Unit 2 Seminar

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• Unit 2Seminar
• Dr. J. V. Stoia

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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?

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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.

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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.

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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.

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Question 1

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

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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?

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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.

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Question 2

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

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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.

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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.

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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)

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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

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Acquired Immunity
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Trivia Question

• Where does the term vaccination come from?

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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

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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

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B lymphocyte cells include

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

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Orderly Function of the Immune System (contd.)

• Immunoglobulins
• IgG (75-85)
• IgA (5-15)
• IgM (5-10)
• IgD (0.2)
• IgE (0.5)

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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.

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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

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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

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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

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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.

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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

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Autoimmune Diseases

• What is autoimmune disease?
• What are some examples?

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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.

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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.

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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.

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Autoimmune Diseases (contd.)

• Collagen Diseases
• Systemic lupus erythematosus
• Scleroderma
• Sjogren syndrome
• Rheumatoid arthritis
• Juvenile rheumatoid arthritis
• Ankylosing spondylitis
• Polymyositis

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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.

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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

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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.

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Autoimmune Diseases (contd.)

• Rheumatoid arthritis treatment aimed at
• Reducing inflammation and pain
• Preserving joint function
• Preventing joint deformities

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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

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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.

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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.

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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