NRS 641 Topic 1 Discussion Papers

Primary and Second line of Immunity

Immunity is the ability of the body to prevent the entry of infectious agents and fight the disease-causing micro-organisms. Immunity can either be innate or adaptive. Innate immunity is acquired naturally and forms the primary (first) and secondary (second) line of defense (Günther & Seyfert, 2018). The primary defense is formed by chemical and physical barriers that prevent infections. 

NRS 641 Topic 1 Discussion Papers

The physical barriers include intact skin, cilia, and nosocomial bacteria, which prevent the entry of infection.  Chemical barriers include mucus, stomach acid, tears, vaginal secretions, and urine flow. On the other hand, secondary defense is formed by white blood cells that fight those pathogens that overcome the primary barriers.

Adaptive immunity protects the body upon re-exposure to the primary pathogens.  It is divided into active and passive. T lymphocytes and B lymphocytes are activated to release antibodies that form cell-mediated and immune-mediated immune responses, respectively (Günther & Seyfert, 2018).  These responses are part of active immunity that destroys pathogens.

In addition, memory cells are formed that aid in fighting the same infections in the future. Finally, in passive immunity, antibodies are created outside the body and can be passed from mother to child during breastfeeding or through the injection of antibodies. Interference in these defensive mechanisms reduces immunity and invasion of the body by infections.

Various factors, including diet, lifestyle, sleep, personal hygiene, genetics, and physical activities, influence the level of immunity (Zimmermann & Curtis, 2019 NRS 641 Topic 1 Discussion Papers). For instance, physically active individuals, lead a healthy lifestyle, maintain a high level of hygiene, and practice healthy sleeping patterns are likely to have boosted immunity, unlike those who do not. Furthermore,  age and general wellbeing also affect immunity.

Children have underdeveloped immune responses, whereas the elderly and those with chronic conditions have declined the number of protective cells, leading to reduced immunity. As a result, there is an increased risk of infection due to impaired immunity.

References

  • Günther, J., & Seyfert, H.-M. (2018). The first line of defense: insights into mechanisms and relevance of phagocytosis in epithelial cells. Seminars in Immunopathology, 40(6), 555–565. https://doi.org/10.1007/s00281-018-0701-1
  • Zimmermann, P., & Curtis, N. (2019). Factors that influence the immune response to vaccination. Clinical Microbiology Reviews, 32(2). https://doi.org/10.1128/CMR.00084-18

DQ 1 part 2 – Systemic Lupus Erythematous (SLE)

SLE is an autoimmune multi-organ condition characterized by the production of autoantibodies immune complexes that attack the body`s nucleic acids and proteins. The body’s immune system fails to differentiate between its cells and foreign cells resulting in autoantibody formation (Fava & Petri, 2019).

The autoantibodies and immune complexes lead to a dysregulated immune response that results in causing inflammation, tissue injuries, pain, and damage. As a result, any organs of the body, including kidneys, heart, skin, lungs, central nervous system, joints, blood, and peripheral nervous system, are affected.  Symptoms can either be mild or life-threatening according to the level of tissue involvement.

Unfortunately, the exact cause of immune disturbance remains unknown, but various factors are implicated in etiology. They include genetic predisposition such as HLA gene, hormones including androgen and estrogens, and environmental such as sunlight, chemicals, and sunlight(Fava & Petri, 2019). The immune disturbance leads to suppression of individuals’ immune systems, thus predisposing one to various complications such as life-threatening infections and organ failure.

Prevention of complications and improving patients’ quality of life involves patient education. Education should focus on making the patients understand the nature of the conditions and their effect in compromising the immune status(Navarra et al., 2020). As a result, patients should be educated on medication adherence, frequent medical evaluation for new symptoms, and the need for lipid and sugar monitoring to prevent cardiovascular conditions. 

Furthermore, these patients are at increased risk of infection; therefore, they should always check for signs of infection such as fever while seeking early treatment to prevent complications arising from severe infections. Dietary advice includes limiting salt intake, reducing alcohol intake, limiting fat intake while encouraging intake of omega-containing meals and calcium-rich meals. Also, SLE patients should avoid sunlight exposure and ultraviolet light. Finally, they should receive vaccines, quit smoking cigarettes, and plan appropriately for pregnancy.

References

Topic 1 DQ 2

Management of SLE

SLE management is guided by patient symptoms and the severity of the conditions. Therefore, various medications, including corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), hydroxychloroquine, and immunosuppressive agents such as azathioprine, are used in flare management. All these medications play various roles in controlling the disease process, including pain and inflammation (Fava & Petri, 2019).  However, hydroxychloroquine is widely used for the long-term management of patients with SLE.

Hydroxychloroquine is an antimalarial agent that has properties of disease-modifying anti-rheumatic drugs.  It acts using various mechanisms to mediate immunomodulation without overt causing immunosuppression.  This is achieved through inhibition of eosinophil chemotaxis and neutrophil locomotion while impairing complement-dependent antigen-antibody reactions (Garg et al., 2021). As a result, it is used to treat constitutional symptoms, arthritis arthralgia, and prevent lupus skin rushes. Furthermore, it reduces mortality and morbidity while avoiding flares.  However, hydroxychloroquine monitoring is an integral part of the administration.

Renal and liver functions and retinal examination must be conducted during treatment because it causes toxicity to the liver and kidneys while damaging the retina. In addition, it has other side effects, including diarrhea, angioedema, seizures, ataxia, deafness, liver failure, skin rashes, tinnitus, nausea, and headache.  However, complete blood count, creatinine level, and urinalysis should be checked regularly to assess new organ involvement.

Finally, hydroxychloroquine interacts with other medications and should be administered with care.  It causes pharmacodynamics antagonism when administered with vaccines such as anthrax, hepatitis A, B, and pneumococcal vaccines, among others, therefore, contraindicated (Garg et al., 2021).

Furthermore, it causes QT interval prolongation when administered with albuterol, alfuzosin, amoxapine, and apomorphine; hence, care should be taken. Finally, it causes severe immunosuppression when administered with other immunosuppressive agents such as adalimumab, increasing the risk of infection. Also, over-the-counter medications should be avoided when using hydroxychloroquine to minimize unwanted interactions.

References

  • Fava, A., & Petri, M. (2019). Systemic lupus erythematosus: Diagnosis and clinical management. Journal of Autoimmunity, 96, 1–13. https://doi.org/10.1016/j.jaut.2018.11.001
  • Garg, S., Unnithan, R., Hansen, K. E., Costedoat-Chalumeau, N., & Bartels, C. M. (2021). Clinical significance of monitoring hydroxychloroquine levels in patients with systemic lupus erythematosus: A systematic review and meta-analysis. Arthritis Care & Research, 73(5), 707–716. https://doi.org/10.1002/acr.24155

NRS 641 Topic 1 Discussion Papers Topic 2 DQ 1

Medications Avoided in Elderly.

Elderly individuals are at increased risk of developing various chronic conditions that require the use of various medications. However, these medications may end up causing more harm than benefit as there is derangement in organ functions in the elderly. Organs such as the liver, kidney, and gastrointestinal are required for absorption, metabolism, distribution, and excretion.

Failure in any organ leads to deranged drug function due to pharmacokinetics’ interference. Therefore, to avoid toxicity, the American Geriatric Society provides clear guidelines regarding the prescription of drugs in the elderly to prevent potentially inappropriate medications (PIMs) use as evidenced By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel, (2019).

First-generation antihistamines are anticholinergic drugs listed among other medications as “avoid” in the elderly population. These groups include meclizine, promethazine, chlorpheniramine, clemastine, and doxylamine, among others. They are commonly prescribed to treat rhinitis, insomnia, eczema, pruritus, and conjunctivitis. 

However, they easily cross the blood-brain barrier and cause major central nervous system side effects, including drowsiness, sedation, fatigue, and cognitive decline (Fein et al., 2019). Furthermore, age advancement causes age-related changes that occur in the cholinergic system; hence there is the risk of decline in cognitive function when anticholinergics are administered.  Other anticholinergic effects include constipation, dry mouth, confusion, and blurred vision.

Based on pharmacokinetics, antihistamines are absorbed rapidly, attaining an effective plasma concentration within 3 hours.  They undergo hepatic metabolism by cytochrome p450 with potential drug interactions(Fein et al., 2019). Finally, elimination is done by kidneys. Unfortunately, kidney and liver impairment in the elderly increases the risk of toxicity due to impaired metabolism and clearance. Therefore, these medications should be avoided in the elderly population.

References

  • By the 2019 American Geriatrics Society Beers Criteria® Update Expert Panel. (2019). American Geriatrics Society 2019 updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults: 2019 Ags beers criteria® update expert panel. Journal of the American Geriatrics Society, 67(4), 674–694. https://doi.org/10.1111/jgs.15767
  • Fein, M. N., Fischer, D. A., O’Keefe, A. W., & Sussman, G. L. (2019). CSACI position statement: Newer generation H1-antihistamines are safer than first-generation H1-antihistamines and should be the first-line antihistamines for treating allergic rhinitis and urticaria. Allergy, Asthma, and Clinical Immunology: Official Journal of the Canadian Society of Allergy and Clinical Immunology, 15(1), 61. https://doi.org/10.1186/s13223-019-0375-9

Topic 2 DQ 2

Herbal Medicine and Vitamin supplements.

The use of herbal medication for treatment is increasingly being accepted by most people worldwide.  It is estimated that close to 80% of the population uses this product worldwide(Brewer et al., 2019).  Furthermore, the advancement in complementary alternative medicine has led to increased use of herbal medicine and supplements.  Examples of commonly used herbal medicines include Echinacea, garlic, ginger, ginseng, and turmeric, among others.

The use of these products has shown some recent hope of curing various medical conditions. This has resulted in many patients opting for the same, thus leading to the growth and introduction of these products into markets. However, various public health issues remain regarding safety and potential side effects, and monitoring of their use is limited(Brewer et al., 2019). Furthermore, there is inadequate knowledge about the mode of action, contraindications, and interactions. Therefore, nurses and other healthcare workers should intervene to protect the general population.

Nurses advocate for patient safety and ensure the provision of quality care to patients.  Likewise, nurses should be at the forefront of educating populations about the risk of using non-tested or unapproved products for care. Furthermore, nurses can work with various regulatory authorities to ensure that all herbal medications are safe for use with suitable quality(Welz et al., 2018). 

This can be achieved by ensuring that quality testing and production standards are adhered to before releasing the medication to the general population. In addition, herbal medicines and supplement produce must be licensed to ensure quality. The licensed individuals must understand the information regarding the herbal medicine including indication, use, regulatory information, adverse effects, and safety for use.

Finally, there is need for continuous research regarding herbal medicine. This research should focus on identifying the mode of action, side effects, and molecular components of these products.  This will be essential in improving the safety and quality of herbal medicine and herbal supplements.

References

  • Brewer, N. J., Turrise, S. L., Kim-Godwin, Y. S., & Pond, R. S., Jr. (2019). Nurses’ knowledge and treatment beliefs: Use of complementary and alternative medicine for pain management. Journal of Holistic Nursing: Official Journal of the American Holistic Nurses’ Association, 37(3), 248–259. https://doi.org/10.1177/0898010118822212
  • Welz, A. N., Emberger-Klein, A., & Menrad, K. (2018). Why people use herbal medicine: insights from a focus-group study in Germany. BMC Complementary and Alternative Medicine, 18(1). https://doi.org/10.1186/s12906-018-2160-6