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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 (cont’d.)

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 (cont’d.)

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 (cont’d.)

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 body’s 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 (cont’d.)

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 person’s entire lifetime.

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Autoimmune Diseases (cont’d.)

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 (cont’d.)

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

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Autoimmune Diseases (cont’d.)

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 (cont’d.)

Butterfly face rash Alopecia Photosensitivity Raynaud’s

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

Systemic Lupus Erythematosus (SLE)

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Autoimmune Diseases (cont’d.)

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 (cont’d.)

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

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Autoimmune Diseases (cont’d.)

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 (cont’d.)

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 (cont’d.)

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 (cont’d.)

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