Test 4 Allergies & immune disorders

Question 1

1. What are the different OTC medications for seasonal allergies? What are the advantages and disadvantages of each? (ch.34 pp slide 9)

Answer 1

 Drug therapy: diphenhydramine (Benadryl), pseudoephedrine hydrochloride (Sudafed), fexofenadine (less sedating), take care w/sedating antihistamines
 Desensitization: immunotherapy, client receives weekly or twice weekly injections of dilute but increasingly higher concentration of an allergen w/out interruption

Question 2

2. What is the vaccine for HPV (733)? What is HPV (pg.1016)?

Answer 2

 Gardasil
 sexually transmitted infection that causes venereal warts; transmitted by genital–genital, genital–anal, or genital–oral contact with an infected person and contagious as long as the warts are present.

Question 3

3. Lupus manifestations

Answer 3

 Alopecia
 Butterfly rash on nose & cheecks, dry brittle skin
 Later sx: peripheral edema & impaired renal function
 Blurred vision, weakness
 Anemia, anorexia, weight loss
 Fatigue/malaise
 Fever, joint pain, swelling & tenderness
 Pericarditis, Raynaud’s phenomenon
 Depression

Question 4

3. Lupus Risk groups

Answer 4

 More common in woman than men
 Females age 15-45 years old
 Asian, Hispanic, or African decent
 Can be caused by environmental or genetic factors
 Intake of meds used for seizures, HTN & infections

Question 5

3. Lupus client education

Answer 5

 Avoid sunlight & ultraviolet radiation
 Use sunscreens of SPF of 15 or higher & wear clothing that covers the arms and legs along w/wide brimmed hat to shade the face (no sunlamps or tanning booths)
 Allow for adequate rest periods w/regular activity to promote mobility, prevent joint stiffness & fatigue (major issue)
 Maintain well-balanced diet & increase fluids to raise energy levels & promote tissue healing
 Avoid crowds, people w/infections
 Periodically review medication program w/providers
 Take meds exactly as directed (DON’T STOP MEDS IF SX ARE RELIEVED)
 If sx become worse don’t increase the dosage or used over the counter drugs unless advised by provider
 Nonpharmacologic comfort measures: A moist form of heat may relieve joint stiffness (warm NOT hot soaks, wraps, towels), making sure not to burn skin
 Wash hair w/mild shampoo & soaps, avoid irritants

Question 6

4. Fibromyalgia: manifestations, client education (ATI pg.520)

Answer 6

Manifestations:
 All-over joint pain
 Migraines, IBS

Client Education:
 Limit intake of caffeine, alcohol & other substances that interfere w/sleep
 Avoid: cured, red meats, fried foods/artificial trans-fat, artificial sweeteners & foods high in carbs
 Some clients are advised to change or reduce their work schedules in order to improve overall health
 healthy diet: dark leafy greens, bananas, sweet potatoes, healthy fats, antioxidants
 Engage in regular, low impact exercise
 Develop a routine for sleep

Question 7

5. RA: manifestations (ATI pg.425)

Answer 7

 Swelling
 Redness
 Warmth
 Pain at rest or after immobility (morning stiffness)

Question 8

6. Methotrexate K,H,K (Pharm ATI.pg.240, Pg.213)

Answer 8

 Immunosuppressant: avoid large crowds, fresh fruits, or flowers, people w/infections
 Avoid alcohol
 Given for RA (cytotoxic drug)
 Avoid live vaccinations(MMR, rotavirus, small pox, chicken pox, yellow fever)
 Report manifestations of infection (fever, sore throat)
 Can cause alopecia, renal damage, hepatotoxicity w/long term use (monitor LFT’s & kidney function tests)

Question 9

7. Gout manifestations

Answer 9

 Severe joint pain (specially in metatarsophalangeal joint of the great toe)
 Redness, swelling & warmth on affected joint
 Painful, swollen joint that is very painful if touched or moved
 Appearance of tophi (deposits of uric acid crystals)
tight appearance in skin

Question 10

7. Gout causes

Answer 10

 Uric acid production that is greater than excretion of it by the kidneys
 Genetics
 Middle & older adult males
 Secondary: caused by another disease or condition (chronic kidney failure, some carcinomas, excessive diuretic use), can affect people of any age.

Question 11

7. Gout client education

Answer 11

 Stay on a low-purine diet, which includes no organ meats or shellfish.
 Limit alcohol intake
 Avoid starvation diets, aspirin & diuretics
 Limit physical or emotional stress
 Increase fluid intake
 Practice medication adherence
 Use stress management techniques

Question 12

8. Allergy testing and client education (ch.34 pp slide 8)

Answer 12

Diagnostic Tests:
 Radioallergosorbent blood test (RAST)
 Scratch or prick test, patch test, intradermal injection test, skin testing w/extracts of various substances (antigens)
 Elimination diets: try to establish cause & effect relationships
Client Education:
 Clients w/inhalant allergies or allergic rhinitis may develop nasal polyps from the chronic inflammation
 Prone to sinus infections, secondary pulmonary infections & asthma

Question 13

9. Hydroxychloroquine K,H,K (pg.869)

Answer 13

 May cause blurred vision (monitor corneal changes)
 Produces immune suppression but reduces inflammation (avoid large crowds, fresh fruits, or flowers, people w/infections)
 Report manifestations of infection (fever, sore throat)
 Monitor for rashes (steven Johnson’s syndrome)
 Not safe during pregnancy

Question 14

10. Lyme disease: stage 1

Answer 14

 Red macula/papule @ site of bite
 Bull’s eye rash (erythema migrans)
 Round rings surrounding the center
 Neck stiffness, Headaches
 Pain

Question 15

10. Lyme disease: stage 2

Answer 15

 Pruritic lesions
 Fever, chills, malaise
 Papules (develops 20-30 days after bite)
 N/V
 Sore throat, flu- like sx

Question 16

10. Lyme disease stage 3

Answer 16

 @ least 4 weeks after bite
 Arthritis
 Musculoskeletal problems
 Joints (mainly knees) are warm, swollen & painful
 Joint erosion resulting from inflammation

Question 17

10. Lyme disease prevention (pg.880)

Answer 17

 Wear light colored clothing (increases tick visibility)
 Wear long sleeved shirts & long pants (tuck pants into socks or boots)
 Treat clothing w/tick repellant
 Wear a hat, pull long hair back so it doesn’t brush against shrubs or other vegetation
 Walk in the center of a path surrounded by grass, brush or woods
 Take a shower ASAP after potential exposure to ticks (tick check in hairy areas & back of the knees & neck)
 Run clothes in hot dryer for 10 mins before washing them to kill any ticks left on the clothes. (remove ticks w/tweezers)
 Apply antibacterial ointment to bite

Question 18

11. Allergies: subjective manifestations

Answer 18

 Pruritus
 Nausea
 Uneasiness- oxygen

Question 19

11. Allergies objective manifestations

Answer 19

 Sneezing
 Excessive nasal secretions & tearing
 Dark circles under eyes
 Inflamed nasal membranes
 Skin rash
 Diarrhea
 Cough, wheezes, impaired breathing

Question 20

11. Allergy nursing considerations/preventions

Answer 20

-remove rings from swollen fingers
-schedule for diagnostic skin testing: avoid taking prescribed or over the counter antihistamines or cold preparations for at least 48-72hrs before testing.
-Instruct on use of epipen
-Administer serial doses & monitor after desensitization
-Client & family teaching to avoid or reduce exposure
-Latex allergies: use non latex gloves & non latex equipment, avoid rubber stoppers on vials

Question 21

12. Types of Immunity (CH.34 pp slide 3)

Answer 21

Naturally Acquired active: occurs as a direct result of infection by a specific microorganism (measles)
Artificially acquired active: results from administration of a killed or weakened microorganism or toxoid (influenza)
Passive immunity: ready-made antibodies are given to a susceptible person (newborns receive passive immunity to some disease for which their mothers have manufactured antibodies)

Question 22

13. Autoimmune disorders nursing management (pp slide 15)

Answer 22

-Obtain fam hx & V/S
-Examine client for signs of localized inflammation & compromised body functions
-Assess pharynx & level of energy
-Review lab test findings (report patterns to identify exacerbations)