DONE: Immune Part 2 Flashcards
Poor nutrition Stress: Humidity Poor sanitation Crowded living conditions Pollution Dust Medications that can alter the immune system What do these conditions describe?
A: reasons for infection
Break the chain of infection, we need an ____ ____ that has the ability to cause an infection, it needs to have the strength and the ability to ___; a ____ is just a place where it can live until it has a ______ and then a means of ______
A: infectious agent Spread Reservoir portal of exit transmission
How do you break the chain of infection?
A: Medical asepsis
Other types of Standard precautions
Body substance isolation
Protective isolation
What are the Common Allergens?
A: Pollen
Mold
Pet dander
Dust and dust mites
What should you educate the patient on regarding pollen?
A: Shower or bathe before bedtime –especially hair; if they go outside and it’s a high pollen count day then pollen will get into their hair; if they don’t shower or bathe before bedtime, they go to bed the pollen gets into their pillow so it becomes a vicious circle
Stay inside on dry, windy days because there is so much pollen circulating around
Where are the areas for mold growth that the patient would need to be educated on?
A: With mold we want to remove houseplants
Frequently clean:
Shower curtains
Bathroom windows
Damp walls
Indoor trash cans
All of these places are a really good environment for mold to grow
The best solution for ____ is not to have any pets at all, keep them ___ and keep them out of your ___, the ____ that collects in your house and is impossible to get rid of
A: pet dander
Outside
Bed
dander
_______ collects in house dust and takes 4 or more weeks to die down
A: Dander
Allergen resistant bedding
Air filter
Bathe pets often
A: reduce pet dander
Remove: drapes, feather pillows, upholstered furniture, non-washable comforters, and soft toys
might have to replace carpet with tile and wood
Mop & vacuum often (use HEPA filter) to clean out the small particles
A: reduce dust/dust mite (feces) allergies
Dust mites can just get in carpeting/drapes and it’s actually the ____ of the dust mites that people are allergic to
A: feces
Block H1 receptors preventing the histamine response, these are not the H2 blockers those are for GI effects
What medication treats these allergens?
A: Antihistamines:
___________ work by causing vasoconstriction in the capillaries of the nasal membrane that your blood vessels in your nose swell up as that is part of their vascular response
A: Decongestants
Note: decreasing the size or constricting those vessels it causes shrinkage in the mucous membrane and decrease fluid secretion
_____ ______ is used inhalation wise and is prophylactic with ppl with bronchiole asthma, is taken daily and it helps to inhibit the release of histamine and prevent an exacerbation
A: Cromolyn sodium
_____ _____ sprays helps to decrease nasal swelling
A: Nasal steroid
It’s very rare but there are some mast cell stabilizer _______; one is called Pataday
A: Eye drops: Note (FYI) and is very expensive but it does exist
Name the types of autoimmune disorders?
A: Rheumatoid Arthritis
Systemic Lupus Erythmatosus from now on this will be called Lupus or SLE
Nonsteroidal anti-inflammatory drugs interferes with prostaglandin, they decrease inflammation and pain; aspirin is one that is commonly used for ______
A: RA treatment
Prednisone which is a steroid and anti-inflammatory, it’s an adrenal hormone, an immunosuppressant and it also decreases the inflammatory response and is used for?
A: RA treatment
Note: Side effects for Prednisone are nausea, diarrhea, abdominal cramping, depression, pancreatitis; steroids are not to be taken lightly and remember that you never ever suddenly stop a corticosteroid
Disease modifying agents work by altering the body’s response to whatever is going on and is commonly used for?
A: RA treatment
Methotrexate is a medication that is used for different things depending on the dosage of the drug; it is given as a antineoplastic for what autoimmune disease process?
A: given for rheumatoid arthritis, it does have an immunosuppressant effect it is used for SEVERE rheumatoid arthritis that is unresponsive to other treatments
Note: what you need to know that just by the dose, by looking at the dosage, look into your resources, when used as an antineoplastic it is at a higher dose and is given more often; side effects: aplastic anemia which can be fatal, pulmonary fibrosis and liver damage
_____ is for SEVERE cases of rheumatoid arthritis also and it has side effects of aplastic anemia
A: Hydroxychloroquine
____ inhibits inflammation and is it also modifies the immune response
A: Gold
____ which is a fairly common one that slows the progression of rheumatoid arthritis by binding to tumor necrosis factor so it helps to decrease inflammation and slows the progression of the disease, but side effects are infections, leukemia, it alters the immune system so rheumatoid arthritis treatment can alter the immune system so we have to be careful with that
A: Etanercept
Pain, chronic, debilitating pain Decreased Mobility Risk for injury Self-care deficit: dressing/grooming Ineffective coping Also body image and huge risk for infection
A: nursing diagnosis for RA
Relieve pain
Inhibit inflammation
Preserve joint function
Prevent deformity and there you will see a swan neck deformity in that index finger…
A: RA treatment goals
Assessment
Joint movement
Deformities: note which joints are affected
Pain assessment;
Functional status including ADL’s, work, recreation, what are they able to do, what do they wish they could do,
Management of therapeutic regimen and are they following it
A: RA nursing interventions
Education is really key as it is with so many different things; you want to teach them things to manage pain and ______ things because with chronic pain we can’t just give them more and more and say well this is going to be gone in a couple of days, this is something that they are going to be living with for the rest of their lives so things like: _____ and _____, ______, taking _____ as ordered and on time, warm or hot shower in the morning or evening can help to relieve some of the pain
A: non-pharmacologic Meditation Biofeedback Distraction Medications
With RA patients you will need to assist with ____ as necessary, if we have a joint that is going through a flare up or an exacerbation then that joint needs to ____, the other joints need to be kept ___; we want to Prevent flexion contractions so we do that by having the pt lay face down on the bed with their feet hanging off the mattress between the mattress and the floor board several times a day to keep their foot in the correct position because it needs to be for walking we might also have to use splints and gentle ROM; Keep patient warm that helps with the comfort
A: ADLs
Rest
Active
RA patient’s ____ is going to be more vulnerable especially if they are on steroids; and you know that skin delicacy you have the same cells lining your GI tract as you do closing your skin so you have to be mindful of that too and watch for bleeding in the ____
A: skin
GI tract
Encourage independence as able; encourage them at home to have a firm mattress, straight back chairs that have arm rests that will make it easier for them to get up and down by themselves they might need some assistive devices to help with getting dressed, there are things that help with putting on socks and fastening buttons, there are shoelaces that are elastic that they just leave them in their shoes all the time and it turns a tie shoe into a slip on, Velcro is very nice also for shoes and for clothes fastening if they can’t manipulate buttons and zippers; they might have a problem with body image too as their disease progresses
A: RA intervention
Space activities with rest periods so in the hospital or teaching when they are going home, to space themselves and with rheumatoid arthritis and a lot of these disease they feel better in the morning so they will wake up and get their warm shower, get dressed and that is the best time for them to be active so if they are scheduling appointments or if you are scheduling things for them in the hospital mornings are better because it just wears them out by the afternoon
A: RA intervention
Assess need for home health care, do they have steps at home, do they need assistive devices, do they need grab bars in the showers to help prevent falls, those sorts of things and you can also ask for a home safety visit that is something that you can request
A: RA intervention
Pain management, like I said this is chronic pain so we are not going to be as successful of getting rid of 100% of the pain the way we can with acute pain because this is something that they are going to have for the rest of their lives so we just have to keep upping the pain medication so teach them to use heat or cold, they can use warm packs or ice packs 15-20 mins at a time 3-4x a day and they need to be sure to take it off after that 15 mins, teach them about their medications and some of those adjunctive methods that we talked about earlier, there is also a tens unit which gives an electrical stimulation to an area to interrupt the pain pathways, biofeedback, meditation, and acupuncture
A: RA intervention
______ is a removing of the inflamed membrane early in the disease process the membrane that lines the capsule of the joint
A: Synovectomy: surgical treatment of RA
