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Immune System
Constellation of responses to attacks from
outside the body.
Cell and proteins which protect body fromantigen. (viruses, bacteria, fungi )
Immunity the bodys ability to resist
infection.
Maintains homeostasis
Monitors degradation
Removal of damaged cells
Discovers and destroys abnormal cells
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Immune System
Antigen
Substance foreign to the body
Antibody (Immunoglobulins)
Molecule made by lymph tissue
Defends body against bacteria, viruses, or other
foreign bodies (antigens)
Each antibody reacts to a certain foreign body
Allergen substance that causes inappropriate
immune response (allergy)
Major Histocompatibility Complex Main Menu
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Formation, development, and specialization of all
functional blood cells
Back
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Cells of the Immune System
Cells destined to
become immunecells, like all blood
cells, arise in the
bone marrow from
so-called stem cells.
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T-Cells
T helper
A pertinent coordinator ofimmune regulation.
To augment or potentiateimmune responses byactivating other WBC.
T killer/suppressor
Directly killing certaintumor cells, viral-infectedcells and sometimesparasites.
also important in down-regulation of immuneresponses.
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Natural KillerCells
Effector cells that
directly kill certain
tumors such as
melanomas,
lymphomas and viral-infected cells, most
notably herpes and
cytomegalovirus-
infected cells.
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Granulocytes
composed of
neutrophils,
eosinophils andbasophils, based on
their staining
characteristics with
certain dyes. Important in the
removal of bacteria
and parasites from the
body.
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Macrophages
regulation of immune
responses.
Scavengers - pick upand ingest foreign
materials and present
these antigens to other
cells
Initiation of an immune
response
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Monocytes (2-6%) circulate in the blood
Macrophages found in body tissues Scavengers Secrete a wide variety of powerful
chemicals Activates T cells.
Phagocytes and Granulocytes
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Neutrophils (40-75%) Circulate in blood but move into tissues PRN Contain granules filled with potent chemicals Destroys microbes + key role in acute
inflammatory reactions.
Eosinophils(2-5%) Allergy, suppresses inflammation & helminthes
(parasitic worm) infection, Decrease granulocyte migration
Basophils(0.2-0.5%)
inflammatory mediator release Mast cells
granule-containing cells in tissue.
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Activation of B cells to make Antibody
AB Cell uses one of itsreceptors to bind to itsmatching antigen, which theB cell engulfs and
processes. The B cell then displays a
piece of the antigen, boundto a Class II MHC (majorhistocompatibility complex)protein, on the cell surface.
This whole complex thenbinds to an activated helperT cell to stimulates thetransformation of the B cellinto an antibody secreting
Plasma cell.
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Immunoglobulin
Immunoglobulin G / IgG (75%) Found in serum and tissue (instertitial fluid)
Assumes a major role in blood and tissue born
pathogen Activates complement system
Crosses the placenta
Immunoglobulin A / IgA (15%) Appears in the body fluid e.g. saliva, sweat,pulmo,
gastro, repro
Prevents absorption of antigen from food
Passes to neonates in breast milk
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Immunoglobulin
Immunoglobulin M / IgM (10%) Appears in the intravascular serum
First Ig produced in response to bacterial and viral
Activates the compliment system Immunoglobulin D / IgD (0.2%)
Appears in small amount serum
Influences B lymphocyte to differentiate
Immunoglobulin E / IgE (.004%) Appears in serum
Takes part in allergic and hypersensitivity reaction
Parasitic infection
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T - Cells T cells attacks and destroys
diseased cells they recognizeas foreign.
T lymphocytes are
responsible for cell-mediatedimmunity (or cellularimmunity).
T cells also orchestrate,regulate and coordinate theoverall immune response.
T cells depend on unique cellsurface molecules called theMajor HistocompatibilityComplex (MHC) to helpthem recognize antigenfragments
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T - Cells
Immature T cells (termed T Stem cells)
Migrate to the thymus gland in the neck, wherethey mature and differentiate into various types
of mature T cells. Killer T cell
Helper T cell
Suppressor T cell
Memory T cell
Produce substances called Cytokines
Interleukins which further stimulate the immuneresponse.
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T Cells - Types Cytotoxic orkillerT cells (CD8+)- do their work by releasing
lymphotoxins, which cause cell lysis
HelperT cells (CD4+) - serve as managers, directing the immune
response,
secrete chemicals called lymphokines that stimulate cytotoxic T cells
and B cells to grow and divide, attract neutrophils, and enhance the
ability of macrophages to engulf and destroy microbes
SuppressorT cells
a component of the immune system that suppress immune responses of
other cells.
These cells are involved in closing down immune responses after theyhave successfully tackled invading organisms and also in keeping in
check immune responses that may potentially attack one's own tissues
("autoimmunity").
Memory T cells - programmed to recognize and respond to a pathogen
once it has invaded and been repelled.
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Lymphatic System
The lymphatic system is a complex network
of lymphoid organs, lymph nodes, lymph
ducts, lymphatic tissues, lymph capillaries
and lymph vessels.
They produce and transport lymph fluid from
tissues to the circulatory system.
The lymphatic system is a major componentof the immune system.
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Lymphatic System Functions:
To collect and return interstitial fluid, including
plasma protein to the blood, and thus help
maintain fluid balance.
To defend the body against disease by
producing lymphocytes
To absorb lipids from the intestine and
transport them to the blood.
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Lymphoid Organs
Thymus Gland
Red Bone Marrow
Spleen Lymph nodes
Peyers Patches
Tonsils Adenoid
Vermiform Appendix
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Innate (natural Immunity) Provides a non specific response to invader
Basis is their ability to recognize self and non self
Natural mechanism
Includes Physical and chemical barriers (Normal Flora)
Skin Genitourinary
Respiratory
Muco cilliary action
Cell of the innate immune response
Inflamatory response
Complement response
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Inflammatory Response
The complex biological response of vasculartissues to harmful stimuli, such as pathogens,damaged cells, or irritants
Acute Inflammation initial response of the body to harmful stimuli
achieved by the increased movement of plasmaand leukocytes from the blood into the injured
tissues. cascade of biochemical events propagates and
matures the inflammatory response, involving thelocal vascular system, the immune system, andvarious cells within the injured tissue.
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Inflammatory Response
Chronic Inflammation
Prolonged inflammation
leads to a progressive shift in the type of cells
which are present at the site of inflammation andis characterized by simultaneous destruction and
healing of the tissue from the inflammatory
process.
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Causes ofAcute Inflammation Microbial infections
Hypersensitivity reactions
Physical agents Irritant and corrosive
chemicals
Tissue necrosis
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Five Cardinal Symptoms ofAcute
Inflammation
Redness (rubor)
Heat (calor)
Swelling (tumor) Pain (dolor)
Loss of Function
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Vasodilatation
CellularInjury
TemporaryVasoconstrictions
IncreasePermeability
Increase Bloodflow
Heat (Calor)
Redness (Rubor)
Plasma Leak intothe affected part
Swelling (Tumor)
Increase NervePressure
Pain (Dolor)LOSS OF
FUNCTION
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Histamine Causes vascular dilatationand the immediate transient
phase of increased vascular permeability
stored in mast cells, basophil and eosinophil leukocytes,
and platelets
Lysosomal
compounds
released from neutrophils
increase vascular permeability
Prostaglandins a group of long-chain fatty acids derived from arachidonicacid and synthesized by many cell types
prostaglandins potentiate the increase in vascular
permeability
Leukotrienes synthesized from arachidonic acid, especially in neutrophils,
and appear to have vasoactive properties
a mixture of leukotrienes is involved in type I hypersensitivity
5-
hydroxytryptamine
(serotonin)
a potent vasoconstrictor
present in high concentration in mast cells and platelets
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Plasma Factors
Complementsystem cascade system of enzymatic proteins activated
during inflammatory response
Coagulation system responsible for the conversion of soluble fibrinogen
into fibrin
activate the coagulation, kinin and fibrinolytic systems
Kinin system (stimulates pain receptors)
activated by coagulation factor Bradykinin is also a chemical mediator of pain
Fibrinolyticsystem Plasmin is responsible for the Iysis of fibrin into fibrin
degradation products
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Complement System Circulating Plasma proteins made in the liver
Activated when Antigen-antibody connects
It coats microbes with molecules that make them moresusceptible to engulfment by phagocytes
They also encourage polys to adhere to the walls of capillaries(margination) from which they can squeeze through in a matterof minutes to arrive at a damaged area
Emigration by squeezing of the wandering macrophagesthrough the capillary walls to the tissue
Extravasation also know as diapedesis
Once phagocytes do their job, they die and their "corpses,"pockets of damaged tissue, and fluid form pus.
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Immunity
Acquired
Passive Active
Natural Artificial Natural Artificial
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Types ofAcquired Immunity
Acquired Active Immunity (exposure)
The immunologic defenses are developed by the
persons own body in response to the presence of
antigens. Immunity last many years or even lifetime.
Acquired Passive Immunity (transferred)
Atemporary immunity transmitted from anothersource that has developed immunity.
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Acquired Active
Naturally Acquired Active
Exposure to different pathogens leads to
infections, which result in a protective immune
response against these pathogens.
Artificially Acquired Active
Vaccine used for active immunization consist of
live (attenuated) organism, killed whole organism,
microbial components or secreted toxin.
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Acquired Passive
Naturally Acquired Passive
Immunity is transferred form mother to fetus
through placental transfer of IgG or colostral
transfer of IgA.
Artificially Acquired Passive
Artificially transferred by injection of gamma
globulins from other individual or gamma globulins
from an immune animal.
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PhagocyticHumoral
Cellular
Stages of Immune Response
RecognitionProliferation
Response
Effector
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Phagocytosis
Involves WBC and Macrophages
Has the ability to ingest foreign matter
They also responsible for removing bodys dead
cell Cell in the necrotic tissue release a substance that
cause inflamatory response
Apoptisis programmed death cell
Main Menu
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Antigen Recognition
The mechanism by which the B
lymphocytes recognize the invading antigen
and respond by producing antibodies.
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Role ofAntibodies Defend against foreign
invaders in several ways.
Agglutination bind orclumping together of antigenand antibody that helps clear
the body of the invadingorganism by facilitatingphagocytosis.
Opsonization coating stickysubstances that facilitatesphagocytosis.
Each antibody moleculeconsist of two subunits, eachof which contains a light and aheavy peptide chain.
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Antigen Antibody Binding
Antigenic Determinant
The portion of the
antigen involve in
binding with theantibody.
Lock-and-key situation
The binding of the Fab
fragment (antibody-
binding site) to the
antigenic determinant.
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Cell Mediated Immunity
CD - stands forCluster ofDifferentiation
(CD8+ is read "CD8 positive)
The large number of molecules on the surfaces
of lymphocytes allows huge variability in theforms of the receptors
They are produced with random configurations
on their surfaces
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I. Recognition StageII. Proliferation Stage
III. Response Stage
IV. Effector Stage
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I. Recognition Stage
Recognize
invaders as foreign
Presentation to themacrophages
Macrophages plays
an important role in
processing theantigen
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II. Proliferation Stage
The dormant lymphocytes proliferate and
differentiate into cytotoxic (killer) T Cells or
B Cells responsible for formation and
release of antibodies
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III. Response Stage
The cytotoxic T cell and the B Cell
perform cellular and humoral function
respectively.
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IV. Effector Stage
Antigens are destroyed or neutralized
through the action of antibodies, complement,
macrophages and cytotoxic T Cells.
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HISTORY
Age
Life style
Nutrition Recent exposure to pathogen
Drug intake
immunization
History of immune disorder
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Respiratory
Changes in respiratory rate
Cough (dry or productive)
Abnormal lung sounds
Rhinitis
Hyperventilation
Bronchospasm
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Cardiovascular
Hypotension
Tachycardia
DysrhytmiaVasculitis
Anemia
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Genitourinary
Frequency and burning on urination
Hematuria
Discharge
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Gastrointestinal
Hepatosplenomegally
Colitis
Vomiting Diarrhea
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Skin
Rashes
Lesion
Dermatitis
Hematoma or purpura
Edema or urticaria
Inflammation
Discharge
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Neurosensory
Cognitive dysfunction
Hearing loss
Visual design
Headaches and migraine
Ataxia
Tetany
Main Menu
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Leukocyte and Lymphocyte Tests
Humoral (Antibody Mediated) Immunity Test
Cellular (Cell Mediated) Immunity Test
Phagocytic Cell Function TestComplement Component Test
Hypersensitivity Test
HIV Infection Test
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Overview
Caused by an oversensitive immune system
An allergic reaction is when the immune
system reacts to substances (allergens) that
are generally harmless and in most people donot cause an immune response.
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In a person with allergies, the first exposure
to the allergen triggers the immune system to
recognize the substance. Succeeding exposure will usually result in
symptoms.
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When an allergen enters the body of aperson with a sensitized immune system,
histamine and other chemicals are released
by certain cells. This causes itching, swelling, mucus
production, muscle spasms, hives,
rashes, and other symptoms.
Symptoms vary in severity from person to
person.
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Some disorders may be associated withallergies. These include eczemaandasthma, among others.
Commonallergens include those that
contact the skin, breathing passages, orthe surface of the eye (such as pollen; seealso allergy to mold, dander, dust).
Food allergies and drugallergies are
common. Allergic reactions can be caused by insect
bites, jewelry, cosmetics, and almost anysubstance that contacts the body.
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Signs & Symptoms
runny nose
tearing eyes, burningor itching eyes
red eyes,conjunctivitis
swollen eyes
itching nose, mouth,throat, skin, or anyother area
wheezing
coughing
difficulty breathing hives (skin wheals)
skin rashes
stomach cramps
vomiting diarrhea
headache
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Prevention
Children who have been breastfed areless likely to have allergies.
There is also evidence that infants
exposed to certain airborne allergens(such as dust mites and cat dander) maybe less likely to develop related allergies.
Once allergies have developed, treatingthe allergies and carefully avoiding thosethings that cause reactions can preventallergies in the future.
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HYPERSENSITIVITY REACTIONS
Are immune responses to allergens that result in
tissue destruction
Type I (ANAPHYLACTIC) reactions.
Anaphylaxis is an acute, life-threatening allergicreaction marked by rapidly progressive urticaria
& respiratory distress which may result in
anaphylactic shock.
ETIOLOGY. Results from ingesting or systemicexposure to allergenic substances (drugs, foods,
insect-venom)
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PATHOPHYSIOLOGY
Exposure to allergen
Production of IgE binds to mast cells & basophils
Reexposure IgE reacts immediately to the allergen
Release of potent chemicals mediators (histamine, ECF-A)
Ig G or IgM releases 2 other chemical mediators
(bradykinin & leukotrienes)Profound vascular changes
Vascular collapse ANAPHYLACTIC SHOCK
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ASSESSMENT FINDINGS
LOCA
L EFFECTS wheals with surroundingred flares & urticaria
SYSTEMIC MANIFESTATIONS.
Intense urticaria and edema at the site of
injection rapidly spreading in the face, handsand other body areas
Respiratory distress from bonchospasm,
coughing, sneezing or wheezing Arrhythmias, tachycardia, or bradycardia,
hypotension & signs of circulatory collapse
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NURSING MANAGEMENT
Establish patent airway Administer epinephrine, IM or SQ to constrict
blood vessels, raise RR, improve myocardialcontractility
Establish patent IV line for fluid administration Oxygen therapy
Administer prescribed medications (anti-
histamine, bronchodilators, vasopressors,corticosteroids)
Teach preventive measures
Maintain safety precautions
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Type II (CYTOTOXIC) reactions are
mediated by Ig G and IgM, which attach tocells (usually circulating blood elements)and cause cell lysis. Ex. Hemolytic anemia
Type III (IMMUNE COMPLEX) reaction are mediated by antigen-antibodycomplexes that deposit in the lining ofblood vessels or on tissue surfaces ex.
Rheumatoid arthritis, serum sickness Type IV (DELAYED HYPERSENSITIVITY)
reactions are mediated by lymphokinesreleased from sensitized lymphocytes
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AIDS
Acquired immunodeficiency syndrome
Collection of symptoms and infectionsresulting from the specific damage to theimmune system caused by infection with thehuman immunodeficiency virus (HIV) whichallows normally benign organisms to flourishand cause disease.
The virus causes cell death and a decline in
immune function resulting in opportunistic
infections, malignancies & neurologic
problems
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Anatomy of the HIVVirus
Gp120 Envelope Protein
Gp41 Envelope Protein
P17 matrix protein
P24 Capsule Protein
Reverse Transcriptase
The Lipid Membrane
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Anatomy of the HIVVirus HIV Human Immuno Virus
AIDS
CD4 count is
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Etiology
Risk factor
Unprotected vaginal, anal. Or oral intercourse
IV drug used with contaminated needles
HIV infected mother to child in utero (Vertical
Transmission)
Contaminated needle stick
Blood and blood product recipient
Semen used forAI (artificial insemination)
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PATHOPHYSIOLOGYHIV (Retrovirus)
Carries genetic information as RNA
Attach to surface antigen (CD4)
Transmits genetic information into the human cell
Primary cells affected are the Helper T cells
Direct infiltration into the CNS
HIV RNA enters the cell, reverse transcriptase converts RNA
to DNA (deoxyribonucleic acid) material
As DNA, the virus is able to replicate as the cell replicate
Rapid cell destruction & proliferation can occur
Virus can lie dormant for approx.10
years
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Stages of HIVdisease
Primary Infection (Acute HIV)
Period from infections with HIV to the
development of antibodies to HIV
Viremia stage Severe-flu like symptoms
Window period
Test negative with HIV antibody test
Viral set point Balance between HIV and immune response
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HIV asymptomatic
CD4 is > 500
Feeling well
HIV symptomatic
CD4 is 200-499
Gradual falling of CD4
AIDS
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Symptoms
Flu-like symptoms
No symptoms (asymptomatic)
Fever, Fatigue, Diarrhea, Skin Rashes,
Night Sweats, Loss of appetite,lymphadenopathy (enlarge lymph nodes)
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Opportunistic Infections
Pneumocystis Carinii Pneumonia
Cryptococcal Meningitis
Toxoplasmosis
Candidiasis Histoplasmosis
Cytomegaloviris infection
Tuberculosis
Kaposis sarcoma, anA
IDS related lymphoma Neurologic deficit (AIDS dementia) characterized by
behavioral, cognitive and motor deterioration
Problems with other organs; lungs, liver, kidneys,
intestines, and heart.
LABORATORYAND DIAGNOSTIC
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LABORATORYANDDIAGNOSTIC
STUDY
ELIZA (enzyme linked immunosorbent assay) Diagnostics.
Identifies antibodies directed specifically against HIV.
Western Blot Assay
To confirm HIV antibodies
Viral Load
Measures HIV RNA in the plasma
Better predictor of the risk of HIV progression than CD4
CD4 count, CD4/CD8 ratio
Significantly lowering of CD4 over CD8
Ora Quick Rapid HIV 1Antibody Test
Detects antibodies to HIV 1
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Complications:
HIV Encephalopathy
AIDS dementia complex
Progressive decline in cognitive, behavioral, and motor
functions
Wasting syndrome
Profound involuntary wt loss exceeding 10% of baseline
body weight.
Either theres a presence of chronic diarrhea for more
than 30 days or chronic weakness with documentedfever
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Kaposis Sarcoma
tumor caused by Human herpesvirus 8(HHV8)
KS lesions are nodules or blotches that
may be red, purple, brown, or black, andare usually papular(ie palpable or raised).
Can lead to venous stasis, lymphedema(fluid retention)
Skin lesion increase discomfort andinfection
Death may result from tumor progression
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NURSING MANAGEMENT Administer prescribed medications
- Includes antibiotics for HIV-related infections,antiretroviral therapy, antidiarrheals and antiemetics
Promote preventive measures related to thetransmission of HIV
Promote public education regarding HIV & AIDS(teach clients & families to practice safe sex, avoidsharing needles, avoid touching anothers body fluidwithout protection)
Maintain skin integrity
Instruct the client to avoid scratching, strongperfumed soaps and adhesive tapes
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NURSING MANAGEMENT
Help maintain nutritional status- By controlling nausea & vomiting
- Encourage foods that are easy to swallow
- Encouraging oral hygiene before and after meals
- Promoting a high-protein, high-calorie diet
- Monitoring weight, intake & output
- Monitoring fluid & electrolyte balance
- Administering appetite stimulants
Teach ways to cope with chronic illness to
the client & significant others.
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NURSING MANAGEMENT Promote infection prevention
- Discuss importance of personal hygiene, keepingbathrooms and kitchens clean
- Avoid exposure to individuals who are sick,avoiding smoking and alcohol
- Adequate rest, activity and a well-balanced diet
Discuss ways the client and family canassist with mental status problems.
These includes putting notes on note boards,using calendar and clocks to orient the client totime & place.
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Terminologies
Infection
The invasion and multiplication of microorganism
in the body tissue that result in cellular injury.
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Terminologies contd Microorganism
Infectious agent
Pathogen
Microorganism that causes a disease
Pathogenicity The ability of the microorganism to produce a disease
Virulence
The degree of pathogenicity
Sepsis
The state of infection Asepsis
The freedom from disease causing microorganism
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InfectiousA
gentReservoir
Portal of Exit from Reservoir
Mode of Transmission
Portal of Entry to the Susceptible Host
Susceptible Host
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