Line of defenses

Topic 1 DQ1

Part 1

What are the differences between primary and secondary line of defense? What factors interfere with these mechanisms? How are these levels of immunity affected in a child, an elderly person, or a person with a chronic disease? Include active, passive, innate, and acquired immunity in your response.

Part 2

Choose an inflammatory or infectious process and explain the pathophysiology changes that may occur. What patient education would need to be included related to this disorder? Make sure that you select a different medical condition than your peers. Include the name of the medical condition in the subject line so that the medical condition can be followed. Include your references in APA style.

Sample Student Answer 1

Part 1

Primary line of defenses are physical or chemical barriers that protect the body from the first contact with pathogens or infections ((Riddell, 2020). They include the skin, mucus, saliva, stomach acid, and white blood cells called neutrophils, to list a few. The second line of defense or secondary defense is a faster and stronger form of defense compared to primary defense in dealing with pathogens. It involves the response of non-specific phagocytes and other internal body mechanisms comprising of innate immunity.

It usually occurs after an initial immune response to a given attack by a pathogen, for example, the second attack of a given bacterial disease (Riddell, 2020).  Some of the factors that interfere with the two lines of defense include diet, sleeping habits, hygiene, physical exercise, lifestyle habits like smoking or drinking alcohol, to list a few.

Active immunity is acquired either through vaccination or through natural immunity. This means that with increased exposure to pathogens, one builds active immunity. Passive immunity, on the other hand, is given to a person rather than being produced internally and can either occur naturally or passed from a mother to a child, either during the fetal stage or during breastfeeding.

The innate immune system provides the first-line response against infection and is usually weaker in newborns compared to later stages in life. It is a form of immunity that one is born with. The last form of immunity is acquired immunity is acquired over one’s lifetime, usually through exposure to pathogens or through vaccination (Simon et al., 2015)

Part 2

Influenza is one of the most common infectious diseases. Influenza causes lung inflammation as compromise resulting from direct exposure of the viral injection on the respiratory epithelium. The viral transmission occurs when an individual is exposed to contaminated aerosols, resulting in an immune response that causes the inflammation of the lungs. The inflammation can spread systemically and manifest as a multiorgan failure, at times causing severe respiratory distress and risk of getting myocardial disease (Kalil & Thomas, 2019).

Reference

Kalil, A. C., & Thomas, P. G. (2019). Influenza virus-related critical illness: pathophysiology and epidemiology. Critical care (London, England), 23(1), 258. https://doi.org/10.1186/s13054-019-2539-x

Riddell, N. E. (2020). Immune Responses: Primary and Secondary. eLS, 1, 316-326. https://doi.org/10.1002/9780470015902.a0029196

Simon, A. K., Hollander, G. A., & McMichael, A. (2015). Evolution of the immune system in humans from infancy to old age. Proceedings. Biological Sciences, 282(1821), 20143085. https://doi.org/10.1098/rspb.2014.3085

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Sample student answer 2

Replies to Robertta Shelton

Part 1:

The primary line and secondary of defense are the human body’s way of protecting itself. The primary line of defense has natural barriers, which include physical, biochemical, and mechanical barriers on the surface of the body. This protects the body from tissue injury and infection. The secondary line of defense takes action when the first line of defense fails. This second line of defense includes an inflammatory response that prevents infection and promotes healing of the tissue. It is a response to tissue injury or infection (McCance & Huether, 2018, p. 208).

Some factors that could interfere with the first line of defense include compromised skin from an injury such as a cut, burn, or crack. Some factors that interfere with the secondary line of defense include a pathogen that has surpassed the first line of defense (for example, through compromised skin) and introduced itself to the body, which in turn causes an inflammatory response to fight it off.

The level of immunity varies from person to person and age can be a determining factor. Active immunity is when the body builds up antibodies to an organism after being exposed to it. Passive immunity is when the body is given those antibodies (for example, through breast milk for an infant). Innate immunity is the natural barrier of epithelial tissue. People are born with this type of immunity. Inflammation that results from an infection adapts to the microorganism involved, developing a memory on how to handle it and creating future immunity to it. This is known as acquired immunity (McCance & Huether, 2018, p. 201). Newborns are at a higher risk for infection as they have not built up immunity yet.

They have innate immunity and are given passive immunity through breast milk and the placenta, yet, they have a very immature immune system. The older adult population has a more difficult time dealing with infection/inflammatory processes because of underlying conditions and age making them susceptible to infection with a higher chance that they will be unable to fight it off. Also, a person with a chronic disease may have issues because of being immunocompromised if they are exposed to an infectious microorganism. The body may decide that the chronic illness takes precedence and leave the infectious microorganism to attack the immune system, leading to serious complications and/or death.

Reference

McCance, K.L., & Huether, S.E. (2018). Pathophysiology (8th ed.). Elsevier Health Sciences.

Part 2: Rheumatoid Arthritis (RA)

An example of an inflammatory disease is Rheumatoid Arthritis (RA). This is an autoimmune disease that attacks the joints of the individual affected. This is a painful disease process that mainly affects the joints (knees, wrists, hands) and sometimes it can lead to issues in major organ tissues. Individuals affected by this often experience flare ups that are sometime debilitating and times of remission. The flare ups can include severe pain in the joints, stiffness, weight loss, fever, and fatigue (CDC, 2020).

In this disease process, the body’s immune system attacks healthy cells in the body for an unknown reason. Specifically, there is inflammation of tendons that result in bone erosion and cartilage destruction. Although the cause of RA is unknown, there are risk factors that can increase the chances of developing it. These risk factors include aging, being a female, family history, smoking, history of never giving birth, some early life exposures, and obesity. Some of these risk factors are impossible to prevent/change.

However, there are a few risk factors that are preventable, such as smoking and obesity. In educating patients related to RA, it is important to include smoking cessation, exercise, eating a healthy diet, and maintaining a healthy weight. This disease isn’t treatable, but symptoms are manageable through lifestyle changes and medications. There are anti-rheumatic medications that help with the symptoms and prevent disease progression in these patients (Lin et al., 2020).

References

Centers for Disease Control and Prevention (CDC). (2020). Rheumatoid arthritis (RA). Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/arthritis/basics/rheumatoid-arthritis.html

Lin, Y.-J., Anzaghe, M., & Schülke, S. (2020). Update on the pathomechanism, diagnosis, and treatment options for rheumatoid arthritis. Cells, 9(4), 880. https://doi.org/10.3390/cells9040880

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Topic 1 DQ 2

Select a medication used in evidence-based treatment guidelines for the condition chosen in the first discussion question. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions of which one should be aware. Make sure that you select a different medication than your peers. Include the name of the medication in the subject line so that the medications can be followed. Include your references in APA style.

Sample Student Answer 1

Zanamivir

There are a few FDA-approved antiviral drugs recommended by CDC to treat the symptoms of influenza both type A and B. One of the drugs is Zanamivir. Zanamivir is a neuraminidase inhibitorthat works by binding to the active site of the neuraminidase enzyme. Doing so renders the influenza virus incapable of escaping the host cells and infecting others. Therefore, the drug by interfering with the virus’s neuraminidase enzyme, the release and multiplication of the viral progeny is hindered (Tarbet et al., 2014). In most cases, Zanamivir is well tolerated.

However, cases of patients with underlying respiratory diseases have reported severe bronchospasm as one of the side effects of taking the medication. Other common side effects include headache, nausea and vomiting, cold like symptoms like sneezing or sore throat, dizziness, and wheezing. The drug is contraindicated for patients with milk protein hypersensitivity (Tarbet et al., 2014). One of the drug interactions with Zanamivir is when mixed with Abacavir since the combination of the two may decrease the excretion rate of Abacavir resulting in a higher serum level (Drug, 2022).

References

Drug. (2022). Zanamivir Interactions. Drug.com. https://www.drugs.com/drug-interactions/zanamivir.html

Tarbet, E. B., Hamilton, S., Vollmer, A. H., Luttick, A., Ng, W. C., Pryor, M., Hurst, B. L., Crawford, S., Smee, D. F., & Tucker, S. P. (2014). A zanamivir dimer with prophylactic and enhanced therapeutic activity against influenza viruses. The Journal of antimicrobial chemotherapy, 69(8), 2164–2174. https://doi.org/10.1093/jac/dku127

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Sample student answer 2

Cefazolin

The medical condition I referenced in DQ 1 was infective endocarditis (IE). Antibiotics are the preferred treatment for IE. Goals to maximize treatment success are early diagnosis, accurate microorganism identification through blood cultures, prolonged IV administration of bactericidal antimicrobial agents, and aggressive surgical management of correctable mechanical complications.

In patients who have a more stable presentation, antibiotic therapy can be delayed until cultures and sensitivities are available. However, in patients with a more acute presentation, prompt empiric antibiotic treatment is often required to reduce the risk of complications (McCance & Huether 2019).

Staphylococcus aureusis the most frequently identified pathogen. This was not always historically the case but this shift is partially attributable to an increased rate of intravenous drug abuse in North America, the healthcare-associated infection has become increasingly common, representing about 30% of all endocarditis cases (Tackling & Lala, 2021). Cefazolin is classified as a broad spectrum cephalosporin antibiotic. It is often given to people who have a penicillin allergy.

Severe side effects I would recommend the patient call immediately if they should experience are the following: watery or bloody stools, stomach cramps or fever during treatment or for up to two or more months after stopping treatment, rash, hives, itching, difficulty breathing or swallowing, blistering, peeling, or shedding skin, swelling in legs and feet, decreased urination, dark urine, yellowing of skin or eyes, pain in the upper right part of stomach, fainting, a return of fever, sore throat, chills, or other signs of infection (Medline Plus, 2021).

McCance, K.L. & Huether, S.E. (2019). Pathophysiology: The biologic basis for disease in adults and children, (8th ed.). Elsevier.

Medline Plus (2021). Cefazolin Injection. https://medlineplus.gov/druginfo/meds/a682731.html

Tackling, G. & Lala, V. (2021). Endocarditis Antibiotic Regimen. https://www.ncbi.nlm.nih.gov/books/NBK542162/