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S3 1538 > S3 M6 Immunity > Flashcards

S3 M6 Immunity Flashcards

1
Q

Tuberculosis

A

Disease affecting lung parenchyma

associated with poverty

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2
Q

TB spread is

A

airborne

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3
Q

TB patho

A

airborne

multiply in alveoli and get transported via blood and lymph

as infected cells die they accumulate in lung causing bronchopneumonia

Can recur

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4
Q

TB infection occurs to weeks after exposure

A

2 to 10

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5
Q

S/S of EARLY TB

insidious

A

Low fever

cough

sweats

fatigue

weight loss

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6
Q

As TB progresses S/S includes

A

Mucopurulent sputum expectorate

Hemoptysis - blood in cough

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7
Q

Elder TB patients have _ pronounced symptoms

A

Less

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8
Q

If pt presents with positive skin, blood or sputum, for TB

A

Do history, physical exam, Chest xray, Drug susceptibility testing.

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9
Q

5mm or greater on TB test

A

Positive

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10
Q

Blood tests for TB

A

QuantiFERON Gold

T-Spot

rules out Active and Latent infections

Good for BCG vaccinated people

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11
Q

TB meds

A

Anti-TB agents

INH, Rifampin, Pyrazinamide, Ethambutol

Given for 6 to 12 months

Prolong treatment to ensure eradication

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12
Q

TB drug resistance

A

Primary - resistance to ONE drug in people who have not had previous treatment

Secondary - resistance to ONE OR MORE in people undergoing therapy

Multi - resistance to TWO agents

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13
Q

TB treatment phases

A

phase 1: all drugs + Vit B6 for 8 weeks

phase 2: INH and rifampin for 4 to 7 months

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14
Q

Nursing priorities with TB

A

Airway clearance

Adherence to meds

^ Activity and nutrition

Prevent transmission

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15
Q

Airway clearance with TB interventions

A

^ fluid intake

Postural drainage

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16
Q

Adherence to meds with TB

A

Take meds on empty stomach or 1h before meal

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17
Q

Food that messes with TB meds

A

Tune

Aged cheese

Red wine

Soy sauce

Yeast extract

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18
Q

Rifampin makes what meds less effective

A

Warfarin

digoxin

corticosteroids

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19
Q

Contact lenses and rifampin

A

Will be discolored

switch to glasses

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20
Q

Side effects of antiTB meds

A

Liver/Kidney problems (BUN, creatinine, enzymes)

Hearing loss

Rash

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21
Q

Prevent transmission with TB

A

Cover mouth

dispose of tissues

Hand hygiene

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22
Q

Do you report TB to the health department

A

YES

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23
Q

Allergies are related to Ig

A

IgE

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24
Q

Anaphylaxis

A

Type I hypersensitivity

Rapid release of IgE

severe life-threatening reaction

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25
Q

Pathophysiology or anaphylaxis

A

IgE antibodies sense allergen, release histamines, prostaglandins and inflammatory leukotrienes

This results in angioedema, hypotension and bronchoconstriction

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26
Q

Common causes of anaphylaxis

A

Antibiotics and radiocontrast agents

Penicillin most common culprit

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27
Q

The faster the onset of anaphylaxis

A

The more severe the reaction

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28
Q

Mild anaphylaxis S/S

A

tingling and warmth

fullness in mouth and throat

nasal and periorbital swelling

sneezing and tearing of eyes

onset is first 2h of exposure

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29
Q

Moderate anaphylaxis S/S

A

flushing/warmth/itching

Anxiety

Bronchospasms

edema or airways

cough/wheezing

onset within first 2h

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30
Q

Severe anaphylaxis S/S

A

Abrupt onset

severe dyspnea

cyanosis

hypotension

V/D

seizures

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31
Q

Treatment for anaphylaxis

A

Strict avoidance

Epinephrine (EpiPen Auvi-Q)

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32
Q

As nurses we should _ for anaphylaxis

A

Screen

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33
Q

Venom immunotherapy

Desensitization

A

Good for those allergic to bees, ants, wasps

Food for those allergic to insulin or penicillin

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34
Q

Med management of anaphylaxis

A

O2

Epi

Antihistamines

Corticosteroids

IV fluids

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35
Q

After treatment for anaphylaxis watch for rebound reaction which happens…

A

4 to 8 h after

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36
Q

Nursing management of anaphylaxis

A

Check airway breathing and vitals

Notify providers

Instructions after recovery, like what to avoid and getting an epipen

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37
Q

Emergency nursing measures for anaphylaxis

A

Intubating

Admin emergency meds

IV lines + fluids

O2 admin

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38
Q

SLE

Systemic lupus erythematosus

A

Inflammatory autoimmune disorder

Affects body organs

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39
Q

Lupus

SLE patho

A

Body recognized one or more components of normal cell nucleus as foreign

Increase in antibodies against those nuclear antigens

Specific increase in B-lymphocyte Stimulator (BLyS)

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40
Q

Factors that contribute to lupus

A

Genetic

Immunologic

Hormonal

Environmental

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41
Q

SLE manifestations

A

Fever, malaise, weight loss, anorexia

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42
Q

Most commonly affected system by SLE

A

Gastrointestinal tract

Liver

Ocular system

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43
Q

Skin manifestations of lupus

A

Rash on nose bridge and cheeks

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44
Q

With SLE, skin lesions are worsened by

A

sunlight

ultraviolet light

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45
Q

Earliest symptoms of SLE

A

Joint problems

Arthralgia

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46
Q

Heart symptoms with SLE

A

Pericarditis

Hypertension

Dysrhythmias

Valve problems

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47
Q

Kidneys and SLE

A

Nephritis

Serum creatinine for screening

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48
Q

CNS and SLE

A

cognitive impairment

seizure

strokes

central and peripheral neuropathy

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49
Q

Diagnosing SLE

A

History

Physical

Blood tests

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50
Q

Erythematous rash

Erythematous plaque with scale

A

Sign of lupus

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51
Q

Scalp with SLE

Mouth with SLE

A

Alopecia

Ulcerations

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52
Q

Lesions of fingertips, elbows, forearms and toes

A

Vascular lupus

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53
Q

SLE has 11 criteria

if _ are present, lupus is diagnosed

A

4

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54
Q

Blood work for lupus

A

Anti-DNA

Anti-ds DNA

Anti-Sm

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55
Q

Mainstay of SLE management

A

Pain

Immunosuppression

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56
Q

Meds for SLE

A

Monoclonal antibodies

Corticosteroids

Antimalaria agents

NSAIDS

Immunosuppressive agents

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57
Q

Belimumab

A

Approved by FDA for SLE

Monoclonal antibody that renders BLyS inactive

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58
Q

Risk factor for corticosteroids and SLE

A

Osteoporosis

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59
Q

Nursing management focus with SLE

A

Fatigue

Impaired skin integrity

Body image disturbance

Deficit in knowledge

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60
Q

SLE patients should avoid

A

SUN

Ultraviolet light

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61
Q

SLE patients need to increase

A

screenings

health promoting activities

have good diet

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62
Q

Immunosuppressants and corticosteroid side effects with lupus

A

increased risk for infection

Increased risk for osteoporosis

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63
Q

RA patho

A

Immune system attacks joints causing effusion pain and edema

After triggering even subsides pannus occurs

This results in destruction of joint cartilage and bone

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64
Q

Pannus

A

Proliferation of new synovial joint tissue WITH inflammatory cells already formed

occurs due to RA

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65
Q

RA is autoimmune

A

body attack self

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66
Q

S/S of RA

A

PAIN

joint swelling

limited movement

stiffness

weakness

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67
Q

Diagnosing RA

A

Health history

Lab values

Xray

CT

MRI

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68
Q

Rx management of RA

A

salicylates (aspirin)

NSAIDs

DMARDs (work on autoimmune response)

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69
Q

None Rx management of RA

A

Heat/Paraffin baths 20 min max

Therapeutic exercises

Braces, splints, assistive devices (canes)

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70
Q

Treatment goals for RA

A

v inflammation

control pain

^ mobility

^ PT knowledge

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71
Q

RA exercise and activity

A

Physical/occupation therapy

TENS

relaxation techniques

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72
Q

Sleep with RA can be aided by

A

Pain interferes with sleep

Low dose antidepressants

Amitriptyline

Good sleep hygiene (cold room, no tv, no eating in bed, etc.)

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73
Q

clues for RA problems in elderly

A

Gait pattern change

Guarding

Joint flexion

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74
Q

What joints are affected first by RA

A

fingers

wrists

toes

small joints first

75
Q

MS
Multiple sclerosis 101

A

progressive demyelinating disease of the CNS

Impaired transmission of nerve impulses

onset at 25 to 35 y

76
Q

MS Patho

A

T and B cells demyelinate nerve cells in CNS

plaque appears on demyelinated nerves further interrupting connections

axon begin to degenerate resulting in permanent damage

77
Q

Most frequently affected nerves

A

Optic chiasm

Cerebrum

Cerebellum

Spinal cord

78
Q

MS S/S

A

Fatigue

Depression

Weakness

Numbness

Bad coordination

79
Q

Vision with MS

A

Diplopia (double)

Blurred

80
Q

MS and pain

MS and spasticity

MS and ataxia

A

pain - social isolation

spasticity - messes with motor pathways

ataxia - impaired movement

81
Q

MS assessment and diagnosis

A

Plaque in CNS observed via MRI

82
Q

Common symptoms of MS that require interventions

A

Ataxia

Bladder dysfunction

Depression

Fatigue

Spasticity

83
Q

Disease-modifying therapies for MS

A

reduce frequency or relapse

reduce duration of relapse

reduce number and size of plaques

84
Q

Disease modifying meds

A

Interferon beta 1a - flu like symptoms

Glatiramer acetate - takes 6m

IV methylprednisolone - key agent in treatment, no long term benefits

Mitoxantrone - cardiac toxicity

85
Q

Symptoms management meds MS

A

Baclofen and benzos - spasticity

anticholinergics - bladder issues

Ascorbic acid for UTIs

86
Q

Nursing interventions for MS

A

Exercises

Minimizing spasticity and contractures

Nutrition

Minimize immobility

87
Q

Nursing treatment of MS for walking

A

Assistive devices

Gait training

88
Q

Nursing treatment for bladder/bowels

A

Training to control and respond in time

self cath

89
Q

Nursing treatment and sallowing

A

Speech/language pathologist to assist with dysphagia

90
Q

MS and home living

A

assistive eating devices

raised toilet seats

bathing aids

phone modifications

long-handled comd

91
Q

MS and sex

A

Go to sex counselor

be open

92
Q

Crohn’s disease 101

A

Chronic inflammation of GI

Most common in distal ileum and ascending colon

93
Q

Crohn patho

A

small lesions that expand and thicken becoming fibrotic

intestinal lumen narrows

94
Q

S/S of crohn

A

prominent right lower quadrant pain

unrelieved diarrhea

pain occurs after meals

95
Q

Secondary complications of crohns

A

weight loss

malnutrition

anemia

96
Q

stretorrhea and chron

A

fat in feces

97
Q

Assessment for crohns

A

CT and MRI

98
Q

Crohn bowl complications

A

obstruction

structural problems

perianal disease

Enterocutaneous fistula - opening between small bowels and skin

99
Q

Enterocutaneous fistula

A

opening between small bowels and skin

100
Q

Ulcerative colitis 101

A

ulcerative inflammatory disease of mucosal and submucosal layers of colon and rectum

101
Q

Characteristics of Ulcerative colitis

A

Abdominal cramps

Bloody/purulent diarrhea

LEFT lower quadrant pain

Weight loss

six or more liquid stools a day

102
Q

Patho of ulcerative colitis

A

mucosa become edematous and inflamed

colonic epithelium sheds

Eventually the bowel narrows, shortens and thickens

103
Q

Assessment for ulcerative colitis

A

abdominal x ray

colonoscopy

104
Q

Ulcerative colitis may lead to toxic mega colon this is treated with

A

NG suction

IV fluids

Lytes

Corticosteroids

Antibiotics

SURGERY

105
Q

Diet for ulcerative colitis

A

Oral fluids

Low residue

High protein, high calorie diet

Supplemental vitamins, iron

106
Q

Food to avoid with ulcerative colitis

A

cold food

milk

107
Q

Rx or ulcerative colitis

A

sedatives antidiarrheals antiperistalitics for diarrhea

Aminosalicilates to reduce inflammation

Corticosteroids to reduce swelling

Immunomodulators to treat underlying cause

108
Q

Partial or complete obstruction or bowels =

A

surgery

109
Q

Colectomy and ileostomy

A

removal of colon and stoma for drainage

used in IBD problems

110
Q

Restorative proctocolectomy with Ileal Pouch Anal anastomosis

A

Redirects GI process while intestines heal

Prevents permanent ileostomy need

111
Q

Normal elimination nursing interventions

A

food diary

give meds

increase fluid intake

record frequency and consistency of stool

112
Q

Pain nursing interventions for IBD

A

Analgesics

Position changes

Heat

113
Q

When doing parenteral nutrition for IBD patients monitor

A

glucose q6h

114
Q

Mental health and ulcerative colitis

A

Promote rest

Reduce anxiety

Enhance coping measures

115
Q

With bedridden IBD patients monitor for

A

skin breakdown

116
Q

2 types of TB

A

Active- showing symptoms, neutrophils and macrophages fight infection

Latent- NOT active but carrier of encapsulated bacteria

117
Q

Ghon complex

A

Latent TB

Cheesy protective casing of TB bacteria

Bursts when PT is immunocompromised

118
Q

Most obvious TB S/S

A

Cough lasting more than 3 weeks

low grade fever

blood in sputum

119
Q

if PPD test is greater than 10mm

A

POSITIVE

Induration (raised) MUST be present

120
Q

PPD test is considered

A

SCREENING not diagnostic

TB GOLD, Chest xray and Acid fast are diagnostic

ACID FAST CULTURE IS THE GOLD STANDARD OF TB TESTING

121
Q

Is tuberculosis an aerobic bacteria

A

YES

hence the lungs

122
Q

Standard number of meds to take for TB

A

4

isoniazide

Rifampin

Pyrazinamide

Ethambutol

123
Q

All TB meds are toxic to

A

LIVER

do enzyme tests

124
Q

For tb take B6

take meds 1 h _ meals

when to take

A

to prevent neuropathy

before

SAME TIME QDAY

125
Q

When is a TB patient not contagious

A

after 2-3 weeks

AND
3 negative sputum cultures

AND

Med compliant

126
Q

when are sputum samples done for TB

A

Q2-4W

Helps track progress

127
Q

Drinking on TB meds

A

NO

128
Q

S/S or hepatotoxicity

S/S nerutoxicity

A

Jaundice, Right upper quadrant pain, Fever

Numbness, tingling

129
Q

Anaphylactoid reaction

A

Not same as anaphylaxis

NON IgE

No sensitization

130
Q

Fluids with Anaphylaxis

A

Increased permeability of capillaries

Fill up with fluid in lungs

N/V/D etc.

131
Q

If you have Mild anaphylaxis now

A

DOT NOT mean will have Mild anaphylaxis next time

132
Q

Solution to push IV for anaphylaxis

A

Isotonic

LR
NS

133
Q

Nursing managment basics for anaphylais

A

Stop allergen

Give epi FIRST, IV, O2

134
Q

If you have allergy

awareness

A

wear bracelet

Inform school nurse/teachers

ask for return demonstration when showing how to use

135
Q

Hold epipen in injection place for

A

FULL 10 SECONDS

136
Q

Types of lupus

A

Discoid

Cutaneous

Medication induced

137
Q

Lupus is thought to be linked to

A

Estrogen

Higher rate in women

138
Q

Most common sign of lupus

A

Low grade fever

joint pain

MALAR RASH ON TEST (the nose cheekbone thing)

139
Q

Discoid lesions

A

Scaly

very clear

cause alopecia

Sign of LUPUS

140
Q

Lupus and sun

A

Photosensitivity

Worsens the rash and lesions

141
Q

Lupus related arthritis

A

Swelling of joints due to lupus

BILATERAL AND SEMETRICK

142
Q

S/S of nephritis

A

Cloudiness blood or puss in urine

Pain at kidneys

BUN Creatinine urinalysis labs

143
Q

Indicative test for lupus

A

ANA

History of symptoms

144
Q

Why are kidneys stressed during lupus

A

Kidneys are our filters

NEED EM

145
Q

Meds for lupus

A

hydroxychloroquine

corticosteroids

Methotrexate and azathioprine (immunosuppressants)

NEED TO BE SAFE BECAUSE THESE MEDS WILL DISTROY IMMUNITY

146
Q

As nurses helping with lupus

A

Manage pain

Rest

MONITOR KIDNEYS

V/S, edema, breath sounds

Monitor Mental status

147
Q

for alergic reactions do you shut the med off first or give epi

A

SHUT THE MED OFF

148
Q

Clean mouth with lupus

and avoid

A

soars are sensitive

spicy foods and alcohol

149
Q

1 pt education of lupus

A

MEDS ARE IMMUNOSUPRESSANTS, let everyone know and make sure pt understands what that means

Wear masks, avoid public places

150
Q

RA joint deformities can result in

A

loss of use

151
Q

3 DISTINCT CHARACTERISTICS OF RA

A

Inflammation

Autoimmunity

Degeneration of articular cartilage

152
Q

Contractures

A

muscles bones joints get stuck due to joint destruction RA

153
Q

When in they day is the pain worse

A

MORNING

ON TEST

154
Q

RA starts at

A

Joints of fingers

155
Q

RA hand deformities

A

Subluxation ?

Boutonniere —\ finger

Swan neck ^v^ finger

156
Q

RA foot deformities

A

Major bunion

Toes going in different directions

157
Q

Why doe joint deformities happen

A

destruction and recalcification of tissue

158
Q

Biggest difference between lupus and RA

A

Degeneration and destruction of tissue with RA
ON TEST

159
Q

Diagnosing RA

A

Rheumatoid factor RF is the standard

ANA will pop for autoimmune problem but will NOT narrow down the disease

160
Q

Types of exercises for RA

Types of meds

A

Range Of Motion

NSAIDS CORTICOSTEROIDS DMARDS
STAY AWAY FROM PEOPLE
HIGH INFECTION RISK

161
Q

DMARDs

A

stop progression but can not fix damaged joints

does not work indefinitely

Nonbiologic - take longer to work then biologic

162
Q

Infliximab DMARD

A

Works to improve the immune system

163
Q

MS

autoimmune disease

A

Degenerative disease

demyelinating of nerves

Affected nerves are random, this is why symptoms are random

164
Q

MS symptoms are determined by

A

Scarring

165
Q

MS affects _ 2x more

A

women

166
Q

Can you get myelination back with MS

A

NO

167
Q

Diagnosing MS

A

MRI

CSF spinal tap

EMG - assesses nerve response

Neuro exam

168
Q

MS meds are immunosuppressive so

A

Wear masks

Stay away from crowds

Take steps to not get sick

169
Q

DMARDs decrease

A

Frequency and duration of relapse

Can decrease plaque in brain

WILL BE ON TEST

170
Q

Main focus of nursing care for MS

A

Safety first

assistive devices

Bladder/bowel care

Cognitive function

Meds

171
Q

Ulcerative colitis only affects

Starts at

A

Mucosal and Submucosal layers

Low part of rectum and works its way up

172
Q

Crohn’s disease affects

A

All layers of intestine from mouth to butt but not continuously

here and there

173
Q

movement number

Ulcerative colitis UC pain will start at

A

15 to 20 bowel movements

Left lower side

Bleeding

174
Q

movement number

CD pain

A

5 stool movements

pain in right lower quadrant

175
Q

UC complications

A

Loss of Haustra - smooths out intestine, these parts can absorb nutrients

Toxic megacolon - colon dilates, inflammation. Unable to contract, distends, becomes paralyzed

176
Q

Cobblestone intestine is related to

A

CD

177
Q

IBS labs

A

Albumin will be LOW malnutrition

ESR, C reactive protein - inflammation

Stool sample

CBC

Chem panel

178
Q

IBS diagnostics

A

MRE - magnetic resonance enterography

MRI/CT

Sigmoidoscopy

Colonoscope

Endoscopy

179
Q

With IBS diet avoid

A

FIBER - will make you shit more

POPCORN - will get stuck and infected

RED MEAT - slow digestion

Peal fruit and veg

180
Q

IBS treatments side effects

A

5 Aminosalicylic acid - nausea fever rash, kidney toxicity

Steroids and immunosuppressants - avoid getting sick

181
Q

Surgery for IBS

Always give

A

Ileostomy, Colectomy, Proctocolectomy

ANTIBIOTICS

182
Q

IBS diet

A

Low fiber

High protein

High calorie

183
Q

Toxic megacolon treatment

A

NPO

bowel suction

TPN

if not resolved by 3 days, surgery

184
Q

Before applying a valve sticker to the colostomy use

A

barrier cream, prevents skin breakdown

S3 1538 (15 decks)

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