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Nursing IV: Test 3 > Important info from Immunity > Flashcards

Important info from Immunity Flashcards

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0
Q

RA

-Why would they have Anemia

A
  1. Anemia may be present as a result of blood loss from salicylate therapy
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1
Q

Pt Comes in With Suspected RA

-What to look for in physical assessment

A
  1. Pain (mostly in upper extremities)
  2. Symmetrical inflammation of peripheral joints
  3. Swollen, red, warm, boggy joints that are tender to palpitation
  4. Decreased ROM
  5. Fatigue, weakness
  6. morning stiffness lasting more than 1 hour
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2
Q

RA

-Prolonged Inactivity?

A
  1. Prolonged bed rest or inactivity is not prescribed for acute episodes
    - May result in irreversible immobility in the older adult
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3
Q

Older Adult Considerations

A
  1. Medications are used with greater caution in older adults
    - Increased risk of toxicity
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4
Q

First Sign of RA or SLE??

A
  1. Fatigue
  2. Loss of appetite
  3. Weight loss
  4. Nonspecific aching and stiffness
  5. Low grade fever
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5
Q

RA

-What are some extra-articular manifestations

A
  1. Subcutaneous nodules
  2. Pleural effusion
  3. Vasculitis
  4. Pericarditis
  5. Splenomegaly
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6
Q

RA

-Finding of Diagnostic Tests

A
  1. Elevated ESR and RH factors
  2. CBC identifies Anemia
  3. Cyclic citrullinated peptide is elevated
  4. Synovial fluid shows inflammatory changes (Proteins & wbc’s)
  5. Xray shows Erosion and joint space narrowing (later in dz)
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7
Q

RA

-Aspirin Considerations

A
  1. Full anti-inflammatory effect of aspirin is achieved at 4g/day.
  2. This is right underneath the toxic dose
    - toxicity causes tinnitus & hearing loss
  3. GI s/e and interference w/ platelet function are the greatest hazards of aspirin therapy
  4. Take with Meals, milk or antacids to minimize GI s/e
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8
Q

RA
-Consideration for anti-rheumatic Drugs
(Gold salts, anti-malarial agents)

A
  1. All these drugs are fairly toxic

2. Close monitoring is necessary during the course of therapy

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9
Q

RA

-Methotrexate

A
  1. Immune suppression
  2. Many now consider methotrexate the treatment of choice for clients with aggressive RA
  3. Weekly dose can produce benefits in as few as 2-4 wks
  4. GI irritation and stomatitis are most frequent s/e
  5. Folic acid reduces s/e
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10
Q
  • RA

- Humira

A
  1. Biological response modifier given to people w/ RA to reduce inflammatory events of poly-arthritis and slow progression of joint damage
  2. Given by SubCut Injection
  3. CONTRAINDICATED in client with active or chronic INFECTION
  4. Test Client for TB before administration
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11
Q

RA

-Gold Salt Nursing Considerations

A
  1. Monitor client after infection for
    - anaphylactic reaction
    - fainting, dizziness, sweating
  2. Parenteral
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12
Q

RA
-Antimalarial Nursing Considerations
(Plaquenil)

A
  1. Should not be used during pregnancy
  2. REGULAR EYE EXAM
    - Can cause pigmentary retinitis and vision loss
  3. Take w/ meals
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13
Q

RA

-Sulfasalazine Nursing Considerations

A
  1. Administer in evenly divided doses
  2. Maintain high fluid intake
  3. May cause yellow-orange skin or urine discoloration
  4. Regular CBC’s necessary
  5. Take with Meals
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14
Q

RA

-Things to teach EVERYONE with RA

A
  1. Rest & exercise (mild to moderate exercise)
  2. Heat & Cold (Moist heat is most effective)
  3. PT & OT
  4. Nutrition (High omega-3) (obesity places strain on joints)
  5. Complimentary Med (Hydrothreapy & acupuncture)
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15
Q

SLE

-Joint Symptoms

A

Joint symptoms affect more than 90% of clients with SLE

16
Q

SLE

-Common Manifestations

A
  1. Anemia, leukopenia & thrombocytopenia are common
  2. Pericarditis, vasculitis, and RAYNAUD’S phenomenon, often occur
  3. Organic brain syndrome
17
Q

SLE

-Neuro Manifestations

A
  1. Organic Brain syndrome
    - Decrease in intellect, memory loss, and disorientation
  2. Psychosis, seizures, depression and stroke
  3. Photophobia, transient blindness
18
Q

SLE

-Result of Diagnostic Tests

A
  1. Anti-DNA antibody testing (Present with SLE specifically)
  2. ESR is elevated
  3. Serum complement levels are decreased “used up”
  4. CBC (anemia, leukoopenia, lymphocytopenia, thrombocytopenia)
  5. Urinalysis (Proteinuria, hematuria w/ kidney involvement)
  6. Creat and BUN (abnormal with kidney involvement)
19
Q

SLE

-Infection Prevention

A
  1. Prophylactic antibiotics for dental work or surgical procedures
  2. Immunizations for flu, pneumonia, TB test
  3. Hand hygiene
20
Q

HIV

-AZT

A
  1. dose-limiting S/E are anemia and neutropenia
  2. S/E include nausea and headache
  3. 30 min before or 1 hour after meals
21
Q

HIV

-Didanosine DDI

A
  1. Increases CD4 cell counts and lowers p24 antigen levels
  2. Does not cause anemia but can cause neutropenia
  3. Increased risk of pancratitis, peripheral neuropathy, and dry mouth
  4. Interferes w/ absorption of ketoconazole
22
Q

HIV

-Combivir

A
  1. Combination of Zidovudine & Lamivudine
23
Q

HIV

-Immunizations for HIV positive clients

A
  1. Pneumococcal & Influenza
  2. Hepatitis B
  3. Haemophilus influenzae b
  4. Client with positive PPD and negative chest x-ray
    - Give prophylactic isoniazid
24
Q

HIV

-Prophylactic Treatment CD4<200

A
  1. When CD4 count falls below 200, prophylactic treatment for PCP is begun
25
Q

HIV

-Prophylactic treatment CD4 <100

A
  1. Clients with CD4 count less than 100 are started on prophylactic treatment for MAC

Nursing IV: Test 3 (7 decks)

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