The Immune and Lymphatic Systems and Cancer

Transcription

1 The Immune and Lymphatic Systems and Cancer 1. Define important words in this chapter 2. Explain the structure and function of the immune and lymphatic systems 3. Discuss changes in the immune and lymphatic systems due to aging 4. Describe a common disorder of the immune system 5. Discuss infection prevention guidelines for a resident with HIV/AIDS 6. Discuss care guidelines for a resident with HIV/AIDS 7. Describe cancer 8. Discuss care guidelines for a resident with cancer Supplemental Tools transparency 24-1 the lymphatic system handout 24-1 myths about hiv and aids chapter 24: exam Assignments textbook reading, pp workbook exercises, pp Overview of Teaching Strategies This chapter describes the immune and lymphatic systems and how they work together to protect the body from disease. Different types of immunity are described, as well as normal changes of aging for these systems. There is detailed information about HIV/AIDS, including activities that do and do not spread HIV/AIDS. Infection prevention guidelines are described, with emphasis on the fact that if Standard Precautions are consistently followed, care for a resident with HIV/AIDS is no different from care for any other resident. This chapter also contains information about cancer, including risk factors, treatment, and care guidelines. 1. Define important words in this chapter textbook p. 429 workbook p. 131 Pronounce and define each of the key terms listed in the Learning Objective on page Explain the structure and function of the immune and lymphatic systems textbook pp workbook p. 131 Review the following points about the immune system: Protects the body from harmful substances Non-specific immunity is present at birth and protects the body from disease in general. Specific immunity is acquired by the body and manufactures antibodies as a response to an antigen in the body. With active immunity, vaccines cause the body to produce antibodies to protect against a particular disease. With passive immunity, a person is given the antibodies needed to defend against the antigen. Display Transparency 24-1 the lymphatic system Lymph Review the following points about the lymphatic system: Removes excess fluids and waste products from the tissues Helps the immune system fight infection

2 163 Thymus gland makes T-cells, which attack and destroy specific types of pathogens. Review the functions of the immune and lymphatic systems: Protect against the invasion of foreign substances and pathogens Return extra fluid to the circulatory system 3. Discuss changes in the immune and lymphatic systems due to aging textbook p. 431 workbook p. 131 Review normal changes of aging: Immune system weakens, causing increased risk of all types of infections. Antibody response slows. T-cells decrease in number. Response to vaccine decreases. 4. Describe a common disorder of the immune system textbook pp workbook pp Pronounce and define the following key terms: Acquired immune deficiency syndrome (AIDS) Human immunodeficiency virus (HIV) Review the following points about HIV and AIDS: HIV attacks the body s immune system and damages or destroys cells. Cause: HIV virus acquired through blood or body fluids from an infected person AIDS is the final stage of HIV infection. Review the most common methods of transmission of HIV: Unprotected or poorly-protected oral, vaginal, or anal sex with an infected person Sharing drug needles or syringes Transmission from infected mother to newborn during pregnancy, birth, or breastfeeding Explain to students that in the healthcare setting, infections can be spread through accidental contact with contaminated body fluids, needles or other sharp objects, or contaminated supplies or equipment. Distribute Handout 24-1 myths about hiv and aids Review the following common activities that do not spread HIV: Hugging another person Shaking hands Sitting on a toilet seat Drinking water from a drinking fountain Touching a doorknob, telephone, table, or chair Using drinking glasses or dishes of infected person Being bitten by mosquitoes Review ways to protect against the spread of HIV/ AIDS: Practice Standard Precautions on every person in your care. Be careful with handling and disposing of sharps. Cover any cuts, sores, tears, breaks, or rashes before caring for residents. Never share needles or syringes. Do not have unprotected sex. Stay in a monogamous relationship. Practice abstinence. Get tested for HIV and re-tested if necessary. Review the signs and symptoms of HIV infections and AIDS: Flu-like symptoms Headaches Loss of appetite Weight loss Night sweats Shaking, chills Dry cough Shortness of breath

3 164 Swollen lymph nodes Sore throat Cold sores or fever blisters on lips Mouth sores White patches on the mouth or tongue Cauliflower-like warts on the skin or in mouth Bleeding, inflamed gums Yeast infections Skin rashes or sores Bruising that does not go away Dry skin Nausea and vomiting Blurred vision Memory loss Opportunistic infection Explain to students that people with weakened immune systems due to HIV/AIDS may get diseases that a healthy person would be able to fight off. Emphasize that lack of treatment for HIV/AIDS increases the risk of serious complications and death from the disease. Autoimmune disease Review the following points about autoimmune diseases: The body is unable to recognize its own tissue and attacks it. Examples: systemic lupus erythematosis and rheumatoid arthritis Cause: unknown, but may be genetic links, microorganisms or medications that act as triggers Signs and symptoms: fever, fatigue, dizziness Treatment: hormone supplements, medications, blood transfusions, insulin 5. Discuss infection prevention guidelines for a resident with HIV/AIDS textbook pp workbook p. 132 Remind students that it is very important to follow Standard Precautions with every single resident in their care. Explain that if they do that, there should be no difference in the care given to residents with HIV/AIDS and care given to any other resident. Review infection prevention guidelines for HIV/AIDS: Follow proper infection prevention procedures and Standard Precautions with all residents. Wear appropriate PPE. Cover all broken skin with appropriate bandages before giving care. Wash hands and other areas of body immediately after contact with blood or body fluids. Handle and dispose of sharps carefully. Remind residents and visitors to wash their hands often. Do not share residents personal items. Properly disinfect surfaces. 6. Discuss care guidelines for a resident with HIV/AIDS textbook pp workbook pp. 133 Homophobia Review the guidelines for HIV/AIDS: Wash hands often and help residents wash hands. Disinfect surfaces often. Protect resident from people having known contagious diseases. Change linen whenever it is soiled. Observe for skin breakdown. Change positions every two hours, or as directed. Give back rubs for comfort. Monitor vital signs often. Allow rest and recognize limitations. Ambulate carefully. Allow time for ADLs.

4 165 Perform ROM exercises as ordered. Give quality mouth care frequently. Use soft toothbrushes or swabs for oral care. Report if resident is not eating or not enjoying food. Encourage residents to follow their special diets. Encourage fluids. Give small meals throughout day or BRAT, BRATY, or BRATT diet for nausea and diarrhea. Carefully measure weight and I&O. Offer a trip to the bathroom or bedpan as often as needed. Encourage independence. Give emotional support. Be aware of other support systems. Review symptoms to report to the nurse for HIV/ AIDS: Loss of appetite, vomiting, or diarrhea Weight loss Reduced intake of fluids Mouth sores or discomfort Dysphagia Bleeding from anywhere on the body Bruising of skin Pressure ulcers Cracks, breaks, rashes, lumps, or sores on the skin Blood in stool Changes in vital signs Nervousness, withdrawal, severe mood swings, depression Behavior that puts resident or others at risk, suicidal thoughts or comments 7. Describe cancer textbook pp workbook pp Pronounce and define the following key terms: Cancer Tumor Benign Malignant Metastasize Review risk factors for Age Race Gender Family history Tobacco use Alcohol use Poor diet/obesity Lack of exercise Chemicals and food additives Radiation Sun exposure Review the American Cancer Society s signs of Fever Fatigue Unexplained weight loss Pain Skin changes New mole or change in appearance of existing mole or wart Change in bowel/bladder function Sore that does not heal Unusual bleeding/discharge Any thickening in breast, scrotum, or other areas Indigestion, difficulty swallowing Nagging cough or hoarseness Biopsy Briefly describe each of the following treatments for Surgery Radiation therapy Chemotherapy Hormone therapy Immunotherapy Explain that these treatments are often used in combination.

5 Discuss care guidelines for a resident with cancer textbook pp workbook p. 134 Review skin care guidelines for residents with Observe skin to prevent pressure ulcers. Change position every two hours or as directed. Follow special skin care orders exactly. Use special mattresses or pads in beds and chairs to reduce risk of pressure ulcers. Keep skin clean and dry. Apply lotion to dry skin. Do not use lotion on areas having radiation therapy. Do not remove any markings used with radiation therapy. Report signs of infection. Review guidelines for supporting good self-image in residents with Help residents stay clean and well-groomed. Offer wigs, scarves, or hats for hair loss. Assist with application of makeup, as requested. Review oral care guidelines for residents with Give oral care often. Be gentle. Use soft brushes or special swabs. Use mild mouth rinses to reduce bad taste from medication or vomiting. Review guidelines for pain in residents with Be alert for signs of pain and report immediately. Provide comfort measures, such as back rubs and repositioning. Play soft music, read, or talk quietly with residents. Notify nurse of side effects of pain medication. Report irritation around transdermal patches or resident having more than one patch on the body. Observe for redness, swelling, or warmth around the insertion site of PCA pump. Report signs of breakthrough pain. Review vital signs guidelines for residents with Monitor all vital signs, especially temperature. Report changes in vital signs to nurse. Review guidelines for mobility for residents with Allow plenty of time for rest. Recognize limitations. Assist with ambulation. Review nutrition guidelines for residents with Provide small, frequent meals to reduce nausea and prevent weight loss. Serve favorite foods and nutritious snacks. Provide food when hunger occurs. Try cool or cold foods. Cut foods into small pieces. Use plastic utensils. Weigh residents as ordered and report loss or gain. Encourage fluids. Monitor I&O and report changes. Review guidelines for bladder and bowel changes for residents with Assist residents with toileting often. Give catheter care as needed. Carefully measure output. Test stool for occult blood as ordered. Review guidelines for mental status and emotional needs of residents with Be sensitive to residents wishes. Listen if residents want to express feelings. Spend as much time with residents as possible. Encourage activities. Ask social worker about support groups. Do not use clichés. Provide support during painful episodes and difficult times.

6 167 Remind residents that there can be good days ahead. Observe and report signs of depression or comments about suicide. Review symptoms to observe and report: Pain or increased pain Changes in vital signs Signs of new bumps or lumps or changes in skin Rashes, cracks, sores, breaks, or reddened areas on the skin Odors Burns or skin irritation Bruising of the skin Difficulty with ambulation Fainting Increased fatigue or weakness Chest pain or tightness Shortness of breath Appetite changes or weight loss Difficulty chewing or swallowing Dry, sore mouth and mouth or lip sores Inflammation or irritation of the mucous membranes in the mouth Bleeding from inside the mouth Nausea or vomiting Flatus, diarrhea, or constipation Blood in the stool Change in output Any change in urine or blood in urine Urinary tract infection Change in mental status or confusion Anxiety, fear, or angry feelings Signs of depression Chapter Review Exam distribute chapter 24: exam (appendix c, pp ) Answers to Chapter Review in Textbook 1. Nonspecific immunity is present at birth and protects the body from disease in general. Specific immunity is a type of immunity acquired by the body. 2. Examples of active immunity body manufacturing antibodies as a response to an antigen, vaccine; examples of passive immunity mother passing antibodies to child, injection of antibodies 3. Lymph carries disease-fighting cells called lymphocytes. 4. Answers include: Immune system weakens, causing increased risk of all types of infections. Antibody response slows. T-cells decrease in number. Response to vaccine decreases. 5. Through blood or body fluids from an infected person 6. Answers include: unprotected or poorly-protected oral, vaginal or anal sex with an infected person; sharing drug needles or syringes; transmission from infected mother to newborn during pregnancy, birth, or breastfeeding; in the healthcare setting, infections can be spread through accidental contact with contaminated body fluids, needles or other sharp objects, or contaminated supplies or equipment 7. Answers include: through air or water; by insects, including mosquitoes; in saliva, tears, or sweat; through casual contact, such as hugging, shaking hands, or sharing dishes; and through closed-mouth or social kissing, such as kissing someone s cheek 8. No 9. With an autoimmune disease, the body is unable to recognize its own tissue. The immune mechanism sees the normal body tissues as foreign and begins to attack the tissues. Allow students enough time to finish the test. See Appendix D for answers to the chapter exams.

7 Answers include: Follow proper infection prevention procedures and Standard Precautions with all residents. Wear appropriate PPE. Cover all broken skin with appropriate bandages before giving care. Wash hands and other areas of body immediately after contact with blood or body fluids. Handle and dispose of sharps carefully. Remind residents and visitors to wash their hands often. Do not share residents personal items. Properly disinfect surfaces. 11. No 12. No 13. Answers include: Wash hands often and help residents wash hands. Disinfect surfaces often. Protect resident from people having known contagious diseases. Change linen whenever it is soiled. Observe for skin breakdown. Change positions every two hours, or as directed. Give back rubs for comfort. Monitor vital signs often. Allow rest and recognize limitations. Ambulate carefully. Allow time for ADLs. Perform ROM exercises as ordered. Give quality mouth care frequently. Use soft toothbrushes or swabs for oral care. Report if resident is not eating or not enjoying food. Encourage residents to follow their special diets. Encourage fluids. Give small meals throughout day or BRAT, BRATY, or BRATT diet for nausea and diarrhea. Carefully measure weight and I&O. Offer a trip to the bathroom or bedpan as often as needed. Encourage independence. Give emotional support. Be aware of other support systems. 14. Benign tumors grow slowly and do not spread to other parts of the body. Malignant tumors grow rapidly and invade surrounding tissue. 15. Answers include: fever; fatigue; unexplained weight loss; pain; skin changes; new mole or change in appearance of existing mole or wart; change in bowel/bladder function; sore that does not heal; unusual bleeding/discharge; any thickening in breast, scrotum or other areas; indigestion, difficulty swallowing; or nagging cough or hoarseness 16. Answers include: The goal of surgery is to try to remove as much of the cancer as possible. Radiation therapy uses high-energy rays to attempt to destroy cancer cells in a specific area. Chemotherapy involves chemical agents or medications being administered, usually intravenously, to kill malignant cells and tissues. Hormone therapy uses medications to alter the hormones in the body. Immunotherapy uses the body s immune system to fight the malignant tumors. 17. Answers include: Skin care: Observe skin to prevent pressure ulcers. Change position every two hours or as directed. Follow special skin care orders exactly. Use special mattresses or pads in beds and chairs to reduce risk of pressure ulcers. Keep skin clean and dry. Apply lotion to dry skin. Do not use lotion on areas having radiation therapy. Do not remove any markings used with radiation therapy. Report signs of infection. Self-image: Help residents stay clean and wellgroomed. Offer wigs, scarves, or hats for hair loss. Assist with application of makeup, as requested. Oral care: Give oral care often. Be gentle. Use soft brushes or special swabs. Use mild mouth rinses to reduce bad taste from medication or vomiting. Pain: Be alert for signs of pain and report immediately. Provide comfort measures, such as back rubs and repositioning. Play soft music, read, or talk quietly with residents. Notify nurse of side effects of pain medication. Report irritation around transdermal patches or resident having more than one patch on the body. Observe for redness, swelling, or warmth around the insertion site of PCA pump. Report signs of breakthrough pain. Vital signs: Monitor all vital signs, especially temperature. Report changes in vital signs to nurse. Mobility: Allow plenty of time for rest. Recognize limitations. Assist with ambulation. Nutrition: Provide small, frequent meals to reduce nausea and prevent weight loss. Serve favorite foods and nutritious snacks. Provide food when hunger occurs. Try cool or cold foods. Cut foods into small pieces. Use plastic utensils. Weigh residents as ordered and report loss or gain. Encourage fluids. Monitor I&O and report changes.

8 169 Bladder and bowel changes: Assist residents with toileting often. Give catheter care as needed. Carefully measure output. Test stool for occult blood as ordered. Mental status and emotional needs: Be sensitive to residents wishes. Listen if residents want to express feelings. Spend as much time with residents as possible. Encourage activities. Ask social worker about support groups. Do not use clichés. Provide support during painful episodes and difficult times. Remind residents that there can be good days ahead. Observe and report signs of depression or comments about suicide.