S3 M6 Immunity Flashcards
Tuberculosis
Disease affecting lung parenchyma
associated with poverty
TB spread is
airborne
TB patho
airborne
multiply in alveoli and get transported via blood and lymph
as infected cells die they accumulate in lung causing bronchopneumonia
Can recur
TB infection occurs to weeks after exposure
2 to 10
S/S of EARLY TB
insidious
Low fever
cough
sweats
fatigue
weight loss
As TB progresses S/S includes
Mucopurulent sputum expectorate
Hemoptysis - blood in cough
Elder TB patients have _ pronounced symptoms
Less
If pt presents with positive skin, blood or sputum, for TB
Do history, physical exam, Chest xray, Drug susceptibility testing.
5mm or greater on TB test
Positive
Blood tests for TB
QuantiFERON Gold
T-Spot
rules out Active and Latent infections
Good for BCG vaccinated people
TB meds
Anti-TB agents
INH, Rifampin, Pyrazinamide, Ethambutol
Given for 6 to 12 months
Prolong treatment to ensure eradication
TB drug resistance
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
TB treatment phases
phase 1: all drugs + Vit B6 for 8 weeks
phase 2: INH and rifampin for 4 to 7 months
Nursing priorities with TB
Airway clearance
Adherence to meds
^ Activity and nutrition
Prevent transmission
Airway clearance with TB interventions
^ fluid intake
Postural drainage
Adherence to meds with TB
Take meds on empty stomach or 1h before meal
Food that messes with TB meds
Tune
Aged cheese
Red wine
Soy sauce
Yeast extract
Rifampin makes what meds less effective
Warfarin
digoxin
corticosteroids
Contact lenses and rifampin
Will be discolored
switch to glasses
Side effects of antiTB meds
Liver/Kidney problems (BUN, creatinine, enzymes)
Hearing loss
Rash
Prevent transmission with TB
Cover mouth
dispose of tissues
Hand hygiene
Do you report TB to the health department
YES
Allergies are related to Ig
IgE
Anaphylaxis
Type I hypersensitivity
Rapid release of IgE
severe life-threatening reaction
Pathophysiology or anaphylaxis
IgE antibodies sense allergen, release histamines, prostaglandins and inflammatory leukotrienes
This results in angioedema, hypotension and bronchoconstriction
Common causes of anaphylaxis
Antibiotics and radiocontrast agents
Penicillin most common culprit
The faster the onset of anaphylaxis
The more severe the reaction
Mild anaphylaxis S/S
tingling and warmth
fullness in mouth and throat
nasal and periorbital swelling
sneezing and tearing of eyes
onset is first 2h of exposure
Moderate anaphylaxis S/S
flushing/warmth/itching
Anxiety
Bronchospasms
edema or airways
cough/wheezing
onset within first 2h
Severe anaphylaxis S/S
Abrupt onset
severe dyspnea
cyanosis
hypotension
V/D
seizures
Treatment for anaphylaxis
Strict avoidance
Epinephrine (EpiPen Auvi-Q)
As nurses we should _ for anaphylaxis
Screen
Venom immunotherapy
Desensitization
Good for those allergic to bees, ants, wasps
Food for those allergic to insulin or penicillin
Med management of anaphylaxis
O2
Epi
Antihistamines
Corticosteroids
IV fluids
After treatment for anaphylaxis watch for rebound reaction which happens…
4 to 8 h after
Nursing management of anaphylaxis
Check airway breathing and vitals
Notify providers
Instructions after recovery, like what to avoid and getting an epipen
Emergency nursing measures for anaphylaxis
Intubating
Admin emergency meds
IV lines + fluids
O2 admin
SLE
Systemic lupus erythematosus
Inflammatory autoimmune disorder
Affects body organs
Lupus
SLE patho
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)
Factors that contribute to lupus
Genetic
Immunologic
Hormonal
Environmental
SLE manifestations
Fever, malaise, weight loss, anorexia
Most commonly affected system by SLE
Gastrointestinal tract
Liver
Ocular system
Skin manifestations of lupus
Rash on nose bridge and cheeks
With SLE, skin lesions are worsened by
sunlight
ultraviolet light
Earliest symptoms of SLE
Joint problems
Arthralgia
Heart symptoms with SLE
Pericarditis
Hypertension
Dysrhythmias
Valve problems
Kidneys and SLE
Nephritis
Serum creatinine for screening
CNS and SLE
cognitive impairment
seizure
strokes
central and peripheral neuropathy
Diagnosing SLE
History
Physical
Blood tests
Erythematous rash
Erythematous plaque with scale
Sign of lupus
Scalp with SLE
Mouth with SLE
Alopecia
Ulcerations
Lesions of fingertips, elbows, forearms and toes
Vascular lupus
SLE has 11 criteria
if _ are present, lupus is diagnosed
4
Blood work for lupus
Anti-DNA
Anti-ds DNA
Anti-Sm
Mainstay of SLE management
Pain
Immunosuppression
Meds for SLE
Monoclonal antibodies
Corticosteroids
Antimalaria agents
NSAIDS
Immunosuppressive agents
Belimumab
Approved by FDA for SLE
Monoclonal antibody that renders BLyS inactive
Risk factor for corticosteroids and SLE
Osteoporosis
Nursing management focus with SLE
Fatigue
Impaired skin integrity
Body image disturbance
Deficit in knowledge
SLE patients should avoid
SUN
Ultraviolet light
SLE patients need to increase
screenings
health promoting activities
have good diet
Immunosuppressants and corticosteroid side effects with lupus
increased risk for infection
Increased risk for osteoporosis
RA patho
Immune system attacks joints causing effusion pain and edema
After triggering even subsides pannus occurs
This results in destruction of joint cartilage and bone
Pannus
Proliferation of new synovial joint tissue WITH inflammatory cells already formed
occurs due to RA
RA is autoimmune
body attack self
S/S of RA
PAIN
joint swelling
limited movement
stiffness
weakness
Diagnosing RA
Health history
Lab values
Xray
CT
MRI
Rx management of RA
salicylates (aspirin)
NSAIDs
DMARDs (work on autoimmune response)
None Rx management of RA
Heat/Paraffin baths 20 min max
Therapeutic exercises
Braces, splints, assistive devices (canes)
Treatment goals for RA
v inflammation
control pain
^ mobility
^ PT knowledge
RA exercise and activity
Physical/occupation therapy
TENS
relaxation techniques
Sleep with RA can be aided by
Pain interferes with sleep
Low dose antidepressants
Amitriptyline
Good sleep hygiene (cold room, no tv, no eating in bed, etc.)
clues for RA problems in elderly
Gait pattern change
Guarding
Joint flexion
What joints are affected first by RA
fingers
wrists
toes
small joints first
MS
Multiple sclerosis 101
progressive demyelinating disease of the CNS
Impaired transmission of nerve impulses
onset at 25 to 35 y
MS Patho
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
Most frequently affected nerves
Optic chiasm
Cerebrum
Cerebellum
Spinal cord
MS S/S
Fatigue
Depression
Weakness
Numbness
Bad coordination
Vision with MS
Diplopia (double)
Blurred
MS and pain
MS and spasticity
MS and ataxia
pain - social isolation
spasticity - messes with motor pathways
ataxia - impaired movement
MS assessment and diagnosis
Plaque in CNS observed via MRI
Common symptoms of MS that require interventions
Ataxia
Bladder dysfunction
Depression
Fatigue
Spasticity
Disease-modifying therapies for MS
reduce frequency or relapse
reduce duration of relapse
reduce number and size of plaques
Disease modifying meds
Interferon beta 1a - flu like symptoms
Glatiramer acetate - takes 6m
IV methylprednisolone - key agent in treatment, no long term benefits
Mitoxantrone - cardiac toxicity
Symptoms management meds MS
Baclofen and benzos - spasticity
anticholinergics - bladder issues
Ascorbic acid for UTIs
Nursing interventions for MS
Exercises
Minimizing spasticity and contractures
Nutrition
Minimize immobility
Nursing treatment of MS for walking
Assistive devices
Gait training
Nursing treatment for bladder/bowels
Training to control and respond in time
self cath
Nursing treatment and sallowing
Speech/language pathologist to assist with dysphagia
MS and home living
assistive eating devices
raised toilet seats
bathing aids
phone modifications
long-handled comd
MS and sex
Go to sex counselor
be open
Crohn’s disease 101
Chronic inflammation of GI
Most common in distal ileum and ascending colon
Crohn patho
small lesions that expand and thicken becoming fibrotic
intestinal lumen narrows
S/S of crohn
prominent right lower quadrant pain
unrelieved diarrhea
pain occurs after meals
Secondary complications of crohns
weight loss
malnutrition
anemia
stretorrhea and chron
fat in feces
Assessment for crohns
CT and MRI
Crohn bowl complications
obstruction
structural problems
perianal disease
Enterocutaneous fistula - opening between small bowels and skin
Enterocutaneous fistula
opening between small bowels and skin
Ulcerative colitis 101
ulcerative inflammatory disease of mucosal and submucosal layers of colon and rectum
Characteristics of Ulcerative colitis
Abdominal cramps
Bloody/purulent diarrhea
LEFT lower quadrant pain
Weight loss
six or more liquid stools a day
Patho of ulcerative colitis
mucosa become edematous and inflamed
colonic epithelium sheds
Eventually the bowel narrows, shortens and thickens
Assessment for ulcerative colitis
abdominal x ray
colonoscopy
Ulcerative colitis may lead to toxic mega colon this is treated with
NG suction
IV fluids
Lytes
Corticosteroids
Antibiotics
SURGERY
Diet for ulcerative colitis
Oral fluids
Low residue
High protein, high calorie diet
Supplemental vitamins, iron
Food to avoid with ulcerative colitis
cold food
milk
Rx or ulcerative colitis
sedatives antidiarrheals antiperistalitics for diarrhea
Aminosalicilates to reduce inflammation
Corticosteroids to reduce swelling
Immunomodulators to treat underlying cause
Partial or complete obstruction or bowels =
surgery
Colectomy and ileostomy
removal of colon and stoma for drainage
used in IBD problems
Restorative proctocolectomy with Ileal Pouch Anal anastomosis
Redirects GI process while intestines heal
Prevents permanent ileostomy need
Normal elimination nursing interventions
food diary
give meds
increase fluid intake
record frequency and consistency of stool
Pain nursing interventions for IBD
Analgesics
Position changes
Heat
When doing parenteral nutrition for IBD patients monitor
glucose q6h
Mental health and ulcerative colitis
Promote rest
Reduce anxiety
Enhance coping measures
With bedridden IBD patients monitor for
skin breakdown
2 types of TB
Active- showing symptoms, neutrophils and macrophages fight infection
Latent- NOT active but carrier of encapsulated bacteria
Ghon complex
Latent TB
Cheesy protective casing of TB bacteria
Bursts when PT is immunocompromised
Most obvious TB S/S
Cough lasting more than 3 weeks
low grade fever
blood in sputum
if PPD test is greater than 10mm
POSITIVE
Induration (raised) MUST be present
PPD test is considered
SCREENING not diagnostic
TB GOLD, Chest xray and Acid fast are diagnostic
ACID FAST CULTURE IS THE GOLD STANDARD OF TB TESTING
Is tuberculosis an aerobic bacteria
YES
hence the lungs
Standard number of meds to take for TB
4
isoniazide
Rifampin
Pyrazinamide
Ethambutol
All TB meds are toxic to
LIVER
do enzyme tests
For tb take B6
take meds 1 h _ meals
when to take
to prevent neuropathy
before
SAME TIME QDAY
When is a TB patient not contagious
after 2-3 weeks
AND
3 negative sputum cultures
AND
Med compliant
when are sputum samples done for TB
Q2-4W
Helps track progress
Drinking on TB meds
NO
S/S or hepatotoxicity
S/S nerutoxicity
Jaundice, Right upper quadrant pain, Fever
Numbness, tingling
Anaphylactoid reaction
Not same as anaphylaxis
NON IgE
No sensitization
Fluids with Anaphylaxis
Increased permeability of capillaries
Fill up with fluid in lungs
N/V/D etc.
If you have Mild anaphylaxis now
DOT NOT mean will have Mild anaphylaxis next time
Solution to push IV for anaphylaxis
Isotonic
LR
NS
Nursing managment basics for anaphylais
Stop allergen
Give epi FIRST, IV, O2
If you have allergy
awareness
wear bracelet
Inform school nurse/teachers
ask for return demonstration when showing how to use
Hold epipen in injection place for
FULL 10 SECONDS
Types of lupus
Discoid
Cutaneous
Medication induced
Lupus is thought to be linked to
Estrogen
Higher rate in women
Most common sign of lupus
Low grade fever
joint pain
MALAR RASH ON TEST (the nose cheekbone thing)
Discoid lesions
Scaly
very clear
cause alopecia
Sign of LUPUS
Lupus and sun
Photosensitivity
Worsens the rash and lesions
Lupus related arthritis
Swelling of joints due to lupus
BILATERAL AND SEMETRICK
S/S of nephritis
Cloudiness blood or puss in urine
Pain at kidneys
BUN Creatinine urinalysis labs
Indicative test for lupus
ANA
History of symptoms
Why are kidneys stressed during lupus
Kidneys are our filters
NEED EM
Meds for lupus
hydroxychloroquine
corticosteroids
Methotrexate and azathioprine (immunosuppressants)
NEED TO BE SAFE BECAUSE THESE MEDS WILL DISTROY IMMUNITY
As nurses helping with lupus
Manage pain
Rest
MONITOR KIDNEYS
V/S, edema, breath sounds
Monitor Mental status
for alergic reactions do you shut the med off first or give epi
SHUT THE MED OFF
Clean mouth with lupus
and avoid
soars are sensitive
spicy foods and alcohol
1 pt education of lupus
MEDS ARE IMMUNOSUPRESSANTS, let everyone know and make sure pt understands what that means
Wear masks, avoid public places
RA joint deformities can result in
loss of use
3 DISTINCT CHARACTERISTICS OF RA
Inflammation
Autoimmunity
Degeneration of articular cartilage
Contractures
muscles bones joints get stuck due to joint destruction RA
When in they day is the pain worse
MORNING
ON TEST
RA starts at
Joints of fingers
RA hand deformities
Subluxation ?
Boutonniere —\ finger
Swan neck ^v^ finger
RA foot deformities
Major bunion
Toes going in different directions
Why doe joint deformities happen
destruction and recalcification of tissue
Biggest difference between lupus and RA
Degeneration and destruction of tissue with RA
ON TEST
Diagnosing RA
Rheumatoid factor RF is the standard
ANA will pop for autoimmune problem but will NOT narrow down the disease
Types of exercises for RA
Types of meds
Range Of Motion
NSAIDS CORTICOSTEROIDS DMARDS
STAY AWAY FROM PEOPLE
HIGH INFECTION RISK
DMARDs
stop progression but can not fix damaged joints
does not work indefinitely
Nonbiologic - take longer to work then biologic
Infliximab DMARD
Works to improve the immune system
MS
autoimmune disease
Degenerative disease
demyelinating of nerves
Affected nerves are random, this is why symptoms are random
MS symptoms are determined by
Scarring
MS affects _ 2x more
women
Can you get myelination back with MS
NO
Diagnosing MS
MRI
CSF spinal tap
EMG - assesses nerve response
Neuro exam
MS meds are immunosuppressive so
Wear masks
Stay away from crowds
Take steps to not get sick
DMARDs decrease
Frequency and duration of relapse
Can decrease plaque in brain
WILL BE ON TEST
Main focus of nursing care for MS
Safety first
assistive devices
Bladder/bowel care
Cognitive function
Meds
Ulcerative colitis only affects
Starts at
Mucosal and Submucosal layers
Low part of rectum and works its way up
Crohn’s disease affects
All layers of intestine from mouth to butt but not continuously
here and there
movement number
Ulcerative colitis UC pain will start at
15 to 20 bowel movements
Left lower side
Bleeding
movement number
CD pain
5 stool movements
pain in right lower quadrant
UC complications
Loss of Haustra - smooths out intestine, these parts can absorb nutrients
Toxic megacolon - colon dilates, inflammation. Unable to contract, distends, becomes paralyzed
Cobblestone intestine is related to
CD
IBS labs
Albumin will be LOW malnutrition
ESR, C reactive protein - inflammation
Stool sample
CBC
Chem panel
IBS diagnostics
MRE - magnetic resonance enterography
MRI/CT
Sigmoidoscopy
Colonoscope
Endoscopy
With IBS diet avoid
FIBER - will make you shit more
POPCORN - will get stuck and infected
RED MEAT - slow digestion
Peal fruit and veg
IBS treatments side effects
5 Aminosalicylic acid - nausea fever rash, kidney toxicity
Steroids and immunosuppressants - avoid getting sick
Surgery for IBS
Always give
Ileostomy, Colectomy, Proctocolectomy
ANTIBIOTICS
IBS diet
Low fiber
High protein
High calorie
Toxic megacolon treatment
NPO
bowel suction
TPN
if not resolved by 3 days, surgery
Before applying a valve sticker to the colostomy use
barrier cream, prevents skin breakdown
