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191 Cards in this Set
- Front
- Back
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Body fluids or infected CD4 lymphocytes?
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Transmission of HIV
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Blood, seminal fluid, vaginal secretions, amniotic fluid, and breast milk?
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Transmission of HIV
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Infection occurs during delivery?
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Transmission of HIV
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Casual contact does not cause?
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Transmission of HIV
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Breaks in skin and mucosa increase risk?
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Transmission of HIV
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Sharing infected injection equipment?
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High Risk Behaviors HIV
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Sex with infected persons?
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High Risk Behaviors HIV
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Standard precautions, "safe" sex, abstain from sharing sexual fluids, reduce partners to one, always use condoms, do not share injection equipment, blood screening and treatment of blood products?
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Prevention of HIV/AIDS
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Wash area with soap and water, ID PT and secure testing, report to employee health or emergency room, start prophylaxis within 2 hours, if needle stick - milk?
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Occupational exposure to HIV / Aids
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Detects antibodies against HIV?
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(EIA) enzyme immunoassay (HIV / AIDS)
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Used to confirm EIA, detects antibodies?
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The Western Blot Test (HIV / Aids)
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Amount of HIV RNA in the system will be screened periodically throughout the disease process?
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Viral load (HIV/AIDS)
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Measure of immunity test used in HIV / AIDS?
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CD4 / CD8
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Primary, asymptomatic, symptomatic, full blown?
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Stages of HIV disease
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Acute infection / acute syndrome
CDC category A Symptoms are none to flu-like Window of time lacking HIV antibodies Rapid viral replication and dissemination throughout the body Viral set point balances virus and immune response? |
Primary infection HIV
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CDC category A
More than 500 CD4 T-lymphocytes Upon reaching the viral set point this begins Body has sufficient immune response to defend against pathogens May last 8-10 years? |
HIV asymptomatic
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CDC category B
200-499 CD4 + lymphocytes CD4 T-cells gradually fall Develops symptoms or conditions related to HIV that are not classified as category C Patients who are once treated for a category B condition are considered category B? |
HIV symptomatic
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Oral or persistent vaginal candidiasis
Fever and diarrhea over a month TB, pneumonia, sepsis, or meningitis? |
Category B diseases HIV
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CDC category C
Less than 200 CD4+lymphocytes As levels drop below 100, the immune system is significantly impaired Will have many conditions Will qualify for disability? |
Full blown AIDS
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Combination therapy used in the treatment of AIDS?
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HAART
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Nucleoside reverse transcriptase inhibitor (NRTIs)
Non-nucleoside reverse transcriptase inhibitors (NNRTIs) Protease Inhibitors (PIs) Fusion inhibitors Use of combination therapy HAART Entry inhibitors CCRS coreceptor antagonists HIV integrase strand transfer inhibitor? |
Treatment HIV / AIDS
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Management focuses upon the treatment on specific manifestations and conditions related to the disease?
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Treatment of HIV / AIDS
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Now viewed as a chronic disease that needs to be managed?
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HIV
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Occurring in HIV patients using PIs and having increased triglycerides?
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Hyperlipidemias
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The only statin drugs possibly safe for HIV patients?
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Pravachol and crestor
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HIV patients with insulin resistance and metabolic syndrome are associated with?
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The use of Protease inhibitors (PIs)
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More susceptible to risk factors
Not sure whether it is HIV itself or the medicines used to treat HIV? |
Cardiovascular disease
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Monitor lipid levels and blood sugar
Control blood pressure and weight, exercise, stop smoking TX conditions that develop? |
Combating drug complications in the HIV patient
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Are at risk for pathogenic infections that anyone can get as well as opportunistic infections in the environment that are normally kept in check by a healthy immune system?
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HIV AIDS
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The most common infection in the HIV / AIDS patient?
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Pneumocystis carinii pneumonia (PCP)
HIV / AIDS |
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Initial symptoms may be non-specific including non-productive cough, fever, chills, dyspnea and chest pain in the AIDS patient?
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Pneumocystis carinii pneumonia (PCP)
HIV / AIDS |
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If untreated, progresses to pulmonary impairment and respiratory failure in the AIDS patient?
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Pneumocystis carinii pneumonia (PCP)
HIV / AIDS |
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Treatment includes TMP-SMZ or pentamidine IV and prophylactic TMP-SMZ (sulfa drugs) for the patient with AIDS?
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Pneumocystis carinii pneumonia (PCP)
HIV / AIDS |
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Important in patients taking sulfa drugs?
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Avoid sunlight and push fluids
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Important to HIV patients taking Pneumocystis carinii pneumonia (PCP)?
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Monitor glucose and blood pressure
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How to rule out TB in the AIDS patient?
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Sputum culture
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May treat prophylactically if low CD4 counts
Will treat with biaxin or zithromax (MAC) in the AIDS patient? |
Mycobacterium avium complex (MAC)
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Could be due to new infection or reactivation of dormant
Will not have positive skin test due to low immunity / AIDS? |
Tuberculosis
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May progress to esophagus and stomach
Tx with Mycelex troches or nystatin and ketoconazole / AIDS GI? |
Oral candidiasis
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Given for severe chronic diarrhea related to HIV infection or enteric pathogens?
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Octrepotide acetate-sandostatin
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Common causes of diarrhea in AIDS patient?
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Cryptosporidium, salmonella, giardia
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10% weight loss and chronic diarrhea or chronic weakness and fever with absence of any of cause
Protein energy malnutrition Anorexia, diarrhea, malabsorption, and lack of nutrition contributes? AIDS |
Wasting syndrome
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Progressive cognitive, behavioral, and motor decline
Probably directly related to the HIV infection? |
HIV encephalopathy
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Cryptococcus neoformans
Depression and other neurological disorders? AIDS |
Manifestation of AIDS neurologically
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Direct effects of HIV or infections
HIV encephalopathy Cryptococcus and neuropathy? AIDS |
Manifestation of AIDS neurologically
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Treat with amphotericin B or diflucan in the AIDS patient?
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Cryptococcus
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Drugs to treat neuropathy in the AIDS patient?
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Neurotin or Lyrica
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Cutaneous lesions that may involve multiple organ systems, causing discomfort, disfigurement, ulcerations and potential infection
B cell lymphomas? AIDS |
Kaposi's sarcoma
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Physical and psychosocial
Risk factors Immune function Nutrition Skin Respiratory and neurologic Fluid and electrolyte Health knowledge? AIDS |
Nursing Assessment
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Impaired skin, diarrhea, risk for infection, activity intolerance, disturbed thought, infective airway, pain, imbalanced nutrition, isolation, anticipatory grieving, knowledge deficit?
AIDS |
Nursing Diagnoses
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Opportunistic infections
Impaired breathing or respiratory failure Wasting syndrome Fluid and electrolyte imbalance Adverse reaction to medication? AIDS |
Collaborative Problems
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Avoid foods that act as bowel irritants such as raw fruits and vegetables, carbonated beverages, spicy foods, and foods of extreme temperatures?
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AIDS
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Small, frequent meals
Administer medications as prescribed Assess and promote self-care strategies to control diarrhea? AIDS |
Promoting Usual Bowel Pattern
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Assess mental and neurologic status
Use clear simple language if mental status is altered Maintain daily routine Orientation techniques PT safety Maintain and improve functional ability Instruct and involve family in communication and care? AIDS |
Maintaining Thought Processes
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Monitor weight, I&O, dietary intake, and factors that interfere with nutrition
Provide dietary consultation Control nausea with antiemetics Provide oral hygiene Treat oral discomfort Administer dietary supplements May require enteral feedings or parenteral nutrition? AIDS |
Nutrition
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Is a major focus of rheumatology
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Conncective Tissue Disease (CTD)
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Is any disease or condition involving the musculoskeletal system?
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Rheumatic disease
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Inflammation of one or more joints?
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Arthritis
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Non-inflammatory arthritis is not?
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Systemic
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Inflammatory arthritis?
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RA and SLE
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Most common connective tissue disease and the most destructive to joints?
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RA
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Chronic, progressive, systemic, inflammatory auto-immune disease primarily affecting the synovial joints?
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RA
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Onset is 20-40 with the most damage being done in the first six years?
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RA
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Autoantibodies, called rheumatoid factors, form and attack healthy tissue?
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RA
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Affects synovial tissue of any organ or body system?
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RA
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Synovial swelling and fluid accumulation?
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RA
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Pannus, eroded cartiledge and muscle atrophy
Degenerative changes and degredation Joint narrowing? |
RA
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Pain, joint swelling, limited movement, stiffness, weakness, fatigue?
RA |
Clinical manifestations
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Onset and evolution of symptoms
Family Hx Past health Hx Contributing factors? RA |
Assessment
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Functional, arthrocentesis, x-rays, bone scans, CT scans, MRIs, tissue biopsy, blood studies?
RA |
Assessment
Diagnostic Findings |
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Pulling fluid out of the joint for testing?
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Arthrocentesis
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Rhematoid factor test for RA?
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Positive
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Antinuclear antibody titer test for RA?
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High
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ESR test for RA?
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Shows inflammation if increased
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Serum complement level RA?
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Decreased due to inflammation
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Serum protein electrophoresis RA?
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Looking for certain proteins in RA patients
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Serum immunoglobulins RA?
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Serum blood test for RA
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Antibodies to cyclic CCP RA?
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A new test more specific to RA
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Serum complement RA?
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Gets all used up because of inflammation
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Fever
Fatigue Anemia Enlarge lymph nodes Raynaud's and Sjorgren's syndromes? RA |
Systemic Effects
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Any organ system may be involved; arteritis, neuropathy, and other neurologic manifestations; cleritis; pericardities; pleural effusion; splenomegaly; and renal involvement
Skin and mucosal manifestations? RA |
Systemic Effects
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Non steroidal anti-inflammatory drugs (NSAIDs), for example
celecoxib, roecoxib, valdecoxib with cox-2 inhibiting properties Disease modifying antirheumatic drugs (DMARDs), such as hydroxychloroquine, sulfasalazine, gold, and minocycline? RA |
Drug therapy, mild disease
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Methotrexate
Leflunomide Biological response modifiers such as entanercept, infiximab, adalimumab, anakinra? RA |
Drug therapy, moderate to severe disease
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Plasmapheresis
Promotion of self-care fatigue management Enhancement of body image Health Teaching? RA |
Nonpharmacologic treatment RA
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Usually strikes between the ages of 15 and 45
More in women of African-American, Hispanic, Asian or American Indian descent? |
Lupus
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Chronic multisystem autoimmune disease
The body produces autoantibodies that attack part of the body and lead to inflammation and organ damage? |
Lupus
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Latin term for wolf that was coined to describe skin lesions resembling wolf bites?
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Lupus
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Called the great imitator because it is easily confused with other disorders
Recurs with flare-ups and then remission Creates both physical and psychosocial challenges? |
Lupus
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Chronic skin disorder with scaling plaques
Lesions on the neck and head, ears and scalp Hair loss with scalp involvement? |
Discoid Lupus
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Caused by hydralazine, procainamide and phenytoin
Resolves when the drug is dc'd Fever, malaise, rash and joint pain? |
Drug induced Lupus
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Most common and most serious form
Systemic details follow? |
(SLE) Systemic lupus erythematosus
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No 2 cases the same
Rash worse with sun exposure Polyarthritis Hip pain from lack of blood to the bone Fever, fatigue, and aches are early signs Pleural effusions and pericarditis? |
Lupus
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Most common manifestations of SLE?
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Arthralgia
Myalgia Arthritis |
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Photo sensitivity
Myelar or Butterfly rash Alopecia? |
Derm / Lupus
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Nephritis is an early manifestation
Proteinuria, casts, and red blood cells in the urine? |
Renal / Lupus
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Pericarditis, myocarditis, endocarditis, and accelerated artherosclerosis, leading to a myocarial infarction
Vasculitis? SLE |
Cardio / Lupus
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Pertonitis causing abdominal pain
Anorexia, N/V Pancreatitis, possible ascites? SLE |
Gastro / Lupus
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Pulmonary hemmorage
Embolism or hypotension Pneumonitis Pleuritis Interstitial lung disease? SLE |
Pulmonary / Lupus
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Anemia
Leukopenia Thrombocytopenia Lymphopenia? SLE |
Hematologic / Lupus
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Mild to Severe
Headaches Seizures Neuropathy Delirium Psychosis? SLE |
Neurologic / Lupus
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Most patients test positive with 5-15% being a false positive?
SLE |
Serum Antinuclear Antibody / Lupus
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Specific for SLE but detected in only 20-30% of patients?
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Anti-smith or Anti-sm test / \Lupus
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60-70% have a higher titer?
SLE |
Anti-double stranded DNA or Anti-dsDNA test / Lupus
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50% positive?
SLE |
Anti-phospholipid antibodies or APL / Lupus
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Chronically false positive may be diagnostic for SLE?
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Cyphyhlis test (VDRL or RPR) / Lupus
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Detects six autoantibodies simultaneously
ENA IgG BeadChip Test detects extractable nuclear antigens (ENAs) Can also diagnose Sjorgen's syndrome, scleroderma, and myositis? SLE |
In vitro diagnostic immunoassay system
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Decrease inflammation
Suppress over active immune system Prevent flare-ups Minimize complications? SLE |
Lupus
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Musculoskeletal problems
Pain Stiffness Inflammation and fever? SLE |
Non-steroidal anti-inflammatory drugs (NSAIDs) / Lupus
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Helps with arthritis, rash, mouth ulcers, fatigue, fever
Takes effect slowly over months Monitor the patients renal and vision? SLE |
Anti-malarial drugs
Plaguenil, Aralen / Lupus |
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Tx rash, arthritis, serositis
Patients with major organ involvement may increase dose up to 1mg/kg/day or 1 gm of methylprednisolone for 3 consecutive days? SLE |
Corticosteroids / Multiple uses / Lupus
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Suppress the hyperactive immune response associated with SLE
Monitor for bone marrow suppression and infection Azathioprine (Imuran), cyclophosphamide (Cytoxan), methotrexate (Rheumatrex, Trexall) and cyclosporine (Neoral, Sandimmune)? |
Cyctotoxic drugs / Lupus
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May show anemia, leukopenia, thrombocytopenia?
SLE |
CBC / Lupus
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Increases with flares?
SLE |
ESR
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May show blood protein, red and white cell casts?
SLE |
Urinalysis / Lupus
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Avoid sun exposure
Use sunscreen with UVA and UVB protection of SPF 15 or more, and wear protective clothing? |
Lupus
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Stay alert to symptoms of a flare or infection
Contact health care provider if they occur? |
Lupus
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Maintain an active lifestyle
Get plenty of rest Eat a well-balanced diet and take mulivitamins Special diet if have pypertension, dyslipidemia, or hyperglycemia? SLE |
Patient Teaching / Lupus
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Avoid smoking
Closely monitor alcohol Consider support groups Birth control, estrogen and pregnancy may trigger a flare Mild soap and no hair processing during flares can lead to alopecia? |
PT teaching / Lupus
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Act by prolonging the effects of the acetylcholine at the neuromuscular junction
Used in MG patients? |
Anti-cholinesterase agents
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Mestinon, mytelase, improstigmin?
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Meds used for MG
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Doses are gradually increased until symptoms subside
Important to take on time Effect within sixty minutes Give with food or milk in divided doses Antidote is Atropine? |
Anti-cholinesterase agents used in MG
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Reduces ACH antibodies in MG patients?
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Prednisone
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Minimizes inflammatory response in patients with MG?
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Imuran or cytoxan
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Removes plasma proteins contributing to MG?
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Plasmaphoresis
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When do you give muscle or CNS depressants to MG patients?
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Never!!!
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Common in MG patients, should have soon after diagnosis?
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Thymectomy
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More than half of MG patients improve after this surgery?
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Thymectomy
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May take two years after this surgery to see improvement in MG patient?
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Thymectomy
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Is the condition of too much medication in the MG patient
Patient will be diaphoretic, weak, bradicardic, vertigo, excessive salivation, N/V and diarrhea Give Atropine? |
Cholinergenic crisis
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The patient has too little of the medication or is no longer responding to the drug
Has difficulty swallowing, chewing, breathing, tachy, restless and anxious? |
Myasthenic Crisis
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Sometimes it's difficult to tell the difference
A dose of Tensilon will show the difference? |
Cholinergenic or myasthenic
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Ensure airway and respiratory support
Take ABG's, serum electrolyte, I&O and daily weights If patient cannot swallow, nasogastric feeding may be required Avoid sedatives and tranquilizers? MG |
The management of a myasthenic crisis
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Chronic autoimmune disease affecting the myelin sheath and conduction pathway of the CNS?
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MS
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Characterized by periods of remission and exacerbation
Inflammatory response resulting in random or patchy areas of plaque in the white matter of the CNS? |
MS
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Impulses are not transmitted effectively
Damage myelin removed by astrocytes which leads to scarring and plaque? |
MS
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T cells may play a role as they stay in the CNS, may allow other leukocytes to enter and lead to inflammation?
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MS
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Most common type of MS?
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Relapsing remitting
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Viral, immune, genetic
Onset 20-40, more females Life expectancy is 35 years after diagnosis? |
MS
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No one test
Hx is key Signs and Symptoms Prior episodes Aggravating factors, fever, PG and fatigue? |
Diagnosis MS
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Fatigue, weakness, stiff unsteady gait, clumsy, ataxia, dysarthria, muscle spasms at night, intention tremor, increased reflexes, positive babinski, blurred vision, diplopia, decreased visual acuity?
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Motor symptoms of MS
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Numbness, tingling, burning sensation, bowel and bladder problems, dizziness with N/V, apathy, forgetful, emotional, labile, cognitive symptoms late in the disease?
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MS
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Spinal fluid will show increased protein and WBC
Increased T-cells and IgG CT and MRI shows plaque EMG may be abnormal PET scan may be abnormal? |
Diagnostics MS
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Shut down the inflammation
Decrease relapse Decrease damage and severity of attack All are injectable ? |
Interferon therapy for MS
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Beta seron for MS is given?
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SQ every other day
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Avenox for MS is given?
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IM weekly
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Rebif in MS is given?
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SubQ weekly
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Can cause depression and thoughts of suicide
Monitor liver and CBC Avoid excess sunlight? MS |
Interferon therapy
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Acids that look like myelin
SubQ daily? MS |
Copaxone
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Blocks receptors on white cells so they can't enter the brain and cause inflammation
Given IV every month through the touch program? MS |
Tysabri monoclonal antibody
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Drug that suppresses the T and B cells that attack the myelin
Given for MS patients IV every 3 months for 2 years Is cardiotoxic? MS |
Nivantrone (chemo)
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This medication has no effect on the frequency or exacerbation of MS?
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Steroids
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Drugs that treat muscle spasms in MS?
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Baclofen, valium, flexoril
muscle relaxers |
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Impaired physical mobility
Risk for injury Impaired bowel / bladder Impaired verbal Disturbed thought Ineffective coping Impaired home maintenance Sexual dysfunction? MS |
Nursing Diagnosis
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Promote physical mobility
Avoid injury Achieve continence Promote speech and swallow Improve cognition Develop coping skills Improve home maintenance Adapt sexual function? MS |
Nursing Care Plan
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Minimize stress
Even temperatures Assistive devices as needed? MS |
Interventions
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An acute autoimmune disorder characterized by varying degrees of muscle weakness and paralysis?
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Guillain-Barre Syndrome
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The client's life and ultimate potential for rehabilitation is dependent on appropriate interventions and effective nursing care
Will recover? |
Guillain-Barre Syndrome
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Muscle weakness and PAIN have abrupt onset
Cause remains obscure May follow a virus? |
GB
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Cerebral function or pupillary signs are not affected?
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GB
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The most common clinical pattern is that the immune system starts to destroy the myelin sheath surrounding the axons so impulses are not conducted
Myelin sheaths will grow back? |
GB
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Weakness and parasthesia begin in the lower extremities and progress upward toward the trunk, arms, and cranial nerves?
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Ascending GBS
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ANS, bradycardia, sweating and hypotension usually lasts for 2 weeks?
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GBS
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First two to three weeks, acute focus on respiratory and prevention of immobility complications and ANS
Plateau leveling off of symptoms, ANS improves, recovery is several months to two years with a gradual return to function? |
GBS
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Priority is to maintain adequate respiratory function, implement interdisciplinary actions, airway management, elevate head of bed at least 45 degrees and use suction?
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Breathing interventions GBS
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Chest physiotherapy
Incentive spirometry Oxygen Monitor ABG and vital capacity Keep trach set at bedside? |
Breathing interventions GBS
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Can affect both the sympathetic and parasympathetic systems
Client is placed on a cardiac monitor because of the risk for arrythmias HTN treated with betablockers or nitroprusside IV fluids for hypotension Client placed in supine position Atropine for bradycardia? GBS |
Cardiac
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Plasmaphoresis or IV immunoglobin
Plasma exchange NO corticosteriods? GBS |
Drug therapy
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Removes the circulating antibodies assumed to cause the diseases in GBS
Plasma is selectively separated from whole blood Blood cells are returned to the client without the plasma Plasma usually replaces itself or the client gets albumin? |
Plasmaphoresis
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Often worse at night, only relieved with opiates, analgesia pump or continuous IV drip, frequent repositioning, message, ice, heat, relaxation, guided imagery, distraction?
GBS |
Acute pain
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Assess muscle function every 2 to 4 hours
Assistive devices Ensure safety Encourage independence in GBS? |
Impaired physical mobility and self-care deficit
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A debilitating disease affecting motor ability
Characterized by tremor, rigidity, bradykinesia, and postural instability? |
Parkinsons
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Exact cause unknown, possibly involving environment and genetic factors?
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Parkinsons
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Lack of dopamine to balance acetylcholine
Hard to control or initiate voluntary movement? |
Parkinsons
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Assists with controlled refined movement?
PD |
Dopamine
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Early signs are fatigue, moving more slowly, pill rolling, tremor at rest that worsens with stress
Decreased fine motor dexterity like writing, eating, and dressing? |
Parkinsons Disease
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Stiff from contraction of muscles, cog wheel rigidity, heaviness or aching in muscles
Slow to start and continue Mostly seen in chewing, swallowing, drooling and speaking Mask like expression, may appear frozen Postural Hypotension? |
Parkinsons Disease
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Abnormal posture, stooped forward
Loss of balance, shuffle walk Constipation, urinary hesitation and seborrhea (sweating of face and neck) Depression, dementia and sleep disturbances? |
Parkinsons Disease
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No specific dx test
Total disability in 10-20 years Most die from pneumonia Meds to help with sx and good nursing care to help with complications? |
PD
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Dopaminergics, combinations stimulate dopamine receptors in the brain help increase mobility and decrease rigidity
Avoid excess B6 and protein when taking May darken urine and cause N/V Watch for off/on effect, may need drug holiday? PD |
Levodopa and Carbidopa
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Can cause dyskinesia's or hypotension
Is less effective over time May need drug holiday? |
Levodopa combinations
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Catechol O-methyltransferase inhibitors tasmar/comtan block the breakdown of levodopa?
PD |
Watch liver function
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Inhibit enzyme that inactivates the dopamine Eldepryl/carbex helps for 1-2 years watch BP and functional status?
PD |
Monoamine Oxidase
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Acts in the brain may be given with dopamine requip mirapex parlodel?
PD |
Dopamine agonists
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Blocks the excitatory acetylcholine help with drooling tremors rigidity
Give early in disease or late May cause problems with elimination dry mouth tachycardia? PD |
Antichilinergics-artane cogentin
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Long-term drug therapy regimens often cause delirium, cognitive impairment, decreased effectiveness of the drug, or hallucinations
Reduce medications or frequency of administration Take "drug holiday", especially in the use of levodopa therapy? PD |
Drug toxicity
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Implanted pacemaker device in the thalmus
Stimulated to block impulses that cause tremor and stiffness Some good results? PD |
Deep Brain Stimulation
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Pallidotomy destroys tissue in the brain affected leads to increased mobility
Stereotaxic thalamotomy needle into thalamus helps tremor and rigidity Fetal tissue transplant to grow and restore dopamine? PD |
Surgery
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To grow and restore dopamine?
PD |
Fetal tissue transplant
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Destroys tissue in the brain
affected by PD which leads to increased mobility? |
Pallidotomy
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Needle inserted into the thalmus of a PD patient
Helps tremor and rigidity? |
Stereotaxic thalamotomy
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Impaired physical mobility
Risk for falls Imbalanced nutrition Impaired communication Risk for ineffective airway? PD |
Nursing Diagnosis
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