S4E1 Flashcards
RA dx
XR
Positive rheumatoid factor
Synovial fluid analysis
Elevated ESR
CBC
HIV/AIDs dx
EIA w/ western blot
Viral load
CD4/CD8
CD4+ below ______ = AIDs
200
HIV/AIDs tx
Antiretroviral therapies
Name that disease
Progressive immunodeficiency
⬆️susceptibility to opportunistic infections
Attacks T-cells
Affects CD4+
HIV/AIDs
HIV/AIDs s/s
Any organ system involvement
Resp
GI
Onc
Neuro
Fatigue
HIV/AIDs causes
Bodily fluids
Transfused blood products
HIV/AIDs risk factors
Sharing dirty needles
Intimate contact
Blood transfusion prior to 1985
Infants born to mothers with HIV
AIDs opportunistic infections
Protozoan/fungus: pcp
Fungi: candidiasis
Viruses: harpies simplex 1 & 2
Bacteria: TB
PCP
Pneumocystis carinii pneumonia
Most common
Non-productive cough
Fever
Chills
Dyspnea
PCP can cause resp failure to develop after ______ days of initial appearance
2-3
PCP dx
Sputum induction
Bronchial-alveolar lavage
Trans bronchial biopsy (broncoscopy)
Candidiasis
Occurs in almost all pt with AIDs
Oral infection can spread through GI
Unable to absorb nutrients
Opportunistic conditions
Kaposi’s sarcoma
Wasting disease
AIDs dementia complex
Name the opportunistic condition…
Most common HIV related malignancy
Endothelial layer of blood/lymphatic vessels
Localized cutaneous lesions on skin or organs
Can lead to organ failure
Kaposi’s Sarcoma
Kaposi’s sarcoma dx
Biopsy
Name the opportunistic condition…
Profound involuntary wt loss
Protein-energy malnutrition(hyper metabolic)
Chronic diarrhea for >30 days
Chronic weakness
Intermittent/constant fever
Wasting disease
Nurse management for HIV/AIDs
Individualized plan of care
Know code status
Note fever and pattern if present
Asses tender/swollen lymph nodes
Monitor for s/s of infection
Look inside pts mouth
Encourage daily oral rinse(NS or Bicarb)
Standard precautions
Support in social impact coping
Discourage prognosis of AIDs
Eval pt for tx response
Baseline labs
Follow ups
Ensure viral load ⬇️ and CD4+ ⬆️
Asses for compliance vs resistance
Watch for neuro changes
GI issues
What can peripheral neuropathy in an HIV/AIDs pt be indicative of ?
Toxicity
Post exposure of HIV/Aids in clinic
Wash area
Report immediately
Go to ED
Take prescribed meds
Don’t forget paperwork from ED
HIV transmission prevention/reduction
Abstinence
Barrier devices
Avoid sharing needles, razors, tooth brushes, etc
No breast feeding if positive
No donating blood products if positive
Standard precautions
Nurse must education pt
Guess the disorder
Causes muscle pain & fatigue
W>M
Fibromyalgia
Fibromyalgia causes
Stressful/traumatic events (MVA)
Repetitive injuries
Illness
Certain diseases
No cause
Fibromyalgia s/s
Troubles sleeping
Morning stiffness
Headaches
Painful menstrual periods
Tingling or numbness and hands and feet
Thinking and memory problems(fibro fog)
Criteria for fibromyalgia
11 of 18 painful tender points
3 months or more
Fibromyalgia risk factors
Rheumatoid arthritis
Systemic lupus erythematosus
Ankylosis spondylitis
Women with fam Hx of fibromyalgia
Fibromyalgia providers
Rheumatologist
Physical therapist
Pain or rheumatology clinic
Fibromyalgia pharm tx
NSAIDs (muscle pain/stiffness)
Tricyclic antidepressants (restore sleep)
SSRI’s
Anticonvulsants
Fibromyalgia, nurse management
Individualized exercise programs
Therapeutic massage/heat applications
Make changes as needed
Stress management
Regular sleep schedule
Relaxation time throughout the day
Support/encouragement to improve QOL
Take their concerns, seriously
Education on medication regimen, and lifestyle interventions
Connect patient to support groups & I’m fine resources
Guess that autoimmune disorder
Exaggerated production of auto antibodies, resulting in chronic inflammation of connective tissues
Affect multiple organ systems
Recurring remission/exacerbation
W>M
Etiology unknown
SLE - systemic lupus erythematosus
SLE s/s
Facial arrhythmia(butterfly rash)*
Arthritis
Photosensitivity
Pleurisy *
Pericarditis *
Fever
Fatigue
Wt loss
Mouth/throat ulcers *
Neurological changes
Neurosis*
Seizures*
Depression
Psych
SLE nurse management
Prevent loss of organ function, disability
Monitor labs that reflect inflammation
Supportive, physical and psychological care
Apply heat packs to relieve joint pain/stiffness
Encourage exercise
SLE common nursing diagnosis
Fatigue
Impaired skin integrity
Body image disturbance
Knowledge deficit r/t self management of disease process
SLE patient teaching
Avoid ultraviolet light exposure
Encourage routine
Periodic screenings
Health promotion activities
Rest balance with exercise
Nutritious diet/dietary consult
Medication regimen with side effects
Cardiovascular/renal involvement risk of:
⬆️ risk of Artherosclerosis
Hypertension
Renal failure
SLE pharm therapy
Corticosteroids
Antimalarials
NSAIDS
Immunosuppressive agents
B-cell depleting therapies
How to Monitor organ involvement in SLE
Joint pain/stiffness, weakness, fever, fatigue, chills
dyspnea, Chest pain, edema of arm/legs
Size, types, location of skin lesions
I&Os
Serum lab work
Vitals
Weight
Inspect for hair loss
Check skin/mucous membranes for Petechia, bleeding, ulcers, paler, bruising
Guess that auto immune disorder
Chronic attacks on joints, tendons, muscles, ligaments, and blood vessels
Results in deformity
Spontaneous remission
unpredictable exacerbations
Requires lifelong treatment; sometimes surgery
Rheumatoid arthritis
Rheumatoid arthritis s/s
Bilateral joint pain, tenderness, warmth, swelling
Morning stiffness, Parathesias
Stiff, weak muscles
Rheumatoid nodules
Pannus tissue
Sleep disturbance
fatigue
Altered mood
Limited mobility
Rheumatoid arthritis pharmacy tx
Salicylates
NSAID
COX-2 enzyme blockers
Cortical steroids
Immunosuppressive
DMARDs
Antimalarials
Gold penicillamine
Sulfasalazine
Rheumatoid arthritis concerns
Addisonian crisis (⬇️ BP)
Hypoglycemia
Rheumatoid arthritis flareup triggers
Emotional/physical stress
Sick
Surgery
Rheumatoid arthritis, nurse management
Monitoring/managing medication side effects
Bone marrow suppress
Anemia
G.I. disturbances
Rush
Assess patient in taking medication correctly
Use adopted devices correctly
Occupational/physical therapy referrals
Support services: meals on wheels; arthritis association
Teach to maintain independence, function and safety in home
Sepsis schlock s/s
Sepsis (sirs+confirmed infection)
Hypotension won’t resolve with adequate fluids
General Sepsis labs & numbers
Lactate >2 mmol/L
WBC <4x10 /Lor >10x10/L
Creatinine > 2mg/dL
INR >1.5
APTT >60 seconds
Platelet <100x10/L
⬇️ urine OP
⬆️WBC (left shift)
⬆️CRP/ESR (inflammatory markers)
⬆️lactate (hypoperfusion markers)
⬆️glucose,creatinine,bilirubin(organ failure)
➕ blood cultures
Impaired coagulation (INR, PTT, platelets)
This improves morbidity and mortality outcome for sepsis
Early identification and appropriate management
Sepsis nurse management
Know H&P, labs & imaging
Prompt recognition
Timely antibiotic administration
Fluid resuscitation
Hemodynamic support
Control source of infection with or w/o sx
Studies to identify source of infection
Chest radiograph
Urinalysis
Blood cultures
CT
Surgical interventions for sepsis
Drainage
Debridement
Device removal
If sepsis is definite/probable and shock is either present or absent….
Administer antibiotics immediately, ideally within 1 hour of recognition
If sepsis is possible and shock is present…
Administer antibiotics immediately, ideally within 1 hour of recognition
If sepsis is possible, but shock is absent…
-Rapid assessment of infectious versus non-infectious causes of acute illness
-Administer antibiotics within 3 hours if concerned for infection persist
____________ is the first line vasopressor
Norepinephrine or epi
Target MAP for patient with septic shock on vasopressors
65 mm Hg
(Consider monitoring arterial BP)
_______ is the second line vasopressor
Dobutamine
Sepsis risk factors
Suppressed immune system
Extreme age (young or old)
Ppl who received organ transplant
Surgical procedure
Indeelling devices
Sickness
Existing wound
Pressure associated injury or infection
Infection risk
Hospital admission
Chronic disease
Genetics
Sepsis can lead to_____
MODS
MODS starts with _____
An infection
SIRS initially occurs with
A localized infection & inflammation that caused a wide spread inflammatory response
SIRS dx is 2 or more of…
Fever or <36
>90 bpm
>20 RR
PaCO2 of <32 mmHg
WBC >12x10 or <4x10
Sepsis is dx if…
Confirmed source of infection
&
Meets SIRS criteria (2 or more)
Severe sepsis (sepsis + organ dysfunction)
Hypotension
Hypoperfusion
Lactic acidosis
SBP <90 or drop of >40 mmHg
Low ph
Low bicarbonate
No improvement to hypotension if adequate fluid resuscitation isn’t working
Septic shock
MODS is…
Septic shock (sepsis+hypotension)
> 2 organs failing
______ occurs at the beginning of sepsis
SIRS (but sirs doesn’t always mean sepsis)
If concern for sepsis or septic shock, take vital signs every….
5 to 15 minutes
What does the map tell us?
How well organs are being perfused
Why do we use vasopressors during septic shock?
To keep map above 65
⬇️vasodialation
Why does lactic go up during septic shock?
Because body can’t use aerobic so they turn over to anaerobic to metabolize which means alter tissue perfusion
Why does hypovolemia/hypotension happen during septic shock
Extreme immune response
Vasodilation
Fluid leaves blood vessels goes into tissue
Causing edema & hypovolemia
Common sepsis sites
GI (abdominal)
Resp (lungs)
GU ( urinary tract)
Early “warm” stage of septic shock
Warm skin
Compensation happening
Vasodilation
Hyper dynamic
⬇️BP
⬆️HR
⬆️RR
Fever
⬆️CO
Restless
Anxiety
Late “cold” septic shock
Cold and clammy
Hypodynamic
Vasoconstriction
⬇️⬇️⬇️⬇️⬇️BP
⬆️HR
⬆️RR
Oliguria
Coma
Hypothermia
⬇️CO
Septic shock nurse management
Start antibiotics
Enteral nutrition
Protein activated C (drotrecogin Alpha)
Titrate Vasopressors (norepinephrine)
Initropics (dobutamine)
Crystalloids/colloid solutions
Steroids ( corticosteroids)
Hemodynamic monitoring
Oxygenate
Cultures (B4 ANTIBIOTICS!!!)
Keep glucose < 180
Monitor lactate & uop
⬆️ perfusion
Oxygenate
Fight microorganism
⬇️ inflammation
Nutrition
Control blood glucose vessels
