IMMUNE SYSTEM
active vs. natural immunity
active= antibody/cellular response to antigens or infections
natural= chemical (gastric secretions) and physical (skin, mucosal membranes) barriers
HIV life cycle
1. attachment to CD4 cells
2. fusion
3. reverse transcriptase
4. integration
5. replication
6. budding
Calculate the total intake in mL’s:
6 oz peaches
3 oz salmon
Two (2) cans of ginger ale (12 0z each)
1 house salad
8 oz water
960
A patient receives:
Chicken broth 250 mL
Gelatin dessert 120 mL
Mashed potatoes
Ice chips 1 cup
Enteral feeding 400 mL
What is the total intake?
890 mL
Which items should be EXCLUDED from intake calculations?
Applesauce
Cooked cereals
Pureed vegetables
Whole foods (apple, banana, cheeseburger, etc)
Condiments (ketchup, mustard, mayo)
humoral vs. cell-mediated immunity
humoral = b-cell release antibodies to defend the body against infections; activated by helper t-cells
cell-mediated= cytotoxic cells recognize infected cells and attack those cells resulting in cellular death; activated by helper t-cells
HAART therapy for HIV
The use of numerous HIV medications to prevent resistance
Solumedrol 1.5 mg/kg is ordered for a child weighing 6 lb. Solumedrol is available as 75 mg / 2 mL is available. How many mL must the nurse administer?
0.11mL
A nurse adminsterd 2.5 tablets with a dose of 500mg each. What was the total dose adminstered in mg?
1250 mg
This type of IV fluid causes fluid to move out of cells, making it useful for cerebral edema.
Hypertonic fluids (e.g., 3% NS)
Immunity obtained from other sources. Examples between natural and artificial sources.
Passive immunity
natural= mother to child
artificial= IVIG - immunoglobulin infusions
Zidovudine moa and adr
zidovudine is a nucleotide reverse transcriptase inhibitor that mimics nucleosides to prevent proper reverse transcription
May cause bone marrow suppression
Order Gentamycin 50 mg IV q6h. Gentamycin available 80mg/2ml. How many ml will you give per dose? For the entire day?
1.25 ml/dose; 5ml/day
Amoxicillin 25 mg/kg/day divided BID is prescribed.
Child weighs 22 lb.
Medication available: 250 mg / 5 mL
How many mL per dose?
2.5 mL per dose
Dairy products reduce absorption of this antibiotic class.
Tetracyclines
Immunity obtained from self. Examples of natural and artificial sources.
Active immunity= body produces antibodies needed to defend against infection
natural= post-infection memory cells
artificial= vaccinations
Raltegravir moa and ADR
Raltegravir is an integrase inhibitor that prevents HIV DNA from being integrated into the cell's DNA.
May cause CNS effects
A patient with severe diarrhea has a serum potassium of 2.7 mEq/L. The provider orders potassium chloride 40 mEq IV to infuse over 4 hours. The IV bag contains KCl 20 mEq in 100 mL.
What is the IV pump rate (mL/hr)?
50 mL/hr
Heparin infusion 18 units/kg/hr ordered.
Patient weighs 44 lb.
IV bag contains 25,000 units in 500 mL.
How many mL/hr?
7.2 mL/hr
Which meds require extra calculation safety?
Insulin
Heparin
Pediatric meds
IV electrolytes
Different types of vaccinations. Provide examples.
live vaccines= varicella and MMR
inactive vaccines= flu
toxoid vaccines= Tdap
recombinant vaccines= Hep B and HPV
A live vaccine is contraindicated in what condition?
immunocompromised patients
The provider orders calcium gluconate IV push at 100 mg/min. The patient requires 1 g total.
How long (in minutes) should the medication be administered?
10 minutes
A patient with hypokalemia is ordered 60 mEq KCl IV, but only 20 mEq may infuse per hour via central line.
IV bags available: 40 mEq in 250 mL.
a. How many hours will the infusion take?
b. What is the pump rate (mL/hr)?
a. 60 mEq ÷ 20 mEq/hr = 3 hours
b. 40 mEq = 250 mL
125 mL/hr
Name a teaching point for vaccines.
Mild fever expected
Soreness at site
Live vaccines contraindicated for immunocompromised
Multiple doses may be required