Chapter 19 Med Surg/ caring for patients with immune disorders

What are Type 1 hypersensitive reactions

1. Anaphylactic Reactions 2. Allergic Rhinitis 4. Atopic Dermatitis 4. Angioedema

What are Type 2 hypersensitive reactions

1. Hemolytic Transfusion Reaction

Question 7. The nurse is caring for a client admitted with atopic dermatitis (eczema). Which of the following interventions should the nurse implement? 1. Suggest a lukewarm soak followed with application of emollients. 2. Administer antiretroviral drugs as ordered. 3. Place the client in isolation. 4. Prepare the client for debridement.

1. Suggest a lukewarm soak followed with application of emollients.

A patient who has been diagnosed with systemic lupus erythematosus is being discharged. The patient reports she is leaving shortly for a 3-week tour of the Grand Canyon and whitewater rafting. Which of the following patient statements conveys the patient's understanding of the plan of care? Select all that apply. 1. "As long as I wear sunscreen, I can be in the sun all day." 2. "I will wear clothing on all exposed skin." 3. "If I develop a rash, I should avoid the sun." 4. "I will use sunscreen on exposed skin at all times." 5. "The early morning sun presents the strongest danger." 6. "I will wear a hat."

2. "I will wear clothing on all exposed skin." 4. "I will use sunscreen on exposed skin at all times." 6. "I will wear a hat."

Question 16. The nurse is reviewing orders for a group of clients. Which client might the nurse see a prescription for a CD4 count? 1. A client with renal failure 2. A client with HIV 3. A client with anemia 4. A client with arthritis

2. A client with HIV

Question 3. The nurse is caring for a client exhibiting symptoms of nasal itching, watery rhinorrhea, itchy red eyes, and sneezing. The nurse suspects this client has which of the following diagnoses? 1. Atopic dermatitis 2. Allergic rhinitis 3. Urticaria 4. Serum sickness

2. Allergic rhinitis

Question 12. The nurse is assessing a client and notes cervical lymph nodes are enlarged, moveable, and painful upon palpation. Which of the following can the nurse conclude from these findings? 1. Cancer 2. Infection 3. Renal failure 4. Arthritis

2. Infection

Question 19. The nurse is reviewing risk factors for a latex allergy. Which of the following individuals is at high risk for developing a latex allergy? 1. A teacher 2. An airplane pilot 3. A dental assistant 4. A farmer

3. A Dental assistant

Question 17. The nurse is taking a surgical history. Which of the following surgeries place a client at risk for a weakened immune system? Select all that apply. 1. Appendectomy 2. Lobectomy 3. Splenectomy 4. Thymectomy 5. Tonsillectomy

3. Splenectomy 4. Thymectomy

Question 13. A client with type O blood is about to undergo surgery. Which blood type will the nurse ensure is on hand? 1. A 2. B 3. AB 4. O

4. O

Nursing Diagnosis' for Systemic Lupus Erythematosus

Acute pain Disturbed body image fatigue Ineffective health maintenance

Characteristics of Pernicious Anemia

Antibodies against gastric parietal cells and intrinsic factor Vitamin B12 deficiency RBC decrease production Also caused by gastric or small bowel reactions

Nursing Diagnosis' for Hemolytic Transfusion reactions

Fear Ineffective tissue perfusion risk for injury deficient knowledge

Types of autoimmune disorders

Idiopathic thrombocytopenic purpura Multiple sclerosis Myasthenia gravis Rheumatoid arthritis Ulcerative colitis

Characteristic of Autoimmune disorders

Immune system recognizes body's own cells as foreign Immune response destroys cells

What do hypersensitivity reaction do to the body?

Injury to the body due to exaggerated response

Treatment for Hashimoto's Thyroiditis

Lifelong Thyroxine

Immediate treatment for anaphylaxis

Oxygen, epinephrine, antihistamines, corticosteroids, vasopressors, mechanical ventilation

Characteristics of Hemolytic Transfusion reaction

RBC's with foreign antigens rapidly lysed Occludes blood vessels Ischemia, necrosis Life threatening Prevention is Key - Rhogam - Careful blood transfusion administration

Complications for Anaphylaxis

Respiratory arrest cardiac arrest

What causes Hypogammaglobulinemia

The congenital form of this disorder affects males

Education for Idiopathic Autoimmune Hemolytic Anemia

The patient and family are instructed on the medical regimen, and their understanding is verified.

Why someone gets Pernicious Anemia

There tends to be a familial tendency toward the autoimmune form of pernicious anemia. Causes of the acquired form of pernicious anemia (non-immune-related) include any type of gastric or small-bowel resections coupled with no or inadequate vitamin B12 or intrinsic factor replacement.

Etiology is Systemic Lupus Erythematosus

Young Women of childbearing years 1st degree relative of lupus patients African American/Hispanic population more likely to develop frequently

4 types of hypersensitivity reactions

1. Anaphylaxis 2. Hemolytic Transfusion reactions 3. Measles 4. Transplant rejections

Three Categories of immune disorders

1. Hyper sensitivity 2. Autoimmune disorders 3. Immune Deficiencies

Question 15. The nurse is reviewing orders for a client with systemic lupus erythematosus (SLE). Which medication will the nurse question? 1. Phenytoin 2. Belimumab 3. Methylprednisolone 4. Acetaminophen

1. Phenytoin

What are Type 3 hypersensitive reactions

1. Serum sickness

The nurse is observing a patient who is receiving an antibiotic. Which of these would the nurse recognize as a sign of anaphylaxis (SATA) 1. Stridor 2. Wheezing 3. Respiratory arrest 4. Hypertension 5. Bradycardia

1. Stridor 2. Wheezing 3. Respiratory arrest

Question 19. The immune system can mistakenly react to itself. This is known as which of the following? 1. Passive immunity 2. Autoimmune disease 3. Cell-mediated immunity 4. Anaphylactic reaction

2. Autoimmune disease

Question 1. The nurse is caring for a client with systemic lupus erythematosus (SLE). What clinical manifestations will the nurse expect to find during assessment? 1. Expiratory wheezing 2. Pericardial friction rub 3. Enlarged lymph nodes 4. Watery diarrhea

2. Pericardial friction rub

Question 18. The nurse is teaching a client who underwent a renal transplant about immunosuppressants. The nurse will include which information in the teaching? 1. Take on an empty stomach. 2. Report signs of infection. 3. This medication will take weeks for effects to be noticed. 4. Severe itching is a normal occurrence while taking this medication.

2. Report signs of infection.

Question 18. The nurse is caring for a client who is diagnosed with goiter secondary to Hashimoto's thyroiditis. Which interventions will the nurse expect to implement? 1. Encourage frequent activity. 2. Provide a regular diet. 3. Apply antiembolic stockings while client is in bed. 4. Encourage client to consume food high in iodine.

3. Apply antiembolic stockings while client is in bed.

Question 13. The nurse is reviewing laboratory test results for a client who developed a potential hemolytic reaction. Which laboratory test will the nurse expect to read to confirm this reaction? 1. C-reactive protein (CRP) 2. Erythrocyte sedimentation rate (ESR) 3. Direct Coombs test 4. Antinuclear antibody (ANA)

3. Direct Coombs test

How to prevent a hemolytic transfusion reaction

Administer Rhogam for Rho(D) negative patients Careful blood transfusion administration

Characteristics of Idiopathic Autoimmune Hemolytic Anemia

Antibodies attach to RBCs - lyse or agglutinate

Therapeutic interventions for Hemolytic Transfusion reaction

Antihistamines Corticosteroids Sympathomemetics

Diagnostic tests for transplant rejection

Biopsy Scans Blood tests Arteriography Ultrasonography

Nursing Diagnosis for Ankylosing Spondylitis

Chronic Pain Powerlessness Fatigue Self care deficit Impaired Physical Mobility

Diagnostic tests for Systemic Lupus Erythematosus

Complete blood count Antinuclear antibody (ANA) Anti-Smith (a highly specific immunoglobulin for systemic lupus erythematosus [SLE]) Anti-nDNA positive in 60% to 80% of SLE patients Anti-Ro (SSA), an immunoglobulin, positive in 30% of SLE patients Anti-La (SSB), an immunoglobulin, positive in 15% of SLE patients Complement ESR and C-reactive protein (CRP) nonspecific 24-hour urine creatinine clearance If ruling out kidney involvement: • Urinalysis • Serum creatinine • Kidney biopsy

Exposure to Latex can cause which types of reactions

Contact Dermititis and Anaphylaxis

Diagnostic test for Hemolytic transfusion reaction

Coombs test

Diagnostic tests for Hypogammaglobulinemia

Immunoelectrophoresis, which measures the level of each immunoglobulin, can be performed

Symptoms of Atopic Dermatitis

Initial:Pruritus, edema, and extremely dry skin Followed by: Red weeping lesions that break open crust over and scale off. Final: Skin thickens in affected areas (lichenification)

What reaction happens in Type 1 hypersensitivity

Involves the release of histamine and other mediators from mast cells and basophils

Signs and Symptoms of Ankylosing Spondylitis

Lower back stiffness Pain Lordosis, Kyphosis Spasms Fatigue Anorexia Weight loss

What effect does systemic lupus have on bone mineral density and risk factors?

Lowered bones density and increased risks for fractures.

Characteristics of allergic rhinitis

Most common form of allergies Sx: Sneezing, nasal itching, runny nose, itchy red eyes

Treatment for Ankylosing Spondylitis

No cure, supportive care, surgery Range of motion frequently

Complications of Systemic Lupus Erythematosus

Osteonecrosis Kidney disease thrombocytopenia emboli myocarditis vasculitis Mescenteric or intestinal vasculitis Sepsis

Signs and Symptoms of Discoid Lypus Erythematosus

Patchy, crusty, sharply defined skin plaques Occur on face/sun exposed areas

What are allergies that happen throughout they year called?

Perennial

Most common causes of Contact Dermititis

Poison Oak and Poison Ivy

When do you see a Hemolytic transfusion reaction

Pregnancy and blood transfusions

Nursing Care for Hemolytic Transfusion reactions

Prevention Careful transfusion monitoring If Reaction, Stop Blood, Follow policy Education

Treatment for transplant rejection

Preventive preoperative preparation with medications, transfusions, or radiation to minimize the risk of rejection

Symptoms of Hypogammaglobulinemia

Recurrent infections occur, especially from Staphylococcus and Streptococcus organisms.

Diagnostic tests for Idiopathic Autoimmune Hemolytic Anemia

The RBC count, hemoglobin (Hgb) level, and hematocrit (Hct) level are low. Microscopic examination reveals fragmented RBCs. Lactate dehydrogenase and serum bilirubin levels are elevated because of RBC destruction and tissue ischemia. The direct antiglobulin test (also called the Coombs test) helps determine if the cause of hemolytic anemia is due to antibodies attached to RBCs.

Characteristics of Transplant rejection

Transplanted living tissue sensed as foreign Lymphocytes sensitized immediately Invade transplanted tissue and destroy it Failure of organ or tissue Infection can result in death Prevention - immunosuppression therapy

What does a Type 1 hypersensitivity reaction lead to

Urticaria, eczema, angioedema, conjunctivitis, alergic rhinitis, asthma, gastroenteritis, and anaphylaxis

What happens when histamine is released?

Vasodilation, bronchoconstriction, mucus secretion, and vascular permeability occues

Signs and symptoms of Angioedema

acute, localized swelling of the skin; mucosa; and submucosa due to vascular leakage. Depending on the location and extensiveness of the edema, angioedema eruptions are usually nonpruritic and painless. However, it can be life threatening if the upper airway is involved and obstruction of the airway develops. The eruptions usually last longer than with urticaria. They most commonly affect the face, eyes, and lips.

Diagnosis of Contact Dermatitis

assessment of the skin and lesions through biopsy, culture or patch testing, and a detailed patient history.

Characteristics of Anaphylaxis

severe systemic type 1 reaction widespread histamine release Bronchial narrowing: Stridor, Wheezing, Respiratory arrest Hypotension, tachycardia, cardiac arrest.

Cause of Ankylosing Spondylitis

strong evidence of a familial tendency, but no other specific causes are known. Ankylosing spondylitis tends to afflict men more than women. It is usually diagnosed between the later teens and age 40.

Symptoms of Idiopathic Autoimmune Hemolytic Anemia

vary from mild fatigue and pallor to severe hypotension, dyspnea, palpitations, headaches, and jaundice. Problems concentrating and thinking frequently occur.

A patient asks the nurse how an allergy can develop to a medication that has been taken before without problems. Which of the following is the most appropriate response? 1. "It probably is due to your age, because as we age, the body becomes more sensitive to environmental stimuli, which leads to hypersensitivities." 2. "What have you eaten in the last 24 hours? Most medications are altered by food, thereby producing different effects in the body." 3. "Viral illnesses and exposure to various chemicals and environmental substances can alter the immune system and its response to previously benign stimuli." 4. "Patients who have autoimmune disorders such as lupus or arthritis tend to develop sensitivities to common medications."

"Viral illnesses and exposure to various chemicals and environmental substances can alter the immune system and its response to previously benign stimuli."

Question 15. The nurse is caring for a client with allergic rhinitis. Which interventions will the nurse anticipate implementing? Select all that apply. 1. Administration of a prescribed antihistamine. 2. Teach client to avoid environmental stimuli. 3. Administration of corticosteroids as ordered. 4. Administration of antibiotics as ordered. 5. Routinely check vital signs every 2 hours.

1. Administration of a prescribed antihistamine. 2. Teach client to avoid environmental stimuli. 3. Administration of corticosteroids as ordered.

Question 5. The nurse is evaluating if teaching was effective for a client with a prescription of diphenhydramine for itching. Which statement made by the client indicates an understanding? 1. "I should be careful when driving while taking this medication." 2. "I can still take my loratadine while taking this medication." 3. "I must take this medication with food." 4. "I can drink alcohol in moderation."

1. "I should be careful when driving while taking this medication."

The nurse is caring for a patient who asks what ankylosing spondylitis is. Which of the following responses from the nurse is appropriate? 1. "It is a chronic progressive inflammatory disease of the spine and large limb joints." 2. "Autoantibodies lyse red blood cells." 3. "There is formation of antigen-antibody complexes leading to inflammation." 4. "Production of immunoglobulin E antibodies occurs."

1. "It is a chronic progressive inflammatory disease of the spine and large limb joints."

Question 4. The nurse is taking a medication history of a client who reports an allergy to penicillin. The nurse asks what happens when they take penicillin, and the client states, "My stomach gets upset and I have diarrhea." Which of the following responses by the nurse is best? 1. "What you are experiencing is a side effect to the medication, not an allergy." 2. "You need to carry an EpiPen with you in case this happens while taking the medication." 3. "You should wear a medical alert bracelet listing penicillin allergy." 4. "You should not take cephalosporins because you can have a reaction to drugs from this class too."

1. "What you are experiencing is a side effect to the medication, not an allergy."

Question 7. The nurse is caring for a client with pernicious anemia. The nurse can expect to implement which intervention? 1. Administer vitamin B12 as prescribed. 2. Strict 1500 mL/day fluid restriction. 3. Place the client in protective isolation. 4. Teach the client to use a brown soap.

1. Administer vitamin B12 as prescribed.

The nurse is caring for a patient with allergic rhinitis. Which of the following interventions should the nurse anticipate will be included in the treatment plan for this patient? Select all that apply. 1. Antihistamines 2. Anticholinergics 3. Avoiding environmental stimuli 4. Decongestants 5. Immunotherapy 6. Steroids

1. Antihistamines 3. Avoiding environmental stimuli 4. Decongestants 5. Immunotherapy 6. Steroids

Question 14. The nurse is caring for a client with an allergy to bee stings. Which of the following is most important for the nurse to teach the client? 1. Carry an epinephrine pen at all times. 2. Avoid going outdoors in the summer. 3. Take 50 mg of diphenhydramine (Benadryl) 2 hours before going outside. 4. Encourage the client to remove all bee hives from their home.

1. Carry an epinephrine pen at all times.

What are type 4 hypersensitivity reactions?

1. Contact dermatitis 2. Transplant rejection 3. Autoimmune disorders

What are the 3 types of Lupus Erythematosus

1. Discoid Lupus Erythematosus - Skin lesions 2. Drug Induced systemic Lupus Erythematosus - after certain medication use 3. Systemic Lupus Erythematosus - Chronic, inflammatory, multisystem disorder

Question 2. The nurse is teaching a client who returned to the unit after an appendectomy to report clinical manifestations of infection. Which of the following will the nurse encourage the client to report? Select all that apply. 1. Fever 2. Redness of the incision site 3. Swelling of the incision site 4. Cool to touch 5. Pain of the incision site

1. Fever 2. Redness of the incision site 3. Swelling of the incision site 5.Pain of the incision site

Which of these are the 3 categories of immune disorders 1. Hypersensitivity reactions 2. Auto immune disorders 3. Immune deficiencies 4. Arthritis 5. Anemia

1. Hypersensitivity reactions 2. Auto immune disorders 3. Immune deficiencies

Types of immune deficiencies

1. Hypogammaglobulinemia 2. Acquired immunodeficiency syndrome (AIDS)

Question 11. The nurse is educating a client diagnosed with systemic lupus erythematosus (SLE) about triggers for the condition. Which triggers will the nurse include in the teaching? Select all that apply. 1. Infection 2. Surgery 3. Stress 4. Emotional crisis 5. Immunizations

1. Infection 2. Surgery 3. Stress 4. Emotional crisis 5. Immunizations

Which of these nursing interventions would the nurse implement for a type 1 hypersensitivity reaction? (SATA) 1. Monitor respiratory status 2. Monitor LOC 3. Place the patient in isolation 4. Provide information 5. Teach to avoid rubbing or applying pressure for itching

1. Monitor respiratory status 2. Monitor LOC 4. Provide information

Question 18. The nurse is discussing immunity with a client. The client asks what type of immunity her child will receive if she breastfeeds. The nurse will reply with which of the following? 1. Naturally acquired passive immunity 2. Artificially acquired active immunity 3. Naturally acquired active immunity 4. Artificially acquired passive immunity

1. Naturally acquired passive immunity

Which of these would the nurse anticipate would be order for a patient experiencing anaphylaxis (SATA) 1. Oxygen 2. Epinephrine 3. Insulin 4. Antihistamines 5. Corticosteroids 6. Mechanical Ventilation

1. Oxygen 2. Epinephrine 4. Antihistamines 5. Corticosteroids 6. Mechanical Ventilation

What are autoimmune disorders?

1. Pernicious anemia 2. idopathic Autoimmune hemolytic anemia 3. Hashimoto's Thyroiditis 4. Lupus 5. Ankylosing Spondylitis

Question 9. The nurse is caring for a client admitted with urticaria. Which clinical manifestations will the nurse expect to see during assessment? 1. Raised, pruritic, nontender, erythematous wheals on the skin 2. Pruritis, edema, and extremely dry skin 3. Sneezing, itching, rhinorrhea, and itchy eyes 4. Fever, malaise, muscle soreness, arthralgia, and splenomegaly

1. Raised, pruritic, nontender, erythematous wheals on the skin

types of autoimmune disorders

1. Rheumatoid arthritis 2. Ulcerative Colitis Multiple Sclerosis

Question 20. The nurse is monitoring a client who is receiving a blood transfusion. The client suddenly reports chills, low back pain, tachycardia, and dyspnea. Aside from remaining with the client, place the nursing actions in order from first to last. 1. Stop the transfusion. 2. Transfuse normal saline as ordered. 3. Notify the health-care provider. 4. Return the unused blood and tubing to the blood bank.

1. Stop the transfusion. 2. Transfuse normal saline as ordered. 3. Notify the health-care provider. 4. Return the unused blood and tubing to the blood bank.

Question 1. The nurse is teaching a client with contact dermatitis about skin care and prevention of infection. What will the nurse include in the teaching? Select all that apply. 1. Wear clean, white cotton gloves at night. 2. Keep fingernails short and clean. 3. Use topical corticosteroids on dry skin. 4. Take oral antihistamines to reduce itching. 5. Rub skin gently instead of scratching.

1. Wear clean, white cotton gloves at night 2. Keep fingernails short and clean 4. Take oral antihistamines to reduce itching 5. Rub skin gently instead of scratching

Question 19. A client presents to the emergency department with stridor, wheezing, dyspnea, and facial edema. The nurse concludes this client is experiencing an anaphylactic reaction. Which interventions will the nurse implement? Select all that apply. 1. Administer oxygen as prescribed. 2. Place an endotracheal (ET) intubation kit at the bedside. 3. Administer the prescribed antibiotic. 4. Place the client on a cardiac monitor. 5. Obtain the prescribed intravenous (IV) access.

1.Administer oxygen as prescribed. 2.Place an endotracheal (ET) intubation kit at the bedside. 4. Place the client on a cardiac monitor. 5. Obtain the prescribed intravenous (IV) access.

Pathophysiology of Atopic Dermatitis

2 Theories: 1. Allergic response that is being mediated from IgE antibodies 2. defect in skin cells that damage the skins protective barrier.

Question 4. The nurse is discussing vaccinations with an older adult. Which of the following statements made by the client indicates an understanding regarding the teaching? 1. "I should get a flu shot every other year so I don't get the flu." 2. "I should get a shingles vaccine because I am over 60." 3. "I had a tetanus shot 15 years ago, so I don't need another one." 4. "I should get a shot for pneumonia every 5 years."

2. "I should get a shingles vaccine because I am over 60."

The nurse is collecting data from a patient with contact dermatitis. Which data is essential for the nurse to obtain? 1. Date of gastric surgery 2. Appearance of skin lesions 3. Weight gain 4. Appetite

2. Appearance of skin lesions

Question 8. The nurse is preparing to administer a cephalosporin intravenously to a client. Which information is most important for the nurse to ask before administering the medication? 1. Is the client allergic to shellfish? 2. Does the client have an allergy to penicillin? 3. Is the client taking any other medications? 4. Has the client experienced diarrhea in the past from antibiotics?

2. Does the client have an allergy to penicillin?

Question 6. The nurse is caring for a client with hypothyroidism. Which clinical manifestations can the nurse expect the client to exhibit? Select all that apply. 1. Hypertension 2. Dyspnea 3. Diarrhea 4. Slow mental processes 5. Sensitivity to heat

2. Dyspnea 4. Slow mental processes

The nurse is collecting data on a patient with suspected pernicious anemia. Which of these signs or symptoms would the nurse expect to find for this patient? Select all that apply. 1. Back spasms 2. Glossitis 3. Itching 4. Kyphosis 5. Pallor 6. Weakness

2. Glossitis 5. Pallor 6. Weakness

Question 16. After an infection, a client develops antibodies and memory cells specific to the pathogen that caused the infection. What type of immunity will the client receive? 1. Artificially acquired passive immunity 2. Naturally acquired active immunity 3. Naturally acquired passive immunity 4. Artificially acquired active immunity

2. Naturally acquired active immunity

Question 20. A client receiving a blood transfusion experiences a sudden onset of chest pain, tachycardia, tachypnea, dyspnea, and urticaria. The nurse concludes this client is experiencing a hemolytic transfusion reaction. Which of the following actions will the nurse take? Select all that apply. 1. Double-check the patient's blood type in the medical record 2. Notify the health care provider (HCP) 3. Stop the blood transfusion immediately 4. Monitor symptoms and vital signs 5. Inform the blood bank

2. Notify the health care provider (HCP) 3. Stop the blood transfusion immediately 4. Monitor symptoms and vital signs 5. Inform the blood bank

Question 1. The nurse is caring for a client with a latex allergy. Which of the following requires correction by the nurse? 1. The unlicensed assistive personnel (UAP) places a cart with latex-free supplies outside the client's room. 2. The UAP wears powdered latex gloves when bathing the client. 3. The UAP removes the avocado and banana from the lunch tray. 4. The UAP places a "latex allergy" sign on the client's door.

2. The UAP wears powdered latex gloves when bathing the client.

Question 14. The nurse is teaching a daycare about planning a peanut-free menu for a class with children with peanut allergies. Which of the following food choices indicates a need for further teaching? 1. Fresh carrots 2. Trail mix 3. Cheddar snack crackers 4. Oranges

2. Trail mix

Question 17. The nurse is providing teaching to a client receiving methylprednisolone (Solu-Medrol). Which statement made by the client indicates a need for further teaching? 1. "I need to take this medication with food." 2. "I should monitor my weight while taking this medicine." 3. "I can stop taking this medication as soon as I feel better." 4. "This medicine might make my blood sugar high."

3. "I can stop taking this medication as soon as I feel better."

Question 13. The nurse is caring for a group of clients. Which client will the nurse see first? 1. A client who has pernicious anemia receiving B12 injections 2. A client with allergic rhinitis who has developed sinusitis 3. A client who got admitted for angioedema from a bee sting 4. A client with systemic lupus erythematosus (SLE) who is crying

3. A client who got admitted for angioedema from a bee sting

Question 11. The nurse is caring for a client who is diagnosed with goiter secondary to Hashimoto's thyroiditis. Which interventions will the nurse expect to implement? 1. Encourage frequent activity. 2. Provide a regular diet. 3. Apply antiembolic stockings while client is in bed. 4. Encourage client to consume food high in iodine.

3. Apply antiembolic stockings while client is in bed.

Question 10. Which of the following types of immunity involve T cells? 1. Passive immunity 2. Active immunity 3. Cell-mediated immunity 4. Humoral immunity

3. Cell-mediated immunity

Question 8. The nurse is caring for a client who presents with severe shortness of breath, wheezing, and hives. Which of the following medications would the nurse expect to administer as ordered? 1. Proton-pump inhibitor (PPI) 2. Antibiotic 3. Epinephrine 4. Opioid analgesic

3. Epinephrine

Question 18. The nurse is caring for a client with systemic lupus erythematosus (SLE). The nurse will be most concerned with which finding? 1. Complaints of joint stiffness 2. A "butterfly" rash on the face 3. Foamy, brown-colored urine 4. Drowsiness during the day

3. Foamy, brown-colored urine

A patient is receiving cefuroxime (Zinacef) intravenously. Fifteen minutes after the cefuroxime is started, the patient reports an uneasy feeling as well as feeling very warm. Which actions would the nurse take now? Select all that apply. 1. Offer the patient ice water. 2. Discontinue the angiocath. 3. Stay with the patient. 4. Turn off the intravenous infusion. 5. Call for assistance. 6. Monitor vital signs.

3. Stay with the patient. 4. Turn off the intravenous infusion. 5. Call for assistance. 6. Monitor vital signs.

How many types of hypersensitive reactions are there?

4

A patient is admitted with an autoimmune disease and asks the nurse what autoimmune means. Which of the following responses by the nurse would be appropriate? 1. "Immune cells produce too many antibodies." 2. "Immune cells grow and multiply too rapidly." 3. "Immune cells are not produced in sufficient amounts." 4. "Immune cells are unable to distinguish between 'self' and 'not self.'"

4. "Immune cells are unable to distinguish between 'self' and 'not self.'"

Question 4. The nurse is caring for a group of clients. Which client will the nurse see first? 1. A client with contact dermatitis who reports redness and itching to both hands 2. A client receiving the fifth dose of antibiotic who reports of watery diarrhea 3. A client with ankylosing spondylitis who reports joint pains in early mornings 4. A client receiving a blood transfusion who reports fever, low back pain, and itching

4. A client receiving a blood transfusion who reports fever, low back pain, and itching

Question 6. A client is diagnosed with ankylosing spondylitis. Which intervention will the nurse implement? 1. Encourage a diet high in starch. 2. Discourage range-of-motion exercises. 3. Provide a soft mattress for sleeping. 4. Give the prescribed ibuprofen.

4. Give the prescribed ibuprofen.

Question 12. The nurse is reviewing vaccination records for an older adult. Which of the following vaccinations should the nurse suggest the client receive? 1. Varicella vaccine 2. Rotavirus vaccine 3. Hepatitis B vaccine 4. Pneumococcal vaccine

4. Pneumococcal vaccine

Question 12. The nurse is caring for a client with pernicious anemia. Which clinical manifestations will the nurse expect during assessment? 1. Lower back stiffness, lordosis, and fatigue 2. Sensitivity to cold, facial edema, and anorexia 3. Hypotension, dyspnea, and jaundice 4. Weakness, tongue inflammation, and pallor

4. Weakness, tongue inflammation, and pallor

Question 8. The nurse is teaching a client with systemic lupus erythematosus (SLE) how to prevent exacerbations of the illness. What should the nurse include in teaching? 1. Sleep for 6 hours every night. 2. Cool baths for joint stiffness. 3. Eat a high-carbohydrate diet. 4. Wear protection from the sun.

4.. Wear protection from the sun

Diagnostic tests for Angioedema

A comprehensive history and physical examination confirm the diagnosis. Skin testing may be performed to determine the specific antigen.

Symptoms of a Hemolytic transfusion reaction

A hemolytic transfusion reaction is usually accompanied by a rather sudden onset of low back (flank) or chest pain, hypotension, fever rising more than 1.8°F (1°C), chills, tachycardia, tachypnea, wheezing, dyspnea, urticaria, and anxiety. The patient also may report a headache and nausea.

Characteristics of Hypogammaglobulinemia

Absence/ deficiency of one or more of the 5 immunoglobins from defective B cell function Prone to infection

What is immunotherapy

Allergy shots used for severe or debilitating symptomatic patients

Symptoms of Ankylosing Spondylitis

Ankylosing spondylitis causes an insidious onset of lower back stiffness and pain, which is worse in the morning. As the disease progresses, the pain worsens and there are spasms of the back muscles. The normal curvature of the lower back (lordosis) flattens, and the curvature of the upper back (kyphosis) increases. Patients may also experience fatigue, anorexia, and weight loss.

Characteristics of Serum sickness

Antigen-Antibody complexes cause symptoms of inflammation 7-10 days after penicillin/sulfonamide Severe urticaria and angioedema Brief and self limiting condition

Pathophysiology for Allergic Rhinitis

Antigen/antibody reaction Ciliary action decrease and mucous secretions increase. Vasodilation and local tissue edema occurs

Treatment of contact dermatitis

Antihistamines, Topical corticosteroids More severe reactions may need systemic corticosteroids or topical immunomodulators

Treatment for Atopic Dermatitis

Antipruritics-reduce itching Lukewarm soaks w/ application of emollients and oil in water Topical corticosteroids- antiinflammatories Topical calcineurin inhibitors- reduce inflammatory response Dilute Bleach soaks Eliminate triggers

Characteristics of Hashimoto's Thyroiditis

Autoantibodies for thyroid-stimulating hormone, thyroid gland overstimulation Then Autoantibodies destroy thyroid, hypothyroidism Lifelong thyroxine

Therapeutic interventions for Pernicious Anemia

Corsticosteroids Lifelong B12 injections

Treatment of Pernicious anemia

Corticosteroids if immunological B12 therapy for life

Education for patients with Systemic Lupus Erythematosus

Explain the signs of bleeding and of cardiac and vascular problems, such as myocardial infarction and thrombophlebitis. Encourage medical alert usage. Provide smoking cessation information to patients who smoke. Because kidney disease is a major complication of SLE, patients must learn the signs of impending problems that need to be relayed to the HCP immediately. These include facial puffiness and "foamy" or "cola-colored" urine, which are indicative of proteinuria and hematuria, respectively. Explain that regular ophthalmic examinations are needed for early detection and treatment of the complications that antimalarial drugs and corticosteroids can produce, such as retinal bleeding, glaucoma, and cataracts.

Diagnostic tests for Ankylosing Spondylitis

Findings such as a positive family history, a positive HLA-B27 blood test, negative Rh, and radiographs of the joints showing spinal changes and fusion (although these changes are a late finding) confirm a diagnosis of ankylosing spondylitis. There are no specific immunological tests to diagnose ankylosing spondylitis.

Characteristics of Angioedema

Form of urticaria affects submucosal/subcutaneous tissue rather than skin Painless, dermal erthyematous/ subcutaneous eruptions, Skin/Mucous membrane edema

What are allergies called if they happen only part of the year?

Hay Fever

Pathophysiology for Hypogammaglobulinemia

Hypogammaglobulinemia is either a hereditary congenital disorder or acquired after childhood from unknown causes. It is characterized by the absence or deficiency of one or more of the five classes of immunoglobulins (IgG, IgM, IgA, IgD, and IgE) from defective B-cell function. The lack of normal function of these antibodies makes the patient prone to infections.

Nursing care for Hashimoto's Thyroiditis

If the patient has a goiter, a soft diet may be needed for comfort. Frequent rest periods may be needed as well as slowly increasing patient activity. Antiembolic stockings may help prevent venous stasis during the low-energy, decreased-activity phase. Daily weights and monitoring of intake and output when cardiac status is compromised are important to detect abnormalities such as fluid retention. Because weight gain and facial puffiness alter patients' self-image, patients need an opportunity to verbalize their feelings to help them adjust to this disease process.

Pathophysiology of Anaphylaxis

IgE from previous exposure causes a widespread release of histamine and other chemical mediators contained within the mast cells.

Characteristics of Type 3 Hypersensitivity Reactions

Immune Complexes formed by antigens and antibodies Antigen-Antibody complexes within blood vessels Enzymes lead to blood vessel damage Red edematous lesion, bleeding, necrosis

Diagnostic tests for Hashimoto's Thyroiditis

Immunofluorescent assay, a test that detects antigens on cells using an antibody with a fluorescent tag, detects antithyroid antibodies. Serum TSH levels are elevated, whereas triiodothyronine (T3) and thyroxine (T4) levels are low. A thyroid scan is also done.

Therapeutic interventions for Idiopathic Autoimmune Hemolytic Anemia

Immunosuppressive medications Oxygen Corticosteroids Folic Acid Transfusion Erythrocytapheresis Splenectomy

Nursing diagnosis' for Type 1 hypersensitivity reaction

Impaired gas exchange Anxiety Risk for impaired skin integrity Ineffective health maintenance

Pathophysiology for Idiopathic Autoimmune Hemolytic Anemia

In this disorder, autoantibodies, for no known reason, are produced that attach to RBCs and cause them to either lyse or agglutinate (clump). When lysis occurs, fragments of the destroyed RBCs circulate in the blood. If agglutination occurs, occlusions in the small blood vessels are followed by tissue ischemia.

Symptoms of Hashimoto's Thyroiditis

Initial signs and symptoms are those of hyperthyroidism, such as restlessness, tremors, chest pain, increased appetite, diarrhea, moist skin, heat intolerance, and weight loss. These manifestations may go unrecognized and progress quickly into hypothyroidism. At this point, an enlarged thyroid gland (goiter) may be seen. Signs and symptoms may include fatigue, bradycardia, hypotension, dyspnea, anorexia, constipation, dry skin, weight gain, sensitivity to cold, facial puffiness, and a slowing of mental processes.

What is rhinophototherapy used for

Light waves to reduce the hyperimmune response seen in the disorder Takes 3x a week for 3 weeks to relieve symptoms of allergic rhinitis

Signs and Symptoms of Idiopathic Autoimmune Hemolytic Anemia

Mild Fatigue Pallor Hypotension Dyspnea Jaundice

Therapeutics interventions for Hypogammaglobulinemia

Minimizing infections Ig G injections Fresh frozen plasma

Nursing care for Hypogammaglobulinemia

Monitor for infections. Any break in the skin must be cleansed immediately and monitored for infection development. Genetic counseling may be recommended. Education on signs and symptoms of various infections and seeking medical help promptly, avoiding crowds, the need for good nutrition, hydration, and hygiene is provided.

Nursing care for Type 1 hypersensitivity reaction are?

Monitor respiratory status Monitor LOC stay with patient Provide education Note and document skin and lesions Teach rubbing or pressure not scratching Teach patient to wear medical bracelet Discuss methods to avoid allergen

Nursing care for Serum Sickness

Monitoring for symptoms evaluation of medication effects Education

What treatment for allergic rhinitis should be used with caution in older adults

Nasal corticosteroids as they dry out the nares

Treatment of Ankylosing Spondylitis

No Cure, treatment consists of measures to minimize the symptoms. Analgesics and muscle relaxants for pain relief, anti-inflammatory agents to decrease joint inflammation, and physical therapy to maintain muscle strength and joint range of motion are used. Biological agents such as antitumor necrosis factor (TNF)-a, including etanercept (Enbrel), infliximab (Remicade), and adalimumab (Humira), have shown promising results in changing the disease progression. Surgery can be done to replace fused joints. For kyphosis, cervical or lumbar osteotomy can be performed. Physiotherapy and exercise can be beneicial in managing symptoms.

Education for Hashimoto's Thyroiditis

Patients taking thyroid hormone replacement therapy should avoid foods high in iodine. Their diet should also consist of large amounts of fiber to combat constipation. During the hyperthyroidism phase, a diet high in protein and carbohydrates encourages weight gain. Education regarding prescribed medications is also needed. Cholestyramine, ferrous sulfate, sucralfate, iron-containing multivitamins, calcium carbonate, and all other antacids interfere with the absorption of levothyroxine from the gastrointestinal tract. Therefore, levothyroxine should be taken a minimum of 4 hours after taking these medications.

Diagnostic tests for Atopic Dermatitis

Physical exam Serum IgE Culture and sensitivity test

Signs and symptoms of Drug Induced Systemic Lupus Erythematosus

Pleuropericardial inflammation Fever Rash Arthritis

Diagnostic Tests for Pernicious Anemia

RBCs are examined under a microscope for shape. B12 levels folic acid levels Methylmalonic Acid level Gastric secretion analysis Serum Cobalamin Radioimmunoassay or Enzyme-linked immunosorbent assay

Characteristics of Uticaria (Hives)

Release of histamine Raised, pruritic, nontender, erythematous wheals on the skin

Pathophysiology of Systemic Lupus Erythematosus

SLE is an autoimmune disease characterized by spontaneous remissions and exacerbations. In SLE, the body develops abnormal antibodies (antinuclear antibodies [ANAs]) against its own tissue, leading to the formation of immune complexes. These in turn activate the complement system, resulting in negative autoimmune effects on the patient's healthy connective tissue. Many of the manifestations result from recurring injuries to the patient's vascular system. The resulting immune complexes lodge in the blood and organs, leading to inflammation, damage, and possibly death.

Treatment for serum sickness

Self limiting so treatment focuses on symptom management Antipyretics Analgesics Anti-inflammatories Anti-histamines Epinephrine Corticosteroids

Complications of Hemolytic Transfusion Reaction

Shock Acute Kidney injury

Symptoms of Serum Sickness

Signs and symptoms usually occur 7 days to 3 weeks after exposure. Most predominant is severe urticaria and angioedema. The patient may have a fever, malaise, muscle soreness, arthralgia, splenomegaly, and, occasionally, nausea, vomiting, and diarrhea. Lymphadenopathy may occur, especially in the lymph nodes closest to the antigen entry site.

Complications of allergic rhinitis

Sinusitis, nasal polyps, asthma, and chronic bronchitis can occur with repeated episodes of allergic rhinitis

Diagnostic tests for allergic rhinitis

Skin testing Radioallergosorbent (RAST) test in-vitro allergy test

Anaphylaxis signs and symptoms

Smooth muscle spasms, stridor, wheezing, dyspnea, laryngeal edema, cramping, diarrhea, nausea, vomiting, capillary permeability increases allowing fluid shift, Hypotension, tachycardia, blood volume decreases, redness and warm skin, apprehension, drowsiness, profound restlessness, headache, and possible seizures.

Common Systemic Lupus Erythematosus Flare Triggers

Sunlight (reflected off water and snow; window glass does not fully protect) Fluorescent and halogen lights Stress Emotional crisis Overwork Lack of rest Infection Surgery or injury Hormones Pregnancy and after delivery (postpartum) Stopping medications suddenly Environmental sensitivities or allergies Immunizations Certain prescription drugs Some over-the-counter drugs, such as cough syrups

Treatment for Idiopathic Autoimmune Hemolytic Anemia

Supportive measures, such as supplemental oxygen, may be started. Folic acid may be prescribed to increase production of RBCs. IV immunoglobulin, immunosuppressant medications, and corticosteroids may be useful in obtaining remission. In more severe cases, blood transfusions and erythrocytapheresis (a process in which abnormal RBCs are removed and replaced with normal RBCs) may be instituted. For severe cases, a splenectomy may be performed to stop the destruction of RBCs.

Treatment of Systemic Lupus Erythematosus

Symptom management Nonsteroidal anti-inflammatory drugs (NSAIDs) Immunosuppressants Corticosteroids Antimalarials Intravenous immunoglobulin

Therapeutic interventions for Systemic Lupus Erythematosus

Symptomatic management NSAIDs Immunosuppressants Corticosteroids Antimalarials IV immunoglobulin

Patient teaching for corticosteroids

Take with food Dont stop taking suddenly

Patient teaching after a transplant

Teach patient signs and symptoms of transplant rejection. Rejection can take days, weeks, months or even years. Compliance with medication is essential.

Patient teaching for EpiPen

Teach patient to avoid exposing drug to heat or light.

Patient teaching for corticosteroids

Teach: • Take orally with food. • Never stop taking suddenly. Monitor: • Weight • Edema, shortness of breath, jugular vein distention for heart failure development • Blood glucose level • Gastrointestinal bleeding

Pathophysiology of Pernicious Anemia

The body's immune system targets its own tissues. It then develops antibodies that destroy the parietal cells and disrupt intrinsic factor and hydrochloric acid production. These antibodies can alter the binding sites. This impairs the absorption of vitamin B12 in the ileum. A vitamin B12 deficiency may result. This leads to insufficient and deformed RBCs with poor oxygen-carrying capacity.

Causes of Hashimoto's Thyroiditis

The exact cause is unknown, although it occurs in females eight times more often than in males. It is also more common in people aged 30 to 50 years and in patients with Down syndrome and Turner syndrome.

Treatment for Angioedema

The most basic treatment involves avoiding the antigen or allergen desensitization. Cinryze, a C1-INH, is for routine prophylaxis against angioedema attacks. Acute symptoms may be relieved with antihistamines, corticosteroids, or other medications. Berinert, also a C1-INH, treats angioedema of the abdomen, face, or throat. Haegarda is a human plasma-derived, concentrate prepared from donors. Ecallantide (Kalbitor), a plasma kallikrein inhibitor, and icatibant (Firazyr), a selective bradykinin B2 receptor antagonist, help control symptoms. Infusion of fresh frozen plasma reverses the angioedema symptoms associated with ACE inhibitor-induced angioedema, which tends to be resistant to standard treatments. Androgens, antifibrinolytics, and immunosuppressive therapy are useful in the long-term treatment of some acquired types of angioedema.

Nursing care for Idiopathic Autoimmune Hemolytic Anemia

The patient's signs and symptoms should be monitored and reported as needed. Frequent rest periods should be planned into the patient's daily routine to prevent fatigue. Blood products are administered as ordered to replace RBCs.

Treatments of Hashimoto's Thyroiditis

Thyroid hormone replacement therapy of thyroxine is the primary means of treatment. Lifelong thyroid hormone therapy is needed.

Complications of transplant rejection

Total failure and loss of transplanted organ or tissue Cause of death is most commonly due to infection, with immunosuppression therapy a contributory factor

Treatment of Hypogammaglobulinemia

Treatment is aimed at minimizing infections while increasing immune system function through subcutaneous injections or IV infusions of immunoglobulin. Immunoglobulin mainly contains IgG, so fresh frozen plasma is given to replace IgM. IgA cannot be replaced, increasing the risk for frequent pulmonary infections. Gene therapy has been shown to be successful in stabilizing infant immune systems with severe combined immunodeficiency but has been less effective with older patients.

Serum sickness can occur 7 to 10 days after penicillin or sulfonamide is given. True or false

True

True or False A patient can still have a reaction even if the blood being infused is the same blood type

True

Therapeutic interventions for Contact Dermatitis

Use antihistamines, topical drying agents, corticosteroids Take tepid baking soda baths or aveeno baths Wash with brown soap (Fels-Naptha) Avoid scratching

Nursing care for Pernicious Anemia

Vitamin B12 is administered as ordered. Care related to fatigue and safety are important. Ambulation, frequent rest periods, and assistance with activities of daily living (ADLs) as indicated by the patient's activity tolerance are helpful for the patient with anemia.

Diagnostic test for Serum Sickness

WBC count Sedimentation rate C-Reactive Protein Complement Assay Peripheral blood smear

What should be monitored in patients taking corticosteroids

Weight Edema, SOB, jugular vein distention for HF development Blood Glucose lvl Gastric bleeding

What is a haptens

When a substance or chemical comes in contact with the skin, it is absorbed and binds with special skin proteins

pathophysciology of Contact Dermititis

When a substance or chemical comes in contact with the skin, it is absorbed and binds with special skin proteins called haptens. With the first contact, there is no reaction or symptoms, but within 7 to 10 days T memory cells are formed. Therefore, on subsequent exposures, the T memory cells quickly become activated T cells, which secrete the chemicals that may cause symptoms.

Symptoms of Contact Dermatitis

Within a number of hours of exposure, the area of contact becomes red and pruritic, with fragile vesicles. Secondary infections may develop.

Pathophysiology of Hemolytic Transfusion reaction

a Type 2 reaction in which incompatible surface antigen blood is transfused

Pathophysiology of Ankylosing Spondylitis

also called rheumatoid spondylitis, is a chronic progressive inflammatory disease primarily of the spine and sacroiliac area. It can also affect the large limb joints. The inflammatory process begins in the lower region of the back and progresses upward. A specific histocompatibility antigen (antigen that identifies self), human leukocyte antigen (HLA) B27 is formed that stimulates an immune response. It can result in complete fusion of the spine. This causes complete rigidity in the spine, a condition known as "bamboo spine."

3 examples of corticosteroids

dexamethasone (Decadron) hydrocortisone (Solu-Cortef) methylprednisolone (Solu-Medrol)

treatment for uticaria

epinephrine corticosteroids antihistamines H2 histamine blockers monoclonal antibody therapy accupuncture

Symptoms of Pernicious Anemia

increasing weakness, loss of appetite, glossitis (inflammation or infection of the tongue), and pallor. Irritability, confusion, and numbness or tingling in the extremities (peripheral neuropathy) occur because the nervous system is affected.

Patient education for Pernicious anemia

patient and family need education regarding oral or parenteral medication therapy. If vitamin B12 injections are prescribed, the patient must understand that this is a lifelong need to prevent the return of symptoms. Patients should not miss injections, periodic vitamin B12 testing, or follow-up appointments.

diagnosis of Uticaria

physical exam and history

Pathophysiology of Serum sickness

reaction in which antigen-antibody complexes form and lodge in small vessels. Leads to inflammation, tissue damage, and necrosis. Usually occurs after a dose of penicillin or sulfonamide.

Pathophysiology of Angioedema

result of vascular permeability that increases in the submucosal and subcutaneous layers. It may be acquired or hereditary. It may be caused by hypersensitivity (e.g., food, drugs, or insect stings), physical stimuli (e.g., cold), autoimmune disease or infection, angiotensin-converting enzyme (ACE) inhibitors, NSAIDs, or C1 esterase inhibitor (C1-INH) deficiency or dysfunction (hereditary and acquired)

What symptoms should you report immediately for Type 1 Hypersensitivity reaction

sudden dyspnea, shortness of breath, anxiety, restlessness, or chest or back pain

Pathophysiology of type 2 hypersensitivity reaction

the destruction of a cell or substance that has an antigen attached to its cell membrane, which is sensed by either immunoglobulin G (IgG) or immunoglobulin M (IgM) as being a foreign antigen

Cause of Systemic Lupus Erythematosus

unknown, but the disorder tends to occur in families. Identified chromosomal markers indicate a genetic link. Environmental factors may also play a critical role in the development of SLE. Infections, high stress levels, various hormones and drugs (especially antibiotics such as sulfonamides and penicillin), and ultraviolet light have all been linked to triggering SLE. Exacerbation of symptoms, also called a flare, often occurs before the start of menstruation and during pregnancy, demonstrating the link hormones may have in triggering SLE. African Americans, Hispanics, Native Americans, and Asians are two to three times more likely to develop SLE than others. Lupus most often affects women between the ages 15 and 40 and at a rate of 10 times more often than for men. With improved therapy, the mortality rate for patients with SLE has improved greatly. The leading causes of death are kidney failure, heart failure, and central nervous system involvement.

What causes allergic shiners

venous congestion in the maxillary sinuses

Symptoms of Systemic Lupus Erythematosus

• Early symptoms are vague, then fatigue, fever • Dermatological: Butterfly rash (face), photosensitivity, mucosal ulcers, alopecia, pain, pruritus, bruising • Musculoskeletal: Arthralgia, arthritis • Hematologic: Anemia, leukocytopenia, elevated erythrocyte sedimentation rate (ESR), thrombocytopenia, false-positive venereal disease research laboratory test • Cardiopulmonary: Pericarditis, myocarditis, myocardial infarction, vasculitis, pleurisy, valvular heart disease • Renal: Renal failure, urinary tract infections, fluid and electrolyte imbalances • Central nervous system: Cranial neuropathies, cognitive impairment, mental changes, seizures • Gastrointestinal: Anorexia, ascites, pancreatitis, intestinal vasculitis • Ophthalmological: Conjunctivitis, dry eyes, glaucoma, cataracts, retinal pigmentation

Characteristics of Contact Dermatitis

Chemical comes in contact with skin On second exposure, T cells secrete chemicals Poison Ivy, Poison Oak, Latex rubber Reddened Pruritic, Fragile vesicles

Characteristics of Ankylosing Spondylitis

Chronic Progressice Inflammatory Disease - Sarcroiliac, costocertebral, large peripheral joints

Complications of Systemic Lupus Erythematosus

Emboli Mesenteric or intestinal vasculitis leading to obstruction, perforation, or infarction Myocarditis Osteonecrosis Renal failure Sepsis Thrombocytopenia Vasculitis

Nursing care for Systemic Lupus Erythematosus

Prevention of exacerbations (flares) is important. Therefore, taking preventive measures is suggested.

Question 10. Which is an administration priority for epinephrine? 1. Oral 2. Intravenous (IV) 3. Topical 4. Injection

2. Intravenous (IV)

Diagnostic test for Anaphylaxis

ABGs History ECG After crisis- allergy testing

Nursing Diagnosis' for Serum Sickness

Acute pain Risk for deficient fluid volume

What is a type 1 hypersensitivity reaction?

Anaphylactic reaction Occurs immediately mild to severe, life threatening

When do you take vitals for a blood transfusion

Before administration 15 minutes into transfusion

Signs and symptoms of Systemic Lupus Erythematosus

Butterfly rash, brusing, photosensitivity, alopecia, pain, pruritis Arthralgia, arthritis Anemia, leukocytopenia, thrombocytopenia Pericarditis, myocarditis, MI, casculitis, Pleurisy, valvular disease Kidney disease, UTI, fluid and electrolyte imbalance Cranial neuropathies, seizures, cognitive impairment Anorexia, ascites, pancreatitis intestinal vasculitis Conjunctivitis, dry eyes, glaucoma, cataracts, retinal pigmentation

What is a allergic Shiner

Dark circles under the eyes

Characteristics of Type 4 Hypersensitivity reactions

Delayed reaction Sensitized T lymphocyte contacts antigen Cell-mediated immune response Necrosis

Symptoms of Transplant rejection

Dependent on: • Involved transplanted tissue or organ • Severity of reaction Reflect failure of the organ or tissue

Characteristics of Type 2 Hypersensitivity reaction

Destruction of substance with antigen May be beneficial (bacteria) Not beneficial when red blood cell sensed as foreign

Nursing care for Anaphylaxis

Early recognition: Maintain airway Emotional support Education

Treatments for allergic rhinitis

Elimination of the environmental stimuli Antihistamines and decongestants Corticosteroids via inhilation or nasal spray Intranasal saline irrigation

What are therapeutic interventions for Uticaria (hives)?

Epinephrine Corticosteroids antihistamines Histamine H2 blockers

Treatments for Anaphylaxis

Epinephrine IM IV access O2 Tracheostomy or endotraceal intibation kit Antihistamines Corticosteroids

Early Signs and symptoms of Systemic Lupus Erythematosus

Fatigue and fever Are vague

Nursing care for Ankylosing Spondylitis

Nursing care focuses on administration and evaluation of prescribed medications as well as patient education to help reduce pain and stiffness, including providing disease information. Teach proper posture, range-of-motion exercises, and changing positions frequently. Also teach patients to sleep on a mattress that is irm without a pillow or with a thin pillow. Pain management, rest periods, assistance with ADLs, and exercise promotion are provided.

Characteristics of Atopic Dermatitis

Often called Ecxema inflammatory skin response Pruritus, edema. extremely dry skin, blisters, crusts, scales

Characteristics of Immune Deficiencies

One or more components of the immune system is completely absent or deficient

Treatment for Hemolytic transfusion reaction

RhoGAM

Patient teaching for Antihistamines

• Take with or without food. • Avoid ethanol, central nervous system depressants, and over-the-counter antihistamines. • Avoid prolonged exposure to sunlight. • Use caution with activities requiring mental alertness.