EXAM 4

Actions that decrease ICP

1. HOB no less than 30 d to reduce ICP and promote venous drainage 2. avoid extreme flexion and extension 3. Patent airway, vent as needed 4. O2 prn to maintain PaCO2 above 60mmHg 5. Stool softeners 6. C-spine stability 7. Report CSF drainage 8. Low stimulus environment 9. Repo q2h 10. Monitor fluid and electrolytes and for diabetes insipidus 12. If on vent brief periods of hyperventilation in 1st 24h 13. Seizure precautions 14. Explain procedures to patients even if in coma

(HIV/AIDS) Primary/acute infection characterized by

1. High levels of viral replication 2. widespread dissemination of HIV 3. destruction of CD4+ T-cells lead to dramatic drop in CD4+ T-cells

(HIV/AIDS) Opportunistic infections

1. bacterial diseases- TB, bacterial pneumonia, septicemia 2. HIV associated malignancies- Kaposi's sarcoma. lymphoma, squamous cell carcinoma 3. VIral diseases caused by cytomegalovirus, herpes simplex, herpes zoster 4. Fungal diseases, pneumocystis jirovecii pneumonia (PCP), candidiasis, cryptococcus penicilliosis 5. Protozoal diseases- PCP, toxoplasmosis, microsporidiosis, cryptosporidiosis, isosporiasis leishmaniasis

Lupus risk factors

1. female 2. 20-40yo 3. african american, asian and native american 4. decreases in women following menapause

Lupus physical assessment findings

1. fever 2. anemia 3. lymphadenopathy 4. pericarditis (presence of pleural friction rub) 5. Raynaud's phenomenon 6. findings consistent with organ involvement 7. erythematous "butterfly" rash over nose and cheeks 8. alopecia

RA expected findings

1. pain at rest and movement 2. morning stiffness 3. pleuritic pain 4. xerostomia (dry mouth) 5. anorexia/ wt. loss 6. fatigue 7. paraesthesias 8. recent illness/stress 9. lack of function 10. joint swelling/ deformity 11. subcutaneous nodules 12. fever 13. muscle weakness/atrophy 14. reddened sclera 15. lymph node enlargement

Nursing care for SLE Assess for...

1. pain, mobility, fatigue 2. VS, esp BP 3. systemic manifestations 4. HTN and edema (renal compromise) 5. Urine output 6. diminished breath sounds (PE) 7. tachycardia 8. rubor, pallor, cyanosis of hands, feet (vasculitis) Raynaud's syndrome 9. changes in mental status 10. BUN, Cr and urine output for renal incvolvment 11. nutritional status 12. limit Na intake 13. small frequent meals

(HIV/AIDS) Pt. education

1. practice good hygiene 2. avoid crowded places and travel to countries with poor sanitation 3. avoid raw foods 4. avoid cleaning pet litter 5. avoid friends and family with cold/flu 6. use hot water to wash dishes 7. adhere to ART therapy 8. frequent follow ups to monitor CD4+ 9 constructive coping 10. report infection ASAP

Pregnant women with HIV are at risk for?

1. pre-term labor 2. fetal growth restriction 3. premature rupture of membranes 4. intrapartum or postpartum hemorrhage 5. postpartum infection 6. poor wound healing 7. UTI

Neutropenic precautions

1. restrict visitors 2. prohibiting visits by people with infections 3. restricting exposure to live plants 4. restricting ingestion of fresh fruits and veggies 5. avoid rectal temp and IM injections

HIV/AIDS health promotion

1. teach pt how virus is transmitted and ways to prevent 2. encourage pt to maintain up to date immunizations 3. standard precautions

Early signs of septic shock

BP normal Decreased MAP 5-10mmHg Pulse- norm - increased Urine output- norm- decreased Skin temp- pale and cool Sensorium- anxious Resps- increased rate and depth

Late signs of septic shock

BP- systolic below 90mmHg and MAP decreased >20 Pulse- increased rate and weak Urine output- decreased 0.5mL/kg/hr Skin temp- Cool, moist, mottled Sensorium- Decreased LOC and AMS Resps- Increased rate and shallow

Cyclosporine

Immunosuppressant Do not give if recent live vaccine like flu, recent contact with chicken pox or herpes zoster RIsk of infection Hepatotoxic nephrotoxic

A nurse is caring for a client who has HIV. Which of the following laboratory tests should the nurse monitor to assess the effectiveness of therapy? A) Quantitative RNA assay B) Platelet count C) Enzyme immunoassay (EIA) test D) Western blot

ANS: A A quantitative RNA assay measures the viral load and is useful in monitoring HIV disease progression and treatment effectiveness

A nurse is preparing a client who has AIDS for discharge. Which of the following statements should the nurse include in the discharge instructions? A) "Prevent the spread of infection with good household cleaning practices." B) " disinfect equipment contaminated with blood or body fluids for twenty-four hours." C) " food preparation is not your responsibility." D) "Burn soiled dressings."

ANS: A The client should follow standard precautions and use a 1:10 solution of bleach to disinfect areas that come into contact with blood and body fluids.

A nurse is caring for a client who has HIV. Which of the following laboratory values is the nurse's priority? A) Positive western blot test B) CD4-T-cell count 180 cells/mm C) Platelets 150,000/mm D) WBC 5,000/mm

ANS: B A CD4-T- cell count less than 180 cells/mm indicates that the client is severely immunocompromised and is at high risk for infection. Therefore, this value is a priority for the nurse to report to the provider.

A nurse is a provider's office is assessing a client who has AIDS. Then nurse notes that the client has multiple and widespread raised, purplish-blown skin lesions. The nurse should recognize that these findings indicate which of the following conditions? A) Actinic keratosis B) Kaposi's sarcoma C) Toxic epidermal necrosis D) Basal cell carcinoma

ANS: B Kaposi's sarcoma are AIDS-related malignant skin and mucous membrane lesions that are usually purplish-brown, raised and edematous.

A nurse is presenting a community-based program about HIV and AIDS. A client asks the nurse to describe the initial symptoms experienced with HIV infection. Which of the following manifestations should the nurse include in the explanation of initial symptoms? A) Pneumocystis lung infection B) Flu-like symptoms and night sweats C) Fungal and bacterial infections D) Kaposi's sarcoma

ANS: B The nurse should explain that the initial symptoms may include flu-like symptoms and night sweats in category A of HIV infection.

A nurse is assessing a client who has a history of HIV with phagocytic dysfunction. The nurse should monitor this client for which of the following conditions? A) Dehydration B) Fungal infection C) Compartment syndrome D) Pleural effusion

ANS: B The nurse should monitor the client for fungal infections due to the impairment of the phagocytic cells. Fungal and bacterial infections are the primary results of the dysfunction

A nurse is talking with a client who has to come to the clinic for HIV testing. The nurse should explain that, after the laboratory has the enzyme-linked immunosorbent assay (ELISA) results, it will use which of the following tests to confirm the diagnosis? A) CD4+ T-Cells count B) Western blot analysis C) Quantitative RNA assay D) Viral load test

ANS: B The western blot analysis is used to confirm seropositivity when the ELISA test has a positive result. ELISA is inexpensive and accurate with few false-positives. Western blot is expensive, so is done only for confirmation

A nurse is creating home instructions for a client who has immunodeficiency. Which of the following statements by the client indicates an understanding of the teaching? A) "I will limit the use of emollient skin cream to once a week." B) "I will expect to have a mild, occasional fever." C) " I will avoid people who have just received an immunization." D) "I might experience harmless white patches in my mouth."

ANS: C The client should avoid people who received a vaccination, especially a live vaccine, to prevent contracting the disease.

A nurse is caring for a client who has a new diagnosis of human immunodeficiency virus (HIV). He states, " I don't care what the doctors say, there is no way I can have HIV, and I don't need treatment for something I don't have." The nurse identifies that the client is experiencing which of the following types of crisis? A) Adventitious B) Internal C) Maturational D) Situational

ANS: D A diagnosis of HIV is a situational crisis which is one that is unexpected but is part of regular life such as a serious illness or financial loss.

A nurse in a clinic is assessing a client who has AIDS and a significantly decreased CD4-T-cell count. The nurse should recognize that the client is at risk for developing which of the following infectious oral conditions? A) Halitosis B) Gingivitis C) Xerostomia D) Candidiasis

ANS: D Although oral candidiasis can affect anyone, it occurs most often in infants, toddlers, older adults, and clients whose immune systems have been compromised by illness, such as AIDS, or medications.

A nurse is caring for a client who has HIV-1 infection and is prescribed zidovudine as part of antiretroviral therapy. The nurse should monitor the client for which of the following adverse effects of this medication? A) Cardiac dysrhythmia B) Metabolic alkalosis C) Renal failure D) Aplastic anemia

ANS: D Severe myelosuppression that results in anemia (decreased red blood cells), agranulocytosis (decreased white blood cells), and thrombocytopenia (decreased platelets), is a life-threatening adverse reaction to zidovudine therapy. Consequently, zidovudine must be used cautiously in clients already experiencing myelosuppression, and the client must be monitored with a CBC performed every few weeks for early detection of marrow failure, which may lead to aplastic anemia.

A nurse is setting goals for a client who has AIDS and is at the end of life. Which of the following are realistic goals? A) The client will verbalize an understanding of the mode of disease transmission B) The client will experience a weight gain of one to two pounds per week C) The client will increase attendance at community social activities D) The client will receive medication to minimize episodes of breakthrough pain

ANS: D The client should receive medication to minimize episodes of break though pain as a goal for the end of life care

A nurse is implementing a plan of care for a client who has AIDS with recurring pneumonia. Which of the following actions should the nurse take? A) Encourage fluid intake of 1500mL/day B) Position head of bed at 10 degrees C) Cough and deep breathe every 8hr D) Obtain a sputum culture

ANS: D The nurse should obtain a sputum culture to determine which antibiotic is needed for the organism that is causing the pneumonia

HIV is a virus that targets and destroys what cells and what type of immunity is affected

CD4+ cells Innate is effected

RA teaching

COnsume foods high in protein, vitamins and iron Sm. freq meals Hot and cold therapy Phys. act Rest periods Morning stiffness (hot shower) Pain in hands (heated paraffin) Edema (cold tx)

secondary immunodeficiency

loss of immune functioning as a result of an illness or treatment, use of immunosuppressive meds, malnutrition, or protein losing state, prematurity, or HIV infection

Systemic Inflammatory Response Syndrome (SIRS)

overwhelming inflammatory response in the absence of infection causing relative hypovolemia and decreased tissue perfusion

Craniotomy

surgical removal of part of the bone from the skull to expose the brain and relieve swelling Manitol is given q6h for 24-72h post-op Phenytoin ( Dilantin), diazepam to prevent seizure Monitor ICP HOB no less than 30 degrees to prevent increase in ICP

Lymphocytes

(t cells and B cells) T-cells Indicate cell mediated immunity B-cells indicate humoral immunity % circulating- 20-40% Increased: Chronic bacterial infection viruses Mono, mumps, measles Bacterial hepatitis Leukemia (lymphocytic) Myeloma Decreased: Leukemia Sepsis

lupus erythematosus (SLE)

- Autoimmune, Inflammatory of connective tissue that causes major organs to fail - *Kidneys* - Discoid (skin) & Systemic - Usually women, if men Respiratory - Monitor: BUN, Creatinine, BP, UO

Hyperacute transplant rejection

-Within minutes -Pre-existing recipient antibodies react to donor antigen (type II hypersensitivity reaction), activate complement. -Widespread thrombosis of graft vessels causing ischemia/necrosis. Graft must be removed. severe HTN and pain at site

Eosinophils

1-4% Increased in allergic reaction Parasitic infection eczema Leukemia autoimmune disease Decreased Stress corticosteroids

Risk factors for RA

1. Female 3:1 compaired to male 2. 20-50yo 3. genetic predisposition 4. Epstein barr 5. stress 6 environmental 7. older age

AIDS defining conditions

1. candidiasis of esophagus, bronchi, trachea and lungs 2. herpes simplex: chronic ulcers x1 mo or more 3. HIV related encephalopathy 4. disseminated or extra pulmonary histoplasmosis 5. kaposi's sarcoma 6. Burkitt's lymphoma 7. mycobacterium TB of any state 8. PCP 9. recurrent pneumonia 10. progressive multifocal leukoencephalopathy 11. recurrent salmonella septicemia 12. wasting syndrome

Lupus expected findings

1. fatigue 2. alopecia 3. blurred vision 4. pleuritic pain 5. anorexia 6. depression 7. joint pain, swelling and tenderness

Monocytes

2-8% circulating Increased Chronic inflammation Protozoal infections TB Viral infections (mono) Decreased Corticosteroid treatment Aplastic anemia Hairy cell anemia

CD8 cells

2nd way Tc can induce apoptosis- express Fas ligand, which reacts with the Fas receptor on the host cell >>> apoptosis

NOrmal ICP

5-15 mmHg Limit monitoring to 3-5d Persistant elevation = brain death

Children with HIV + mothers need?

6wk course of zidoudine therapy

Normal CD4+ count

700-1,000 500 can also be considered normal

Radioallergosorbent test (RAST)

A blood test used to detect antibodies associated with allergens Advantages: will not precipitate a dangerous rxn and is quicker than skin test Disadvantages: Avail for fewer antigens can be less sensitive than skin testing

Basophils

A circulating leukocyte that produces histamine. 0.5-1% Increased in leukemia decreased in acute allergic reaction hypothyroidism stress

Treatment for ICP

A drainage catheter, inserted via ventriculostomy into lateral ventricle, can monitor ICP and drain CSF to maintain normal pressure. System is calibrated with transducer leveled 1 inch above ear (height of foramen of Munro); sterile technique is of utmost importance. Laboratory tests augment and monitor treatment approaches; serum osmolarity monitors hydration status; ABGs measure pH, O2, and CO2 (hydrogen ions and CO2 are vasodilators that increase ICP) Medication therapy: Osmotic diuretics (mannitol) and loop diuretics such as furosemide (Lasix) are mainstays to decrease ICP; they draw water from edematous tissues into vascular system Corticosteroids may aid in decreasing ICP, especially with tumors Nutrition therapy: Sources of protein and glucose, usually with TPN or enteral feedings

Lab tests for head injury

ABGs CBC w/ diff Blood glucose Electrolyte levels Serum osmolarity (urine) Toxicology EKG Monitor anti-seizure med levels

A nurse is caring for a client who is HIV positive and is one day postoperative following an appendectomy. The nurse should wear a gown as personal protective equipment when taking which of the following actions? A) Talking to the client at the bedside B) Administering an intermittent IV bolus medication C) Completing a dressing change D) Administering an IM injections

ANS: C Standard precautions require personal protective equipment when there is a risk of contact with body fluids. A dressing change does present a risk for coming into contact with body fluids

A group of nurses are discussing risk factors for transmission of human immunodeficiency virus (HIV) from clients. Which of the following individuals should the nurse identify as being at the greatest risk for contracting HIV? A) An occupational therapist who works with a client who has HIV B) A personal trainer who works with a client who has HIV C) A phlebotomist who collects blood from clients who have HIV D) A nurse who works for an insurance company and collects urine samples from clients who have HIV

ANS: C The greatest risk for exposure to HIV is from a needle stick; therefore, the phlebotomist who collects blood is at greatest risk.

(HIV/AIDS) Treatment for women who decide to go through with pregnancy with HIV

ART tx regardless of CD4+ count or viral load Standard tx is BID until gives birth IV admin during labor and oral zidovudine (AZT) for newborn 6-12h after birth GOal is to reduce viral load as much as possible which reduces risk of transmission to fetus

Adaptive immunity

Acquired after exposure to pathogen. Most effective type of immunity Develops less rapidly ex: flu shot

Active immunity

Adaptive process that allows the body to make antibodies in response to exposure of antigens to the body Natural- produced in response to exposure Artificial- When vaccine is given and body produces antibodies

HIV affects immune system function via?

Alterations mainly in T-cells function but also affects B-cells (natural killer cells) and monocyte and macrophage functions As CD4+ decrease CD8 increase but as it progresses will decline

What is an adequate CD4+ response on ART therapy

An increase in the range of 50-150mm/ yr Generally accelerated response in 1st 3mo

Serologic testing algorithm for recent HIV seroconversion (STARHS)

Analyzes HIV + blood samples to determine whether HIV infections is recent or ongoing

Passive immunity

Antibodies passed from one person to another Natural- mom to baby Artificial- Immunoglobins admin to individual

Infant/child immune syst can not fight infections without?

Appropriate T-cell, B-cell, natural killer cells and monocyte and macrophage function

Pericardial TB

Arises during successful ART in pts with HIV TB co-infections who are receiving TB tx

Stage 3 of HIV/AIDS

As T cells are further reduced, immune function is impaired, and opportunistic infections occur

Chronic stage of HIV

Asymptomatic Infection -First several years after initial infection (up to 10 years) -Asymptomatic or relatively limited signs of infection (vague and nonspecific) -Can still infect others during this time Symptomatic Infection -CD4+ declines to 200 cells/uL and viral load increases -More active stage -Symptoms: fever, frequent night sweats, chronic diarrhea, recurrent headaches, severe fatigue -Oropharyngeal candidiasis (thrush) most common infection during this stage -Can also develop: shingles, persistent vaginal candidal infections, outbreaks of oral or genital herpes, bacterial infections, Kaposi sarcoma -Oral hairy leukoplakia = another indicator of disease progression

Immune Thrombocytopenic Purpura (ITP)

Autoimmune platelet destruction is a common cause of thrombocytopenia and should be suspected in patients with ecchymoses, petechiae, mucosal bleeding, and no other obvious causes of thrombocytopenia (ex- medications, bone marrow failure) .

Considerations for allergy skin testing

Avoid corticosteroids and antihistamines 48hr-2wks prior to testing

humoral immunity

B cells produce antibodies after exposure to specific antigens; type of adaptive immunity

When and how should women with HIV give birth

C-section 38wks

Labs for sepsis

CBC BMP BUN Cr Lactic Blood cultures UA

Labs for HIV/AIDS

CBC--> RBC- Hgb- HCT = anmemia? BUN Cr ALT/AST Viral load T-cell count CBC w/ diff PLT count less than 150,000

Intracranial Hemorrhage

Can occur in the epidural, subdural or intracerebral space. Its a collection of blood following head trauma. Can be a delay of subacute or chronic subdural hematoma

Comorbidities in older adults associated with HIV/AIDS

Cardiovascular disease and diabetes are contributing factors

B-Cell defecits also occur in HIV infected children by

Contributing to high rates of bacterial infections. B-cells demonstrate impaired response to mitogens and antigens Infants lack pool of B-Cells for recall antigens

Prednisone

Corticosteroid Risk of infection osteoporosis Adrenal suppression NV Hypotension Confusion (if stopped abruptly) Fluid retention GI discomfort and or distress Hyperglycemia Hypokalemia

Sepsis

Dangerous infection of the blood

RA labs Anti CCP antibodies

Detects antibodies to cyclic citrullinated peptide Positive in most RA cases

HIV differentiation assay

Differentiates HIV-1 and HIV-2

Phenytoin

Dilantin Anticonvulsant Used prophylactically to prevent or treat seizures. 1st med used to suppress seizure act that did not depress entire cns COnsiderations Dosing is patient specific and based on theraputic blood levels check for med interactions

phenytoin interactions

Drug: Increase effects of cimetidine, isoniazid, chloramphenicol; decrease effects with folic acid, calcium, antacids, sucralfate, vinblastine, cisplatin. Decrease effects of anticoagulants, oral contraceptives, antihistamines, corticosteroids, theophylline, cyclosporin, quinidine, dopamine, rifampin. Food: Decreased effects of folic acid, calcium, and vitamin D as absorption is decreased by phenytoin.

Glascow Coma Scale

EYE OPENING 4 - spontaneous 3 - open to speech 2 - open to pain 1 - no response VERBAL 5 - alert and oriented 4 - disoriented conversation 3 - inappropriate words 2 - nonsensical sounds 1 - no response MOTOR 6 - spontaneous 5 - localizes pain 4 - withdraws to pain 3 - decorticate posturing 2 - decerebrate posturing 1 - no movement

How is HIV diagnosed

ElISA follow by western blot to confirm

ESR (erythrocyte sedimentation rate)

Elevation is associated with inflammation or infection 20-40= mild 40-70= mod 70-150 = severe

(HIV/AIDS) Stage 1

Flu-like sx Viral load high/ high circulating virus No T-cells to fight off infections Defining conditions- none CD4+ T-lymphocyte count 500 cells/mm3 or more decreased

What plays a role in fighting HIV infection in newborns

Functional killer cells play a role in fighting viruses and critical to immunity in newborn while T-cell line develops Decreased function of natural killer cells contribute to increased sensitivity of viral infections in HIV infected infants/children

If temp is greater than 100.4 in HIV what do you do

Go to Dr. Get labs Vitals

Ribavirin

Guanosine analogue-->inhibits viral 'R'NA polymerase-->inhibits viral 'r'eplication Uses = 'R'SV bronchiolitis

CD4 cells

Helper T cells mediate immune response

Adverse effects associated with all HIV tx

Hepatotoxicity Nephrotoxicity Osteopenia Along with increased risk of cardiovascular disease and MI

How can ICP be increased

Hypercarbia- cerebral vasodilation Endotracheal or oral suctioning COughing Extreme head/ neck flexion HOB less than 30 degrees Increased intra-abd pressure (restrictive clothing) Valsalva maneuver

RA complications secondary osteoporosis

Immobilization caused by arthritis can contribute to development of osteoporosis encourage wt. bearing act

innate immunity

Immunity that is present before exposure and effective from birth. Responds to a broad range of pathogens.

Labs for Lupus

Immunologic tests to diagnose SLE antinuclear antibodies (ANA) produced against ones own DNA Positive titers in 95% of lupus pts 1. SLE prep 2. dsDNA (specific to SLE) 3. ssDNA 4. Anti-DNP 5. SS-A 6. serum complement decreased 7. ESR increased d/t systemic inflammation 8. BUN and Cr increased with kidney involvement 9. UA positive for proteins and RBC's 10. CBC

Left Shift

Increase in immature neutrophils (bands or stabs) that occurs with an acute infection Neutrophils production increased allowing the release of immature neuts that are not capable of phagocytosis

RA vasculitis

Inflammation of arteries can disrupt blood flow causing ishemia skin eyes and brain are most commonly affected Monitor for skin lesions decrease in vision and sx of cognitive dysfunction

SLE complications Pericarditis and Myocarditis

Inflammation of the heart and its vessels and the surrounding sac Monitor for CP, fatigue, arrhythmias and fever Pt Ed Report cp remind to take meds avoid stress

Acute HIV infection

Interval between the appearance of detectable HIV RNA and 1st detection of antibodies Flu-like sx

RA diagnostic procedures Atherocetesis

Is a synovial fluid aspiration with RA increase WBCs and RF present in fluid

SLE complications Lupus nephritis

It cant be managed by immunosuppressants and corticosteroids. can develop CKD, resulting in possible need for transplant Leading cause in SLE death

Infratentorial craniotomy

Keep HOB flat and lay on either side 24-48h to prevent pressure on neck incision site

What diagnostic testing is contraindicated in ICP

Lumbar puncture

What two types of cells are the powerhouse of immune system?

Lymphocytes- 20-40% or 1-4 Neutrophils- 55-70% or 2.5-8 They have the highest count of all WBCs

Mycobacterium avium complex

MAC caused by atypical mycobacteria; opportunistic infection that occurs mainly in people with advanced human immunodeficiency virus infection. Mail=nly affects the lungs can be deadly if spreads to other organs

Risk factors for head injury

MVI or motorcycle Drug/alcohol use Sports injury Assault GSW Falls

Neutorphils

Majority are segmented (mature) with others banded (immature) % circulating 55-70% Increased: Acute bacterial infection myelocytic leukemia Trauma RA Decreased: Sepsis Radiation tx Aplastic anemia Chemo Influenza

Human Leukocyte Antigen (HLA)

Molecules found on all nucleated cells in the body that help the immune system to recognize whether or not a cell is foreign to the body. These antigens are inherited from one's parents. Human leukocyte antigens are used to determine the compatibility of kidneys and pancreases for transplantation from one individual to another. The major groups of HLA antigens are HLA-A, HLA-B, and HLA-DR.

Criteria for SIRS

Must have 2 or more of 4 sx 1. temp above 100.5 or below 96.8 2. HR above 90 3. Resp above 20 or PaCo2 below 32 4. WBC above 12,000 or below 4,000

Meds for SLE NSAIDs

NSAIDS- reduce inflammation contraindicated for pts with impaired kidney function Monitor for NSAID induced hepatitis

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Nausea or vomiting. Cramps or tremors. Depressed mood,memory impairment. Irritability. Personality changes, such as combativeness, confusion, and hallucinations. Seizures. Stupor or coma.

How is HIV for infants different than adults

Need PCR test 2 to confirm. ELISA and OroQuick can give false positive Body has not yet produced antibodies other than those passed from mother Need prophylactic antibiotics starting at 4-6wks old

Neutopenia

Neutrophil count less than 2,000 Viral infect If lower than 1,000 need to be put on precautions

What cells are responsible for immunity and how do they function

Neutrophils lymphocytes (T cells and B cells, NK cells) Monocytes/macrophages WBC

Acute Organ Transplant Rejection

Occurs 1wk-2yrs after surgery Increased dose of immunosupressants needed

COncussion or mild TBI

Occurs after head trauma the results in a change of neuro function and brain damage resolves in 72h

Organ rejection Chronic

Occurs gradually over months to years Gradual return to azotemia, fluid retention, electrolyte imbalance, fatigue

Lines of defense

Physical- skin Chemical- gastric acid. Sterilizes food before entering GI tract Molecular- plasma proteins (phlegm) Cellular- phagocytes

Open head injury

Pose high risk for infection Scalp injuries often result in profuse bleeding d/t the poor vasoconstriction of the blood vessels on scalp

RA labs C- reactive protein

Positive with RA Can be done in place of ESR useful for diagnostic disease or monitoring disease act and for monitoring anti-inflammatory process

(HIV/AIDS) Persistent generalized lymphadenopathy

Possible to remain in this stage for years AIDS develops in most within 7-10yrs Opportunistic infections occur

RA Meds Corticosteroids

Prednisone Strong anti inflammatory meds can be given for acute exacerbations or advanced forms not for long term use d/t sig adverse effects (osteoporosis, hyperglycemia, immunosuppression, cataracts) COnsiderations: Observe for cushingoid changes Monitor wt and BP Pt education: Observe for changes in vision BS Impaired healing Follow rx do not stop abruptly

Meds for SLE Corticosteroids

Prednisone is used for immunosuppression and to decrease inflammation Monitor for fluid retention, HTN and impaird kidney function Do not stop abruptly

Pre-exposure prophylaxis (PrEP)

Prevention method People without HIV take truvida daily to reduce risk of infection Commit to taking drug everyday and having follow ups q3mo

(HIV/AIDS) Period from infection with HIV to development of HIV antibodies

Primary infection or acute HIV infection (aka window period) Part of stage 0

Multiple organ dysfunction syndrome (MODS)

Progressive impairment of two or more organ systems resulting from an uncontrolled inflammatory response to a severe illness or injury.

(HIV/AIDS) Meds

Protease inhibitors- atazanavir, nelfinavir, saquinavir, indinavir. Inhibit and enzyme needed for virus to replicate Integrase inhibitors- raltegravir Antineoplastic meds- interleukin is an immunostimulant that enhances the immune response and reduces production of cancer cells commonly used with Kaposi's sarcoma

interferon

Protein produced by cells in response to being infected by a virus; helps other cells resist the virus.

Why are viral loads often not supressed

Pt. not adhering to tx plan ** nurse must ask pt to describe how they take ART therapy

Immune reconstruction Inflammatory Syndrome (IRIS)

Rapid restoration of organism specific immune response to infections that cause either the deterioration of a treated infection or new presentation of subclinical infections

RA therapeutic procedures Plasmapheresis

Removes circulating antibodies from plasma, decreases attacks on pts tissues May be done for life threatening exacerbations

Subarachnoid screw bolt

Screw into subarachnoid space drilled through skull. -lower infection -easier to place -can only sample CSF cant drain -less accuracy

What increases the risk of developing DIC

Septic shock

Endstage AIDS

Severe immune deficiency Very vulnerable to infections High viral loads CD4+ less than 200 S/S: 1. bacterial, fungal, or viral opportunistic infections 2. fever 3. wasting syndrome 4. fatigue 5. neoplasms 6. cognitive changes

Cervical spine injury

Should always be suspected with head injury. Must be ruled out prior to removing collar

RA therapeutic procedures Joint arthroplasty

Surgical repair and replacement of a joint that has not responded to med therapy

Leukopenia

TOT WBC count less than 4,000 Can indicate drug toxicity, autoimmune disease, bone marrow failure, and some overwhelming infections

Belimumab

TX SLE Side effects NVD H/A Depression Insomnia Infusion rxn Increased risk of infection

HIV-1 nucleic acid amplification test and HIV-1 p24 antigen

Test directly for HIV

HIV/ 1-HIV-2 antigen/ antibody combonation assay

Tests for both antibody and virus for both HIV-1 and HIV-2

Histocompatibility

The immunologic similarity between an organ donor and a transplant recipient

Intraventricular catheter

This is the most common type of ICP monitoring and it is located in the lateral ventricle on the nondominate side, it is very accurate but it must be kept level with the foramen of Monro (middle of the ear) for an accurate reading. You can drain CSF with it. It has a risk for infection, edema, and bleeding

Leukocytosis

Tot WBC count greater than 10,000 Can indicate inflammation, infection, some malignancies, trauma, dehydration, stress, steroid use, thyroid storm Pt. with splenectomy can have persistently increased WBC

Post exposure prophylaxis

Treatment administered to an individual after exposure to an infectious disease to prevent the disease 2-3 meds must be taken for 28d

RA complications Sjögren's syndrome

Triad of sx's Dry eyes, mouth and vagina Provide eye gtts Artificial saliva Vaginal lubricants Provide fluids with meals

Kaposi's sarcoma

Tumors caused by a human herpes virus seen in AIDS, leasons usually appears purplish in color. Appears on legs and face, inside mouth and other parts of the body

RA Meds NSAIDS

Tx begins with NSAIDS Provide analgesic, antipyretic, anti-inflammatory effects Can cause GI distress COnsiderations: Request rx for GI acid lowering agent if GI upset persists Monitor for fluid retention HTN Renal dysfunction Bleeding PT ED: Take with food or full glass of water or milk Avoid alcohol, can increase risk for bleeding

Hydroxycloroquine

Used for suppression of synovitis, fever and fatigue

How do children contract HIV

Vertically- perinatal transmission or via breast milk (mom to baby) Horizontally- transmission via non-sterile needles or sex

What is a better prediction of risk of HIV progression

Viral load better than CD4+ Lower the viral load the longer it takes for AIDS to develop and longer survival time

(HIV/AIDS) Asymptomatic infections/ clinical latency

Viral replication continues within lymphatics but slows down

(HIV/AIDS) Amount of virus in body after initial immune response subsides is referred as

Viral set point Results in equilibrium between HIV levels and the immune response that may be elicited Higher viral set point the poorer the prognosis

RA labs Elevated WBCs

WBCs can be elevated during exacerbation and decrease in RBC d/t anemia

Contusion

When the brain is bruised and the pt has a period of unconsciousness associated with stupor and or confusion

Diffuse axonal injury

Widespread injury to the brain that results in coma and is seen in severe head trauma

RA meds Disease modifying antirheumatic drugs (DMARDS)

Work in a variety of ways to slow progression of RA and suppress immune syst response to RA that cause pain and inflammation Antimalarial- hydroxychloroquine Antibiotic- minocycline SUlfonamide- sulfazine Biologic response modifier- etanercept, infliximab, adalimumab, chelator penicillamine Cytotoxic meds- methotrexate, lefludomide, cyclophosphamide, asathioprine

Rheumatoid Arthritis

a chronic autoimmune disorder in which the joints and some organs of other body systems are attacked

Epidural or subdural sensor

a fiber optic sensor put into epidural space via burr hole. Uses light sensors to measure ICP. Does not penetrate dura.

AIDS (acquired immune deficiency syndrome)

a life-threatening, sexually transmitted infection caused by the human immunodeficiency virus (HIV). AIDS depletes the immune system, leaving the person vulnerable to infections.

Western blot

a test that detects HIV antibodies and confirms the results of earlier ELISA tests

Complications of ICP

brain stem herniation, diabetes insipidus, SIADH Inadequate cerebral perfusion

SLE meds

corticosteroids Immunosuppressant agents- methotrexate and azathioprine used to suppress the immune response MOnitor for: toxic effects bone marrow suppression increased liver enzymes Encourage frequent eye exams

Plethysmography

determining the changes in volume of an organ part or body

ELISA

enzyme-linked immunosorbent assay (test to detect anti-HIV antibodies)

Decerebrate

extension away from body, pronation of arms/legs

Decorticate

flexion into body,

synergic graft (isograft)

from clone or identical twin

HIV

human immunodeficiency virus

Skull fractures

linear, depressed, basilar Nurse shluld be alert for CSF leakage. Know how it happened

Mannitol

osmotic diuretic used to treat cerebral edema when used for increased ICP. Draws fluid from brain into blood Considerations Admin via IV to treat acute cerebral edema Insert indwelling foley to monitor output MOnitor urine osmolarity MOnitor serum electrolyte and osmolarity closely

Barbiturates

patient may be placed in coma to decrease cellular metabolic demand until ICP can be decreased Common meds incl: phenobarbital thiopental Makes the ability to assess neuro hard DOse is adjusted to keep pt in coma mech vent, cardiac and hemodynamic monitoring and ICP monitoring req

Antivirals

prevent replication of viruses within host cells

septic shock

sepsis and uncontrollable decreased blood pressure Sepsis + hypotension BP does not go up after fluid replacement

Cushing's Triad

three classic signs—bradycardia, hypertension, and bradypnea—seen with pressure on the medulla as a result of brain stem herniation

allograft

transplantation of healthy tissue from one person to another person; also called homograft

autograft

transplantation of healthy tissue from one site to another site in the same individual

cell-mediated immunity

type of immunity produced by T cells that attack infected or abnormal body cells

Wasting Syndrome

weight loss of 10 % of body wt, decrease in muscular strength, appetite, and mental activity; associated with AIDS. Diarrhea weakness and fever for more than 30 days

Common s/s of HIV/AIDS in child/infant

1. FTT 2. recurrent bacterial infections 3. opportunistic infections 4. chronic/recurrent diarrhea 5. developmental delay 6. prolonged candidiasis

(HIV/AIDS) Nursing care

1. assess risk factors 2. monitor I&O 3. daily wts 4. monitor nutritional status 5. monitor electrolytes 6. assess skin integrity 7. pain 8. monitor vs esp. temp 9. lung sounds 10. neuro status 11. O2 prn 12. analgesia prn 13. skin care

(SLE) Pt. education

1. avoid UV and prolonged exposure to sun 2. use mild protein shampoo and avoid harsh hair treatments 3. use steroid creams for skin rash 4. report evidence of infections 5. avoid crowds and people who are sick

RA labs Antinuclear antibody titer (ANA)

Antibody produced against ones own DNA + ANA associated with RA (norm is -) Other autoimmune disorders can increase

Acyclovir (Zovirax)

Antiretrovirals. Uses: genital herpes, shingles, HIV. Precautions: administer with food, increase fluid intake, and begin therapy with first onset of symptoms.

(HIV/AIDS) Stage 2

Asymptomatic up to 10yrs Defining conditions- none CD4+ T-lymphocytes count 200-499 14-28%

GCS scoring

Best 15 13 or higher- minor head trauma 9-12- moderate heat trauma less than 8- severe head trauma, intubation needed

What makes up the immune system

Bone marrow- RBC, WBC and platelets produced and rapidly grow Lymph nodes- WBC filters and stores (reason why lymph nodes swell with illness) Lymph vessels- carry WBC t/o body Tonsils- Produce antibodies and a small amt of WBCs Spleen- filters blood, RBC graveyard and convert to bilirubin, makes lymphocytes, stores blood cells. if no spleed increased risk of infection Thymus- T cell maturation site

Manifestations of increased ICP in infants

Bulging fontanel Cranial suture separation increased head circumference High pitched cry

Head injury diagnostic procedures

Cervical spine films to dx C-spine injury CT/MRI Calculation of cerebral perfusion using ICP monitor

Manifestations of increased ICP

Change in LOC, headache, papilledema, vomiting (projectile), increased PP, decreased pulse and resp, seizures, motor and sensory changes

(HIV/AIDS) S/s of acute infection

Flu-like sx for 2-4wks wt. loss low grade fever fatigue sore throat night sweats myalgia Ability to spread virus is highest in this stage d/t large amounts of HIV being produced and CD4+ drops

Signs and symptoms of increased ICP

Severe H/A LOC changes Restlessness Irritability Dilated, pinpoint, unilateral pupils Slowness to react Changes in breathing patterns Decreased motor functions Abnormal posturing Seizures Cushing's Triad

Disseminated Intravascular Coagulation (DIC)

abnormal blood clotting in small vessels throughout the body that cuts off the supply of oxygen to distal tissues, resulting in damage to body organs

What is SIADH?

abnormal stimulation to the hypothalamic area of the brain, causing excessive secretion of antidiuretic hormone (Vasopressin)

pneumocytis pneumonia (PCP)

an opportunistic infection caused by the yeast-like fungus Pneumocystis carinii AIDS SX: Dyspnea Fever Non-productive cough Chest discomfort Tachypnea Tachycardia

What do B cells produce

antibodies and memory cells Produced in bone marrow Antibodies bind to antigens to prevent replication and marks cells for destruction

diabetes insipidus

antidiuretic hormone is not secreted adequately, or the kidney is resistant to its effect

Rheumatoid Factor

blood test to detect the presence of rheumatoid factor, a substance present in patients with rheumatoid arthritis Level is 1:40-1:60 expected reference range is less than 1:20 Other autoimmune disease can affect this

CSF leakage

can come from nose or ears and can indicate basilar skull fx Test for presence of "Halo" indicated by clear yellow tinted ring surrounding a drop of blood placed on gauze