Test 3 - immunity & Mood

What are the two types of IBD?

Crohn's disease and ulcerative colitis

Acute onset of symptoms

IgE-mediated response

What are some causes of an anaphylactic reaction?

Insect sting (bee, wasp, ant) Medication allergy Food allergy (peanuts, eggs, shellfish)

Individuals at risk for TB may take

Isoniazid

A client being treated for tuberculosis is determined to be drug resistant. Which medications will no longer be effective in the treatment of tuberculosis?

Isoniazid and rifampin

Which RA medications are NOT safe during pregnancy?

Methotrexate and Rituximab

Complications of ulcer colitis

Mouth ulcer arthritis colon cancer toxic megacolon skin rash Pseudopolyps (markers of episodes of severe inflammation) primary sclerosis cholangitis (chronic liver disease) uveitis (redness of eye, can cause blurred vision)

Treatment for TB

TB meds for 6+ months frequent outpatient treatment Resp isolation until negative sputum decreased activity

Anyone who's had contact with tuberculosis in the past can give it to any of the other residents of the shelter, even if they didn't get sick themselves." How could the educator best respond to this comment?

"Actually, people who have the latent form of the disease won't be sick and can't spread it either." Contact with M. tuberculosis without the development of progressive primary tuberculosis results in a latent infection that is not communicable. Vaccination is not a common intervention in the United States.

Pharmacologic Interventions for anaphylactic shock

-Epinephrine -Antihistamine (Diphenhydramine) -Albuterol -Steroids -Oxygen -IV fluids

What is the prophylactic treatment for tuberculosis?

antitubercular therapy

How long does a patient stay on TB meds

6-12 months

What is the usual duration of prophylactic isoniazid therapy?

6-12 months

A nurse is administering a purified protein derivative (PPD) test to a client. Which statement concerning PPD testing is true?

A positive reaction indicates that the client has been exposed to the disease. A positive reaction means the client has been exposed to TB; it isn't conclusive for the presence of active disease. A positive reaction consists of palpable swelling and induration of 5 to 15 mm. It can be read 48 to 72 hours after the injection. In clients with positive reactions, further studies are usually done to rule out active disease.

Which type of infection control precautions would the nurse anticipate?

Airborne precautions

Diagnostic test for SLE

Anti DNA test (ANA) anti-DNA may be low or absent in remission. ANA and lupus erythematosus cell test results are positive in active SLE.

Teaching for RA

Application of heat/cold TENS unit Relaxation Position changes Diversion activities

Patient education for MS

Avoid fatigue - balance rest and activity Well balanced nutrition limit exposures to infection avoid extreme heat and cold manage stress complication of immobility - bowel function

Chron's disease

Characterized by periods of remission and exacerbation. Prominent right lower quadrant abdominal pain and diarrhea unrelieved by defecation Abdominal tenderness and spasm. Because eating stimulates intestinal peristalsis, the crampy pains occur after meals. Chronic symptoms include diarrhea, abdominal pain, steatorrhea (i.e., excessive fat in the feces), anorexia, weight loss, and nutritional deficiencies.

rheumatoid arthritis

Chronic inflammation of synovial joints

Major side affect of Pyrazinamide

increased uric acid jaundice vomiting & confusion minor s/e Joint pain

(PPD) of the tuberculin bacilli is given. Which sign would indicate a positive test result?

indurated wheal over 10 mm in diameter appears in 48 to 72 hours.

Tuberculosis medication

isoniazid rifampin pyrazinamide ethambutol

Management of SLE

monoclonal antibodies (Belimumab) corticosteroids: used topically for cutaneous manifestations Intravenous (IV) administration of corticosteroids is an alternative to traditional high-dose oral administration antimalarial agents NSAIDs immunosuppressive agents

Major side effect of Isoniazid

peripheral nephritis (Weakness, numbness, and pain from nerve damage, usually in the hands and feet.) Skin itching / rash jaundice vomiting & confusion

Anti smith antibody test

specific for SLE, tests the disease activity, it's response to therapy, and renal involvement.

Major depressive disorder

typically involves 2 weeks or more of a sad mood or lack of interest in life activities, with at least four other symptoms of depression such as: anhedonia and changes in weight, sleep, energy, concentration, decision making, self-esteem, and goals.

Major side affects of Ethambutol

visual impairment / loss

how long the antitubercular medication will need to be taken?

"You can take drug therapy for as long as 24 months or until all tubercle bacilli are eliminated." The goal of treatment is to eliminate all tubercle bacilli from an infected person while avoiding emergence of significant drug resistance. Treatment of active tuberculosis requires the use of multiple drugs. Tuberculosis is an unusual disease in that drug therapy is required for a relatively long period.

Adverse affect of sulfasalazine

- can cause drug induced pancreatitis - paradoxic exacerbation of colitis is a rare adverse affect -headache, nausea, vomiting, and abdominal pain -hypersensitivity reaction (less common): skin rash, fever, aplastic anemia, hepatoxicity, agranulocytes -reversible deduction in sperm count has been seen in males -folic acid supplement is required as it impairs folate absorption *a reduction in dose may be beneficial

Risk factors for TB

-Close contact with someone with TB -Inhalation of airborne nuclei -Substance abuse (Iv drug injection, alcohol abuse) -Overcrowding in homes -Inadequate health care -Immunocompromised health status i.e. HIV, cancer etc. -Immigration from countries with high prevalence of TB -Institutionalized (prisons, psych institutions, long term care facilities) -Pre-existing medical conditions (diabetes, CKD, organ transplant)

Treatment for RA

-DMARD (first line of treatment) (Plaquenil, Hydroxychloroquine) -Immunosuppressant: Methotrexate -NSAIDS/Salicylates: Aspirin, Ibuprofen, Naprosyn, Motrin -Corticosteroids -Biologics: Infliximab (Remicade) -Non opioid medication for pain -Heat/cold application -deformity preventing devices -Physical Therapy -Surgery - joint replacement -Paraffin baths (dips)- wrist and small join involvement -Rest when needed and to avoid becoming overly fatigued

What is Multiple Sclerosis?

-Progressive & degenerative disease that attacks the CNS -Chronic neurologic disease due to patches of demyelination in the CNS (brain & spinal cord) especially the white matter around the ventricles.

TB Skin test measurements

0-4mm is not significant 5mm < significant in people who may be at risk 10mm < significant in people who have normal or mildly impaired immunity

Priority care for anaphylactic shock

1. Remove/Stop the reason for the reaction, example stop the medication 2. Give EPIPEN 3. CPR and Airway management 4. IV therapy

Stages of rheumatoid arthritis

1. Synovitis - thickened synovial membranes; inflammation 2. Pannus - Granulation tissue forms 3. Fibrous ankylosis - fibrous tissue evolves into scar tissue

The health care provider is preparing to order rifampin and pyrazinamide for a female client with active tuberculosis. What question should the provider ask this client before confirming this order?

Are you pregnant? Pyrazinamide and streptomycin are contraindicated in pregnancy. A regimen of INH, rifampin, and ethambutol is usually used in the treatment of pregnant women.

A homeless client comes to the clinic coughing up blood and is diagnosed with active tuberculosis (TB). Which intervention by the nurse will be most effective in ensuring adherence with the pharmacological treatment regimen?

Arrange for the client to come to a community center each day to receive a meal and medication.

which symptoms in MS require treatment?

Ataxia Bladder dysfunction depression fatigue spasticity

Inflammaotry Bowel Disease

Autoimmune- mediated intestinal inflammation

Patient teaching for SLE

Avoid sun 10am-4pm (causes rashes to break out) Cover skin with high SPF sunblock Sun-protective clothing such as hats with wide brims, long sleeved shirts More sensitive to indoor fluorescent lighting. Use non-fluorescent light bulbs.

Diagnostic tests for Ulcerative colitis

Colonoscopy - sigmoidoscopy usually shows erythematous, grandular, or frankly ulcerated rectal mucosa with mucus and blood Biopsy - check severity and to Exclude Crohn's disease Serological markers - ANCA (70% of patients with UC have this) Serological marker - ASCA (70% of patients with Crohn's have this Surgery can be curative

What is the gold standard for confirmation of TB disease?

Culture

Diagnostic testing for Chron's disease

Double-contrast barium enema (rarely used) - in subacute/chronic presentations to show mucosal irregularity and narrowing. CT - may show an inflammatory mass, abscess formation, or localized or free perforation. MRI - for anal disease Biopsy - check severity and confirm Crohn's disease Presence of chronic diarrhea for more than four weeks and evidence of active inflammation on endoscopy and chronic changes on biopsy. Eliminate differentials with: -History - risk factors -Laboratory studies - stool culture for bacteria (C. difficile, Salmonella, Shigella, Campylobacter, Yersinia) Endoscopy - continuous inflammatory lesion beginning mainly from the distal colon

What is the most important requirements in the treatment of anaphylactic shock?

Early detection Early diagnosis immediate intervention without delay in each step

S/S of multiple sclerosis

Ears: tinnitus (ringing in the ears) decreased hearing Eyes: Nystagmus (repetitive, uncontrolled eye movement) Diplopia - double vision blurred vision eye pain scotoma (blind spot) Mouth: Dysarthria (difficulty speaking) (slurred, explosive, scanning) Dysphagia (trouble swallowing) Musculoskeletal: weakness that progresses to paralysis ataxia (without coordination) vertigo (spinning or dizziness) muscle spasticity Renal: urinary retention constipation spastic bladder Sensory Numbness, tingling, burning Sexual decreased libido, impotence

Medical management of IBS

Goal is to relieve abdominal pain and control diarrhea / constipation Stress reduction, adequate sleep, exercise regimen can improve symptoms

clinical manifestation of RA

Gradual onset: symmetric joint pain and morning joint stiffness lasting longer than 1 hour of 3 or more joints Subcutaneous nodules Deformities of the hands (e.g., ulnar deviation and swan neck deformity) and feet Characteristically, the pattern of joint involvement begins in the small joints of the hands, wrists, and feet. Systemic effects: low grade fever malaise & weakness anorexia & weight loss fatigued by afternoon vasculitis (inflammation of blood vessels)

An 80-year-old client is diagnosed with latent tuberculosis infection. What is a risk for the elderly population when being treated with INH?

Hepatotoxicity Although INH is the drug of choice for treatment of LTBI, its use is controversial in older adults. Because risks of drug-induced hepatotoxicity are higher in this population, some clinicians believe that those clients with positive skin tests should have additional risk factors (e.g., recent skin-test conversion, immunosuppression, previous gastrectomy) before receiving INH.

Diagnostics for MS

History - clinical manifestation - CSF Analysis - MRI

MS Medications

Interferon: For optimal control of disability, disease-modifying medications should be started early in the course of the disease Baclofen: treats spasticity Benzodiazepine: can treat muscle spasms & spasticity IV Methylprednisolone: shortens RR

A client is prescribed isoniazid (INH) for a diagnosis of tuberculosis. Which adverse effect will result in discontinuation of the medication?

Jaundice Potentially serious adverse effects of INH include hepatotoxicity. Hepatotoxicity may be manifested by symptoms of hepatitis (e.g., anorexia, nausea, fatigue, malaise, jaundice) or elevated liver enzymes. The nurse reports their development to the health care provider promptly to prevent possible liver failure and death.

What are some symptoms related to SLE?

Joint pain, skin lesions, fever, fatigue

What is monitored monthly while on TB medications?

Liver enzymes Blood urea (BUN) Creatinine Sputum cultures

A client is receiving rifampin and isoniazid in combination for treatment of tuberculosis. What would the nurse need to monitor closely?

Liver function When rifampin and isoniazid are used in combination, the possibility of toxic liver reactions increases, requiring close monitoring.

Diet for Chron's and Ulcerative Colitis?

Low residue diet could result in a reduction of stool quantity and frequency. eggs, refined grains, white rice, seafood, and poultry. Dairy intake is limited, and high fiber-containing food and whole grains are typically entirely avoided.

The nurse would be aware of this TB condition if the lab reports showed which bacteria?

Mycobacterium tuberculosis

S/S of Rheumatoid arthritis

PAIN Joint swelling Limited movement Stiffness Weakness Fatigue

What kind of patient are at high risk for anaphylactic reactions?

Patients with a known allergy to iodine or fish and those who have had previous allergic reactions to contrast agents

Discharge planning for patient with MS

Physical Mobility / gait training - PT&OT Avoidance of injury Achievement of bladder and bowel continence Promotion of speech and swallowing mechanisms (Speech therapy) Improvement of cognitive function Development of coping strengths Improved home maintenance management Adaptation of sexual dysfunction

Diagnostic for RA

Positive serum - rheumatoid factor Increased ESR Increased C-reactive protein Elevated WBC w/ increased neutrophils Anemia

signs and symptoms of anaphylactic shock

Rapid onset Impending doom (anxiety, weakness, apprehension) Sweating Dyspnea - tight throat, bronchospasm, laryngeal edema Pruritus (itching) Urticaria (Hives, welts, rash) Hypotension, Tachycardia LOC Tingling and swelling in mouth, tongue, face, throat

Major side effect of Rifampicin

Red and orange secretions and urine Jaundice Vomiting & confusion Skin itching / rash purpura, shock minor side effects: anorexia, nausea, abdominal pain

How do you know if TB medications have worked?

Reduction in symptoms and negative sputum in --- days. if no improvement, this may indicate that patient is non compliant with medication regimen.

A nurse is assigned to care for a client with tuberculosis who has been prescribed rifampin. What should the nurse confirm to be sure that rifampin is not contraindicated in the client?

Renal impairment The nurse should ensure that the client does not have renal impairment because rifampin is contraindicated in clients with this condition. Pyrazinamide and not rifampin is contraindicated in clients with severe hepatic damage, diabetes mellitus, and acute gout.

Which drug as a first-line treatment option for TB?

Rifampin

Diagnostic testing for TB

Skin test Mantoux (screen) chest x-ray Sputum (3 specimens collected on different days)

S/S of Systemic Lupus Erythematosus

Skin: Butterfly rash rashes to areas of the skin exposed to sunlight photosensitivity Musculoskeletal ***Joint symptoms, with arthralgias, arthritis (synovitis), or both (earliest manifestation) weight loss fatigue fever / infection arthritis emotional lability Cardiac: Vascular inflammation **pericarditis (most common) Reynaud's phenomenon Pulmonary Increased RR (Tachypnea) Cough Pleural inflammation effusion Renal proteinuria hematuria CNS Neurologic disorders Hematologic disorders **must have 4/11 symptoms to be classified

A patient who wears contact lenses is to be placed on rifampin for tuberculosis therapy. What should the nurse tell the patient?

Switch to glasses while taking this medication. The nurse informs the patient that rifampin may discolor contact lenses and that the patient may want to wear eyeglasses during treatment.

A client, being treated for latent tuberculosis (TB) on an out-client basis, tells the nurse, "I've been feeling pretty good lately, so I haven't actually been all that consistent with taking my drugs." Subsequent health education by the nurse should focus on what subject?

The need to consistently take the prescribed drugs in order to cure TB Consistent adherence to treatment is imperative to ensure successful treatment of TB. Nonadherence leads to resistance and unsuccessful treatment.

A nurse who provides weekly care in a homeless shelter has unknowingly inhaled airborne Mycobacterium tuberculosis (TB) and has subsequently developed latent tuberculosis infection. Which statement is accurate regarding this nurse?

The nurse is likely asymptomatic. Latent TB infection is not an active form of TB, and affected individuals are asymptomatic and cannot pass on the disease to others. It does not confer immunity. However, small numbers of organisms may remain viable for years. Later, if immune mechanisms decline or fail, latent TB infection has the potential to develop into secondary TB.

What is the cure for SLE

This is an autoimmune disease with no cure, goal is to manage symptoms and flare ups

Sulfasalazine

Used for colonic diseases either as an initial treatment or to maintain remission.

Goals of treatment for MS

delay the progression of the disease, manage chronic symptoms, and treat acute exacerbations. promote safe independent self care

Colitis

inflammation of the colon

The nurse is caring for a client who is taking INH for tuberculosis. What adverse effect is this client most at risk for?

liver dysfunction Clients taking INH are most at risk for hepatotoxicity.

S&S of tuberculosis

low-grade fever Malaise (general discomfort) cough (productive or non-productive) night sweats anorexia weight loss progressive fatigue pleuritic chest pain Hemoptysis (coughing up blood) (advanced state)

Major side affect of streptomycin

ototoxic (hearing or balance problems) skin itching / rash deafness dizziness

Patients taking INH should avoid what foods

that contain tyramine and histamine (tuna, aged cheese, red wine, soy sauce, yeast extracts), because eating them while taking INH may result in headache, flushing, hypotension, lightheadedness, palpitations, and diaphoresis. Patients should also avoid alcohol because of the high potential for hepatotoxic effects.