S3 U4 4.4

neonate normal temp

97.7-99.5 36.5-37.5

Which disorders have an autoimmune basis? Select all that apply. A.Type 2 diabetes B.Systemic lupus erythematosus C. Hypothyroidism D.Rheumatoid arthritis E.Irritable bowel disease F.Ulcerative colitis

B D E F A- only type 1

what is more common in kids with lupus than adults

HA, mood disorders, cognitive disorders, seizures

RA and SLE are what type of hypersensitivity reactions

III or immune complex reaction

What is lupus?

Inflammatory autoimmune disorder, affects multiple organ systems

risk for SLE

Women 10x more than men. Typical onset 20-40, but does occur in children In the US, there is a higher incidence of the disease in those of African, Hispanic, Native American, and Asian descent. flares highly have to do with UV radiation - avoid sun

A nurse plans to include the parents of a patient with anorexia in therapy sessions along with the patient. What fact should the nurse remember about parents of children with anorexia? A.They tend to overprotect their children. B.They usually have a history of substance abuse. C.They maintain emotional distance from their children. D.They alternate between loving and rejecting their children.

a

Which behavior is an early sign of an abusive personality? Select all that apply. One, some, or all responses may be correct. 1 Verbal abusive 2 Jealous, controlling 3 Enforces rigid sex roles 4 Hypersensitive, easily insulted 5 Isolates partner from family and friends 6 Makes others responsible for their feelings

all

management for SLE

antiinflammatory topical cortisone - corticosteroid; reduces inflammation and promotes fading; raises risk for infection acetaminophen and NSAIDs for joint and muscle pain hydroxychloroquine - decrease absorption of UV light decreasing skin lesions (frequent eye exams before starting and q6mo belimumab - no live vaccines for 30 days before treatment, increase r/o infection; targets b cells who are making the bad antibodies but kills a lot of b cells it does not need to; immunosuppressant chronic steroid therapy for systemic disease methotrexate and azathioprine for renal or CNS; immunosuppressants

Which cell types associated with the inflammatory response participate in phagocytosis? (cells that gobble up bacteria and things that are not supposed to be in the body) A.Neutrophils and eosinophils B.Macrophages and neutrophils C.Macrophages and eosinophils D.Eosinophils and basophils

b macrophages = monocytes

A patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I hate the way I look! I never go anyplace except here to the health clinic." An appropriate nursing diagnosis for the patient is: A: Activity intolerance R/T fatigue and inactivity B. Impaired skin integrity R/T itching and skin sloughing C. Social isolation R/T embarrassment about the effects of SLE D. Impaired social interaction R/T lack of social skills

c

The nurse assesses a patient who sustained a scalding burn to the left dorsal surface of the hand that occurred one day ago. There is redness, swelling, and warmth. The patient has pain, decreased fine motor movements, and limited range of motion. What do these findings indicate? A.Stage II of inflammation B.Serious infection that should be reported C.Cardinal signs of inflammation D.Probable inappropriate first-aid treatment

c

triggers for SLE flare ups

sun estrogen harsh soaps and perfumes infectious illnesses procainamide, hydralizine, isoniazid

education for SLE

●Cleanse skin with mild soap and pat dry, do not rub ●Avoid drying products like power or rubbing alcohol ●Apply lotion liberally to dry skin ●Avoid direct sunlight, if in sun use sunscreen and cover body with long sleeves, pants and large brimmed hat ●Inspect skin daily for open areas or rash ●Give special attention to hair d/t high risk of alopecia Medication Education: Avoid large crowds and sick people if on steroid or immunosuppressants. Take meds early in the morning before breakfast when corticosteroid levels are the lowest

things that are effected by SLE

●Skin - really like skin; they clump and Stick to the wall or epithelium of vessels and organs. ●Joints ●Kidneys ●Heart ●Blood cells

A child died from injuries sustained in an explosion at school. Which response will the emergency department nurse give to the parents who ask to see their child? 1 "You can see your child now and spend time with her." 2 "It would be best to wait until you feel calmer." 3 "Please wait for the health care provider to talk to you." 4 "Seeing your child at the funeral home is easier."

1 Seeing their child as soon as possible will validate the death for them and trigger the grieving process. Making the parents wait will increase anxiety and delay and prolong the grieving process. The parents may want to talk with the health care provider later, but their most immediate need is to see their child. Asking the parents to wait and see the child in the funeral home is easier for the hospital staff, but delaying does not help the parents.

What is a Type III Hypersensitivity or Immune Complex Reaction?

1.Body cell bursts and releases innards (particularly parts of nucleus) 2.Body's immune system labels nucleus shrapnel as antigens 3.B cells decide to make antibodies against these "nuclear antigens" 4.The antibodies are called "antinuclear antibodies" which 5.Happens to be one of the labs you need to know that is usually elevated with Lupus

A 2-year-old child is admitted with multiple fractures and bruises, and abuse is suspected. Which nursing assessment findings support this suspicion? Select all that apply. One, some, or all responses may be correct. 1 Bedwetting 2 Thumb-sucking 3 Difficulty consoling 4 Underdevelopment for age 5 Demands for physical closeness

34 Abused children may be difficult to console because they have not had positive past interpersonal experiences. Failure to thrive is often seen in abused children. It results from emotional stress as well as from neglect of physical needs. The task of nighttime bladder training may not be completed until 4 or 5 years of age, and sometimes even later. Thumb-sucking is not noteworthy because many children, not just those who are abused, continue to suck their thumbs for several years. Abused children do not seek physical closeness because their needs for comfort have not been met in the past.

Which defense mechanism is most often used by parents who abuse an infant or toddler? 1 Identification 2 Denial 3 Rationalization 4 Displacement

4 Displacement is a defense mechanism in which one's pent-up feelings toward others who are a threat are discharged on others who are less threatening. Identification is the unconscious wish to be like another person. Denial is ignoring, avoiding, or refusing to recognize painful realities. Rationalization is making acceptable or plausible excuses for an undesirable behavior.

While assessing a neonate's temperature, the nurse observes a drop in the body temperature. Which would be the reason for this temperature drop? 1 Increased basal metabolic rate 2 Decreased involuntary shivering 3 Increased voluntary movements 4 Decreased nonshivering thermogenesis

4 Neonates are susceptible to heat loss or cold stress. Nonshivering thermogenesis is a natural mechanism of heat production that occurs to minimize heat loss in a neonate. This mechanism's failure may lead to a drop in body temperature. The basal metabolic rate (BMR) accounts for heat production; an increased BMR may raise the body temperature. Shivering is an involuntary movement that produces heat, which may not be seen in neonates. Voluntary movements cause increases in body temperature.

The nurse is aware that which of the following is a life-threatening complication of bulimia nervosa? A.Serum calcium 10.1 mg/dl B.Heart rate 56 bpm C.Serum potassium 2.9 mEq/L D.Respiratory rate 16 breaths/minute

c

What is the treatment team's priority In planning the care of a client with an eating disorder? a.Preventing the patient from performing any muscle-building exercises b.Keeping the patient on bed rest until she attains a specified weight c.Meeting daily to discuss manipulation and countertransference d.Monitoring the patient's vital signs and weight daily

c

Which management strategy does the nurse expect when caring for a patient with an autoimmune disease? A.Antibiotic drugs B.Antihistamine drugs C.Anti-inflammatory drugs D.Bronchodilator drugs

c

Which primary intervention would the nurse implement for a client who is given an as-needed medication and confined to seclusion to protect the other clients? 1 Continue intensive nursing interactions. 2 Evaluate the client's progress toward self-control. 3 Determine whether any staff member has been injured. 4 Observe the client for side effects of the medication given.

2 The primary intervention in this situation is to evaluate the client's progress toward self-control. For the safety of the client and everyone on the unit, improvement in a client's level of self-control is essential before the degree of restraint and seclusion is progressively reduced. Continuing intensive interaction at this time would not be productive and could cause the client's behavior to escalate.

Which of the following would a nurse most likely observe in a patient with anorexia? Select all that apply. A.Preoccupation with food B.Amenorrhea C.Body weight w/in normal range D.Lanugo E.Bradycardia F.Hypertension G.Hyperthermia

a b d e

The nurse is admitting a patient who is diagnosed with new onset Type 1 Diabetes. While performing the initial physical assessment and nursing history, which of the following s/s would the nurse expect to find? Select all that apply. A.Polyuria B.Polydipsia C.Weight gain D.Irritability E.Diaphoresis F.Abdominal pain G.Tachycardia

a and b Weight loss not gain Irritability and diaphoresis are more hypoglycemia Abdominal pain can be a s/s, if they have vomited enough Tachycardia is a s/s of hypoglycemia

In which conditions is the inflammatory response present? Select all that apply. A.Sprain injuries to joints B.Appendicitis C.Hypothyroidism D.Myocardial infarction E.Contact dermatitis F.Allergic rhinitis

itis = inflammation A B D E F

Diet for lupus

low sodium and protein

labs for lupus

●Skin biopsy (scraping) for discoid type ●ANA (antinuclear antibodies) - B cells make them but they are bad ●Anticardiolipin (false-positive for syphilis) normally positive ●Rheumatoid factor - looking for antibodies B cells make against their own cells ●Erythrocyte sedimentation rate & CRP - tells us there is inflammation; shows if it is getting worse or better ●Specific tests like anti-Smith ●CBC - elevated WBC (body thinks it is under attack) or decreased WBC ●BUN/Creat - elevated with kidney damage ●Cardiac enzymes - shows the lining is being attacked none are definitive and diagnosis is s/s and rule out other things

Which questions would the nurse ask the parents of a child who is suspected of being bullied at school? Select all that apply. One, some, or all responses may be correct. 1 "Does your child exhibit any anxiety?" 2 "Has your child tried to harm himself or herself?" 3 "How is your child's academic performance?" 4 "Has your child committed any criminal acts?" 5 "Does your child participate socially in school?"

123 A child that is being bullied is at increased risk for anxiety, self-harm behaviors, and poor academic performance. Future problems of bullies include a higher risk of antisocial behavior and participation in criminal behaviors.

Which traits would be expected when a client is in the reorganization phase of rape-trauma syndrome? Select all that apply. One, some, or all responses may be correct. 1 Eating disorders 2 Blaming self for the incident 3 Fear of being alone or in a crowd 4 Not being able to stop talking about it 5 Fleeing the job or home or making other radical changes 6 Having a calm demeanor and seeming to act as if nothing happened

13 A client in the reorganization phase of rape-trauma syndrome might develop an eating disorder or express fear of being alone or in a crowd. In the acute period of disorganization, clients may blame themselves for the incident. A client might not be able to stop talking about the event during the outward adjustment phase of rape-trauma syndrome. Victims sometimes flee their job or home or make other radical changes during the acute phase of disorganization. At other times, a victim will have a calm demeanor and seem to act as if nothing happened during the disorganization phase of rape-trauma syndrome.

A client has been robbed, beaten, and sexually assaulted. The primary health care provider prescribes 0.25 mg of alprazolam for agitation. The nurse will administer this medication when which event occurs? 1 The client's crying increases. 2 The client requests something to calm her. 3 The nurse determines a need to reduce her anxiety. 4 The primary health care provider is getting ready to perform a vaginal examination.

2 Because a sexual assault is a threat to the sense of control over one's life, some control should be given back to the client as soon as possible. Crying is a typical way to express emotions; the client should be told that medication is available if desired. The nurse determining a need to reduce the client's anxiety or administering the medication when the primary health care provider is getting ready to do a vaginal examination takes control away from the client. She may view these actions as an additional assault on the body, which increases feelings of vulnerability and anxiety and does not restore control.

Which description BEST characterizes autoimmune disease? A.Cell-mediated immune response that does not cause an antibody-mediated response B.The synthetic substances used to stimulate or suppress the response of the immune system C.Inappropriate immune response to one's own healthy cells and tissues D.An altered immune response that results in an immediate hypersensitivity reaction

c

Which outcome statement reflects one of the goals of drug therapy for autoimmune disease? A.The patient lists steps to take in case of a hypersensitivity response. B.The patient demonstrates a respiratory rate within the normal range C.The patient verbalizes feelings of reduced anxiety and apprehension. D.The patient retains enough immunity to prevent serious infections.

d

Which laboratory test is the only significant test for diagnosing a patient with discoid lupus? A.Antinuclear antibody B.Serum complement C.Complete blood count D.Skin biopsy

d - only affects skin

A 2½-year-old child is admitted for treatment of injuries supposedly sustained in a fall down a flight of stairs. Which statements are more likely to come from a parent who engages in child abuse? Select all that apply. One, some, or all responses may be correct. 1 "Trial and error is a way for kids to learn about accidents and dangers." 2 "Every time I turn around the kid is falling over something." 3 "This child is adventurous and doesn't understand about getting hurt." 4 "The kid didn't have a problem using the stairs without my help before this." 5 "Little kids are always on the go, and I just can't keep running after him." 6 "We live in a two-story house; do you have any ideas to keep him off the stairs?"

1234 Abusive parents often have a poor understanding of the expected growth and development of children and tend to blame the child. Statements 1 to 5 suggest a combination of a poor understanding and blaming. When the parents ask for help and suggestions, this indicates a knowledge deficit but also a readiness to learn and to correct problems. Admitting to knowledge deficit and seeking corrective action are not behaviors that abusive parents usually display.

S/S of SLE

fever - classic sign of a flare; happens first; why it is systemic fatigue - antibodies are attacking things it should not making you tired joint pain - if immune complexes are in the joint; arthritis skin rash - very common symptom; butterfly rash; alopecia; mucosa- mouth, serosa - lining of organs and body cavities weight loss - goes along with fatigue; body is fighting a war organ specific symptoms - nephritis pancytopenia - in bone marrow causing thrombocytopenia(platelets), anemia, and leukopenia (WBC and RBC) remissions and exacerbations

what is ANA in lupis

high

The nurse is caring for a preoperative patient w/Type 1 diabetes. On the morning of surgery, the nurse should carry out which of the following actions? A.Clarify the insulin dose with the physician B.Administer an oral antidiabetic agent C.Administer and IV insulin infusion D.Administer the full daily insulin dose

a

s/s of heat stroke

giddiness, excessive thirst, nausea, and increased body temperature. Heat exhaustion is indicated by a fluid volume deficient. Heat exhaustion occurs when profuse diaphoresis results in excess water and electrolyte loss. Accidental hypothermia usually develops gradually and goes unnoticed for several hours.

The nurse is assessing a toddler and the dynamics of the child's family in which abuse is suspected. Which behaviors are expected? Select all that apply. One, some, or all responses may be correct. 1 The child cringes when approached. 2 The parents cannot explain previously healed injuries. 3 The parents are overly affectionate toward the child. 4 The child lies still while surveying the environment. 5 The parents give detailed accounts of the child's injuries.

124 The child cringes when approached because past experiences with adults have resulted in pain rather than comfort. Evidence of past injuries may exist, but the parents do not discuss it, because this would be an admission of child abuse. Abused children are always on the alert for potential abuse. Lying motionless is an attempt to avoid attention; also, in the past the abused child's attempts to resist abuse have often precipitated more abuse. Abusive parents are unable to provide any emotional support and will not exhibit overly affectionate behavior. Because abusive parents try to hide the fact of abuse, explanations about injuries are usually fabricated, inconsistent, and vague.