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192 Cards in this Set
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- Back
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Define Immunity
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The state of responsiveness to foreign substances such as microorganisms or tumor proteins. What three functions do immune responses serve?
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What three functions do immune responses serve? (DONT HURT SNAILS)
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1) Defense: Body protects against invasions by microorganisms and prevents the development of infection by ATTACKING foreign antigens and pathogens 2) Homeostasis: Damaged cellular substances are digested and removed- by this mechanism, the body's different cell types remain uniform and unchanged 3) Surveillance: Mutations continually arise in the body but are normally recognize as foreign cells and destroyed |
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Immunity is classified as either?
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Innate or acquired
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Innate Immunity= A _______ response Primary white blood cells involved are the? |
Present at birth, with the primary role being the first line of defense ; nonspecific (NOT ANTIGEN SPECIFC) Therefore, it can respond within minutes to an invading microbe Neutrophils and monocytes |
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Acquired Immunity + list two types
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The DEVELOPMENT of immunity (active or passive)
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Active Acquired Immunity
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Results from the invasion of the body by foreign substances such as microbes/SUBSEQUENT development of antibodies & sensitized lymphocytes. With each reinvasion of the microbes, the body responds more rapidly and vigorously to fight off the invader. Because antibodies are synthesized, it takes longer to develop but is long lasting (Specific) MEMORY
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Passive Acquired Immunity
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The HOST RECIEVES antibodies to an antigen(a substance that ellicits an immune response), rather than synthesizing or making the antibodies themselves. This may take place naturally through the transfer of immunoglobulin's across the placental membrane from mother to fetus (IMMEDIATE EFFECT) SHORT LIVED; NO MEMORY |
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Antigen
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A substance that elicits an immune response (Most being composed of protein) However other substances can also act as antigens: Polysach, lipoproteins, + nucleic acids ALL BODY CELLS HAVE ANTIGENS ON THEIR SURFACES THAT ARE UNIQUE TO THAT PERSON AND ALLOW THE BODY TO RECOGNIZE SELF. |
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How many types of altered immune responses are there, dealing with hypersensitivity?
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I, II, III, IV (4
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When does immunocompetence exist? (Hint: this is a good thing)
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When the body's immune system is ABLE to identify, inactivate (deactivate) or destroy foreign substances
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When the immune system is incompetent or under responsive, what happens?
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Severe infections, immunodeficiency disease, malignancy may occur (
1. the state or presence of a malignant tumor; cancer.) |
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When the immune system OVERREACTS, or is OVERRESPONSIVE to foreign antigens, what is occurring? These are your _______ Also consists of ______ :(
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ALLERGIES (hypersensitivity), Auto immune diseases (reacting against its own tissue)
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Autoimmune diseases are a type of ________ response, and occur when the body FAILS to recognize self proteins and reacts against SELF antigens
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Hypersensitivity
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Classification of hypersensitivity reactions may be done according to? (3)
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1) Source of antigen 2) Time sequence (immediate/delayed) 3)Basic immunologic mechanisms that cause the injury |
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Which types of reactions are IMMEDIATE? Examples of ______ immunity
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1-3; Humeral
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Which types of reaction is delayed (THE LAST ONE :() and is an example of ______
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Delayed hypersensitivity reaction; related to cell-mediated immunity
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Humans need both humeral and cell-mediated immunity to stay _____
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Healthy
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Each type of immunity has unique properties and different methods of action, reacting against particular ______
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Antigens
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Humoral immunity consists of _______ mediated immunity
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Antibody (Humor: Body Fluid):
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Antibodies are produced by?
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Plasma cells (differentiated B cells) Different types being IgG, IgA, IgM, IGE, IgD
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Immune responses that are initiated through specific antigen recognition by ______ cells are termed cell-mediated immunity
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T cells (cell types involved: t cells, NK cells, and macrophages) |
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Type 1 reactions are known as _________ can include different examples, such as _______. This one is considered the MOST ______ Usually a genetic predisposition to the development of allergies exists.
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Anaphylactic Reactions (IgE-mediated reactions), EEEEK! Anaphylaxis =occurring in susceptible people who are HIGHLY sensitized to SPECIFIC allergens. MOST Severe
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The clinical manifestations of an anaphylactic reaction depend on whether the mediators remain local or become _____, also if they affect particular organs
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Systemic
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With mediators remain localized (Ex: Mosquito Bite), wheal and flare reaction occurs. Usually occurs within minutes-> hours and is not_____
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Dangerous (Usually do wheal and flare reaction for skin testing allergies)
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ANAPLYAXIS can include ___ and ___ rashes
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Systemic and localized
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Reaction usually occurs within ____ and can be LIFE THREATENING, due to?
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Minutes, bronchial constriction and subsequent airway obstruction/VASCULAR collapse
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If due to injection of insect bite, initially what will we see around the site?
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Itching(pruiritus), Edema, Erythema (Red)
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SHOCK can occur RAPIDLY and is manifested by?
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INCREASED PULSE (TACHYCARDIA), HYPOTENSION (Pulse increases as compensation), dilated pupils, increased vascular perm, vasodilation, increased dyspnea (difficult or labored breathing.), and possibly cyanosis, mucous production, Bronchial edema and angioedema (swelling of dermis) Our airways are constricting, as well as our smooth muscles contracting. Everything is just constricting
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What can occur if emergency treatment is not initiated?
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Death
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List categories that are common for causing anaphylactic shock?
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Drugs (Cillins, + others), Insect Venoms, Foods (Eggs, milk, peanuts, chocolate, strawberries), Treatment Measures (Blood products), Animal Sera (rabies)
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Another random symptom of Anaphylactic Reactions includes ______ ________ permeability. List associated symptoms
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Increased Vascular Perm/Dilation (VASODILATION); Runny nose, stuffy, runny eyes, increased mucous production in airways. The vasodilation/increased vascular perm is related to the redness.
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What is actually responsible for causing the problem/symptoms in Anaphylaxis Reactions? (2)
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Histamine +SRS-A = Slow Releasing Sub of Anaphlaxis
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Remember that ANAPHALYCTIC IS AN UMBRELLA THAT ENCOMPASSES ALL MANY MAJOR THINGS, Including: ANAPHALYTIC = TYPE 1 REACTIONS
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Hives, Allergies/Runny Nose, Asthma, Eczema, Anaphylaxis (More severe one)
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Due to our muscles contracting, our ______ are constricting in response
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Airways (When airways constrict, that can lead to asthma- wheezing)
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Vasodilation can lead to? (2) Causing us to go into?
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Hypotension and erythema; shock
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What do we usually take in response for Anaphalaxis?
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Antihistamines (a drug or other compound that inhibits the physiological effects of histamine, used especially in the treatment of allergies) OR Epinephrine( Treats severe allergic reactions (including anaphylaxis) in an emergency situation. Nebulizers: Will go directly into the airway, helping to relax muscle contraction Prednisone: used to relieve rheumatic and allergic conditions (a corticosteroid) Dyfrohydramine (IV)Treats severe allergic reactions, motion sickness, and symptoms of Parkinson's disease. This medicine is an antihistamine. + OXYGEN |
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What does epinephrine do that makes it work? (2 main things)
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1) Works as a VascoCONSTRICTOR to counteract decrease in BP, by raising it 2) Also counteracts the histamine effect (Ex: Epi Pen, during anaphylaxis) We can give this IV or SUBQ! We give different concentrations depending on IV or Sub Q. May give epi even every 5 or so through IV, depending on RESPONSE of the patient |
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The shock with anaphylaxis is due to _____ COLLAPSE
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Vascular
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Ice can help with?
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Swelling
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What is another type of reaction (not anaphylaxis, under anaphaltyic reactions?)
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Atopic Reactions
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Approximately ____ of the population is atopic, having an INHERITED tendency to become sensitive to?
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20%, environmental allergens
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The atopic diseases that can result are? (5) All you need to know, then move on to Type 2
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(Inherited Allergies/Atopic Reactions) 1) Allergic Rhinitis 2) Asthma 3) Atopic Dermatitis (Ex: Eczema) 4) Urticaria (Hives) 5) Angioedema |
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Allergic Rhinitis AKA = Most ____
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HAYYYY FEVER; Most common
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What's the most common type 1 hypersensitivity reaction? May occur either seasonally OR perennial=
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Allergic Rhinitis/Hay Fever Perennial= YEAR ROUND. |
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What are the primary causes of allergic rhinitis?
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Pollens, dust, molds, animal dander
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Target areas affected?
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Conjunctiva of eyes/mucosa of upper respiratory tract
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Symptoms affiliated with allergic rhinitis? (atopic)
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Nasal discharge, sneezing, lacrimation (water eyes), mucosal swelling with airway obstruction, pruritus around eyes, nose, throat, mouth
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What do we usually do for allergic Rhinitis? (Examples of medications)
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Claritin, Benadryl (can cause some sleepiness) -Usually any type of antihistamine |
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Antihistamines work to _________ the histamine
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BLOCK
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A lot of the newer medications are supposed to be _____, so you can take them during the day
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Nondrowsy
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Examples of other random medications:
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Eye drops(allergy eyedrops block mastcells/histamine), nasal sprays. Can help to shrink the swelling
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Asthma. Many people with asthma usually have a history of ____ disorders
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atopic
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Inflammatory mediators produce what, with asthma?
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Bronchial smooth muscle CONTRACTION (bad), excessive mucous secretion, bronchial action, edema of bronchial mucosa (muc. membranes of bronchi), and decreased lung compliance
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Bronchial action due to ?
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SRS-A (slow reacting substance of Anaphalxis+ Histamine again! (comes back into picture with atopic, as being one of the reasons again. Basically one of the main reasons for a lot of the symptoms)
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Symptoms with asthma:
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Dyspnea, wheezing, coughing, tightness in chest, thick sputum
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What can people with asthma use for medications? :)
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Inhalers and Bronchodilators to counter react the bronchiole constriction that's happening-Ex Nebulizers Help to open up the airways/relax, corticosteroid inhalers that can help with inflammation and swelling (Pretty much all a variety of inhalers, for those with asthma)
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Atopic Dermatitis (AKA) Ex:
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A condition that makes your skin red/itchy Example: (Eczema) |
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ECZEMA " " AKA !
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THE ITCH THAT RASHES. Usually skin will be itchy first, prior to a rash that appears.
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Atopic Dermatitis is a CHRONIC, _____ skin disorder (think back to atopic definition) Characterized by (2)
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INHERITED Exacerbation: A worsening Remissions |
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What causes atopic dermatitis? Symptoms=
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Environmental Allergens (Elevated IgE levels) Vasodilation of blood vessels, resulting in interstitial edema, dryness, cracks, erythema, swelling
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The skin reactions is more _________ WE DONT SEE A TYPICAL WHEAL-FLARE REACTION
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Generalized
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Rash typically occurs on the extensor area of our?
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Extremities (Legs, anticubital, popliteal space)
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Treatment for Atopic Dermatitis/Treatment for Eczema or any type of itchy rash
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HYDROCORTISONE, other moisturizers (Cream, lotions, ointments) -Treats skin irritation. People that have severe asthma/other reactions can't rely on these supplies alone. Aren't strong enough PREDNISONE to put on skin(helps to decrease inflammation, inflammatory response ANTIHISTAMINES: Help with itching |
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How many times a day do the lotions usually go on?
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At least twice a day. We want to use a THIN layer, as it can actually thin the skin- we want to be careful of the face. Can also dry skin out, so use it sparingly
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HIVES AKA
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URTICARIA
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Hives is a skin ACUTE reaction to _____ allergens occurring in the atopic person
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Systemic
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Symptoms of Hives
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Transient wheals varying in size and shape with flaring caused by histamine (pink raised, itchy). Can be bumps/vesicles/fluid filled.
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Develops _____ after exposure to an allergen
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RAPIDLY (Rapid post exposure)
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Hives can last?
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Minutes to hours
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HIVES ARE EXTREMELY
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Itchy
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Hives causes localized _______
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Vasodilation, forming wheels
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Treatment for Hives? _____ If very severe, ____
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Regular Antihistamines; Epinephrine
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Hot vs. Cold Urticaria
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Other forms of Urticaria/Diff hives (Can be brought on by temperature changes, hormonal) When hot, hives may go away? Odd
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Angioedema- Where? Specific Areas that can be affected
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Swelling in the deep layers of skin- Eyelids, lips, tongue, larynx, hands, feet, GI tract, genital area. Skin can look normal or have reddish hue
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With the swelling of the skin, what can also occur?
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Itching
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Time Span
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Several hours-days
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TYPE 1: REMEMBER FAMILY HX=
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Important risk factor when considering whether a patient will have allergies or have a reaction. Can have a reaction to medications, so we need to be EXTREMELY careful (Ex: Antibiotics)
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To sum up before moving on to type 2, what are the primary factors that are responsible for the symptoms with Type 1?
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Histamine & SRSA (Ex: Mast cells)
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Type II reactions AKA
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Cytotoxic Cytolytic Reactions (Cellular Reactions) =Toxic to living cells; (Type 2 Sensitivity Reactions) |
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Explain what is happening and what is activated as a result? (starting the reaction)
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IgG or IgM antibodies to antigen on cell surface (The complex of this ACTIVATES complement), which then starts the reaction
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Cellular Tissue is destroyed in two ways from the reaction =
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1) Activation of complement system resulting in cytolysis (bursting) 2) Enhanced phagocytosis |
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What types of target cells are being destroyed/breaking down?
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THE RBC's, WBC's, AND PLATLETES (Erythrocytes, Leukocytes, and Platelets (Destruction of Blood Cells)
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To demonstrate these type of reactions, we will mostly be dealing with?
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Transfusion Reactions (Blood)
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Pathophysiologic disorders that are characteristics of Type 2 reactions=
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ABO incapability transfusion reaction (blood types), rh incompabitlitly transfusion reaction (during pregnancy if baby has positive rh factor and you have negative, and the blood cells cross the placenta), autoimmune and drug related hemolytic anemia's (hemolytic=rupture/destruction of RBC's anemia= deficiency of RBC's or of hemoglobin/ can cause weakness, LEUKOPENIA (reduction in WBC's), thrombocytopenia (deficiency of platelets in the blood) ALL OF THESE CAN CAUSE DESTRUCTION OF THE BLOOD CELLS AND LEAD TO REACTIONS
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If you get blood that doesn't agree with you, you can have a ______ reaction
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A hemolytic transfusion reaction is a serious complication that can occur after a transfusion of blood. The red blood cells that were given in the transfusion are destroyed by the patient's immune system
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Adverse=
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Unfavorable, harmful
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Transfusion Reactions: Adverse reaction to a blood transfusion with mild to _____ symptoms
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Severe (Will Vary)
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How many types of different transfusion reactions are there? Name them
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5- Acute, Febrile, Allergic, Circulatory Overload, Septicemia
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Out of all the transfusion reactions that we will talk about, remember that the allergic one is actually a type ___ reaction, due to the HISTAMINE
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TYPE 1
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Acute Hemolytic: Most often caused by?
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Mislabeling blood products, or giving blood to the wrong patient. Not super common due to health industry being good, = a good thing
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When do ACUTE hemolytic reactions typically occur?
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Within the first 15 minutes of blood going into patient (SHORT)
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What is happening physiologically?
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Agglutination (clumping) of RBC's OBSTRUCTS the capillaries
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When you have blockage of the caps, this also blocks?
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Clotting factors- can allow bleeding to occur
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RBC destruction releases ______, which is filtered by ______
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Hemoglobin (getting released, this was on the RBC's), filtered by kidney
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What can end up happening to the kidneys?
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(RBC's also clumping in kidneys) If kidney tubules get blocked, we can have acute renal failure (obstruction/bleeding of kidneys)
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Crucial symptom affiliated with kidneys, that could be concerning?
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Back Pain
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VERY IMPORTANT THAT WE ARE DOING ______ VITAL SIGNS
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BASELINE (PRIOR TO BLOOD PRODUCT) WE NEED TO KNOW WHERE THE PATIENT IS NOW, BECAUSE IF CHANGE, WE CAN PICK UP ON QUICKLY. (We can compare scary findings, to what the original baseline findings were)
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Symptoms affiliated with acute hemolytic reactions
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FEVER, CHILLS, low back pain (kidneys-obstruction), BP DROPS, Hypotension (SHOCK), INCREASED HEART RATE-Tachycardia, So increased RESP RATE,Facial flushing
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We need to be on the look out for shock. Also acute hemolytic reactions can cause ____ arrest, + (2 other severe)
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Cardiac, ARF (Acute Renal Failure), or death! VASCULAR COLLAPSE TOO
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With tubing, 2 clamps. One connected to ____, other to____
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Blood; Saline
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For protective measures, some facilities will run their blood at a slow rate (@ every ___ min) and doing vital signs every ____ minutes. Some facilities just check every ___ min
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15; 5; 15
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How often do we check vital signs, when giving blood?
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Depends on the POLICY of the facility.
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Can a person have a reaction, even after the first 15 minutes?
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YES
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NURSING INTERVENTION FOR ACUTE HEMOLYTIC REACTION:
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STOP transfusion immediately, REMOVE IV set up and replace with NEW to keep VEIN OPEN WITH THE NORMAL SALINE THAT IS HUNG (KVO): Keep vein open. Remain with the patient, watch them, take vital signs often+assess, monitor for symptoms of complications, monitor their Input and Output.. ALSO
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What should we collect if something goes wrong?
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Samples (Blood and urine)+ Bring the blood tubing back to the lab+LET PROVIDER KNOW
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Febrile Reaction caused by? And what does FEBRILE MEAN?
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Leukocyte incompabitlitly (FEVER) Something again within the blood product that is NOT compatible, going to cause a fever (specifically the wbcs)
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People who have had ______ transfusions, are susceptible to developing this type of reaction
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Multiple (You would spike a fever during the transfusion)
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Symptoms associated with Febrile Reaction
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Spike a sudden fever, headache/flushing, a little muscle pain- but that's about it.
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WE DONT SEE CHANGES IN OTHER MAJOR SYMPTOMS (EX)
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NOTHING WITH BP, TACYCADRIA,
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Nursing Intervention
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Again, stop the transfusion, KVO, Do assessment, notify MD. ALSO ANTIPYRETIC
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If patient not undergoing shock, no airway involvement, or anything extreme, MD may recommend antipyretic and say just continue , or stop(Ex)=
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Tylenol/Acetometaphine (AntiPyretic: Reduces Fever) And cautiously continue (or stop)
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A lot of the times doctors and nurses will just prescribe ______ ahead of time, if pt already knows they typically get febrile reactions
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Antipyretics
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ADDITIONAL PREVENTION METHOD (alongside providing meds earlier)
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1) Additional filter on tubing (more specific for WBC's) |
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ALLERGIC Reaction (again, remember)
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Type 1
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With allergic reactions, this is when the patient is sensitive to?
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Plasma Proteins (general)
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Types of people susceptible to allergic reactions?
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Those with increased allergies
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Allergic reactions can be mild to ____
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Severe (ANAPHALYTIC)
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Symptoms of Allergic Reactions
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Hives, itching, flushing, wheezing, cyanosis (shock), shock, cardiac arrest (all of them)
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Nursing Interventions (main one), + prescribe _____
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AGAIN, STOP THE TRANSFUSION, KVO, NOTIFY MD. GIVE ANTIHISTAIME FOR ALLERGY
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We can restart if symptoms are ?
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Transient/Mild (Provider may say okay stop for 15 min- give them a break and prescribe some IV Benadryl and then continue) + monitor
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Obviously if the patient is having fever or respiratory symptoms, we do NOT want to?
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Restart
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Another item we may prescribe if super serious
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Epinephrine
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PREVENTION: Administer ____ prior to transfusion if known hx allergies, per order
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Antihistamines (Ex: Benadryl)
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Circulatory overload: Happens when? (2 situations)
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Infusion rate TOO FAST OR with patient with decreased cardiac/renal function
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Circulatory overload is for your patient with?
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FLUID VOLUME EXCESS. We are giving them blood and then cause them to go into EXCESS (Think about this- They are getting even more fluid, and they already have problems)
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Patients at risk for circulatory overload?
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Elderly, patients with symptoms/issues already such as dyspnea, cough, lung-crackles, tachycardia, increased BP, distended neck veins (Think of all the symptoms your patient had) + her hypertension Symptoms can vary from mild to extreme (pulmonary edema) |
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Nursing Interventions
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DECREASE infusion rate, INCREASE HEIGHT OF BED (HOB) with feet down/dependent so we don't overwhelm the heart with more fluid, notify MD, give oxygen/diuretics
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PREVENTION: What do we need to do to prevent this?
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Adjust rate per pt. size and their own individual tolerance (infuse at slow rate- people in the hospital will already know to do this for their precautionary patients)
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Interventions are going to obviously
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VARY, depending on what is going on
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Septicemia Reaction:
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Transfusion of contaminated blood products
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Symptoms affiliated with septicemia?
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Rapid onset of chills, HIGH fever, V, D, DECREASE BP (as always), shock (obv because this is SEVERE)
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Nursing Interventions
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Stop transfusion, notify MD, KVO, VITALS, return blood and tubing to lab for testing
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HOW LONG DO WE INFUSE?
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NO MORE THAN 4 HOURS, OR RISK FOR BEING CONTAMINATED INCREASES
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Other specific symptoms affiliated with septicemia reaction
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Blood cx (cultures/testing), give them o2/ANTIBIOTICS (SOMETHING MADE IT BAD), VASOPRESSORS (a drug causing the constriction of blood vessels, so they don't absorb a lot), volume expanders
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Volume Expanders
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A volume expander is a type of intravenous therapy that has the function of providing volume for the circulatory system. It may be used for fluid replacement
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WHAT IS KEY FOR TREATMENT?
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ASSESSMENT!
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Type III Immune=
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COMPLEX REACTIONS (3= COMPLICATED)
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What is happening with type 3 reactions? What type of complexes are forming?
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Complexes are forming (antigens and immunoglobluins) become DEPOSITED into tissues and capillaries, staying FIXED + release chemotactic factors that lead to?
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What do these chemotactic factors lead to?
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Tissue damage/inflammation and destruction of the tissue involved
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Type 3 reactions can be ____ or _____ or ____ and ____
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Local; Systemic+ immediate, or delayed
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What do the clinical manifestations depend upon?
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The number of complexes/location of body
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What are some common sites for deposits?
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Kidneys, lungs, blood, vessels, skin, joints
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Really severe Type 3 reactions are associated with _____ diseases, such as?
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Autoimmune; SLE and RA (Systemic Lupus Erythematous) and Rheumatoid Arthritis
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What organ can also be affected?
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Heart
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LUPUS= SLOW OR FAST FOR SYMPTOMS?
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Slow
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What parts can be affected with RA?
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Heart, Kidneys, Joints
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TYPE 3= ANYTHING REALLY THAT IS ______
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AUTOIMMUNE; DUE TO COMPLEXES BEING ATTACHED TO TISSUES/ORGANS. THEN BODY CAUSES DESTRUCTION IN THAT AREA
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Systemic Lupus Erythematous = _____ progressive disease, extremely ____
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CHRONIC; variable (able to change), therefore really difficult to diagnose - can take years. Or super obvious (variable)
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As a result, lupus is often difficult for predicting _____________
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Progression
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Lupus can consist of periods of ____ and _____
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Exacerbations (flare ups) and remissions (improves)
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Risk groups for lupus
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Child-bearing age (more common in woman), African Americans, Asians, Native Americans
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What makes people get Lupus?
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Possible genetic component? Family history of autoimmune?
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What are some precipitating factors (Contributes)/triggers
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Menarche, Postpartum period after pregnancy (short time immediately after birth), sun exposure, medications, and stress
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List symptoms of Lupus (PRODOME: EARLY)
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Excessive fatigue, fever, weight loss (getting sick), arthralgia (pain of joint) Skin= Dry, scaly rash on sun exposed areas Ulcers of mouth/nose Alopecia (partial/complete absence of hair) with or without lesions. Hair will regrow, unless lesions were present/disturbed areas |
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What type of rash typically appears and where? Happens with____ % of lupus patients
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Butterfly rash; on cheeks and nose, 50 %
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Symptoms continued- What about the muscles?
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Fatigue so muscles (musculoskeletal) will have POLYarthralgia( is defined as aches in the joints, joint pains) particularly in early AM, possibility of arthritis (90%) may have deformities, cardiopulmonary issues (tachypnea, cough, restrictive lung disease arrhythmia (due to fibrosis = thickening/scarring of connective tissue) of SA and AV node. Hypertension, CAD (Coronary Artery Disease)- MAY NEED AGRESSIVE THERAPY Pericarditis, Endocarditis |
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Kidney symptoms. What is a specific disease that is common? 50% within ___ year of diagnosis
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Lupus nephritis;1
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Starts with mild proteinuria (the presence of abnormal quantities of protein in the urine, which may indicate damage to the kidneys.) = HOW YOU KNOW KIDNEY DAMAGE and then progresses rapidly to?
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Glomerulonephritis (acute inflammation of the kidney, typically caused by an immune response.)
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What is the goal of treatment for lupus?
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To SLOW PROGRESSION and PRESERVE function by MANAGING the disease
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Symptoms affiliated with N.S+ what type of syndrome?
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Seizures, peripheral neuropathy (Weakness, numbness, and pain from nerve damage, usually in the hands and feet.) +ORGANIC BRAIN SYNDROME
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Organic Brain Syndrome
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Disorder thought process, memory problems, depression, psychosis, probably recovery but with some residual impairment
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Hematologic symptoms
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Anemia, antibody formation against blood cells, bleeding problems. Therefore, what are they susceptible to?
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Those with lupus have an ____ tendency for?
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infection, susceptibility for it, also PNEMUONIA (DAMN SO MUCH)
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Common causes of death related to lupus?
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Infection, pneumonia We take fevers very seriously |
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Diagnostic Tests for Lupus (2)- What is the most specific test?
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Antismith (Anti-Sm): MOST SPECIFIC TEST + Monitor disease with anti- DNA titers (ESR,,CRP, ANA = Antinuclear Antibody Titer, CBC, BUN, Urinary Analysis |
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Nursing Interventions Lupus (Main)
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Manage active phase of disease while preventing long-term tissue damage
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Do people with Lupus need to be hospitalized?
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Not necessarily. If complications, yes
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There is a better prognosis for the patient if we can diagnose _____
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Early
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List 3 Goals Again
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MAXMIZE symptom management (just so many- we want to manage), avoid activities that increase exacerbations, maintain optimal role and self image
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Other Interventions Include:
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Medications
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Examples of Meds
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Plaquenil to decrease inflammatory response,corticosteriods (temp. for acute phases), immunosuppressant drugs, NSAIDs (FOR PAIN AND INFLAMMATION), Chemotherapy agents |
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During the acute phase, what do we need to be documenting?
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Response to therapy, fever patterns, joint inflammation, dec rojm, fatigue. Daily I & O's, weight, due to corticosteroids and possible renal failure |
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What do corticosteroids mainly do?
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Decrease inflammation
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We also need to watch for?
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Signs and Symptoms of bleeding, neuro status, peripheral neuropathy.
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Educate patients regarding?
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Disease process, therapy, risk for infertility -Teach them to avoid and eliminate exposure to aggregating factors (Sun, stress, infection) |
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Psychological conditions
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Vague onset, underdiagnosed, hereditary considerations with genetic counseling, self esteem issues as well as fatigue, and pain interfering with quality of life, family/friend education regarding disease process, young adults have difficulty with decreased sun exposure and physical limitations (ROJM limited with joint pain)
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TYPE IV = LAST ONE= ____ AKA ____
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DELAYED Hypersensitivty AKA CELL-MEDIATED RESPONSE
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Explain Type 4 more
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Sensitized T cells attack antigens or release cytokines which attract macrophages, which then release enzymes causing TISSUE DESTRUCTION (similar to part of 3)
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How long for reaction of type 4 (delayed) to occur?
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Usually 24-48 hours
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Examples of Delayed Hypersensitivity
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Contact Dermatitis, Microbial hypersensitivities, transplant rejections, some drug sensitivities, poison oak
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Contact Dermatits: Skin is first introduced to substance and epidermal ____ becomes antigenic. What ends up forming 7-14 days later?
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PROTIEN ; Memory Cells
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Antigenic/sensitized. Subsequent exposure-person develops eczematous rash in 48 hours. Examples
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Metals, Catechols (poison oak & ivy, sumac), cosmetics
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Symptoms:
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Itchy, Skin edematous, red, papules, vesicles, burning, stinging
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Whereas contact dermatitis tends is a _____ reaction, atopic dermatitis is a _____ reaction
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localized; generalized
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Latex Allergy: Caused by? Has increased or decreased?
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Chemicals in manufacturing process of gloves- Increased since 1987 as we started using gloves more
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Symptoms
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Dryness, itching, fissures, redness, swelling, crusting (again 24-48 hours)
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Chronic exposure of latex gloves can lead to?
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LICHENIFICATION: THICKING OF SKIN- SCALING and hyperpigmentation
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We need to determine patient sensitivity through health history, T/F
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True
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With delayed reactions, it will have taken _______ to develop
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Subsequent
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Other types of allergies related to food=
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Avacados, Guava, Kiwi, Banana's, Tomatoes, Potatoes, peaches, grapes, apricots, chestnuts, hazelnuts
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