Tiffany Test 3 Flashcards
AIDS
- Most common secondary immune deficiency disease in the world
- Identified in 1981
- Serious worldwide epidemic
Laboratory Assessment of HIV
- Lymphocyte counts
- CD4+ T-cell and CD8+ T-cell count
- Antibody tests
- ELISA - first
- Western blot- if elisa is positive then do this
- Home tests (e.g., OraQuick In-Home HIV test)
- Viral load testing
- Blood chemistries, CBC, stool testing, biopsies
Viral load
amount of virus present in blood/other body fluids
Window Period
risk of transmission due to negative test during certain time frame
Drug Therapy for HIV
- Antiretroviral drugs – Multiple drugs used together in combinations (HAART)
- NRTIs
- NNRTIs
- PIs
- Integrase inhibitors
- Fusion inhibitors
- Entry inhibitors
liver produces __ and _____
prothrombin and vitamin k
what is the result of a hematologic disorder?
impaired gas exchange and tissue perfusion
what are the diagnostic tests for hematologic disorders?
- peripheral blood smear: quick analysis of size and shape of RBC
- CBC: reb wbc count, h and h
- reticulocyte count- blood marrow function
- hemoglobin electrophoresis: detects abnormal forms of hemoglobin
- coombs: looking for blood typing
- serum ferritin, transferrin, and TIBC: measure iron levels
- PT: prothrombin time-measure bleeding and coagulation
- INR: measure bleeding and coagulation
- PTT: measure bleeding and coagulation
- anti-factor Xa test: heparin
- platelet aggregation: when using aspirin
what is anemia?
Reduction in number of RBCs, Hgb, or Hct
what are some causes of anemia?
impaired function, decreased production, increased destruction
∙ dietary problems ∙ genetic disorders ∙ bone marrow disease ∙ excessive bleeding
Systemic Manifestations of Anemia
▪ Integumentary
-pallor, cool to touch, brittle nails, intolerance to cold
▪ Cardiovascular
-tachycardia at rest and increases with activity, orthostatic hypotension, murmurs or gallops (when severe)
▪ Respiratory
-dyspnea on exertion, decreased O2 sats
▪ Neurological
-increased fatigue, decreased LOC, headache
Vaso-occlusive event (VOE)
-repeated episodes can cause organ damage and infarction
Etiology – ∙ HbS cells sensitive to ↓O2 conditions ∙ Sickle shaped RBC’s adhere to each other and vascular endothelium ∙ compromises circulation → pain → edema → tissue hypoxia → infarction Causes – ∙ low/high temps hypoxia ∙ dehydration ∙ physical exertion venous stasis ∙ stress ∙ pregnancy alcohol ∙infection
Sickle Cell Anemia manifestations
- Cardiovascular- low BP, slow cap refill
- Skin- pallor, cyanosis, ulcers
- Abdominal- damage to spleen and liver, look for pain, -enlargement of spleen or liver
- Kidney- poor kidney perfusion, chronic kidney disease, hyperkalemia, fluid volume overload
- Musculoskeletal- arms and legs are sites of blood cell occlusion, move all joints? look for swelling
- Neuro- during crisis at risk for stroke, and hypoxia, check LOC
Diagnosis of sickle cell anemia
∙ early diagnosis critical – all States mandate
newborn screening
Lab assessment:
- Percentage of HbgS
- CBC: anemia
- WBC: elevated
Diagnostic test:
-Based on complications: ie; EKG to r/o MI
Sickle Cell Crisis Interventions
1 priority is managing pain
Managing pain:
- IV analgesics: Opiods - IV hydration - Hydroxyurea - Complimentary therapies
Preventing sepsis:
- role of the spleen: immunizations - antibiotics - assessments - lab data
Perfusion:
- Remove restrictive clothing - Keep room > 72 degrees F - Keep extremities extended - Oxygen - Transfusion
reduce condition that is causing the sickling
IV opioids is the best way to manage pain, PCA
IV hydration- normal saline
IV fluids will hopefully reduce the clumping of the sickle cells
most patients who come in are dehydrated in sickle cell crisis so blood is hypertonic so give NS or hypotonic solution. BP will tell how hydrated they are
Hydroxyurea - medication that can help with sickle cell crisis
oral, reduce number of sickling events
comfortable in bed, extremities extended: get blood flow back, restricted clothing: can encourage clot formation, do not move knees above bed, keep temp above 72: cold causes vasoconstriction, elevated HOB no more than 30 degrees
decreases immune function can lead to sepsis
spleen can not function with our immunity response- get flu vaccine and pneumococcal
o2 given during crisis
transfusion with RBC will dilute hemoglobin s levels and will provide RBC when pt is anemic
*teaching prevention of sickle cell crisis, and when to come in for treatment: early is better!
DKA
- Uncontrolled hyperglycemia, metabolic acidosis, ketones
- Results from insulin deficiency and increase in counterregulatory hormone release
- Infection is the most common precipitating factor
DI
Water metabolism problem caused by an ADH deficiency (either decrease in ADH synthesis or inability of kidneys to respond to ADH) Classifications Kidneys: Do not conserve fluid Do not reabsorb water Put out large amounts of dilute urine Risk for dehydration!
Assessment findings in DI
think about dehydration due to massive water loss
skin- dry, cracked, poor skin turgor
lab values- hypernatremia due to loss of water
GU-Increased UOP, dilute, low specific gravity
Cardio-Hypotension, tachy, weak pulses, hemoconcentation (risk for hypernatremia)
Neuro-Great thirst, Decreased LOC (with dehydration)
Management of DI:
I/Os, IVF, weights, urine specific gravity
Oral chlorpropamide
Desmopressin acetate
Early detection of dehydration and maintenance of adequate hydration
Lifelong vasopressin therapy with permanent condition
Teach patients to weigh themselves daily to identify weight gain
SIADH Interventions
- Fluid restriction - patient is retaining water
- Drug therapy: diuretics, hypertonic saline (3% saline IV), Vasopressin antagonists
- Monitor for fluid overload
- Monitor labs
- Safe environment - Risk for seizure due to Sodium levels
- Neurologic assessment - Decreased serum sodium levels can lead to CNS/LOC changes
Posted care for hypophysectomy:
managing ICP and anything that will delay healing
Monitor neurologic response- change in LOC, vision, mental status, strength in extremities
Assess for post nasal drip- csf leak due to “digging around in brain” (clear drainage, positive for glucose, severe headache)
Elevate HOB- promote drainage to release any ICP
Assess nasal drainage- color, clarity, odor
Avoid coughing soon after surgery- can increase ICP
Assess for meningitis- sx in brain increases risk for meningitis. monitor temp, vitals, change in LOC, headache, neucoregidity
Hormone replacement- lifelong HRT
Avoid bending- decrease ICP
Avoid straining at stool- to decrease ICP
Avoid tooth brushing- can introduce foreign particles, and infection and can cause delay in healing in sx site
Numbness in the area of the incision
Decreased sense of smell
Vasopressin- at risk for DI
Monitor fluid balance- i/o’s, cardiovascular status
Adrenal Medulla
Catecholamine secretion
Epinephrine
Norepinephrine
Adrenal cortex
- sex hormones: androgen and estrogen
- sugar: glucocorticoids (cortisol): response to stress, protein, carb, fat metabolism. immune function, na+ and water balance, emotional stability, prevents - hypoglycemia - increases liver gluconeogenesis, maintains responsiveness of cardiac muscles
- salt - mineralcorticoids aldosterone- maintain ECF volume, promotes na and water reabsorption, potassium excretions
Glucocorticoids
Essential for life Main = cortisol Metabolism Response to stress Immune function Emotional stability Prevent hypoglycemia Catecholamine action = muscle cells
Mineralocorticoids:
Fluid and electrolyte balance
Regulated by RAS, K levels, ACTH
Aldosterone:
Regulates Na++ and K+
Promotes sodium and water reabsorption
Promotes potassium excretion
Manifestations Adrenal Insufficiency
- Hyperkalemia
- Hypoglycemia
- Hyponatremia
- Hypovolemia
- Weakness
- Anorexia, weight loss, fatigue
- Hyperpigmentation = Dark pigment on knuckles, knees, elbows
Interventions for addisons
-Interventions focus on fluid balance, fluid deficit, and preventing hypoglycemia
Hormone replacement therapy
-Priority: Prevent complications = risk for cardiac dysrhythmias secondary to hyperkalemia
- Monitor for hypoglycemia and hyperkalemia
- HRT
- Diet high in protein, carbs, and normal Na+
- Avoid stress, illness, and strenuous exercis
