- Innate: exists at birth without prior contact with antigen; includes skin, mucous membranes, cilia, gastric juice, enzymes in tears and sliva, coughing, sneezing; WBCs (neurtrophils and monocytes), inflammatory process. - Acquired: active=body develops antibodies and sensitized lymphocytes to foreign substance after invasion (may be natural or artificial), long term--memory! passive=host receives antibodies (temporary- no memory agent)-can be natural or artificial (antibodies are administered)

=antibody mediated immunity - antibodies are produced by plasma cells (B-cells) - immunoglobulins are antibodies - 20-30% of lymphocytes - responsible for immunity to bacteria (and some extra-cellular viruses) - have memory cells

- multi-system inflm autoimmune dz - cause-UV radiation, drugs, chems, viral inf, stess, increased estrogen activity - pattern of remission/exacerbations, chronic, unpredictable course - production of autoantibodies against nucleic acids (ANA); B and T cell hyperactivity - white less freq than others, women 20-40 - dz of connective tissue: polyarthralgia, rash, alopecia, oral/nasal ulcers, proteinurea, fibrosis of heart valves, neuropathy, psych, cognitive dys, Raynauds, seizures, anemia of chronic dz, fever, weight loss, fatigue - Dx-Anti-Smith ab's and Anti-DNA ab's are very specific to Lupus-LE cells present-ESR-CRP-decreased complement-RF+-ANA+-pancytopenia-UA shows proteinurea - Tx=NSAIDs, glucocorticoids, immunosuppressants (azathioprine,cyclophosphamide, methotrexate, mycophenolate), antimalarial drugs (hydroxychloroquine), biologic agents (belimumab), vit D - Avoid sun!, photosens meds, avoid stress - cause of death=renal failure (nephritis), cardiovascular thrombotic event, generalized infection - ND's=fatigue, acute pain, impaired skin integrity

- autoimmune dz of CNS (not periphery), chronic, progressive; tx by neurologist - cause=viral, immunologic, genetic - onset is insidous, gradual - demylination of nerve fibers of white and gray matter in brain and spinal cord...sclerotic plaques (seen on MRI) - over-active t-lymphocytes, antigen-ab rxns in CNS - initial sx-blurred vision, tinnitus, paresthesias, sensation changes, vertigo, Lhermitte's sign - Northern climates - adults age 20-50, more women - lack of or altered nerve conduction (spacity) - 4 types - Key features=charcot triad (nystagmus, dysarthia (slurred speech), intention tremors (shake when reach)), muscle weakness/spacsticity, fatigue, ataxia, paresthesia, bowel/bladder dys, cognitive changes, dysphagia, heat exacerbates MS, neuropathic pain (trigeminal neuralgia, HA, extremity pain, pain from spasms), constipation - Tx for pain=anticonvulsants, antidepressants, benzos, anti-arrhythmics, anti-inflam, muscle relax - other Tx=glucocorticoids (reduce inflm at site of demylenation-given IV), immunosuppressants (methotrexate, azathioprine), immunomodulators (betaseron, avonex-given sub Q), antispasmotics (baclofen--pump), valium, botox, surgery - Dx=MRI, CSF-spec IgG and elevated protein level, presence of WBC, electromyography (nerve conduction study), [elevated ANA or ESR or Lyme titer to r/o other causes] - Nursing Mgt-constipation (from meds, \< fluids, immobility), bladder dysfunction (failure to store-hypertonic bladder), failure to empty (hypotonic bladder\ =neurogenic bladder, lack nerve impulses to contract bladder) - exacerbated by PMS and post-partum; no sx during PG

- tenonotomy-cut tendon - rhizotomy-chemically ablate nerve - myelotomy-cut nerve at spinal level - motor point blocks-interupt impulses bye anesthesia or destroy nerve at motor point to relieve spasicity

- autoimmune-ab's attack Ach receptors at neuromuscular jnct; not enough Ach or too much cholinesterase; chronic, no cure - fluctuating skeletal muscle weakness - triggered by viral infection, hyperplasia of thymus (t-cells), genetic component - age 10-65, more women-peak age is childbearing years. - highly variable course of dz - affects muscles of resp, swallow, chew, speak, eyes, facial - death=resp failure - Dx-EMG (electromyography), tensilon test, muscle biopsy (shows Ach receptor antibodies) - Tensilon Test-inject tensilon (anticholinesterase), if muscle response improves=MG, no response-not MG; must have atropine available due to brady from tensilon - Meds= anticholineserase drugs (Mestinon and Neostigmine) must be taken on time, 30-60 min bf meal with water only, immunosuppressants (azathioprine, cyclosporine), corticosteroids - plasmaphersis, thymectomy to remove thymus - Nursing Mgt-monitor resp status, aspiration precautions, myesthenic crisis (not enough meds vs cholinergic crisis--too much med), monitor blood levels - myesthenic crisis-may need vent support, s/s weak skeletal muscles, ptosis, diff swallowing, dyspnea, resp failure; results from not enough meds vs. cholinergic crisis which is from too many meds - monitor resp function with PFT (neg inspiratory pressure, tidal volumes, vital capacity), 25% reduction from baseline=resp failure

- chronic, systemic, nonsuppurative (=inflm without pus) inflammation of diarthrodial joints due to infiltration of immune cells (t lymphocytes) into synovial fluid where they release cytokines: TNF - triggered by environment, virus, antigen, stress, genetic - 2-3 x more common in women - mostly muskuloskeletal, but anywhere connective tissue is present, vasculitis if bv involvement - AM stiffness, bilateral, symmetrical, usually upper extremeties first,generalized weakness, anorexia, wt loss, fever, pain\ , ulnar drift - Dx=RF+, ANA+, CRP elevated, ESR elevated, CBC (anemia of chronic dz), decreased serum complement, elevated IgG, arthrocentesis with synovial fluid analysis, Xray, CT, MRI, bone scan - Tx-focus on early intervention, prevent inflm and erosion...remission - Meds-NSAIDs, steroids (for exacerbations), biologic therapies, immunosuppressants (DMARDs)--leflunomide, Enbrel, Methotrexate, Cyclosporine - Non-drug=PT, OT, heat/cold, water exercise, min joint stress, splinting, massage, balanced nutr, incr mobility - Nursing-med compliance to preent joint destruction - RA-systemic, swollen, small, stiff - OA-large, obese, asymmetric, degenerative, osteophytes (spurs)

AH II Test 1 Flashcards by Liz Hall

Immunity

**Innate: **exists at birth without prior contact with antigen; includes skin, mucous membranes, cilia, gastric juice, enzymes in tears and sliva, coughing, sneezing; WBCs (neurtrophils and monocytes), inflammatory process.
Acquired:

active=body develops antibodies and sensitized lymphocytes to foreign substance after invasion (may be natural or artificial), long term–memory!

passive=host receives antibodies (temporary-no memory agent)-can be natural or artificial (antibodies are administered)

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Functions of the

Immune Response

Defense (protects against microo’s, prevents infection, attacks foreign antigens/pathogens)
Homeostasis (digest damaged cellular substances)
Surveillance (recognize/destroy cell mutations, prevent malignancies)

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Spleen

lymphoid tissue that stores lymphocytes, filters foreign substances from the blood

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Phagocytes

-include monocytes and macrophages (capture and present antigen to lymphocytes to stimulate immune response)

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Interferon

Interferon=immunomodulator

a cytokine protein that activates components of the immune system, also modifies the immune response by (at times) suppressing antibody production, used to treat some immune disorders.(alpha, beta, gamma)

examples–inhibit viral replication, activate NK cells and macrophages, antiproliferative effects on tumor cells, promotes B-cell differentiation

Tachycardia and orthostatic hypotension are also commonly reported, also depression and suicidal ideation, photosensitivity.

Complement= enzymatic proteins in serum that, when activated, destroy cell membrane of antigen.

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Humoral Immunity

=antibody mediated immunity

antibodies are produced by plasma cells (B-cells)
immunoglobulins are antibodies
20-30% of lymphocytes
responsible for immunity to bacteria (and some extra-cellular viruses)
have memory cells

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Cell-Mediated Immunity

immune response is initiated through specific antigen recognition by T cells
70-80% of lymphocytes are T lymphocytes
responsible for immunity to viruses, fungi and malignancies
attack antigen directly
responsible for organ rejection
have memory cells
T Helper cells are responsible for regulation activity of all immune cells (activate antibody-producing B cells)

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Immunosuppressed/

Immunocompromised

high dose steroids
immunosuppressants
chemo
AIDS/HIV
organ/bone marrow transplant
asplenic
very young/old
severe infection
chronic dz (DM or SLE)

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Labs that indicate infection

WBC’s elevated and shift to left (neutrophils)
lower Total Complement Assay normal is75-160 (used up when fighting infection)
increased ESR (sed rate)-normal is <30
increased CRP-normal is 6.8-820
ANA should be neg
RF should be neg
Serum Lactate Level-increased when there’s generalized infection in the blood stream.

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SLE

multi-system inflm autoimmune dz
cause-UV radiation, drugs, chems, viral inf, stess, increased estrogen activity
pattern of remission/exacerbations, chronic, unpredictable course
production of autoantibodies against nucleic acids (ANA); B and T cell hyperactivity
white less freq than others, women 20-40
dz of connective tissue: polyarthralgia, rash, alopecia, oral/nasal ulcers, proteinurea, fibrosis of heart valves, neuropathy, psych, cognitive dys, Raynauds, seizures, anemia of chronic dz, fever, weight loss, fatigue
Dx-Anti-Smith ab’s and Anti-DNA ab’s are very specific to Lupus-LE cells present-ESR-CRP-decreased complement-RF+-ANA+-pancytopenia-UA shows proteinurea
Tx=NSAIDs, glucocorticoids, immunosuppressants (azathioprine,cyclophosphamide, methotrexate, mycophenolate), antimalarial drugs (hydroxychloroquine), biologic agents (belimumab), vit D
Avoid sun!, photosens meds, avoid stress
cause of death=renal failure (nephritis), cardiovascular thrombotic event, generalized infection
ND’s=fatigue, acute pain, impaired skin integrity

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autoimmune dz of CNS (not periphery), chronic, progressive; tx by neurologist
cause=viral, immunologic, genetic
onset is insidous, gradual
demylination of nerve fibers of white and gray matter in brain and spinal cord…sclerotic plaques (seen on MRI)
over-active t-lymphocytes, antigen-ab rxns in CNS
initial sx-blurred vision, tinnitus, paresthesias, sensation changes, vertigo, Lhermitte’s sign
Northern climates
adults age 20-50, more women
lack of or altered nerve conduction (spacity)
4 types
Key features=charcot triad (nystagmus, dysarthia (slurred speech), intention tremors (shake when reach)), muscle weakness/spacsticity, fatigue, ataxia, paresthesia, bowel/bladder dys, cognitive changes, dysphagia, heat exacerbates MS, neuropathic pain (trigeminal neuralgia, HA, extremity pain, pain from spasms), constipation
Tx for pain=anticonvulsants, **antidepressants, **benzos, anti-arrhythmics, anti-inflam, muscle relax
other Tx=glucocorticoids (reduce inflm at site of demylenation-given IV), immunosuppressants (methotrexate, azathioprine), immunomodulators (betaseron, avonex-given sub Q), antispasmotics (baclofen–pump), valium, botox, surgery
Dx=MRI, CSF-spec IgG and elevated protein level, presence of WBC, electromyography (nerve conduction study), [elevated ANA or ESR or Lyme titer to r/o other causes]
Nursing Mgt-constipation (from meds, < fluids, immobility), bladder dysfunction (failure to store-hypertonic bladder), failure to empty (hypotonic bladder*=neurogenic bladder, lack nerve impulses to contract bladder)
exacerbated by PMS and post-partum; no sx during PG

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Surgeries for MS

tenonotomy-cut tendon
rhizotomy-chemically ablate nerve
myelotomy-cut nerve at spinal level
motor point blocks-interupt impulses bye anesthesia or destroy nerve at motor point to relieve spasicity

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Guillain-Barre Syndrome

(acute idiopathic polyneuritis)

affects PERIPHERAL nervous system, cranial nerves
autoimmune, inflammatory
demylelination of the axons (temporary)
pain, tingling , crawling skin
ascending* or descending
abrupt onset, acute, NOT chronic
self-limiting, complete recovery possible (85-95%)
often follows acute illness such as URI, CMV or epstein-barr, post immunization, Campylobacter jejuni
Dx-LP with elevated CSF proteins, leukocytosis, EMG shows nerve conduction delays, PFT-worry about breathing if chest muscles paralyze
Nursing Mgt-vent, plasmapheresis to remove antibodies, high dose immunoglobulins (Sandoglobulin)
pain mgt (neuropathic), immobility, eye care (no blink)
death-PE (immobility), upper GI bleed (?)

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Myasthenia gravis

autoimmune-ab’s attack Ach receptors at neuromuscular jnct; not enough Ach or too much cholinesterase; chronic, no cure
fluctuating skeletal muscle weakness
triggered by viral infection, hyperplasia of thymus (t-cells), genetic component
age 10-65, more women-peak age is childbearing years.
highly variable course of dz
affects muscles of resp, swallow, chew, speak, eyes, facial
death=resp failure
Dx-EMG (electromyography), tensilon test, muscle biopsy (shows Ach receptor antibodies)
Tensilon Test-inject tensilon (anticholinesterase), if muscle response improves=MG, no response-not MG; must have atropine available due to brady from tensilon
Meds= anticholineserase drugs (Mestinon and Neostigmine) must be taken on time, 30-60 min bf meal with water only, immunosuppressants (azathioprine, cyclosporine), corticosteroids
plasmaphersis, thymectomy to remove thymus
Nursing Mgt-monitor resp status, aspiration precautions, myesthenic crisis (not enough meds vs cholinergic crisis–too much med), monitor blood levels
myesthenic crisis-may need vent support, s/s weak skeletal muscles, ptosis, diff swallowing, dyspnea, resp failure; results from not enough meds vs. cholinergic crisis which is from too many meds
monitor resp function with PFT (neg inspiratory pressure, tidal volumes, vital capacity), 25% reduction from baseline=resp failure

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Aspiration

-may cause temperature elevation after meals!

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Rheumatoid Arthritis

chronic, systemic, nonsuppurative (=inflm without pus) inflammation of diarthrodial joints due to infiltration of immune cells (t lymphocytes) into synovial fluid where they release cytokines: TNF
triggered by environment, virus, antigen, stress, genetic
2-3 x more common in women
mostly muskuloskeletal, but anywhere connective tissue is present, vasculitis if bv involvement
AM stiffness, bilateral, symmetrical, usually upper extremeties first,generalized weakness, anorexia, wt loss, fever, pain*, ulnar drift
Dx=RF+, ANA+, CRP elevated, ESR elevated, CBC (anemia of chronic dz), decreased serum complement, elevated IgG, arthrocentesis with synovial fluid analysis, Xray, CT, MRI, bone scan
Tx-focus on early intervention, prevent inflm and erosion…remission
Meds-NSAIDs, steroids (for exacerbations), biologic therapies, immunosuppressants (DMARDs)–leflunomide, Enbrel, Methotrexate, Cyclosporine
Non-drug=PT, OT, heat/cold, water exercise, min joint stress, splinting, massage, balanced nutr, incr mobility
Nursing-med compliance to preent joint destruction
RA-systemic, swollen, small, stiff
OA-large, obese, asymmetric, degenerative, osteophytes (spurs)

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HIV

RNA retro-virus, invades CD4+ receptor cells (T helper cells) and CNS cells (HIV encephalopathy)
found in blood, semen, vaginal secretions, breast milk
considered to be an STD
Clinical manifestations=1. acute infection-HIV-specific ab’s produced (seroconversion) and mono-like syndrome may occur (2-4 wks post-exposure last 1-2 wks), high viral load, CD4+ Tcells fall, then return. 2. early chronic inf=asymptomatic, CD4’s above 500, fatigue, HA, lymphadenopathy. ** 3. Late chronic** infection=AIDS…CD4<200, opportunistic inf, opp cancer, wasting syndrome, AIDS dementia complex
most common tests=ELISA, Western Blot, oraquick-20 mins (all tests-HIV antibodies)
monitoring-CD4 count (good>350), viral load (HIV RNA)
acyclovir (anti-viral) if exposed to chicken pox; or varicella immune globulin
ART-begin when CD4<350,or AIDS-defining illness, or PG, HIV nephropathy, HBV
inaddition to ART: antifungals, antivirals, antiprotozals, antimycobacterials, antibiotics, chemo, immunomodulator tx (interferon, G-CSF), vaccines

Medical Mgt of HIV

(Classes of Antiretrovirals)

-Nucleoside Reverse Transcriptase Inhibitors (NRTI)
Becomes part of HIV DNA, damaging it, and it cannot take control of host DNA

**-Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI) **Attaches to reverse transcriptase, prevents conversion of HIV RNA into HIV DNA

-Nucleotide Reverse Transcriptase Inhibitors (NtRTI)
Inhibits reverse transcriptase

**-Protease Inhibitors (PI) **Prevents protease enzyme from cutting HIV viral protein into viral particles that infect new CD4 T cells.

**-Fusion Inhibitors (FI) **Block fusion of HIV with new host cell

-SCHEDULE is important to maintain therapeutic level–and prevent viral activity and drug resistance

Other Meds for HIV

topicals for oral lesions (Magic Mouthwash=benedryl, malox, lidocaine)
antiemetics (Marinol)
appetite stimulants (Megace, Reglan)
Sandostatin-slows GI motility (and opioids) for diarrhea
Haldol, antipsychotics for HIV encephalopathy

Cancer Facts

2nd leading cause of death-after HD
more than 200 types
Initiation-mutation of stem cells
Promotion-carcinogen=oncogene=virus, chemical (alcohol, tobacco, immunosuppressants, smoked foods, nitrites, high fat, low fiber), radiation agent (sun)
Differentiated (good-resemble the cells they came from, have specialized function) vs poorly differentiated/undifferentiated-do not resemble normal cells and have no function
Benign Tumors-expanisive only, normal differentiation, localized, encapsulated, sl. vascularity, rarely recur after tx
Malignant-infiltrative and expanisive, poorly differentiated, non-encapsulated, metastasis, marked vascularity (angiogenesis), recurs after tx.
lung cancer is most deadly-prostate and breast are most common.

Early Warning Signs of CA

change in bowel/bladder
a lesion that does not heal
unusual bleeding/discharge
thickening or lump in breast or elsewhere
indigestion/difficulty swallowing
obvious changes in wart or mole
nagging cough, persistant hoarseness
unexplained weight loss

Staging of CA

-Grading=degree of differentiation (1-4) with 4 being most undifferentiated.

TNM System for Staging

(extent and spread of dz-to determine course of therapy, evaluation of tx plan and prognosis)

T: tumor size (0-4)
N: node involvement (0-3)
M: presence of metastasis (0-1)

Tumor Markers

Hormones-ACTH (adrenal), ADH (pituitary)
Antigens-PSA (prostate), AFP (liver/testicular CA), CEA (colorectal CA), CA-125 (ovarian)
Genes-BRCA1 and BRCA2 (breast and ovarian); L1307K (colon)
Cholesterol <80 with colon cancer

S/S of Bowel Perforation

fever
abd pain
distension
VS changes
shock
absent bowel sounds
blood-rectal
rigid, board-like abd
N/V

Fecal Occult Blood Testing

- typically need 3 tests - avoid red meat, vit C, turnips, horseradish, ASA, NSAIDs, anticoags, steroids

CA Screening (Secondary Prevention)

- Testicular (age 15-34)--no screening recommended - Prostate \>50--DRE and PSA (prostate will be hard and stone-like if malignant) - Cervical (age 21-65) pap smear q3yr - Breast (more common white women, high SEC); mammography age 50-74, biannual - No screenings for pancreatic, endometrial, lung, oral, or skin

Breast CA Rx

- lumpectomy - simple mastecomy - modified radical matectomy (breast, chest wall, lymph nodes) - radical (breast, musculature, chest wall, nodes) - sentinel node-during surgery, inject breast tissue with dye to determine extent of lymph node excision necessary - Tamoxifen and Raloxifene-for estrogen receptor + tumors, delays recurrence in post-menopausal pts

Smoking

- \>CO in blood, increased erythropoesis - clumps of platelets--PE - constictsarteries-wrinkles, impotence, stimulates release of epi and norepi - inhibits cholesterol clearing \>atherosclerosis, LDL - delayed wound healing - \>gastric ulcers, herniated disk, HTN - emphysema, bronchitis - \>bladder CA - Second hand smoke-hearing loss, vascular damage, HD, resp illness

Smoking Cessation

5 A's (every encounter) ## Footnote - Ask to id smokers - Advise to quit - Assess willingness to quit - Assist-help develop plan - Arrange-schedule follow-up Combo of behavioral and nicotine repl therapy (NRT) - Patch-dif strengths-wean down every 4 wks, repl every day in hairless location bt neck and waist - Gum-2 and 4 mg - 2mg is same as one cigarette, chew and park, max 24 per day, 3 month prgm - Meds for nicotine addiction= **Zyban** (bupropion, Wellbutrin), use with gum/patch, begin 1-2 wks prior to quit, use 7-12 wks post, up to 6 months; helps with cravings **Chantix**-begin 1 wk prior, titrate over time, blocks nicotine from reaching receptors in the brain; psychotropic drug--negative effects -Auricular therapy-accupuncture

Lung CA

-Dx- **bronchoscopy**-direct visualization, take biopsies, remove foreign bodies (complications-aspiration, bronchospasm-stridor, hypoxia, pneumothorax-air in pleural space, bleeding, cardiac dysrhythmias-due to stim of vagus nerve) **FNB**-local anesthesia (complications-pneumothorax-air tight dressing to avoid)

CA Treatment

- **Surgery**-curative (remove), diagnostic (biopsy), palliative (debulking-relieve pressure,pain, obstruction), prophylactive, reconstructive. types=cryosurgery, laser, stereotactic radiosurgery (gamma knife) - **Radiation**-damages genetic material of highly mitotic cells; can cure skin, Hodgkins, breast, prostate, larynx, bladder, anal; may be used as adjuvent, prophylactic, or palliative; can be external or internal (brachytherapy). Skin-desquamation (dry or moist), temporary (no ice packs or heating pads, no ointments without approval. Chronic skin rxns=atrophy, thinning, fibrosis, ulcerations, necrosis, telangiectasis. Other SE-alopecia, stomatitis, diarrhea, anorexia, dry mouth, halitosis - **Biological Response Modifiers** (BMR's)-most activate the immune sys to destroy CA cells. Examples-Interferon, Interleukin-2, Monoclonal Antibodies - **Chemotherapy**-cytotoxic drugs given systmeically. Induction (no other tx avail), adjuvant, neoadjuvant (to decr # of CA cells bf surgery), combination (2+ chemo agents). Phase specific (affect reproducing cells-specifc phase of cell cycle), non-phase specific (resting cells and reproducing cells)

Central Venous Catheter

- CW Hohn - Portacath (CA pts, sickle cell); non-coring needle, flush q1month - PICC - flush q8h, CXR to confirm placement, sterile dressing change, heparin flush, use pre-filled or 10ml syringe - Midline Catheter (central line) Avoids irritation at insertion site--vessicant drugs (always assess blood return!), useful for long-term Vessicants=chemo drugs, KCl, vancomycin, amiodarone, epi, calcium, dilaudid if vessicant drug infiltrates-stop infusion, aspirate to remove as much as possible, apply ice/heat, elevate extremity unclot central line with urokinase other complications-infection (culture tip), phlebitis, vagal rxn (with removal)

Side Effects of Chemo

- Bone marrow suppression: - GI tract-mucositis, N/V, taste alterations - alopecia - fatigue - Know RBC, WBC, platelets, BUN, creatinine, Mg, K - Bone pain - Pain-PQRST - fever\* (may be blunted due to immunosuppression) - thrombcytopenia (low plts)-infuse for \<50,000 - if WBCs\<1000-1500-modify/stop chemo - continue chemo until ANC is reduced by half (risk of infection increases as ANC decreses) - ANC is calculated based on segs/bands - Neutropenic precautions for ANC \< 500 (pt wears mask upon leaving room) - prone to-skin integrity, malignancy (bone), malnutrition - Tumor lysis syndrome: hyperkalemia, hyperuricemia, hyperphosphatemia, hypocalcemia

Colony Stimulating Factor (CSF)

- G-CSF(watch for E.coli allergy), new G-CSF (longer acting-once per chemo cycle), GM-CSF (watch for yeast allergy) - give subQ, 25G needle, room temp, not within 24 hours of chemo, ice after injection if plt are low

Sepsis

- can develop suddenly - increased HR, decreased BP, increased RR with crackles, increased temp (possible) - flushed skin (vasodilate) - decreased urine output - third spacing (periph edema) - T=38.5/101 call doc; blood cultures bf tylenol - CBC with dif, fluid rpl, triple anti-inf, vasoactive drugs, O2, colony stim factors (CSFs)

Drugs that cause bleeding

ASA NSAIDs Steroids Anti-coagulants

Bleeding Precautions

- No IM injections - no rectal insertins - electric razor only - no throw rugs - no open-toed shoes - no spicy foods or EtOH - soft toothbrush

Drugs for N/V

Zofran Reglan Decadron Compazine Zantac

Side Effects of Opioids

- N/V - sedation - respiratory depression - itching - dry mouth - urinary retention - constipation

Meds for Nerve Pain

- Anticonvulsants (Neurontin, Dilantin, Tegretol) - Steroids - TCA (Elavil, nortriptyline)