NURS 3365 BB ASSIGNMENT 3 answers and rationaleS

Questions 1-3 refer to this scenario: A man presents to an ER with a large laceration sustained at a construction site a few hours before. The area around the laceration is erythematous, painful, and swollen. 1. The erythema and swelling can be explained at a cellular level by all the following EXCEPT a. mast cell degranulation and release of histamine. True (see concept map) b. pro-inflammatory prostaglandins released. True c. increased vasomotor tone (tightening) of the capillaries in the area. False statement, so this is the CORRECT answer. Any inflammatory response involves some degree of DECREASED vasomotor tone—ie, capillaries in the area must VASODILATE (relax, have less tone) in order for substances to “ooze out”-- leak out of the blood to go “help” healing in the tissue. So usually we equate “dilation and leakage” with inflammation. This is why you often see swelling with inflammation—the swelling is caused by the dilated blood vessels and accumulation of leakage. d. local reaction to acute phase reactants. True 2. The patient is given a TIG (tetanus immunoglobulin) injection because the wound is high risk for tetanus exposure and he doesn’t remember ever having a tetanus vaccination. The purpose of the TIG is to a. prevent any tetanus bacteria from activating the inflammatory system. Wrong—inflammation will be activated as soon as any cell in the body is irritated and/or injured. Giving antibodies (immunoglobulins)– the “IG” in TIG—doesn’t prevent inflammation. b. introduce tetanus bacteria so that the immunocyte system can create antibodies to tetanus. Wrong—TIG is antibodies, not the microbe itself. c. give the patient natural active acquired immunity. Wrong—the word “natural” implies that a person contracted tetanus (HAD the disease) and created their own antibodies as a result of the active disease. d. provide tetanus antibodies to fight any tetanus bacteria that might be present. CORRECT —just in case this person’s body was invaded by a tetanus bacteria, giving them antibodies NOW will help them fight the microbe NOW. This is called conferring artificial passive acquired immunity. 3. The patient (should or should not) be instructed to also get a tetanus vaccination, because . a. should: he needs protection against future tetanus exposure. CORRECT : passive immunity (when you DON’T make the antibodies in your own body, but are given them) is very short-lived. The antibodies that are GIVEN to you, that you DON’T create on your own, will disintegrate within a few weeks. So you WILL need a vaccination, which confers artificial ACTIVE immunity— having a weak tetanus injected in you will make you create your OWN antibodies, which are long-lived. b. should: the vaccination will provide additional passive immunity. Wrong—see above (vaccination and PASSIVE shouldn’t be in the same sentence; vACcination = ACtive) c. should not: the TIG is enough, as it will provide long term active acquired immunity Wrong—see above d. should not: the vaccine will do nothing for the current exposure. Wrong—see above. Look at this answer closely. The last part is true. A vaccination WILL NOT help a person RIGHT NOW, because creating your antibodies takes time. But the question asked should he go ahead and get a vaccination? Yes, he should. No, it won’t help him NOW, but it will help him if he ever gets a tetanus microbe inside his body in the future—his antibodies can THEN kill the microbe swiftly. 4. A microbe invades the body for the first time. Which statement is most likely about the processes that follow? a. Plasma cells (a type of B-lymphocyte) will immediately secrete T-cells specific to that microbe. Wrong. Plasma cells secrete antibodies, not T-cells. b. CD4 cells will introduce remnants of the microbe to the plasma cells, which directly phagocytize the remnants. Wrong— plasma cells are not phagocytes. They are a form of B lymphocyte. c. Antigens will be created from the memory cells of immunocytes. Wrong—doesn’t make sense. Don’t confuse the word antigen with the word antibody. d. Immunocytes will begin the process of developing memory to that microbe. Correct— During the inflammatory process, if a microbe is involved, the T-cells and/or B-cells are “called in” and begin to develop microbe-specific memory. Especially let’s focus on the antibodies… the Bcells will begin the memory process, and as a result, antibodies that are specific to that particular microbe will be formed and will be on hand for the next time the body “sees” that microbe. (Tcells do similar process, but don’t create antibodies.) 5. A patient has a systemic inflammation. All the following are likely associated with his condition EXCEPT a. increased acute phase reactants. True – acute phase reactants have the job of increasing inflammation as needed—“fuel on the fire”; especially they increase circulating in the blood when there is a systemic inflammation. b. lab results showing a high C-reactive protein (CRP). True—CRP is one of the acute phase reactants. c. lab results showing leukopenia. False, so this is CORRECT answer. During systemic inflammation, leukocytes will increase in number so as to participate in the various parts of the inflammatory response, especially neutrophils, which act as phagocytes (see concept map). So leukocytosis and neutrophilia are part of inflammation, not leukopenia (PENIA= “lower numbers than normal”). d. increased pro-inflammatory prostaglandins. True – remember that prostaglandins have two subcategories—the duty of INCREASING inflammation is called “pro-inflammatory.” The other types of prostaglandins are “protective”—they bolster certain aspects of body function 6. A baby who has received immunoglobulins against the “XYZ” virus via its mother’s milk now has a. natural active acquired immunity. Wrong—an example of this is getting chicken pox. b. natural passive acquired immunity. Correct—natural (from mom); passive = baby did NOT make its own antibodies. c. passive innate immunity. Wrong—mixed up terms. Remember that when we are talking about immunoglobulins, we are automatically thinking of the third line of defense – ACQUIRED immunity, not innate. (Innate involves first and second line of defense) d. active innate immunity. Wrong—see above about acquired vs innate. 7. The baby in the previous question will . a. have lifelong immunity to the XYZ virus because of receiving the immunoglobulins that are specific to that particular microbe. Wrong—can’t get lifelong immunity from receiving SOMEONE ELSE’s antibodies. b. develop temporary immunity to the XYZ virus due to receiving Mom’s antibodies that are specific to that particular microbe. Correct—passive acquired immunity is ok for right NOW, but the antibodies will disintegrate within a short time—hence “temporary.” c. now have complete 2nd line of defense protection, having received it in the breast milk. Wrong— remember that when we are talking about immunoglobulins, we are automatically thinking of the third line of defense d. develop alphabetophobia due overdose of anti-XYZ immunoglobulins.  8. A person starts Jazzercise for the first time and becomes very sore all over. The most appropriate self-treatment for this person is to , because . a. take an NSAID such as Aleve : it powerfully suppresses phospholipase enzymes in the arachidonic pathway. Wrong—steroids suppress phospholipase. NSAID are non-steroidal antiinflammatories that work further down in the arachidonic pathway. See page 19 of RRD. b. take an NSAID such as Advil : it is an effective suppressor of certain levels of pro- inflammatory prostaglandin activity. Correct c. go in for a CRP test: it will determine the degree of pain. Wrong --CRP is an acute phase reactant that will increase when you have an inflammation but it is very non-specific—you can’t judge degree of pain by that (besides that, FYI—everyone’s pain is different—not something that can be generically measured.) d. take an antihistamine: it will suppress steroidal influence. Wrong—we haven’t discussed antihistamines, but we have talked about histamine, which you know to be a substance that is part of the inflammatory response. So in a sense an anti-histamine suppresses a certain part of inflammation. Steroids also, in a much different way, suppress inflammation—you know this too— via suppressing prostaglandins. So antihistamines suppressing steroids doesn’t make sense. 9. A patient has been in the hospital for treatment of an infection. One day his BP drops to 80/50 (normal ~ 120/80), he has a fever of 102, and he becomes restless and confused. All the following are correct about this situation EXCEPT a. a likely diagnosis is septic shock, partly because his BP is low, and he has S&S related to low blood volume to the brain. True – the definition of shock is low BP that causes S&S. And since he has an infection, it makes sense that sepsis has become involved (sepsis— the inflammatory response to a systemic infection) b. a good mini-concept map would be: infection goes systemic (sepsis) increases circulating acute phase reactantssystemic vasodilationless blood centrally low BP. True—this is exactly how septic shock works. It is the massive vasodilation from massive, systemic inflammatory response that causes the BP go become so low that the patient can’t get enough blood to the brain restless, confused. c. a good mini-concept map would be: local infection gets worse invades lining of blood vessels in the arealocal sepsis develops chronic inflammation results in hypotension. False, so this is the CORRECT answer. The term “local sepsis” is an oxymoron—by definition, sepsis is not local but systemic. d. the patient’s blood work will show leukocytosis, neutrophilia, and high CRP as part of the high degree of inflammatory response in his body. True. See the table on the next page. It is numbered I-XIV. In the right column are words and phrases that link in some way with each of the numbered items on the left. In other words, this is a typical “matching” exercise. Fill out the table, and use it to answer questions 10-15 directly below. ONLY ONE ANSWER TO EACH LEFT- HAND TERM, AND DO NOT CHOOSE THE SAME ANSWER MORE THAN ONCE— CHOOSE THE BEST FIT. 10. Granuloma (#I) a. I b. N--local chronic inflammatory tissue reaction c. A d. F 11. Example of qualitative defect of “not enough” inflammatory function (#IV) a. K-- chemotactic defect – without chemotaxis, certain important cells (phagocytes, immunocytes) wouldn’t be “called” in to help at the site of a defense breach. b. L c. G d. N 12. Leukopenia (#V11) a. D b. E --example of quantitative defect of “not enough” inflammatory function—leukopenia means less numbers of WBCs than usual, making this a quantitative defect. c. K d. O 13. Part of inflammation in which vasomotor tone of capillaries “relaxes” (#X) a. H b. N c. A vasodilation d. J 14. Steroidal suppression of protective prostaglandins (#XII) a. B b. F c. M d. G –Remember that steroids do what you WANT them to do when they suppress the pro-inflammatory side of prostaglandins. So if someone gets a course of steroids for an acute back injury, and the patient feels better, it’s because the steroid is suppressing the inflammation that causes pain. If that person were to STAY on steroids for a long time, though, the side effects could include problems such as stomach ulcers. This risk is related to the fact that steroids are non-specific—as they are suppressing inflammation, they are also suppressing the “protective” aspect of prostaglandins, including protecting the stomach lining from stomach acid. So, long-term steroids use (such as for someone with chronic inflammatory diseases like autoimmune diseases) sometimes has bad side effects. This is an important concept. See RRD 3, page 14.