SOC3 Exam 2
Understanding cancer pain
"Pain is whatever the experiencing person says it is, and exists whenever he says it does." "an unpleasant sensory and emotional experience in association with actual or potential tissue damage, or described in terms of such damage." 30% to 50% of people with cancer experience pain while undergoing treatment, and 70% to 90% of people with advanced cancer experience pain chronic pain- persistent- can be r(X) successfully in about 95% of people with drug and non-drug therapies acute flairs- breakthrough don't become drug addicts, there will be things left later on to treat the pain
Patients who have received chemotherapy in the past 48 hours should have a _________________ sign posted outside their door.
"chemotherapy precautions"
cisplatin
(GFR, creatinine, BUN) prehydrate and posthydrate IV and need to monitor lungs for s/s of HF
NSAIDs only available by prescription
* Naprosyn (naproxen) diclonfenac sodium (Voltaren) indomethacin (indocin)
highest amount of purines found in which foods
- liver, pancreas, kidney, brains, sweetbreads, anchovies, sardines, gravies, meat extracts, mincemeat Embryo/germ of grains and legumes, asparagas, dry beans, lentils, dry peas, spinach
pregnancy induced HTN
1) >140/90 during the second half 2) generalized edema 3) proteinuria
initial screening for lupus
1) CBC 2) liver and kidney screening panels 3) lab tests for specific autoantibodies- ANA 4) urinalysis 5) blood chemistries 6) erythrocyte sedimentation rate
side effects of antimalarials
1) CNS: HA, nervousness, irritability, dizziness, muscle weakness, and tinnitus 2) GI: NV, diarrhea, abdominal cramps, loss of appetite 3) Opthalmologic: visual disturbances and retinal changes are manifested by blurring of vision and difficulty in focusing. DAMAGE TO RETINA. risk of retinal damage 1:5,000. eye exam before rx and yearly 4) dermatologic: dryness, pruritus, alopecia, skin and mucosal pigmentation, skin eruptions, and exfoliative dermatitis 5) hematologic: blood dyscrasia and hemolysis in patients with glucose 6-phosphate dehydrogenase (G6PD) deficiency 6) Pregnancy: antimalarials are usually continued during pregnancy. they do cross the placenta but a clinical trial and case series have not found safety issues
9 major side/adverse effects of corticosteroids
1) CNS: depression, mood swings, and psychosis 2) CV: CHF and HTN 3) Endocrine: cushing's syndrome, menstrual irregularities, and hyperglycemia 4) GI: irritation, peptic ulcer disease, weight gain 5) dermatologic: thin skin, petechiae, ecchymoses, facial erythema, poor wound healing, hirsutism, urticaria, and acne 6) MS- muscle weakness, loss of muscle mass, and osteoporosis 7) Opthalmologic- increased intaocular pressure, glaucoma, exopthalmos, and cataracts 8) other: immunosuppression and increased susceptibility to infection 9) cross placenta, used cautiously during pregnancy, no large doses when breastfeeding
calcineurin inhibitor examples (2)
1) Cyclosporine A (Neoral, Sandimmune) 2) Tacrolimus (Prograf, FK506)
2 other CM of RA
1) Extrasynovial rhematoid nodules 2) Raynauds phenomenon
3 commonly prescribed antidepressants
1) Flavil 2) Pamelor 3) Nopramin
how to administer EpiPen
1) Form fist around auto injector 2) with your other hand, pull off gray cap 3) hold black tip near outer thigh 4) swing and job firmly into outer thigh so auto-injector is perpendicular (at 90 degree angle to things 5) hold in place and count to 10 6) remove the Epipen and massage the injection area for 10 seconds
5 tests that can be done to assess a patient for kidney disease
1) GFR and proteinuria 2) protein/creatinine ratio 3) urinalysis 4) measurement of serum creatinine concentration 5) kidney biopsy
7 side effects of NSAIDS
1) GI: dyspepsia, heartburn, epigastric distress, NV, anorexia, abdominal pain, GI bleeding, mucosal lesions 2) GU: fluid retention, reduced creatinine clearance, acute tubular necrosis with renal failure 3) hepatic: acute reversible hepatotoxicity 4) CV: HTN and moderate to severe noncardiogenic pulmonary edema, increase risk of MI 5) hematologic: altered hemostasis through effects on platelet function 6) other: skin eruption, sensitivity reaction, tinnitus, and hearing loss 7) pregnancy and lactation: should be avoided after the first trimester
5 chief joints involved
1) HIP 2) KNEE 3) HAND 4) SPINE 5) OTHER
5 pregnancy complications related to lupus
1) Lupus flare 2) Miscarriage 3) Pregnancy-induced HTN 4) Pre-eclampsia 5) Eclampsia 6) Neonatal lupus
2 types of localized scleroderma
1) Morphea 2) linear scleroderma (en coup de sabre)
most common side effects of Avastin (Bevacizumab) include
1) NOSEBLEEDS 2) HA 3) High BP 4) inflammation of the nose 5) protein in the urine 6) tase change 7) dry skin 8) rectal bleeding 9) tear production disorder 10) back pain 11) inflammation of the skin
frequently used medications for lupus (6 categories)
1) NSAIDS 2) antimalarials 3) corticosteroids 4) immunosuppressive 5) IV immunoglobulins
6 types of drugs for gout
1) NSAIDs 2) Colchicine 3) Probenecid/Benemid 4) Uricase 5) Allopurinol 6) Corticosteroids
s/s suggesting renal failure (6)
1) NV 2) anorexia 3) anemia 4) lethargy 5) pruritus 6) changing level of consciousness
physical exam on someone with compartment syndrome
1) Pain when the area is squeezed 2) Extreme pain when you move the affected area 3) a person with compartment syndrome in the foot or lower leg will have severe pain when moving the toes up and down 4) Swelling in the area
6 Ps of neuromuscular involvement
1) Pulselessness 2) Paralysis 3) Parethesias 4) Pallor 5) pAIN 6) Poikilothermia
Felty's syndrome 3 conditions
1) RA 2) Splenomegaly 3) leukopenia
CM of scleroderma (6)
1) Raynaud's 2) MS features 3) GI features 4) pulmonary features 5) cardiac features 6) renal features
4 main classic CT diseases
1) SLE 2) RA 3) Scleroderma 4) Sjoren's syndrome
5 RA complications
1) Sjoren's syndrome 2) Felty's syndrome 3) Ruptured Baker cysts 4) Carpal tunnel syndrome 5) cervical spine instability
graft rejection involves which components
1) T lymphocytes 2) B lymphocytes 3) Macrophages 4) Cytokines inflammatory injury and graft damage
s/s of GI perforation (4)
1) abdominal pain 2) NV 3) constipation 4) fever
characteristics of OA
1) absence of synovial membrane inflammation 2) lack of systemic s/s 3) normal synovial fluid 4) loss of auricular cartilage tends to occur over 40 5) men=women occurrence (women more severely affected) 6) high stress on joints- athletes torn ACL or meniscectomy increases risk of oseoarthritis
6 types of medication to treat DJD
1) acetaminophen (<4 mg/day) 2) Salicylates 3) NSAIDs 4) COX-2 inhibitors- Celbrex 5) intra-articular injections (tiamcinolone) (sodium hyaluronate) no maore than 2-3 times per year 6) complimentary alternative medicine- glucosamine, condrotin sulfate, capsacin cream
what to do if suspect compartment syndrome
1) affected limb or limbs at level of heart NO ELEVATION NO ICE
eclampsia
1) all above symptoms 2) seizures
adverse effects of glucosamine
1) allergy to shellfish 2) rash 3) GI distrubances- diarrhea 4) drowsiness 5) HA
drug therapy for tumor lysis syndrome includes
1) allopurinal/xyloprin daily 2) bicarb drip- alkalinize the body with continuous infusion
5 categories of DMARDs
1) anti-malarial medications 2) arava 3) organ anti rejection drugs- cyclosporine 4) Misc.-Azulfidine and Gold 5) chemo drugs- methotrexate, Azathioprine (Imuran)and Cytoxan
8 main drug groups for type I hypersensitivity reactions
1) antihistamines 2) decongestants 3) corticosteroids 4) mast cell stabilizers 5) leukotriene antagonists 6) bronchodilator therapy 7) complementary and alternative therapy 8) desensitization therapy
what other categories of medication are used
1) antimalarials 2) remission-inducing agents 3) immunosuppressants 4) methotrexate 5) TNF
4 main gropus of pharmacological measures
1) appetite stimulants 2) corticosteroids 3) cannabinoids 4) anabolic agents
3 clinical stages of gout
1) asymptomatic hyperuricemia 2) acute gouty arthritis 3) tophaceous gout
how to treat SVC
1) attention to airway, breathing, and circulation (ABCs) is required 2) glucocorticoids (Prednisone, solumedrol) 3) furosemide/lasix 4) high-dose radiation therapy 5) may require surgically placed stent if severe and unresponsive
work up on someone with scleroderma
1) autoantibodies in blood 2) CT scan 3) radiography 4) echocardiography 5) right-heart catheterization 6) esophagraphy 7) pulmonary function testing 8) serum N-terminal pro-brain natriuretic peptide 9) cardiac rhythm monitoring 10) esophagogastroduodenoscopy 11) biopsy of skin and lungs
5 main immunosuppressives
1) azathioprine 2) cyclosphosphamide 3) methotrexate 4) cyclosporine 5) mycophenolate mofetil
management of oral mucositis ladder
1) bland rinses 2) mucosal coating agents 3) water-soluble lubricating agents 4) topical anesthetics 5) cellulose film-forming agents for covering localized ulcerative lesions
3 adverse effects of anthracyclines
1) cardiotoxicity 2) severe or febrile neutropenia 3) vomiting
evaluation of ILD should include (4)
1) chest radiograph 2) CT of lungs 3) pulmonary function tests including diffusing capacity 4) serum levels of antibodies
r(x) of xerostomia
1) chewing gum 2) saliva substitutes 3) gravy and sauces help swallowing 4) drink with food 5) KY gel or "Oral Balance" lubricants 6) working with the patient to find out what works best for them
who typically receives bone marrow transplantation
1) childhood and adult leukemia 2) pts. with certain solid tumors
6 groups of people more at risk for developing a latex allergy
1) children w/ spin bifida (early and frequency health care. about 1/2) 2) people with urinary tract abnormalities at birth 3) people who undergo multiple surgeries or medical procedures 4) healthcare workers 5) rubber industry workers 6) people with a family history of allergies
7 drugs implicated as activators of drug-induced lupus
1) chlorpromazine (thorazine) 2) isoniazid (INH) 3) Methyldopa (Aldomet) 4) hydralazine (Apresoline) 5) Procainamide (Pronestyl) 6) Minocycline (Minocin) 7) Anti-TNF (etanercept and infliximab)
CMS of distal neuromuscular status
1) circulation: assess for pulses, delayed cap refill, cyanosis 2) movement: assess for movement of fingers/toes 3) sensation: assess for sensation; paresthesia or anesthesia
4 major opioid side effects
1) constipation 2) NV 3) sleepiness 4) respiratory depression
8 broad immunosuppresive therapies
1) corticosteroids 2) calcineurin inhibitors 3) sirolimus 4) azathioprine 5) mycophenolate mofetil 6) cyclophosphamide 7) polyclonal antibodies 8) monoclonal antibodies
rx for systemic sclerosis
1) corticosteroids 2) immunosuppressants 3) specific treatment (depending on specific organ involvement) 4) stress management
side effects of inhaled steroids
1) cough 2) hoarseness 3) yeast infections of the mouth
miscarriage
1) cramping 2) vaginal bleeding
endocrinopathies include what three things
1) cushing syndrome (ectopic cortisol) 2) SIADH- ectopic ADH production 3) polycythemia- excess erythropoietin production
what are s/s of lupus attributed to
1) damage caused directly by autoantibodies 2) deposition of immune complexes 3) cell-mediated immune mechanisms
8 reasons why pt. with dermatomyelotis may have worse outcomes
1) delay in initial treatment greater than 6 months after symptoms onset 2) greater weakness at presentation 3) presence of dysphagia 4) respiratory muscle weakness 5) intersitial lung disease 6) associated malignany 7) cardiac involvement 8) advanced age
9 potential psychological manifestations
1) depression 2) difficulty completing self-care activities 3) inability to maintain employment 4) decreased social activities 5) lack of energy or ambition 6) irritability 7) impaired concentration 8) insomnia 9) suicidal thoughts
2 corticosteroids
1) dexamethasone 2) prednisone
What can cause cancer pain
1) directly by tumor (pressure, obstruction, invasion of sensitive structures, stretching of visceral surfaces, tissue destruction, and inflammation) 2) treatment 3) other sources like infection
Teach the patient to watch for signs and symptoms of renal complications and report them promptly to the physician:
1) facial swelling 2) peripheral edema 3) "foamy" urine (proteinuria) 4) "coke-colored" urine (hematuria) 5) nocturia and urinary frequency
general physiological manifestations r/t lupus
1) fatigue 2) weight gain or loss 3) fever (increased temperature over normal baseline) 4) tachycardia
side effects of monoclonal antibodies
1) fever, chills 2) dyspnea, chest pain 3) NV 4) increased infection risk 5) anaphylaxis- pulmonary edema, CParrest
5 commonly affected joints for RA
1) fingers 2) feet 3) wrists 4) elbows 5) knees less commonly affected- shoulder, hips, cervical spine
other potential renal manifestations
1) fluid and electrolyte imbalance 2) sacral edema 3) bounding pulse, S3 gallop 4) engorgement of neck and hand veins 5) dyspnea, crackles in lungs 6) cyanosis 7) decreased hematocrit 8) urine specific gravity <1.010 9) variable serum Na 10) serum osmolality <275 mOsm/kg
what to monitor in transplant pts taking corticosteroids
1) for above side effects 2) for infections
etiology of scleroderma (5)
1) genetic abnormalities 2) infectious agents 3) environmental factors 4) drugs 5) stress
steroid side effects with long-term use include
1) growth suppression 2) DM 3) cataracts 4) osteoporosis 5) muscle weakness
SLE nephropathy s/s (8)
1) hematuria (5 RBCs is sig) 2) proteinuria (>1) 3) sterile pyuria 4) elevated creatinine level 5) elevated BUN 6) weight gain 7) ankle edema 8) HTN
Rx for PM
1) high dose steroids muscle strength improves in 4-6 weeks (distinguish btwn inclusion body myositis) 2) unresponsive- immunosuppressive 3) IVIG 4) specialized exercise therapy 5) stress management
hip precautions
1) hip abducted-- slight external rotation via wedge pillow, abductor splint and 2 pillows between legs 2) avoid adduction and extreme rotation of hip- place trochanter rolls along legs vary depending upon type of prosthesis 3) turning- only to uncooperative side, with wedge pillow 4) avoid hip flexion over 90 degrees- semi fowlers position, raise the bed less than 90 degrees 5) don't cross legs, hips higher than knees when sitting, knees need to be 6 inches apart, no pigeon toed 6) don't sit for longer than 45-60 minutes at a time without standing and stretching use elevated toilet seat for the first 8 weeks
management of tumor lysis syndrome
1) hydration 2) monitor uric acid levels regularly 3) drug therapy
tumor lysis syndrome results in what three things
1) hyperK 2) hyperPO4 3) uric acid nephropathy
4 Non-opioids- NSAIDs
1) ibuprofen 2) aspirin 3) naproxen 4) acetaminophen (not really an NSAID?)
etiology of SLE (4)
1) immune system dysfunction 2) genetics 3) environmental influences 4) hormones
serious risks associated with immunosuppresives
1) increased susceptibility to infection, bone marrow suppression, development of malignancies 2) dermatologic- alopecia (cyclophosphamide and methotrexate) 3) GI: NV, stomatisits, esophagitis, and hepatotoxicity 4) GU: hemorrhagic cycstitis, hematuria, amenorrhea, importence, and gonadal suppression (cyclophosphamide only) 5) hematologic (thrombocytopenia, leukopenia, pancytopenia, anemia, myelosuppression) 6) respiratory- pulmonary fibrosis 7) risks to fetus, use contraception during treatment and for 12 weeks after ending azathioprine therapy, may pass into breast milk
examples of mast cell stabilizers
1) intal 2) tilade 3) crolom 4) alomide 5) alocril 6) opticrom 7) alamast 8) nasalcrome
3 steps of donor bone marrow transplant
1) intensive radiation therapy and/or chemotherapy to destroy active bone marrow and leukemic cells 2) bone marrow aspirated from a carefully matched donor (usually sibling) is IV infused to the pt 3) engraftment takes place w/in 3-4 wks- marrow from donor found way to pt's bone marrow to produce essential elements
four major complications of dermatomyelitis
1) intersitial lung disease 2) esophageal disease 3) myocarditis 3) malignancy
5 types of systemic scleroderma
1) limited cutaneous disease 2) diffuse cutaneous disease 3) sine scleroderma 4) undifferentiated CTD 5) overlap syndromes
what 4 organ tissues may be involved
1) lungs 2) heart 3) kidneys 4) skin
what three laboratory assays detect Antiphospholipid Antibodies
1) lupus anticoagulants 2) anticardiolipin antibodies 3) anti-B2 glycoprotein I
2 appetite stimulants
1) megesterol acetate/megace 2) medroxyprogesterone
nursing considerations r/t sirolimus
1) monitor CBC 2) monitor for infections 3) monitor and manage painful joints, high cholesterol, and diarrhea
nursing considerations r/t monoclonal antibodies
1) monitor for infection 2) used infrequently at this time for rejection episodes 3) manage hypersensitivity potential
nursing considerations r/t cyclophosphamide
1) monitor for infections 2) monitor CBC 3) monitor urine and dipstick for blood
nursing considerations r/t polyclonal antiboides
1) monitor for infections 2) next line to abort acute rejection after corticosteroids 3) premed with: diphenyhyradmine, acetaminophen, methylprednisolone (solumedrol), meperidine/demerol for rigors
nursing considerations r/t calcineurin inhibitors
1) monitor kidney function 2) monitor liver function 3) monitor neuro status- for tremors 4) monitor for infections
lupus flare with pregnancy
1) morning stiffness and swollen joints 2) fever 3) development or worsening of rash
diagnosis of RA- 4/7 must be present
1) morning stiffness over 1 hr for at least 6 weeks 2) arthritis involvement of 3+ joints 3) symmetric arthritis 4) arthritis of hand joints 5) Rheumatoid nodules 6) serum rheumatoid factor 7) radiologic changes of erosions or decalcification
symptoms of xerostomia
1) mouth discomfort 2) taste, chew, swallowing is all problematic 3) impacts on speaking 4) increases psychosocial problems 5) can lead to aspiration pneumonia and septicemia
3 things to confirm the diagnosis of dermatomyositis
1) muscle biopsy 2) EMG 3) Blood tests
side effects of Azathioprine
1) myelosuppression 2) increased infection risk
side effects of cyclophosphamide
1) myelosuppression 2) increased infection risk 2) hemorrhagic cystitis
side effects of sirolimus
1) myelosuppression 2) increased infection risk 3) arthralgias 4) hypercholesterolemia 5) diarrhea
side effects of calcineurin inhibitors
1) nephrotoxicity 2) increased infection risk 3) neurotoxicity- tremors and increased risk for seizures 4) hepatotoxicity 5) HTN 6) hirsutism 7) gingival hyperplasia
WHO's pain ladder
1) nonopiods, such as ibuprofen/motrin or acetaminophen/tylenol 2) mild opioids such as oxycodone are added 3) strong opioids such as morphine, hydromorphone/dilaudid until the pt. is free of pain
collaborative management of hypercalcemia
1) oral hydration 2) NS IV 3) drug therapy: calcitonin, pamidronate 4) dialysis
long acting analgesics (2) how often are they give?
1) oxycontin 2) MS contin q12 or q8
CM of cancer (6)
1) pain 2) fatigue 3) cachexia 4) anemia, leukopenia, thrombocytopenia 5) infection 6) paraneoplastic syndromes
CM of DJD
1) pain in joint; especially with ambulation aggravated by weight breading 2) sitffness at rest 3) morning stiffness may be present but lasts only 1 hour 4) limited ROM- flexion contractors 5) effusion or swelling of joint- asymmetric possibly 6) crepitus 7) Heberden's- DIP joints 8) Bouchard's nodes: PIP less common 9) muscle wasting, dislocation, deformity, limp 10) nocturnal pain 11) increased symptoms at end of day
s/s of polymyositis (6)
1) pain- marked weakness and of loss of muscle mass in the proximal musculature- shoulder and pelvic girdle 2) hip extensors affected- diff. in ascending or rising from seat 3) tichening of the skin on the fingers and hands 4) dysphagia (1/3 of pts) 5) low grade fever and peripheral adenopathy 6) foot drop in one or both feet (advanced PM)
8 side effects of chemotherapy
1) pancytopenia 2) alopecia or hair loss 3) NV 4) oral mucositis 5) skin changes 6) anxiety, sleep disturbances 7) altered bowel elimination 8) changes in cognitive function
4 tips in preventing IV extravasation
1) patent IV 2) good blood return 3) use CVL when possible 4) check IV sites hourly
cardiopulmonary manifestations contribute significantly to moribidity and mortality in patients with SLE. Name 4
1) pericarditis 2) myocarditis 3) MI 4) pleuritic chest pain
nonpharmacologic measures to treat cachexia
1) physical exercise 2) relaxation exercise 3) dietary counseling
drug-induced lupus erythematosus 4 characteristics
1) pleuropericardial inflammation 2) pleuritic chest pain 3) pericarditis 4) fever, rash, and arthritis serologic changes
corticosteroids name 2
1) prednisone 2) methyprednisolone (solu-medrol- IV)
collaborative management of sepsis and DIC
1) prevention 2) IV antibiotic therapy 3) anticoagulants 4) FFP
6 manifestations of type I hypersensitivity
1) pruritis 2) urticaria 3) edema 4) conjuctivitis 5) rhinitis 6) GI cramps and malabsorption
most frequent causes of mortality for those with systemic sclerosis
1) pulmonary HTN and scleroderma renal crisis ar ethe most frequent causes of mortality
Assessing cancer pain- patient's perspective
1) put it in writing 2) plan to ask questions 3) have a note taker 4) make your views heard What to write down: OPQRST, how quickly it comes on and how long it lasts, medications, side effects of medications, quality of life issues pain scales
3 highly effective MOA of corticosteroids
1) reducing inflammation 2) relieving muscle and joint pain and fatigue 3) suppressing the immune system also useful in controlling major organ involvement r/t SLE
antiemetic drugs include which 5 types of categories
1) serotonin antagonists 2) corticosteroids 3) benzodiazepines 4) neurokinin receptor antagonist 5) prokinetic agents
process for autologous BMT
1) several aphereses over a week to 10 days 2) intensive chemo 3) administration of harvested stem cells, or PSCT
8 major complications of joint surgery
1) shock r/t blood loss 2) DVT- TEDs and pulmonary stockings, SCDs, mobilize, hep. lovenox, coumadin 3) PE- fat embolism 4) infection- less than 1% of total joint replacements 5) disclocations 2% of THA w/in first 2 months 6) nerve injury- abductor pillow or splint, nv checks important 7) urinary retention 8) constipation
when should pt. with SLE who has a fever call the physician
1) signs and symptoms of an infection appear 2) fever > 101F
3 main symptoms of dermatomyositis
1) skin rash 2) symmetric proximal muscle weakness 3) pain
environmental factors that researchers are considering include
1) sunlight 2) stress 3) certain chemical substances 4) toxic exposures 5) infectious agents such as viruses
3 CM of joints in RA
1) swan neck deformity 2) Buotonniere deformity 3) ulnar deviation or drift
6 major types of surgery for OA
1) synovectomy 2) tenosynovectomy 3) arthrodesis 4) bone grafts 5) osteotomy 6) arthroplasty
three categories of diagnostic tests
1) tests for blood cell abnormalities 2) measurements of autoimmunity
two other medications used to treat lupus
1) thalidomide 2) dehydroepiandrosterone (DHEA)
paraneoplastic syndromes include (7)
1) thromboemboli 2) superior vena cava syndrome 3) tumor lysis syndrome 4) endocrinopathies 5) sepsis and DIC 6) spinal cord injury 7) hypercalcemia
skin features of scleroderma
1) tightening of the skin in the face, with a characteristic beaklike faces and paucity of wrinkles 2) sclerodactyly 3) anterior chest salt-and-pepper hypopigmentation and diffuse hyperpigmentation in white woman
neonatal lupus 3 things
1) transient rash 2) transient blood count abnormalities 3) HB
what to do is extravasation occurs?
1) turn off infusion immediately 2) leave needle/catheter 3) slowly aspirate as much of the drug as possible 4) do not apply pressure to the area 5) remove IV access while aspirating 6) don't use site for further IV access 7) inform physician and obtain substance-specific measures 8) elevate area for 48 hours to minimize swelling 9) protocols for drug-specific extravasation procedures
four types of hypersensitivities
1) type I- IgE mediated 2) type II- Tissue-specific reactions 3) type III- immune complex mediated 4) type IV- cell mediated
s/s of anaphylaxis
1) uneasiness, apprehension, weakness, and impending doom 2) pruritus and urticaria 3) erythema and sometimes angioedema of the eyes, lips, or tongue 4) bronchoconstriction, mucosal edema, and excess mucus stimulaiton- from histamine 5) congestion, rhinorrhea, dyspnea, and increasing respiratory distress with audible wheezing result can be fatal
different types of brachytherapy (2)
1) unsealed soluble isotopes 2) sealed implants
what do need to monitor for pts. with TLS of bicarb drip
1) urine pH needs to be greater than or equal to 7 2) metabolic acidosis so the body will start breathing shallowly and have a decreased respiratory rate
skin care during tele therapy
1) wash irradiated area gently each day with water alone or mild soap (ivory) and water- less is considered better 2) rinse soap thoroughly from skin 3) don't wash off ink/dye radiation marking 4) PAT dry, not rub 5) no powders, ointments, lotions, or creams on the irradiated skin (aloe is the most common prescription) 6) wear soft clothing 7) avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs irradiated skin 8) avoid sun exposure of irradiated skin- shield with cloth, avoid heat exposure
side effects with short-term steroid use
1) weight gain 2) fluid retention 3) HTN 4) increased gastric acid 5) hyperglycemia
pre-eclampsia
1)>140/90 during the second half 2) proteinura 3) epigastric pain 4) hyperrelexia 5) edema, including face and hands 6) HA
generally how many puffs relieve the wheezing and chest tightness associated with a mild attack
1-2
Transplants are divided into three categories based on the similarity between the donor and the recipient:
1-Autotransplants 2-Allotransplants 3-Xenotransplants
what percent of cancer patients w/ chronic pain also experience breakthrough pain?
1/2-2/3 need medication can receive for this pain discuss with healthcare provider
interstitial lung disease
10% of cases respiratory failure may result from diaphragmatic and chest muscle weakness can result in rapid respiratory failure and death
prealbumin moderate risk
10-17
dose of Arava
10-20 mg 1 daily taken on empty stomach or with meals
how often do RA pts get Sjorens
10-25%
A screening test for _____ is standard in assessing SLE because it is positive in close to 100 percent of patients with active SLE
100% but also positive in people with CT disease
average survival from diagnosis of systemic sclerosis
12 years
when does permanent nerve injury occur
12-24 hours of compression
leukopenia is found in ________ of pts with SLE
15-20%
prevalence of dermatomoysitis
1:100,000 in general population
fourfold diagnosis of polymyositis
1_ elevation of muscle enzymes in the blood- CPK 2) HP 3) electromyograph (EMG) alteration 4) positive muscle biopsy
onset of effect for radiopharmaceuticals
2 or more weeks
magic mouthwash (4)
2% viscous lidocaine diphenhydramine solution nystatin cherry syrup
when will hair grow back
2-3 months after chemo may be curlier, straighter, or a different color
how many people are affect by OA/DJD
20 mill Americans
Eye disease occurs in approximately _______ of patients with SLE
20 percent
how often does thrombocytopenia occur in lupus patients
25-35%
female to male prevalence of dermatomyositis
2:1
RA incidence
3-15% of US pop. 6 million RA (75% females) 20-40 incidence increases with age
to maintain freedom from pain, drugs should be given "by the clock" that is every __________ rather than on demand
3-6 hours
duration of action of radiopharmaceuticals
3-6 months
how long until gold improves symptoms
3-6 months
who is most at risk for scleroderma
3-9 times higher in women 30-50 yo peak onset
low purine foods
304 eggs per week nuts and PB low fat and fat free cheeses and ice cream pudding milk cream style soups made with low-fat milk soups made without meat extract or north many veggies fruits and juices breads and cereals- low fiber white flour pasta and macaroni rice soda coffee and tea gelatin cake and cookies fats in small amounts sugar and sweets in small amounts
encourage ____________ intake/day
3L of fluid
there needs to be serial or simultaneous presence of at least _____ of the eleven findings to diagnose lupus
4
at any time during the course of the disease about ________% of patients with SLE will be anemic?
40
peak incidence age of dermatomyositis
40-50
recommended dose of chondroitin
400 mg 3 times daily 2-4 mo. to notice sig. improvement
administration of IVIG
400 mg/kg for 5 days administer the drug safely and monitor the patient to minimize adverse effects and achieve expected outcomes experience HA that can be helped by slowing the infusion
when does pancytopenia appear
5-7 days (perhaps 7-10 days) after initiation of chemo reach Nadir 14-21 days after rx
what % of autoimmune diseases are idiopathic?
50%
normal amount of saliva
500-600 mL
what is required with arthroplasty
6 wks anticoag therapy for DVT
Pain occurs in ____________ of persons with advanced stages of cancer
60-80%
when does erythematous mucositis typically appear
7-10 days after initiation of high-dose cancer therapy
____% hospice in patients have xerostomia
77% hospice in patients maybe reduced volume or composition
scheduling activity and rest for pts with lupus
8-10 hours a night of restful sleeps, naps, and timeouts physical activity encouraged
cachexia is present in ____% of cancer patients at death
80
Episodic fever is experienced by more than ___________ of SLE patients, and there is no particular fever pattern.
80 percent low grade complicating infection- urinary and respiratory
_____ of people over age 70 have symptoms
80%
The World Health Organization reports that in __________ of all cancer cases, pain can be controlled.
85%-97%
_____% of advanced cancer patients have xerostomia
90
___ of all people will have x-ray features of DJD in weight bearing joints by age 40
90%
RF present in serum in ____ of patients
90% indicated autoimmunity
prealbumin severe
<10
prealbumin no risk
>17 reference range is 17-39
what are the two classic findings shown in muscle biopsy for dermatomyelositis
A mixed B- and T-cell perivascular inflammatory infiltrate perifascicular muscle fiber atrophy
mycophenolate mofetil (CellCept)
A strong immunosuppressive drug developed to prevent the rejection of transplanted organs alternative to cyclophosphamide for lupus with kidney involvement keeps T and B lymphocytes from replicating
skin test
A test in which your skin is pricked and exposed to latex can determine your reaction to latex. In this test, small amounts of latex are placed on the skin of your forearm or back. Your skin is then pricked with a needle, to allow a tiny amount of the substance beneath your skin surface. If you're allergic to a particular substance being tested, you develop a raised bump or reaction
brand names of leukotriene antagonists
Accolate Singulair Zyflo
alternative therapies for OA
Acupuncture Yoga Massage Guided imagery Therapeutic touch
over-the-counter combination allergy drugs
Allegra-D, Claritin-D, Zyrtec-D Benadryl Allergy and Sinus Tylenol Allergy and Sinus
hypersensitivity is
Altered immunologic response to an antigen that results in disease or damage to the host
side effects of gold injections
An itchy skin rash. Mouth sores.
cachexia includes several factors
Anorexia early satiety weight loss Anemia asthenia (marked weakness) taste alterations altered protein, CHO, and Lipid metabolism
what test is highly specific for SLE
Anti-dsDNA 50% of patients with SLE are positive useful to measure disease activity
two auto-antibodies found only in lupus
AntidsDNA and anti-Sm
biphosphonates (2) what do they do?
Aredia and clodronate relieve pain of cancer that has spread to the bones
what to monitor in pts taking Glucosamine
BS
prophylactic antimicrobials include
Bactrim/septra - for PCP Nystatin or mycelex - for fungal infections Valacyclovir/valtrex - for CMV Clarithromycin/biaxin - for MAI
prophylactic antimicrobial for PCP
Bactrim/septra- sulfamethoxazole and trimethoprim
Pharm rx for extrinsic asthma
Beta 2 agonist and corticosteroids anti-inflammatory medications
be aware of OTC meds that may contain glucosamine
Bioflex, Arth-x-plus, Nutri-Joint
lab data r/t IVIGs
CBC, WBC differential, renal function studies, BUN/creatinine; liver function tests; pulmonary function tests; chest X-ray; and ECG
lab data r/t immunosuppressives
CBC, differential, platelet count, renal function studies, liver function tests, pulmonary functions tests, chest Xray, and ECG
what is rheumatoid arthritis?
CT disorder a chronic systemic disease characterized by progressive and potentially deforming inflammation of the joints (synovial)
most common route for chemotherapy agents
CVL- port, hickman, PICC
how to prevent osteoporosis r/t corticosteroids
Ca, vit. D, Mg supplement and weight bearing exercise to prevent
mycophenolate mofetil brand name
Cellcept
Classify SLE in hypersensitivity disorders
Classic Type III
RA consultations
Consultation with rheumatology, orthopedics, and/or infectious disease may be necessary. Involvement by cardiology, pulmonology, nephrology, and ophthalmology often is necessitated by secondary organ involvement in those areas.
what is the major tool in assessing the progress of the disease and/or the efficacy of Rx
Creatine phosphokinase (CPK)
measurement of serume creatinine concentration
Creatinine is a waste product of muscle metabolism that is excreted by the kidneys. Loss of renal function as a consequence of lupus nephritis causes increases in serum levels of creatinine. The concentration of creatinine in the serum can be used to assess the degree of renal impairment.
medications for dry eye
Cyclosporin eyedrops (Restasis) reduce inflammation of the tear glands improving their function
what to teach SLE pt. r/t CP
DON'T SMOKE good foot care avoid cold temperatures and keep hands and feet warm s/s of vascular impairment that need to be reported to the physician, including a change in skin color or sensation or appearance of lesions s/s of thromboses
how to stop taking corticosteroids
DONT STOP Suddenly endogenous adrenal hormone production is slowed or stopped
common side effect of oral gold
Decreased appetite, nausea, and diarrhea. Problems with the skin, blood, kidneys, or lungs (rare).
side effects of IVIGs
Dermatologic: rash, mild skin reaction at the injection site GI: abdominal cramps, nausea, vomiting Musculoskeletal: chest, back or hip pain; muscle pain; joint pain Neurologic: anxiety, chills, dizziness, fever, HA Other: chest tightness, diff. breathing, burning sensation in the head
anticardiolipin antibodies
ELISA using cardiolipin as putative antigen
in RA what levels are elevated
ESR CRP- liver protein responds to inflamation or infection; complement syndrome ANA in 30% of patients
what else is elevated in gout
ESR WBC
how to prevent compartment syndrome
Elevation and Ice can help decrease the risk of development There may be no way to prevent this condition; however, early diagnosis and treatment will help prevent many of the complications
when pt. is less than 66 lbs use
EpiPen Jr. .15 mg rather than EpiPen over approx. 66 lbs
allergy
Exaggerated immune response to nonself
what causes the anemia?
Fe deficiency, GI bleed, medications, and autoantibody formation to RBCs
milk pain treatment
For mild cancer pain, acetaminophen or nonsteroidal anti-inflammatory medications (NSAIDs), such as ibruprofen, are often used.
what is the most serious potentially fatal side effect of Bevacizuman (Avastin)
GI perforation development of a hole in the stomach, small intestine, or large intestine
side effects of antimalarials
Gastrointestinal upset, rash, headache, blurred vision due to a rare effect on one of the small muscles in the eye, discoloration of the skin, myopathy (weakness of muscles), abnormal effects on blood, hearing problems, breakage of red blood cells in patients who have G6PD deficiency, and retinal toxicity. Retinal toxicity is rare.
is gold a first line treatment
Gold is not usually the first treatment given to people with rheumatoid arthritis, since methotrexate and other DMARDs are available.
s/s of skin rash r/t dermatomyositis
Gottron's sign/Papules heliotrope or "lilac" shawl or v- sign
potential complication of donor bone marrow transplant
Graft v. Host disease
when to not take glucosamine
HTN pregnant if taken with condroitin- may cause bleeding
side effects of decongestants
HTN sleeplessness, anxiety, dizziness, excitability, and nervousness not for people with glaucoma irritability restrict urinary flow
What is PM linked to/associated with
ILD increase in the occurence of cancers (pvarian, lung, pancreatic, stomach, and colorectal cancers)
azathioprine brand name
Imuran
how long until DMARDs are effective?
It takes roughly three to six months before a beneficial effect is seen. This may be because of the large volumes of distribution required.
rarer side effects
Kidney problems that causes loss of protein in the urine. Suppression of blood cell production, which may increase the risk of infection or serious bleeding. (A return to normal blood cell production may take several weeks after the drug is no longer taken.) bowel or lung inflammation
post op care for TKA
Maintain neutral rotation with knee in extension and degree of flexion as ordered Maintain immobilization devices if ordered Maintain slight elevation of extremity Avoid "gatching" bed under knee or pillows under knees Out of bed to chair night of surgery or first post op day, keeping extremity in full extension Trapeze for positioning Continuous passive motion (CPM) machine can assist with passive flexion and extension
additional s/s of dermatomyositis
Mechanic's hands periungal erythema centripetal flagellate erythema comprises linear, violaceous streaks on the trunk (possibly caused by itching pruritic skin) dysphagia (difficulty swallowing)
calcitonin (1), what does it do? how is it administered?
Miacalcin, relief for bone pain, nasal spray
autoimmunity
Misdirected Immune Response against Self
symmetric proximal muscle weakness r/t dermatomyositis
Muscle may deteriorate and render the infected temporarily paralyzed unable to walk, run, get out of bed, swallow food and liquids.
how many people suffer from autoimmune disease
NIH estimates up to 23.5* million Americans suffer from autoimmune disease and that the prevalence is rising. We at AARDA say that 50 million* Americans suffer from autoimmune disease.
why do cancer patients take antidepressants
NOT to relieve depression help relieve nerve pain that sometimes develops from cancer treatment
what is used when salicylates are inneftive
NSAIDs such as Naproysn, Diclofenac Na (Voltaren) and indomethacin
what drugs are contraindicated for oral mucositis
NSAIDs that affect platelet adhesion and damage gastric mucosa are contraindicated, especially if thrombocytopenia is present
alloimmunity
Normal Immune reaction against beneficial foreign tissue
what is the most common cause of joint disability
OA/DJD
what corticosteroid is used most often to treat lupus
Prednisone
progressive relaxation
Progressive relaxation is a technique used to reduce cancer pain in specific areas of the body. This technique entails lying down and successively clenching and releasing individual muscle groups, eventually focusing on those involved with the pain
sirolimus brand name
Rapamune
Raynaud disease (primary Raynaud)
Raynaud disease is the occurrence of the vasospasm alone, with no association with another illness.
periungal erythema
Redness around the nails
RICE stands for
Rituximab/Rituxan Ifosphamide Carboplatin Etoposide
intravenous immunoglobulins used to control
SLE with organ involvement or vasculitis
How to remember the classic CM of lupus
SOAPBRAIN-MD Serositis Oral ulcers Arthritis Photosensitivity Blood Changes Renal involvement (proteinuria or casts) ANA Immunological changes Neurological signs (seizures, frank psychosis) Malar rash discoid rash
other targeted therapies
STI-571 or imatinib mesylate (Gleevec) and bortezomib (Velcade)
what may be prescribed for severe burns?
Silvadene/Silver sulfasalazine Can't give if have sulfa allergy
radiopharmaceuticals (1) what do they do?
Strontium-89 (Metastron) help reduce pain of cancer that has spread to the bones
paraneoplastic syndromes
Symptom complexes that can't be explained by the local or distant spread of the tumor or by the effects of hormones released by the tissue from which the tumor arose
4 categories of lupus
Systemic lupus erythematosus cutaneous lupus drug-induced systemic lupus erythematosus neonatal lupus
the skin and lungs also show prominent
T-cell lymphocyte infiltration
recently what has been associated with the development of lupus symtoms
TNF (tumor necrosis factor) used to treat RA, Crohn's disease, and ankylosing spondylitis
estimated incidence and prevalence of scleroderma
The estimated incidence of scleroderma is 19 cases per million population, and the prevalence of systemic sclerosis has been estimated at 240 cases per million population
Pain r/t dermatomyositis
The pain may resemble the type experienced after strenuous exercise. Some have little pain, while in others , the pain may be severe.
subjective CM of fatigue
Tiredness, weakness, lack of energy, exhaustion, lethargy, inability to concentrate, depression, sleepiness, boredom, and lack of motivation
when will my hair start to fall out?
Your hair may start to fall out 2 to 3 weeks after chemotherapy begins.
osteoarthritis
a slow progressive, noninflammatory disease of mobile joints, especially weight-bearing joints Degeneration of articular cartilage of joints and surrounding tissue asymmetric inadequate nutrition of cartilage
Frequently, patients ascribe their first symptoms or worsening symptoms to______________________________________.
a stressful event, such as divorce, death of a loved one, or job loss.
what is immunotherapy?
a treatment used by allergy specialists (allergists) to reduce sensitivity to allergens.
Side effects of thalidomide
abdominal pain, infection, chills, diarrhea, liver abnormalities, anemia, peripheral edema, hyperlipidemia, leukopenia, insomnia, sensory neuropathy, albuminuria, hematuria, ovarian failure, and thrombosis strictly contraindicated in women who are pregnant or might become pregnant
Marfan Syndrome
abnormal fibrillin (elastin precursor) risk: aortic aneurysm
photosensitivity r/t lupus
abnormal reaction to the UV rays of the sun development or exacerbation of a rash sometimes accompanied by systemic symptoms
how long does stiffness last? when?
about 1 hour upon risking in the AM
percocet
acetominophen and oxycodone
aspirin is a brand name for what?
acetylsalicylic acid
scleroderma
activation of immune cells that produces scar tissue in the skin, internal organs, and small blood vessels
cytarabine (ARA-C)
acute myolgous leukemia cerebellar toxicity- physical assessment, signature page daily, romberg test, signature will get wavy
teletherapy
administered external to the body machines direct beas of radiation pt. is not radioactive
when does polymyositis tend to become evident
adulthood
arthroplasty
advanced joint destruction when conservative treatment failed cemented (methylmethacralate) cementless (porous surface allowing bone to fill in)- more protective weight bearing post op
risk of retinal toxicity r/t antimalarials
advancing age, impairment of kidney or liver function, and cumulate dose above 700 grams
stickler syndrome
affects collagen, distinctive facial appearance, eye abnormalities, hearing loss, and joint problems
cutaneous lupus
affects skin primarily common among pts with lupus erythematosus most severe form- chronic cutaneous lupus commonly known as discoid lupus
when to do mouth care
after meals bedtime soft bristled brush or sponges/toothettes
what lab values should review to confirm a patient's nutrition status?
albumin- 3.5-5.5 (late info) prealbumin >17 = no risk
reasons radiation might be useful
alievate symptoms and prevent complications by reducing size of tumor before obstruction or hemorrhage preoperatively- shrink a tumor mass before resection postoperatively- destroy any possibly remaining cells locally
cyclophosphamide (Cytoxan)
alkylating agent and strong immunosuppressive treats lupus with kidney disease or other internal organ involvement suppresses immune system sever side effects- risk of serious infection
physical
all body systems, to determine baseline data and alterations in function; temperature; pulse; respiration; weight; skin color; lesions; hair and mucus membranes
most commonly reported CAM adverse effects
allergic in nature urticaria, contact dermatitis, and anaphylaxis
Rituximab/rituxan adverse effects
allergic reactions give premeds: tylenol, benadryl, and corticosteroid
latex allergy may cause
allergic reactions reneging from sneezing or a runny nose to anaphylaxis
this is especially useful for people who have
allergic rhinitis (hay fever)
history r/t IVIGs
allergy to Igs, sepsis, volume depletion, IgA deficiency, paraproteinemia, renal insufficiency, DM, methotrexate, and virus vaccines
Hx r/t immunosuppressives
allergy to immunosuppressive drugs, infections, impaired hepatic or renal function, pregnancy, lactation, corticosteroid therapy, immunosuppression, bone marrow suppression, and appropriate contraception
how to assist the patient with psychosocial issues
allow expression of feelings assess coping acknowledge the feelings of denial and anger are normal explore sources of potential support and community resources concealing skin lesions and hair loss discussion interpersonal and social conflicts counseling and support groups
constipation r/t opioids
almost every person immediate bowel regimen 8-10 glasses of water, increase fiber, activity, stool softener docusate (laxative)- colace, senna-sanokot
eye drops
alrex and dexamethasone
tamoxifen
an estrogen antagonist, is effective for recent-onset and tender gynecomastia when used in doses of 10-20 mg twice daily. Up to 80% of patients report partial to complete resolution. Tamoxifen is typically used for 3 months before referral to a surgeon. Nausea and epigastric discomfort are the main adverse effects.
myocarditis
an inflammation of the heart muscle may also occur
NSAIDs: usefulness in lupus
analgesic, anti-inflammator, antipyretic inhibit the release of prostaglandings and leukotrienes treat joint pain and welling as well as muscle pain treat pleuritic chest pain
High purine foods to avoid
anchovies, roe, herring and macherel, sardines, scallops and mussels, game meats- goose duck partridge, organ meats, meat extracts, mincemeat, browth bouillon consomme gravy, yeast
3 medications for gynecomastia
androgens tomxifen danazol
what type of anemia?
anemia of chronic disease autoimmune hemolytic anemia- with a positive Coombs test is much less common
which blood cell abnormalities typically accompany lupus?
anemia, leukopenia, and thrombocytopenia
2) mucosal coating agents
antacid solutions and kaolin solutions
MOA of antimalarial
anti-inflammatory affect platelets to reduce the risk of blood clots and lower plasma lipid levels
before chemo
anticipatory nausea
2 main types of adjuvant medication
antidepressants anticonvulsants
clomiphene
antiestrogen, can be administered on a trial basis at a dose of 50-100 mg per day for up to 6 months. Approximately 50% of patients achieve partial reduction in breast size, and approximately 20% of patients note complete resolution. Adverse effects, while rare, include visual problems, rash, and nausea.
azathioprine (Imuran)
antimetabolite blocking metabolic steps within immune cells interfering with immune function fewer serious side effects
what to administer PRN
antimicrobials, topical analgesics, petroleum jelly to lip, artificial saliva
most characteristic autoantibodies in lupus
antinuclear antibodies target nucleic acids, proteins, and ribonucleoprotein complexes inside a cell's nucleus
using CAM
anxiety, depression, and HA most often used when chronic or untreatable disease exists balance the use of CAM with risks and benefits importnat in field of allergy and immunology
stomatitis
any inflammatory condition of oral tissue, including mucosa, dentition/periapices, and periodontium infections of oral tissues as well as mucositis
connective tissue
any type of tissue with an extensive extracellular matrix proteins and carbs two major protein molucules: collagen and elastin
bone grafts
are used when fusing larger, more difficult joints, such as hips and ankles.
neuokinin receptor antagonist
arepitant/emend
where does inflammation spread?
articular cartilage joint capsule ligaments tendons
how to help dryness of eyes
artifical tears eye lubricant ointments minize hair dryers plug duct close
3) water-soluble lubricating agents
artificial saliva for xerostomia
when is surgery useful
as a local treatment when the cancer is still localized
how often does dysphagia occur in dermatomyelotitis
as many as 33% of cases
care of patient radioactive from brachytherapy (sealed)
assign pt. to private room place caution "radioactivity material" on door keep door closed wear dosimeter badges wear lead apron when providing care no pregnant nurses limit each visitor to 30 min/ visit/day- no pregnant or child visitors never tough radioactive source with bare hands
mobility after THA
assist pt. may be out of bed to chair from night of surgery/2 post op day use walker use reacher physical therapy (give analgesics 20-30 minutes before)
leukotriene modifiers treat
asthma nasal allergy
The majority of people with lupus have some degree of _________________
asymptomatic microscopic kidney damage.
What is dermatomyelotitis associated with
autoantibodies
Antiphospholipid Antibodies
autoantibodies that react with phospholipids resulting in increased risk of thrombosis 50% of people with SLE persistently positive lupus anticoagulant or medium-to-high titer thrombosis, fetal loss, multiple first trimester losses, or preterm birth from severe placental vasculopathy
many CT diseases are the result of what?
autoimmunity
latex allergy is related to which foods
avocados, bananas, chesnuts, kiwis, passion fruits
inhaled steroids
azmacort flovent pulmicort asmanex q-var alvesco aerobid advair and symbicort- combine steroid with another drug
another adjuvant effective for some people experiencing shooting, tabbing, and knife-life neuropathic pain
baclofen (Lioresol)
nasal steroids
beconase flonase nasocort nasonex rhinocort veramyst generic fluticasone
3 things to do when acute exacerbation of gout
bedrest for first 24 hot or cold compress elevation of affected joint
cytotoxic precautions when using the toilet
before flushing, put the lid down or cover it with a pad flushing twice helps ensure all waste is disposed of wash hands well commode will be cleaned with special soap let nurse know if there is a spill
administration of antimalarials
before or after meals at the same time each day to maintain drug levels
first generation antihistamines
benadryl (diphenhydramine) chloritmeton (chlorpheniramine) dimetapp (brompheniramine)
presentation of polymyositis
bilateral proximal muscle weakness often noted in the upper legs due to early fatige with walking inability to rise from a seated position or inability to rise arms above head weakeness is progressive cytotoxic- T lymphocyte inflammation no skin involvement
MOA of monoclonal antibodies
bind to CD3 receptors on T cells, causing cell lysis inhibits function of cytotoxic t cells
evaluation
biopsy of grafter tissue evaluation of function
treatment with avastin can result in serious and sometimes fetal ________
bleeding coughing up blood, bleeding in the stomach, vomiting blood, bleeding in the brain, nosebleeds, vaginal bleed
how do leukotriene antagonists work?
block the effects of leukotrienes, chemicals produced in the body in response to an allergy
radiography of joints
bony erosions, cysts, osteopenia, joint space swelling calcifications, narrowed joint, space, deformities, separations, and fractures
uricase
breaks down uric acid
malar rash
butterfly rash classic CM
The most severe form of malnutrition related to cancer
cachexia
MOA of calcineurin inhibitors
calcineurin-protein that activates T lymphocytes prevents production of IL2 and interferon inhibits cytotxic t cells and B lymphocytes
what to look at if giving calcitonin
calcium phosphate
Arava (leflunomide)
calms inflammation associated with RA interferes with genes in developing cells, like those of the immune system
kidney biopsy
can be used to determine the presence of immune complexes and the presence, extent, and type of inflammation in the glomeruli. Diagnosing the extent and type of inflammation may help to determine a treatment program for lupus.
antimalarials
can be used to treat joint pain that occurs with RA effective in controlling lupus arthritis, skin rashes, mouth ulcers, fatigue, and fever effective in treating discoid lupus erythematosus
teach r/t Arava
can cause serious birth defects both men and women should use a reliable method of BC while being treated with the medication If a woman taking Arava wishes to become pregnant, she must stop the Arava, take a medication called cholestyramine for 11 days to get all the Arava out of the body, and then have a blood test to prove that the drug is gone. Less is known about the effects of Arava on men planning to father children. To be safe, men should consider cholestyramine treatment before attempting to conceive
urinalysis
can indicate the presence or extent of renal disease. For example, proteinuria can be a reliable indicator of renal disease. The presence of RBCs, WBCs, and cellular casts, particularly red cell casts, in the urine also indicates renal disease
blood test
can measure your immune system's response to latex by assessing the amount of allergy-type antibodies in your bloodstream, known as immunoglobulin E (IgE) antibodies.
how quickly do antidepressants start to work?
can take several weeks to become effective
when are corticosteroids given to gout patents
can't tolerate NSAIDs
rare complication of sjoren's
cancer of lymph glands
three medications associated with peripheral neuropathy
carboplatin, etoposide, vincristine
SIADH is most commonly found in....
carcinoma of the lung
acute concern of hypercalcemia
cardiac dysrhythmias, mental status change, muscle weakness long term: calcification
rx of infection r/t lupus
cardinal signs of infection may be mased bc of SLE rx ex) fever suppressed by antiinflammatory therapy alert to medication reactions
who is more at risk for photosensitivity
causcasians
aquired (secondary) immunodeficiency
caused by another illness: cancer, viral illness, normal physiologic changes of aging, nutritional deficiency, iatrogenic deficiency, burn victims, deficiency caused by stress
apheresis
cells are harvested from the patient by vein
which cancers commonly use brachytherapy?
cervical, prostate, breast, and skin cancer
intrathecal
chemotherapy administered into the CSF
probenecid/benemid
chronic gout and gouty arthritis increases the excretion of uric acid
anylosing spondylitis
chronic inflammatory disease of the axial skeleton with variable involvement of peripheral joints and noarticular structures systemic rheumatic disease strong genetic component autoimmune low back pain
patho of SLE
chronic multisystem inflammatory disease autoantibodies against nucleic acids, erythrocytes, coag. proteins, phospholipids, lymphocytes, platelets *** Deposition of circulating immune complexes containing antibody against host DNA
scleroderma is a ___________________________________ in it's more sever form it also affects ___________________________
chronic systemic autoimmune disease hardening of the skin accumulation of CT may affect internal organs- GI tract, lungs, heart, kidneys
Sjoren's syndrome
chronic, slowly progressing inability to secrete saliva and tears also occur with other 3 CTDs xerostomia
which drugs may induce nausea and for how long
cisplatin 5-7 days
prophylactic antimicrobial for MAI (mycobacterium avium intracellularae)
clarithromycin/biaxin
prescription decongestants
claritin-D
what does inflammation cause
coagulation fibrin products deposited in synovial membrane
types of tele therapy
cobalt, electron beam, linear accelerator and proton beam therapy
CAM for gout
coffee drinking associated with uric acid levels vit. c may reduce uric acid bot not megadoses cherries lower uric acid levels
discoid rash
coin-shaped or oval in shape- disk and it is seen on areas of the skin exposed to sunlight red and raised, become scaly, leave a scar chages in coloring to skin scalp, face in butterfly distrbution, v of neck usually painless and not itchy
collegen vascular diseases are associated with
collagen and blood vessel abnormalities
disease in which inflammation or weakness of collagen tends to occur are also referred to as
collagen diseases
what types of cancer does Bevacizumab (Avastin) mainly treat
colorectal, lung, and kidney cancer, and eye disease
Percutaneous electrical nerve-stimulation (PENS)
combines acupuncture with electrical stimulation of the nerves to achieve pain control.
integrative medicine
combines conventional western medical therapies and CAM yoga breathing to reduce need for medications immune enhancement products
extrinsic asthma
common chronic inflammatory disease of the airways- airway obstruction, bronchospasm
chronic pain interventions
comprehensive assessment OPQRST evaluate past control measures reduce or eliminate factors that precipitate or increase the pain experience nonpharmacologic techniques prescribed analgesics
superior vena cava syndrome
compressed or obstructed by tumor growth
risk for infection
compromised host precautions prophylactic antimicrobials
what is a compartment
confined space in-between fascia that contains muscle tissue, nerves, and blood vessels fascia doesn't expand
what is required with IV access
confirmation of patency of IV access as evidenced of good blood return is required
ruptured baker cysts (synovial cyst of the popliteal speace)
confused with DVT pain, edema, and inflammation of posterior knee and calf ultrasound dx rest, elevate, needle puncture of the calf, knee joint, aspiration, referral
2 types of immunodeficiency
congenital (primary) and acquired (secondary)
what is dematomyositis
connective-tissue disease that is characterized by inflammation of the muscles and the skin Immune complex deposition in the vessels considered to be part of a complement-mediated vasculopathy perivascular and perimysial inflammation, as well as perifascicular necrosis
as long as a woman is not hypercoagulable....
consider oral contraception don't increase flares
Complement
constitute a serum enzyme system that helps mediate inflammation
why are adjuvants used
contribute to the analgesia and calm fears and anxiety
what is the front line drug for acute rejection
corticosteroid bolus large dose IV 1 gram IVP for example
kidney damage may necessitate rx with
corticosteroids, cytotoxic agents, dialysis, or renal transplantation
options for emotional rest
counseling for the pt. and family
MOA of cyclophosphamide
cross links DNA resulting in cell death results in decreases numbers and activity of T and B cells
tophi
crystal deposition in SQ tissues cause small, white modules visible through the skin
what is gouty arthritis
crystallization in synovial fluid acute painful inflammation of the joint
best management of cancer cachexia is to
cure the cancer
what would you absorb if: cortisol
cushing's syndrome hyperglycemia osteoporosis production of acid
most common retinal change in SLE
cytoid bodies
cyclophosphamide bran name
cytoxan
irritants
damage intima of vein but not tissue
what eye problems may antimalarials cause
damage to the retine- impair vision-particularly color vision rarely blindness 1:5,000 retinal damage
prophylactic antimicrobial for PCP in those allergic to sulfa
dapsone- diaminodiphenyl sulfone
first anthracycline discovered
daunorubicin (Daunomycin) Doxorubicin (Adriamycin) shortly thereafter
acute rejection
days- a few months post-transplant cell-mediated process- lymphocytes main cells involved generally asymptomatic bc immunosuppresive drugs abnormal lab values (organ that was transplanted not functioning correctly)
corticosteroids (2) may help control ___________________
decadron deamethosone increased ICP
oral steroids
deltasone, also called prednisone
corticosteroids
dexamethasone/decadron useful for inflammatory hyperglycemia short-term side effect BS monitoring increased gastric acid secretion, retain fluid and Na- because has an aldosterone - increase BP
corticosteroids: 2 what do they do?
dexamthasone and prednisone reduce inflammation
some major causes of gout
diet accelerated rate of pure synthesis with overproduction of irc acid high grade cancer- tumor lysis syndrome
recommendations for people with SLE and weight changes
dietary plan w/ registered dietitian encourage exercise as tolerated record the pt's weight at each visit teach pt. to weigh themselves once a week
anaphylactic shock symptoms from latex
diff. breathing wheezing drop in BP dizziness loss of consciousness confusion slurred speech rapid or weak pulse blueness of your skin, including your lips and nail beds diarrhea NV
shawl or V sign
diffuse, flat, erythematous lesion over the back and shoulders or in a V over the posterior neck and back or neck and upper chest- worsens with UV
s/s of Sjorens
diminished lacrimal and salivary gland secretion complaints of burning, gritty, itchy eyes decreased tearing and photosensitivity complaints of dry mouth and nose
there are two types of latex: hardened rubber and dipped latex, with which do most allergic reactions occur?
dipped latex bc they're often used directly on the skin
potential problems of SLE eye problems
discomfort visual impairment potential for injury diff. carrying out activities of daily living
common latex products
dishwashing gloves, carpeting, waistbands on clothing, balloons, rubber toys, hot water bottles, baby bottle nipples, diapers, sanitary pads, rubber bands, erasers, condoms, diaphragms, swim goggles, racket handles, motorcycle and bicycle handgrips BP cuffs, stethoscopes, IV tubing, syringes, respirators, electrode pads, surgical masks
side effects of antidepressants
dizziness and GI problems
risks of IVIGs compared to immunosuppressive and corticosteroids
doesn't suppress the immune system in the same way as corticosteroids and immunosuppressives and therefore there is less risk
2 Anthracyclines
doxorubicin/adriamycin and daunorubicin
other items that should be handled with cytotoxic precautions
dressings/bandages diapers pads drainage tubes ostomy supplies soiled linen soiled clothing tissues
dry mouth tips
drink plenty of fluids, humidifying air, and good dental care to avoid dental decay stimulated to produce saliva by sucking on sugarless lemon drops or glycerin swabs dental care
cannabinoid
dronabinol/marinol
significant side effects first generation antihistamines
drowsiness dry mouth
Bevacizumab is a
drug that blocks angiogenesis humanized monoclonal antibody that binds to vascular endothelial growth factor A first clinically available angiogenesis inhibitor a drug approved from metastatic cancers
assessment for pts. with SLE and fever
drugs WBC count
spinal cord compression management
early recognition and treatment palliative high-dose corticosteroids high-dose radiation surgery external back or neck braces to reduce pressure in the spinal cord
x ray findings for RA
early stages- no findings other than soft tissue swelling in late stages- narrowing of joint spaces and subchondral erosions
changes in articular cartilage with OA
early- cartilage is thicker progresses to thinner and cartilage softens integrity of surface breeched deep cartilage ulcers
SVC s/s
edema of face= stokes' sign eden of neck= collar of stokes pemberton's sign: pt. eve late both arms until touch side of face, += facial congestion, cyanosis, respiratory distress edema of arms and hands, dyspnea, erythema, and epistaxis difficulty swalling/dysphagia HA stridor (breath sounds and lung function are typically clear/normal
asymptomatic hyperuricemia
elevated serum uric acid level no CMs
NV is a side effect because most chemotherapy drugs are __________
emetogenic
how do the vast majority of decongestants work
enchange norepi and eli or adrenergic activity by stimulating the a-adrenergic receptors vasoconstriction- reduced inflammation and mucus formation
common decongestants
ephedrine phenylephrine phenylpropanolamine synephrine pseudophedrine
what medication is given for anaphylaxis
epinephrine
Don't confuse one for IV/cardiac use with IM/subQ/anaphylaxis use
epinephrine injection 1:1000 (.01ml/kg) for anaphylaxis EPINEPHRINE INJECTION, USP, 1:10,000 FOR Intravenous or cardiac use.
grade 2
erythema and ulcers pts can swallow solid diet
Gottron's sign
erythmematous scaly eruption over the extensor surfaces of the MCP and digits, symmetric over the MCP and interphalngeal joints, elbows, and knees) mimic psoriasis
Gold administration
every week for first 22 weeks
what is SLE characterized by
exacerbations and remissions
what is extrinsic asthma caused by
exaggerated immune response to exogenous anti gents wheezing, coughing, chest tightness, and SOB
polyclonal antibodies
examples- antithymotic globulin ARG ATGAM
scleroderma is characterized by
excessive fibrosis in the skin and other affected organs
what exams are recommended at least every 6 months
eye exams
Immunodeficiency
failure of immune mechanisms of self-defense
treatment for compartment syndrome
fasciotomy- surgery immediately cuts through muscle tissue relieve the pressure left open or closed during second surgery 48-72 hours later maybe need skin grafts dressing loosened or cut down to relieve the pressure
Most frequently reported symptom of cancer and cancer treatment
fatigue
nearly universal complaint of patients with SLE even when no other manifestations of the disease are present
fatigue cause unknown- investigate for hypothyroidism, adrenal dysfunction, overextension, insomnia, depression, stress, anemia, and other inflammatory diseases fibromyalgia is a common cause of fatigue in SLE patients
if a pt. with lupus gets normal rest will it help their tiredness
fatigue my persist, won't refresh
symptoms of SLE
fatigue, arthralgia, arthritis, fever (>100F), skin rash, anemia, edema, pleurisy, facial rash, photosensitivity, alopecia, Raynaud's phenomenon, seizures, mouth or nose ulcers, arthralgias or arthritis (90%), vasculitis and rash (70-80%), renal disease (40-50%), hematologic changes (50%), CV (30-50%)
CM of hypercalcemia
fatigue, loss of appetite, NV, constipation, polyuria, severe muscle weakness, loss of deep tendon reflexes, paralytic ileum, dehydration, ECG changes
Autoimmune disease is one of the top 10 leading causes of death in
female children and women in all age groups up to 64 years of age
who is more at risk for polymyositis
females
who is more at risk for SLE
females, childbearing age first degree relatives of people with lupus- hereditary component
estrogens, progestins, or antiandrogen receptor drugs cause
feminine manifestations in men gynecomastia
systemic signs r/t RA
fever, malaise, rash lymphadenopathy, splenomegaly Raynauds phenomenon
benefits of radiopharmaceuticals
few side effects act on cancer while sparing soft tissue
how will body fill the defect
fibrocartilage inferior
late side effects of tele therapy
fibrosis (scar tissue- restricted movement) damage to the bowels- diarrhea and bleeding memory loss infertility second cancer (rare)
cartilage
fibrous CT- closely packed collagenous in a rubbery gelatinous substance called chondrin
risks of having a child with heart block for a mother with anti-Ro (SSA) and anti-La (SSB) antibodies
first time moms or moms who have had healthy babies (2%) for moms who have previously given birth to a child with heart block (18%)
medium protein foods to limit
fish and shell fish poultry, beef, lamb, pork, and other red meats, dried beans, peas, lentils, asparagus, muschorroms, spinach, cauliflower, green peas, lasts, wheat germ and bran, whole grain breads and cereals
what if pain is consistently just before it is time to take your next does of medication?
fixed-scheduled medication needs to e adjusted
erythroderma
flat, erythematous lesion similar to the shawl sign but located in the malar region and the forehead
meditation
focus on his or her own breathing or repetition of a word
high dose methotrexate
folic acid antagonist tumor lysis syndrome- uric acid will crystalize in acidic environment need to alkalize the blood continuous bicarbonate IV- urine pH 7 or above rescue with Ca Leukovorin (folic acid) given every 6 hours after 24 hours following people can end up going into renal failure
when is ice used?
for acute inflammation
what is the result of pannus
formation inhibits joint tissue regeneration formation of scar tissue that immobilizes the joint pain, joint deformity, and loss of function
describe fatigue r/t lupus
frequent, persistent complaint often described as a bone-tired feeling or a paralyzing feeling
instructions for sun-sensitive pts
frequently apply suncreen- UVA and UVB at least SPF 15 avoid unprotected exposure between 10 and 4 reflected off water and snow glass doesn't provide protection fluorescent and halogen lights may emit UV rays and can aggravate lupus
arthrodesis
fusion of a joint for stabilization and pain relief Bone ends are fixed together by hardware (screws, pins, plates, nails)
Antiseizure drug that can help control peripheral neuropathy caused by what three medications
gabapentin (Neurontin) carboplatin, etoposide, vincristine
ESR and CRP are nonspecific tests to detect
generalized inflammation increased with active lupus decreases with corticosteroids or NSAIDs don't directly reflect disease activity
some causes for autoimmune disease
genetic environmental hormonal immunological stress
autoimmune CTDs are caused by
genetic and environmental
recommendations for people with SLE and fatigue
get 8-10 hours of sleep at night exercise encouraged as tolerated energy-conserving plan may need a nap
how is more production in the bone marrow induced and more stem cells into the circulation achieved
give pt. hematopoietic growth factors
neoadjuvant chemo
given before other rx, such as surgery, with the goal of decreasing the tumor cell burden
what eye problems may corticosteroids cause
glaucoma cataracts
how does gold work to treat RA
gold salts appear to accumulate slowly in the body and, over time, they reduce inflammation and slow the progression of rheumatoid arthritis.
what is elevated serum uric acid
greater than 7.5
common reactions of pts. with lupus
grief, depression, and anger
possible side effects of Arava
hair loss, irritation of the liver, rash, nausea, diarrhea, and abdominal pain
general characteristics of breakthrough pain
happens fast lasts from seconds to minutes to hours avg. duration was 30 minutes unexpectedly for no obvious reasons or triggered by an activity like coughing, moving, or going to the bathroom
cytotoxic precautions
harmful for the cells in the body medication or body fluids must not come in contact with other people hugging, kissing, and touching are all safe beginning 48-72 hours after chemo completion
Fifty percent of people with lupus _________________
have clinical renal disease.
care for older adult with THA
heals off bed prevent ulcers move slowly0 orthostatic hypo get out of bed ASAP to avoid respiratory complications- incentive spirometer mental status change may mean infection w/p fever need for psin meds
do these conditions r/t neonatal lupus last?
heart block almost always permanent- pacemaker for life skin rash usually appears about 6 weeks, disappears at 8 months liver and blood problems also transient
most common manifestation of neonatal lupus
heart block- heart beats abnormally slowly rash- most often see around the eyes
why are anticonsulvants taken?
help relieve neuropathic (nerve) pain
Ifosphamide
hemmorhagic cystitis potential- urine dipstick for blood MESNA- bladder protective agent
what to loo out for with phosphamides
hemorrhagic cystitis give MESNA given choice to bank sperm or eggs
phosphamide
hemorrhagic systitis
What is gout
heterogenous, metabolic disease that is often familial abnormal amounts of urates in the body overproduction or under excretion of uric acid
moderate to severe pain treatment
higher doses of opioid medications often not given as combination products. Adjuvant medications, NSAIDs, and acetaminophen may also be used. The opioid medications used to treat moderate to severe pain include morphine, fentanyl, oxycodone, and hydromorphone.
pros and cons of surgery
highest rate of cure for localized disease in most instances cons: deforming, debilitating
7 mediators in Type I hypersensitivity reaction
histamine leukotrines prostaglandins platelet-activating factor kinins serotonin anaphylatoxins
alternative medical systems
homeopathy naturopathy traditional Chinese medicine (TCM) Ayurveda
how are hormones related to SLE?
hormones are more prevalent in women during their reproductive years flares during pregnancy/postpartum
what are corticosteroids
hormones secreted by the cortex of the adrenal gland
pathogenesis of scleroderma
host may have genetic susceptibility, infection, environmental factors, or microchimerism that leads to vascular problems (endothelial cell injury, vasoconstriction, vascular occlusion, tissue hypoxia) and immune reactions (T cell activation, macrophage activation, autoantibodies, cytokines)- fibroblast activation and growth- fibrosis
MHC is known as the _________ in humans
human leukocyte antigen (HLA) series of genes located on chromosome 6
assessment prior to giving NSAIDs
hx: allergy to salicylates or other NSAIDs, cardiovascular dysfunction, hypertension, peptic ulcer, GI bleeding or other bleeding disorders, impaired hepatic or renal function, pregnancy, and lactation Laboratory data: hepatic and renal studies, complete blood count (CBC), clotting times, urinalysis, serum electrolytes, and stool for occult blood Physical: all body systems to determine baseline data and alterations in function, skin color, lesions, edema, hearing, orientation, reflexes, temperature, pulse, respirations, and blood pressure
other corticosteroids include
hydrocortisone methylprednisolone dexamethasone (Decadro)
two most often prescribed antimalarials
hydroxycholorquine sulfate (Plaquenil) and chloroquine (Aralen)
5) cellulose film-forming agents for covering localized ulcerative lesions
hydroxypropyl cellulose
3 types of rejection
hyperacute, acute, and chronic
PTH ectopic hormone production
hypercalcemia brittle bones
side effects of corticosteroids
hyperglycemia PUD HTN Na/H2O retention osteoporosis increased infection risk delayed healing fragile skin easy bruising hirsutism psychiatric manigestations
two broad types of immune disorders
hypersensitivity immunodeficiency
type I hypersensitivity is
hypersensitivity of allergens that may be inhaled, ingested, injected, contacted
calcitonin ectopic hormone
hypocalcemia
congenital (primary) immunodeficiency
hypogammaglobulinemia- deficient immunoglobulins severe ombined immune deficiencies- SCIDs DiGeorge syndrome- congenital thymic aplasia/hypoplasia
collaborative care of SIADH
hyponatremia restore normal fluid and Na balance- restrict fluid, administer sodium provide supportive care
which NSAID medications cause GI problems
ibuprofen and aspirin not acetaminophen
which NSAIDs have a greater impact on inflammation
ibuprofen, aspirin and naproxen > acetominophen
Extrasynovial rhumatoid nodules
identical to nodules of Rheumatic Fever central tissue necrosis proliferating CT skin, cardiac valves, pericardium, plea, lung parenchyma, spleen
ra etiology
idiopathic autoantibody (Rheumatoid Factor) Chronic inflammation releasing cytokines infectious (E-B Virus, papovirus, mycobacteria) genetic predisposition (2-3 times more likely) trauma
cause of dermatomyositis
idiopathic triggers: virus (manly previously dx with infectious mononucleosis and EPV), medication, stress overlap with SLE, scleroderma, vasculitis
cause of polymyositis
idiopathic related to autoimmune factors, genetics, viruses, infectious- pathogens that cause lyme disease, toxoplasmosis, stress initial injury- muscle autoantigen released and subsequently taken up by macrophages and CD4 + TH cells, further inglammatory mediator release, CD8 cytotoxic cells- muscle destruction
MOA of ATGAM
immunizing horse with human T cells directed against T cells
treatment of graft rejection
immunosuppression
For people with very severe symptoms, and those who cannot take allergy medications-
immunotherapy is an alternative
what does epinephrine do
improve breathing through beta2 stimulation and bronchodilation stimulate heart through beta 1 raise a dropping blood pressure through alpha stimulation and vasoconstriction reverse hives, reduce swelling of face, lips, and throat
second option for cancer cachexia
improve nutrition
when are opiates typically used
in PCA
angiogenesis inhibitors
include thalidomide, endostatin and bevacizumab/Avastin
alternative/complementary therapy
includes cognitive/behavioral techniques such as relaxation (reduces tension in muscles)- quiet or deep breathing, distraction, and visualization and mind/body techniques such as hypnosis and biofeedback.
short and long term side effects of corticosteroids
increased appetite and weight gain- short weight gain, moon face, osteoporosis, and other side effects- long
side effects of mycophenolate mofetil
increased infection risk thrombocytpenia diarrhea NV
what is interstitial lung disease associated with
increased morbidity and mortality
massage
increases blood circulation and relieves tension
biggest risk w/ CVL
infection
viruses and lupus
infectious agents such as viruses infect B cells and cause them to produce autoantibodies Epstein-Barr virus cross react with bodily proteins in genetically susceptible people
tachycardia is frequently the result of
inflamed heart tissue or infection
In patients with connective tissue disease, it is common for collagen and elastin to become injured by _____________
inflammation
cervical spine radiography
inflammation and destruction of cartilage, bone, and ligaments. This most commonly occurs in the upper cervical spine. Laxity and destruction of ligaments can lead to significant instability with frank subluxation and cord damage.
oral mucositis
inflammation of oral mucosa erythema or ulceration
SLE
inflammation of the CT can effect every organ system
pericarditis
inflammation of the pericardium is the most common cardiac abnormality in SLE
serositis
inflammation of the serous tissues of the body, the tissues lining the lungs (pleura), heart (pericardium), and the inner lining of the abdomen (peritoneum) and organs within
eye problems are related to __________
inflammatory process due to drug rx (cortico or antimalarials) separate problem
mast cell stabilizers are available as
inhalers (for asthma) eyedrops (allergic conjuctivitis) nasal sprays (allergy symptoms)
lupus anticoagulants
inhibit certain anticoag tests but are associated with thrombosis, pregnancy loss, and other manifestations of the antiphospholipid syndrome
MOA of corticosteroids
inhibits T cell activation and proliferations inhibits cytokine production suppresses inflammation
MOA of mycophenolate mofetil
inhibits purine synthesis suppresses T and B cell proliferation
Azathioprine MOA
inhibits purine synthesis supresses T and B cell proliferation
causes of perineal nerve injury
injury to leg trauma- broken leg, knee injury, surgery, ankle injuries
what else can antidepressants help cope with
insomnia take at bedtime
osteogenesis imperfecta (brittle bone disease)
insufficient production of good quality collagen to produce healthy, strong bones
potential adverse effects of Bevacizumab
interfere with normal processes such as wound healing and worsen problems r/t CAD and PAD
brachytherapy is also known as
internal radiotherapy sealed source radiotherapy curietherapy endocurietherapy
brachytherapy
internal therapy includes placement of radioactive substances in or near the site of cancer or the injection or ingestion of radioactive isotopes emits radiation for a period of time and is a hazard to others
what is a frequent manifestation of polymyositis?
interstitial lung disease
xenotransplants
involve transfer across species barriers Currently, xenotransplants are largely experimental and relegated to the laboratory, given the complex, potent immunologic barriers to success. pig valve transplantation in humans has been done successfully for many years
allotransplants
involve transfer from one individual to a different individual of the same species the most common scenario for most solid organ transplants performed today.
GFR
is done by collecting a 24-hour urine sample for measurement of creatinine clearance.
peripheral blood stem cell transplant
is the harvesting of a patient's own circulating stem cells for later reinfusion
mild latex allergy
itching, skin redness, hives or rash
Hx for antimalarials
known allergies to the prescribed drugs, psoriasis, retinal disease, hepatic disease, alcoholism, pregnancy, and lactation CBC, liver function tests, and G6PD deficiency all body systems to determine baseline data and alterations in function, skin color and lesions, mucous membranes, hair, reflexes, muscle strength, auditory and opthalmologic screening, liver palpation, and abdominal examination
where is EpiPen administered
large outer thigh muscles
what appears later
larger weight bearing joints
sunlight r/t lupus
lead to skin rash and exacerbate systemic manifestations of lupus exposure to UVA or UVB light- certain cellular porteins to accumulate in abnormally large amounts on the cell's surface
Tophaceous gout
lesions of chronicity deposit of irate crystals painless, irregular swellings helix of ear fingers, hands, knees, feet ulnar sugace of forearm, tibial surface of leg achilles tendon olecranon bursa r/t carpal tunnel syndrome
the effects of antihistamines
less likely to have an inflamed nasal passage- less runny nose, sneezing, and other symptoms
how much pain is associated with early stages of malignancy?
little or no pain
what to document r/t oral mucosa?
location, size and character of fissures, blisters, sores and drainage
why can nasal spray and eye drop decongestants only be used for a few days
long term use makes symptoms worse rebound decongestion
adipose
loose CT that stores fat
benzodiaxapines
lorazepam/ativan
X rays of DJD
loss of articular cartilage osteophytes- bone spurs
what is sclerodactyly
loss of skin creases, joint contractures, and sparse hair
chronic management between attacks
low purine ETOH and specific foods greater than 3 liters of liquid per day avoid thiazide and loon diretics- inhibit renal excretion of uric acid (hydrochlorothiazide, furosemide) avoid nicotinic acid avoid ASA
where is compartment syndrome most common
lower leg and forearm hand, foot, thigh, and upper arm
side effects of anticonvulsants
lowered blood counts, dizziness, blurred vision, and nausea
specific eye problems r/t lupus
lupus rash on eyelids dry-eye related to Sjoren's syndrome= Kerato-conjunctivitis- need artificial tears cytoid bodies reflect microangiopathy of the retinal capillaries and localized microinfarction of the superficial nerve fiber layers of the retina.
two meds for fibromyalgia
lyrica (pregabalin) cymbalta (duloxetine)
diagnosis of systemic sclerosis
major criteria 1) sclerodermatous involvement proximal to the digits minor criteria 1) sclerodactyly 2) digital pitting scars or tissue loss of the volar pads of the fingertips 3) bibasilar pulmonary fibrosis
main antigens involved in triggering the rejection process are coded for by a group of genes known as
major histocompatibility complex (MHC)
surgical procedures for ra
major joint surgery- covered with DJD
In postmenopausal women taking DHEA what must be monitored?
mammograms and PAP smears
complementary and alternative therapy
manipulative and body-based (chiropractic, osteopathic, and massage) mind-body (meditation, prayer, art, music, and dance) biological based (herbs, vitamins, and natural products) energy- biofield, Qjong, and bioelectromagnetic
side effects of androgens
masculinize women acne, hypercalcemia, liver dysfunction
how does Bevacizuman (Avastin) relate to wound healing
may be slow or incomplete even fatal stop 28 days before voluntary surgery until wound fully healed stop if patients experience slow wound healing
surgery r/t SLE
may exacerbate hospitalization required for minor surgery discharge delayed if elective postpone until under control
when are full effects of mast cell stabilizers felt
may take several weeks
ways NSAID therapy is variable
may work on a patient for some time and then for some unknown reason, stop working switch patient to a diff. NSAID only take one NSAID at any given time
carpal tunnel syndrome
median nerve compression neuropathy pain or paresthesias Phalen or Tinel test rest, immobilization, NSAIDs, surgery
humoral rejection
mediated by recipient's antibodies blood trnasufison, previous transplant, or pregnancy
Disease Modifying Antirheumatic Drugs (DMARDs)
medications that work by altering the immune system. These drugs halt the underlying processes that cause certain forms of inflammatory arthritis including RA, Ankylosing spondylitis, and psoriatic arthritis
what to assess for weight changes r/t SLE
meidcation usual dietary intake
who doesn't use DHEA
men
90% of people with primary gout are
men over 30
what are antimalarials usually combined with?
methotrexate or sulfasalzine
prokinetic agents
metoclopramide/reglan
systemic lupus erythematosus varies greatly in severity from
mild cases to severe cases w/ sig. and potentially fatal damage to vital organs such as the lungs, heart, kidneys, and brain
mast cells are used to rx
mild to mod. inflammation in the bronchial tubes and other allergy symptoms prevent asthma symptoms during exercise- given b4 exposure to allergen
coating agents combined with topical anesthetics
milk of magnesia kaolin with pectin suspension mixtures of aluminum MgOH- many antacids
protein foods with high biologic value
milk: double-strength; cheese (especially cottage, also cheddar), tuna fish, fish, chicken, pork
bone
mineralized CT that contains collagen and CaPO4
discharge teaching
minimize stress on new hip- avoid lifting 20-40 pounds, avoid gaining weight signs of wound infection exercise program as ordered routine post op discharge instruction
post-op nursing care
monitor for bleeding- empty drains, observe dressing, mark drainage may require fluid resuscitation, blood transfusions EBL on operative report orthostatic hypotension monitor urine output
nursing considerations r/t mycophenolate mofetil
monitor for infections monitor CBC monitor and manage GI dysfunction
nursing considerations r/t azathioprine
monitor for infections and CBC
biological response modifiers
monoclonal antibodies (e.g., trastuzumab [Herceptin] and rituximab [Rituxan]), cytokines (interferons, interleukins), vaccines, gene therapy and immunostimulants (BCG).3
TNF inhibitors
monoclonal antibodies afainst TNF Infliximab/remicade and adalimumab/Humira entanercept/Enbrel Interleukins (Kineret)
chronic rejection
months-years post-transplant increasingly common atrophy, fibrosis, and arteriosclerosis
cellular rejection
more common type of rejection after organ transplants Mediated by T lymphocytes activation and proliferation after exposure to donor MHC molecules
What is sensitization
more exposure you have, more likely your body is going to respond
what is used for chronic inflammation: heat or ice
more often heat
monoclonal antibodies example
moromonab- OKT3
how is breakthrough pain most commonly treated in the hospital?
morphine or dilaudid/hydromorphone IVP
Pros of anthracyclines
most effective anticancer treatment against more types of cancer than nay other class
second generation antihistamines
much less likely to have side effects of sedation and dry mouth long-acting option allegra (fexofenadine) claritin (loratidine) zyrtec (ceterizine)
grade 4
mucositis to the extent that alimentation is not possible
what is the only truly diagnostic thing for dermatomyositis?
muscle biopsy
administration of steroids- how often? how long until effects?
must be taken daily may take 1-2 weeks before full effect of medication
NSAIDs r/t gout
naproxen, indomethacin, voltaren (diclonfenac) active PUD, impaired renal functions and allergic response to NSAIDs would be contraindications
naprosyn is a brand name for what?
naproxin
effects of histamine in the body
nasal passage swelling, and swelling of airways increased vascular permeability, constriction of smooth muscle, stimulation of irritant receptors
routes of administration of decongestants
nasal spray, eye drop, liquid, or pill form
platin
nephrotoxic
what do we worry about with cysplatin
nephrotoxic
3 anticonvulsant medications used for cancer pain
neuontin tegretol klonopin
CSFs that can shorten this
neupogen neulasta epoietin alfa
what is the most commonly used adjuvant
neurontin (gabapentin)
damage from RA results from which cells
neutrophils T-cells cytokines
is immunosuppression required for autotransplants?
no
is immunosuppression required for xenotransplants?
no
is the pt. radioactive in tele therapy?
no
are antimalarials stopped with pregnancy
no They do cross the placenta, but a clinical trial and case studies have not found safety issues.
treatment of latex allergy
no cure, based on prevention avoid products that contain latex less severe- antihistamines and corticosteroid creams severe- carry EpiPen shock- Epi, trip to ER, O2, corticosteroids
rx for dermatomyelotitis
no known cure specialized exercise therapy medication: corticosteroids and immunosuppressants stress management
grade 0
none
what is normal CRP? High?
normal is 0 high is above 1 usually with inflammation above 10 mg
how does synovial fluid differ in those that have RA
normal: clear and yellow with WBCs less than 200 RA: turbine with WBCs 15,000-20,000
how will CBC for someone with RA look
normocytic normochromic anemia of chronic disease
immunizations r/t lupus
not been shown to exacerbate SLE influenza nad pneumococcal vaccines routinely recommended
MOA of IVIGs
not well understood reduce antibody production or promote the clearance of immune complexes from the body
symptoms of perineal nerve injury
numbness, ingling, pins and needles sensation foot droop- foot in plantar flexion pain in foot or shin foot weakness
prophylactic antimicrobial for fungal infections
nystatin or mycelex/clotrimazole
DJD is r/t
obesity, trauma, weight bearing stresses, genetics, hormones, aging, immune responses, and congenital abnormalities
during chemo
occur when give and for 1-2 days after
How is the dose of corticosteroids decided
once the symptoms of lupus have responded to rx the dose is usually tapered until the lowest possible dose that controls disease activity is achieved- monitor patients during this time for pain, fever, fatigue some only during active stages of the disease severe disease or more serious organ involvement- long term treatment
serotonin antagonists
ondanestron/zofran
Protein/creatinine ratio
one-time voided specimen
forms of leukotriene antagonists
only available with prescription pills, chewable tablets, oral granules
mild to moderate pain treatment
opioid medications are often used, usually as combination tablets with NSAIDs or acetaminophen. Some of the opioid medications used as combination products are hydrocodone, codeine, or oxycodone. Adjuvant medications may also be used for pain that is difficult to manage. Adjuvants are medications that were originally designed to treat conditions other than pain, such as tricyclic antidepressants.
collaborative care for RA
optimal nutrition- weight reduction, iron rich foods plus Ca and vit. D client and family coping OT and PT relxation techniques community referrals
do oral contraceptives or oral therapy increased SLE flares?
oral contraceptives do not increase flares in SLE, but hormone therapy does cause an increase in mild-to-moderate flares
Administration of immunosuppressives
orally and intravenously
routes of admin. for opioids
orally, by patch, rectally, by injection, transmucosally and are formulated to be long- and short-acting
methotrexate
originally developed as a cancer treatment and later approved for RA- antimetabolie lupus arthritis CBC and liver function tests prescribed daily folic acid
surgeries for OA
osteotomy, arthroplasty, or total joint replacement arthroscopic surgery for knee and hip autologous chondrocyte transplantation for younger clients
what may other people who are allergic to latex react with
other rubber- such as erasers, rubber toy parts, rubber bands, rubber in medical devices, and rubber in the elastic in clothing
peroneal nerve injury
outside part of lower knee foot droop can occur can't dorsiflex sooner treated, better outcome
how fast does polymyositis come on
over weeks to months
secondary gout results from
overproduction of uric acid results from cancer, cytotoxic drugs Paget's disease, multiple myeloma
autologous BMT
own bone marrow removed before the intensive rx then rein fused
what other notable opioid can be used
oxycodone
DOA oxycodone v. oxycontin
oxycodone- short acting 4-6 hours oxycontin- sustained release (can't crush it) 2 times daily
one side effect of radiopharmaceuticals
pain increase before it decreases
octreotide (Sandostatin)
pain of bowel obstruction controls sever diarrhea
capsaicin cream
pain relief depletes substance P
local manifestations appear gradually. what tends to start initially
painful tender joints of the MCP and PIP of hands and wrists DIP too
fibrin that develops into granulation tissue is called
pannus
physical therapy goals for RA
paraffin baths, heat lamps heat and cold compresses to maintain joint and muscle strength water exercises are good which eases joint movements
who shouldn't take acetaminophen?
people who have three or more alcoholic drinks in the course of 24 hours
who shouldn't take Arava
people with liver disease, pregnant or nursing women, people with immune systems weakened by an immune deficiency or disorder
opioids combined with acetaminophen
percocet tylox
opioids combined with aspirin
percodan
Carboplatin
peripheral neuropathy central neurotoxicity: dizziness, confusion, visual changes, ringing in the ears nephrotoxicity
etoposide
peripheral neuropathy (numbness in fingers and toes) may occur with repeated doses
vincristine
peripheral neuropathy (numbness in fingers and toes) may occur with repeated doses
complications of compartment syndrome
permanent injury to nerves and muscles amputation
how is stress related to autoimmune disease
physical and psychological stress 80% reported uncommon emotional stress before the disease onset stress-related hormones lead to immune dysregulation altering and amplifying cytokine production
routes of steroid administration
pills (severe allergies), inhalers (asthma), nasal sprays (seasonal and year round allergies) creams (skin allergies), eye drops (allergic conjunctivitis)
which routes can be taken longer safely
pills and liquid
what is often found in the lumen of the narrowed vessels
platelet microthrombi
pleuritic chest pain
pleurisy- most common respiratory manifestation in SLE can also be associated with pleural effusions
eryhtropoietin hormone production
polycythemia- plethora risk for thromboembolism
most common protocols for NV r/t chemo
pre-chemo antimetic prescription multiple antiseptics scheduled throughout chemo protocol and for 1-2 days afterwards PRN anti emetics available for breakthrough nausea
best early indicator of nutritional problems
prealbumin
MOA of ATG
prepared by immunizing rabbit with human T cells
opioids are always _________ medication
prescription
what to assess in pt. with fatigue
presence of depression, anxiety, other stressors daily activity levels
lab findings for PM
presence of specific autoantibodies in > 65% of pts. elevated serum creatine kinase (CPK)
cyclosporine
prevent body from rejecting transplanted organs rheumatic diseases treats antimetabolite
neonatal lupus
problems in the heart, skin, liver, and blood not the same as SLE associated with maternal antibodies anti-Ro(SSA) and anti-La(SSB) identified in utero 18-24 weeks
Ehlers-Danlos syndrome
progressive deterioration of collagens, different EDS affecting different sites in the body, such as joints, heart valves, organ walls, arterial walls
immunosuppressants r/t RA
progressive disease methotrexate azathiprine using earlier in disease process
what to do after hair falls out?
protect your head from the sun use sunscreen or wear a hat when outside protect head from the cold, wear a hat or scarf try wearing a soft scarf when you sleep
what can be given to help with gastric upset caused by NSAIDs
proton pump inhibitors such as protoprazole H2 receptor blockers- ranitidin, phanotidine, symantidine
which decongestant is controlled for behind the counter use? why?
pseudophedrine- sudafe used to make meth
cervical spine instability
pts. with established RA who have degeneration of the ligaments and bone in the C-spine area instability at C1-C2 level minor trauma- neurologic sequelae
how often do you assess oral mucosa?
q4 roof of mouth, under tongue, between teeth and cheeks
short-acting bronchodilator
quick relief for symptoms during an attack
myocardial infarction
r.t atherosclerosis increased in SLE patients even below 35 years
potential side effects of teleltherapy
radiation therapy can cause both early and late side effects acute side effects during treatment and chronic side effects occur months or even years after rx ends
unsealed soluble isotopes
radioactive iodine (for thyroid cancer) enters body fluids via oral or IV routes eliminated in excreta eliminated within 48 hours
use of corticosteroids for allergies
reduce inflammation prevent and treat nasal stuffiness, sneezing, itchy runny nose decrease inflammation and swelling from other types of allergic reactions
MOA corticosteroids
reduce inflammation suppress immune response control exacerbation of symptoms control severe forms of the disease serious illness or prior to surgery- administered IV
chondrotin sulfate
reduce painful symptoms improve walking distance longer to produce results than NSAIDs but last three months after medication stopped slow progression of disease increases amount of hyaluronic acid and inhibits the activity of enzymes that break down cartilage anti-inflammatory properites to provide pain relief
immunosuppressives are generally used to
reduce rejection of transplanted organs.
when can cancer also be used
reduce tumor cell burden before other therapy palliate symptoms to stage cancer to slow tumor groth
lupus nephritis can lead to
reduced levels of creatinine clearance
why used for OA?
reduces symptoms and slowed longterm progression minimal adverse effects comb. with condroitin glycosaminoglycans and hyaluronic acid, thereby serving as a substrate for the production of articular cartilage longer onset of action than NSAIDs
NSAIds
reducing swelling and inflammation. Some NSAIDs, notably ibuprofen, aspirin and naproxen, have a greater impact on inflammation than does acetaminophen can cause gastrointestinal problems, especially ibuprofen and aspirin. Acetaminophen does not cause this side effect, and the newest NSAIDs, the COX-2 inhibitors Celebrex and Vioxx, reportedly have a minimal impact on the gastrointestinal tract. shouldn't be taken if people have 3 or more alcoholic drinks
allopurinol
refer to tumor lysis syndrome talk
what tests need done when taking Arava
regular blood tests for liver function and blood count testing
Linen contaminated with body fluids from patients who have received chemotherapy in the past 48 hours may be bagged in a ______________ and placed with dirty linens to be laundered.
regular linen bag
what test should be done for those taking gold
regular urine tests to check protein and blood tests for kidney function
HLA molecules can initiate
rejection and graft disease via humoral or cellular mechanisms
how do bronchodilators work
relax muscle bands that tighten around airways through Beta 2 adrenergic stimulation improves breathing help clear mucus
Transcutaneous electrical nerve stimulation (TENS)
relieves pain by sending small electrical impulses through electrodes placed on the skin to underlying nerve fibers.
other major features of OA
remodeling and hypertrophy of bone bony sclerosis osteophytes or bone spurs- restrict movement periarticular muscle wasting
osteotomy
removal of a wedge of bone to correct deformity and achieve alignment and thus relieving pain.
synovectomy
removal of synovial membrane in affected joints; prevents tendon rupture
crystal aggregates deposited in the kidneys can lead to
renal stones and renal failure 1000 times more prevalent than in general population
tenosynovectomy
repair or removal of damaged tendons
Total hip arthroplasty
replacement of acetabulum and head of femur with prosthesis RA and DJD with severe disability and pain fractured hip with nonunion
alternative therapies
replacements for western medicine
what do you need to assess specifically for?
respiratory depression/sedation
TKA
resurfacing of the femur, tibia and patella with metal and plastic components
what to do with dislodged implants
retrieve with long forceps dispose in lead container
Raynaud's Phenomenon
reversible ischemia of peripheral arterioles various stimui exposure to cold or stress intense vasospasm and associated pallor and often cyanosis hyperemic phase with associated erythema rarely tissue necrosis fingers, tose, nose, ears, tongue
Mechanic's hands
rough, cracked skin at the tips and lateral aspects of the fingers forming irregular dirty-appearing, lines that resemble those seen in a laborer
doxorubicin/adriamycin and daunorubicin
rubicins, anthracycline red color potentially cardiotoxic: cardiac assessment- scans and physical assessment BNP is most diagnostic for HF
complementary medicine
rx inconjuction with western medicine aromatherapy can be used to lessen pt's discomfort after surgery
adjuvant chemo
rx of chancre w/ drugs after surgical resection of the primary tumor when there is a high risk of systemic recurrence- breast and colon cancer
CM of graft rejection
s/ of dysfunction of transplanted tissue or organ s/ of failure of above
when to go to the doctor
s/ of eye infection, redness, pain
drug of first choice for RA
salicylates ASA 4-6 g daily
sealed implants
seeds or needles implanted into specific tissues patient is radioactive, excreta are not radioactive
prescription combination drugs
semprex-D Naphcon, Vasocon, Zaditor, Patanol, Optivar
Patients with Felty syndrome are prone to
serious bacterial infections
compartment syndrome
serious condition involving increased pressure in a muscle compartment muscle and nerve damage and problems with blood flow
side effects of polyclonal antibodies
serum sickness (type III reaction- fever, chills, muscle and joint pain) back pain dyspnea hypotension myelosuppression increased infection risk anaphylaxis
customary to give
several at scheduled intervals around the clock several PRN for breakthrough
how is immunotherapy done
several injections given regularly over several years first shots very tiny amounts of antigens, progressively increase dosages over time your body with adjust to the antigen and become less sensitive to it desensitization 3 to 5 year regimen only partially effective in some
how often do most people with breakthrough pain experience episodes?
several times a day
Antimalarials r/t RA
severe disease effects begin in 3 months chloroquine, hydroxychloroquine side effects: N, abdominal discomfort, rash, blurred vision, retinal damage
what is universally present in affected organs for those with scleroderma
severe fibroproliferative vasculopathy that affects small arteries and arterioles
vasicants
severe local tissue breakdown and necrosis
compartment syndrome causes
severe pain that does not go away when you take pain medicine or raise the affected area. Decreased sensation Numbness and tingling Paleness of skin Weakness
glucosamine is prepared from
shells of crabs and other shellfish
are side effects from immunosuppressive reversible
side effects are dose-dependent and are generally reversible by reducing the dose or stopping the medication
Colchicine
sig. side effects- ab cramps, diarrhea, NV given within first few hours after onset of symptoms
toxic exposures r/t lupus include
silica and mercury
MOA of sirolimus
similar suppressive effect on immune system inhibits IL-2 and other cytokines blocking activation of T and B cells
what to assess for SLE r/t CP manifestations
skin color and temperature lesions cap. refill edema/pain in extremities
acute tele therapy side effects
skin irritation or tissue damage fatigue nausea (especially with abdomen and brain)
Thalidomide MOA
sleep aid rx skin manifestations of lupus by inhibiting inflammatory cytokines in the skin and underlying blood vessels
Mechanism of fatigue is unknown but associated with a variety of factors such as:
sleep disturbance biochemical changes related to disease and treatment psychosocial factors level of activity Nutrition other environmental and physical factors
remission-inducing agents
slow acting drugs effects begin after 2 months gold salts (Ridaura) penicillamine (Depen)
morre severe latex allergy
sneezing, runny nose, itchy, watery eyes, scratchy throat, difficulty breathing, wheezing, cough
do all pts with SLE take medications
some never require medications others only as needed many require constant therapy with variable doses
grade 1
soreness and erythema
cytotoxic precautions include what equipment
special gowns gloves masks goggles special waste containers red linen bags special clean up kits for big spills
Anti-Sm
specific for SLE but only 30 percent of patients with SLE have a positive anti-Sm test
pregnancy complications r/t lupus
spontaneous abortion and premature delivery more common for women with SLE
when is chemotherapy used
spread of malignant cells risk of recurrence systemically is high
medications that shouldn't be consumed with grapefruit juice
statins, antihstamines (fexofenadine and terfenadine), calcium channel blockers, psychiatric medications (buspirone, triazolam, carbamazepine, diazepam, midazolam, sertraline) intestinal medications (cisapride) immune suppressants (cyclosporine and tacrolimus) methadone (pain), sildenafil-viagra (impotence drug), HIV medication (saquinavir), antiarrhythmics- amiodarone (cordarone) and disopyramide (norpace)
what is heat therapy especially useful for
stiffness
side effects of leukotriene modifiers
stomach pain or stomach upset heart burn fever stuffy nose cough rash HA
side effect of condroitin
stomach upset nausea allergic bc made from cow sources
how do mast cell stabilizers work?
stop release of histamine from mast cells some have important anti-inflammatory effects
Rheumatology
sub-specialty in internal medicine and pediatrics, devoted to diagnosis and therapy of rheumatic diseases. Clinicians who specialize in rheumatology are called rheumatologists. Rheumatologists deal mainly with clinical problems involving joints, soft tissues, autoimmune diseases, vasculitis, and heritable connective tissue disorders.
what is xerostomia
subjective symptom dry mouth
CM of gout
sudden onset, night affected great toe assymmetric fever common to 39 C swollen, very tender with overlying skin tense, warm, and dusky red local desquamation and pruruitus tophi on external ears, hands, feet, elbow and pre patellar bursa
medications that increase the risk of lupus flare
sulfonamide antibiotics
things to kelp with mild to moderate OA
supervised waling program weight reduction assistive devices warm compresses rest and reduction to stress PT and OT collaboration referrals preparation for surgery
rx for perineal nerve injury
surgery, repairing, taking pressure off, grafting new nerve PT Orthotics- ankle and foot brace
Describe the joints in RA
symmetric joint swelling feels warm and boggy ruddy and cyanotic color thin and shiny skin
why is SLE so difficult to diagnose?
symptoms may be vague easily confused with other disorders transient or prolonged severe symptoms with few abnormal lab test results
first joint tissue involved in RA
synovial membrane
Danazol
synthetic derivative of testosterone, inhibits pituitary secretion of LH and follicle-stimulating hormone (FSH), which decreases estrogen synthesis from the testicles. The dose used for gynecomastia is 200mg twice daily. Complete resolution of breast enlargement has been reported in 23% of cases. Adverse effects include weight gain, acne, muscle cramps, fluid retention, nausea, and abnormal liver function test results.
advantages of chemo
systemic useful against disseminated
disadvantages of chemo
systemic adverse effects myelopsuppression; infection; bleeding;anemia leukopenia, infection anorexia, mucositis, NV, diarrhea alopecia reproductive dysfunction
how to care for oral mucosa
systemic assessment of oral cavity to identify lesions early oral hygiene and other supportive care measures assessment scales to grade the level of stomatitis
RA
systemic disorder in which immune cells attack and inflame the membrane around joints heart, lungs, and eyes
CM of RA may begin with
systemic manifestations fever, fatigue, weakness, anorexia, weight loss, generalized aching and stiffness
scleroderma is also known as
systemic sclerosis
side effects of bronchodilators
tachycardia and HTN
issues with chemo and radiation
target actively reproducing cells of malignancy but also suppress activity of: skin, hair, mucus membranes (alopecia and impaired first line of defense), bone marrow (panyctopenia), reproductive cells (sterility)
recommendations for people with SLE and fever
teach to monitor temp. look for s/s of infection- urinary and respiratory cardinal signs may be masked bc of medications
fibrous connective tissue
tendons and ligament closely packed collagenous fibers
can polymyositis be treated
tends to respond well to treatments
what is CRP used for in lupus and RA?
test effectiveness of treatment and monitor periods of disease flareup
how to confirm diagnosis of compartment syndrome
the doctor or nurse may need to directly measure the pressure in the compartment. This is done using a needle attached to a pressure meter, which is placed into the body area. The test must be done during and after an activity that causes pain.
how do doses differ for drugs comparing cancer to RA
the doses are significantly lower and the risks of side effects tend to be considerably less than when prescribed in higher doses for cancer treatment.
What may cause leukopenia
the lupus itself or the prednisone
who shouldn't receive Bevacizumab (Avastin)
those scheduled for soon voluntary surgery those who have recently coughed up blood or have serious bleeding
who among cancer pts. is at most risk for hypercalcemia
those with bone metastasis
side effects of mast cell stabilizers
throat irritation, coughing, skin rashes with inhaled Tilade- bad taste eye drops- burning, stinging or blurred vision
what to avoid
tobacco or alcohol products spicy, salty, acidic, dry, rough, hard food hot liquids denture use all day (only with meals)
when does osteoarthritis develop
too much load or biomaterial properties of the articular cartilage are inferior repetitive impact loading
how are corticosteroids administered
topical cream or ointment for skin rashes injectable- intramuscular or IV admin
autotransplants
transfer of tissue or organs from one part of an individual to another part of the same individual. They are the most common type of transplants and include skin grafts and vein grafts for bypasses.
preop care
transfer techniques practiced beforehand muscle exercises to maintain tone
what to do before hair falls out?
treat it gently, wash it with mild shampoo and pat it dry with a soft towel cut your hair short shave your head with an electric shaver get a wig
acute gouty arthritis
triggers: trauma, drugs, alcohol great toe (50%) vulnerable heel, ankle, foot instep, wrist, elbow severe pain- noticed at night, hot, tender, red, swollen, lasts few hours mainly lymphanigitis and systemic signs of infection- leukocytosis, fever, elevated ESR
disadv. of radiation therapy
tumor must be radiosensitive large tumor cells not easily treated localized rx with limitations
what is cachectin?
tumor necrosis factor role in regulation of autoimmune responses selective destruction of malignanct cells
tylox
tylenol and oxycodone
what is the most common type of hypersensitivity?
type I
organ transplantation acute graft rejection=
type IV hypersensitvity reaction
blood
type of CT extrcellular matrix plasma and erythrocytes, leukocytes, and platelets
polymyositis
type of chronic inflammatory myopathy r/t dermatomyositis and myositis many muscle inflammation
grade 3
ulcers, extensive erythema pts can't swallow solid diet
etiology of cachexia
unclear related to a complex network of inflammatory cytokines activated by the malignancy
what does primary got result from
under excretion of uric acid
when are corticosteroids used for RA
unremitting disease with extra-articular symptoms prednise, hydrocortisone
long-acting bronchodilator
up to 12-hour of relief for asthma symptoms
cytoxan/cyclophosphamide what would you monitor?
urine dipstick for blood!! hemmorhagic cystitis potential
how does medication leave the body
urine, bowel movements, blood, phlegm, sweat, semen, vaginal fluid, vomit, saliva
epipen
used in community
bronchodilator therapy
used to control asthma therapy prescription short-acting and log-acting
prophylactic antimicrobial for CMV
valacyclovir/valtrex
rx of SLE
varied no one cure 1) rest 2) protection from direct sunlight 3) healthful diet 4) treatment of infections 5) avoidance of aggravating factors 6) pregnancy- planned for times when disease is under control
mixed CT disease
various CTDs coexist and overlap: SLE, systemic sclerosis, dermatomyositis, polymyositis, Sjorgen syndrome chronic and usually milder
aldosterone hormone production
vasoconstriction- high BP hypokalemia hypernatremia, high fluid volume
some types of bronchodilators
ventolin- albuterol, proventil, pro-air, xopenex, maxair douneb- ipratropium bromide/salbutanol- atrovent (anticholinergic) and albuterol (sympathomimetic
heliotrope or lilac rash
violaceous eruption on the upper eyelids and in rare casues on the lower eyelids often w/ itching and swelling) most specific rash in DM only present in a minority of patients
4) topical anesthetics
viscous lidocaine, benzocaine sprays/gels, dyclonine rinses, diphenhydramine solutions
typical post op for TKA
vitals frequently circulation and sensation in legs and feet large dressing applied to surgical area hemovac IV- adequate fluids antibiotics administered every 8 hours until drains are removed foley catheter 1-2 days DVT prophylaxis: TEDs, SCD, heparin, lovenox PCA and anti-nause med. clear liquids to diet as tolerated coughing and deep breathing 10 times hour IS CPM- slowly and smoothly bends and straighten knee PT- pain meds 30 min. before
unregulated production of cachectin leads to
wasting cachexia inflammatory and/or autoimmune diseases septic shock
what to rinse mouth with
water of NS, or 1/2 strength peroxide/NS frequently
1) bland rinses
water, NS, NaHCO3
dehydroepiandrosterone (DHEA) MOA
weak male hormone benefits worm by restoring balance of male-femal hormones improves bone mineral density in women with lupus receiving corticosteroids not approved by FDA- need compounding pharmacist- medical grade and monitor response
esophageal disease
weakness of the striated muscle of the upper 1/3 of the esophagus and/or oropharyngeal muscles can lead to nasal regurgitation, dysphagia, aspiration more common in elderly pts leads to increased incidence of bacterial pneumonia
many patients with SLE experience changes in _________
weight 1/2 of patients report weight loss- decreased appetite, side effects of medications, GI problems, or fever weight gain r/t medications or fluid restrictions from kidney disease
CPM machine
well padded cycle and ROM every 8 hours joint moving properly on machine confused- controls placed out of reach assess response to the machine turn off when having a meal in bed
diet and nutrition r/t
well-balanced diet is essential in maintaining good health low-fat and low-cholesterol- increased risk of heart disease restricted diet r/t fluid rention, HTN, kidney disease and other problems diet counseling especially for pts who struggle with weight loss, weight gain, GI distress, or food intolerances
NV r/t opioids
when beginning using opioids, usually goes away anti-emetics zofran (ondansetron) seratonin antagonist and kytirl (granisetron)
when are intra-articular steroids used for RA
when no more than 2 joints are involved 4 injections per year per joint
when are SLE patients given a corticosteroid
when they do not improve or who are not expected to respond to NSAIDs or antimalarials may be given a corticosteroid
when to use systemic analgesics for oral mucositis
when topical anesthetic strategies are not sufficient
administration of corticosteroids
with food or milk (to decrease GI symptoms)
administration of NSAIDs
with food or milk to decrease gastric irritation
when does mucositis typically heal
within 2-4 weeks after cessation of cytotoxic chemotherapy
hyperacute rejection
within minutes bc of presence of antibodies in the recipient, antibodies that are specific to the donor DIC swollen, darkened graft, which undergoes ischemic necrosis
anti-B2 glycoprotein I
won't detect caridolipin unless B2 glycoprotein I is present
is immunosuppression required for allotransplants?
yes, to prevent rejection
do these lupus symptoms resolve?
yes, when the drug is stopped
ZAP
zero acceptance of pain; pain assessment and management guide; patient self-assessment form; patient journal communication between health care provider and patient
purchasing capsaicin cream
zostrix, capzasin-P and capsin w/ and w/o prescription 0.025 to 0.075% burning sensation, diminish after several applications don't touch eyes wash hands after using
over the counter decongestants
zyrtec-D, sudafed tablets or liquid neo-synephrine and afrin nasal spray visine eye drops