Immunologic Problems Flashcards
Most important for to report for a client taking prednisone after an organ transplant
- Multiple bruises in arm
- NA 146
- BS 110
- Black colored stool
- Black colored stool
All are possible with prednisone use
Nurse give ID of allergen to patient undergoing skin test for allergies, patient reports feeling dizzy,SOB, anxious. What action should the nurse take first.
- 6 L oxygen via face mask
- Obtain IV access with large-bore catherer
- Give Epinephrine 0.5 mg IM
- Admin Albuterol per Nebulizer
Give Epinephrine 0.5 mg IM
Epinephrine is the initial drug treatment for anaphylaxis.
Oxygen & Albuterol are correct but after Epinephrine. Which will preventn/ reverse cardiovascular collapse
Which requires immediate intervention for an HIV client with severe esophagitis caused by Candida albicans.
- Donning mask and gown b4 entering the room
- Giving glass of water after admin of oral nystatin suspension
- Suggesting chili or chicken soup for dinner
- Placing No Visitor sign on door
Giving glass of water after admin of oral nystatin suspension
Nystatin (Antifungal) should remain in contact with esophageal tissue as long as possible
HIV patient is recieving Trimethoprim-sulfamethoxazole (TMP-SMX) as treatment for Pneumocystis jiroveci. Which is most important to communicate with HCP
- Blistering rash
- Fluid intake 2L daily
- K 3.4
- Patient enjoys time in the sun
- Blistering rash
Trimethoprim-sulfamethoxazole
Can cause Stevens-Johnsons syndrome.
2L is sufficient to prevent crystaluria & renal damage associated with Trimethoprim-sulfamethoxazole (Antibiotics)
Photo sensitivity is a concern but not the priority
How big of a skin induration for HIV patient is considered positive FOR TB?
Size for a 3rd world refuge
Size for normal person?
5 mm for Positive for people with HIV, recent contacts of people with infectious TB, people with chest x-ray findings suggestive of previous TB, people with organ transplants, and other immunosuppressed people
> 10mm Recent immigrants (<5 years) from countries with a high prevalence of TB
Patients who use injection drugs
Residents and employees of high-risk group housing settings (correctional facilities, nursing homes, homeless shelters, hospitals, and other healthcare facilities)
Mycobacteriology laboratory personnel
Children under 5 years of age and children and adolescents exposed to adults in high-risk categories
People with a low body weight (<90% of ideal body weight).
> 15mm Regular people
Indicate size of induration for possible positive TB
___ mm
Patients with HIV
Those who’ve had recent contact with someone who has TB
Patients with fibrotic changes on a chest X-ray consistent with old TB
Organ transplant recipients
Patients who are immunosuppressed for reasons other than organ transplant (for example, those taking the equivalent of >15 mg/day of prednisone for 1 month or longer, those taking TNF-α antagonists)
____ mm
Recent immigrants (<5 years) from countries with a high prevalence of TB
Patients who use injection drugs
Residents and employees of high-risk group housing settings (correctional facilities, nursing homes, homeless shelters, hospitals, and other healthcare facilities)
Mycobacteriology laboratory personnel
Children under 5 years of age and children and adolescents exposed to adults in high-risk categories
People with a low body weight (<90% of ideal body weight).
____ mm
Individuals with no known TB risk factors
5mm
Patients with HIV
Those who’ve had recent contact with someone who has TB
Patients with fibrotic changes on a chest X-ray consistent with old TB
Organ transplant recipients
Patients who are immunosuppressed for reasons other than organ transplant (for example, those taking the equivalent of >15 mg/day of prednisone for 1 month or longer, those taking TNF-α antagonists)
10 mm
Recent immigrants (<5 years) from countries with a high prevalence of TB
Patients who use injection drugs
Residents and employees of high-risk group housing settings (correctional facilities, nursing homes, homeless shelters, hospitals, and other healthcare facilities)
Mycobacteriology laboratory personnel
Children under 5 years of age and children and adolescents exposed to adults in high-risk categories
People with a low body weight (<90% of ideal body weight).
15 mm
Individuals with no known TB risk factors
Liver Transplant Patient is taking cyclosporine (immune Suppressant), Prednisone (Corticosteroids), mycophenolate ( Immunosuppressive drug)
Which is the most concern
- Gums appear pink and swollen
- BS 162
- Nontender lump above clavicle
- Grade 1+ pitting edema
Nontender lump above clavicle
Patients taking immunosuppressants are at increased risk for Cancer. Possible lymphoma.
Others are common side effects of immunosupprants
Prednisone: rheumatoid arthritis, inflammatory bowel disease (IBD), asthma, allergies
Cyclosporine
Class
Use
SE & Serious Side effects
Contradictions
Class: Cyclosporine Immunosuppressant agent.
Use:
Prevention of organ rejection in transplant recipients
Treatment of certain autoimmune diseases: rheumatoid arthritis and psoriasis.
Management of severe cases of atopic dermatitis (eczema) when other treatments have failed.
Side Effects (SE):
SE
Tremor
Hypertension (high blood pressure)
Headache
Nausea and vomiting
Renal dysfunction (kidney problems)
Serious Side Effects:
While rare, serious side effects can occur and may include:
Nephrotoxicity (damage to the kidneys)
Increased risk of infections (due to suppressed immune function)
Hepatotoxicity (liver damage)
Neurotoxicity (damage to the nervous system)
Hypertension (high blood pressure)
Increased risk of certain cancers, particularly lymphomas
Contraindications:
Cyclosporine should not be used in individuals with:
Uncontrolled hypertension
Severe renal impairment
Active infections
Severe hepatic impairment
Prednisone
Class
Uses
SE and Serious Side Effects
Contradictions
Anti-inflammatory
Primarily used as an anti-inflammatory medication.
Immune Suppression: It suppresses the immune system and is used to treat autoimmune disorders such as rheumatoid arthritis, lupus, and inflammatory bowel disease.
Allergic Reactions: It can also be used to treat severe allergic reactions.
Asthma and other respiratory conditions to reduce inflammation and ease breathing
Cancer Treatment:
Side Effects (SE):
Common side effects include:
Increased appetite and weight gain
Insomnia
Mood changes, including irritability or agitation
Elevated blood sugar levels (especially in people with diabetes)
Fluid retention
Facial swelling (“moon face”)
Increased susceptibility to infections
Long-term use SE:
Osteoporosis (bone weakening)
Adrenal suppression (reduced function of adrenal glands)
Cataracts and glaucoma
Increased risk of infections
Increased blood pressure and risk of cardiovascular disease
Contraindications:
Systemic fungal infections
Active untreated infections
Patients receiving live vaccines due to potential for impaired immune response
Mycophenolate
Class
Use
SE and Serious Side Effects
Contradictions
Mycophenolate belongs to the class of immunosuppressant medications.
Use: Prevent organ rejection in patients who have received kidney, heart, or liver transplants.
Mycophenolate works by suppressing the immune system to prevent it from attacking the transplanted organ.
Side Effects (SE):
Nausea
Vomiting
Diarrhea
Abdominal pain
Headache
Insomnia
Serious Side Effects:
Increased susceptibility to infections due to weakened immune function
Bone marrow suppression, which can lead to anemia, leukopenia (low white blood cell count), and thrombocytopenia (low platelet count)
Hepatotoxicity (liver damage)
Increased risk of certain cancers, particularly skin cancers and lymphomas
Contraindications:
Mycophenolate is contraindicated
Severe renal impairment
Active infections
Pre-existing conditions that may predispose to infections
It’s important for patients taking mycophenolate to be monitored closely by healthcare providers for any signs of infection or other adverse effects due to its immunosuppressive nature.
Patient with HIV has been started on antireteoviral therapy. Which test is best to monitor to determine the response to therapy?
- CD4
- CBC
- Total lymphocytes percent
- Viral load
- Viral load
Viral load measure the amount of HIV genetic material in blood. Decrease in viral load = effective therapy
CD4: between T-cells 500 and 1,200 Higher better
Total lymphocytes % = between 20% and 40%
Methotrexate is not safe for pregant women.
What type of medication is it?
Chemotherapy and Immunosuppressive drug
It can treat cancer of the blood, bone, lung, breast, head, and neck. It can also treat rheumatoid arthritis and psoriasis.
Patient has exacerbation of SLE and has been receiving prednisone 20mg/ day for 4 days. What action is most important for nurse to question
- Discontinue after today’s use
- Give “catch up” dose of varicella vaccine
- Check C-reactive protein level
- Admin 800 mg ibuprofen PO TID
Give “catch up” dose of varicella vaccine
Varicella is a Live Vaccine which is Contradicted with use of steroids ( Steroids suppress immune system & infection can occur)
Longterm dosage of steroids require tapering off but 4 days can be stopped quickly
RA patient is about to start subcutaneous etanercept what is the most important to communicate
- Currently taking methotrexate
- Positive TB skin test result
- Type II DM for 5 years
- Anxious about self-inject
Positive TB skin test result
Tumor necrosis factor antagonists increase risk of reactivation of latent TB.
Which finding is most important to warrant further investigation before staffing a new nurse.
- Takes Enalapril for HTN
- Allergic to bananas, avocados, papayas
- Received tetanus vaccine 3 years ago
- TB induration 5mm at 48 hrs
Allergic to bananas, avocados, papayas
High incidents of latex allergies occur with these people.
