Protection Flashcards
Rheumatoid Arthritis
•chronic, systemic, autoimmune disease
- inflammation of the connective tissue in the synovial joints
•Periods of remission and exacerbation!!
RA risk factors
•Peak age 30-50 women more common
•Unknown cause
- likely a combination of genetic, smoking, and environmental triggers–typically autoimmune.
• Smoking increases risk in patients genetically predisposed and may interfere with treatment
RA 3 distinct characteristics
Inflammation
Autoimmune
Degeneration
RA symptoms
Onset typically subtle: •Fatigue •Anorexia •Weight loss •Generalized stiffness that becomes localized stiffness with progression
RA Articular Manifestations: Joints
Characteristics and signs
Symmetrically and bilaterally in the small joints of the hands, wrist and feet.
- Knees, hips, elbows, ankles, cervical spine joints may also be affected
- Morning stiffness-60 min to several hr
- Pain
- Limited motion
- Signs of inflammation (erythema, heat, swelling, tenderness
- Tenosynovitis: inflammation of tendon
- Subluxation: dislocation
- Deformities in the hands
Other RA Manifestations: Extra-articular (outside a joint)
- flexion contractures
- Sjögren’s syndrome
- dry eyes and mouth
- felty syndrome
- swollen spleen, decreased white blood cell count, and repeated infections
RA: Diagnostic Studies lab findings for early detection
•RF positive
•ESR and CRP (increased = active inflammation)
•Anti-CCP
- can be seen 5-10 years before symptoms develop.
RA Treatment: Goals
Treatment must begin early to avoid deformity—early treatment is key!!
- Decrease joint pain and swelling
- Achieve clinical remission
- Decrease likelihood of joint deformity
- Minimize disability/Maximize participation in ADLs
RA: Management
- Pharmacologic therapy
- Non-pharmacologic therapy
- Nutritional therapy
- Sleep promotion
- Joint Protection
- Heat/cold therapy
- Exercise therapy
•The progression of joint damage can be slowed or stopped with aggressive, early treatment.
RA Pharmacological Therapy
- Non-biologic DMARDS (Disease-Modifying Anti-Rheumatic Drugs)
- Biologic Response Modifiers (BRMs)
- NSAIDS
- COX-2 enzyme blockers
- Short-term, low-dose antidepressants for depression or sleep problems. Amitriptyline (Elavil), paroxetine (Paxil), sertraline (Zoloft).
- Corticosteroids
What happens if drug therapy not started for RA
Irreversible changes can occur in the first year if drug therapy not started
Disease-modifying antirheumatic drugs (DMARDs)
•Slow disease progression and decrease risk of joint deformity and erosion
RA Drug Therapy: DMARDs
•Methotrexate
What are the side effects ?
•Early treatment
•Side effects (rare): 🦴 marrow suppression and hepatotoxicity
- Need to monitor CBC
RA Drug Therapy: DMARDs
•Sulfasalazine (Azulfidine) and Hydroxychloroquine (Plaquenil)
- Used for mild to moderate disease
- Drink fluids
- Wear sunscreen
- Eye exam: baseline, then every 6 to 12 months
RA Drug Therapy: Biologic Response Modifiers (BRMs)
Slow progression
•Used to treat moderate to severe disease not responsive to DMARDs
•Used alone or in combination with DMARDs
•Are more expensive.
•Examples: Remicade, Humira, Cimzia, Etantercept, (Infliximab)
RA Drug Therapy: Celebrex
Decrease inflammation process.
- Less likely to cause gastric irritation and ulceration
- increased risk of blood clots
RA Drug Therapy: Corticosteroids
Where are they given? What are complications?
** Intraarticular injections
•Low-dose oral for limited time
•Complications: osteoporosis and avascular necrosis(death of 🦴 tissue due to a lack of 🩸 supply)
Can result in weight gain
RA: Non-Pharmacologic therapy
•Heat:
- baths or showers, warm moist compresses (20 min)
- Tends to improve effectiveness of therapeutic exercises.
•Assistive Devices to support joints (Crutches, splints, walkers, cervical collars, canes, shoe supports)
•Muscle relaxation techniques
•Self hypnosis
RA: Nutritional Therapy
•Balanced nutrition important
•Pain, fatigue, and depression lead to decreased appetite
•Lower endurance and mobility cause inability to shop for and prepare food resulting in weight loss
- work with OT for plan
RA: Sleep Promotion
•Alternate rest periods with activity
•Avoid total bed rest
•8 to 10 hours of sleep plus daytime rest
•Modify activities to avoid overexertion
•Firm mattress or bed board
•Encourage positions of extension
- Avoid flexion positions
•No pillows under knees
•Small, flat pillow under head and shoulders
•Low-dose antidepressants to reestablish sleep patterns and improve pain management.
RA: Joint Protection
- Modify tasks for less stress on joints
- Energy conservation
- Work simplification techniques
- Pacing and organizing
- Use of carts
- Joint protective devices
- Delegation
- Occupational therapy
- Assistive devices
RA cold and heat therapy
Relieve pain, stiffness, and muscle spasm
Cold:
- benefit during disease activity
- don’t exceed 15 min
- ice or frozen veggies
Heat:
- relieve chronic stiffness
- don’t exceed 20 mins
- heating pad, moist hot packs, paraffin baths, warm bath or shower
- be carful about burns, DONT use with topical heating cream
RA: Exercise Therapy
Individualized exercise plan to
•Improve flexibility and strength
•Increase overall endurance
•Need both recreational and therapeutic exercise
•Avoid overly aggressive exercise
•Gentle ROM exercises done daily to keep joints functional
•Aquatic exercises in warm water beneficial
•Limit to one or two repetitions during acute inflammation
RA: Surgical Therapy
Relieve severe pain
•improve function
- Synovectomy
- Total joint replacement (arthroplasty)
RA older population considerations
- May also have OA (fracture risk)
- Polypharmacy can lead to joint pain
- Musculoskeletal pain / weakness may be related to depression and inactivity
- More sensitive to therapeutic and toxic drug effects
- Need simple plan to improve adherence
RA patient education
Medications
Independence/ safety at home
Manage fatigue and depression
RA groups
RA continuing care
Referral to home care for elderly Assess home environment (safety) Asses ability to do ADL - may need adaptive devices - may need home assistance Medical follow up care
What are STI and how are the spread
Infectious diseases spread through sexual contact with the penis, vagina, anus, mouth, or sexual fluids of an infected person
spread:
•Skin-to-skin
•Via blood
•Autoinoculation (spread through touch of infection)
•Not typically transmitted from inanimate objects
STI risk factors
Alcohol / drug use New / multiple partners Sexual partners that have more partners Incorrect use of condom Sharing needles
Already had a STI
Being non vaccinated for STI
High risk populations for STI
- Adolescents and young adults (age less than 25)
- Men who have sex with men (MSM)
- Persons in correctional facilities
- Transgender persons
- Victims of sexual assault
- Women
HIV main transmission
Who is at greatest risk ?
Unprotected sex with an HIV-infected partner
•Greatest risk is for partner who receives semen
•Women at higher risk
HIV BLOOD TRANSMISSION
- Sharing drug-using paraphernalia is highly risky
- Routine screening of blood donors have improved blood supply safety
- Puncture wounds are most common means of work-related HIV transmission
Perinatal transmission of HIV
Can occur during pregnancy, delivery, or breastfeeding
• infants born to women with untreated HIV most likely will be born with the infection
- Treatment can reduce rate of transmission
CD4+T cell is the target cell for HIV
Lab values?
Immune problems (s/s) start when CD4+ T cell counts drop to less than 500 cells •Severe problems develop when less than 200 CD4+ T cells (AIDS) •Normal range is 600 to 1200 cells
Insufficient immune response allows for opportunistic diseases
Acute infection of HIV S/S
•FLU-like symptoms
- Fever, swollen lymph nodes, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and/or a diffuse rash
•Highly infectious !!! 😷
Asymptomatic infection of HIV complication
Left untreated, a diagnosis of AIDS is made about 10 years after initial HIV infection
Symptom typically go away and people don’t know they have HIV
Symptomatic infection of HIV
Labs and Signs during this stage
• CD4+ T cells decline closer to 200 cells
•Symptoms become worse
- persistent FEVER, frequent NIGHT SWEATS, chronic DIARRHEA, recurrent headaches, severe FATIGUE
Acquired immunodeficiency syndrome (AIDS)
(Develop from HIV)
What are the signs?
Immune system severely compromised •Infections •Malignancies (tumor) •Wasting •HIV-related cognitive changes *** Pneumocystis jiroveci pneumonia **Kaposi sarcoma (cancer lesion) ** Oral thrush and hairy leukoplakia
Diagnostic studies for HIV
Monitoring for HIV
•Antibody/Antigen tests
- Done using BLOOD or SALIVA - Many people are unaware they have it
HIV progression is monitored by:
- CD4 cell count
- Viral load
Care focus for HIV
What should we monitor?
Monitor:
-disease progression
- immune function
Prevent, detect and/or treat opportunistic infections
- manage symptoms
•Initiate and monitor ART
•Prevent further transmission of HIVDrug Therapy GOAL for HIV
- Decrease viral load
- Maintain/increase CD4 counts
- Delay disease progression
- Prevent HIV transmission
- Prevent HIV-related symptoms and opportunistic diseases
(drug) Preventing Transmission of HIV
Preexposure prophylaxis (PrEP): Descovy
Taken every day to protect from getting HIV from partner
Antiretroviral Therapy (ART) for HIV
What does it do?
What happens if they miss a dose?
can significantly slow progression
- Can prevent transmission* adherence to drug is critical to prevent
• if pts stop using can lead to drug resistance even after a few missed doses
ART drug side effects
•Anxiety, fear, depression •Diarrhea **Peripheral neuropathy •Pain •Nausea/vomiting •Fatigue
•Lipodystrophy: amount and/or distribution of adipose tissue in the body is abnormal
Nursing Assessment HIV
Questions to ask
- Received blood transfusion or clotting factors before 1985?
- Shared drug-using equipment?
- Had sexual experiences with their penis, vagina, rectum, or mouth in contact with these areas of another person?
- Had a sexually transmitted infection?
HIV Goals for care
- Adherence with drug regimens
- Adopting a healthy lifestyle
- Protecting others from HIV
- Beneficial relationships
- Explore spiritual issues
- Coping with the disease and its treatment
Primary prevention of HIV
Primary prevention and health promotion are the most effective strategies
•Early intervention is facilitated by health promotion practices
Prevention of HIV
Sex, drugs, moms, healthcare workers
•Avoiding or modifying risky behaviors
•Increase safer sexual practices
- Abstinence
- Limit activities involving contact with the mouth, penis, vagina, or rectum
- condoms
- Educate about (PrEP)
- Don’t use drugs/ share equipment
- No sex under influence
- Refer for help with substance use
Decreasing risks: Perinatal transmission
•Encourage family planning
•Appropriately medicate HIV-infected pregnant women
Decreasing risk at work:
•Adhere to precautions and safety measures to avoid exposure
•Report all exposures for timely treatment and counseling
•Determine the HIV status of the exposure source
•Postexposure prophylaxis (PrEP) with combination Anti-retroviral therapy (ART) can significantly decrease risk of infection
Delaying HIV progression not related to drug therapy
Health promotion
Promoting a healthy immune system •Nutritional support •Moderating or eliminating alcohol, tobacco, and drug use **Keeping up to date with vaccinations** •Getting adequate rest and exercise *Avoiding exposure to infectious agents*
Protection from HIV Infection
What can someone do to protect themselves from getting HIV?
- Abstain from sharing sexual fluids (semen/ vaginal) or from sex entirely.
- Reduce # of sexual partners to one.
- Always use latex condoms
- Do not reuse condoms.
- Use dental dams for oral-genital or anal stimulation.
- Avoid using cervical caps or diaphragms without using a condom as well.
- Avoid anal intercourse
- Avoid manual/digital-anal intercourse.
- Do not ingest urine or semen.
- Avoid sharing razors, toothbrushes, sex toys, or blood-contaminated articles
- Engage in non-penetrative sexual activity.
- Never share drug needles.
Chlamydia S/s
Most common STI
S/S- often non- can cause infertility
🔴MEN-urethritis, erythema to scrotum, epididymitis (inflammation of testicle)
WOMEN-cervicitis, (PID), damage fallopian tubes, ectopic pregnancy, and chronic pelvic pain.
Chlamydia diagnosis
Diagnosis
- endocervical, vaginal, or urethral (NAAT) swabs; urine sample
Chlamydia patient education
All sexual contacts within 60 days should be evaluated and treated
•Abstain from sex for 7 days after treatment or until all partners have been treated an abstained for 7 days
•High rate of recurrence of infection
•Review risk reduction methods
•Teach patients to return with persistent or recurrent symptoms
Gonorrhea s/s
MEN-most symptomatic
urethritis, dysuria, PURULENT DISCHARGE, or epididymitis
WOMEN-asymptomatic or minor symptoms that are overlooked:
increased vaginal discharge, dysuria, urinary frequency, bleeding after sex, or cervical exudate
BOTH- can have rectal symptoms like discharge, bleeding, anorectal pain, pruritis, tenesmus(incomplete defecation), mucus coated stools, or painful BMs.
can have sore throat from oral sex.
Gonorrhea diagnostic
- Dx: symptoms, lab tests, NAAT, urine culture
Trichomoniasis signs
•more common in women
- Most asymptomatic
MEN-burning urination, ejaculation, or urethral discharge
WOMEN-painful urination, itching, painful intercourse, 🩸 after sex, 🟡 🟢 discharge with a foul odor, cervix can have a 🍓 appearance
Trichomoniasis diagnostic and treatment
When to repeat testing ?
Dx done by NAAT swab of vaginal, cervical secretions or urine
Tests also can be done during PAP smear samples
•Treatment:
- MetronidAZOLE (Flagyl) or TinidAZOLE (Tindamax)
- Repeat testing in 3 mos.
Herpes Simplex 1 and 2 SIGNS
Risk and Transmission?
Lifelong incurable infection
•HSV-1 typically associated with oral lesions(cold sores, fever blisters)
• HSV-2 is more common on the genitals or anus
• more common in women
•Transmission can occur when the person has symptoms but also when they show no signs of infection-asymptomatic viral shedding
•HSV-2 is more likely to shed than 1.
Herpes Simplex 1 and 2 STAGES
- Prodromal(tingling/itching)
- Vesicular(blisters/lesions)
- Ulcerative(lesions rupture)
- Final(crusting).
General Herpes Simplex SIGNS
1) regional lymphadenopathy
2) systemic flu-like symptoms
- fever, headache
- malaise ( general feeling bad)
- myalgia (muscle pain)
HSV reactivation
How can patients infect self?
What are triggers?
How do pregnant women have to give birth?
Pts can auto-inoculate themselves if active lesions are touched or scratched causing additional infections in the buttocks, groin, thighs, fingers, and eyes
- Triggers include stress, fatigue, sunburn, general illness, immunosuppression, and menses
- Pregnant women can transmit HSV to their baby during a vaginal birth—C-section is necessary.
HSV diagnostic
culture from open lesions
and blood tests
Genital Herpes patient education
What can patient do during active lesions?
•Identify triggers
•Active outbreak:
- Good hygiene; loose, cotton undergarments; abstinence until lesions healed
- Keep lesions clean and dry
- Pour water on perineum during urination to reduce pain
- Local anesthetics: lidocaine gel
- Analgesics
- Ice packsSyphilis
What is it and risk factors
- sexually transmitted bacterial infection by direct contact with (chancre) PAINLESS ULCER
- highest with black men who have sex with men 25-29 years old
Syphilis diagnostic and treatment
When to re-examine?
- Dx: blood test
- Treatment: Penicillin G benzathine
- cannot reverse damage that is already present in the late stages of the disease.
- All sexual contacts from the preceding 90 days should be treated.
- *Re-exam and f/u testing q 6 months for 2 years to ensure cure.
Candidiasis
PH and transmission
•Vaginal pH below 4.5
- Infection and inflammation of the vagina, cervix, and vulva often occur when changes in the pH balance
•Yeast infection caused by the fungus candida
•Can be transmitted sexually, through contaminated hands, clothing, and douching
Candidiasis
Signs and treatment
- S/S: abnormal discharge (white, thick, curd like), pruritus, reddened vulva, painful urination
- Treatment:
- symptomatic relief of itching with corticosteroid cream.
- Antifungal agents like Monostat
Bacterial vaginosis
- bacteria overgrowth in vagina
- transmission during sex or douching
- watery discharge with fish odor; no signs
- treat with flagyl or lactobacillus acidophilus which is in yogurt
Health promotion for people with STI
- safe sex or no sex
- address drug and alcohol issues
- look before sex ( some may not have signs)
- condoms
- screening
- encourage vaccines
- emotional support
- hygiene
- don’t scratch or itch infection
- wash with soap
- never Douche
Chalmydia treatment
- Azithromycin 1 dose
OR
- Doxycycline BID x 7d.
- Avoid excessive ☀️ exposure with Doxy
- Take on empty stomach; avoid taking with antacids, iron, or dairy; avoid during pregnancyGonorrhea treatment
When is it started?
What medications ?
•Often started BEOFRE test results return
• IM Ceftriaxone WITH oral Azithromycin
- Increasing resistance rate requires that patients be treated with 2 antibiotics
HSV treatment and management
NO CURE !!
- Antiviral (Zovirax & Valtrex) can shorten the duration of HSV viral shedding, shorten the healing time of eruptions, and reduce frequency of outbreaks
Management:
- identify trigging factors
- abstain from sexual contact while lesions present until fully healed
- symptomatic care
- confidential counseling
Why are women at more risk with gonorrhea ? And what can it lead to
Women are at increased risk for complications due to being asymptomatic
untreated can lead to pelvic inflammatory disease (PID) ➡️which can lead to ectopic pregnancy, infertility, and chronic pelvic pain.
