids and produced by mature B cells (plasma cells) in response to an antigen. there are five classes of immunoglobulins IgG most abundant and accounting for most protective activity against infections. IgG is transported from the mother through the placenta into the fetus IgA found in blood and body fluids such as tears, saliva and digestive fluids. Important in preventing infectious microorganisms from attaching to epithelial barriers. IgM is found in blood, is the largest immunoglobulin and is the first antibody produced during the initial response to antigen IgE has a very specific function as a mediator of many allergic responses and in the defence aginst parasitic infections. IgD the function of IgD is to signal the B cells to be activated. By being activated, B cells are ready to take part in the defense of the body as part of the immune system. Function of antibodies The chief function of antibodies is to protect the individual from infection. This can be executed directly or indirectly. Directly by neutralisation (blocking the binding of antigen to receptors), precipitation (making a soluble antigen into insoluble precipitate) or agglutination (clumping particles) Indirectly through binding to antigens that cause the activation of the inflammatory response which enhances phagocytosis and activation of the complement system which leads to destruction of the microorganism. https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 8/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle 3.3. Cell Mediated Immunity Cell-mediated immune responses involve the destruction of infected cells by cytotoxic T cells, or the destruction of intracellular pathogens by macrophages. Once they have completed their development in the thymus, T cells enter the bloodstream and are carried by the circulation. They recirculate between blood and peripheral lymphoid tissue until they encounter their specific antigen Mature recirculating T cells that have not yet encountered their antigens are known as naive T cells. To participate in an adaptive immune response, a naive T cell must first encounter antigen, and then be induced to proliferate and differentiate into cells capable of contributing to the removal of the antigen.The activation of naive T cells in response to antigen and their subsequent proliferation and differentiation, constitutes a primary immune response. At the same time as providing effector T cells, this response generates immunological memory which gives protection from subsequent challenge by the same pathogen.To wrap up, Naive T cells are T cells that are differentiated and have been released by the thymus but have not yet encountered their corresponding antigens, while effector T cells are T cells that are generated from naive T cells after they have encountered their corresponding antigens. Effector T cells include Cytotoxic T-cells (CD8 + T Cells) which destroy infected cells.; and Helper T-cells (CD4 + T cells) which send signals that direct other immune cells to fight infection. They not only help activate B cells to secrete antibodies and macrophages to destroy ingested microbes, but they also help activate cytotoxic T cells to kill infected target cells.  Watch This is a simplified video showcasing and illustrating cell mediated and humoral immune response. Acquired Immunity: Humoral and Cellular Immunity - Medical Surgical - Immune | @Level… @Level… https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 9/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle 4. Hypersensitivity reactions Autoimmunity arises when the immune system attacks the body's own cells because there is a failure to recognise self-antigens. Hypersensitivity is an immune response that is exaggerated or inappropriately activated, resulting in damage or injury. The are four types of hypersensitivity reaction Type I immunoglobulin E mediated reaction. The mediator is histamine, released by mast cells which causes smooth muscle contraction of the bronchus, increases vascular permeability leading to oedema, and causes vasodilation manifested by increased blood flow. Further, it causes an increase in gastric acid secretion. example is food allergy. Watch this video to further your understanding of Type I hypersensitivity reaction Type I hypersensitivity (IgE-mediated hypersensitivity) - causes, symptoms, pathology Type II tissue specific reaction. These are reactions against a specific cell or tissue in which antibodies (IgG or IgM) are directed against cellular or extracellular matrix antigens, resulting in cellular destruction, functional loss, or tissue damage. Damage can occure either by Antibody binding to cell surface receptors and altering its activity Activation of the complement pathway which offers protection of the host from infection/inflammation by recruiting (chemotaxis) and enhancing phagocytosis by innate immune cells (opsonisation), leading to lysis (break down) of the target cells. Antibody dependent cytotoxicity (cell mediated immunity). Example of Type II is anemia or thrombocytopenia Type III immune complex mediated reaction.Antigen-antibody complexes are pre-formed in the circulation before their deposition in tissues. These immune complexes can precipitate in various tissues such as skin, joints, vessels, or glomeruli and trigger the classical complement pathway. Complement activation leads to the recruitment of inflammatory cells (monocytes and neutrophils) that release enzymes at the site of immune complexes, causing tissue damage. an example is serum sickness and Lupus Type IV this hypersensitivity reaction is mediated by T cells that provoke an inflammatory reaction against antigens. After antigen exposure, an initial local immune and inflammatory response occurs that attracts leukocytes. The antigen engulfed by the macrophages and monocytes is presented to T cells, which then becomes sensitized and activated. These cells then release cytokines and chemokines, which can cause tissue damage and may result in illnesses. An example is eczema and asthma Autoimmune responses can be the product of hypersensitivity reactions but hypersensitivity reactions can occur without autoimmunity. Hypersensitivity reactions can be either delayed meaning it takes several hours to appear and are at maximum severity days after initial exposure. Reactions can also be immediate occurring minutes to few hours after exposure. Allergy refers to hypersensitivity to environmental antigens called allergens. This includes pollens, foods, animals, smoke etc. These https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 10/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle are the most common hypersensitivity disease. The following image presents a summary of the different types of hypersensitivity reactions https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 11/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle 4.1. Blood Transfusion Reaction The ABO blood groups are determined by the presence of certain sugar molecules (antigens) attached to the surface of the red blood cell. For example, individuals with the A antigen attached to the surface of their red blood cell are type A blood. At birth, antibodies to ABO antigens are not present in the plasma. Ingestion of bacteria with food or from the environment exposes the immune system to antigens identical to the ABO antigens found on erythrocytes. If an individual is exposed to an antigen they donot possess, then an antibody to that antigen is formed. For example an individual who is Type B blood will develop an anti A antibody. That's why, people with blood group A cannot receive blood from blood group B and vice versa. Normal healthy individuals, from early in childhood, make red cell antibodies against A or B antigens that are not expressed on their own cells. These naturally occurring antibodies are mainly IgM immunoglobulins. They attack and rapidly destroy red cells carrying the corresponding antigen. Check this table to identify what antibodies would act against each blood group Name of Blood Group Antigens present on the red cell surface ABO antibodies present in the plasma Type O nil anti-A and anti-B Type A A antigen anti-B Type B B antigen anti-A Type AB A and B antigens nil a reaction to a blood transfusion is a Type II hypersensitivity reaction in which specific antibodies bind to antigens, resulting in tissue damage or destruction. Antibody binding can result in cell lysis. Mismatched red blood cells are rapidly destroyed by specific preformed antibodies (anti-ABO or -Rh) and complement. Although fixation of complement can result in direct cell lysis, phagocytosis and recruitment of inflammatory mediators causing of cell injury.  Engage Can a person from blood group O donate blood to a person with blood group A? Can a person from blood group AB donate blood to a person from blood group B? https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 12/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle 4.2. Transplantation rejection Transplant rejection may be hyper acute, acute or chronic depending on the amount of time that elapses between transplantation and rejection. Hyper acute is immediate and rare. When circulation is re established to the grafted area, the graft immediately turns white instead of pink indicating rejection. This occurs because of pre existing antibody (Type II) reaction to antigens on the cells in the grafted tissues. Acute rejection is a cell mediated immune response that occurs within days to months after transplantation. This is because the recipient develops an immune response against the transplanted organ and attacks it. A biopsy will show an infiltration of lymphocytes and macrophages which is characteristic of Type IV hypersensitivity reaction. Chronic rejection occurs after a period of months or years of normal function. It is a slow and progressive organ failure resulting from a mild type IV hypersensitivity reaction  Watch Watch this video, a summary of transplant rejection Kidney Transplants https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 13/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle 5. Pharmacologic management of allergic reactionsReaction Anaphylaxis is a potentially life threatening, severe allergic reaction and should always be treated as a medical emergency. Adrenaline (epinephrine) is the first line treatment for anaphylaxis. Anaphylaxis occurs after exposure to an allergen (usually to foods, insects or medicines), to which a person is allergic. Not all people with allergies are at risk of anaphylaxis. antihistamines can also be given for mild allergic reactions.The ASCIA Action Plan for Anaphylaxis is an emergency response plan for severe allergic reactions (anaphylaxis). It also shows how to treat mild anaphylactic reactions. https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 14/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle 5.1. Medications to treat allergic reactions Let's have a look at the medications that treat allergic reactions. 1. Adrenalin Epi pen injection is indicated in the emergency treatment of type I allergic reactions, including anaphylaxis. Adrenalin is also used to increase mean arterial blood pressure in adult patients with hypotension associated with septic shock It is also used in treating mucosal congestion of hay fever, rhinitis, and acute sinusitis; to relieve bronchial asthmatic paroxysms;. General action: mimics all actions of the sympathetic nervous system except those on the facial arteries and sweat glands.It acts on alpha and beta-adrenergic receptors. Epinephrine acts on alpha and beta receptors and is the strongest alpha receptor activator. Through its action on alpha-adrenergic receptors, it minimizes the vasodilation and increased the vascular permeability that occurs during anaphylaxis, which can cause the loss of intravascular fluid volume as well as hypotension. Epinephrine relaxes the smooth muscle of the bronchi and iris and is a histamine antagonist, rendering it useful in treating the manifestations of allergic reactions and associated conditions. This drug also produces an increase in blood sugar and increases glycogenolysis in the liver. Through its action on beta-adrenergic receptors, it leads to bronchial smooth muscle relaxation that helps to relieve bronchospasm, wheezing, and shortness of breath that may occur during anaphylaxis General side effects:Transient and minor side effects of anxiety, headache, fear, and palpitations.High arterial blood pressure, cardiac arrhythmias, hemorrhage , constriction of renal blood vessels and decrease urine formation, loss of blood flow to the digits General contraindications : not to be given for patients with Dysrhythmias (heart rate > 100/minute) Narrow-angle glaucoma Hemorrhagic, traumatic, or cardiogenic shock Cerebral arteriosclerosis Coronary insufficiency 2nd stage of labor Local anesthesia of fingers, toes, ears, nose, or genitalia General nursing considerations: monitor vital signs (HR, BP, RR); check BGL, check digits for poor blood supply. Assess for arrhythmias. Extravasation of adrenaline may cause tissue necrosis to skin. Therefore, monitor IV site every hour. Have phentolamine close to the bedside of the patient 2. Antihistamines (Loratidine. fexofenadine, Cetrizine) treat histamine-mediated conditions. There are two main classes of histamine receptors: H-1 receptors and H-2 receptors. Antihistamine drugs that bind to H-1 receptors are generally used to treat allergies and allergic rhinitis. Drugs that bind to H-2 receptors treat upper gastrointestinal conditions that are caused by excessive stomach acid which we covered in NURBN2023 General action: Since histamine induces an increased level of vascular permeability, which leads to fluid moving from capillaries into the surrounding tissues, antihistamines working on the H1 receptors stop this action causing a decrease in swelling. General side effects: Drowsiness, Dry mouth, dry eyes, Blurred or double vision, Dizziness and headache, hypotension, Mucous thickening in the airways, Rapid heart rated, difficulty urinating and constipation. General contraindications : Pregnancy and lactation. Antihistamines are contraindicated during pregnancy and lactation unless the benefit to the mother clearly outweighs the potential risk to the fetus or baby. Renal or hepatic impairment. They should be used with caution in renal or hepatic impairment, which could alter the metabolism and excretion of the drug. Arrhythmias. Special care should be taken when these drugs are used by any patient with a history of arrhythmias or prolonged QT intervals because fatal cardiac arrhythmias have been associated with the use of certain antihistamines and drugs that increase QT intervals General Nursing considerations Assess for possible contraindications or cautions: any history of allergy to antihistamines; pregnancy and lactation; and prolonged QT interval, renal and hepatic impairment. Perform a physical examination to establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with the drug therapy. Assess the skin color, texture, and lesions to monitor for anticholinergic effects or allergy. Evaluate orientation, affect, and reflexes to monitor for changes due to CNS effects. Assess respirations and adventitious sounds to monitor drug effects. Evaluate renal and liver function tests to monitor for factors that could affect the metabolism or excretion of the drug. 3. Hydrocortisone (IV) an adrenocorticoid synthetic used to suppress immunity General action: decreases inflammation by stabilising leucocyte lysosomal membranes, suppresses immunity stimulates bone marrow and influences fat, carbohydrates and protein metabolism. A General use: severe allergic reactions to decrease inflammation https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 15/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle General side effects: insomnia, psychotic behaviour, hypertension, arrhythmia, thromboembolism, peptic ulcer, osteoporosis, cataract, delayed wound healing, increased susceptibility to infection, hyperglycemia General interactions: increased risk of GI distress with NSAIDs, contraindicated in patients with hypersensitivity to this drug General Nursing considerations: monitor blood glucose level in diabetics, use cautiously in patients with stomach ulcer, monitor weight, electrolytes and blood pressure, low sodium diet to be given with therapy, individulas with diabetes nmay require an adjustment of their insulin dose, caution patient not to discontinue drug abruptly, primary adrenal insufficiency signs and symptoms, long term therapy requires the patient to be placed on low sodium, high potassium diet and taking vitamin D or calcium supplements. Note: Post grafts and transplants, patients will be on immunosuppressive therapy such as prednisone to decrease the risk of rejection. Prednisone is one of those vmedications and it is the oral form of hydrocortisone with similar side effects and interactions https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 16/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle 6. Cancer Cancer is an uncontrolled proliferation (growth and multiplication) of cells that arise from any type of cells in the body. Normally, cells grow and divide to form new cells while old cells are removed or replaced by new cells. This ordered process does not exist in cancer and becomes deranged. a malignant tumor is not self limiting in its growth, survives the normal signals for damaged cells to be destroyed , is capable of invading other cells and spreading to distant tissues. a benign tumor or growth does not spread or invade other tissues and once removed does not have the ability to reappear again usually. Carcinogenesis Is the process by which normal cells transform to malignant cells and involves a series of events that cause cells to transform into cancerous cells. The three key events are 1. Initiation - the cells are exposed to an initiating factor (carcinogen) 2. promotion - the cell is exposed to additional factors (co-carcinogens) that promote growth of the transformed cell 3. Progression - when the cellualr changes become irreversible and express malignant characteristics The difference between normal and cancer cell is outline din this table. Cancer and the Immune System The immune system reacts to infection and cell damage ; and is able to recognise self from non self. the immune system plays a role in the prevention and development of cancer. Immune surveillance recognises some early stage cancers as foreign and suppresses or eliminates them before developing further. Key components of the immune system which help with that are cytotoxic T cells and natural killer cells. While the immune response may be effective against a small number of abnormal cells, it is not able to destroy larger numbers of abnormal cells. The immune system is altered in the presence of cancer hence it continues to get activated in an attempt to get rid of cancerous cells even when these are not destroyed. Cytokines that are released in response to cancer are Interleukin 1 to induce inflammatory response Interleukin 2 to increase the function of natural killer cells tumor necrosis factors from macrophages which are toxic to cancer cells interferons from WBC which are toxic to cancer and inhibit cell growth Factors that increase risk of cancer Cigarette smoking viral infections such as Hepatitis B and C, Human Papilloma Virus, Human Herpes Virus Alcohol consumption Exposure to radiation Dietary factors (low fibre, highly processed, red meat occupational hazards like asbestos exposure Cancer Signs https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 17/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle Usually use the mnemonic CAUTION UP The C refers to changes in bowel or bladder habits, A refers to a sore that does not heal U refers to unusual bleeding or discharge T refers to thickening or lump in breast or elsewhere I refers to indigestion or difficulty in swallowing O refers to obvious changes in warts or moles N refers to nagging cough or persistent hoarseness U refers to unexplained weight loss P refers to pernicious anemia Note: It is important to note these signs do not necessarily indicate cancer, but they may warrant further investigation to uncover their underlying cause. Tumor Markers A tumor marker is a biomarker found in blood, urine, or body tissues that can be elevated by the presence of one or more types of cancer. The image below depicts the different tumor markers and the different cancers that cause their elevation https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 18/19 29/10/2024, 13:52 Immunology Pathophysiology and Pharmacology Book | Moodle 6.1. Medical management of cancer Chemotherapy These are non selective cytotoxic drugs that target vital cellular or metabolic processes critical to both malignant and normal cell growth proliferation and growth. Curative chemotherapy aims to eliminate all cancer cells from the body to achieve a cure. Chemotherapy can also be used as an adjuvant in combination with other treatments or with palliative intent to control cancer growth for a time course and manage symptoms. Chemotherapy can cause fatigue, loss of appetite, nausea, bowel issues such as constipation or diarrhoea, hair loss, mouth sores, skin and nail problems. Patients may have trouble concentrating or remembering things. There can also be nerve and muscle effects and hearing changes. Due to immunosuppression, there is increased risk of infections. This is because chemotherapy can reduce the levels of white blood cells, which are necessary for fighting infections. Sexuality and fertility problems, such as reduced sexual desire or loss of fertility. But patients might be able to store eggs (ova), embryos or sperm for use at a later date. Most side effects are temporary and gradually improve after you have finished treatment. Nurses play an important role in assessing and managing many of the problems experienced by patients undergoing chemotherapy. Assessing fluid and electrolyte balance. Anorexia, nausea, vomiting, altered taste, mucositis, and diarrhea put patients at risk for nutritional and fluid electrolyte disturbances. Modifying risks for infection and bleeding. Suppression of the bone marrow and immune system is expected and frequently serves as a guide in determining appropriate chemotherapy dosage but increases the risk of anemia, infection, and bleeding disorders. Administering chemotherapy. The patient is observed closely during its administration because of the risk and consequences of extravasation, particularly of vesicant agent. Protecting caregivers Nurses must be familiar with their institutional policies regarding personal protective equipment, handling and disposal of chemotherapeutic agents and supplies, and management of accidental spills or exposures. https://moodle.federation.edu.au/mod/book/tool/print/index.php?id=7654114 19/19