M/s Exam 2

Front 1

Immune: HIV/AIDS drug cocktail classes(5)

Back 1

1) nucleotide reverse transcriptase inhibitase
2) nonnucleotide reverse transcriptase inhibitors
3) protease inhibitors
4) fusion inhibitors
5) integrase inhibitors
-all only work if consistent, so only fo compliance
-all common SE is neuropathy and pancreatitis

Front 2

Nucleotide reverse transcriptase

Back 2

1) Retrovir-previously AZT, SE flu like, bone pain, it suppresses immune system even more
2) DDI
3) DDC
4) D4T

Front 3

Nonnucleotide reverse transcriptase inhibitors

Back 3

converts RNA to DNA, stops enzyme, these can cause SJS, N/V and liver and psych problems
1) Rescriptor
2) Viramune

Front 4

Protease inhibitors

Back 4

protease splices chains and releases them, inhibits that, SE n/v, diarrhea, flu like sx, paresthesia

Front 5

Fusion inhibitors

Back 5

Fuzeon: work when HIV tries to inject cell, so stops process, causes allergy type rxn and fatigue

Front 6

integrase inhibitors

Back 6

Raltegravir: new drug, integrase needed to push RNA to cell after infusion

Front 7

Opportunistic infections

Back 7

infections others may be exposed to but will never get it b/c of healthy immune systems, should cancer pts get these? no, not common, these infxns are also a dx tool besides cd4 for AIDS not just HIV

Front 8

Opportunistic infx-pneumocystis pneumonia

Back 8

dx with bronchoscopy and sputum, pneumonia so those s/sx: sob, nonproductive cough, wt loss, night sweats, fatigue, fever, may treat prophylactically w/ Bactrum-also w/ UTIs, SE are glucose control issues hypo and HYPER can cause diabetes
**the most common opportunistic infx in hiv/aids pts

Front 9

two types of pneumocystis pneumonia

Back 9

carinii and jiroveci
jiroveci is the one they think is causing pneumocystis now

Front 10

opportunistic infx-tb

Back 10

hiv/aids high risk, ppd then chest xray in normal, checked q6months, but may not have enough immunity for + ppd so only 5 ml, treat prophylactically w/ rifampin and INH rifampin nasty SE to liver and turn orange - pressure isolation, sputum sample

Front 11

opportunistic infx-candida

Back 11

white cheesey lesions, tx with Nistatin-can cause heartburn, also in cancer pts
-Gluconezol-thrombocytopenia causes decreased bone marrow and wipe out platelents, doesn't work enough and get it down GI tract, anfotenison beta cause cardiac arythmias and toxic to kidneys

Front 12

opportunistic infx- mycobacterium avium complex

Back 12

MAC- in tb family, acid fast bacillus, but it is not contagious, won't see unless CD4 really low less than 50, sx night sweats, fever, dramatic wt loss, prophylactic tx w/ biaxin and ethambutol, rifampin or cipro:
mac affects GI tract so some get tpn,
Amicasin-ototoxicity and nephrotoxicity SE another prophylactic drug

Front 13

opportunistic infx-Kaposi's sarcoma

Back 13

a cancer of skin us. but can affect any organ, r/t a herpes strain, begins w/ purple lesions will have s/sx of the organ affected
tx-cancer so radiation and chemo, SE of gi tract, alopecia, bone marrow suppression

Front 14

opportunistic infx AIDS dimentia (encephalopathy)

Back 14

change in motor, cognitive function, this and parkinson's- handwriting changes, causes- aids virus affects brain cells, cns lymphoma toxoplasmosis, cryptococus, need to rule out other diseases of the brain i.e. meningitis, and treat the cause of it, some go crazy, tx depends on cause

Front 15

Nursing care AIDS- assessment

Back 15

look at person as whole, aids affects it all, head to toe assessment

Front 16

aids interventions- education

Back 16

education-prevention
reduce sex risks- abstinence and monogamous relationships, alternatives to penetration, latex condoms only
-reduce drug risks- don't do drugs at least don't use iv or share needles, needle exchange
-reduce perinatal risks- no bf, reproductive options
-reduce work risks- only protective covered needles, if needle stick report it

Front 17

aids interventions- general

Back 17

physical health-good health practices w/ hiv not aids, marinol has thc, aids-stabilize

Front 18

aids interventions- economics
-body image
-relationships
-spiritual
-other issues

Back 18

exprensive, drugs 20k/yr
-look bad, kaposis, wt loss
-not gay men having sex, but relationships
-anticipatory grieving, pts know they're terminal, promote coping
-others- noncompliance, euthenasia, homophobia, end of life, resource allocation, ethics

Front 19

STI-general

Back 19

r/t sexual activity, not necessarily penetration, many can be cured if caught early gonorrhea, chlam, syphilis

Front 20

STI-reportable disesases

Back 20

chlamydia, syphilis, gonorrhea
chlamydia most common sti

Front 21

sti- bacterial vaginosis

Back 21

not really sti, overgrowth of bact, fishy odor, tx- good hygeine, no tight pants, no pantyhose in summer, wear cotton panties grannie, limit sex partners, abst and monogamy,

Front 22

sti- trichomoniasis

Back 22

protozoan, common
sx- thin frothy yellow/green discharge, maloderous and irritating, untx-> pelvic infl disease, cancer, infertility tx with flagyl (se heartburn), have partners treated or will go back and forth

Front 23

sti- chlamydia

Back 23

most commonly reported, curable, transm sexually but could be in eye f/ not washing hands, mom-> baby in delivery, dx w cultures, asymptomatic often sometimes discharge, low back/abd pain, sex pain, vague sx, untreated-> PID, infertility, sepsis, death

Front 24

sti- gonorrhea

Back 24

2nd most common disease, "the clap", dx with smea culture, aslso asymptomatic or discharge, both tx w/ antibiotics, trickier b/c some drugs vs strains

Front 25

sti- general herpes

Back 25

herpex complex 1- oral sores
herpes complex 2- genitals
-can switch back and forth tho w/ oral sex, genetalia then lesions/vescicles then crust over, may think its jock itch,

outbreaks- stress, fatigue, menstrual, sunburns, women shed it more

****Zovirax anti-viral drug, cream q4h for 5 days at outbreak, or liquid po

-w/ lesions wear loose clothes and keep dry

Front 26

sti- syphilis

Back 26

spirochete and curable, dx w/ blood test

Front 27

sti- syphilis stages name

Back 27

1) primary
2) lecondary
3) latent
4) tertiary

Front 28

sti- syphilis primary

Back 28

10-90 days post exposure, chancres-red lesions on genitals, mouth, rectum dep on sex, can be cured here or 2nd stage, contagious, universal precausions

Front 29

sti- syphilis secondary

Back 29

3 weeks->6 months
red rashes on palms and feet soles, flu like sx, lesions contagious

Front 30

sti- syphilis latent

Back 30

immune system kicks in, less spirochetes/infx

Front 31

sti- syphilis tertiary

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end stage, brain damage, heart and lungs damaged, can lead to death

Front 32

sti- syphilis tx

Back 32

penicilin gold standard

Front 33

syphilis nursing care- assessment

Back 33

number of partners, when started, protection, hx of stds, drugs, what they're doing, ask about discharge, pain, hygeine

Front 34

sti- syphilis nursing care intervention

Back 34

educate- safe sex, abstinence, being faithful, lower number of partners
prevent infx-if see something weird on privates don't touch the person, don't douche it pushes up to pelvic cavity
find out who they have been w/ b/c everyone needs tx, report to health dpt, don't have sex while actively infx

Front 35

Immune Hypersensitivity- general

Back 35

immune system carried away, overreacting to allergin, over rx to response

Front 36

immune hypersensitivity- type I

Back 36

Type I- Anaphylactoid
a) anaphylaxis
b) atopic

Front 37

immune hypersensitivity- type I Anaphylactoid a) anaphylaxis

Back 37

mediated by imunoglobin E, ingest something 1st time nothing happens but cellularly it does, mast cells and basophils bind so next time rx and attack it, smooth muscle contract vasodilation, hypotension, itching, incr mucus, impending doom, full throat, edema in face and neck, chest tight, wheezing, itching, tingly,

if untx- anxiety, airway der, feel hot then go into shock, hypotensive, cyanotic, death

tx-epi, at hospital benadryl, could be steroids, tagamet histamine blocker, most critical thing-airway, anaphylactic-allergy bracelet at all times,
*******ALLERGY BRACELET MOST CRITICAL

Front 38

immune hypersensitivity- type I Anaphylactoid b) atopic

Back 38

b) atopic- environmental allergins, contact dermititis, seasonal, can have anaphylactic but not common, runny nose..tx with claritin, zyrtic, etc. avoid allergins but not always possible

Front 39

immune hypersensitivity- 4 types

Back 39

I) anaphylactoid
a) anaphylaxis
b) atopic
II) cytotoxic
III) immune complex
IV) delayed

Front 40

immune hypersensitivity- type II

Back 40

cytotoxic- immunoglobin G or M, best ex is hemolytic transfusion rx, good pasture syndrome= antibody antigen rx affects lung and kidneys

Front 41

immune hypersensitivity- type III

Back 41

Immune Complex
-antibody antigen complex, instead of eating complex puts in tissue --> lupus, RA, etc. body says it's not supposed to be there so fights it, so glomerular attacked --> renal failure, tx- what has been affected

Front 42

immune hypersensitivity- type IV

Back 42

Delayed
happens 24-72h after exposure, tb testing, poison oak, smallbox, some transplant rxns

Front 43

immune hypersensitivity- auto immune problems

Back 43

involves T or B cells, don't know what causes it, women more autoimmune rxns, more intense rxns to infx can fight it better but over-react to own selves, hormones

Front 44

autoimmune disease- general

Back 44

over 70 autoimmune diseases- Hashimotis thyroiditis, lupus, RA, MS, scleroderma, etc.

75% women

close to equator less MS

Front 45

autoimmune disease- microchiumerism

Back 45

cells of 2 ppl (mom and baby) in same person, immediately after birth fetal cells still in mom, fetal cells close enough to mom so confuses immune system, attacks cells

Front 46

autoimmune disease- molecular mimicry

Back 46

some nasty viruses (flu, herpes) look like a myelin cell or some nml cell so body confused

Front 47

autoimmune disease- systematic lupus erythematosus- what is it

Back 47

autoimmune disease, chronic multisystem inflam disease, period of remission and exascerbation, mild/mod/severe sx, cause-dk, genes, hormones, race (white ppl less at risk)

Front 48

autoimmune disease- lupus etiology

Back 48

exascerbation triggered by stress, pregnancy, UV, light/sun, focus on systemic type, (also discoid and drug induced)

Front 49

autoimmune disease- lupus patho

Back 49

antibodies vs nuclear antigens, likes cytoplasm and blood cells, makes immune complex and puts in connective tissue --> type 3 immune response, body attacks it

Front 50

autoimmune disease- lupus clinical manifestations dermatologic

Back 50

redness, rash, butterfly rash across face, alopecia patchy will grow back

Front 51

autoimmune disease- lupus clinical manifestations musculo

Back 51

aches and pains, arthritis

Front 52

autoimmune disease- lupus clinical manifestations cardiopulmonary

Back 52

increased risk atherosclorosis and pericarditis, pneumonitis and pleural effusion, all inflam responses

Front 53

autoimmune disease- lupus clinical manifestations renal

Back 53

high risk for lupus nephritis and glomerular nephritis, leading cause of death is kidneys, monitor BUN and creatine

Front 54

autoimmune disease- lupus clinical manifestations CNS

Back 54

psych, seizures, stroke 3rd leading cause of death so clotting problems

Front 55

autoimmune disease- lupus clinical manifestations hematologic

Back 55

2nd leading cause is infx, 90% have anemia, leukopenia (infx), thrombocytopenia, clotting problems

Front 56

autoimmune disease- lupus clinical manifestations GI

Back 56

pancreatitis, nausea, diarrhea, fatigue, fever

Front 57

autoimmune disease- lupus dx

Back 57

4/11 criteria

Front 58

autoimmune disease- lupus what labs will we see?

Back 58

RBC low, WBC low unless actively fighting infx, platelets 40% low, + ANA or antinuclear antibodies (not unique to lupus tho)

Front 59

autoimmune disease- lupus tx

Back 59

meds- steroids suppress immune system, NSAIDS, immunosuppressent agents, antimilarial

prevent- stress mgt

educate- stay out of sun, reduce stress, if slight fever call dx b/c risk for infx

other- body image, support groups if pt on dialysis i&o, kidney function, daily wts

Front 60

autoimmune disease- systemic sclerosis aka scleroderma- what is it

Back 60

disorder of connective tissue, fibrotic degenerative, skin thickens and tightens, too much fibrous connective tissue, localized or systemic, dk cause, environmental toxins cilia produced and deposited, too much deposited, feels tight

Front 61

autoimmune disease- scleroderma s/sx- calinosis and raynauds

Back 61

calinosis-abnormal Ca salt deposits in skin
Raynauds-vasopasmin fingers/toes, low blood flow r/t cold, bright blue then red color as warm, wear gloves when get something out of fridge

Front 62

autoimmune disease- scleroderma s/sx- esoph

Back 62

can't get food f/ esophagus to stomach, collagen and connective tissue so thick

Front 63

autoimmune disease- scleroderma s/sx- sclerodactyly

Back 63

fingers looked folded over, permanently flexed b/c thick skin

Front 64

autoimmune disease- scleroderma s/sx- talang

Back 64

capillaries permanently dilated see on skin, hands/face sm capillaries, see swelling in hands and around organs

Front 65

autoimmune disease- scleroderma dx

Back 65

autoantibody test SCL 70 but us dx by sx, nursing dx body image impaired mobility

Front 66

autoimmune disease- scleroderma tx

Back 66

steroids for immune system, D Penicilimine (not peniccilin) high solubility of collagen, SE- blood and liver
Minocyclene-helps reduce sx of thickening of collagen
main tx ************ is maintaining ADLs, skin thick and tight, PT/OT helps, treat sx, Raynauds no fingerstick b/c impaired circulation

Front 67

autoimmune disease- fibromyalgia and sleep

Back 67

********fibromyalgia often have sleep problems 80%- sleep apnea, restless leg syndrome

Front 68

hematological system what is it

Back 68

blood and blood forming tissue, purpose is to carry oxygen, nutrition, get rid of co2, also carries electrons, hormones, enzymes

Front 69

hematological system hematopoiesis

Back 69

how a cell becomes a mature cell, pluripotent --> either RBC, platelet, macrophage, eosinophil, basophil

Front 70

hematological system anemia

Back 70

is defined as a qualitative or quantitative deficiency of hemoglobin, a molecule found inside red blood cells (RBCs). Since hemoglobin normally carries oxygen from the lungs to the tissues, anemia leads to hypoxia (lack of oxygen) in organs. Since all human cells depend on oxygen for survival, varying degrees of anemia can have a wide range of clinical consequences. Anemia is caused by the lack of iron in the body as well.

Front 71

hematological system anemia 3 categories name

Back 71

1) loss of RBCs
2) decreased production of RBCs
3) increased destruction of RBCs

Front 72

hematological system anemia- category 1 loss of RBCs

Back 72

acutely such as a hemorrhage or chronically through low-volume loss

bleeding-either out of the body or internally, int-abd distention, bruising, also anemia-pallor, cold intolerance

Front 73

hematological system anemia- category 2

Back 73

decreased production of RBCs- chronic, nutritional issues-iron, B12, folic acid, most common anemia type, not enough iron for hmgb synthesis, RBC small and not bright enough (hematocrit), lose 1 mg iron thru GI tract, sweat, urine daily, excessive blood destruction is hemolysis

Front 74

hematological system anemia category 3

Back 74

increased destruction of RBCs, or deficient red blood cell production (ineffective hematopoiesis).

Front 75

hematological system anemia general

Back 75

most common hemat problem, usually caused by other things

Front 76

hematological system anemia clinical manifestations

Back 76

tissues not enough oxygen so pump more, winded pulse high, palpitations, CHF heart overworks and fluid backs up

skin-pallor, jaundice if rbcs broken up too much, fingernails rigid/concaved, skin cool b/c vital organs want o2

mouth- red smooth tongue glossitis inflam, iron def is red beefy tongue, cracks in mouth chelitis

GI- enlarged spleen and maybe liver

musculo- fatigue and w/ vit b12 and folic acid --> weaker, vit b12 get numbness and and tingly (paresthesia) if too long may have memory/confusion

Front 77

hematological system anemia nursing care plans

Back 77

increase ADLS, lower fatigue, incr nutrition, maintain tissue perfusion, blood transfusion dep on underlying problems/ iron, b12, folic acid fixable easily, hemorrage-transfusion, for the others monitor cbc b/c can develop antibodies against anemia drugs

***********2 questions on blood transfusion

Front 78

hematological system anemia category 2 causes

Back 78

-iron deficiency
-vit b12 deficiency
-folic acid deficiency
-aplastic anemia

Front 79

hematological system anemia cat 2 low iron intervention

Back 79

give iron supplement- diet and supplement

diet-red meat, esp liver, mussle, eggs, dried fruit, legumes, dark leafy veggies (except spinach-Ca impedes), fortified breads, eat with citrus type things OJ and grapefruit juice

oral supplement- 3-4 doses daily, little elemental iron f/ foods, ******give on empty stomach, but can cause nausea so maybe a little food, GI upset, turn stool dark black (worry about GI bleed) kids-liquid back of throat b/c will stain

Parenteral- IM or IV nasty on tissue, IM-very deep, Z track and air lock to inject air so don't come back out, inject w/ diff needle then you draw w/
IV-test dose to make sure no rx, dark brown color, IVP or IVPB, given solo and slow 1 mL/min and flush good with NS, protect IV site so don't infiltrate

Front 80

hematological system anemia cat 2 from low vit b12 causes

Back 80

nutrition (strict vegetarians)
GI related removal of stomach
intrinsic factor in stomach lining needed to absorb vit b12, some pts not enough intrinsic factor
pernicious anemia- r/t intrinsic factor, whether gastrectomy or not enough