Immune Flashcards
5 cardinal symptoms of inflammation
warmth, erythema, pain, decreased function, edema
HIV transmission
babies, banging, blood
at which stage of HIV is it spread the most? why?
primary, 2nd place asymptomatic; patient doesn’t realize they have it
why might a pt not know they have HIV at first?
very general nonspecific flu like symptoms
what is AIDS
T cells drop below 200, immune system is significantly impaired, no ability to fight infection
what infections are AIDs pts most at risk for
any - most get opportunistic infections like pneumonia, TB, thrush, cellulitis
GI s/s of AIDs
anorexia, n/v, chronic severe diarrhea, weight loss, wasting syndrome
what is wasting syndrome
loss of at least 10% of body weight
complications of thrush
can cause sternal pain, ulcers, painful swallowing - makes pt’s more anorexic
Kaposi Sarcoma
skin malignancy, small, painless purplish/brown raised lesions on skin, progresses throughout all of the body - lymph nodes, lungs, etc.
integumentary s/s of aids
dry, itchy, irritated skin, prone to rashes, eczema, psoriasis
petechiae, bleeding gums
pt education- when AIDs positive
med adherence, notify all partners, limit spread through not engaging in risky behaviors, cannot donate blood, plasma, sperm
as a healthcare worker, what should you do when exposed to a patient’s blood
wash area thoroughly/flush eyes for at least 1 minute, report it (both u & pt need to be tested), practice safe sex until you are confirmed negative
PrEP
pre-exposure prophylaxis
who is PrEP for?
those whose behavior puts them at risk for getting HIV - sexual partner with HIV, needle sharer
PrEP pt education
MUST take consistently, need regular follow ups with HCP
who is post-exposure prophylaxis for?
healthcare workers exposed, individuals exposed through high risk sex/needle sharing
post-exposure prophylaxis considerations
4 week intensive course, must start within 72 hours of exposure, not to be treated as a plan b
HIV treatment
antiretroviral therapy - not a cure, reduces spread and prolongs life
antiretroviral therapy pt education
start as soon as possible, must adhere, will need routine follow ups
nonadherence of antiretroviral therapy leads to -
more expensive, more complicated, less successful treatment
what is being tested in follow up appts for antiretroviral therapy
HIV viral load, T cells, liver & kidney labs
lipodystrophy syndrome s/s
fat loss in arms, legs, and face; fat buildup in abdomen & neck; gynecomastia
lipodystrophy syndrome cause
side effect of antiretroviral therapy
lipodystrophy syndrome complications
increased risks of hypercholesterolemia, heart disease, DM
pt teaching to prevent infection
do not clean litter boxes/bird cages, no rare/undercooked meat, frequent oral care, monitor own temp, urine, mouth - report changes immediately
what should nurse assess for/monitor related to infection
labs - WBC, ANC, viral load, T cells; watch for AMS
mouth for thrush, lung sounds for pneumonia, urine for UTI indicators
what meds may be given for pneumonia in HIV pt
bronchodilators, glucocorticoids
cachexia interventions
be gentle, get another person when moving them, use air mattress, reposition frequently
what kind of diet should HIV pt be on
low fat, high protein, high calorie diet; dietary supplements, small frequent meals
what should pt avoid to help w HIV diarrhea
high fiber foods, alcohol, caffeine, spicy foods
what med may be given to help w HIV diarrhea?
scheduled loperamide
anaphylaxis
body releases excess histamine in response to a normally nontoxic allergen - leading to widespread edema
anaphylaxis s/s
hypoTN, bronchospasm, LOC, flushing, itching, wheezing, sense of impending doom, severe dyspnea, shock, MI
priority interventions for pt experiencing anaphylaxis
1 - stop med if being infused
2 - subQ epi, IV if that’s ineffective
3 - assess resp & CV status
what medications will be given to someone experiencing anaphylaxis
immediate epi
IV fluids, pressors, antihistamines, corticosteroids, bronchodilators
when can a rebound reaction occur? why is this important
4-12 hours; pts must call 911 immediately even if they gave themselves epi; must monitor closely
pt education for anaphylaxis
strict avoidance, wear ID bracelet with allergies, always carry an epi-pen
how do you use an epi-pen
remove from tub, remove cap, jab firmly, perpendicular into outer thigh until a click is heard - push injector, remove & massage site for 10 seconds
what should a pt do immediately after using an epi-pen
call 911 to get ambulance to hospital
why is getting an ambulance important after epi-pen administration?
high risk of arresting within 5-30 minutes
articular features of RA
joint inflammation - pain, swelling, warmth, redness, decreased fx; morning stiffness; joints feel spongey/soft
can get deformities in hands/feet
how long can someone be in the asymptomatic phase of HIV
decades - risk of spread
extra-articular s/s of RA
fever, weight loss, fatigue, anemia, Raynaud’s, scleritis, pericarditis, splenomegaly, Sjogren’s
Sjogren’s
associated w RA - excessive dryness in eyes & mucus membranes
symptom of RA - indicates poor prognosis
nontender, moveable nodules in subQ tissue
elevated ESR and CRP indicate
inflammation somewhere in the body
arthrocentesis
pulls out synovial fluid for testing, also relieves some swelling/pain
arthrocentesis post-procedure
have pt rest or “baby” extremity, monitor puncture site for infection
what NSAIDs may be used for RA
ibuprofen, celecoxib
purpose of NSAIDs for RA
don’t prevent joint damage, helps inflammation short term until other drugs kick in
what glucocorticoids may be used for RA
prednisone, methylprednisolone, dexamethasone
purpose of glucocorticoids for RA
high dose during exacerbations & at beginning of treatment, commonly used when changing meds/waiting for meds to kick in
most common DMARD
methotrexate
s/e of methotrexate
anemia, GI bleeding, infection, photosensitivity, immunosuppression
what test must be done before starting methotrexate/periodically during treatment, why?
pregnancy test
causes SEVERE birth defects
when are biologic drugs used for RA
moderate-severe RA, pt doesn’t respond to DMARDs
ex of biologic drugs
adalimumab
adalimumab considerations
given through subQ injection, increases risk of infection
what kind of exercise is good for RA patients
water aerobics/swimming
synovectomy
removes inflamed synovial fluid
total joint arthroplasty for RA
only done when nothing else works to relieve pain
plasmapheresis
removes circulating antibodies from plasma - only done with life threatening heart/lung involvement
telltale sign of lupus
butterfly facial rash
s/s of lupus
severe photosensitivity, muscle aches/inflammation in feet/hands, pancytopenia, kidney damage (protein & casts in urine), discoid lesions, alopecia, psychosis, seizures
what s/s will a lupus pt have in a flare up
fever
causes of lupus exacerbation
UV/sunlight exposure, fatigue, stress
common cause of death in lupus
kidney damage - AKI/CKD
how can NSAIDs be used for SLE
decrease pain & inflammation, used until antimalarials kick in
how can corticosteroids be used for SLE
decrease pain, immunosuppressive; used until antimalarials kick in
how can DMARDs be used for lupus
immunosuppressive
main treatment for SLE
antimalarials - hydroxychloroquine
side effects of hydroxychloroquine
visual changes, GI upset, rash, photosensitivity, headache, hair changesp
hydroxychloroquine considerations
takes 2-4 months to kick in; pt should have routine eye exams & report visual changes immediately
pt education SLE
use gentle moisturizing cosmetics w/ SPF, no harsh chemicals/perfume, avoid nicotine, exercise but don’t overdo it, go to follow-up appts, no exposure to UV/sunlight
when does the bullseye rash develop
1-28 days after being bitten
s/s in stage 1 of lymes
fever, myalgia, neck stiffness, headache
stage 1 lymes tx
10 day course of doxy
s/s of stage 2 lymes
pain, malaise, flu like symptoms
possible joint & chest pain, palpitations, SOB, headache, dizziness, eye pain
stage 2 lymes tx
IV abx
s/s of stage 3 lymes
joint/muscle pain/inflammation, rarely arrythmias & conduction issues
proper tick removal
make sure entire tick is removed, clean area thoroughly, monitor for bullseye rash
