Important info from Immunity Flashcards
0
Q
RA
-Why would they have Anemia
A
- Anemia may be present as a result of blood loss from salicylate therapy
1
Q
Pt Comes in With Suspected RA
-What to look for in physical assessment
A
- Pain (mostly in upper extremities)
- Symmetrical inflammation of peripheral joints
- Swollen, red, warm, boggy joints that are tender to palpitation
- Decreased ROM
- Fatigue, weakness
- morning stiffness lasting more than 1 hour
2
Q
RA
-Prolonged Inactivity?
A
- Prolonged bed rest or inactivity is not prescribed for acute episodes
- May result in irreversible immobility in the older adult
3
Q
Older Adult Considerations
A
- Medications are used with greater caution in older adults
- Increased risk of toxicity
4
Q
First Sign of RA or SLE??
A
- Fatigue
- Loss of appetite
- Weight loss
- Nonspecific aching and stiffness
- Low grade fever
5
Q
RA
-What are some extra-articular manifestations
A
- Subcutaneous nodules
- Pleural effusion
- Vasculitis
- Pericarditis
- Splenomegaly
6
Q
RA
-Finding of Diagnostic Tests
A
- Elevated ESR and RH factors
- CBC identifies Anemia
- Cyclic citrullinated peptide is elevated
- Synovial fluid shows inflammatory changes (Proteins & wbc’s)
- Xray shows Erosion and joint space narrowing (later in dz)
7
Q
RA
-Aspirin Considerations
A
- Full anti-inflammatory effect of aspirin is achieved at 4g/day.
- This is right underneath the toxic dose
- toxicity causes tinnitus & hearing loss - GI s/e and interference w/ platelet function are the greatest hazards of aspirin therapy
- Take with Meals, milk or antacids to minimize GI s/e
8
Q
RA
-Consideration for anti-rheumatic Drugs
(Gold salts, anti-malarial agents)
A
- All these drugs are fairly toxic
2. Close monitoring is necessary during the course of therapy
9
Q
RA
-Methotrexate
A
- Immune suppression
- Many now consider methotrexate the treatment of choice for clients with aggressive RA
- Weekly dose can produce benefits in as few as 2-4 wks
- GI irritation and stomatitis are most frequent s/e
- Folic acid reduces s/e
10
Q
- RA
- Humira
A
- Biological response modifier given to people w/ RA to reduce inflammatory events of poly-arthritis and slow progression of joint damage
- Given by SubCut Injection
- CONTRAINDICATED in client with active or chronic INFECTION
- Test Client for TB before administration
11
Q
RA
-Gold Salt Nursing Considerations
A
- Monitor client after infection for
- anaphylactic reaction
- fainting, dizziness, sweating - Parenteral
12
Q
RA
-Antimalarial Nursing Considerations
(Plaquenil)
A
- Should not be used during pregnancy
- REGULAR EYE EXAM
- Can cause pigmentary retinitis and vision loss - Take w/ meals
13
Q
RA
-Sulfasalazine Nursing Considerations
A
- Administer in evenly divided doses
- Maintain high fluid intake
- May cause yellow-orange skin or urine discoloration
- Regular CBC’s necessary
- Take with Meals
14
Q
RA
-Things to teach EVERYONE with RA
A
- Rest & exercise (mild to moderate exercise)
- Heat & Cold (Moist heat is most effective)
- PT & OT
- Nutrition (High omega-3) (obesity places strain on joints)
- Complimentary Med (Hydrothreapy & acupuncture)
15
Q
SLE
-Joint Symptoms
A
Joint symptoms affect more than 90% of clients with SLE
16
Q
SLE
-Common Manifestations
A
- Anemia, leukopenia & thrombocytopenia are common
- Pericarditis, vasculitis, and RAYNAUD’S phenomenon, often occur
- Organic brain syndrome
17
Q
SLE
-Neuro Manifestations
A
- Organic Brain syndrome
- Decrease in intellect, memory loss, and disorientation - Psychosis, seizures, depression and stroke
- Photophobia, transient blindness
18
Q
SLE
-Result of Diagnostic Tests
A
- Anti-DNA antibody testing (Present with SLE specifically)
- ESR is elevated
- Serum complement levels are decreased “used up”
- CBC (anemia, leukoopenia, lymphocytopenia, thrombocytopenia)
- Urinalysis (Proteinuria, hematuria w/ kidney involvement)
- Creat and BUN (abnormal with kidney involvement)
19
Q
SLE
-Infection Prevention
A
- Prophylactic antibiotics for dental work or surgical procedures
- Immunizations for flu, pneumonia, TB test
- Hand hygiene
20
Q
HIV
-AZT
A
- dose-limiting S/E are anemia and neutropenia
- S/E include nausea and headache
- 30 min before or 1 hour after meals
21
Q
HIV
-Didanosine DDI
A
- Increases CD4 cell counts and lowers p24 antigen levels
- Does not cause anemia but can cause neutropenia
- Increased risk of pancratitis, peripheral neuropathy, and dry mouth
- Interferes w/ absorption of ketoconazole
22
Q
HIV
-Combivir
A
- Combination of Zidovudine & Lamivudine
23
Q
HIV
-Immunizations for HIV positive clients
A
- Pneumococcal & Influenza
- Hepatitis B
- Haemophilus influenzae b
- Client with positive PPD and negative chest x-ray
- Give prophylactic isoniazid
24
Q
HIV
-Prophylactic Treatment CD4<200
A
- When CD4 count falls below 200, prophylactic treatment for PCP is begun
25
Q
HIV
-Prophylactic treatment CD4 <100
A
- Clients with CD4 count less than 100 are started on prophylactic treatment for MAC
