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Unit 2 Seminar

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Title: Immunologic Diseases and Conditions Author: Michael & Eleftheria Parafink Created Date: 10/27/2004 3:39:18 PM Document presentation format – PowerPoint PPT presentation

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Title: Unit 2 Seminar


1
  • Unit 2Seminar
  • Dr. J. V. Stoia

2
Question 1
  • You are asked to place an HIV positive patient in
    an exam room and obtain vital signs. The patient
    brings into the exam room a requested urine
    specimen. What infection control precautions
    should you be using in this situation?

3
Question 1
  • Because the patient may be immunodeficient, you
    should first make sure to wash your hands
    properly and thoroughly before approaching and
    touching the patient.

4
Question 1
  • Gloves or other personal protective equipment are
    not necessary for normal contact with the patient
    (i.e., obtaining radial pulse or blood pressure).
    However, when coming in potential contact with
    body fluids (i.e., urine specimen, saliva with
    oral temperature probe) you should wear gloves.

5
Question 1
  • Remember that equipment used to obtain the vital
    signs (i.e., stethoscope, thermometer) will need
    to be properly disinfected before being reused on
    another patient. If they are available, use
    disposable probes and other equipment.

6
Question 1
  • . Finally, rewash your hands after contact with
    the patient is complete.

7
Question 2
  • Many elderly patients with rheumatoid arthritis
    are treated with non-steroidal anti-inflammatory
    drugs (NSAIDs) at the outpatient facility you are
    assigned to work. Some express concerns about
    various signs and symptoms they are experiencing.
    What are the side effects of NSAIDs they should
    be concerned about and report to the physician or
    nurse?

8
Question 2
  • Potentially dangerous side effects of NSAID
    therapy include GI ulceration and bleeding, and
    blood dyscrasias (i.e., abnormalities) that may
    affect bleeding and clotting factors.

9
Question 2
  • . Other common side effects are rash, tinnitus,
    and hypersensitivity to sunlight.

10
Question 2
  • Side effects as well as drug toxicities are more
    common in the elderly population not only for
    NSAIDs but other classes of drugs, too. This is
    due to impaired or decreased liver and/or renal
    metabolism as part of the normal aging process.

11
Question 2
  • Encourage each patient to discuss problems such
    as GI upset, GI bleeding, dark or tarry stools,
    increased bruising, rash, or tinnitus with the
    doctor or nurse for further assessment.

12
Major functions of the immune system
  • Protect the body against foreign organisms
  • Maintain homeostasis by eliminating damaged cells
    (phagocytosis)
  • Recognize and guard against abnormal cells
    (inflammatory response)

13
Inappropriate responses of the immune system
  • Hyperactive (allergic) excessive response
  • Immunodeficient (e.g., AIDS) inadequate
    response
  • Autoimmune (e.g., SLE) misdirected response
  • Transplant rejection attack to beneficial
    foreign tissues

14
Acquired Immunity
15
Trivia Question
  • Where does the term vaccination come from?

16
Cellular Elements of Immunity
  • Cellular elements of natural immunity
  • Natural killer cells (NK)
  • Polymorphonuclear neutrophils (PMN)
  • Macrophages
  • Cellular elements of acquired immunity
  • T lymphocyte cells
  • B lymphocyte cells
  • Phagocytes

17
T lymphocyte cells include
  • Cytotoxic T cells destroy virus-infected cells,
    tumor cells, or allograft cells
  • Helper T cells stimulate B cells and activate
    cytotoxic T cells
  • Suppressor T cells moderate the immune response
    by inhibiting B and T cells
  • Memory T cells are reactivated only by
    re-exposure to previous antigen

18
B lymphocyte cells include
  • Memory B cells reactivated only by
    re-exposure to previous antigen
  • Plasma cells secrete antibodies that attach to
    antigens

19
Orderly Function of the Immune System (contd.)
  • Immunoglobulins
  • IgG (75-85)
  • IgA (5-15)
  • IgM (5-10)
  • IgD (0.2)
  • IgE (0.5)

20
Immunodeficiency Diseases
  • Increased susceptibility to bacterial infections
    resulting from a B cell deficiency.
  • Increased susceptibility to viral, fungal, and
    protozoan infections, usually from T cell
    deficiency.

21
Acquired Immunodeficiency Syndrome (AIDS)
  • Caused by human immunodeficiency virus (HIV)
  • Diagnosed by presence of HIV antibodies in the
    blood (common test ELISA confirmation Western
    blot)
  • HIV attacks helper T lymphocytes
  • Reduces cell-mediated immunity
  • Attacks nervous system directly

22
Acquired Immunodeficiency Syndrome (AIDS)
  • HIV transmission is through direct contact with
    blood or semen of infected person
  • sexual contact
  • blood transfusions and other blood products
  • contaminated shared needles (IV drug use, etc.)
  • accidental needle sticks
  • to fetus via placenta or during birth process
    from infected mother

23
Acquired Immunodeficiency Syndrome (AIDS)
  • AIDS treatment
  • currently no cure
  • Goal is to maintain the best possible immune
    status by using immunizations and anti-infective
    therapy

24
Immunodeficiency Diseases (contd.)
  • Universal Precautions
  • Thorough and frequent hand washing.
  • Personal protective equipment worn as required by
    specific task (e.g. gloves, gown, goggles, mask).
  • Proper disposal of all sharps in designated
    biohazard containers.
  • No needle recap prior to disposal.
  • Caution in handling of laboratory specimens.
  • Proper containment and disinfection of blood and
    body fluid spills.
  • Use clean mouthpieces and resuscitation bags.

25
Immunodeficiency Diseases (contd.)
  • Common Variable Immunodeficiency
  • acquired B cell deficiency
  • Selective Immunoglobulin A Deficiency
  • inadequate production of IgA
  • Severe Combined Immunodeficiency
  • ineffective development and function of both T
    cells and B cells

26
Autoimmune Diseases
  • What is autoimmune disease?
  • What are some examples?

27
Autoimmune Diseases
  • Lymphocytes and antibodies are sensitized to
    develop against the bodys own organs or tissues.
  • May be triggered by disease, injury, metabolic
    changes, or mutation in immunologically competent
    cells.
  • May be caused by certain drugs or chemicals,
    trauma, or viral infection.

28
Autoimmune Diseases (contd.)
  • Pernicious anemia
  • Impaired absorption of B12 due to decreased
    gastric production of hydrochloric acid.
  • Treatment consists of monthly intramuscular
    injections of vitamin B12 during the persons
    entire lifetime.

29
Autoimmune Diseases (contd.)
  • Pernicious Anemia
  • Symptoms weakness and tingling and numbness in
    extremities, altered vision, lightheadedness,
    tinnitus, palpitations, weight loss, digestive
    disturbances, sore tongue.
  • Signs decreased red blood cell, white blood
    cell, and platelet counts increased red blood
    cell mean volume decreased hemoglobin levels
    jaundice optic nerve atrophy decreased amount
    of gastric acid.

30
Autoimmune Diseases (contd.)
  • Collagen Diseases
  • Systemic lupus erythematosus
  • Scleroderma
  • Sjogren syndrome
  • Rheumatoid arthritis
  • Juvenile rheumatoid arthritis
  • Ankylosing spondylitis
  • Polymyositis

31
Autoimmune Diseases (contd.)
  • Systemic Lupus Erythematosus (SLE)
  • Inflammation of skin, joints, nervous system,
    kidneys, lungs, and other organs.
  • Butterfly rash across face may be present.
  • Other rashes may appear on other exposed skin
    areas.

32
Autoimmune Diseases (contd.)
Systemic Lupus Erythematosus (SLE)
  • Butterfly face rash
  • Alopecia
  • Photosensitivity
  • Raynauds phenomenon
  • Thrombocytopenia
  • Discoid skin lesion
  • Nasopharyngeal ulceration
  • Polyarthritis
  • Pleuritis or pericarditis
  • Protein or casts in the urine
  • Hemolytic anemia
  • False-positive serology
  • Abnormal blood antibodies
  • LE cells (leukocytes) present in lab testing

33
Autoimmune Diseases (contd.)
  • Rheumatoid arthritis (RA)
  • Chronic, inflammation and edema of the synovial
    membranes surrounding joints.
  • Destruction of cartilage and adjacent bone.
  • May produce weight loss, fever, and malaise.
  • Joint pain and stiffness, especially in morning.
  • Bilateral joint tenderness, edema, erythema,
    warmth.

34
Autoimmune Diseases (contd.)
  • Rheumatoid arthritis treatment aimed at
  • Reducing inflammation and pain
  • Preserving joint function
  • Preventing joint deformities

35
Autoimmune Diseases (contd.)
  • Ankylosing spondylitis
  • Inflammation and ossification of the joints
    leading to decreased range of motion and spinal
    bone fusion.
  • Sacroiliac spine area is usually affected first
    and results in recurring low back pain and
    morning stiffness.
  • History may include inflammatory bowel disease,
    heel pain, and family incidence of arthritic
    conditions

36
Autoimmune Diseases (contd.)
  • Multiple sclerosis (MS)
  • Inflammatory disease of the central nervous
    system.
  • Demyelination of nerves occurs in the brain and
    spinal cord.
  • Signs and symptoms are primarily neurologic and
    related to areas of myelin destruction.

37
Autoimmune Diseases (contd.)
  • Myasthenia gravis (MG)
  • Chronic progressive neuromuscular disorder.
  • Autoantibodies produced to acetylcholine receptor
    in muscle cells.
  • Ineffective nerve-muscle junction results in
    severe weakness, difficulty talking and
    swallowing, drooping eyelids and diplopia.

38
Autoimmune Diseases (contd.)
  • Vasculitis
  • Inflammation in the walls of blood vessels that
    may lead to necrosis, thrombus formation, and
    local infarct
  • Can be classified as small vessel or systemic
    affecting medium and large arteries
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