Exam 2

Question 1

Ace Inhibitors

Answer 1

Blood vessels dilates and blood pressure is reduced.

End in -pril

May cause dizziness, orthostatic BP, GI distress, nonproductive cough, and headache.

The first dose may cause a sudden drop in BP.

Question 2

Digoxin

Answer 2

A fib and heart failure

Check K levels.

HR must be at least 60

0.8-2

Consume foods rich in K. Potatoes, avocados

antiarrhythmic

Question 3

Active acquired immunity

Answer 3

Developed by the person’s own body. Typically lasts many years or a lifetime. One example is chickenpox or through vaccines.

Question 4

Passive acquired immunity

Answer 4

Temporary immunity transmitted from a source outside the body. Developed immunity through previous disease or immunization. An example is getting a rabies vaccine after being bitten.

Question 5

What is apoptosis?

Answer 5

Body’s way of destroying worn-out cells (such as blood or skin cells or cells that need to be renewed).

Question 6

What is left shift?

Answer 6

It means the patient is very ill and septic. Bone marrow can not produce enough mature. Immune cells are not capable of phagocytosis. The body is running out of ideas to treat the infection.

Question 7

What are immune system changes in older adults?

Answer 7

Neutrophils less active= higher risk of infection;
May have an infection but WBC doesn’t reflect it = Infection may be overlooked;
May not have a fever= infection may be overlooked;
Less new antibodies= Less response to new antigens;

Question 8

Primary immune deficiency diseases (PIDDs)

Answer 8

Diagnosed at infancy. Genes are messed up from the start. Live vaccines are contradicted because the patients can not generate antibodies.

Question 9

What does Immunoglobulin (IVIG) do?

Answer 9

Gene therapy. Artificially gives patients what they need as a boost.

Question 10

ANC normal value

Answer 10

greater than 1500 cells/mm^3

Question 11

What is Kaposi Sarcoma?

Answer 11

Most common AIDS related malignancy. Skin lesion.

Question 12

Zidovudine (retrovir, Aztec)

Answer 12

Nucleoside. Interferes with HIV replication.
CAUTION! It is metabolized in the liver and excreted in the urine therefore us caution in patients with renal failure, liver impairment. Causes severe bone marrow suppression.

Question 13

Acyclovir (zovirax)

Answer 13

Antiviral. Inhibits viral DNA replication. CAUTION! Excreted unchanged in the urine therefore not used for the renal impaired. Not in combination with other nephrotoxic meds. Check renal function! Watch out for renal side effects.

Question 14

Drug therapy used to treat different conditions associated with AIDS assessment

Answer 14

Assess for changes in LOC, vital signs, pupil size and reactivity, limb strength

Question 15

Rheumatic disease is characterized by

Answer 15

Arthritis and pain.

The result is swelling in small joints, pain, stiffness and fatigue.

Question 16

Creatinine

Answer 16

0.5-1.5

Increase may indicate kidney damage associated with Lupus, Scleroderma, Polyarteritis

Question 17

Erythrocyte Count

Answer 17

Decrease can be seen in RA, Lupus.

Question 18

ESR

Answer 18

Also known as sed rate.
Increase with inflammatory connective tissue diseases. the higher the ESR= Greater inflammatory activity.
Normal: Over age 50? Men- less than 20, Women less than 30.
Under age 50? Men- less than 15, Women less than 25

Question 19

Hematocrit

Answer 19

Decrease with chronic inflammation. (the anemia associated with chronic disease)

Question 20

WBC

Answer 20

Decrease with Lupus

Question 21

Uric Acid

Answer 21

Increase with gout.

Normal 2.5-8

Question 22

Normal Antinuclear Antibody (ANA) Value

Answer 22

Normal=Negative

Measures antibodies that react with various antigens.

Question 23

Normal Anti-DNA, DNA Binding Value

Answer 23

Normal-=Negative

high seen in Lupus.

Question 24

Normal C-Reactive Protein Levels

Answer 24

Normal= None or very tiny amount.

Positive means active inflammation.

Question 25

Rheumatoid Factor (RF)

Answer 25

Normal=Negative. | Checks the presence of abnormal antibodies.

Question 26

Aspirin

Answer 26

Anti-inflammatory, Analgesic, antipyretic. CAN CAUSE BLEEDING! monitor for signs of GI bleeding. Monitor for purpura (red or purple discolored spots). Give with food. Check for tinnitus

Question 27

NSAIDs

Answer 27

Anti-inflammatory, Analgesic, Antipyretic, Platelet aggregation inhibitor. INCREASED RISK FOR CARDIOVASCULAR EVENTS! MI and Stroke. Check for adverse effects (GI, neuri, cardio, renal)

Question 28

DMARDs hydroxychloroquine (Plaquenil) chloroquine (Aralen)

Answer 28

OK to give with NSAIDs CAN CAUSE RETINAL DAMAGE! Needs eye exam every 6-12 months. Report headache. Report blurred vision.

Question 29

DMARD | tofacitinib (Xelijanz)

Answer 29

Give BID. Monitor lipids 4-8 weeks after initiation. CAN CAUSE LIVER DAMAGE! CHECK LIVER ENZYMES ROUTINELY!

Question 30

``` DMARD methotrexate (Rheumatrex) azathioprine (muran) ```

Answer 30

MAY CAUSE BIRTH DEFECTS! | USE STRICT BORTH CONTROL!

Question 31

Corticosteroids | prednisone

Answer 31

Causes elevated blood sugar. Use with caution with diabetic patients

Question 32

Cortisone injections

Answer 32

Short term fix for larger joints. Can cause muscle wasting if injected incorrectly.

Question 33

Is local anesthetic getting into the patient's system?

Answer 33

Assess for metallic taste, tinnitus, nervousness, slurred speech, bradycardia, hypotension, decreased respirations, seizures.

Question 34

Why do we test for TB with RA?

Answer 34

Pt with latent TB can reactivate.

Question 35

Community acquired pneumonia

Answer 35

Occurs in the community setting or within the first 48 hours after hospitalizations.

Question 36

Health care associated pneumonia

Answer 36

The causative pathogens are often multidrug-resistant (MDR); identifying is crucial; difficult to treat, initial antibiotic treatment must not be delayed

Question 37

Hospital acquired pneumonia

Answer 37

Develops 48 hours or more after admission; predisposed pts have comorbidities, supine positioning and aspiration, coma, malnutrition, prolonged hospitalization, hypotension, and metabolic disorders; exposed to potential bacteria from other sources (respiratory therapy devices and equipment, and transmission of pathogens by the hands of health care personnel). prolonged or inappropriate use of antibiotics; the use of nasogastric tubes. Presentation is a new pulmonary infiltrate on chest x-ray combined with evidence of infection such as fever, respiratory symptoms, purulent sputum, or leukocytosis.

Question 38

Ventilator-Associated Pneumonia

Answer 38

A subtype of HAP; however, the pt has been endotracheally intubated and has received mechanical ventilatory support for at least 48 hours. VAP occurring within 96 hours of the onset of mechanical ventilation is usually due to antibiotic-sensitive bacteria that colonize the patient prior to hospital admission, whereas VAP developing after 96 hours of ventilatory support is more often associated with MDR bacteria.

Question 39

Aspiration Pneumonia

Answer 39

Entry of substances into the lower airway. The most common form of aspiration pneumonia is bacterial infection from aspiration of bacteria that normally reside in the upper airways; other agents such as gastric contents, chemical contents, or gases. This type of aspiration or ingestion may impair the lung defenses, cause inflammatory changes, and lead to bacterial growth and a resulting pneumonia.