immune/renal

TB in HIV pt. Class 3 tuberculosis is a clinically active and contagious disease?

Class 3 tuberculosis is a clinically active and contagious disease; -diagnosed either with positive bacteriological studies, or with both a significant reaction to a TB skin test and clinical or x-ray evidence of current disease. -Tuberculosis is the leading cause of mortality in clients with HIV infection. -usually treated on an outpatient basis, and this does not change based on the client's HIV status. -Although clients with HIV are more likely to develop active tuberculosis, they are not more likely to develop multidrug resistant tuberculosis. -Immune-compromised clients, such as individuals who are HIV positive, are less likely to have high fever because of a diminished inflammatory and immune response to infection.

Lapatinib-

Clients with advanced breast cancer have an overexpressed HER-2. Lapatinib inhibits epidermal growth factor-r (EGFR)-tyrosine kinase (TK) and binds HER-2.

What should you teach patient to expect after getting a vaccine?

Teaching: flu-like symptoms common, slight fever, redness in the area, edema. Bad= allergic reaction, anaphylactic reaction. When to schedule boosters

RA is an autoimmune disorder identified by the presence of antinuclear antibodies-

generally affects the joints of the wrist -metacarpophalangeal joints -proximal interphalangeal joints -elbow; glenohumeral joints; cervical spine; and hip, knee, ankle, tarsal, and metatarsophalangeal joints bilaterally. RA involves inflammation of the joints bilaterally. Osteoarthritis involves degeneration of the joints. Obesity is a risk factor for osteoarthritis. Osteoarthritis asymmetrically affects weight-bearing joints and the hands.

glomerulonephritis:

The smoky urine and the stated symptoms would lead the nurse to suspect glomerulonephritis, -usually occurs after a recent streptococcal infection.

Sirolimus is an antiproliferative medication that may cause adverse immunosuppressive effects such as

thrombocytopenia and leucopenia.

When giving an immunization, what should you keep on hand and how long should the patient be monitored before leaving?

· Keep epinephrine available, (1:1000 SC) · Have patients wait 20-30 minutes prior to leaving to assure no immediate reaction.

When should immunizations NOT be given?

· No influenza vaccine if allergic to eggs, tetanus antitoxin · Withhold if respiratory infection · No polio vaccine, MMR, or live virus vaccines to immunosuppressed patients. · No MMR, pneumococcal or varicella to pregnant women · No simultaneous live attenuated virus, vaccines and passive immunization (gamma globulin) passive antibodies interfere with live attenuated virus

Cardiac dysrhythmias-

- are associated with increases or decreases in potassium and calcium. An increase in body temperature reflects a possible infection, not an electrolyte imbalance.

Tacrolimus and cyclosporine-

- are calcineurin inhibitors that may cause adverse effects such as hypertension, nephrotoxicity, and gingival hyperplasia. -tx for transplant rejection.

Azathioprine is an immunosuppressive medication prescribed to clients after transplant surgery to prevent organ rejection. However, azathioprine is known to cause ...

- bone marrow suppression, which results in - anemia -thrombocytopenia. The nurse anticipates that the client is receiving azathioprine.

When there is edema or fluid overload, the accumulating body fluid will cause a-

- decrease in the specific gravity of the urine.

A client with diabetes insipidus excretes a large amount of dilute urine; dilute urine will have a..

- decreased specific gravity. Polyuria is excretion of large amounts of urine, making the specific gravity low.

An elevated temperature can lead to-

- dehydration and an increased urine specific gravity.

Scheduled immunizations for preschool children include-

- diphtheria, tetanus, and pertussis (DTaP); -inactivated polio vaccine (IPV); - measles, mumps, and rubella (MMR) at 4 to 6 years (usually required by law). Hepatitis immunization is given in three doses between birth and 9 months; the tetanus/diphtheria vaccine is given at 7 to 10 years of age, with subsequent doses based on the age when the vaccine was first received. Hepatitis B immunization is not required once immunity is established; administration of a subsequent dose of tetanus/diphtheria vaccine is based on the age when the first dose is received. The Haemophilus influenzae type B (Hib) vaccine is given at 12 to 15 months.

Psoriasis-

- dry, scaly lesions that occur most often on the elbows, knees, scalp, and torso.

Tacrolimus is known to cause...

- hyperkalemia -hypertension.

Azathioprine and mycophenolate mofetil are administered to...

- inhibit purine synthesis and suppress cell-mediated and humoral immunity.

Methylprednisolone-

- is a corticosteroid that inhibits cytokine production.

Moniliasis-

- is a fungal infection caused by Candida albicans. -Nystatin is an antifungal medication used to treat fungal infections. -Nystatin is the medication used to treat clients with moniliasis.

Basiliximab-

- is a monoclonal antibody that may cause adverse side effects related to the gastrointestinal system.

Erlotinib-

- is an EFGR-TK inhibitor prescribed to treat non-small cell lung cancer and advanced pancreatic cancer.

Tertiary syphilis, also known as "late syphilis,"-

- is the final stage of syphilis. -At this stage, the sexually transmitted infection is a slowly progressive inflammatory disease, potentially involving many organs such as the skin, brain, and heart.

Primary syphilis-

- is the stage of initial infection and is characterized by the presence of a chancre, a painless lesion at the site of infection.

Isoniazid-

- is used as first-line medication therapy for tuberculosis. - take the medication on an empty stomach.

In atopic dermatitis, the client has...

- lichenification with scaling and excoriation, which causes extreme itching.

Fibrotic changes-

- occur with type III immune complex reactions.

Latent syphilis-

- occurs after the secondary stage and before the late stage of syphilis. -no clinical signs and symptoms.

Which inactivate vaccines are safe for a child receiving prednisone?

- pertussis (whooping cough) vaccine is made from inactivated toxins. -inactivated poliovirus vaccine; it is not a live attenuated virus vaccine. -NOT Tetanus immune globulin is an antitoxin that provides transient passive immunity; tetanus toxoid is contraindicated. Live attenuated virus vaccines are contraindicated for a child on prednisone. Both the rubeola (measles) and the varicella (chickenpox) vaccines are made live attenuated viruses.

The diagnostic feature of contact dermatitis is...

- the presence of localized eczematous eruptions with well-defined and geometric margins. -The diagnostic feature of medication eruption is the presence of bright-red erythematous macules and papules in large areas.

strategies for vaccinating children...

- topical anesthesia during vaccination -Injecting the most painful vaccine last -held upright during vaccination to reduce limb movement and simplify the procedure. -Intramuscular injections should be administered rapidly, without prior aspiration, to reduce the time required for the procedure. -Administering acetaminophen or ibuprofen after a vaccination does not significantly reduce the incidence of fever or pain but does diminish the immune response to the vaccine.

Cachexia:

-(extreme body wasting and malnutrition) may occur during treatment or with advanced cancer.

associated with scarlet fever-

-A rash on the hands and feet.

trench mouth tx:

-A topical application of antibacterial and mouth irrigations with chlorhexidine treats those clients.

What causes anemia and thrombocytopenia?

-Bone marrow dysfunction from cancer

Lyme Disease treatment: pg. 359

-Doxycycline or amoxicillin is prescribed during this uncomplicated stage for 14-21 days. -Erythromycin can be used for patients who are allergic to penicillin. , or cefuroxime have all been shown to have equivalent efficacy for treatment of Lyme disease.

Lyme Disease early and localized stage I symptoms

-Erythema migrans (round/oval, flat/slightly raised rash often in a bull's eye pattern. -Pain/stiffness in muscles/joints -Symptoms being within 3-30 days of tick bite, most present in 7-14 days. -Doxycycline or amoxicillin is prescribed during this uncomplicated stage for 14-21 days.

scleroderma-

-Firm skin fixed to tissue -advanced stage the client has the appearance of a living mummy.

Innate immunity or natural immunity-

-First line of protection -any natural protective feature of a human Intact skin Ciliary movement Gastric acid Tears-washing action Zinc in prostatic fluid Sweat Urine - washing actions

Lyme Disease Stage II (early disseminated stage) treatment:

-For severe disease, IV antibiotics (e.g., ceftriaxone or cefotaxime) are given for at least 30 days.

occurs in polyarteritis nodosa:

-Inflammation of small arteries -collagen disease affecting the arteries and nervous system.

What should patients with chemotherapy-induced neuropathy (CIPN) report to HCP? pg. 377

-Loss of sensation, especially in the lower extremities. -Symptoms include: numbness/tingling, neuropathic pain, and changes in gait and balance.

Lyme Disease Stage II (early disseminated stage) symptoms:

-Occurs 2-12 weeks after the tick bite. -Patient may devolop carditis with dysrhythmias, dyspnea, dizziness, or palpitations and CNS disorders such as meningitis, facial paralysis (often misdiagnosed as Bell palsy), and peripheral neuritis. -For severe disease, IV antibiotics (e.g., ceftriaxone or cefotaxime) are given for at least 30 days.

What does bone metastasis cause?

-Pain -Fractures -Spinal cord compression (SCC) -Hypercalcemia each of which reduces mobility. ***SCC and hypercalcemia are oncologic emergencies***

(HIV)-associated Pneumocystis jiroveci pneumonia tx drug:

-Pentamidine isethionate

What cardiac conditions can happen from radiation?

-Pericarditis -Coronary artery disease -Myocardia dysfunction -Valvular heart disease Higher risk for heart disease has been noted in patients with classic risk factors for cardiac problems such as HTN, smoking, and hypercholesterolemia. chemotherapy agents can also contribute to cardiac dysfunction through loss of myocardial muscle mass, leading to heart failure. these late effects of therapy are sometimes reversible but may be permanenet.

When monoclonal antibodies are administered, a flulike syndrome occurs during the first few days of treatment because of cytokine release. s/s and tx:

-Rigors -headache -myalgia -gastrointestinal disturbances can be experienced. Acetaminophen, diphenhydramine, and methylprednisolone are administered to reduce these effects. Sirolimus and cyclosporine are used in combination to reduce the graft loss that occurs in transplant recipients.

What would be considered an oncologic emergency?

-SCC -Hypercalcemia -Superior vena cava (SVC) syndrome: results from compression of this vessel

Diagnosing: to assess the patient's immune status-

-Serum protein (normal 6-8 g/dL) -Protein electrophoresis: analyzes protein function (albumin, gamma globulin), used to assess immune function. Antibody testing Skin testing (TB skin test positive = redness, induration, t-cell formation (cell mediated immunity)) Assesses cell mediated immunity e.g. PPD

associated with rheumatic fever-

-Shoulder and knee pain

Hypocalcemia

-Spasm of the facial muscles after a tap over the facial nerve (Chvostek sign) indicates.

rifampin-

-Staining of bodily fluids -additional method of contraception is required

Mycophenolate is a lymphocyte-specific inhibitor of purine synthesis with suppressive effects on both T and B lymphocytes. -

-Tacrolimus and cyclosporine are coadministered with mycophenolate as an additive effect because the medications act later in the lymphocyte activation pathway by a different mechanism, thus reducing late graft loss. Administering acetaminophen, diphenhydramine, and methylprednisolone reduces the expected adverse effects such as headache, myalgia, and various gastrointestinal disturbances occurring with monoclonal antibodies such as muromonab-CD3.

Which vaccines are recommended during pregnancy?

-Tdap boost during 3rd trimester -covid/flu

Prevention and early detection of Lyme disease: pg. 360

-Wait 4-6 weeks after being bitten by a tick before being tested for Lyme disease (testing before this time is not reliable). -Report symptoms such as a rash or influenza-like illness to your HCP immediately

occurs in children who have type 1 diabetes-

-Weight loss generally

An immediate reaction is-

-a type I hypersensitive reaction that includes -allergic asthma -hay fever -anaphylaxis.

type III reaction: immune-complex:

-antigen: extracellular fungal, viral, bacterial -IgG, IgM -ex: SLE, RA, acute glomerulonephritis -erythema and edema in 3-8 hr

A cytotoxic reaction is a type II hypersensitivity reaction that includes-

-autoimmune hemolytic anemia -Goodpasture syndrome -myasthenia gravis.

natural passive immunity-

-baby through placenta/breast milk -neonate initially protected against MMR if mother immunized. -offers temporary protection

The normal lymphocyte count

-between 5000 and 10,000 cells/mm3. -A client with AIDS is leukopenic and has a lymphocyte count of less than 3500 cells/mm3.

SLE:

-butterfly rash -Polyarthritis with joint changes similar to RA

Pentamidine isethionate can cause-

-can cause either hypoglycemia or hyperglycemia even after therapy is discontinued, and BG levels should be monitored. -Hypotension -Hyperkalemia -Hypocalcemia -tx for (HIV)-associated Pneumocystis jiroveci pneumonia

Histamine-

-causes itching or pruritus, erythema, and nasal and conjunctival mucus secretion..

tx for gonorrhea?

-ceftriaxone Many female clients who contract gonorrhea are asymptomatic or overlook the minor symptoms, making possible for the bacteria to remain a source of infection. The infection can be treated with one intramuscular injection of ceftriaxone. There is no evidence to support the medication to treat this infection has many adverse effects.

Type II reaction: cytotoxic

-cell surface of RBCs and cell basement membrane -IgG, IgM -complement lysis, macrophages in tissues -ex: transfusion reaction, good pasture syndrom, thrombocytopenic purpura, graves disease

hyponatriemia-

-confusion, lethargy, diarrhea, and seizures.

Clients with AIDS experience-

-delusions -memory loss -hopelessness -paranoid thinking. -decrease in energy.

pyrazinamide-

-drink at least 8 ounces of water with the medication

The initial action for anaphylaxis would be...

-epinephrine to correct bronchoconstriction and arterial dilation. -Normal saline is given to correct hypotension caused by arterial dilation - Use of steroids methylprednisolone decreases the inappropriate inflammatory response that causes symptoms of anaphylaxis. -Administration of high levels of oxygen is needed to correct hypoxemia but will not be effective until bronchoconstriction is corrected through epinephrine

s/s of anemia

-fatigue -SOB -tachycardia -may be caused by the disease or by cancer treatment, especially chemotherapy

Rifampin-

-first-line medication in the treatment of TB -report any yellow tinge to the skin because this may be a sign of liver toxicity or failure. - Staining of bodily fluids such as tears, urine, and sweat, is commonly associated with rifampin, so warning the clients who use contact lenses of staining side effects will be beneficial. -The nurse should instruct the client to report any increased tendency to bruise or bleed immediately, because this may indicate liver toxicity or damage. A reddish orange tinge to secretions is common with rifampin and not harmful, so the client does not need to report the color change.

A major side effect of monoclonal antibodies such as basiliximab and daclizumab is ...

-gastrointestinal disturbances.

Antitubercular medications- isoniazid (INH) rifampin (RIF):

-hepatotoxic -liver function should be assessed before initiation of pharmacological therapy.

Allergic rhinitis and anaphylactic shock are examples of ...

-humoral immunity that are mediated by antibodies released by B lymphocytes.

S/S of thrombocytopenia

-impaired clotting -increased risk for bleeding -may be caused by the disease or by cancer treatment, especially chemotherapy

Adverse Affects of neurotoxic chemotherapy agents:

-injure peripheral nerves, leading to peripheral neuropathy with reduced sensory perception.

Myasthenia gravis-

-is a rare chronic autoimmune disease leading to neuromuscular disease, producing -progressive muscle weakness -diplopia (double vision) -fatigue -difficulty chewing

Serum sickness-

-is a type III immune complex-mediated reaction. -manifests with an elevated body temperature -severe joint pain -rashes on the limbs -enlarged lymph nodes.

Cyclophosphamide -

-is administered to treat cancers, autoimmune disorders, and amyloidosis.

Crohn disease-

-is an autoimmune disease that affects the gastrointestinal tract, producing -diarrhea -low-grade fever -weight loss -abdominal pain. .

Sjögren syndrome-

-is an autoimmune disorder associated with -dry eyes -dry mucous membranes located in the nose, mouth, and vagina

Goodpasture syndrome-

-is an autoimmune disorder that may lead to kidney problems such as glomerulonephritis, as well as destruction of the collagen proteins in the lungs. A client with Goodpasture syndrome and subsequent glomerulonephritis may have -SOB -hemoptysis -generalized edema -HTN -decreased urine output -weight gain -tachycardia.

In nonspecific eczematous dermatitis lesions...

-lesions evolve from vesicles to weeping papules and plaques.

acute glomerulonephritis tx:

-low protein diet - low sodium diet -fluid restrictions. The goal is to minimize unnecessary fluid intake.

Mycophenolate-

-may cause adverse effects such as leukopenia, thrombocytopenia, and nausea.

measles immunization should be given when?

-measles immunization should be given between 12 and 15 months.

artificial passive immunity-

-occurs via a specific transfusion such as immunoglobulins. ex: Rabies, tetanus, snake bite, covid, gamma globulin injection following Hep A exposure

artificial active immunity-

-occurs via vaccination or immunization pg. 40 Ex: MMR, Polio, DPT, Hep B vaccines

Natural active immunity-

-occurs when an antigen enters the body and the body creates antibodies to fight off the antigen. i.e. Chickenpox

A delayed reaction is a type IV hypersensitivity reaction that may include-

-poison ivy skin rashes -graft rejection -sarcoidosis

Treatment of non-Hodgkin lymphoma includes administration of ..

-rituximab and tositumomab.

Which vaccines can a child NOT get while taking prednisone?

-rubeola (measles) -varicella (chickenpox) vaccines are made live attenuated viruses -NOT Tetanus immune globulin is an antitoxin that provides transient passive immunity; tetanus toxoid is contraindicated. Live attenuated virus vaccines are contraindicated for a child on prednisone. Both the rubeola (measles) and the varicella (chickenpox) vaccines are made live attenuated viruses.

cancer patient GI nursing interventions: pg. 377

-smaller, frequent meals, general healthy eating recommendations, or help to facilitate enteral tube or parenteral nutrition if warranted. -abdominal tumors in GI may reduce ability to absorb nutrition and eliminate wastes. This needs to be addressed promptly to avoid bowel obstruction. -tumors that invade the liver could lead to liver failure or death because of its important metabolic functions.

type IV reaction: delayed hypersensitivity:

antigen: intracellular/extracellular -no antibody involvement -mediators of injury: cytokines and T cytotoxic cells -ex: contact dermatitis (i.e. poison ivy) -erythema and edema in 24-48 hr (i.e. TB test)

Lyme Disease Pathophysiology

caused by spirochete Borrelia burgdorferi (common in rodents) and spread to humans through bite of an infected deer tick (Ixodes) or "black-legged tick" affected cells start to reproduce in the skin, lymphoid tissues, meninges, neurons, pericardium, myocardium, and joint tissue.

What adverse events should be reported after getting a vaccine?

***Fever, injection-site hypersensitivity, unspecified rash, and injection side edema should be reported to the Vaccine Adverse Event Reporting System (VAERS)***

Measles:

- Macules are erythematous flat spots on the skin as seen in...

examples of cell-mediated immunity-

- TB -graft rejection - contact dermatitis -fungal infections

Type I reaction

pollen, food drugs, dust -IgE -ex: allergic rhinitis, asthma, atopic dermatitis, urticaria, angioedema -skin test: wheal and flare