Title: Unit 2 Seminar
1- Unit 2Seminar
- Dr. J. V. Stoia
2Question 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?
3Question 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.
4Question 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.
5Question 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.
6Question 1
- . Finally, rewash your hands after contact with
the patient is complete.
7Question 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?
8Question 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.
9Question 2
- . Other common side effects are rash, tinnitus,
and hypersensitivity to sunlight.
10Question 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.
11Question 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.
12Major 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)
13Inappropriate 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
14Acquired Immunity
15Trivia Question
- Where does the term vaccination come from?
16Cellular 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
17T 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
18B lymphocyte cells include
- Memory B cells reactivated only by
re-exposure to previous antigen - Plasma cells secrete antibodies that attach to
antigens
19Orderly Function of the Immune System (contd.)
- Immunoglobulins
- IgG (75-85)
- IgA (5-15)
- IgM (5-10)
- IgD (0.2)
- IgE (0.5)
20Immunodeficiency 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.
21Acquired 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
22Acquired 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
23Acquired Immunodeficiency Syndrome (AIDS)
- AIDS treatment
- currently no cure
- Goal is to maintain the best possible immune
status by using immunizations and anti-infective
therapy
24Immunodeficiency 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.
25Immunodeficiency 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
26Autoimmune Diseases
- What is autoimmune disease?
- What are some examples?
27Autoimmune 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.
28Autoimmune 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.
29Autoimmune 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.
30Autoimmune Diseases (contd.)
- Collagen Diseases
- Systemic lupus erythematosus
- Scleroderma
- Sjogren syndrome
- Rheumatoid arthritis
- Juvenile rheumatoid arthritis
- Ankylosing spondylitis
- Polymyositis
31Autoimmune 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.
32Autoimmune 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
33Autoimmune 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.
34Autoimmune Diseases (contd.)
- Rheumatoid arthritis treatment aimed at
- Reducing inflammation and pain
- Preserving joint function
- Preventing joint deformities
35Autoimmune 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
36Autoimmune 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.
37Autoimmune 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.
38Autoimmune 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