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105 Cards in this Set

  • Front
  • Back
what is the definition of Lupus Erythematosus (SLE)
chronic, systemic, inflammatory connective tissue disease which involves multiple body systems. maybe autoimmune, with hormonal/genetic componets
what is SLE characterized by
remission and exacerbations
what are the 3 forms of lupus erythematosus
SLE, discoid, an drug induced
what is the pathophysiology of LE
widespread destruction of collage in body- can lead to organ destruction and death. estrogen inhibits suppressor t cell function leading to abnormal immune response
what are the incidences of LE
affects more women, african americans, latino, asian and native americans more than caucasians. 30-50 is most common age
what are the signs and symptoms of LE
arthritis, photosensitivity, flat or raised butterfly rash, discoid rash, sustained fatigue, alopecia, anemia/leukopenia, unexplained low grade fever, raynaud's phenomenon.
what is the most common symptom in LE
arthritis- arthralgia & myalgia 90% of people
what is the most recognized symptom of LE
butterfly rash, occurs in 50% of people
where does discoid rash usually occur
scalp neck ears head, raised disk shaped patches with scaling plaques
what are the symptoms that indicate organ involvement in LE
renal impairment (1/2 cases) - proteinuria, casts, & RBC in urine
40-50% suffer cardiac & pulmonary effects - pericarditis, pleurisy, pleural rubs
CNS- seizures, cognitive changes, migraine
how is pt diagnosed with LE
must have 4 of the 11 criteria established by American Rheumatism Assoc
what are the 11 criteria for LE
malar rash, discoid rash, photosensitivity, mucus membrane ulcers, arthritis, pleuritis/pericarditis, urine casts/protein, seizures, decreased RBC/WBC, abnormal immune tests, abnormal antinuclear antibody
what drugs can cause lupus like symptoms
pronestyl, dilantin, and isoniazid (INH)
what are the medical interventions for LE
anti-inflammatories, antimalaria (helps with arthritis, steroids, cytotoxic drugs
what do the steroids do
suppress tissue inflammation reducing damage to organs TAPER DRUG
what to cytotoxic drugs do
suppress hyperactive immune response
what are the nursing interventions for LE
psychosocial support.
pain management
weekly skin inspections - sun screen
prevent fatigue, joint pain (HEAT THERAPY), deterioration
balanced diet
aware of signs of exacerbation
health maintenance/promotion
complications of LE
peripheral vascular disease & loss of limbs
hypertension
stroke
renal failure
congestive heart failure
what is death usually related to in LE
renal failure or infections
what is Scleroderma
chronic disorder - excessive connective tissue causes hardening of skin (maybe organs too)
no know cause
autoimmune
signs and symptoms of scleroderma
changes in face and fingers
gradual hardening of skin and swelling of distal extremities
joint involvement
raynaud's
dysphagia
what are the specific skin changes in Scleroderma
edema, pallor, firm skin, slightly pigmented, fixed to underlying tissues.
face is taut shiny and masklike
classification of scleroderma
systemic (involves organs)
localized (small patches on skin)
how is pt diagnosed with scleroderma
no single diagnostic test - ANA is most sensitive, increased ESR, anemia
BEST TEST IS SKIN BIOPSY of LESION
complications of scleroderma
heart and lung: pneumonia, R side heart fail, pericarditis, dysrythmias
ABD: diarrhea, constipation, cramping
Renal: proteinuria, hematura, failure
what drugs are used to treat the s/s of scleroderma
steriods, immunosuppressants, antacids & histamine receport antagonists (GI symptoms), salicylates and analgesics for joint pain
how does physical therapy help with scleroderma
helps with muscle contractures
what is Fibromyalgia
a rheumatic syndrom, causes musculoskeletal pain, spasms, stiffness, tenderness and sleep disturbances
90% women
what may cause Fibromyalgia
sleep disorders, depression, infections, maybe complication of hypothyroidism, RA or sleep apnea
what are s/s of Fibromyalgia
similar to chronic fatigue syndrome but with chronic achy muscle pains.

pain can be localized or throughout
how is pt diagnosed with Fibromyalgia
Hx and physical assessment, rule out other causes
must have pain that is present for at least 3 months and at 11 of the 18 tender points on palpation
what is used to treat Fibromyalgia
NSAID, amitriptyline (antidepressant), muscle relaxants
healthy diet and lifestyle
what is a restrictive lung disease
a limitation to full expansion of the lungs, lung volume diminishes as a result of decreased lung or thoracic compliance
examples of restrictive lung disease
cystic fibrosis and asthma
what is obstructive airway disease
airway obstruction that limits airflow on expiration. the lungs can't move air out
what is COPD
dead space increases in lungs, trapping carbon dioxide,
what is the incidence of COPD
more and 1 out of 10 suffers from asthma, chronic bronchitis, and emphysema
what is the etiology of COPD
cigarettes, pollution, allergens, and genetics.
cigarettes most common 80-90%
what type of disease is chronic bronchitis
airway disease
what type of disease is emphysema
alveolar disease
definition of bronchitis
hypertrophy of bronchial mucous glands and production on mucoid sputum that is hard to cough up
what is the hallmark symptom of chronic bronchitis
daily productive cough lasting at least 3 months for 2 consecutive years
what leads to airway obstruction & air trapping in chronic bronchitis
excess mucus production, recurrent cough and inflammation
why is infection susceptibility increased in chronic bronchitis
the excess mucus production and impaired ciliary movement, inadequate clearing of secretions
when does productive cough of chronic bronchitis usually occur
on awakening.
what are the assessment finds of chronic bronchitis
coarse crackles, rhonchi and wheezing, SOB
venous congestion can produce hepatomegaly
nail clubbing
polycythemia
what does a pulmonary function test reveal in chronic bronchitis
airflow limitation on expiration.
diminished vital capacity
what is emphysema characterized by
destructive changes in alveolar walls and enlarged air spaces, lungs become distended due to loss of elastin. air is trapped into distal spaces
signs and symptoms of emphysema
dyspnea
little cough/sputum
use of accessory muscles to breathe
diminished breath sounds
increased RR
prolonged expiratory phase
pursed lip breathing
why are most emphysema patients thin
use calories to breath and their appetites are diminished bc they can't breathe
what are the signs and symptoms of COPD
barrel chest, hypoxemia, hypercapnia, difficulty breathing, LOC changes, N/V, flushed apperance, polycythemia, cyanosis, R ventricle failure
what are signs of worsening COPD
dyspnea on exertion, rales, rhonci
what is usual ABG for COPD
respiratory acidosis or comp resp acidosis
how is COPD diagnosed
chest xray, bronchoscopy
what are the goals in COPD
to improve ventilation, remove secretions, prevent complications and slow s/s
what are home interventions for COPD
quit smoking, breathing exercises, chest physiotherapy, nutritional support, increase fluids, oxygen therapy
what medications are used for COPD
bronchodialators, corticosteriods, expecorants
what are the side effects for bronchodialators
increased HR, irregular HR, anxiety, nervousness
side effects for corticosteroids
headache, hoarsness, depression, restlessness, cough, diarrhea, dry mouth, adrenal complications
what is asthma
chronic inflammatory disorder of airways where a stimulus causes airways to narrow. common in children
what are common triggers for asthma
exposure to allergens, exercise, cold, inhaled irritants, emotional stress
signs and symptoms of asthma
SOB, dyspnea, chest tightness, increased RR & HR, wheezing, coughing, anxiety, resp alkalosis, prolonged attack results in resp acidosis

lack of wheezing may mean worsening of disease
how is asthma diagnosed
pulmonary function test, peak expiratory flow rate, ABG, and skin test
what are the severity classifications of asthma
intermittent - occasional flare ups
moderate persistent
severe persistent
meds for intermittent asthma
albuterol (SABA)
steroid inhalers
meds for moderate persistent asthma
low to medium dose LABA - Formoterol
Corticosteriods
Fluticasone/salmeterol
Mast Cell stabilizers- cromoglicic acid
leucotriene modifiers- montelukast
meds for severe persistent asthma
high dose inhaled corticosteroids and LABA
what is nursing care for asthma
peak expiration flow rate
measure peak flow meter
teach about zones on flow meter
teach correct inhaler use
teach importance of step wise approch to meds
what is used in asthma emergency
SABA, steroids, epi, oxygen, IV, fluids
preventative measures for asthma
allergy testing
physical activity
what is the most common bacterial cause for pneumonia
Streptococcus pneumonia
what med is given to treat pneumonia bacteria
Cephalosporin
what are the symptoms of atypical pneumonia
nonproductive cough, sore throat, headache, arthritis, myalgia, and Gi symptoms
what is the mortality rate of hospital acquired pneumonia
20-50% due to coexisting disease and high prevalence of gram negative bacteria resistant to antibiotics
what bacterias are the most common cause of HAP
Staph Aureus, Enterobacter, Klebsiella Pneumoniae and Escherichia Coli

Treated with broad spectrum antibiotics
S/S of pneumonia
decrease breath sounds
craclkes
rhonci
tachypnea and dyspnea
productive cough
fever and increased WBC (look at neutrophils too)
hypoxemia
infiltrates on chest xray
what is the most common s/s in older adults
confusion or irritability decreased LOC from hypoxia
what are preventions for pneumonia
1. Pneumococcal vaccine
2. teaching public
nursing interventions for pneumonia
TC&DB Q2h
incentive spirometry
early mobilization/ambulation
possible bedrest to decrease cellular demand
elevated
head of bed and RT treatments
oxygen
increased fluid
always collect sputum before meds
how is TB diagnosed
Mantoux skin test
Chest x ray
sterile sputum specimen
what are the predisposing/precipitation factors of TB
overcrowded poorly ventilated dwellings
poor nutrition
alcoholism
inadequate treatment of previous TB
preexisiting medical conditions that lower immunity
what is passive Tb
virus is in body but person is not sick, the germ is inactive. person cannot spread TB but has 10% chance of developing it
medication is recommended
s/s of TB
fatigue, malaise, anorexia, weight loss, low grade fever and night sweats, productive cough with productive mucopurulent, sputum, pleuritic chest pain, dyspnea and hemoptysis
what are the first line medications for TB
isoniazid with streptomycin for 6-12 months or more
B6 Pyridoxine
Rifampin
Pyrazinamide
Ethambutol
Streptomycin
side effects of isoniazid
liver damage and GI troubles
se of rifampin
discolored urine, tears, sweat and sun sensitivity
what are nursing interventions for TB
teaching pts to cover mouth with coughing/sneezing
standard and airborne precautions
nutritional support high protein and CHO
nurse should wear fitted TB mask
home precautions for TB
not contagious 2-3 consecutive weeks after meds but meds continued 6-12months
direct observation therapy
anyone in contact needs to be tested
active TB pt should wear mask
cover mouth when coughing/sneezing
what is normal pH
7.35-7.45
normal PaCO2
35-45 high is acidosis
normal HCO3
22-26 high is alkalosis
normal SaO2
95-100%
what conditions increase O2 consumption
fever, illness, heat, decreased Hgb, drugs, pneumonia, HF, lung trauma, increase HR
how is acidosis or alkalosis compensated
by lungs (very quick- hyper/hypoventilation)
by kidneys (slow)
what is resp acidosis
lungs too much CO2, hypoventilation r/t drug od, chest trauma, pulmonary edema, airway obstruction, COPD, neuromuscular disease, asthma
s/s of resp acidosis
hypoventilation, restlessness, confusion, and tachycardia, decreased LOC
what is resp alkalosis
hyperventilation, not enough CO2 r/t anxiety, high altitude, pregnancy, fever, hypoxia, excessive tidal volume in ventilated patients and initial stages of many diseases
s/s of resp alkalosis
hyperventilation, light headedness, muscle cramps and spasms, paresthesia, and palpitations
what is metabolic acidosis
acid base imbalance occurring from problems outside lungs
pts kidneys can't remove excess H+ or they are losing HCO3- through GI track
what does K+ do in met acidosis
serum potassium may increase to dangerous levels attempting to raise extracellular pH, body exchanges intracellular K+ for serum H+ increases K+ in bloodstream
increase serum K+ decrease serum H+
what causes met acidosis
diabetic ketoacidosis, severe diarrhea, renal fail, shock, sepsis, exercise and saliclate overdose
s/s of met acidosis
arrhythmias, hyperventilation, hypotension, lethargy, and coma
what is metabolic alkalosis
increased HCO3 or decrease in body acids without a change in PaCO2
what causes met alkalosis
loss of gastic secretions, prolonged vomiting, overuse of antacids, potassium wasting drugs
s/s of met alkalosis
arrhythmias, confusion, apathy, stupor, hypoventilation, attempting to decrease extracellular pH body exchanges intracellular H+ or serum K+
decrease serum K+ increase serum H+