Im&In SG 4.0 PDF - Advanced Study Guide

**Advanced Study Guide: Detailed Compilation from Submitted Files** **1. Bioterrorism Agents (Bioterrorism agents-updated.doc)** **Smallpox (Variola Virus)** - **Transmission**: Human-to-human via contact or inhalation of droplets. - **Precautions**: Standard, contact, and airborne (N95...

**Advanced Study Guide: Detailed Compilation from Submitted Files** **1. Bioterrorism Agents (Bioterrorism agents-updated.doc)** **Smallpox (Variola Virus)** - **Transmission**: Human-to-human via contact or inhalation of droplets. - **Precautions**: Standard, contact, and airborne (N95 mask). - **Symptoms**: - Myalgias - High fever - Rash that progresses from macules to pustules, then to scabs - Scarring occurs after pustules heal - **Treatment**: - Vaccination within 3 days of exposure - No definitive cure; antivirals like cidofovir (experimental) and Vaccinia immune globulin (VIG) may help. **Anthrax (Bacillus anthracis)** - **Transmission**: No human-to-human transmission; spread through contact with infected animals or spores. - **Precautions**: Standard for inhalation/GI anthrax, contact for cutaneous. - **Symptoms**: - **Inhalation Anthrax**: Flu-like symptoms, respiratory distress, fever, pleural effusions, septicemia, and potential death. - **Cutaneous Anthrax**: Characterized by a necrotic eschar (black sore), pruritic papule, with mild to no systemic symptoms. - **Treatment**: - Pre/post-exposure vaccination - Antibiotics: Ciprofloxacin or doxycycline for 60 days【13†source】. **2. Transmission-Based Categories (CDC Transmission-based categories.docx)** **Contact Transmission:** - **Modes**: Direct (person-to-person physical contact) or indirect (via contaminated objects or fomites). - **Diseases**: MRSA, C. difficile, viral hemorrhagic fevers (e.g., Ebola). - **Precautions**: Gowns, gloves, and hand hygiene are required when entering rooms of patients with contact-transmitted infections【14†source】. **Droplet Transmission:** - **Mode**: Large respiratory droplets from coughing, sneezing, or talking that travel short distances (3-6 feet). - **Diseases**: Bacterial meningitis, seasonal influenza. - **Precautions**: Surgical mask required when within 3-6 feet of the patient. Use gloves and gowns when necessary【14†source】. **Airborne Transmission:** - **Mode**: Small respiratory particles remain suspended in air and travel long distances. - **Diseases**: Tuberculosis, measles, chickenpox. - **Precautions**: N95 respirator, negative pressure rooms【14†source】. **3. Personal Protective Equipment (PPE-Sequence.pdf)** **Steps for Putting On PPE:** 1. **Gown**: Fully cover torso, arms, and wrap around the back. Fasten at the neck and waist. 2. **Mask/Respirator**: Secure ties or elastic bands at the middle of the head and neck. Fit-check the respirator to ensure it fits snugly around the face and below the chin. 3. **Goggles/Face Shield**: Place over face and eyes, adjust to ensure proper fit. 4. **Gloves**: Ensure they extend to cover the wrist of the isolation gown【15†source】. **Steps for Removing PPE:** 1. **Gloves**: Remove carefully, as the outside is contaminated. Peel one glove off, hold in the other hand, and slide fingers under the second glove to remove it without touching the outside. 2. **Goggles/Face Shield**: Remove by lifting from the back without touching the front. 3. **Gown**: Unfasten ties, pull away from the body, touching the inside only, and roll it into a bundle. 4. **Mask/Respirator**: Remove after leaving the patient's room. Grasp the bottom tie first, then the top. 5. **Hand Hygiene**: Perform hand hygiene between steps if necessary and immediately after all PPE is removed【15†source】. **4. Isolation Precautions (Overview of Isolation precautions-2018.doc)** **Standard Precautions:** - Applied in all patient care situations where contact with blood or body fluids is expected. - **Diseases**: Kawasaki disease, mononucleosis, viral gastroenteritis. - **Measures**: Hand hygiene, gloves, gown, face mask, depending on the exposure risk【16†source】. **Contact Precautions:** - **Diseases**: MRSA, C. difficile, scabies, viral hemorrhagic fevers. - **Measures**: Private room, gowns, gloves, dedicated equipment (e.g., stethoscope), daily cleaning of room, hand hygiene when entering/leaving【16†source】. **Droplet Precautions:** - **Diseases**: Influenza, pertussis, mumps, bacterial meningitis, pneumonia. - **Measures**: Surgical masks, gloves, hand hygiene, private room【16†source】. **Airborne Precautions:** - **Diseases**: TB, measles, chickenpox, SARS. - **Measures**: Negative pressure room, N95 respirator, closed door, private room【16†source】. **5. Types of Hypersensitivity Reactions (Type of Hypersensitivity Rxs-updated.doc)** **Type** **Mechanism** **Examples** **Treatment** ------------------------------- ----------------------------------------------- ------------------------------------------- --------------------------------------- **Type I (Allergic)** IgE-mediated; rapid histamine release Anaphylaxis, allergic rhinitis Epinephrine, antihistamines, steroids **Type II (Cytotoxic)** Antibody (IgG/IgM) binds to target cells ABO blood transfusion reaction Stop transfusion, saline, steroids **Type III (Immune Complex)** Antigen-antibody complexes cause inflammation Lupus, post-strep glomerulonephritis Anti-inflammatory drugs **Type IV (Delayed)** T-cell-mediated, delayed response Poison ivy, TB skin test, graft rejection Topical steroids, immunosuppressants - **Key Lab Indicator for Type I Hypersensitivity**: Elevated eosinophils and basophils【17†source】. **6. Immune Drugs (Immune drugs.doc)** **Cytotoxic Drugs:** - **Example**: Methotrexate - **Uses**: Treatment of autoimmune diseases (e.g., rheumatoid arthritis) and as an anti-cancer drug. - **Side Effects**: Hepatotoxicity, teratogenic effects (pregnancy contraindicated). - **Nursing Considerations**: Monitor liver function, teach contraception use for women of childbearing age【18†source】. **Antibodies:** - **Examples**: Basiliximab, daclizumab - **Uses**: Prevention of organ transplant rejection (e.g., kidney transplants). - **Side Effects**: Mild, including fever and nausea. - **Nursing Considerations**: Monitor for allergic reactions【18†source】. **Glucocorticoids:** - **Examples**: Prednisone, methylprednisolone - **Uses**: Management of autoimmune diseases, reduction of inflammation, and prevention of transplant rejection. - **Side Effects**: Hyperglycemia, adrenal suppression, osteoporosis, infection risk. - **Nursing Considerations**: Monitor blood glucose, taper dosage, avoid long-term use【18†source】. **7. Types of Immunity (Type of Immunity chart-updated.doc)** **Type** **How Acquired** **Clinical Significance** ------------------------ -------------------------------------------------------- ------------------------------------------------------ **Natural Passive** Maternal IgG antibodies transfer via placenta Provides short-term immunity for 3-6 months **Artificial Passive** Administered immunoglobulins (e.g., rabies) Provides immediate but short-term immunity **Natural Active** Acquired by contracting the disease (e.g., chickenpox) Provides long-lasting immunity **Artificial Active** Vaccination (e.g., MMR, hepatitis B) Develops long-lasting immunity, may require boosters - **mRNA Vaccines**: First used in COVID-19 vaccines, they stimulate cells to produce proteins that trigger immune responses【19†source】【33†source】. **8. HIV Overview (HIV Vodcast.txt)** **Transmission:** - **Modes**: Direct contact with infected blood, semen, vaginal secretions, and occasionally through saliva and tears. - **High-Risk Groups**: IV drug users, people with multiple sexual partners, individuals with STDs. - **Perinatal Transmission**: Possible during birth and breastfeeding; 25%-66% without treatment, 1%-2% with treatment【32†source】. **Pathophysiology:** - HIV attacks CD4 T-helper cells, turning them into \"HIV factories.\" - **Initial Stage**: Characterized by viremia (high viral load), flu-like symptoms (acute retroviral syndrome). - **Latent Stage**: Virus remains asymptomatic for 8-10 years while continuing to replicate. - **Progression to AIDS**: Occurs when CD4 count falls below 200 or when opportunistic infections (e.g., PCP, candidiasis) occur【32†source】. **Opportunistic Infections:** - **PCP Pneumonia**: Diagnosed via chest X-ray; treated with sulfa drugs. - **Candida**: Can be oral or systemic in HIV patients. - **TB**: May present atypically in immunosuppressed HIV patients. - **Cytomegalovirus (CMV)**: Fatal in immunosuppressed individuals; pregnant healthcare workers should avoid exposure【32†source】. **Treatment:** - **HAART** (Highly Active Antiretroviral Therapy): Requires strict adherence to avoid viral resistance. Goal is to maintain a viral load that is undetectable and CD4 count above 500【32†source】. **HIV Testing:** - **ELISA Test**: Detects HIV antibodies, usually accurate 12 weeks post-exposure. - **Western Blot**: Confirms HIV after a positive ELISA test. - **Post-Test Counseling**: Required for high-risk groups and individuals exposed to the virus【32†source】. **9. Inflammation & Immunity (Inflammation\_Immunity ppt \#2-English.txt)** **Inflammatory Response:** - **Local Signs**: Redness, heat, swelling, pain, loss of function. - **Systemic Signs**: Fever, increased white blood cell count (WBC), increased pulse and respiratory rate, malaise, nausea, and anorexia. - **Left Shift**: Increase in immature WBCs (band cells), indicating acute infection or inflammation【33†source】. **Types of Inflammation:** - **Acute**: Lasts 2-3 weeks, typically leaves no permanent damage (e.g., after a minor injury). - **Chronic**: Long-term inflammation, can last years and is often seen in autoimmune diseases like rheumatoid arthritis【33†source】. **Fever Management:** - **Antipyretic Drugs**: - **Aspirin**: Blocks prostaglandin synthesis. - **Acetaminophen**: Acts on the heat-regulating center in the hypothalamus. - **NSAIDs (e.g., Ibuprofen)**: Have antipyretic and anti-inflammatory effects. - **Corticosteroids**: Prevent cytokine production and prostaglandin synthesis, lowering fever. - **RICE Protocol**: Rest, ice, compression, and elevation for inflammation associated with injury【33†source】. **Innate vs. Adaptive Immunity:** - **Innate Immunity**: Nonspecific defense (e.g., skin, mucous membranes, normal flora). - **Adaptive Immunity**: - **Antibody-Mediated**: Involves immunoglobulins (e.g., IgG fights bacteria/viruses, IgE mediates allergic reactions). - **Cell-Mediated**: Involves T-cells that defend against intracellular pathogens like viruses【33†source】【20†source】. **10. Immune System Organs (Inflammation\_Immunity ppt \#2-English.txt)** - **Tonsils**: Protect against upper respiratory infections. - **Thymus**: Important for T-cell maturation. - **Bone Marrow**: Source of immune cell production. - **Spleen**: Filters blood and initiates immune responses to blood-borne pathogens. - **Liver**: Assists in immune function if spleen is removed【33†source】. **11. Immune System Responses (Inflammation\_Immunity ppt \#2-English.txt)** - **Prostaglandins**: Released during inflammation, leading to fever by acting on the hypothalamus. - **Leukocytosis**: Increase in WBC count, particularly neutrophils, which is a systemic response to inflammation and infection【33†source】. **12. Glucocorticoids in Disease Management (Immune drugs.doc & Inflammation\_Immunity ppt \#2-English.txt)** - **Examples**: Prednisone, dexamethasone. - **Uses**: Used to control autoimmune disease flare-ups, reduce inflammation, and prevent organ transplant rejection. - **Side Effects**: - Hyperglycemia - Adrenal suppression - Osteoporosis - Risk of infection - Growth retardation in children - **Tapering**: Must taper off long-term use to prevent adrenal crisis【18†source】【33†source】. \[End of Notes\]