Test 3 CG Inflammation And Immunity Flashcards
Urate crystals deposit in joints and other body tissues causing inflammation
Can occur from Renal insufficiency, crash diets, chemo, diuretics
Urate crystals can form when you have high levels of uric acid in your blood. Your body produces uric acid when it breaks down purines — substances that are found naturally in your body.
Gout
Also called gout arthritis
Drug therapy for gout
What to take and why
Colchicine and NSAIDS for acute episodes -inflammation
Allopurinol (prevents Uric acid formation)
Diet for gout ?
Low protein diet
Avoid trigger foods
Push fluids
PH increases with alkaline foods
Low purine
Most common arthritis type
•Progressive loss of cartilage & bone in joints leading to loss of joint function & deterioration
•Cartilage disintegrates; bone & cartilage “float” in joint, causing crepitus & bone spurs
•Resultant pain & stiffness leads to decreased mobility
Osteoarthritis
S/s of osteoarthritis
Physical assessment/clinical manifestations
Older than 60/ history
•Joint pain & stiffness
Joint pain in the hands, neck, lower back, knees, or hips is the most common symptom.
- Crepitus
- Heberden’s nodes
- Bouchard’s nodes
- Joint effusions
- Atrophy of skeletal muscle
Tx options for osteoarthritis
Maintain proper nutrition to prevent obesity
Avoid injuries such as contact sports
Take breaks at work to rest joints
Decrease repeatative movements
Stay active and maintain a healthy lifestyle
NSAIDs - short term use
Acetaminophen/ analgesics
Rheumatoid arthritis complications and associated syndromes
Weight loss, fever, extreme fatigue •Subcutaneous nodules-not problematic •Respiratory, cardiac inflammation •Vasculitis •Periungual lesions-due to vasculitis/ischemia •Paresthesias-decreased circulation
- Associated syndromes
- Sjögren’s syndrome
- Felty’s syndrome
- Caplan’s syndrome
Tx for RA- drug therapy
Common connective tissue disease
•Chronic, progressive, systemic inflammatory autoimmune disease; affects primarily synovial joints but any connective tissue
•Autoantibodies (rheumatoid factors) form & attack healthy tissue, causing inflammation, erosion of cartilage & bone, fibrous adhesions & ankyloses
•Remissions & exacerbations common
- DMARDs
- BRMs
- NSAIDs
- Other
- Glucocorticoids
- Immunosuppressive agents
Non Pharm tx for RA
Adequate rest •Proper positioning •Ice & heat application •Complementary & Integrative therapies •Promotion of self-management •Management of fatigue •Enhance body image
Pathophysiology of RA (cause)
The body’s immune system attacking the tissues of the joints, causing pain and inflammation.
RA can cause permanent damage to joints, especially in the early years of the disease.
- Common connective tissue disease
- Chronic, progressive, systemic inflammatory autoimmune disease; affects primarily synovial joints but any connective tissue
- Autoantibodies (rheumatoid factors) form & attack healthy tissue, causing inflammation, erosion of cartilage & bone, fibrous adhesions & ankyloses
- Remissions & exacerbations common
RA s/s
- Physical assessment
- Early—joint stiffness, swelling, pain, fatigue, generalized weakness
- Late—joints become progressively inflamed & quite painful, swollen due to effusion in joint, deformities, osteoporosis, severe fatigue, muscle atrophy-spindle like fingers, decreased ROM; vasculitis (inflammation of the blood vessels)-this leads to organ involvement
S/s of lupus
Skin involvement •Butterfly rash from UV Fever-infection Weight loss •Polyarthritis •osteonecrosis •Alopecia-hair loss •Mouth ulcers •Muscle atrophy •Fever and fatigue •Renal involvement Heart problems /inflammation / raynauds Hematologic disorders Neurological disorders Fatigue Arthritis •Symptoms are not usually fatal **CHART 18-11, pg. 326
Patho / cause of lupus
Chronic progressive inflammatory connective tissue disorder
Can cause major body organs and systems to fail
Spontaneous remission and exacerbations
Complexes tend to be attracted to glomeruli of the the kidneys (lupus nephritis-leading cause of death)
Tx for lupus
Topical cortisone drugs
Plaquenil
Tylenol
NSAIDs
Chronic steroid therapy
Immunosuppressive agents
First drug approved in 60 years- belimumab-immune modulator
Contributing factors to lupus - may make it worse
Powder /drying agents
Rubbing skin
Strong soaps
Direct sunlight, uv light
Not wearing sunscreen
Not taking rest periods/stress
Infection
Life-threatening type I hypersensitivity reaction •Rapid, systemic •Blood vessel dilation •Bronchoconstriction •Decreased CO •Can be fatal
Anaphylaxis
Tx for anaphylaxis
Assess gas exchange first!!
establish or Stabilize airway
Stay with pt
Ensure airway care is available
Epinephrine -IV (preferred) OR IM
Antihistamines
Oxygen, ABGs, suction
Beta-adrenergic agonist
Corticosteroids, oral steroids
S/s of anaphylaxis
- Feelings of uneasiness, apprehension, doom
- Generalized itching, urticaria
- Erythema, angioedema of face
- Wheals or hives
- Congestion, rhinorrhea, dyspnea, bronchoconstriction, wheezing/stridor, respiratory distress & failure due to edema, suffocation, & hypoxemia
A severe type I hypersensitivity reaction that involves the blood vessels & all layers of the skin, mucous membranes, & subcutaneous tissues in the affected area
•Most common cause from drugs is ACEI’s & NSAIDS
Angioedema
Assessment and s/s of angioedema
History •Physical assessment •Deep, firm swelling •Face, lips, tongue, and neck •Immediate intervention for inability to swallow, feeling a lump in the throat, & stridor •Psychosocial assessment
Tx for angioedema
Maintain airway
Reduce anxiety
Severe angioedema is an emergency - call 911
Patient education to prevent anaphylaxis
Avoid allergens when possible
Wear medical alert bracelet
Carry anaphylaxis kit or epinephrine injector
Make sure medical records state allergens
Precautions of drug or agent must be used despite of allergy reaction
Increased response to antigen exposure
Allergies/hypersensitivity
Most common type of allergy
May only occur in area of exposure of antigen
Caused by increased production of antibody which causes inflammation
Allergens contracted by
•Inhalation (pollens, spores, animal dander, dust, grass, ragweed)
•Ingestion (foods, food additives, drugs)
•Injection (bee venom, drugs, biologic substances)
•Contraction (latex, pollens, foods, environmental proteins)
Type 1 rapid hypersensitivity - atopic allergy
Triggered by Plant pollens Molds Dust Animal dander Wool Food Air pollutants
Allergic Rhinosinusitis or hay fever
Examples. Of type 3 complex reactions where the body makes antoantibodies directed against self cells that have foreign protein attached to them
Type 2 reactions
- Reactive cell is T-lymphocyte (T-cell)
- Antibodies & complement not involved
- Local collection of lymphocytes & macrophages causes edema, induration, ischemia, tissue damage at site of exposure
- Example
- PPD-in a person previously exposed, intradermal injection causes T-cells to clump at the injection site, causes erythema
- Contact dermatitis from poison ivy, insect bites
Type 4 delayed hypersensitivity reaction
Development of inappropriate immunity
Antibodies and lymphocytes work against healthy cells and tissues (autoantibodies)
Immune system then fails to recognize certain body cells and tissues as self, which triggers immune reactions
Autoimmunity
Is there a cure for autoimmune disease?
What consists of immunosuppressive therapy?
No
Corticosteroids
Cytotoxic drugs
Selective immunosuppressive therapy
Anti-proliferative drugs
Disease modifying anti-rheumatic drugs
Chronic inflammatory autoimmune connective tissue disease
Hardening of the skin
Scleroderma
Standing after hip replacement
One foot straight in front face forward and the other leg bent down forward inner body with foot flat
Bony protrusion under nails near tip on fingers
Herberdens nodes
Tophi is what?
deposit of monosodium urate crystals, in people with longstanding high levels of uric acid in the blood
Can be on bones of fingers etc
Results from deer tick bite
Flu like symptoms and memory problems
Bulls eye appearance
Antibiotics treat it
Lyme disease
Skin Condition characterized by scaly itchy rash available’s knees and scalp
Joints are stiff especially in the morning
Manage pain and controlling skin lesions. Immuno suppressant’s
Psoriatic arthritis
Chronic pain syndrome
Knawing burning Nerve pain, stiffness, tenderness at certain areas of the neck upper chest trunk Loback extremities that
worsen in times of stress and increased activity and weather
Treated with Lyrica, gabapentin, SNRI, sleep, tramadol, muscle relaxers
Promotion of exercises, stretching, low impact
Fibromyalgia syndrome
