Infection/Immunity Study Flashcards
A 5 month old baby presents to the clinic with acute otitis media. What would the nurse administer to relieve fever and pain?
Tylenol
A 3 year old presents to the clinic with ear pain that started this morning. What do you anticipate the doctor recommending?
Watchful waiting
A new mom wants to know what can be done to decrease the risk of her child developing otitis media. What education would the nurse provide to her?
Breastfeed for at least the first 6 months. Stay up to date with vaccines, especially the pneumococcal vaccine (4 doses that begin at 2 months old) and the influenza vaccine (can be given after 6 months of age). Sit up right when feeding. Do not bottle prop. Eliminate tobacco smoke and any known allergies.
A mother of a child with acute otitis media wants to know what are the potential complications if her child’s otitis media becomes chronic or is left untreated?
Speech delays and hearing loss
A 2 year old presents to the clinic with tugging at the ear, irritability, and fever for 3 days. After an otoscopic exam, the HCP diagnoses acute otitis media. What first line of treatment do you anticipate the doctor ordering?
Oral amoxicillin twice daily for 5-7 days for treatment of the infection. Rotation of acetaminophen and ibuprofen for fever and pain.
When and why should Ibuprofen be administered at night for ear ache rather than acetaminophen?
The effects of ibuprofen lasts longer than that of acetaminophen
For nonpharmacological treatment of pain with acute otitis media, what would the nurse recommend?
Lie on the affected side. External application of heat (warm) and cold (cool) compressions
What is the second line of antibiotics recommended for acute otitis media when oral amoxicillin is not successful?
Azithromycin and/or Cephalosporin
What medication is recommended for highly antibiotic resistant otitis media or noncompliance with previous antibiotic therapy?
IM ceftriaxone
What ear drops can a HCP prescribe to help relieve pain from acute otitis media?
Benzocaine drops
When is a tympanostomy or myringotomy recommended for a patient with acute otitis media?
After 3 episodes in 6 months or 4 episodes in a year
What should a parent be educated about after her child just got tubes placed in the ears (myringotomy/Tympanostomy)?
Tubes will fall out on their own within 8-18 months. Notify the HCP if they fall out before then. Keep ears clean and dry for the first few days. Baths are recommended over showers when bathing to avoid water from entering the ear. Ear wicks should remain loosely placed in ears.
How should ear drops be administered to a child?
For children under 3, pull down and back. For children 3 and up, pull up and back.
Patient presents to the clinic with issues of the left eye. They report green drainage from the eye, crust around the eye in the mornings, a swollen eyelid, and itchiness. What do you suspect?
Bacterial Conjunctivitis
Patient presents to the clinic with watery eyes, inflamed conjuctiva, and swollen eye lids. What do you suspect?
Viral Conjunctivitis
Patient presents to the clinic with stringy discharge from both eyes, swollen eyelids and swelling under the eyes. What do you suspect?
Allergic Conjunctivitis
What would you expect the HCP to order for a patient with bacterial conjunctivitis?
Topical antibacterial agents
What nonpharmocological treatment is used to for bacterial conjunctivitis?
Warm compresses to looses secretions and keep eye clean
What nonpharmocological treatment is used for viral conjunctivitis and allergic conjunctivitis?
Cool compresses to help relieve itching
Treatment of viral conjunctivitis
Removal of secretions and symptomatic care
Treatment of allergic conjunctivitis
Antihistamines
What part of the eye should eye drops be administered in?
Conjucntival sac
Patient education for someone with bacterial and viral conjunctivitis?
Cloths and wipes used for affected eye(s) should be kept away from others’ belongings. Refrain from rubbing the eye. Use good hand hygiene. Do not reuse items that are used on affected eye(s). Keep eyes clean.
What time of the day should eye drops be administered versus eye ointment?
Eye drops should be used during the day while ointment should be used at night because ointment stays in the eye longer but blurs vision
Patient was admitted into the hospital with the flu 2 days ago. They have now developed pneumonia. What type of acquired pneumonia is this?
Hospital-acquired pneumonia
Patient comes into the ER days after attending a concert. He is eventually diagnosed with pneumonia while in the ER. What type of acquired pneumonia is this?
Community acquired pneumonia
Patient presents to the ER, appearing flushed and anxious. with increased respiratory rate, labored breathing, and a productive cough with rust colored sputum. O2 is at 89% on room air. Temperature is 100.5. Crackles are audible in lower lobes. Patient is not up to date on vaccines. What do you suspect the HCP will diagnose this patient with?
Pneumonia
A patient comes to the ER from the nursing home with a decreased LOC and O2 is at 88% on room air. A UTI is ruled out. While waiting for the results from the CXRAY, what do you suspect the patient has?
Pneumonia
Patient with pneumonia is experiencing SOB and O2 is at 91% on 2L NC. What is the priority nursing intervention?
Increase rate of NC and evaluate the outcome for further interventions
Your patient has pneumonia. To improve the patient’s gas exchange and prevent airway obstruction and sepsis, what are your priority interventions?
To improve gas exchange, apply oxygen therapy and encourage bronchia hygiene via an incentive spirometer.
To prevent an airway obstruction, encourage coughing and deep breathing at least every 2 hours, drink at least 2L fluid a day, monitor I&O, monitor mucous membranes and skin turgor, and encourage incentive spirometer at least 10 times an hour while awake
To prevent sepsis, take full course of antibiotics (amoxicillin, ceftriaxone, doxycycline) and steroids. Use bronchodilators and expectorants.
What is a common syndrome that can occur from untreated aspiration pneumonia?
ARDS
A patient asks about what they can do to help prevent their elderly mother from getting pneumonia. What education would you give them?
Avoid exposure to smoke. Receive pneumonia and flu vaccines. Move around as much as possible.
What lab orders do you anticipate the HCP ordering for a patient with suspected pneumonia?
Sputum culture if they have a productive cough, CBC to determine elevated WBC count and to determine if the organism has entered the bloodstream, ABGs to determine baseline arterial oxygen and carbon dioxide levels and to help identify a need for supplemental oxygen, electrolytes,, BUN/Creatinine, influenza testing to rule influenza out since pneumonia often follows pneumonia, and Cxray
because pneumonia usually appears on chest x-ray as an area of increased density
This condition alters the CD4 T cell function
HIV
What virus causes HIV?
Retrovirus
The consquences of HIV are…
Immune ____________; Diminished ability to ___________ other opportunistic diseases and infections; and the _____________ of lymph nodes and lymph organs
Immune deficiency; diminished ability to fight other opportunistic diseases and infections; and destruction of lymph nodes and lymph organs
During stage 1 of HIV (acute), the CD4 T cell count is greater than ___________
500
What phase of HIV is when HIV is most commonly diagnosed?
Stage 2
What phase of HIV is the chronic phase and can last for years to decades?
Stage 2
In stage 2 of HIV, the CD4 T cell count is ___________
200-499
Stage 3 of HIV is also known as ___________
AIDs
For the diagnosis of aids, the CD4 T cell is less than ___________ or there is a presence of an __________________ _______________, along with a positive HIV test
CD4 T cell count is less than 200 or there is a presence of an opportunistic infection
S/S of stage 1 HIV are seen within ___ weeks of first being treated
4 weeks
What are the signs and symptoms of stage 1 HIV?
Fever, sore throat, rash, night sweats, chills, headache, and muscle aches. “Flu-like symptoms”
With treatment during stage 2 of HIV, s/s may be ___________.
Undetected
Without treatment during stage 2 of HIV, there is __________ CD4 T cell function
Poor
Without treatment during stage 2 of HIV, _____________, ___________, abnormally functioning ________, production of incomplete and nonfunctional antibodies can occur, and possible infections
Leukopenia (decreased WBC), lymphocytopenia (decreased lymphocytes, abnormally functioning macrophages
With someone who has not undergone or has stopped treatment during stage 2 of HIV, you should monitor for s/s of ___________, monitor _____________ status, treat symptoms, and encourage __________ calorie, ________ protein meals.
monitor for s/s of infection, monitor nutrition status, encourage high calorie, high protein meals
How can HIV be transmitted?
body fluids (blood, semen, breastmilk, vaginal secretions), sexual contact (genital, oral, or anal contact with exposure of mucous membranes), parenteral (sharing of equipment contaminated with infected blood), and perinatal (from placenta, contact with infected maternal blood or body fluids, and breastmilk)
The results of a positive HIV test take _____ days to be detected after exposure
14-21
The results of a western-blot test (confirms diagnosis) takes _____ days to be detected after exposure
28
The normal CD4 T cell count is ________ to _______
600 to 1500
Viral load measures the actual load of _________________.
HIV in the blood
Patient has a high viral load. The risk of ________ is high.
Transmission
True or false: When a patient’s AIDs has been treated and their T-cell count has improved, they are no longer considered diagnosed with AIDs
False. Diagnosis remains despite treatment or improvement
For a patient who is receiving treatment for AIDs, what test will be routinely monitored to check the effectiveness of the medication?
Viral load
True or false: Antiretroviral therapy does not kill the virus, it only controls the viral replication. It reduces the viral load, improves CD4 T cell count, and slows disease progression
True
Patient education for a patient taking NRTIs for HIV.
Avoid fatty and fried foods (GI upset). Use precautions to prevent injury (neuropathy), report flu-like symptoms (hypersensitivity), and avoid alcohol and check liver enzymes (liver toxicity)
Patient education for a patient taking NNRTIs for HIV
Routinely check CBC and liver enzymes; take drug at least 1 hour before or 2 hours after taking an antacid; notify provider of s/s of infection, rash, blisters, or bruises (allergic reactions)
What NNRTI drug should not be given to a pregnant woman for treatment of HIV?
Efavirenz
Patient education for a patient taking protease inhibitors for HIV
Don’t chew or crush these drugs (increases absorption). Report jaundice, N/V, abd pain (liver toxicity). Avoid St. John’s Wort (reduces PI effectiveness)
Patient education for a patient taking Integrase inhibitors for HIV
Take with food (reduces GI upset). Don’t chew or crush these drugs (increases absorption). Report muscle pain/weakness (rhabdomyolysis)
What classification of medications work by fooling HIV enzyme reverse transcriptase into using these counterfeit bases so that viral DNA synthesis and replication are suppressed
NRTIs (Nucleoside Reverse Transcriptase)
What classification of medications work by binding directly to the HIV-1 enzyme reverse transcriptase, preventing viral cell DNA replication, RNA replication, and protein synthesis which suppresses viral replication of the HIV-1 virus
NNRTIs (Non-nucleoside Reverse Transcriptase Inhibitors)
What classification of medications work by inhibiting the HIV enzyme integrase, which the HIV virus uses to insert the viral DNA into human DNA, causing the viral proteins to not be made and the viral replication is inhibited.
Integrase inhibitors
What protease Inhibitor medication can not be given to a patient with a sulfa allergy?
Darunavir
PREP (pre-exposure) therapy is for people who are at high risk of HIV but are HIV negative. If a patient is diagnosed with ___________, they are not a candidate for this therapy.
Hepatitis B
Patient education for PREP therapy for a patient who is at a high risk of HIV but is HIV negative
Not protected from HIV until 7 consecutive days of medication adherence. If 2 doses are missed/skipped, the process (7 days) has to be restarted.
For a healthcare worker who just had an accidental needle stick from a needle contaminated with HIV, they should…
Wash wound for 1 minute, start PEP(post exposure) therapy within 72 hours
What therapy is done for victims of sexual assault in case of possible HIV exposure
Non-pep therapy
Missing/skipping doses of antiretroviral drug therapy can cause drug resistance because__________________________.
There is not enough medication in the body to inhibit the HIV viral replication
True of false: Regardless of improved viral load, measures still need to be taken to prevent transmission to others.
True
What lab/screenings should be monitored for someone taking NRTIs for treatment of HIV?
BUN/Creatinine and bone mineral density
What labs/screenings should be monitored for someone taking Protease Inhibitors for treatment of HIV?
Glucose, cholesterol, triglycerides, and cardiac function tests
What labs/screenings should be monitored for someone taking integrase inhibitors for treatment of HIV?
Glucose and liver enzymes
This condition is a chronic, progressive systemic inflammatory autoimmune disease process that affects primarily the synovium joints. RF that attack healthy tissue, especially synovium, are formed, causing inflammation and eventually involves articular cartilage, joint capsule, and surrounding ligaments and tendons.
Rheumatoid Arthritis (RA)
What are the risk factors for RA?
More prevalent in young-to-middle aged women. Has infectious organisms (such as Epstein-Barr virus), and physical and emotional stress
Early signs and symptoms of RA
Joint inflammation, generalized weakness, fatigue, anorexia, 2-3lbs weight loss, persistent low grade fever (99.0+), and bilateral/symmetric joint deformities (hands are typically affected first)
Late signs and symptoms of RA
Morning stiffness that lasts for several hours after waking up. Soft and puffy joints. Muscle Atrophy. Decreases ROM in affected joints. Joint deformities. Moderate to severe weight loss. Respiratory and cardiac issues. Dryness of eyes, mouth, and vagina (Sjogren syndrome)
True or false: There is one single test that can diagnose RA on its own
False
An RF factor (presence of IgG and IgM) of ___________ ratio can possibly indicate RA but is not a confirmed diagnosis of RA.
greater than 1:80
The most accurate diagnostic test for RA that detects early RA is _____________
Anti-CCP (anticyclic citrullinated peptide)
This test measures the titer of a group of antibodies that destroy the nucleus of cells and cause tissue death and helps to diagnose RA but is not a confirmed diagnosis of RA
ANA (antinuclear antibody)
Why would a CT scan be ordered to help with a diagnosis of RA
May determine the presence and degree of cervical spine involvement
What procedure is done by inserting a large gauge needle in to the joint to aspirate a sample of synovial fluid for someone with RA. It relieves pressure on the area.
Arthrocentesis
How should a patient manage pain and inflammation (non-pharm) after an arthrocentesis?
Apply ice packs and rest the joint
What will the synovial fluid of someone with RA look like?
Cloudy
DMARD (Methotrexate) is taken to ___________________ and ________________ in someone with RA.
Decrease joint pain and swelling and suppress the immune system
Patient education for someone taking Methotrexate for RA
Take once a week. It takes 4-6 weeks to take effect. Should be on birth control to prevent pregnancy because it is not safe to take during pregnancy. Report any s/s of infection. Avoid alcohol to prevent liver toxicity. Take measures to prevent infection.
An inexpensive drug for treatment of RA
Methotrexate
What medication for treatment of RA neutralizes the biologic activity of tumor necrosis factor-alpha by inhibiting its binding with TNC receptors
Biologic Response Modifiers (Etanercept)
Nursing considerations for a patient taking Etanercept (Biologic Response Modifier) for RA
Given by injection. Must have a negative TBST prior to administration. Large crowds should be avoided. High risk of infection. Medication is expensive.
What classification of medications is used for short term pain and inflammation relief in someone with RA
NSAIDs
What is a patient that is taking NSAIDs at risk for and what can they take to decrease the risk?
At risk for GI bleed. Can take famotidine to decrease GI effects
What should a patient be monitored for if they are taking corticosteroids for RA?
Hyperglycemia, impaired immunity, F&E imbalance, Hypertension, osteoporosis, and glaucoma
Nonpharm interventions for someone with RA
Rest. Apply light ice packs to area for 10-20 minutes at a time. Heated parrafin wax dips. Hot showers rather than tub baths. Apply light heat applications to area for 10-20 minutes at a time.
What procedure can be done for a patient with RA by treating their plasma to remove the antibodies that are causing the disease
Plasmapheresis
What 2 teams would be considered collaborating with to help a patient with RA with exercising?
Physical therapy and occupational therapy
This condition is a chronic and progressive disorder in which inflammatory and immune attacks occur against multiple self tissues and organs
System lupus erythematosus (SLE)
SLE exacerbations (flare ups) accelerate _________ damage
organ
What organs are most affected in SLE?
Kidneys and heart
What drugs can trigger a flare up of SLE?
hydralazine, isonazide, penicillamine D, procainamide
What triggers can cause an SLE flare up?
Infection, environmental exposure, drugs, hormones, UV light rays/sun exposure
What are the most common s/s of SLE?
Fever, rash, and painful swollen joints
Describe butterfly rash that can be seen as a s/s of SLE
Dry, scaly raised rash on the face but can also be seen on other sun-exposed areas
What type of lesions can be seen as a s/s of SLE?
Coin shaped lesions on the face, scalp, and sun exposed areas
How is SLE diagnosed?
By physical changes to joints, antinuclear antibodies (ANA), and elevated ESR indicating there is inflammation in the body
What is the mode of action for antimalarial drugs (hydroxychloroquine and chloroquine) in treatment of SLE?
Immunomodulation and anticlotting
What is a serious side effect of antimalarial drugs in treatment for SLE and what education can be given to the patient to decrease the risk?
Retinal toxicity (vision loss). Have eyes examined before starting medication and routine examinations every 6 months while taking medication.
What classification of medications are used to treat SLE?
Antimalarial drugs-hydroxychloroquine and chloroquine corticosteroids- Prednisone
DMARDS- Methotrexate
Monoclonal antibodies-Belimumab
When is Methotrexate used as treatment for SLE?
When corticosteroids are not effective in controlling the inflammation and suppressing the overactive immune system or if the patient cannot tolerate the dose of corticosteroids that are needed
As far as immunosuppressant, what is the difference between how corticosteroids and DMARDs (Methotrexate) effect the body’s cells?
Corticosteroids suppresses every type of body cell
DMARDs destroy some immune system cells and prevent their reproduction
How should Monoclonal antibodies (Belimumab) be administered for SLE?
IV or subQ
What type of environment should monoclonial antibodies (Belimumab) be administered in and why?
Must be given in a healthcare setting because they have to be monitored for anaphylaxis for 2 hours after administration
This is a hypersensitivity reaction that causes a deep tissue problem by releasing inflammatory proteins, especially bradykinin, into the blood vessels and all layers of the skin, mucous membranes, and subcutaneous tissues in the effected area
Angioedema
What parts of the body is angioedema most commonly seen?
Face, lips, tongue, larynx, and neck
What race is more at risk for angioedema?
African Americans
A patient taking ACE inhibitors (-Pril) are at higher risk of what conditional reaction?
Angioedema. Typically seen within the first 24 hours, but can be seen days, weeks, months, and years of taking the medication.
What sign would cause you to intubate a patient with angioedema?
the presence of stridor (closing of airway)
How should gas exchange be maintained in a patient with angioedema?
Oxygen via NC
What medications are given to a patient with angioedema?
Epinepherine (bronchodilator) and steroids (need to be given several hours after reaction to decrease chance of reoccurence)
This is a condition in which a hypersensitivity reaction involves all blood vessels and bronchiole smooth muscle, causing widespread blood vessel dilation, decreased cardiac output, and bronchoconstriction within seconds to minutes of allergenic exposure
Anaphylaxis
What are the s/s of anaphylaxis?
Facial swelling, widespread hives, pruritis, facial flushing, respiratory distress
A patient experiencing anaphylaxis is having swelling on the lips, tongue, and uvula. What medication will you administer?
Epinepherine
A patient experiencing anaphylaxis is experiencing hives and pruritis. What medications will you administer to treat hives and pruiritis?
Benadryl
What would you first assess for someone possibly experiencing anaphylaxis
Check O2 saturation and assess ability to breathe… have crash cart ready
What type of mask would you use for someone experiencing anaphylaxis?
Nonrebreather mask
What type of fluids should someone experiencing anaphylaxis receive?
Stop any IV fluids currently running, change tubing, and start NS
How many times can epinepherine be administered to someone experiencing anaphylaxis and how often can you administer it?
Up to 3 doses. Can repeat every 5-15 minutes as needed
What medications are used to treat anaphylaxis?
Antihistamines (Diphenhydramine aka Benadryl), Beta-adrenergic agonist (albuterol), corticosteroids (Prednisone), and Epinepherine
How should Diphenhydramine (Benadryl) be administered to someone experiencing anaphylaxis?
IV or IM
How should Albuterol be administered to a patient experiencing anaphylaxis?
Inhaler or nebulizer
What side effect would you monitor for after administering albuterol?
Tachycardia
Why are corticosteroids given to someone with anaphylaxis and how should it be administered?
To suppress the immune response which also aids in preventing the reoccurence of anaphylaxis. Administer IV or PO
What is the Mode of action for epinepherine pertaining to how it treats anaphylaxis?
Constricts blood vessels, improves cardiac contraction, and dilates the bronchioles
How should epinepherine be administered to someone experiencing anaphylaxis?
IM in the thigh or IV
What is the first drug immediately given for treatment of anaphylaxis?
Epinepherine
If administering Epinepherine IM, where should it be administered?
Into the top of the thigh, slightly to the outside, holding the device so the needle enters straight down
True or false: You can inject epinepherine IM through clothing
True, but avoid areas of thicker clothing (seams and pockets for example)
How long should a patient be monitored for after administering epinepherine for anaphylaxis?
4-6 hours
True or false: A patient with SLE can take NSAIDs to help alleviate pain
True
A patient should stay ________ to decrease the risk of progression of SLE.
Active
What would a patient’s urine look like if they have SLE and what does it indicate? A s/s of SLE
Foamy, bloody, cloudy urine indicates proteinuria
What are the priority nursing interventions for a patient with SLE?
Pain management; prevent and monitor organ failure
