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410 Patho exam 6 > Transplant, MS, & HIV > Flashcards

Transplant, MS, & HIV Flashcards

1
Q

The following flashcards are going to be on the Transplant, MS and HIV recording posted on blackboard

A
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2
Q

First thing we are going to talk about is transplants

most of the time we have to give transplants in whole, so like the entire organ needs to be donated

however, liver, lung and bowel can be transplanted in segment

A
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3
Q

how does the transplant process typically work ?

A

recipients match with donors based on ABO blood and HLA typing, medical urgency, time on the waiting list and geographic location

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4
Q

What is HLA ( human leukocyte antigen ) typing and testing mean ?

A

how much antigens a patient has and its compared to the donor and the more similar, the more likely the transplant is to be successful

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5
Q

what type of medication are we placing patients who have a transplant on?

A

immunosuppressive therapy

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6
Q

how many medications are patients with transplants usually are taking ?

and how are they taking it?

A

3 drugs at a time
high dose

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7
Q

why do we give patients who have a transplant a high dosage of drug first then slowly taper down ?

A

to prevent signs of rejection

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8
Q

most of the time patients who have received a transplant are going to be on what ?

so we have to tell them what?

A

these drugs for life

monitor signs of infection because again, its suppressing your bone marrow to prevent rejection, however it surpresses it so you won’t be able to fight off infection

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9
Q

what are the 3 types of transplant rejections that we need to know ?

A

hyper acute rejection
acute rejection
chronic rejection

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10
Q

what is the hyper acute rejection?(patho)

time frame ?

treatment ?

A

presence of antibodies cause destruction of blood vessels

24 hours of rejection

transplanted organ must be removed

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11
Q

what is acute rejection ?
time frame ?
treatment?

A

occurs within first 6 months

is potentially reversible-treated with high doses of immunosuppressants

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12
Q

what is chronic rejection ?
what does it result in?
treatment ?

A

occurs over months to years causes is unknown

results in scarring of transplanted organ

supportive

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13
Q

we discussed all the typical rejections right, usually your own body does not like the foreign transplant body part coming in.

however we can have something called graft vs host,which is ?

A

when the transplant does not like the recipient

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14
Q

typically graft vs host is mainly found in patients who are receiving what ?

A

stem cell transplants

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15
Q

what is the path behind graft vs host ?

A

T cell attack recipient cell-skins, liver and gi tract

skin - rash
liver - hepatic coma
gi - gi bleed

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16
Q

what is the treatment for graft vs host?

A

immunosuppressants work best to prevent but we can use steroids or radiate stem cells before transplants

but no real specific treatment

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17
Q

now the following flashcards are going to be about osteomyelitis

A
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18
Q

what is osteomyelitis ?

A

severe infection of bone, bone marrow and surrounding soft tissue

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19
Q

what is direct osteomyelitis ?

what is indirect osteomyelitis ?

A

open wound, foreign body, DM

elderly, sickle cell, hemodialysis

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20
Q

what is the patho behind osteomyelitis ?

A

microorganism enter blood and grow, increasing pressure in bone, leading to ischemia and vascular compromise of periosteum

infection spreads through bone, cortex and marrow cavity, causing obstruction of blood flow and necrosis

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21
Q

most of the time in osteomyelitis, typically from the lack of good blood flow reaching the bone, infection is very hard to treat, but what do you think we will use to try to treat this ?

A

antibiotics

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22
Q

what is acute osteomyelitis?

A

last less than 1 month, many systemic manifestion

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23
Q

what is chronic osteomyelitis?

A

lasting longer than 1 month or failed antibiotics treatment

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24
Q

what are major complications from osteomyelitis?

A

septicemia, septic arthritis, pathologic fractures

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25
Q

no matter if the patient has acute or chronic osteomyelitis what is the first thing we will do ?and why?

A

culture it - in order to provide the proper antibiotic to treat the infection

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26
Q

how long is the acute antibiotic treatment?

A

PICC or central line for 4-6 weeks

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27
Q

how long is the chronic antibiotic treatment ?

A

PICC or central line for 8 weeks or more

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28
Q

notes
osteomyelitis nursing management

history
- look for risk factors
- evidence of systemic symptoms

assessment
- assess for evidence of infection, pain level, mobility

goals
- manage pain and fever
- minimal to no long term complications

A
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29
Q

what are some basic interventions we are going To do for these patients ?

A

immboliaztion of affect limb

manage pain and muscle spams

sterile dressing change

prevent complications related to immboilty

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30
Q

what are the 3 most common kinds of antibiotics we are going to use to treat osteomyelitis is what?

A

aminoglycoside
cephalosporins
fluoroquinolone

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31
Q

aminoglycoside
what is our main concern ? (2)

A

oto and nephro toxic
( hearing and kidney )

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32
Q

cephalosporins
main concern for this ?

A

allergy for penicillins
- hives, bloody stools

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33
Q

fluoroquinolone
what major complications ? (2)

who is more at risk for developing this condition (2)

A

tendonitis
tendon rupture

elderly patient and steroid usage patients

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34
Q

now the following flashcards are going to be about rheumatoid arthritis

A
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34
Q

what is rheumatoid arthritis ?

A

chronic, systemic autoimmune disease, inflammation of connective tissue in diarthroidal ( synovial ) joints

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35
Q

how is the pain for patients who have rheumatoid arthritis?

A

symmetrical joint pain

joint stiff after inactivity

pain increases with motion

morning stiffness 60mins to several hours

joints tender, painful warm to touch

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36
Q

what is the big key difference to rheumatoid arthritis vs osteoarthritis ?

A

osteoarthritsi - typically as we age, from overuse or injuries to the bone and usually one side or one joint hurts

rheumatoid
- autoimmune and almost all or both joins hurts

37
Q

can you describe to me what a patient will feel like with rheumatoid arthritis in the morning ?

moving pain?

what about not moving ?

how does to feel like?

A

morning stiffness for 60mints

pain with motion

even without motion, it will stiffen up

tender, painful, warm

38
Q

the sad part of rheumatoid arthritis is what ?

A

periods of remission and exacerbation

so you can be fine then flare up then be fine and continue like that for life

and on top of this, systemic issues

38
Q

what are the 3 contractures names and how does it look like ?
describe the image

test question

A

ulnar drift
- fingers are drifting away to the ulnar side, or like to the pinky side

boutonniere deformity
- placing your fingers on the table like your ready to tap on them

swan neck deformity
- fingers are showing like a swan neck

39
Q

why do contracures develop for patients who have rheumatoid arthritis ?

A

if they keep their fingers in a flex position or if they are not moving their fingers

40
Q

how do you diagnose rheumatoid arthritis ?

A

history and physical exam
lab work

41
Q

something important we have to know about rheumatoid arthritis is the lab work.

what does ESR
( sedimentation rate )
&
CRP
( c reactive protein )
tell us about a patient?

A

it tells us that if they are present, there is an inflammation going on somewhere in the body, doesn’t say what exactly is the cause, but just states that their is inflammation

42
Q

additional about diagnosis, what is so special about ANTI-CCP and ANA for patients with rheumatoid arthritis ?

A

ANTI-CCP - is the antibody specific to RA

ANA - comes up in lab work when we can see an autoimmune reaction is occurring

43
Q

how do we treat rheumatoid arthritis ?

A

DMARDS
( disease-modifying antirheumatic drugs )

44
Q

how is DMARDS going to help patient with RA?

A

slow disease progression and decrease rick of joint deformity and erosion

45
Q

what is the medication we need to know about for DMARDS for RA? (3)

A

methotrexate
sulfasalazine (azulfidine)
hydroxychloroquine (plaquenil)

46
Q

how long does it take for methotrexate to start working?

when do we start this?

what are the side effects (2)?

A

4-6 weeks
early treatment
( beginning phases )

bone marrow suppresion
hepatotoxicity

47
Q

typically for sulfasalazine we give it along with hydroxycholorquine for better effectiveness

however what do we recommend patient do do?

A

drink fluids & wear sunscreen

48
Q

plaquenil or hydroxycholorquine has a big risk for developing what ___ and so we have to do this ____

A

vison loss

baseline eye exam and 6-12months eye exam

49
Q

not only are we going to use DMARDS for RA, we can also use another class of medication called ?

A

tumor necrosis factor inhibitors

50
Q

what is the tumor necrosis factor medication we need to know ?

A

tofacitinib ( xeljanz )

51
Q

what is the function of tumor necrosis factor medications ?

A

look for cancer cells and destroy

52
Q

so what is the sad part about giving patients tumor necrosis factor inhibitors?

A

we are increasing the risk of developing cancer cause we are killing off these cells that do the killing of cancerous cells

53
Q

what do we have to tell patients when they are on tumor necrosis factor inhibitors?

A

avoid live vaccine
monitor for infection

54
Q

what are the 2 live vaccines we tell patients to avoid?

A

mmr
varicella

55
Q

NOTES
RA- NURSING MANAGMENT

History and exam-focus on family history, joint and systemic symptoms, previous surgeries, medications
Nursing diagnoses: Impaired mobility, Chronic pain, Disturbed body image
Nonpharmacologic interventions
Nondrug therapy
Balance of rest and activity
Heat and cold application
Relaxation techniques
Joint protection (see Tables 64-4 and 64-11 in the textbook)
Biofeedback
TENS
Hypnosis

A
56
Q

its important to tell patients to cluster things together and then have rest periods to avoid the pain

temperature
sore/swelling - cold
pain - warm

A
57
Q

Alternate rest periods with activity
Helps relieve pain and fatigue
Avoid total bed rest
8 to 10 hours of sleep plus daytime rest
Firm mattress or bed board
Encourage positions of extension
Avoid flexion positions
No pillows under knees
Small, flat pillow under head and shoulders

Energy conservation
Work simplification techniques
Pacing and organizing
Use of carts
Joint protective devices
Delegation
Occupational therapy
Assistive devices

A
58
Q

what’s cold used for RA typically?

what is heat usually helped for in ra?

A

swelling/sore

relieve chronic stiffness

remember dont use more than 10-20mintues

59
Q

now the following flashcards are going to be about lyme disease

A
60
Q

how is lyme disease caused by ?

A

deer tick

61
Q

what is the characteristic of Lyme disease?

A

bulls eye rash

62
Q

how does the bull eye rash feel like?

A

warm and not itchy/painful

63
Q

what are other symptoms other than the bulls eye rash ?

A

flu like symptoms
- low grade fever

64
Q

its very important to note that Lyme disease can go away on its own by the body own defenses, however if we dont treat it can cause what? (3)

A

arthritis & cardiac heart block and bells palsy

65
Q

generally we have to tell patients to wait ____after a tick bite in order to be properly tested

A

4-6 weeks

66
Q

what do we do to treat lyme disease?

A

oral antibiotics
- doxyclcine, cefuroxime and amoxicllini

67
Q

how long is the treatment for Lyme disease?

A

10-21 days

68
Q

if a patient ends up having cardiac or neuro issues when having Lyme disease, we have to do what?

A

give iv antibiotics

69
Q

the following flashcards are going to be about systemic lupus erythematous

A
70
Q

what is systemic lupus erythematous?

A

multisystem autoimmune disease

71
Q

how does lupus present itself on patients?

A

butterfly rash - vascular lesions across the face, and worsens during sun exposure

72
Q

Renal system-goal is to preserve renal function

Hematologic system-clotting disorders, neutropenia, thrombocytopenia

Neurologic system-seizures, cognitive dysfunction, psychiatric disorders

Goals
Have acceptable pain management
Show awareness of and avoid activities that worsen disease
Maintain optimal role function and positive self-image

A
73
Q

the following flashcards are going to be on scleroderma ( systemic sclerosis )

A
74
Q

what is scleroderma ( systemic sclerosis ) ?

A

connective tissue disorder characterized by fibrotic, degenerative, and sometimes, inflammatory changes in the skin, blood vessels, synovium, skeletal muscle and internal organs

75
Q

how do we treat scleroderma?

A

calcium channel bloockers
angiotensin
vasodilator
NSAIDS
vasoactive drugs

76
Q

if youre patient has raynauds phenonoment and on scleroderma, what do we want to avoid ?

A

finger sticks

77
Q

the following flashcards are going to be about HIV

A
78
Q

how is HIV spread?

A

blood and body fluids

79
Q

what is the normal CD4 T-CELL count?

what is when you start having immune problems?

what is when you are getting worse?

A

800-1200 cells
500 cells
less than 200 cells

80
Q

how long do CD4 cells live for?

how long do they live for when you have hiv?

A

100 days

2 days

81
Q

typically if a patient goes out to a bar and hooks up and decides to go get tested the following day, the results will not show positive. why is so?

A

it takes about 6 weeks for an infection to truly start developing and honestly when the results come back

82
Q

in the acute infection process for hiv, how does it look like?

occurs when ?

are they infectious?

A

flu like symptom
- fever, sore throat, headache

2-4 weeks after infection

highly infectious

83
Q

after the acute infection, after this they progress into the asymptomatic infection

which really no symptoms or any signs of infection

however, if left untreated or looked at, what happens?

A

aids after 10 years

84
Q

however not everyone is asymptomatic after the inital acute infection, some become symptomatic

what is going on for their CD4 T cells?

A

declines closer to 200 cells

and symptoms become 100x more worse than before

85
Q

what are some opportunities infections that can occur with patients who have HIV?

A

oral hairy leukoplakia
thrush
kaposia sarcoma

honestly anything

86
Q

what are diagnostic study for hiv?

A

CD4 cell count
viral load

87
Q

what is the criteria for aids? (4)

A

less than cd4 200
one opportunistic infection
one opporunitinstic cancer
wasting syndrome

88
Q

what is the drug therapy for hiv?

A

antiretroviral therapy

89
Q

Do not make assumptions about who may be at risk.
Candid conversation is important for effective management of HIV.
Ask at-risk patients:
Received blood transfusion or clotting factors before 1985

Goals for care are aimed at
Adherence with drug regimens
Adopting a healthy lifestyle
Protecting others from HIV
Beneficial relationships
Explore spiritual issues
Coping with the disease and its treatment

A
90
Q

remember the lower the hiv viral load = the less likely to expose to others and have symptoms

A

410 Patho exam 6 (5 decks)

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