skin, mucous membranes, tears, cilia, saliva,

gastric acid, body pH

active natural develops from exposure to disease, most effective and longest lasting

active artificial develops from vaccination

in utero, breastfeeding

immunoglobulin

inflammation

humoral

cellular

- antibodies build up and circulate in body fluid

- purpose is to nuetralize or eliminate foreign organism

- usually carried on plasma protein

- B lymphocytes (plasma cells and memory cells)

- body cells that offer protection/destruction of foreign cells (bacterial phagocytosis, plasma cells produce immune response, anaphalactic response)

- helper T cells (T4/CD4)

- killer (cyototoxic) T cells

- suppressor T cells (T8/CD8)

- memory cells

age (very young/elderly - decreased T cell, decreased plasma cell, decreased protein, decreased febrile response)

current state of health (chronic health problems decrease immunity)

gender

nutrition

stressors

occupation (health care worker, day care worker, high stress job)

autoimmune diseases

medications (steriods, NSAID, antibiotics, immunosuppressor)

sedentary lifestyle

- HIV is retrovirus

- is a parasite that contains RNA and reverse transcriptase

- binds to receptors on CD4 cells

- CD4 cells become encoded to replicate as HIV

- HIV cells replicate with each division of CD4 cell

- rate of immune system destructio varies

33 million

2.1 million deaths (2007)

5th

homosexual

IV drug user

bisexual

heterosexual (prostitutes, teen runaways)

intimate sexual contact

blodo and blood products (IV drug use, blood transfusions, puncture wounds)

perinatal

- not transmitted by casual contact

- does not live long on inanimate surfaces

- not transmitted via tears, urine, emesis, sweat, feces

- infectious immediately

- life-long ability to transmit virus

- viral load

- portal of entry

- frequency of contact

- host's immune status

- safe sex practices

- no IV drug use

- pregnant women should be tested

- no blood donation if HIV +

- standard precautions for all patients

- rate

- risk should be evaluated: viral load, port of entry, host

- prophylactic meds

- retesting at 3 and 6 months

- candida albicans

- CNS lymphoma

- cryposporidium muris (sever diarrhea from protozoa found in water)

- cytomegalovirus

- Hep B/C

- Herpes Simplex, HSV I and HSV II

- varicella-zoster (usually found on one side of body)

- Kaposi's sarcoma (can spread to lungs, lymph nodes, and GI)

- PCP (requires bactrum for life)

- myobacterium avium complex (MAC)

- myobacterium tuberculosis

- skin sensitivity tests

- bone marrow biopsy

- CBC with diff, coags, hep b&c, tests for STD's

prepartum: AZT oral, combination therapy; avoid amniocentesis, internal fetal monitoring

intrapartum: transmission most common later in pregnancy, and with vaginal delivery; AZT IV; C-section

postpartum: breast feeding contraindicated

no treatment: 25%

AZT: 5-8% risk

AZT and C-section: <2%

- same as long as child is healthy

- varicella is never given to adults, give to children on a case by case basis

- MMR, Hep A and B given

- often dxed when seeking care for STD

- unsafe sex, IV drugs are risk factors

- should be tested for Hep A and Hep B

- decrease viral load

- maintain/raise CD4

- delay developement/treat HIV symptoms and opportunistic diseases

- highly active antiretroviral therapy

- inhibits viral replication, does not kill virus

- combo of different types of antiviral

- helps delay onset of symptoms

- HIV can become resistant to one drug

- PT can be taking 30-40 pills a day with multiple and potentially severe side effects

- cost can be over $2000/month

- compliance can be difficult

- neucleoside reverse transcriptase inhibitors, zidovudine (AZT, Retrovir)

- 1st drugs discovered

- bind reverse transcriptase so that the virus cannot replicate

erthropenia: erthroprotein (3x/week) or Arrocept (1x/week)

neutropenia: neupogin and neutropenic precautions

thrompocetopenia: platelets given (perferred) or neumega (expensive w/ many side effects)

- saquinavir (Invirase)

- ritonavir (Norvir)

- indinavir (Crixivan)

prevent virus from seperate into appropriate length to prevent replication

cannot take St. John's wart

prevents binding of HIV to cell

sub q BID

- Combivir (lamivvudine and zidovudine)

- Kaletra (ritonavir and lopinavir)

A - age, sex, H/W/BMI/idea weight

candidia: diflucin, frequent mouth care

anti-emetics

small, frequent meals

cool foods

decreased spicy foods

Peg feedings

gatorade

occasionally TPN

BRAT diet

low blood flow: cardiogenic and hypovolemic

maldistrubition: nerogenic, anaphylactic, septic

- extremeties of age

- malnutrition

- open wounds

- general debilitation

- immunosuppression

- CHF

- COPD

- Cirrhosis

- Cancer

- CRF

- trauma

- surgical wounds, drains

- invasive lines, diagnostic procedures

- dental abscess, sinus surgery

- drugs: antibiotics, cyotoxic drugs, immuno-suppressive drugs

- myocardial depression

- massive vasodilation

- maldistribution of intravascular volume

- formation of micro-emboli

multiple compensentory mechanism activated to maintain homeostasis

- baroreceptors

- SNS activation (epihenphrine, norepinephrine, renin-angiotension mechanism)

- increased myocardial contractility

- cortisol secretion

- increased CO

-anaerobic metabolism

- compensatory mechanism fail

- multisystem organ dysfunction syndrome if not correct within the hour

- increased capillary permeability

- anasarca

- increased blood viscosity

- DIC often develops d/t increased clotting factors

- hypoxia

- shock is profound

- death is inevitable

- no repsonse to treatment

- sever anasarca

- fluids leaks from tissues

- severly oliuric and anuric

- severe tissue hypoxia/necrosis

- decreased CO

- ineffective tissue perfusion

- deficient intravascular fluid volume

- impaired gas exchange

- risk for injury

- fear

- thorough h and p

- blood c&s (but don't wait for results for broad spectrum antibiotic)

- urinalysis (check for bacteria, hemoturia, increase spec gravity)

- CBC with diff (increased in neutrophils, bands "shift to the left", decreased platlets

- DIC screen

- Chemistries (decreased BUN and Creat - most sens indicator)

- ABG (decrease pH and p02)

- 12 lead EKG

- X-ray

- hemodynamic monitoring

- oxygenation

- fluids

- treat infection

- be prepared to intubate

- suctioning/turning/cough/deep breath

- monitor skin temp, color

- moisture

- check for cyanosis: oral mucous membranes

- fluid resuc: fluid challange, run 500 ml NSS

- may give RBC

- colloids: salt poor albumin

- I&O's, foleu

- PCWP b/t 8-12

- maintain medatbolic: sodium bicarb, K& Mg

- monitor blood gases

- treat infection

B - biochemical (albumin, globulin, prealbumin, Chem 7, CBC, Magnesium)

C - clinical observations (assess for opportunistic infections, discomfort)

D - diet (increase protein, increase calorie count, give vitamin supplement, often lactose free diet)

E - Environmental (asses living arrangement, may not have adequate refrid/stove)