exam 2 Flashcards
Immune and connective tissue disorders, brain and spinal cord disorders, and PNS disorders
immune disorders include:
1- medication induced immunosuppression
2- neutropenia
3-HIV/AIDS
medication induced immunosuppression and goal of therapy
-secondary immune dysfunction
-chemotherapy
-corticosteroids
Goal= 1-prevent infection, 2- treat infections promptly
chemotherapy induced immunosuppression
-cytotoxic= targets rapidly dividing cancer cells
-cells of the immune system are inadvertent targets of chemotherapy, which results in a decrease in lymphocytes and phagocytes
-causes general immunosuppression- remaining lymphocytes unable to release antibodies and lymphokines to facilitate immune response
corticosteroid induced immunosuppresion
-used to treat autoimmune disorders and prevent transplant rejection, interfering with cell-mediated immunity or production of antibodies
-also has anti-inflammatory effect
-suppression of cell-mediated immunity and lymphopenia as well as a decrease in the inflammatory response
(methylprednisolone, prednisone, dexamethasone, betamethasone, hydrocortisone)
neutropenia
a reduction in the number of neutrophils (WBC that fight bacteria) that are essential for fighting infection
-absolute neutrophil count= ANC
= mild: ANC 1000-1500
= moderate: ANC 500-1000
= severe: ANC <500
-if severe, the normal bacteria from mouth and digestive tract can cause serious illness
causes and risks for neutropenia
-causes: chemotherapy, radiation, bone marrow disorders, medications (medication induced), surgery, burns, malnutrition and infections like HIV
-risks: patients with severe neutropenia are at a higher risk for life-threatening infections, requiring close monitoring and preventative care
medication induced neutropenia
-most common mediation that can result in drug-induced neutropenia is chemotherapy!!!! this kills neutrophils
also includes medications for:
-overactive thyroid
-antibiotics
-antivirals
-anti-inflammatory meds for UC or RA
-antipsychotics
-antiarrhythmics
nursing assessment for neutropenia
-VS: monitor for signs of infection like fever, tachycardia, or hypotension
-skin and mucous membranes: assess for redness, swelling, or lesions, especially in the oral cavity and IV sites
-lab monitoring: regularly review CBC to track ANC levels
-symptoms: ask about any chills, sore throat, cough, nasal congestion, rhinorrhea, or urinary symptoms (cloudy or odor) that may indicate infection
nursing management/action for neutropenia
-hand hygiene before and after contact
-protective isolation= neutropenic precautions/reverse isolation: private room with isolation precautions to minimize potential pathogen exposure
-visitor restrictions: limit number of visitors, no sick visitors or care providers, ensure adherence to hygiene protocols
-use PPE like gloves, masks, and gowns
-low bacteria diet: diet restrictions to prevent ingestion of harmful bacteria
-oral care: meticulous oral hygiene to prevent infections in the mouth, soft toothbrushes, avoid flossing if platelets are low
-skin and IV care: maintain skin integrity, avoid invasive procedures, ensure sterile technique for dressing changes and catheter care
-psychosocial support: help patients cope with isolation and the emotional impact of prolonged treatment and infection risk
-fever management: patient with fever (>101F) is considered medial emergency- immediate assessment and prompt initiation of broad-spectrum abx may be required
patient teaching for neutropenia
-regular check ups
-report infections promptly
-universal precautions
-HANDWASHING
-avoid contact with people who have infections or are sick
-avoid large crowds or gatherings
-do not change cat litter boxes
-avoid turtles or reptiles as pets
-eat a low bacteria diet: avoid raw or undercooked meat, poultry, seafood, and eggs. avoid unpasteurized dairy products and juices. wash fruits and veges thoroughly, or opt for cooked versions. no raw nuts and seeds. ensure proper food handling, storage, and preparation to minimize contamination.
HIV/AIDS
HIV= human immunodeficiency virus: attacks the immune system, specifically targeting CD4 cells (T cells), which help the body fight off infections.
-over time if untreated, HIV can destroy so many of these cells that the body becomes unable to defend itself against infections and diseases.
AIDS= acquired immunodeficiency syndrome: the most advanced stage of HIV infection, characterized by a severely weakened immune system. this makes individuals vulnerable to opportunistic infections and certain cancers.
not everyone with HIV develops AIDS!! especially with proper treatment, as antiretroviral therapy (ART) can control the virus and prevent progression to AIDS.
HIV replication
-HIV belongs to a group of viruses known as retroviruses
-targets CD4 receptors, which are expressed on the surface of T lymphocytes, monocytes, dendritic cells, and brain microglia
complex life cycle of HIV: binding, fusion, reverse transcription, integration, transcription/replication, translation/assembly, budding, maturation.
risk factors for HIV/AIDS
-non-discriminatory: sexual orientation, race, ethnicity, gender, age
-transmission: unprotected sex, body fluid, IV drug abuse, occupational exposure, blood transfusions and organ transplant- less likely now due to testing.
diagnostic testing of HIV
-HIV antibody tests- rapid/POC
-EIA= enzyme immunoassay/ELISA=enzyme-linked immunosorbent assay
used to identify antibodies directed specifically against HIV
-western blot: used to confirm sero-positivity when the EIA result is positive
disease monitoring for HIV
the viral load and CD4 count are obtained at the time of diagnosis, and then routinely every 3-4 months for the first 2 years of therapy.
-interval may be extended to 6 months for adherent patients who viral load has been suppressed for more than 2 years
-viral load is used as a marker of response to ART (antiretroviral therapy)
classification of HIV stages
-HIV infection stage 1: at least 500 cells
-HIV infection stage 2: 200-499 cells
-HIV infection stage 3=AIDS: less than 200 cells
Four Fs:
-Flu-like= acute infection
-Feeling fine= asymptomatic, latent infection
-Falling count= symptomatic, opportunistic infections
-Final crisis= AIDS
HIV consists of several stages, ranging from acute infection to death:
-viral transmission, viral infection, and seroconversion
-asymptomatic chronic infection
-symptomatic chronic infection
-acquired immune deficiency syndrome=AIDS
HIV manifestations
-fever
-cough
-weakness
-NVD
-dysphagia
-forgetfulness
-skin lesions
-SOB, DOE
-HA
-vision changes
-pain
-night sweats
-lymphadenopathy
clinical manifestations indicating a deterioration in status requiring immediate attention by a healthcare provider: new cough, increased fatigue, temperature greater than 102, night sweats, new onset of HA, new onset of visual. blurring, recent change in mental status, new skin lesions, new onset of diarrhea, weight loss greater than 10% of previously recorded weight.
Antiretroviral therapy=ART
major goals for initiative ART
-reduce HIV associated morbidity and prolong the duration and quality of survival
-restore and preserve immunologic function
-maximally and durably suppress plasma HIV viral load
-prevent HIV transmission
evaluate hepatic and renal function prior to administration
ART targets different stages of the HIV life cycle:
-to achieve sustained viral suppression, patients are prescribed 2-3 medications from two different classes
-simplifying treatment regiments and decreasing the number of medications that must be taken each day increase patients’ adherence to therapy.
medical management for HIV
prophylaxis medications:
-administered in patients with CD4 count of 200 cells or less to reduce the risk of OI initiated prior to ART therapy.
-awareness of allergies to medications such as bactrim. the decreased CD4 cells may mask reactions. once the CD4 cell begin to increase, allergic reactions may manifest and can be life threatening.
immunizations:
-maintain up to date immunizations including pneumovax and influenza
-live virus for people with HIV and household members are contraindicated.
HIV/AIDS if untreated
-if an HIV infected individual who does not receive treatment, the length of time from infection to death is approximately 12 years.
-in resource limited countries, the time from infection to death is approximately 5 years
-malnutrition, TB, and malaria are co-morbidities that shorten the time the untreated patient survives.
HIV education
-prevention
-awareness
-testing
-follow up appointments
-pre-exposure prophylaxis: truvada-combo of two drugs (tenofovir and emtricitabine) used to reduce the risk of contracting HIV
HIV nursing management
-VS: temp, pulse, respirations, oxygen saturation
-weight trend
-CD4 count
-viral load
-adherence to ART: adherence rate of 95% or greater is essential to achieve viral suppression and prevent the development of resistance to one or more ART medications
-TB status
-Immunization status
-depression
-use universal precautions consistently
-administer ART as prescribed and on time
-provide nutritionally dense foods and small, frequent meals
-provide emotional support
-refer for social services evaluation
-education: avoid high risk behaviors, adhere to treatment regimen, implement infection control precautions at home, s/sx to report to HCP urgently, health maintenance needs.
connective tissue disorders
-systemic lupus erythematous=SLE
-GOUT
systemic lupus erythematous=SLE
autoimmune chronic inflammatory disorder of the connective tissue
-produces antinuclear antibodies=ANA
-causes widespread inflammation and tissue damage of most major body systems
-period of exacerbations and remissions
risk factors for SLE
-gender-female
-age: 20-40 year olds
-race: African American, asian, Native American
-environmental stimulus: infection, medications, sun exposure
-genetic predisposition
SLE diagnosis
-based on combination of clinical symptoms and lab findings
-criteria consists of 11 key signs and lab tests, and a diagnosis is made if a patient meets at least 4 of them
medical history and physical exam
laboratory tests:
-ANA test: most have positive, which indicates presence of autoantibodies
-Anti-dsDNA and anti-smith antibodies: more specific for SLE. presence of anti-double-stranded DNA and anti-smith antibodies can help confirm the diagnosis
-CBC: may cause anemia, low white blood cells (leukopenia), and low platelets (thrombocytopenia)
-urinalysis: checks for protein and blood in urine, which may indicate kidney involvement (lupus nephritis)
-complement levels (C3, C4): proteins are often low in active SLE because the immune system uses them up during inflammation.
signs and symptoms for SLE
-skin rashes: malar or butterfly rash on face
-photosensitivity
-lupus nephritis
-fatigue
-weakness
-malaise
-joint pain and swelling (arthritis)
-fever
-hair loss
-mouth sores
-anorexia, weight loss
-palm erythema
medications for SLE
-NSAIDs: for pain and inflammation in joints and muscles
-antimalarials: to control skin symptoms and joint pain, and to prevent flares
-corticosteroids: used to reduce inflammation during flare-ups but should be tapered and monitored for side effects
-immunosuppressants: help control the immune response, but increase risk of infections
adherence: stress importance of taking meds as prescribed, even when feeling well
side effects: discuss potential side effects of medications like weight gain, increased risk of infections, bone thinning, and the importance of regular monitoring (blood tests for liver and kidney function)
nursing care for SLE
-monitor for complications like renal failure
-identify factors contributing to fatigue
-diet: high vitamin and high iron, high protein if no evidence of kidney disease
-administer medications as prescribed
-monitor VS, Is and Os, daily weights for signs of fluid overload if corticosteroids are used
-monitor for bruising, bleeding, and injury
-monitor for signs of organ involvement such as pleuritis, nephritis, pericarditis, CAD, HTN, neuritis, anemia, and peritonitis
-provide support therapy as major organs become affected
-provide emotional support
-provide information regarding support groups, and encourage the use of community resources
education for SLE
-recognizing and managing flares: early signs of flare, rest and energy conservation, when to seek help (CP, SOB, urinary symptoms)
-preventing flares: sun protection, stress management, balanced diet, regular exercise, medication adherence
-infection prevention: handwashing, masks, avoid crowds and sick people, stay up to date on vaccines
-skin: clean skin with mild soap, avoiding harsh and perfumed substances
-coping: mental health care, support groups
-follow up care: emphasize the importance of regular medical checkups to monitor disease progression, medication effects, and organ function (kidneys, heart), may need to see multiple specialists
gout
-metabolic disease
-hyperuricemia (increased uric acid) and uric acid crystals in joints= tophi, and major organs (kidneys) causing organ dysfunction
-caused by overproduction of uric acid, medications (thiazide diuretics, BBs), another disease (CKD)
signs and symptoms of gout
-excruciating joint pain
-erythema
-swelling
-tophi in great toe
-low-grade fever
-malaise
-HA
-pruritus: urate crystals in the skin
-renal stones from elevated uric acid levels
risk factors for gout
-obesity
-HTN
-diet rich meat and seafood
-use of thiazide diuretics
-consuming large quantities of ETOH (beer)
phases of gout
-acute: acute onset of pain, redness, and swelling
-intercortical: asymptomatic period between attacks
-chronic: repeat attacks over many years causing the formation of tophi in the joints causing destruction
diagnosis of gout
-uric acid level
-synovial fluid exam and urate crystals
-x-ray
-CT scan
medical management for gout
-medications: allopurinol for chronic, colchicine for acute
-diet: avoid purine
-weight management
-limit ETOH
-splint affected joint
-monitor for kidney stones
nursing management for gout
-assess decreased ROM
-assess intense joint pain, and tenderness, swelling, and warmth to affected joint
-assess for presence of tophi
-use ice packs
-administer medications: NSAIDs, uric acid lowering agents, glucocorticoid therapy
nursing care and patient teaching for gout
-avoid purine rich foods: organ and red meat, shellfish, wine, aged cheese, lentils, asparagus, spinach, fructose drinks
-increase urinary pH to above 6 by eating alkaline ash foods such as green beans or broccoli
-avoid alcohol and starvation diets as these can cause attack
-high fluid intake of 2000 mL/day to prevent stone formation
-reduce stress
-bed rest with affected extremity elevated
-monitor joint ROM ability and appearance of joints
-protect the affected joint from excessive movement (immobilize), direct contact with sheets or blankets, no weight bearing
-provide cold to affected joint as prescribed
-administer medications as prescribed
brain disorders
affect cognition, personality, mobility, and ADLs
-chronic: primary headaches, seizure disorders, Parkinson’s disease, Alzheimer’s disease- require lifelong management and coping with exacerbations
-emergency: primary or metastatic brain tumors, meningitis, and encephalitis- may be life-threatening emergencies
brain tumors
-occupies space within the skull
-primary tumors: grow within the brain, benign or malignant, slow growing or aggressive
-secondary tumors: metastasis spread from cancer in another area of the body
effects of brain tumors are caused by inflammation, compression, and infiltration of tissue- cerebral edema, increased ICP, neurologic deficits, seizures, altered pituitary function
diagnosis of brain tumors
-CT
-MRI
-PET
-biopsy
-EEG
-CSF analysis
-toxicology to rule out substance use as cause
signs and symptoms of brain tumors
obtain patient and family history
thorough neuro assessment
symptoms vary with location of tumor, but some include:
-HA
-NV
-new onset seizures
-impaired sensory perceptions: facial numbness or tingling, visual changes (papilledema, loss of vision), hearing changes
-cranial nerve palsy
-loss of balance
-ataxia
-weakness or paralysis: one part or side of body (hemiparesis, hemiplagia)
-abnormal redlexes
-difficulty thinking, speaking, or articulating words-aphasia
-changes in cognition, mentation, or personality
gliomas
infiltrate any portion of the brain
-most common type of brain tumor!
medical management of brain tumors
nonsurgical management
-drug therapy: chemo, hormone suppressing meds, corticosteroids, osmotic diuretics, anticonvulsants, non-opioid analgesics
-radiation therapy
surgical management
-biopsies
-craniotomy
-complication: increased ICP, bleeding, cerebral edema, seizures, VTE
interventions for brain tumors
goal= compensate for self-care deficits, improve nutrition, reduce anxiety, enhance coping skills, free of complications
-frequent neuro and symptom assessments
-VS: watch for cushing’s triad- widened pulse pressure (HTN), bradycardia, irregular respirations: late increased ICP
-treat headaches: analgesics, upright position
-treat NV
-treat fatigue: conserve energy, promote rest
-treat pain
-medication management: dexamethasone, antiepiletics
-monitor elevtrolyes
-Is and Os
-urine specific gravity and osmolality
-cognition: reorientation, orienting devices, assistance with self care, monitoring and intervention for prevention of injury
-seizure precautions: educate on risk for seizures and prophylactic antiepileptics
-emotional support
taking action for brain tumors
-encourage independence for as long as possible
-measures to improve cognitive function
-allow patient to participate in decision making and to express fears and concerns
-presence of family, friends, spiritual advisor and health care personnel may be supportive
-referral to counselor, social worker, home health care, support groups, PT/OT/ST
-referral for hospice care
-improve nutrition: oral hygiene before meals, plan meals for times when patient is comfortable and well rested, measures to make mealtimes as pleasant as possible, offer preferred foods, dietary supplements, daily weight, record daily intake.
