Chapter III. Clinical Discussions of the Disease A.

Anatomy and Physiology

The Lymphatic System The lymphatic system, or lymph system, defends the body from foreign invasion by disease causing agents such as viruses, bacteria, or fungi. The lymphatic system consists macroscopically of: The bone marrow, spleen, thymus gland, lymph nodes, tonsils, appendix, and a few other organs. The lymph system contains a network of vessels that assists in circulating body fluids. These vessels transport excess fluids away from interstitial spaces in body tissue and return it to the bloodstream. Lymphatic vessels prevent the backflow of the lymph fluid. They have specialized

organs called lymph nodes which filter out destroyed microorganisms. The functioning of the lymphatic system is most easily seen at the microscopic level. Blood cells are produced in the marrow of human bone. When mature, white blood cells actively seek out possible pathogens or unknown substances and, using a complex chemical signaling system, can attack directly or provide for the removal of this substance. If a white blood cell is alerted to the presence of unwanted bacteria in the blood, it will find these bacteria and surround it. After a type of white blood cell (a T cell) has the bacteria trapped, it releases a deadly toxin that destroys the bacteria by breaking its outer membrane. The relationship between B-Cells, T-Cells and other cells in the immune system is complex. B and T cells undergo complex transformations in response to signal chemicals and foreign substances. In the transformation of B-Cells, different cancers can present themselves.

Main functions of lymphatic system:

To collect and return interstitial fluid, including plasma protein to the blood, and thus maintain fluid balance.

y y

To defend the body against disease by producing lymphocytes. To absorb lipids from the intestine and transport them to the blood.

The Cardiovascular System The cardiovascular/circulatory system transports food, hormones, metabolic wastes, and gases (oxygen, carbon dioxide) to and from cells. Components of the circulatory system include: blood: consisting of liquid plasma and cells Blood vessels (vascular system): the "channels" (arteries, veins, capillaries) which carry blood to/from all tissues. (Arteries carry blood away from the heart. Veins return blood to the heart. Capillaries are thin-walled blood vessels in which gas/ nutrient/ waste exchange occurs.) heart: a muscular pump to move the blood There are two circulatory "circuits": Pulmonary circulation, involving the "right heart," delivers blood to and from the lungs. The pulmonary artery carries oxygen-poor blood from the "right heart" to the lungs, where oxygenation and carbon-dioxide removal occur. Pulmonary veins carry oxygen-rich blood from the lungs back to the "left heart." Systemic

circulation, driven by the "left heart," carries blood to the rest of the body. Food products enter the system from the digestive organs into the portal vein. Waste products are removed by the liver and kidneys. All systems ultimately return to the "right heart" via the inferior and superior vena cavae. A specialized component of the circulatory system is the lymphatic system, consisting of a moving fluid (lymph/interstitial fluid); vessels (lymphatics); lymph nodes, and organs (bone marrow, liver, spleen, thymus). Through the flow of blood in and out of arteries, and into the veins, and through the lymph nodes and into the lymph, the body is able to eliminate the products of cellular breakdown and bacterial invasion.

The Immune System An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own healthy cells and tissues in order to function properly. Detection is complicated as pathogens can evolve rapidly; producing adaptations that

avoid the immune system and allow the pathogens to successfully infect their hosts. To survive this challenge, multiple mechanisms evolved that recognize and neutralize pathogens. Even simple unicellular organisms such as bacteria possess enzyme systems that protect against viral infections. Other basic immune mechanisms evolved in ancient eukaryotes and remain in their modern descendants, such as plants and insects. These mechanisms include antimicrobial peptides called defensins, phagocytosis, and the complement system. Jawed vertebrates, including humans, have even more sophisticated defense mechanisms.[1] The typical vertebrate immune system consists of many types of proteins, cells, organs, and tissues that interact in an elaborate and dynamic network. As part of this more complex immune response, the human immune system adapts over time to recognize specific pathogens more efficiently. This adaptation process is referred to as "adaptive immunity" or "acquired immunity" and creates immunological memory. Immunological memory created from a primary response to a specific pathogen, provides an enhanced response to secondary encounters with that same, specific pathogen. This process of acquired immunity is the basis of vaccination. Primary response can take 2 days to even 2 weeks to develop. After the body gains immunity towards a certain pathogen, when infection by that pathogen occurs again, the immune response is called the secondary response. Disorders in the immune system can result in disease. Immunodeficiency occurs when the immune system is less active than normal, resulting in recurring and life-threatening infections. Immunodeficiency can either be the result of a genetic disease, such as severe combined immunodeficiency, or be produced by pharmaceuticals or an infection, such as the acquired immune deficiency syndrome (AIDS) that is caused by the retrovirus HIV. In contrast, autoimmune diseases result

from a hyperactive immune system attacking normal tissues as if they were foreign organisms. Common autoimmune diseases include Hashimoto's thyroiditis, rheumatoid arthritis, diabetes mellitus type 1, and lupus erythematosus. Immunology covers the study of all aspects of the immune system, having significant relevance to health and diseases. Further investigation in this field is expected to play a serious role in promotion of health and treatment of diseases.

The Blood Blood is a specialized bodily fluid that delivers necessary substances to the body's cells such as nutrients and oxygen and transports waste products away from those same cells. In vertebrates, it is composed of blood cells suspended in a liquid called blood plasma. Plasma, which constitutes 55% of blood fluid, is mostly water (90% by volume),[1] and contains dissolved proteins, glucose, mineral ions, hormones, carbon dioxide (plasma being the main medium for excretory product transportation), platelets and blood cells themselves. The blood cells present in blood are mainly red blood cells (also called RBCs or erythrocytes) and white blood cells, including leukocytes and platelets. The most abundant cells in vertebrate blood are red blood cells. These contain

hemoglobin, an iron-containing protein, which facilitates transportation of oxygen by reversibly binding to this respiratory gas and greatly increasing its solubility in blood. In contrast, carbon dioxide is almost entirely transported extracellularly dissolved in plasma as bicarbonate ion. Vertebrate blood is bright red when its hemoglobin is oxygenated. Some animals, such as crustaceans and mollusks, use hemocyanin to carry oxygen, instead of hemoglobin. Insects and some mollusks use a fluid called hemolymph instead of blood, the difference being that hemolymph is not contained in a closed circulatory system. In most insects, this "blood" does not contain oxygen-carrying molecules such as hemoglobin because their bodies are small enough for their tracheal system to suffice for supplying oxygen. Blood is circulated around the body through blood vessels by the pumping action of the heart. In animals with lungs, arterial blood carries oxygen from inhaled air to the tissues of the body, and venous blood carries carbon dioxide, a waste product of metabolism produced by cells, from the tissues to the lungs to be exhaled.

B. Pathophysiology

C. Drug Study Drug Name Therapeutic Action Broad-spectrum aminoglycoside antibiotic derived from Micromonos pora Garamycin, Garamycin Ophthalmic, Genoptic Classification: anti-infective; aminoglycoside; antibiotic purpurea. Action is usually bacteriocidal. Indication Contraindication Side Effects/Adverse Effects y Special Senses: Ototoxicity (vestibular disturbances, impaired hearing), optic neuritis. y CNS: Apnea, respiratory paralysis (high doses); y CV: hypotension or hypertension. y GI: Nausea, vomiting, transient Nursing Responsibilities Assessment & Drug Effects
y Lab tests:

Generic Name: Gentamicin Sulfate Brand Name:

Parenteral use restricted to treatment of serious infections of GI, respiratory, and urinary tracts, CNS, bone, skin, and soft tissue (including burns) when

History of hypersensitivity to or toxic reaction with any aminoglycoside antibiotic. Safe use during pregnancy (category C) or lactation is not established

Perform C&S and renal function prior to first dose and periodically during therapy; therapy may begin pending test results. Determine creatinine clearance and serum drug concentrations at frequent

Dosage: IV/IM 2.5 mg/kg q1224h

other less toxic antimicrobial

agents are ineffective or are contraindicate d. Has been used in combination with other antibiotics. Also used topically for primary and secondary skin infections and for superficial infections of external eye and its adnexa.

increase in AST, ALT, and serum LDH and bilirubin; hepatomegaly, splenomegaly. y Hematologic: Increased or decreased reticulocyte counts; granulocytopenia , thrombocytopeni a (fever, bleeding tendency), anemia. y Hypersensitivity: rash, pruritus, urticaria,

intervals, particularly for patients with impaired renal function, infants (renal immaturity), older adults, patients receiving high doses or therapy beyond 10 d, patients with fever or extensive burns, edema, obesity.
y Repeat C&S if

improvement does not occur in 35 d; reevaluate therapy.

y Note: Dosages

exfoliative dermatitis, eosinophilia, burning sensation of skin, drug fever, joint pains, laryngeal edema, anaphylaxis. y Nephrotoxicity: proteinuria, tubular necrosis, cells or casts in urine, hematuria, rising BUN, nonprotein nitrogen, serum creatinine; decre ased creatinine clearance.

are generally adjusted to maintain peak serum gentamicin concentrations of 4 10 g/mL, and trough concentrations of 12 g/mL. Peak concentrations above 12 g/mL and trough concentrations above 2 g/mL are associated with toxicity.
y Draw blood

specimens for peak serum gentamicin concentration 30

y Other: Local irritation and pain following IM use; thrombophlebitis, abscess, superinfections, syndrome of hypocalcemia

min1h after IM administration, and 30 min after completion of a 3060 min IV infusion. Draw blood specimens for trough levels just before the next IM or IV dose. Use nonheparinized tubes to collect blood.

Drug Name

Therapeutic Action Ampicillin belongs to a class of antibiotics

Indication

Contraindication

Side Effects/Adverse Effects y GI: Glossitis, stomatitis, black "hairy" tongue, nausea, vomiting, enterocolitis, pseudomembra nous colitis,

Generic Name: Ampicillin

Ampicillin is used for

The use of ampicillin is contraindicated with a history of hypersensitivity reactions to any kind of penicillin.

called penicillins that treating are used for treating Brand Name: Omnipen, Polycillin, Principen bacterial infections. These antibiotics all have a similar mechanism of action. They stop bacteria from Classificatio n: Antibiotic Penicillin multiplying by preventing bacteria from forming the walls that surround them. The walls are Dosage: 150 to 200 necessary to protect bacteria from their environment and to infections of the middle ear, sinuses, stomach and intestines, bladder, and kidney caused by susceptible bacteria. It also is used for treating uncomplicat ed gonorrhe a,meningitis,

Nursing Responsibilities y Culture infectedarea beforetreatmen t;reculture area if response is not asexpected. y Check IV sitecarefully for signsof thrombosis or drug reaction.

y Do not give IMinjections in thesame site; Hypersensitivity atrophycan : occur. Monitor injectio Skin rashes, n site. urticaria, and diarrhea Anaphylaxis y Lymphatic system: Anemia, y Administer oraldrumg on anempty stomach, 1hr before o 2 hrsafter meals

mg/kg/day. Start with intravenous administrati on for at least three days and continue with the intramuscul ar route every 3 to 4 hours.

keep the contents of the bacterial cell together. Bacteria cannot survive without a cell wall. Penicillins are most effective when bacteria are actively multiplying and forming cell walls. Ampicillin is effective against many bacteria including H. influenzae, N. gonorrhoea, E. coli, Salmonella, and Shigella, strepto cocci and certain strains of staphylococci.

endocarditis and other serious infections.

thrombocytope nia, thrombocytope nic purpura, eosinophilia, leukopenia, and agranulocytosis

with a full glass of water;do not give withfruit juice or softdrinks