Immunity/Lymphatic System
What is Acquired Immunity?
Immunity that is present only after exposure and is highly specific; immunity developed during lifetime i.e. memory
What is the difference between a benign and malignant tumor?
Benign: localized, slow-growing, non-invasive
Malignant: invasive, tissue-destroying, can metastasize
Describe hematopoiesis.
Hematopoiesis is blood cell production.
What is the range for Normal Blood pH?
7.35-7.45
*Narrow range, so any small deviation can be life-threatening
What is the normal electrolyte range for Sodium?
135-145 mmol/L
What are the two defensive mechanisms of Acquired Immunity? Describe each and give an example.
-Humoral (antibodies/immunoglobulins): neutralize or tag pathogens for destruction e.g. IgG
Bonus: Which antibody is the first to respond during an invasion? IgM -- second most abundant
-Cell-mediated (T cell) immunity: directly kill infected cells (cell mediated) by recognizing antigens presented by MHC molecules (proteins found on the surface of cells that help the immune system recognize whether something is “self” or “foreign.”)
a. Helper T cells
b. Killer T cells
Explain the General Adaptation Model (GAS Model).
Week 3 material
Answer: this model represents our response to stress; first is the alarm reaction, next is resistance or adaption, lastly there is exhaustion
*How can you tie this back to cancer? Why is chronic stress a risk factor for developing cancer?
Answer: wear and tear i.e. exhaustion of immune system
What is the difference between Erythropoiesis, Leukopoiesis, and Thrombopoiesis?
Erythropoiesis: the formation of red blood cells, which is stimulated by erythropoietin
Leukopoiesis: formation of WBCs
Thrombopoiesis: formation of platelets
Which issue is occurring when there is an acid deficit or bicarbonate excess?
Alkalosis (think decreased acid and more bicarb)
Which electrolyte is most vital for the heart?
POTASSIUM
Out of range potassium = continuous cardiac monitoring
A nurse is providing education to a student regarding allergies. Which of the following shows the student understands the information? SATA
a. If I have seasonal allergies, I will need to carry an Epipen.
b. The antibody that causes an allergic reaction is IgE.
c. Allergies that cause breathing difficulties are a medical emergency.
d. Allergies occur when the immune system mistakes a harmless substances as threats.
b. The antibody that causes an allergic reaction is IgE.
c. Allergies that cause breathing difficulties are a medical emergency.
d. Allergies occur when the immune system mistakes a harmless substances as threats.
What are some S/S of cancer? HINT: CAUTION mnemonic
Changes in bowel or bladder habits
A sore that does not heal
Unexplained weight loss; unusual bleeding or discharge
Thickening or lump in the breast or elsewhere
Indigestion or difficulty swallowing
Obvious change in a wart or mole
Nagging cough or hoarseness
Describe the clotting cascade.
1. Vessel injury triggers platelet adhesion
2. Platelets release chemical signals
3. Additional platelets aggregate at the site
4. Clotting factors create a stable fibrin mesh i.e.sticky, net-like structure to stop bleeding
5. The clot prevents further blood loss
A 65-year-old male with a COPD exacerbation presents to the ED with severe shortness of breath. Interpret the ABG findings:
pH: 7.22, PaCO2: 62, HCO3: 24
Respiratory acidosis
A nursing student is learning about electrolyte imbalances. Which of the following shows the student understands the material?
a. Hypercalcemia is associated with renal calculi
b. Calcium and Phosphate do not work oppositely
c. Magnesium is what powers Magneto (X-men)
d. Potassium is the most important electrolyte for the brain.
a. Hypercalcemia is associated with renal calculi
Moans, groans, and stones = kidney stones = hypercalcemia
A student nurse is assessing a patient who is in the hospital for an organ transplant rejection. The student knows which type of immunity plays a role in transplant rejection?
a. Autoimmunity
b. Cancer
c. Immunodeficiency
d. Alloimmunity
d. Alloimmunity
Explain why:
An oncology nurse is reviewing cancer staging with a nursing student. Which answer choice shows understanding of cancer staging?
a. Stage I represents metastasis.
b. Stage II represents no lymph involvement
c. Stage III involves regional lymph node
d. Stage IV means the patient has a better prognosis
c. Stage III involves regional lymph node
A 25-year-old female patients presents to the clinic due to heavy menstrual bleeding along with fatigue and weakness. The nurse assesses the patient and finds that the patient is pale, has cool extremities, and her HR is 110. What condition does the nurse suspect?
a. thrombocytopenia
b. leukocytosis
c. anemia
d. sickle cell anemia
c. anemia
Not sickle cell anemia, because a key feature of sickle cell anemia are vasoocclusive crisis, which cause pain.
A 38-year-old mom of 4 has had severe diarrhea for 2 days and has dry skin along with poor skin turgor. Interpret the ABG findings:
pH: 7.28, PaCO2: 41, HCO3: 17
Metabolic acidosis
Diarrhea = loss of bicarbonate, so there is nothing to neutralize acids
A nurse is assessing a patient with a serum sodium level of 128 mmol/L. Which finding requires immediate intervention?
A. Dry mucous membranes
B. Confusion and decreased level of consciousness
C. Complaints of excessive thirst
D. Mild peripheral edema
B. Confusion and decreased level of consciousness due to hyponatremia and this can progress to seizures and coma if not corrected
A nurse is caring for a patient who is recovering from a left breast mastectomy along with lymph node removal. Which of the following nursing interventions should the nurse perform? SATA:
a. insert an IV in the left arm
b. ensure the patient has a lymphedema alert band on the left arm
c. take the blood pressure on the left arm
d. elevate the patients arm using a pillow
b. ensure the patient has a lymphedema alert band on the left arm
d. elevate the patients arm using a pillow
a & c - INCORRECT: patients who undergo lymph node removal for breast cancer are at higher risk for developing secondary lymphedema. Any puncture, trauma, or pressure can worsen the lymphedema. Lymphedema is uncomfortable e.g. the left arm feels heavy. Do not take blood pressure on arm with lymphedema
A patient with leukemia (blood/bone cancer) tells the nurse he is in lots of pain and rates his pain as 10/10 on the pain scale. What is the nurse's first priority?
a. Tell the patient to eat his lunch.
b. Administer the PRN analgesic the doctor has ordered.
c. Tell the patient that rest will help the pain.
d. Tell the patient why the pain is occurring.
b. Administer the PRN analgesic the doctor has ordered.
The nurse's role in cancer care is assessing the patient and addressing the symptoms.
A 52-year-old patient presents to the ED due to a nose bleed that is not stopping. The patient states he bumped his nose on his fridge 2 hours ago and his nose has not stopped bleeding yet. The doctor orders blood work. The nurse suspects which lab value to be low?
a. WBC
b. Platelets
c. Erythropoeitin
d. Acetaminophen
b. Platelets b/c the patient is not clotting correctly.
A 22-year-old college student was hit by a car on campus and this resulted in a broken arm and leg. The student is breathing rapidly and shallowly. Interpret the ABG findings:
pH: 7.52, PaCO2: 26, HCO3: 23
Respiratory alkalosis b/c getting more oxygen than CO2
A nurse is assessing a patient with hypocalcemia. Which findings should the nurse expect? Select all that apply.
A. Muscle spasms and cramps
B. Constipation
C. Numbness and tingling
D. Bone pain
E. Seizures
F. Cardiac arrhythmias
A, C, E, F
Hypocalcemia
• Muscle spasms & cramps (tetany)
• Numbness/tingling
• Seizures
• Cardiac arrhythmias
• Risk of fractures
• Risk of bleeding
B & D seen with hypercalcemia