SOC3 Exam 2

Understanding cancer pain

"Pain is whatever the experiencing person says it is, and exists whenever he says it does." "an unpleasant sensory and emotional experience in association with actual or potential tissue damage, or described in terms of such damage." 30% to 50% of people with cancer experience pain while undergoing treatment, and 70% to 90% of people with advanced cancer experience pain chronic pain- persistent- can be r(X) successfully in about 95% of people with drug and non-drug therapies acute flairs- breakthrough don't become drug addicts, there will be things left later on to treat the pain

Patients who have received chemotherapy in the past 48 hours should have a _________________ sign posted outside their door.

"chemotherapy precautions"

cisplatin

(GFR, creatinine, BUN) prehydrate and posthydrate IV and need to monitor lungs for s/s of HF

NSAIDs only available by prescription

* Naprosyn (naproxen) diclonfenac sodium (Voltaren) indomethacin (indocin)

highest amount of purines found in which foods

- liver, pancreas, kidney, brains, sweetbreads, anchovies, sardines, gravies, meat extracts, mincemeat Embryo/germ of grains and legumes, asparagas, dry beans, lentils, dry peas, spinach

pregnancy induced HTN

1) >140/90 during the second half 2) generalized edema 3) proteinuria

initial screening for lupus

1) CBC 2) liver and kidney screening panels 3) lab tests for specific autoantibodies- ANA 4) urinalysis 5) blood chemistries 6) erythrocyte sedimentation rate

side effects of antimalarials

1) CNS: HA, nervousness, irritability, dizziness, muscle weakness, and tinnitus 2) GI: NV, diarrhea, abdominal cramps, loss of appetite 3) Opthalmologic: visual disturbances and retinal changes are manifested by blurring of vision and difficulty in focusing. DAMAGE TO RETINA. risk of retinal damage 1:5,000. eye exam before rx and yearly 4) dermatologic: dryness, pruritus, alopecia, skin and mucosal pigmentation, skin eruptions, and exfoliative dermatitis 5) hematologic: blood dyscrasia and hemolysis in patients with glucose 6-phosphate dehydrogenase (G6PD) deficiency 6) Pregnancy: antimalarials are usually continued during pregnancy. they do cross the placenta but a clinical trial and case series have not found safety issues

9 major side/adverse effects of corticosteroids

1) CNS: depression, mood swings, and psychosis 2) CV: CHF and HTN 3) Endocrine: cushing's syndrome, menstrual irregularities, and hyperglycemia 4) GI: irritation, peptic ulcer disease, weight gain 5) dermatologic: thin skin, petechiae, ecchymoses, facial erythema, poor wound healing, hirsutism, urticaria, and acne 6) MS- muscle weakness, loss of muscle mass, and osteoporosis 7) Opthalmologic- increased intaocular pressure, glaucoma, exopthalmos, and cataracts 8) other: immunosuppression and increased susceptibility to infection 9) cross placenta, used cautiously during pregnancy, no large doses when breastfeeding

calcineurin inhibitor examples (2)

1) Cyclosporine A (Neoral, Sandimmune) 2) Tacrolimus (Prograf, FK506)

2 other CM of RA

1) Extrasynovial rhematoid nodules 2) Raynauds phenomenon

3 commonly prescribed antidepressants

1) Flavil 2) Pamelor 3) Nopramin

how to administer EpiPen

1) Form fist around auto injector 2) with your other hand, pull off gray cap 3) hold black tip near outer thigh 4) swing and job firmly into outer thigh so auto-injector is perpendicular (at 90 degree angle to things 5) hold in place and count to 10 6) remove the Epipen and massage the injection area for 10 seconds

5 tests that can be done to assess a patient for kidney disease

1) GFR and proteinuria 2) protein/creatinine ratio 3) urinalysis 4) measurement of serum creatinine concentration 5) kidney biopsy

7 side effects of NSAIDS

1) GI: dyspepsia, heartburn, epigastric distress, NV, anorexia, abdominal pain, GI bleeding, mucosal lesions 2) GU: fluid retention, reduced creatinine clearance, acute tubular necrosis with renal failure 3) hepatic: acute reversible hepatotoxicity 4) CV: HTN and moderate to severe noncardiogenic pulmonary edema, increase risk of MI 5) hematologic: altered hemostasis through effects on platelet function 6) other: skin eruption, sensitivity reaction, tinnitus, and hearing loss 7) pregnancy and lactation: should be avoided after the first trimester

5 chief joints involved

1) HIP 2) KNEE 3) HAND 4) SPINE 5) OTHER

5 pregnancy complications related to lupus

1) Lupus flare 2) Miscarriage 3) Pregnancy-induced HTN 4) Pre-eclampsia 5) Eclampsia 6) Neonatal lupus

2 types of localized scleroderma

1) Morphea 2) linear scleroderma (en coup de sabre)

most common side effects of Avastin (Bevacizumab) include

1) NOSEBLEEDS 2) HA 3) High BP 4) inflammation of the nose 5) protein in the urine 6) tase change 7) dry skin 8) rectal bleeding 9) tear production disorder 10) back pain 11) inflammation of the skin

frequently used medications for lupus (6 categories)

1) NSAIDS 2) antimalarials 3) corticosteroids 4) immunosuppressive 5) IV immunoglobulins

6 types of drugs for gout

1) NSAIDs 2) Colchicine 3) Probenecid/Benemid 4) Uricase 5) Allopurinol 6) Corticosteroids

s/s suggesting renal failure (6)

1) NV 2) anorexia 3) anemia 4) lethargy 5) pruritus 6) changing level of consciousness

physical exam on someone with compartment syndrome

1) Pain when the area is squeezed 2) Extreme pain when you move the affected area 3) a person with compartment syndrome in the foot or lower leg will have severe pain when moving the toes up and down 4) Swelling in the area

6 Ps of neuromuscular involvement

1) Pulselessness 2) Paralysis 3) Parethesias 4) Pallor 5) pAIN 6) Poikilothermia

Felty's syndrome 3 conditions

1) RA 2) Splenomegaly 3) leukopenia

CM of scleroderma (6)

1) Raynaud's 2) MS features 3) GI features 4) pulmonary features 5) cardiac features 6) renal features

4 main classic CT diseases

1) SLE 2) RA 3) Scleroderma 4) Sjoren's syndrome

5 RA complications

1) Sjoren's syndrome 2) Felty's syndrome 3) Ruptured Baker cysts 4) Carpal tunnel syndrome 5) cervical spine instability

graft rejection involves which components

1) T lymphocytes 2) B lymphocytes 3) Macrophages 4) Cytokines inflammatory injury and graft damage

s/s of GI perforation (4)

1) abdominal pain 2) NV 3) constipation 4) fever

characteristics of OA

1) absence of synovial membrane inflammation 2) lack of systemic s/s 3) normal synovial fluid 4) loss of auricular cartilage tends to occur over 40 5) men=women occurrence (women more severely affected) 6) high stress on joints- athletes torn ACL or meniscectomy increases risk of oseoarthritis

6 types of medication to treat DJD

1) acetaminophen (<4 mg/day) 2) Salicylates 3) NSAIDs 4) COX-2 inhibitors- Celbrex 5) intra-articular injections (tiamcinolone) (sodium hyaluronate) no maore than 2-3 times per year 6) complimentary alternative medicine- glucosamine, condrotin sulfate, capsacin cream

what to do if suspect compartment syndrome

1) affected limb or limbs at level of heart NO ELEVATION NO ICE

eclampsia

1) all above symptoms 2) seizures

adverse effects of glucosamine

1) allergy to shellfish 2) rash 3) GI distrubances- diarrhea 4) drowsiness 5) HA

drug therapy for tumor lysis syndrome includes

1) allopurinal/xyloprin daily 2) bicarb drip- alkalinize the body with continuous infusion

5 categories of DMARDs

1) anti-malarial medications 2) arava 3) organ anti rejection drugs- cyclosporine 4) Misc.-Azulfidine and Gold 5) chemo drugs- methotrexate, Azathioprine (Imuran)and Cytoxan

8 main drug groups for type I hypersensitivity reactions

1) antihistamines 2) decongestants 3) corticosteroids 4) mast cell stabilizers 5) leukotriene antagonists 6) bronchodilator therapy 7) complementary and alternative therapy 8) desensitization therapy

what other categories of medication are used

1) antimalarials 2) remission-inducing agents 3) immunosuppressants 4) methotrexate 5) TNF

4 main gropus of pharmacological measures

1) appetite stimulants 2) corticosteroids 3) cannabinoids 4) anabolic agents

3 clinical stages of gout

1) asymptomatic hyperuricemia 2) acute gouty arthritis 3) tophaceous gout

how to treat SVC

1) attention to airway, breathing, and circulation (ABCs) is required 2) glucocorticoids (Prednisone, solumedrol) 3) furosemide/lasix 4) high-dose radiation therapy 5) may require surgically placed stent if severe and unresponsive

work up on someone with scleroderma

1) autoantibodies in blood 2) CT scan 3) radiography 4) echocardiography 5) right-heart catheterization 6) esophagraphy 7) pulmonary function testing 8) serum N-terminal pro-brain natriuretic peptide 9) cardiac rhythm monitoring 10) esophagogastroduodenoscopy 11) biopsy of skin and lungs

5 main immunosuppressives

1) azathioprine 2) cyclosphosphamide 3) methotrexate 4) cyclosporine 5) mycophenolate mofetil

management of oral mucositis ladder

1) bland rinses 2) mucosal coating agents 3) water-soluble lubricating agents 4) topical anesthetics 5) cellulose film-forming agents for covering localized ulcerative lesions

3 adverse effects of anthracyclines

1) cardiotoxicity 2) severe or febrile neutropenia 3) vomiting

evaluation of ILD should include (4)

1) chest radiograph 2) CT of lungs 3) pulmonary function tests including diffusing capacity 4) serum levels of antibodies

r(x) of xerostomia

1) chewing gum 2) saliva substitutes 3) gravy and sauces help swallowing 4) drink with food 5) KY gel or "Oral Balance" lubricants 6) working with the patient to find out what works best for them

who typically receives bone marrow transplantation

1) childhood and adult leukemia 2) pts. with certain solid tumors

6 groups of people more at risk for developing a latex allergy

1) children w/ spin bifida (early and frequency health care. about 1/2) 2) people with urinary tract abnormalities at birth 3) people who undergo multiple surgeries or medical procedures 4) healthcare workers 5) rubber industry workers 6) people with a family history of allergies

7 drugs implicated as activators of drug-induced lupus

1) chlorpromazine (thorazine) 2) isoniazid (INH) 3) Methyldopa (Aldomet) 4) hydralazine (Apresoline) 5) Procainamide (Pronestyl) 6) Minocycline (Minocin) 7) Anti-TNF (etanercept and infliximab)

CMS of distal neuromuscular status

1) circulation: assess for pulses, delayed cap refill, cyanosis 2) movement: assess for movement of fingers/toes 3) sensation: assess for sensation; paresthesia or anesthesia

4 major opioid side effects

1) constipation 2) NV 3) sleepiness 4) respiratory depression

8 broad immunosuppresive therapies

1) corticosteroids 2) calcineurin inhibitors 3) sirolimus 4) azathioprine 5) mycophenolate mofetil 6) cyclophosphamide 7) polyclonal antibodies 8) monoclonal antibodies

rx for systemic sclerosis

1) corticosteroids 2) immunosuppressants 3) specific treatment (depending on specific organ involvement) 4) stress management

side effects of inhaled steroids

1) cough 2) hoarseness 3) yeast infections of the mouth

miscarriage

1) cramping 2) vaginal bleeding

endocrinopathies include what three things

1) cushing syndrome (ectopic cortisol) 2) SIADH- ectopic ADH production 3) polycythemia- excess erythropoietin production

what are s/s of lupus attributed to

1) damage caused directly by autoantibodies 2) deposition of immune complexes 3) cell-mediated immune mechanisms

8 reasons why pt. with dermatomyelotis may have worse outcomes

1) delay in initial treatment greater than 6 months after symptoms onset 2) greater weakness at presentation 3) presence of dysphagia 4) respiratory muscle weakness 5) intersitial lung disease 6) associated malignany 7) cardiac involvement 8) advanced age

9 potential psychological manifestations

1) depression 2) difficulty completing self-care activities 3) inability to maintain employment 4) decreased social activities 5) lack of energy or ambition 6) irritability 7) impaired concentration 8) insomnia 9) suicidal thoughts

2 corticosteroids

1) dexamethasone 2) prednisone

What can cause cancer pain

1) directly by tumor (pressure, obstruction, invasion of sensitive structures, stretching of visceral surfaces, tissue destruction, and inflammation) 2) treatment 3) other sources like infection

Teach the patient to watch for signs and symptoms of renal complications and report them promptly to the physician:

1) facial swelling 2) peripheral edema 3) "foamy" urine (proteinuria) 4) "coke-colored" urine (hematuria) 5) nocturia and urinary frequency

general physiological manifestations r/t lupus

1) fatigue 2) weight gain or loss 3) fever (increased temperature over normal baseline) 4) tachycardia

side effects of monoclonal antibodies

1) fever, chills 2) dyspnea, chest pain 3) NV 4) increased infection risk 5) anaphylaxis- pulmonary edema, CParrest

5 commonly affected joints for RA

1) fingers 2) feet 3) wrists 4) elbows 5) knees less commonly affected- shoulder, hips, cervical spine

other potential renal manifestations

1) fluid and electrolyte imbalance 2) sacral edema 3) bounding pulse, S3 gallop 4) engorgement of neck and hand veins 5) dyspnea, crackles in lungs 6) cyanosis 7) decreased hematocrit 8) urine specific gravity <1.010 9) variable serum Na 10) serum osmolality <275 mOsm/kg

what to monitor in transplant pts taking corticosteroids

1) for above side effects 2) for infections

etiology of scleroderma (5)

1) genetic abnormalities 2) infectious agents 3) environmental factors 4) drugs 5) stress

steroid side effects with long-term use include

1) growth suppression 2) DM 3) cataracts 4) osteoporosis 5) muscle weakness

SLE nephropathy s/s (8)

1) hematuria (5 RBCs is sig) 2) proteinuria (>1) 3) sterile pyuria 4) elevated creatinine level 5) elevated BUN 6) weight gain 7) ankle edema 8) HTN

Rx for PM

1) high dose steroids muscle strength improves in 4-6 weeks (distinguish btwn inclusion body myositis) 2) unresponsive- immunosuppressive 3) IVIG 4) specialized exercise therapy 5) stress management

hip precautions

1) hip abducted-- slight external rotation via wedge pillow, abductor splint and 2 pillows between legs 2) avoid adduction and extreme rotation of hip- place trochanter rolls along legs vary depending upon type of prosthesis 3) turning- only to uncooperative side, with wedge pillow 4) avoid hip flexion over 90 degrees- semi fowlers position, raise the bed less than 90 degrees 5) don't cross legs, hips higher than knees when sitting, knees need to be 6 inches apart, no pigeon toed 6) don't sit for longer than 45-60 minutes at a time without standing and stretching use elevated toilet seat for the first 8 weeks

management of tumor lysis syndrome

1) hydration 2) monitor uric acid levels regularly 3) drug therapy

tumor lysis syndrome results in what three things

1) hyperK 2) hyperPO4 3) uric acid nephropathy

4 Non-opioids- NSAIDs

1) ibuprofen 2) aspirin 3) naproxen 4) acetaminophen (not really an NSAID?)

etiology of SLE (4)

1) immune system dysfunction 2) genetics 3) environmental influences 4) hormones

serious risks associated with immunosuppresives

1) increased susceptibility to infection, bone marrow suppression, development of malignancies 2) dermatologic- alopecia (cyclophosphamide and methotrexate) 3) GI: NV, stomatisits, esophagitis, and hepatotoxicity 4) GU: hemorrhagic cycstitis, hematuria, amenorrhea, importence, and gonadal suppression (cyclophosphamide only) 5) hematologic (thrombocytopenia, leukopenia, pancytopenia, anemia, myelosuppression) 6) respiratory- pulmonary fibrosis 7) risks to fetus, use contraception during treatment and for 12 weeks after ending azathioprine therapy, may pass into breast milk

examples of mast cell stabilizers

1) intal 2) tilade 3) crolom 4) alomide 5) alocril 6) opticrom 7) alamast 8) nasalcrome

3 steps of donor bone marrow transplant

1) intensive radiation therapy and/or chemotherapy to destroy active bone marrow and leukemic cells 2) bone marrow aspirated from a carefully matched donor (usually sibling) is IV infused to the pt 3) engraftment takes place w/in 3-4 wks- marrow from donor found way to pt's bone marrow to produce essential elements

four major complications of dermatomyelitis

1) intersitial lung disease 2) esophageal disease 3) myocarditis 3) malignancy

5 types of systemic scleroderma

1) limited cutaneous disease 2) diffuse cutaneous disease 3) sine scleroderma 4) undifferentiated CTD 5) overlap syndromes

what 4 organ tissues may be involved

1) lungs 2) heart 3) kidneys 4) skin

what three laboratory assays detect Antiphospholipid Antibodies

1) lupus anticoagulants 2) anticardiolipin antibodies 3) anti-B2 glycoprotein I

2 appetite stimulants

1) megesterol acetate/megace 2) medroxyprogesterone

nursing considerations r/t sirolimus

1) monitor CBC 2) monitor for infections 3) monitor and manage painful joints, high cholesterol, and diarrhea

nursing considerations r/t monoclonal antibodies

1) monitor for infection 2) used infrequently at this time for rejection episodes 3) manage hypersensitivity potential

nursing considerations r/t cyclophosphamide

1) monitor for infections 2) monitor CBC 3) monitor urine and dipstick for blood

nursing considerations r/t polyclonal antiboides

1) monitor for infections 2) next line to abort acute rejection after corticosteroids 3) premed with: diphenyhyradmine, acetaminophen, methylprednisolone (solumedrol), meperidine/demerol for rigors

nursing considerations r/t calcineurin inhibitors

1) monitor kidney function 2) monitor liver function 3) monitor neuro status- for tremors 4) monitor for infections

lupus flare with pregnancy

1) morning stiffness and swollen joints 2) fever 3) development or worsening of rash

diagnosis of RA- 4/7 must be present

1) morning stiffness over 1 hr for at least 6 weeks 2) arthritis involvement of 3+ joints 3) symmetric arthritis 4) arthritis of hand joints 5) Rheumatoid nodules 6) serum rheumatoid factor 7) radiologic changes of erosions or decalcification

symptoms of xerostomia

1) mouth discomfort 2) taste, chew, swallowing is all problematic 3) impacts on speaking 4) increases psychosocial problems 5) can lead to aspiration pneumonia and septicemia

3 things to confirm the diagnosis of dermatomyositis

1) muscle biopsy 2) EMG 3) Blood tests

side effects of Azathioprine

1) myelosuppression 2) increased infection risk

side effects of cyclophosphamide

1) myelosuppression 2) increased infection risk 2) hemorrhagic cystitis

side effects of sirolimus

1) myelosuppression 2) increased infection risk 3) arthralgias 4) hypercholesterolemia 5) diarrhea

side effects of calcineurin inhibitors

1) nephrotoxicity 2) increased infection risk 3) neurotoxicity- tremors and increased risk for seizures 4) hepatotoxicity 5) HTN 6) hirsutism 7) gingival hyperplasia

WHO's pain ladder

1) nonopiods, such as ibuprofen/motrin or acetaminophen/tylenol 2) mild opioids such as oxycodone are added 3) strong opioids such as morphine, hydromorphone/dilaudid until the pt. is free of pain

collaborative management of hypercalcemia

1) oral hydration 2) NS IV 3) drug therapy: calcitonin, pamidronate 4) dialysis

long acting analgesics (2) how often are they give?

1) oxycontin 2) MS contin q12 or q8

CM of cancer (6)

1) pain 2) fatigue 3) cachexia 4) anemia, leukopenia, thrombocytopenia 5) infection 6) paraneoplastic syndromes

CM of DJD

1) pain in joint; especially with ambulation aggravated by weight breading 2) sitffness at rest 3) morning stiffness may be present but lasts only 1 hour 4) limited ROM- flexion contractors 5) effusion or swelling of joint- asymmetric possibly 6) crepitus 7) Heberden's- DIP joints 8) Bouchard's nodes: PIP less common 9) muscle wasting, dislocation, deformity, limp 10) nocturnal pain 11) increased symptoms at end of day

s/s of polymyositis (6)

1) pain- marked weakness and of loss of muscle mass in the proximal musculature- shoulder and pelvic girdle 2) hip extensors affected- diff. in ascending or rising from seat 3) tichening of the skin on the fingers and hands 4) dysphagia (1/3 of pts) 5) low grade fever and peripheral adenopathy 6) foot drop in one or both feet (advanced PM)

8 side effects of chemotherapy

1) pancytopenia 2) alopecia or hair loss 3) NV 4) oral mucositis 5) skin changes 6) anxiety, sleep disturbances 7) altered bowel elimination 8) changes in cognitive function

4 tips in preventing IV extravasation

1) patent IV 2) good blood return 3) use CVL when possible 4) check IV sites hourly

cardiopulmonary manifestations contribute significantly to moribidity and mortality in patients with SLE. Name 4

1) pericarditis 2) myocarditis 3) MI 4) pleuritic chest pain

nonpharmacologic measures to treat cachexia

1) physical exercise 2) relaxation exercise 3) dietary counseling

drug-induced lupus erythematosus 4 characteristics

1) pleuropericardial inflammation 2) pleuritic chest pain 3) pericarditis 4) fever, rash, and arthritis serologic changes

corticosteroids name 2

1) prednisone 2) methyprednisolone (solu-medrol- IV)

collaborative management of sepsis and DIC

1) prevention 2) IV antibiotic therapy 3) anticoagulants 4) FFP

6 manifestations of type I hypersensitivity

1) pruritis 2) urticaria 3) edema 4) conjuctivitis 5) rhinitis 6) GI cramps and malabsorption

most frequent causes of mortality for those with systemic sclerosis

1) pulmonary HTN and scleroderma renal crisis ar ethe most frequent causes of mortality

Assessing cancer pain- patient's perspective

1) put it in writing 2) plan to ask questions 3) have a note taker 4) make your views heard What to write down: OPQRST, how quickly it comes on and how long it lasts, medications, side effects of medications, quality of life issues pain scales

3 highly effective MOA of corticosteroids

1) reducing inflammation 2) relieving muscle and joint pain and fatigue 3) suppressing the immune system also useful in controlling major organ involvement r/t SLE

antiemetic drugs include which 5 types of categories

1) serotonin antagonists 2) corticosteroids 3) benzodiazepines 4) neurokinin receptor antagonist 5) prokinetic agents

process for autologous BMT

1) several aphereses over a week to 10 days 2) intensive chemo 3) administration of harvested stem cells, or PSCT

8 major complications of joint surgery

1) shock r/t blood loss 2) DVT- TEDs and pulmonary stockings, SCDs, mobilize, hep. lovenox, coumadin 3) PE- fat embolism 4) infection- less than 1% of total joint replacements 5) disclocations 2% of THA w/in first 2 months 6) nerve injury- abductor pillow or splint, nv checks important 7) urinary retention 8) constipation

when should pt. with SLE who has a fever call the physician

1) signs and symptoms of an infection appear 2) fever > 101F

3 main symptoms of dermatomyositis

1) skin rash 2) symmetric proximal muscle weakness 3) pain

environmental factors that researchers are considering include

1) sunlight 2) stress 3) certain chemical substances 4) toxic exposures 5) infectious agents such as viruses

3 CM of joints in RA

1) swan neck deformity 2) Buotonniere deformity 3) ulnar deviation or drift

6 major types of surgery for OA

1) synovectomy 2) tenosynovectomy 3) arthrodesis 4) bone grafts 5) osteotomy 6) arthroplasty

three categories of diagnostic tests

1) tests for blood cell abnormalities 2) measurements of autoimmunity

two other medications used to treat lupus

1) thalidomide 2) dehydroepiandrosterone (DHEA)

paraneoplastic syndromes include (7)

1) thromboemboli 2) superior vena cava syndrome 3) tumor lysis syndrome 4) endocrinopathies 5) sepsis and DIC 6) spinal cord injury 7) hypercalcemia

skin features of scleroderma

1) tightening of the skin in the face, with a characteristic beaklike faces and paucity of wrinkles 2) sclerodactyly 3) anterior chest salt-and-pepper hypopigmentation and diffuse hyperpigmentation in white woman

neonatal lupus 3 things

1) transient rash 2) transient blood count abnormalities 3) HB

what to do is extravasation occurs?

1) turn off infusion immediately 2) leave needle/catheter 3) slowly aspirate as much of the drug as possible 4) do not apply pressure to the area 5) remove IV access while aspirating 6) don't use site for further IV access 7) inform physician and obtain substance-specific measures 8) elevate area for 48 hours to minimize swelling 9) protocols for drug-specific extravasation procedures

four types of hypersensitivities

1) type I- IgE mediated 2) type II- Tissue-specific reactions 3) type III- immune complex mediated 4) type IV- cell mediated

s/s of anaphylaxis

1) uneasiness, apprehension, weakness, and impending doom 2) pruritus and urticaria 3) erythema and sometimes angioedema of the eyes, lips, or tongue 4) bronchoconstriction, mucosal edema, and excess mucus stimulaiton- from histamine 5) congestion, rhinorrhea, dyspnea, and increasing respiratory distress with audible wheezing result can be fatal

different types of brachytherapy (2)

1) unsealed soluble isotopes 2) sealed implants

what do need to monitor for pts. with TLS of bicarb drip

1) urine pH needs to be greater than or equal to 7 2) metabolic acidosis so the body will start breathing shallowly and have a decreased respiratory rate

skin care during tele therapy

1) wash irradiated area gently each day with water alone or mild soap (ivory) and water- less is considered better 2) rinse soap thoroughly from skin 3) don't wash off ink/dye radiation marking 4) PAT dry, not rub 5) no powders, ointments, lotions, or creams on the irradiated skin (aloe is the most common prescription) 6) wear soft clothing 7) avoid wearing belts, buckles, straps, or any type of clothing that binds or rubs irradiated skin 8) avoid sun exposure of irradiated skin- shield with cloth, avoid heat exposure

side effects with short-term steroid use

1) weight gain 2) fluid retention 3) HTN 4) increased gastric acid 5) hyperglycemia

pre-eclampsia

1)>140/90 during the second half 2) proteinura 3) epigastric pain 4) hyperrelexia 5) edema, including face and hands 6) HA

generally how many puffs relieve the wheezing and chest tightness associated with a mild attack

1-2

Transplants are divided into three categories based on the similarity between the donor and the recipient:

1-Autotransplants 2-Allotransplants 3-Xenotransplants

what percent of cancer patients w/ chronic pain also experience breakthrough pain?

1/2-2/3 need medication can receive for this pain discuss with healthcare provider

interstitial lung disease

10% of cases respiratory failure may result from diaphragmatic and chest muscle weakness can result in rapid respiratory failure and death

prealbumin moderate risk

10-17

dose of Arava

10-20 mg 1 daily taken on empty stomach or with meals

how often do RA pts get Sjorens

10-25%

A screening test for _____ is standard in assessing SLE because it is positive in close to 100 percent of patients with active SLE

100% but also positive in people with CT disease

average survival from diagnosis of systemic sclerosis

12 years

when does permanent nerve injury occur

12-24 hours of compression

leukopenia is found in ________ of pts with SLE

15-20%

prevalence of dermatomoysitis

1:100,000 in general population

fourfold diagnosis of polymyositis

1_ elevation of muscle enzymes in the blood- CPK 2) HP 3) electromyograph (EMG) alteration 4) positive muscle biopsy

onset of effect for radiopharmaceuticals

2 or more weeks

magic mouthwash (4)

2% viscous lidocaine diphenhydramine solution nystatin cherry syrup

when will hair grow back

2-3 months after chemo may be curlier, straighter, or a different color

how many people are affect by OA/DJD

20 mill Americans

Eye disease occurs in approximately _______ of patients with SLE

20 percent

how often does thrombocytopenia occur in lupus patients

25-35%

female to male prevalence of dermatomyositis

2:1

RA incidence

3-15% of US pop. 6 million RA (75% females) 20-40 incidence increases with age

to maintain freedom from pain, drugs should be given "by the clock" that is every __________ rather than on demand

3-6 hours

duration of action of radiopharmaceuticals

3-6 months

how long until gold improves symptoms

3-6 months

who is most at risk for scleroderma

3-9 times higher in women 30-50 yo peak onset

low purine foods

304 eggs per week nuts and PB low fat and fat free cheeses and ice cream pudding milk cream style soups made with low-fat milk soups made without meat extract or north many veggies fruits and juices breads and cereals- low fiber white flour pasta and macaroni rice soda coffee and tea gelatin cake and cookies fats in small amounts sugar and sweets in small amounts

encourage ____________ intake/day

3L of fluid

there needs to be serial or simultaneous presence of at least _____ of the eleven findings to diagnose lupus

4

at any time during the course of the disease about ________% of patients with SLE will be anemic?

40

peak incidence age of dermatomyositis

40-50

recommended dose of chondroitin

400 mg 3 times daily 2-4 mo. to notice sig. improvement

administration of IVIG

400 mg/kg for 5 days administer the drug safely and monitor the patient to minimize adverse effects and achieve expected outcomes experience HA that can be helped by slowing the infusion

when does pancytopenia appear

5-7 days (perhaps 7-10 days) after initiation of chemo reach Nadir 14-21 days after rx

what % of autoimmune diseases are idiopathic?

50%

normal amount of saliva

500-600 mL

what is required with arthroplasty

6 wks anticoag therapy for DVT

Pain occurs in ____________ of persons with advanced stages of cancer

60-80%

when does erythematous mucositis typically appear

7-10 days after initiation of high-dose cancer therapy

____% hospice in patients have xerostomia

77% hospice in patients maybe reduced volume or composition

scheduling activity and rest for pts with lupus

8-10 hours a night of restful sleeps, naps, and timeouts physical activity encouraged

cachexia is present in ____% of cancer patients at death

80

Episodic fever is experienced by more than ___________ of SLE patients, and there is no particular fever pattern.

80 percent low grade complicating infection- urinary and respiratory

_____ of people over age 70 have symptoms

80%

The World Health Organization reports that in __________ of all cancer cases, pain can be controlled.

85%-97%

_____% of advanced cancer patients have xerostomia

90

___ of all people will have x-ray features of DJD in weight bearing joints by age 40

90%

RF present in serum in ____ of patients

90% indicated autoimmunity

prealbumin severe

<10

prealbumin no risk

>17 reference range is 17-39

what are the two classic findings shown in muscle biopsy for dermatomyelositis

A mixed B- and T-cell perivascular inflammatory infiltrate perifascicular muscle fiber atrophy

mycophenolate mofetil (CellCept)

A strong immunosuppressive drug developed to prevent the rejection of transplanted organs alternative to cyclophosphamide for lupus with kidney involvement keeps T and B lymphocytes from replicating

skin test

A test in which your skin is pricked and exposed to latex can determine your reaction to latex. In this test, small amounts of latex are placed on the skin of your forearm or back. Your skin is then pricked with a needle, to allow a tiny amount of the substance beneath your skin surface. If you're allergic to a particular substance being tested, you develop a raised bump or reaction

brand names of leukotriene antagonists

Accolate Singulair Zyflo

alternative therapies for OA

Acupuncture Yoga Massage Guided imagery Therapeutic touch

over-the-counter combination allergy drugs

Allegra-D, Claritin-D, Zyrtec-D Benadryl Allergy and Sinus Tylenol Allergy and Sinus

hypersensitivity is

Altered immunologic response to an antigen that results in disease or damage to the host

side effects of gold injections

An itchy skin rash. Mouth sores.

cachexia includes several factors

Anorexia early satiety weight loss Anemia asthenia (marked weakness) taste alterations altered protein, CHO, and Lipid metabolism

what test is highly specific for SLE

Anti-dsDNA 50% of patients with SLE are positive useful to measure disease activity

two auto-antibodies found only in lupus

AntidsDNA and anti-Sm

biphosphonates (2) what do they do?

Aredia and clodronate relieve pain of cancer that has spread to the bones

what to monitor in pts taking Glucosamine

BS

prophylactic antimicrobials include

Bactrim/septra - for PCP Nystatin or mycelex - for fungal infections Valacyclovir/valtrex - for CMV Clarithromycin/biaxin - for MAI

prophylactic antimicrobial for PCP

Bactrim/septra- sulfamethoxazole and trimethoprim

Pharm rx for extrinsic asthma

Beta 2 agonist and corticosteroids anti-inflammatory medications

be aware of OTC meds that may contain glucosamine

Bioflex, Arth-x-plus, Nutri-Joint

lab data r/t IVIGs

CBC, WBC differential, renal function studies, BUN/creatinine; liver function tests; pulmonary function tests; chest X-ray; and ECG

lab data r/t immunosuppressives

CBC, differential, platelet count, renal function studies, liver function tests, pulmonary functions tests, chest Xray, and ECG

what is rheumatoid arthritis?

CT disorder a chronic systemic disease characterized by progressive and potentially deforming inflammation of the joints (synovial)

most common route for chemotherapy agents

CVL- port, hickman, PICC

how to prevent osteoporosis r/t corticosteroids

Ca, vit. D, Mg supplement and weight bearing exercise to prevent

mycophenolate mofetil brand name

Cellcept

Classify SLE in hypersensitivity disorders

Classic Type III

RA consultations

Consultation with rheumatology, orthopedics, and/or infectious disease may be necessary. Involvement by cardiology, pulmonology, nephrology, and ophthalmology often is necessitated by secondary organ involvement in those areas.

what is the major tool in assessing the progress of the disease and/or the efficacy of Rx

Creatine phosphokinase (CPK)

measurement of serume creatinine concentration

Creatinine is a waste product of muscle metabolism that is excreted by the kidneys. Loss of renal function as a consequence of lupus nephritis causes increases in serum levels of creatinine. The concentration of creatinine in the serum can be used to assess the degree of renal impairment.

medications for dry eye

Cyclosporin eyedrops (Restasis) reduce inflammation of the tear glands improving their function

what to teach SLE pt. r/t CP

DON'T SMOKE good foot care avoid cold temperatures and keep hands and feet warm s/s of vascular impairment that need to be reported to the physician, including a change in skin color or sensation or appearance of lesions s/s of thromboses

how to stop taking corticosteroids

DONT STOP Suddenly endogenous adrenal hormone production is slowed or stopped

common side effect of oral gold

Decreased appetite, nausea, and diarrhea. Problems with the skin, blood, kidneys, or lungs (rare).

side effects of IVIGs

Dermatologic: rash, mild skin reaction at the injection site GI: abdominal cramps, nausea, vomiting Musculoskeletal: chest, back or hip pain; muscle pain; joint pain Neurologic: anxiety, chills, dizziness, fever, HA Other: chest tightness, diff. breathing, burning sensation in the head

anticardiolipin antibodies

ELISA using cardiolipin as putative antigen

in RA what levels are elevated

ESR CRP- liver protein responds to inflamation or infection; complement syndrome ANA in 30% of patients

what else is elevated in gout

ESR WBC

how to prevent compartment syndrome

Elevation and Ice can help decrease the risk of development There may be no way to prevent this condition; however, early diagnosis and treatment will help prevent many of the complications

when pt. is less than 66 lbs use

EpiPen Jr. .15 mg rather than EpiPen over approx. 66 lbs

allergy

Exaggerated immune response to nonself

what causes the anemia?

Fe deficiency, GI bleed, medications, and autoantibody formation to RBCs

milk pain treatment

For mild cancer pain, acetaminophen or nonsteroidal anti-inflammatory medications (NSAIDs), such as ibruprofen, are often used.

what is the most serious potentially fatal side effect of Bevacizuman (Avastin)

GI perforation development of a hole in the stomach, small intestine, or large intestine

side effects of antimalarials

Gastrointestinal upset, rash, headache, blurred vision due to a rare effect on one of the small muscles in the eye, discoloration of the skin, myopathy (weakness of muscles), abnormal effects on blood, hearing problems, breakage of red blood cells in patients who have G6PD deficiency, and retinal toxicity. Retinal toxicity is rare.

is gold a first line treatment

Gold is not usually the first treatment given to people with rheumatoid arthritis, since methotrexate and other DMARDs are available.

s/s of skin rash r/t dermatomyositis

Gottron's sign/Papules heliotrope or "lilac" shawl or v- sign

potential complication of donor bone marrow transplant

Graft v. Host disease

when to not take glucosamine

HTN pregnant if taken with condroitin- may cause bleeding

side effects of decongestants

HTN sleeplessness, anxiety, dizziness, excitability, and nervousness not for people with glaucoma irritability restrict urinary flow

What is PM linked to/associated with

ILD increase in the occurence of cancers (pvarian, lung, pancreatic, stomach, and colorectal cancers)

azathioprine brand name

Imuran

how long until DMARDs are effective?

It takes roughly three to six months before a beneficial effect is seen. This may be because of the large volumes of distribution required.

rarer side effects

Kidney problems that causes loss of protein in the urine. Suppression of blood cell production, which may increase the risk of infection or serious bleeding. (A return to normal blood cell production may take several weeks after the drug is no longer taken.) bowel or lung inflammation

post op care for TKA

Maintain neutral rotation with knee in extension and degree of flexion as ordered Maintain immobilization devices if ordered Maintain slight elevation of extremity Avoid "gatching" bed under knee or pillows under knees Out of bed to chair night of surgery or first post op day, keeping extremity in full extension Trapeze for positioning Continuous passive motion (CPM) machine can assist with passive flexion and extension

additional s/s of dermatomyositis

Mechanic's hands periungal erythema centripetal flagellate erythema comprises linear, violaceous streaks on the trunk (possibly caused by itching pruritic skin) dysphagia (difficulty swallowing)

calcitonin (1), what does it do? how is it administered?

Miacalcin, relief for bone pain, nasal spray

autoimmunity

Misdirected Immune Response against Self

symmetric proximal muscle weakness r/t dermatomyositis

Muscle may deteriorate and render the infected temporarily paralyzed unable to walk, run, get out of bed, swallow food and liquids.

how many people suffer from autoimmune disease

NIH estimates up to 23.5* million Americans suffer from autoimmune disease and that the prevalence is rising. We at AARDA say that 50 million* Americans suffer from autoimmune disease.

why do cancer patients take antidepressants

NOT to relieve depression help relieve nerve pain that sometimes develops from cancer treatment

what is used when salicylates are inneftive

NSAIDs such as Naproysn, Diclofenac Na (Voltaren) and indomethacin

what drugs are contraindicated for oral mucositis

NSAIDs that affect platelet adhesion and damage gastric mucosa are contraindicated, especially if thrombocytopenia is present

alloimmunity

Normal Immune reaction against beneficial foreign tissue

what is the most common cause of joint disability

OA/DJD

what corticosteroid is used most often to treat lupus

Prednisone

progressive relaxation

Progressive relaxation is a technique used to reduce cancer pain in specific areas of the body. This technique entails lying down and successively clenching and releasing individual muscle groups, eventually focusing on those involved with the pain

sirolimus brand name

Rapamune

Raynaud disease (primary Raynaud)

Raynaud disease is the occurrence of the vasospasm alone, with no association with another illness.

periungal erythema

Redness around the nails

RICE stands for

Rituximab/Rituxan Ifosphamide Carboplatin Etoposide

intravenous immunoglobulins used to control

SLE with organ involvement or vasculitis

How to remember the classic CM of lupus

SOAPBRAIN-MD Serositis Oral ulcers Arthritis Photosensitivity Blood Changes Renal involvement (proteinuria or casts) ANA Immunological changes Neurological signs (seizures, frank psychosis) Malar rash discoid rash

other targeted therapies

STI-571 or imatinib mesylate (Gleevec) and bortezomib (Velcade)

what may be prescribed for severe burns?

Silvadene/Silver sulfasalazine Can't give if have sulfa allergy

radiopharmaceuticals (1) what do they do?

Strontium-89 (Metastron) help reduce pain of cancer that has spread to the bones

paraneoplastic syndromes

Symptom complexes that can't be explained by the local or distant spread of the tumor or by the effects of hormones released by the tissue from which the tumor arose

4 categories of lupus

Systemic lupus erythematosus cutaneous lupus drug-induced systemic lupus erythematosus neonatal lupus

the skin and lungs also show prominent

T-cell lymphocyte infiltration

recently what has been associated with the development of lupus symtoms

TNF (tumor necrosis factor) used to treat RA, Crohn's disease, and ankylosing spondylitis

estimated incidence and prevalence of scleroderma

The estimated incidence of scleroderma is 19 cases per million population, and the prevalence of systemic sclerosis has been estimated at 240 cases per million population

Pain r/t dermatomyositis

The pain may resemble the type experienced after strenuous exercise. Some have little pain, while in others , the pain may be severe.

subjective CM of fatigue

Tiredness, weakness, lack of energy, exhaustion, lethargy, inability to concentrate, depression, sleepiness, boredom, and lack of motivation

when will my hair start to fall out?

Your hair may start to fall out 2 to 3 weeks after chemotherapy begins.

osteoarthritis

a slow progressive, noninflammatory disease of mobile joints, especially weight-bearing joints Degeneration of articular cartilage of joints and surrounding tissue asymmetric inadequate nutrition of cartilage

Frequently, patients ascribe their first symptoms or worsening symptoms to______________________________________.

a stressful event, such as divorce, death of a loved one, or job loss.

what is immunotherapy?

a treatment used by allergy specialists (allergists) to reduce sensitivity to allergens.

Side effects of thalidomide

abdominal pain, infection, chills, diarrhea, liver abnormalities, anemia, peripheral edema, hyperlipidemia, leukopenia, insomnia, sensory neuropathy, albuminuria, hematuria, ovarian failure, and thrombosis strictly contraindicated in women who are pregnant or might become pregnant

Marfan Syndrome

abnormal fibrillin (elastin precursor) risk: aortic aneurysm

photosensitivity r/t lupus

abnormal reaction to the UV rays of the sun development or exacerbation of a rash sometimes accompanied by systemic symptoms

how long does stiffness last? when?

about 1 hour upon risking in the AM

percocet

acetominophen and oxycodone

aspirin is a brand name for what?

acetylsalicylic acid

scleroderma

activation of immune cells that produces scar tissue in the skin, internal organs, and small blood vessels

cytarabine (ARA-C)

acute myolgous leukemia cerebellar toxicity- physical assessment, signature page daily, romberg test, signature will get wavy

teletherapy

administered external to the body machines direct beas of radiation pt. is not radioactive

when does polymyositis tend to become evident

adulthood

arthroplasty

advanced joint destruction when conservative treatment failed cemented (methylmethacralate) cementless (porous surface allowing bone to fill in)- more protective weight bearing post op

risk of retinal toxicity r/t antimalarials

advancing age, impairment of kidney or liver function, and cumulate dose above 700 grams

stickler syndrome

affects collagen, distinctive facial appearance, eye abnormalities, hearing loss, and joint problems

cutaneous lupus

affects skin primarily common among pts with lupus erythematosus most severe form- chronic cutaneous lupus commonly known as discoid lupus

when to do mouth care

after meals bedtime soft bristled brush or sponges/toothettes

what lab values should review to confirm a patient's nutrition status?

albumin- 3.5-5.5 (late info) prealbumin >17 = no risk

reasons radiation might be useful

alievate symptoms and prevent complications by reducing size of tumor before obstruction or hemorrhage preoperatively- shrink a tumor mass before resection postoperatively- destroy any possibly remaining cells locally

cyclophosphamide (Cytoxan)

alkylating agent and strong immunosuppressive treats lupus with kidney disease or other internal organ involvement suppresses immune system sever side effects- risk of serious infection

physical

all body systems, to determine baseline data and alterations in function; temperature; pulse; respiration; weight; skin color; lesions; hair and mucus membranes

most commonly reported CAM adverse effects

allergic in nature urticaria, contact dermatitis, and anaphylaxis

Rituximab/rituxan adverse effects

allergic reactions give premeds: tylenol, benadryl, and corticosteroid

latex allergy may cause

allergic reactions reneging from sneezing or a runny nose to anaphylaxis

this is especially useful for people who have

allergic rhinitis (hay fever)

history r/t IVIGs

allergy to Igs, sepsis, volume depletion, IgA deficiency, paraproteinemia, renal insufficiency, DM, methotrexate, and virus vaccines

Hx r/t immunosuppressives

allergy to immunosuppressive drugs, infections, impaired hepatic or renal function, pregnancy, lactation, corticosteroid therapy, immunosuppression, bone marrow suppression, and appropriate contraception

how to assist the patient with psychosocial issues

allow expression of feelings assess coping acknowledge the feelings of denial and anger are normal explore sources of potential support and community resources concealing skin lesions and hair loss discussion interpersonal and social conflicts counseling and support groups

constipation r/t opioids

almost every person immediate bowel regimen 8-10 glasses of water, increase fiber, activity, stool softener docusate (laxative)- colace, senna-sanokot

eye drops

alrex and dexamethasone

tamoxifen

an estrogen antagonist, is effective for recent-onset and tender gynecomastia when used in doses of 10-20 mg twice daily. Up to 80% of patients report partial to complete resolution. Tamoxifen is typically used for 3 months before referral to a surgeon. Nausea and epigastric discomfort are the main adverse effects.

myocarditis

an inflammation of the heart muscle may also occur

NSAIDs: usefulness in lupus

analgesic, anti-inflammator, antipyretic inhibit the release of prostaglandings and leukotrienes treat joint pain and welling as well as muscle pain treat pleuritic chest pain

High purine foods to avoid

anchovies, roe, herring and macherel, sardines, scallops and mussels, game meats- goose duck partridge, organ meats, meat extracts, mincemeat, browth bouillon consomme gravy, yeast

3 medications for gynecomastia

androgens tomxifen danazol

what type of anemia?

anemia of chronic disease autoimmune hemolytic anemia- with a positive Coombs test is much less common

which blood cell abnormalities typically accompany lupus?

anemia, leukopenia, and thrombocytopenia

2) mucosal coating agents

antacid solutions and kaolin solutions

MOA of antimalarial

anti-inflammatory affect platelets to reduce the risk of blood clots and lower plasma lipid levels

before chemo

anticipatory nausea

2 main types of adjuvant medication

antidepressants anticonvulsants

clomiphene

antiestrogen, can be administered on a trial basis at a dose of 50-100 mg per day for up to 6 months. Approximately 50% of patients achieve partial reduction in breast size, and approximately 20% of patients note complete resolution. Adverse effects, while rare, include visual problems, rash, and nausea.

azathioprine (Imuran)

antimetabolite blocking metabolic steps within immune cells interfering with immune function fewer serious side effects

what to administer PRN

antimicrobials, topical analgesics, petroleum jelly to lip, artificial saliva

most characteristic autoantibodies in lupus

antinuclear antibodies target nucleic acids, proteins, and ribonucleoprotein complexes inside a cell's nucleus

using CAM

anxiety, depression, and HA most often used when chronic or untreatable disease exists balance the use of CAM with risks and benefits importnat in field of allergy and immunology

stomatitis

any inflammatory condition of oral tissue, including mucosa, dentition/periapices, and periodontium infections of oral tissues as well as mucositis

connective tissue

any type of tissue with an extensive extracellular matrix proteins and carbs two major protein molucules: collagen and elastin

bone grafts

are used when fusing larger, more difficult joints, such as hips and ankles.

neuokinin receptor antagonist

arepitant/emend

where does inflammation spread?

articular cartilage joint capsule ligaments tendons

how to help dryness of eyes

artifical tears eye lubricant ointments minize hair dryers plug duct close

3) water-soluble lubricating agents

artificial saliva for xerostomia

when is surgery useful

as a local treatment when the cancer is still localized

how often does dysphagia occur in dermatomyelotitis

as many as 33% of cases

care of patient radioactive from brachytherapy (sealed)

assign pt. to private room place caution "radioactivity material" on door keep door closed wear dosimeter badges wear lead apron when providing care no pregnant nurses limit each visitor to 30 min/ visit/day- no pregnant or child visitors never tough radioactive source with bare hands

mobility after THA

assist pt. may be out of bed to chair from night of surgery/2 post op day use walker use reacher physical therapy (give analgesics 20-30 minutes before)

leukotriene modifiers treat

asthma nasal allergy

The majority of people with lupus have some degree of _________________

asymptomatic microscopic kidney damage.

What is dermatomyelotitis associated with

autoantibodies

Antiphospholipid Antibodies

autoantibodies that react with phospholipids resulting in increased risk of thrombosis 50% of people with SLE persistently positive lupus anticoagulant or medium-to-high titer thrombosis, fetal loss, multiple first trimester losses, or preterm birth from severe placental vasculopathy

many CT diseases are the result of what?

autoimmunity

latex allergy is related to which foods

avocados, bananas, chesnuts, kiwis, passion fruits

inhaled steroids

azmacort flovent pulmicort asmanex q-var alvesco aerobid advair and symbicort- combine steroid with another drug

another adjuvant effective for some people experiencing shooting, tabbing, and knife-life neuropathic pain

baclofen (Lioresol)

nasal steroids

beconase flonase nasocort nasonex rhinocort veramyst generic fluticasone

3 things to do when acute exacerbation of gout

bedrest for first 24 hot or cold compress elevation of affected joint

cytotoxic precautions when using the toilet

before flushing, put the lid down or cover it with a pad flushing twice helps ensure all waste is disposed of wash hands well commode will be cleaned with special soap let nurse know if there is a spill

administration of antimalarials

before or after meals at the same time each day to maintain drug levels

first generation antihistamines

benadryl (diphenhydramine) chloritmeton (chlorpheniramine) dimetapp (brompheniramine)

presentation of polymyositis

bilateral proximal muscle weakness often noted in the upper legs due to early fatige with walking inability to rise from a seated position or inability to rise arms above head weakeness is progressive cytotoxic- T lymphocyte inflammation no skin involvement

MOA of monoclonal antibodies

bind to CD3 receptors on T cells, causing cell lysis inhibits function of cytotoxic t cells

evaluation

biopsy of grafter tissue evaluation of function

treatment with avastin can result in serious and sometimes fetal ________

bleeding coughing up blood, bleeding in the stomach, vomiting blood, bleeding in the brain, nosebleeds, vaginal bleed

how do leukotriene antagonists work?

block the effects of leukotrienes, chemicals produced in the body in response to an allergy

radiography of joints

bony erosions, cysts, osteopenia, joint space swelling calcifications, narrowed joint, space, deformities, separations, and fractures

uricase

breaks down uric acid

malar rash

butterfly rash classic CM

The most severe form of malnutrition related to cancer

cachexia

MOA of calcineurin inhibitors

calcineurin-protein that activates T lymphocytes prevents production of IL2 and interferon inhibits cytotxic t cells and B lymphocytes

what to look at if giving calcitonin

calcium phosphate

Arava (leflunomide)

calms inflammation associated with RA interferes with genes in developing cells, like those of the immune system

kidney biopsy

can be used to determine the presence of immune complexes and the presence, extent, and type of inflammation in the glomeruli. Diagnosing the extent and type of inflammation may help to determine a treatment program for lupus.

antimalarials

can be used to treat joint pain that occurs with RA effective in controlling lupus arthritis, skin rashes, mouth ulcers, fatigue, and fever effective in treating discoid lupus erythematosus

teach r/t Arava

can cause serious birth defects both men and women should use a reliable method of BC while being treated with the medication If a woman taking Arava wishes to become pregnant, she must stop the Arava, take a medication called cholestyramine for 11 days to get all the Arava out of the body, and then have a blood test to prove that the drug is gone. Less is known about the effects of Arava on men planning to father children. To be safe, men should consider cholestyramine treatment before attempting to conceive

urinalysis

can indicate the presence or extent of renal disease. For example, proteinuria can be a reliable indicator of renal disease. The presence of RBCs, WBCs, and cellular casts, particularly red cell casts, in the urine also indicates renal disease

blood test

can measure your immune system's response to latex by assessing the amount of allergy-type antibodies in your bloodstream, known as immunoglobulin E (IgE) antibodies.

how quickly do antidepressants start to work?

can take several weeks to become effective

when are corticosteroids given to gout patents

can't tolerate NSAIDs

rare complication of sjoren's

cancer of lymph glands

three medications associated with peripheral neuropathy

carboplatin, etoposide, vincristine

SIADH is most commonly found in....

carcinoma of the lung

acute concern of hypercalcemia

cardiac dysrhythmias, mental status change, muscle weakness long term: calcification

rx of infection r/t lupus

cardinal signs of infection may be mased bc of SLE rx ex) fever suppressed by antiinflammatory therapy alert to medication reactions

who is more at risk for photosensitivity

causcasians

aquired (secondary) immunodeficiency

caused by another illness: cancer, viral illness, normal physiologic changes of aging, nutritional deficiency, iatrogenic deficiency, burn victims, deficiency caused by stress

apheresis

cells are harvested from the patient by vein

which cancers commonly use brachytherapy?

cervical, prostate, breast, and skin cancer

intrathecal

chemotherapy administered into the CSF

probenecid/benemid

chronic gout and gouty arthritis increases the excretion of uric acid

anylosing spondylitis

chronic inflammatory disease of the axial skeleton with variable involvement of peripheral joints and noarticular structures systemic rheumatic disease strong genetic component autoimmune low back pain

patho of SLE

chronic multisystem inflammatory disease autoantibodies against nucleic acids, erythrocytes, coag. proteins, phospholipids, lymphocytes, platelets *** Deposition of circulating immune complexes containing antibody against host DNA

scleroderma is a ___________________________________ in it's more sever form it also affects ___________________________

chronic systemic autoimmune disease hardening of the skin accumulation of CT may affect internal organs- GI tract, lungs, heart, kidneys

Sjoren's syndrome

chronic, slowly progressing inability to secrete saliva and tears also occur with other 3 CTDs xerostomia

which drugs may induce nausea and for how long

cisplatin 5-7 days

prophylactic antimicrobial for MAI (mycobacterium avium intracellularae)

clarithromycin/biaxin

prescription decongestants

claritin-D

what does inflammation cause

coagulation fibrin products deposited in synovial membrane

types of tele therapy

cobalt, electron beam, linear accelerator and proton beam therapy

CAM for gout

coffee drinking associated with uric acid levels vit. c may reduce uric acid bot not megadoses cherries lower uric acid levels

discoid rash

coin-shaped or oval in shape- disk and it is seen on areas of the skin exposed to sunlight red and raised, become scaly, leave a scar chages in coloring to skin scalp, face in butterfly distrbution, v of neck usually painless and not itchy

collegen vascular diseases are associated with

collagen and blood vessel abnormalities

disease in which inflammation or weakness of collagen tends to occur are also referred to as

collagen diseases

what types of cancer does Bevacizumab (Avastin) mainly treat

colorectal, lung, and kidney cancer, and eye disease

Percutaneous electrical nerve-stimulation (PENS)

combines acupuncture with electrical stimulation of the nerves to achieve pain control.

integrative medicine

combines conventional western medical therapies and CAM yoga breathing to reduce need for medications immune enhancement products

extrinsic asthma

common chronic inflammatory disease of the airways- airway obstruction, bronchospasm

chronic pain interventions

comprehensive assessment OPQRST evaluate past control measures reduce or eliminate factors that precipitate or increase the pain experience nonpharmacologic techniques prescribed analgesics

superior vena cava syndrome

compressed or obstructed by tumor growth

risk for infection

compromised host precautions prophylactic antimicrobials

what is a compartment

confined space in-between fascia that contains muscle tissue, nerves, and blood vessels fascia doesn't expand

what is required with IV access

confirmation of patency of IV access as evidenced of good blood return is required

ruptured baker cysts (synovial cyst of the popliteal speace)

confused with DVT pain, edema, and inflammation of posterior knee and calf ultrasound dx rest, elevate, needle puncture of the calf, knee joint, aspiration, referral

2 types of immunodeficiency

congenital (primary) and acquired (secondary)

what is dematomyositis

connective-tissue disease that is characterized by inflammation of the muscles and the skin Immune complex deposition in the vessels considered to be part of a complement-mediated vasculopathy perivascular and perimysial inflammation, as well as perifascicular necrosis

as long as a woman is not hypercoagulable....

consider oral contraception don't increase flares

Complement

constitute a serum enzyme system that helps mediate inflammation

why are adjuvants used

contribute to the analgesia and calm fears and anxiety

what is the front line drug for acute rejection

corticosteroid bolus large dose IV 1 gram IVP for example

kidney damage may necessitate rx with

corticosteroids, cytotoxic agents, dialysis, or renal transplantation

options for emotional rest

counseling for the pt. and family

MOA of cyclophosphamide

cross links DNA resulting in cell death results in decreases numbers and activity of T and B cells

tophi

crystal deposition in SQ tissues cause small, white modules visible through the skin

what is gouty arthritis

crystallization in synovial fluid acute painful inflammation of the joint

best management of cancer cachexia is to

cure the cancer

what would you absorb if: cortisol

cushing's syndrome hyperglycemia osteoporosis production of acid

most common retinal change in SLE

cytoid bodies

cyclophosphamide bran name

cytoxan

irritants

damage intima of vein but not tissue

what eye problems may antimalarials cause

damage to the retine- impair vision-particularly color vision rarely blindness 1:5,000 retinal damage

prophylactic antimicrobial for PCP in those allergic to sulfa

dapsone- diaminodiphenyl sulfone

first anthracycline discovered

daunorubicin (Daunomycin) Doxorubicin (Adriamycin) shortly thereafter

acute rejection

days- a few months post-transplant cell-mediated process- lymphocytes main cells involved generally asymptomatic bc immunosuppresive drugs abnormal lab values (organ that was transplanted not functioning correctly)

corticosteroids (2) may help control ___________________

decadron deamethosone increased ICP

oral steroids

deltasone, also called prednisone

corticosteroids

dexamethasone/decadron useful for inflammatory hyperglycemia short-term side effect BS monitoring increased gastric acid secretion, retain fluid and Na- because has an aldosterone - increase BP

corticosteroids: 2 what do they do?

dexamthasone and prednisone reduce inflammation

some major causes of gout

diet accelerated rate of pure synthesis with overproduction of irc acid high grade cancer- tumor lysis syndrome

recommendations for people with SLE and weight changes

dietary plan w/ registered dietitian encourage exercise as tolerated record the pt's weight at each visit teach pt. to weigh themselves once a week

anaphylactic shock symptoms from latex

diff. breathing wheezing drop in BP dizziness loss of consciousness confusion slurred speech rapid or weak pulse blueness of your skin, including your lips and nail beds diarrhea NV

shawl or V sign

diffuse, flat, erythematous lesion over the back and shoulders or in a V over the posterior neck and back or neck and upper chest- worsens with UV

s/s of Sjorens

diminished lacrimal and salivary gland secretion complaints of burning, gritty, itchy eyes decreased tearing and photosensitivity complaints of dry mouth and nose

there are two types of latex: hardened rubber and dipped latex, with which do most allergic reactions occur?

dipped latex bc they're often used directly on the skin

potential problems of SLE eye problems

discomfort visual impairment potential for injury diff. carrying out activities of daily living

common latex products

dishwashing gloves, carpeting, waistbands on clothing, balloons, rubber toys, hot water bottles, baby bottle nipples, diapers, sanitary pads, rubber bands, erasers, condoms, diaphragms, swim goggles, racket handles, motorcycle and bicycle handgrips BP cuffs, stethoscopes, IV tubing, syringes, respirators, electrode pads, surgical masks

side effects of antidepressants

dizziness and GI problems

risks of IVIGs compared to immunosuppressive and corticosteroids

doesn't suppress the immune system in the same way as corticosteroids and immunosuppressives and therefore there is less risk

2 Anthracyclines

doxorubicin/adriamycin and daunorubicin

other items that should be handled with cytotoxic precautions

dressings/bandages diapers pads drainage tubes ostomy supplies soiled linen soiled clothing tissues

dry mouth tips

drink plenty of fluids, humidifying air, and good dental care to avoid dental decay stimulated to produce saliva by sucking on sugarless lemon drops or glycerin swabs dental care

cannabinoid

dronabinol/marinol

significant side effects first generation antihistamines

drowsiness dry mouth

Bevacizumab is a

drug that blocks angiogenesis humanized monoclonal antibody that binds to vascular endothelial growth factor A first clinically available angiogenesis inhibitor a drug approved from metastatic cancers

assessment for pts. with SLE and fever

drugs WBC count

spinal cord compression management

early recognition and treatment palliative high-dose corticosteroids high-dose radiation surgery external back or neck braces to reduce pressure in the spinal cord

x ray findings for RA

early stages- no findings other than soft tissue swelling in late stages- narrowing of joint spaces and subchondral erosions

changes in articular cartilage with OA

early- cartilage is thicker progresses to thinner and cartilage softens integrity of surface breeched deep cartilage ulcers

SVC s/s

edema of face= stokes' sign eden of neck= collar of stokes pemberton's sign: pt. eve late both arms until touch side of face, += facial congestion, cyanosis, respiratory distress edema of arms and hands, dyspnea, erythema, and epistaxis difficulty swalling/dysphagia HA stridor (breath sounds and lung function are typically clear/normal

asymptomatic hyperuricemia

elevated serum uric acid level no CMs

NV is a side effect because most chemotherapy drugs are __________

emetogenic

how do the vast majority of decongestants work

enchange norepi and eli or adrenergic activity by stimulating the a-adrenergic receptors vasoconstriction- reduced inflammation and mucus formation

common decongestants

ephedrine phenylephrine phenylpropanolamine synephrine pseudophedrine

what medication is given for anaphylaxis

epinephrine

Don't confuse one for IV/cardiac use with IM/subQ/anaphylaxis use

epinephrine injection 1:1000 (.01ml/kg) for anaphylaxis EPINEPHRINE INJECTION, USP, 1:10,000 FOR Intravenous or cardiac use.

grade 2

erythema and ulcers pts can swallow solid diet

Gottron's sign

erythmematous scaly eruption over the extensor surfaces of the MCP and digits, symmetric over the MCP and interphalngeal joints, elbows, and knees) mimic psoriasis

Gold administration

every week for first 22 weeks

what is SLE characterized by

exacerbations and remissions

what is extrinsic asthma caused by

exaggerated immune response to exogenous anti gents wheezing, coughing, chest tightness, and SOB

polyclonal antibodies

examples- antithymotic globulin ARG ATGAM

scleroderma is characterized by

excessive fibrosis in the skin and other affected organs

what exams are recommended at least every 6 months

eye exams

Immunodeficiency

failure of immune mechanisms of self-defense

treatment for compartment syndrome

fasciotomy- surgery immediately cuts through muscle tissue relieve the pressure left open or closed during second surgery 48-72 hours later maybe need skin grafts dressing loosened or cut down to relieve the pressure

Most frequently reported symptom of cancer and cancer treatment

fatigue

nearly universal complaint of patients with SLE even when no other manifestations of the disease are present

fatigue cause unknown- investigate for hypothyroidism, adrenal dysfunction, overextension, insomnia, depression, stress, anemia, and other inflammatory diseases fibromyalgia is a common cause of fatigue in SLE patients

if a pt. with lupus gets normal rest will it help their tiredness

fatigue my persist, won't refresh

symptoms of SLE

fatigue, arthralgia, arthritis, fever (>100F), skin rash, anemia, edema, pleurisy, facial rash, photosensitivity, alopecia, Raynaud's phenomenon, seizures, mouth or nose ulcers, arthralgias or arthritis (90%), vasculitis and rash (70-80%), renal disease (40-50%), hematologic changes (50%), CV (30-50%)

CM of hypercalcemia

fatigue, loss of appetite, NV, constipation, polyuria, severe muscle weakness, loss of deep tendon reflexes, paralytic ileum, dehydration, ECG changes

Autoimmune disease is one of the top 10 leading causes of death in

female children and women in all age groups up to 64 years of age

who is more at risk for polymyositis

females

who is more at risk for SLE

females, childbearing age first degree relatives of people with lupus- hereditary component

estrogens, progestins, or antiandrogen receptor drugs cause

feminine manifestations in men gynecomastia

systemic signs r/t RA

fever, malaise, rash lymphadenopathy, splenomegaly Raynauds phenomenon

benefits of radiopharmaceuticals

few side effects act on cancer while sparing soft tissue

how will body fill the defect

fibrocartilage inferior

late side effects of tele therapy

fibrosis (scar tissue- restricted movement) damage to the bowels- diarrhea and bleeding memory loss infertility second cancer (rare)

cartilage

fibrous CT- closely packed collagenous in a rubbery gelatinous substance called chondrin

risks of having a child with heart block for a mother with anti-Ro (SSA) and anti-La (SSB) antibodies

first time moms or moms who have had healthy babies (2%) for moms who have previously given birth to a child with heart block (18%)

medium protein foods to limit

fish and shell fish poultry, beef, lamb, pork, and other red meats, dried beans, peas, lentils, asparagus, muschorroms, spinach, cauliflower, green peas, lasts, wheat germ and bran, whole grain breads and cereals

what if pain is consistently just before it is time to take your next does of medication?

fixed-scheduled medication needs to e adjusted

erythroderma

flat, erythematous lesion similar to the shawl sign but located in the malar region and the forehead

meditation

focus on his or her own breathing or repetition of a word

high dose methotrexate

folic acid antagonist tumor lysis syndrome- uric acid will crystalize in acidic environment need to alkalize the blood continuous bicarbonate IV- urine pH 7 or above rescue with Ca Leukovorin (folic acid) given every 6 hours after 24 hours following people can end up going into renal failure

when is ice used?

for acute inflammation

what is the result of pannus

formation inhibits joint tissue regeneration formation of scar tissue that immobilizes the joint pain, joint deformity, and loss of function

describe fatigue r/t lupus

frequent, persistent complaint often described as a bone-tired feeling or a paralyzing feeling

instructions for sun-sensitive pts

frequently apply suncreen- UVA and UVB at least SPF 15 avoid unprotected exposure between 10 and 4 reflected off water and snow glass doesn't provide protection fluorescent and halogen lights may emit UV rays and can aggravate lupus

arthrodesis

fusion of a joint for stabilization and pain relief Bone ends are fixed together by hardware (screws, pins, plates, nails)

Antiseizure drug that can help control peripheral neuropathy caused by what three medications

gabapentin (Neurontin) carboplatin, etoposide, vincristine

ESR and CRP are nonspecific tests to detect

generalized inflammation increased with active lupus decreases with corticosteroids or NSAIDs don't directly reflect disease activity

some causes for autoimmune disease

genetic environmental hormonal immunological stress

autoimmune CTDs are caused by

genetic and environmental

recommendations for people with SLE and fatigue

get 8-10 hours of sleep at night exercise encouraged as tolerated energy-conserving plan may need a nap

how is more production in the bone marrow induced and more stem cells into the circulation achieved

give pt. hematopoietic growth factors

neoadjuvant chemo

given before other rx, such as surgery, with the goal of decreasing the tumor cell burden

what eye problems may corticosteroids cause

glaucoma cataracts

how does gold work to treat RA

gold salts appear to accumulate slowly in the body and, over time, they reduce inflammation and slow the progression of rheumatoid arthritis.

what is elevated serum uric acid

greater than 7.5

common reactions of pts. with lupus

grief, depression, and anger

possible side effects of Arava

hair loss, irritation of the liver, rash, nausea, diarrhea, and abdominal pain

general characteristics of breakthrough pain

happens fast lasts from seconds to minutes to hours avg. duration was 30 minutes unexpectedly for no obvious reasons or triggered by an activity like coughing, moving, or going to the bathroom

cytotoxic precautions

harmful for the cells in the body medication or body fluids must not come in contact with other people hugging, kissing, and touching are all safe beginning 48-72 hours after chemo completion

Fifty percent of people with lupus _________________

have clinical renal disease.

care for older adult with THA

heals off bed prevent ulcers move slowly0 orthostatic hypo get out of bed ASAP to avoid respiratory complications- incentive spirometer mental status change may mean infection w/p fever need for psin meds

do these conditions r/t neonatal lupus last?

heart block almost always permanent- pacemaker for life skin rash usually appears about 6 weeks, disappears at 8 months liver and blood problems also transient

most common manifestation of neonatal lupus

heart block- heart beats abnormally slowly rash- most often see around the eyes

why are anticonsulvants taken?

help relieve neuropathic (nerve) pain

Ifosphamide

hemmorhagic cystitis potential- urine dipstick for blood MESNA- bladder protective agent

what to loo out for with phosphamides

hemorrhagic cystitis give MESNA given choice to bank sperm or eggs

phosphamide

hemorrhagic systitis

What is gout

heterogenous, metabolic disease that is often familial abnormal amounts of urates in the body overproduction or under excretion of uric acid

moderate to severe pain treatment

higher doses of opioid medications often not given as combination products. Adjuvant medications, NSAIDs, and acetaminophen may also be used. The opioid medications used to treat moderate to severe pain include morphine, fentanyl, oxycodone, and hydromorphone.

pros and cons of surgery

highest rate of cure for localized disease in most instances cons: deforming, debilitating

7 mediators in Type I hypersensitivity reaction

histamine leukotrines prostaglandins platelet-activating factor kinins serotonin anaphylatoxins

alternative medical systems

homeopathy naturopathy traditional Chinese medicine (TCM) Ayurveda

how are hormones related to SLE?

hormones are more prevalent in women during their reproductive years flares during pregnancy/postpartum

what are corticosteroids

hormones secreted by the cortex of the adrenal gland

pathogenesis of scleroderma

host may have genetic susceptibility, infection, environmental factors, or microchimerism that leads to vascular problems (endothelial cell injury, vasoconstriction, vascular occlusion, tissue hypoxia) and immune reactions (T cell activation, macrophage activation, autoantibodies, cytokines)- fibroblast activation and growth- fibrosis

MHC is known as the _________ in humans

human leukocyte antigen (HLA) series of genes located on chromosome 6

assessment prior to giving NSAIDs

hx: allergy to salicylates or other NSAIDs, cardiovascular dysfunction, hypertension, peptic ulcer, GI bleeding or other bleeding disorders, impaired hepatic or renal function, pregnancy, and lactation Laboratory data: hepatic and renal studies, complete blood count (CBC), clotting times, urinalysis, serum electrolytes, and stool for occult blood Physical: all body systems to determine baseline data and alterations in function, skin color, lesions, edema, hearing, orientation, reflexes, temperature, pulse, respirations, and blood pressure

other corticosteroids include

hydrocortisone methylprednisolone dexamethasone (Decadro)

two most often prescribed antimalarials

hydroxycholorquine sulfate (Plaquenil) and chloroquine (Aralen)

5) cellulose film-forming agents for covering localized ulcerative lesions

hydroxypropyl cellulose

3 types of rejection

hyperacute, acute, and chronic

PTH ectopic hormone production

hypercalcemia brittle bones

side effects of corticosteroids

hyperglycemia PUD HTN Na/H2O retention osteoporosis increased infection risk delayed healing fragile skin easy bruising hirsutism psychiatric manigestations

two broad types of immune disorders

hypersensitivity immunodeficiency

type I hypersensitivity is

hypersensitivity of allergens that may be inhaled, ingested, injected, contacted

calcitonin ectopic hormone

hypocalcemia

congenital (primary) immunodeficiency

hypogammaglobulinemia- deficient immunoglobulins severe ombined immune deficiencies- SCIDs DiGeorge syndrome- congenital thymic aplasia/hypoplasia

collaborative care of SIADH

hyponatremia restore normal fluid and Na balance- restrict fluid, administer sodium provide supportive care

which NSAID medications cause GI problems

ibuprofen and aspirin not acetaminophen

which NSAIDs have a greater impact on inflammation

ibuprofen, aspirin and naproxen > acetominophen

Extrasynovial rhumatoid nodules

identical to nodules of Rheumatic Fever central tissue necrosis proliferating CT skin, cardiac valves, pericardium, plea, lung parenchyma, spleen

ra etiology

idiopathic autoantibody (Rheumatoid Factor) Chronic inflammation releasing cytokines infectious (E-B Virus, papovirus, mycobacteria) genetic predisposition (2-3 times more likely) trauma

cause of dermatomyositis

idiopathic triggers: virus (manly previously dx with infectious mononucleosis and EPV), medication, stress overlap with SLE, scleroderma, vasculitis

cause of polymyositis

idiopathic related to autoimmune factors, genetics, viruses, infectious- pathogens that cause lyme disease, toxoplasmosis, stress initial injury- muscle autoantigen released and subsequently taken up by macrophages and CD4 + TH cells, further inglammatory mediator release, CD8 cytotoxic cells- muscle destruction

MOA of ATGAM

immunizing horse with human T cells directed against T cells

treatment of graft rejection

immunosuppression

For people with very severe symptoms, and those who cannot take allergy medications-

immunotherapy is an alternative

what does epinephrine do

improve breathing through beta2 stimulation and bronchodilation stimulate heart through beta 1 raise a dropping blood pressure through alpha stimulation and vasoconstriction reverse hives, reduce swelling of face, lips, and throat

second option for cancer cachexia

improve nutrition

when are opiates typically used

in PCA

angiogenesis inhibitors

include thalidomide, endostatin and bevacizumab/Avastin

alternative/complementary therapy

includes cognitive/behavioral techniques such as relaxation (reduces tension in muscles)- quiet or deep breathing, distraction, and visualization and mind/body techniques such as hypnosis and biofeedback.

short and long term side effects of corticosteroids

increased appetite and weight gain- short weight gain, moon face, osteoporosis, and other side effects- long

side effects of mycophenolate mofetil

increased infection risk thrombocytpenia diarrhea NV

what is interstitial lung disease associated with

increased morbidity and mortality

massage

increases blood circulation and relieves tension

biggest risk w/ CVL

infection

viruses and lupus

infectious agents such as viruses infect B cells and cause them to produce autoantibodies Epstein-Barr virus cross react with bodily proteins in genetically susceptible people

tachycardia is frequently the result of

inflamed heart tissue or infection

In patients with connective tissue disease, it is common for collagen and elastin to become injured by _____________

inflammation

cervical spine radiography

inflammation and destruction of cartilage, bone, and ligaments. This most commonly occurs in the upper cervical spine. Laxity and destruction of ligaments can lead to significant instability with frank subluxation and cord damage.

oral mucositis

inflammation of oral mucosa erythema or ulceration

SLE

inflammation of the CT can effect every organ system

pericarditis

inflammation of the pericardium is the most common cardiac abnormality in SLE

serositis

inflammation of the serous tissues of the body, the tissues lining the lungs (pleura), heart (pericardium), and the inner lining of the abdomen (peritoneum) and organs within

eye problems are related to __________

inflammatory process due to drug rx (cortico or antimalarials) separate problem

mast cell stabilizers are available as

inhalers (for asthma) eyedrops (allergic conjuctivitis) nasal sprays (allergy symptoms)

lupus anticoagulants

inhibit certain anticoag tests but are associated with thrombosis, pregnancy loss, and other manifestations of the antiphospholipid syndrome

MOA of corticosteroids

inhibits T cell activation and proliferations inhibits cytokine production suppresses inflammation

MOA of mycophenolate mofetil

inhibits purine synthesis suppresses T and B cell proliferation

Azathioprine MOA

inhibits purine synthesis supresses T and B cell proliferation

causes of perineal nerve injury

injury to leg trauma- broken leg, knee injury, surgery, ankle injuries

what else can antidepressants help cope with

insomnia take at bedtime

osteogenesis imperfecta (brittle bone disease)

insufficient production of good quality collagen to produce healthy, strong bones

potential adverse effects of Bevacizumab

interfere with normal processes such as wound healing and worsen problems r/t CAD and PAD

brachytherapy is also known as

internal radiotherapy sealed source radiotherapy curietherapy endocurietherapy

brachytherapy

internal therapy includes placement of radioactive substances in or near the site of cancer or the injection or ingestion of radioactive isotopes emits radiation for a period of time and is a hazard to others

what is a frequent manifestation of polymyositis?

interstitial lung disease

xenotransplants

involve transfer across species barriers Currently, xenotransplants are largely experimental and relegated to the laboratory, given the complex, potent immunologic barriers to success. pig valve transplantation in humans has been done successfully for many years

allotransplants

involve transfer from one individual to a different individual of the same species the most common scenario for most solid organ transplants performed today.

GFR

is done by collecting a 24-hour urine sample for measurement of creatinine clearance.

peripheral blood stem cell transplant

is the harvesting of a patient's own circulating stem cells for later reinfusion

mild latex allergy

itching, skin redness, hives or rash

Hx for antimalarials

known allergies to the prescribed drugs, psoriasis, retinal disease, hepatic disease, alcoholism, pregnancy, and lactation CBC, liver function tests, and G6PD deficiency all body systems to determine baseline data and alterations in function, skin color and lesions, mucous membranes, hair, reflexes, muscle strength, auditory and opthalmologic screening, liver palpation, and abdominal examination

where is EpiPen administered

large outer thigh muscles

what appears later

larger weight bearing joints

sunlight r/t lupus

lead to skin rash and exacerbate systemic manifestations of lupus exposure to UVA or UVB light- certain cellular porteins to accumulate in abnormally large amounts on the cell's surface

Tophaceous gout

lesions of chronicity deposit of irate crystals painless, irregular swellings helix of ear fingers, hands, knees, feet ulnar sugace of forearm, tibial surface of leg achilles tendon olecranon bursa r/t carpal tunnel syndrome

the effects of antihistamines

less likely to have an inflamed nasal passage- less runny nose, sneezing, and other symptoms

how much pain is associated with early stages of malignancy?

little or no pain

what to document r/t oral mucosa?

location, size and character of fissures, blisters, sores and drainage

why can nasal spray and eye drop decongestants only be used for a few days

long term use makes symptoms worse rebound decongestion

adipose

loose CT that stores fat

benzodiaxapines

lorazepam/ativan

X rays of DJD

loss of articular cartilage osteophytes- bone spurs

what is sclerodactyly

loss of skin creases, joint contractures, and sparse hair

chronic management between attacks

low purine ETOH and specific foods greater than 3 liters of liquid per day avoid thiazide and loon diretics- inhibit renal excretion of uric acid (hydrochlorothiazide, furosemide) avoid nicotinic acid avoid ASA

where is compartment syndrome most common

lower leg and forearm hand, foot, thigh, and upper arm

side effects of anticonvulsants

lowered blood counts, dizziness, blurred vision, and nausea

specific eye problems r/t lupus

lupus rash on eyelids dry-eye related to Sjoren's syndrome= Kerato-conjunctivitis- need artificial tears cytoid bodies reflect microangiopathy of the retinal capillaries and localized microinfarction of the superficial nerve fiber layers of the retina.

two meds for fibromyalgia

lyrica (pregabalin) cymbalta (duloxetine)

diagnosis of systemic sclerosis

major criteria 1) sclerodermatous involvement proximal to the digits minor criteria 1) sclerodactyly 2) digital pitting scars or tissue loss of the volar pads of the fingertips 3) bibasilar pulmonary fibrosis

main antigens involved in triggering the rejection process are coded for by a group of genes known as

major histocompatibility complex (MHC)

surgical procedures for ra

major joint surgery- covered with DJD

In postmenopausal women taking DHEA what must be monitored?

mammograms and PAP smears

complementary and alternative therapy

manipulative and body-based (chiropractic, osteopathic, and massage) mind-body (meditation, prayer, art, music, and dance) biological based (herbs, vitamins, and natural products) energy- biofield, Qjong, and bioelectromagnetic

side effects of androgens

masculinize women acne, hypercalcemia, liver dysfunction

how does Bevacizuman (Avastin) relate to wound healing

may be slow or incomplete even fatal stop 28 days before voluntary surgery until wound fully healed stop if patients experience slow wound healing

surgery r/t SLE

may exacerbate hospitalization required for minor surgery discharge delayed if elective postpone until under control

when are full effects of mast cell stabilizers felt

may take several weeks

ways NSAID therapy is variable

may work on a patient for some time and then for some unknown reason, stop working switch patient to a diff. NSAID only take one NSAID at any given time

carpal tunnel syndrome

median nerve compression neuropathy pain or paresthesias Phalen or Tinel test rest, immobilization, NSAIDs, surgery

humoral rejection

mediated by recipient's antibodies blood trnasufison, previous transplant, or pregnancy

Disease Modifying Antirheumatic Drugs (DMARDs)

medications that work by altering the immune system. These drugs halt the underlying processes that cause certain forms of inflammatory arthritis including RA, Ankylosing spondylitis, and psoriatic arthritis

what to assess for weight changes r/t SLE

meidcation usual dietary intake

who doesn't use DHEA

men

90% of people with primary gout are

men over 30

what are antimalarials usually combined with?

methotrexate or sulfasalzine

prokinetic agents

metoclopramide/reglan

systemic lupus erythematosus varies greatly in severity from

mild cases to severe cases w/ sig. and potentially fatal damage to vital organs such as the lungs, heart, kidneys, and brain

mast cells are used to rx

mild to mod. inflammation in the bronchial tubes and other allergy symptoms prevent asthma symptoms during exercise- given b4 exposure to allergen

coating agents combined with topical anesthetics

milk of magnesia kaolin with pectin suspension mixtures of aluminum MgOH- many antacids

protein foods with high biologic value

milk: double-strength; cheese (especially cottage, also cheddar), tuna fish, fish, chicken, pork

bone

mineralized CT that contains collagen and CaPO4

discharge teaching

minimize stress on new hip- avoid lifting 20-40 pounds, avoid gaining weight signs of wound infection exercise program as ordered routine post op discharge instruction

post-op nursing care

monitor for bleeding- empty drains, observe dressing, mark drainage may require fluid resuscitation, blood transfusions EBL on operative report orthostatic hypotension monitor urine output

nursing considerations r/t mycophenolate mofetil

monitor for infections monitor CBC monitor and manage GI dysfunction

nursing considerations r/t azathioprine

monitor for infections and CBC

biological response modifiers

monoclonal antibodies (e.g., trastuzumab [Herceptin] and rituximab [Rituxan]), cytokines (interferons, interleukins), vaccines, gene therapy and immunostimulants (BCG).3

TNF inhibitors

monoclonal antibodies afainst TNF Infliximab/remicade and adalimumab/Humira entanercept/Enbrel Interleukins (Kineret)

chronic rejection

months-years post-transplant increasingly common atrophy, fibrosis, and arteriosclerosis

cellular rejection

more common type of rejection after organ transplants Mediated by T lymphocytes activation and proliferation after exposure to donor MHC molecules

What is sensitization

more exposure you have, more likely your body is going to respond

what is used for chronic inflammation: heat or ice

more often heat

monoclonal antibodies example

moromonab- OKT3

how is breakthrough pain most commonly treated in the hospital?

morphine or dilaudid/hydromorphone IVP

Pros of anthracyclines

most effective anticancer treatment against more types of cancer than nay other class

second generation antihistamines

much less likely to have side effects of sedation and dry mouth long-acting option allegra (fexofenadine) claritin (loratidine) zyrtec (ceterizine)

grade 4

mucositis to the extent that alimentation is not possible

what is the only truly diagnostic thing for dermatomyositis?

muscle biopsy

administration of steroids- how often? how long until effects?

must be taken daily may take 1-2 weeks before full effect of medication

NSAIDs r/t gout

naproxen, indomethacin, voltaren (diclonfenac) active PUD, impaired renal functions and allergic response to NSAIDs would be contraindications

naprosyn is a brand name for what?

naproxin

effects of histamine in the body

nasal passage swelling, and swelling of airways increased vascular permeability, constriction of smooth muscle, stimulation of irritant receptors

routes of administration of decongestants

nasal spray, eye drop, liquid, or pill form

platin

nephrotoxic

what do we worry about with cysplatin

nephrotoxic

3 anticonvulsant medications used for cancer pain

neuontin tegretol klonopin

CSFs that can shorten this

neupogen neulasta epoietin alfa

what is the most commonly used adjuvant

neurontin (gabapentin)

damage from RA results from which cells

neutrophils T-cells cytokines

is immunosuppression required for autotransplants?

no

is immunosuppression required for xenotransplants?

no

is the pt. radioactive in tele therapy?

no

are antimalarials stopped with pregnancy

no They do cross the placenta, but a clinical trial and case studies have not found safety issues.

treatment of latex allergy

no cure, based on prevention avoid products that contain latex less severe- antihistamines and corticosteroid creams severe- carry EpiPen shock- Epi, trip to ER, O2, corticosteroids

rx for dermatomyelotitis

no known cure specialized exercise therapy medication: corticosteroids and immunosuppressants stress management

grade 0

none

what is normal CRP? High?

normal is 0 high is above 1 usually with inflammation above 10 mg

how does synovial fluid differ in those that have RA

normal: clear and yellow with WBCs less than 200 RA: turbine with WBCs 15,000-20,000

how will CBC for someone with RA look

normocytic normochromic anemia of chronic disease

immunizations r/t lupus

not been shown to exacerbate SLE influenza nad pneumococcal vaccines routinely recommended

MOA of IVIGs

not well understood reduce antibody production or promote the clearance of immune complexes from the body

symptoms of perineal nerve injury

numbness, ingling, pins and needles sensation foot droop- foot in plantar flexion pain in foot or shin foot weakness

prophylactic antimicrobial for fungal infections

nystatin or mycelex/clotrimazole

DJD is r/t

obesity, trauma, weight bearing stresses, genetics, hormones, aging, immune responses, and congenital abnormalities

during chemo

occur when give and for 1-2 days after

How is the dose of corticosteroids decided

once the symptoms of lupus have responded to rx the dose is usually tapered until the lowest possible dose that controls disease activity is achieved- monitor patients during this time for pain, fever, fatigue some only during active stages of the disease severe disease or more serious organ involvement- long term treatment

serotonin antagonists

ondanestron/zofran

Protein/creatinine ratio

one-time voided specimen

forms of leukotriene antagonists

only available with prescription pills, chewable tablets, oral granules

mild to moderate pain treatment

opioid medications are often used, usually as combination tablets with NSAIDs or acetaminophen. Some of the opioid medications used as combination products are hydrocodone, codeine, or oxycodone. Adjuvant medications may also be used for pain that is difficult to manage. Adjuvants are medications that were originally designed to treat conditions other than pain, such as tricyclic antidepressants.

collaborative care for RA

optimal nutrition- weight reduction, iron rich foods plus Ca and vit. D client and family coping OT and PT relxation techniques community referrals

do oral contraceptives or oral therapy increased SLE flares?

oral contraceptives do not increase flares in SLE, but hormone therapy does cause an increase in mild-to-moderate flares

Administration of immunosuppressives

orally and intravenously

routes of admin. for opioids

orally, by patch, rectally, by injection, transmucosally and are formulated to be long- and short-acting

methotrexate

originally developed as a cancer treatment and later approved for RA- antimetabolie lupus arthritis CBC and liver function tests prescribed daily folic acid

surgeries for OA

osteotomy, arthroplasty, or total joint replacement arthroscopic surgery for knee and hip autologous chondrocyte transplantation for younger clients

what may other people who are allergic to latex react with

other rubber- such as erasers, rubber toy parts, rubber bands, rubber in medical devices, and rubber in the elastic in clothing

peroneal nerve injury

outside part of lower knee foot droop can occur can't dorsiflex sooner treated, better outcome

how fast does polymyositis come on

over weeks to months

secondary gout results from

overproduction of uric acid results from cancer, cytotoxic drugs Paget's disease, multiple myeloma

autologous BMT

own bone marrow removed before the intensive rx then rein fused

what other notable opioid can be used

oxycodone

DOA oxycodone v. oxycontin

oxycodone- short acting 4-6 hours oxycontin- sustained release (can't crush it) 2 times daily

one side effect of radiopharmaceuticals

pain increase before it decreases

octreotide (Sandostatin)

pain of bowel obstruction controls sever diarrhea

capsaicin cream

pain relief depletes substance P

local manifestations appear gradually. what tends to start initially

painful tender joints of the MCP and PIP of hands and wrists DIP too

fibrin that develops into granulation tissue is called

pannus

physical therapy goals for RA

paraffin baths, heat lamps heat and cold compresses to maintain joint and muscle strength water exercises are good which eases joint movements

who shouldn't take acetaminophen?

people who have three or more alcoholic drinks in the course of 24 hours

who shouldn't take Arava

people with liver disease, pregnant or nursing women, people with immune systems weakened by an immune deficiency or disorder

opioids combined with acetaminophen

percocet tylox

opioids combined with aspirin

percodan

Carboplatin

peripheral neuropathy central neurotoxicity: dizziness, confusion, visual changes, ringing in the ears nephrotoxicity

etoposide

peripheral neuropathy (numbness in fingers and toes) may occur with repeated doses

vincristine

peripheral neuropathy (numbness in fingers and toes) may occur with repeated doses

complications of compartment syndrome

permanent injury to nerves and muscles amputation

how is stress related to autoimmune disease

physical and psychological stress 80% reported uncommon emotional stress before the disease onset stress-related hormones lead to immune dysregulation altering and amplifying cytokine production

routes of steroid administration

pills (severe allergies), inhalers (asthma), nasal sprays (seasonal and year round allergies) creams (skin allergies), eye drops (allergic conjunctivitis)

which routes can be taken longer safely

pills and liquid

what is often found in the lumen of the narrowed vessels

platelet microthrombi

pleuritic chest pain

pleurisy- most common respiratory manifestation in SLE can also be associated with pleural effusions

eryhtropoietin hormone production

polycythemia- plethora risk for thromboembolism

most common protocols for NV r/t chemo

pre-chemo antimetic prescription multiple antiseptics scheduled throughout chemo protocol and for 1-2 days afterwards PRN anti emetics available for breakthrough nausea

best early indicator of nutritional problems

prealbumin

MOA of ATG

prepared by immunizing rabbit with human T cells

opioids are always _________ medication

prescription

what to assess in pt. with fatigue

presence of depression, anxiety, other stressors daily activity levels

lab findings for PM

presence of specific autoantibodies in > 65% of pts. elevated serum creatine kinase (CPK)

cyclosporine

prevent body from rejecting transplanted organs rheumatic diseases treats antimetabolite

neonatal lupus

problems in the heart, skin, liver, and blood not the same as SLE associated with maternal antibodies anti-Ro(SSA) and anti-La(SSB) identified in utero 18-24 weeks

Ehlers-Danlos syndrome

progressive deterioration of collagens, different EDS affecting different sites in the body, such as joints, heart valves, organ walls, arterial walls

immunosuppressants r/t RA

progressive disease methotrexate azathiprine using earlier in disease process

what to do after hair falls out?

protect your head from the sun use sunscreen or wear a hat when outside protect head from the cold, wear a hat or scarf try wearing a soft scarf when you sleep

what can be given to help with gastric upset caused by NSAIDs

proton pump inhibitors such as protoprazole H2 receptor blockers- ranitidin, phanotidine, symantidine

which decongestant is controlled for behind the counter use? why?

pseudophedrine- sudafe used to make meth

cervical spine instability

pts. with established RA who have degeneration of the ligaments and bone in the C-spine area instability at C1-C2 level minor trauma- neurologic sequelae

how often do you assess oral mucosa?

q4 roof of mouth, under tongue, between teeth and cheeks

short-acting bronchodilator

quick relief for symptoms during an attack

myocardial infarction

r.t atherosclerosis increased in SLE patients even below 35 years

potential side effects of teleltherapy

radiation therapy can cause both early and late side effects acute side effects during treatment and chronic side effects occur months or even years after rx ends

unsealed soluble isotopes

radioactive iodine (for thyroid cancer) enters body fluids via oral or IV routes eliminated in excreta eliminated within 48 hours

use of corticosteroids for allergies

reduce inflammation prevent and treat nasal stuffiness, sneezing, itchy runny nose decrease inflammation and swelling from other types of allergic reactions

MOA corticosteroids

reduce inflammation suppress immune response control exacerbation of symptoms control severe forms of the disease serious illness or prior to surgery- administered IV

chondrotin sulfate

reduce painful symptoms improve walking distance longer to produce results than NSAIDs but last three months after medication stopped slow progression of disease increases amount of hyaluronic acid and inhibits the activity of enzymes that break down cartilage anti-inflammatory properites to provide pain relief

immunosuppressives are generally used to

reduce rejection of transplanted organs.

when can cancer also be used

reduce tumor cell burden before other therapy palliate symptoms to stage cancer to slow tumor groth

lupus nephritis can lead to

reduced levels of creatinine clearance

why used for OA?

reduces symptoms and slowed longterm progression minimal adverse effects comb. with condroitin glycosaminoglycans and hyaluronic acid, thereby serving as a substrate for the production of articular cartilage longer onset of action than NSAIDs

NSAIds

reducing swelling and inflammation. Some NSAIDs, notably ibuprofen, aspirin and naproxen, have a greater impact on inflammation than does acetaminophen can cause gastrointestinal problems, especially ibuprofen and aspirin. Acetaminophen does not cause this side effect, and the newest NSAIDs, the COX-2 inhibitors Celebrex and Vioxx, reportedly have a minimal impact on the gastrointestinal tract. shouldn't be taken if people have 3 or more alcoholic drinks

allopurinol

refer to tumor lysis syndrome talk

what tests need done when taking Arava

regular blood tests for liver function and blood count testing

Linen contaminated with body fluids from patients who have received chemotherapy in the past 48 hours may be bagged in a ______________ and placed with dirty linens to be laundered.

regular linen bag

what test should be done for those taking gold

regular urine tests to check protein and blood tests for kidney function

HLA molecules can initiate

rejection and graft disease via humoral or cellular mechanisms

how do bronchodilators work

relax muscle bands that tighten around airways through Beta 2 adrenergic stimulation improves breathing help clear mucus

Transcutaneous electrical nerve stimulation (TENS)

relieves pain by sending small electrical impulses through electrodes placed on the skin to underlying nerve fibers.

other major features of OA

remodeling and hypertrophy of bone bony sclerosis osteophytes or bone spurs- restrict movement periarticular muscle wasting

osteotomy

removal of a wedge of bone to correct deformity and achieve alignment and thus relieving pain.

synovectomy

removal of synovial membrane in affected joints; prevents tendon rupture

crystal aggregates deposited in the kidneys can lead to

renal stones and renal failure 1000 times more prevalent than in general population

tenosynovectomy

repair or removal of damaged tendons

Total hip arthroplasty

replacement of acetabulum and head of femur with prosthesis RA and DJD with severe disability and pain fractured hip with nonunion

alternative therapies

replacements for western medicine

what do you need to assess specifically for?

respiratory depression/sedation

TKA

resurfacing of the femur, tibia and patella with metal and plastic components

what to do with dislodged implants

retrieve with long forceps dispose in lead container

Raynaud's Phenomenon

reversible ischemia of peripheral arterioles various stimui exposure to cold or stress intense vasospasm and associated pallor and often cyanosis hyperemic phase with associated erythema rarely tissue necrosis fingers, tose, nose, ears, tongue

Mechanic's hands

rough, cracked skin at the tips and lateral aspects of the fingers forming irregular dirty-appearing, lines that resemble those seen in a laborer

doxorubicin/adriamycin and daunorubicin

rubicins, anthracycline red color potentially cardiotoxic: cardiac assessment- scans and physical assessment BNP is most diagnostic for HF

complementary medicine

rx inconjuction with western medicine aromatherapy can be used to lessen pt's discomfort after surgery

adjuvant chemo

rx of chancre w/ drugs after surgical resection of the primary tumor when there is a high risk of systemic recurrence- breast and colon cancer

CM of graft rejection

s/ of dysfunction of transplanted tissue or organ s/ of failure of above

when to go to the doctor

s/ of eye infection, redness, pain

drug of first choice for RA

salicylates ASA 4-6 g daily

sealed implants

seeds or needles implanted into specific tissues patient is radioactive, excreta are not radioactive

prescription combination drugs

semprex-D Naphcon, Vasocon, Zaditor, Patanol, Optivar

Patients with Felty syndrome are prone to

serious bacterial infections

compartment syndrome

serious condition involving increased pressure in a muscle compartment muscle and nerve damage and problems with blood flow

side effects of polyclonal antibodies

serum sickness (type III reaction- fever, chills, muscle and joint pain) back pain dyspnea hypotension myelosuppression increased infection risk anaphylaxis

customary to give

several at scheduled intervals around the clock several PRN for breakthrough

how is immunotherapy done

several injections given regularly over several years first shots very tiny amounts of antigens, progressively increase dosages over time your body with adjust to the antigen and become less sensitive to it desensitization 3 to 5 year regimen only partially effective in some

how often do most people with breakthrough pain experience episodes?

several times a day

Antimalarials r/t RA

severe disease effects begin in 3 months chloroquine, hydroxychloroquine side effects: N, abdominal discomfort, rash, blurred vision, retinal damage

what is universally present in affected organs for those with scleroderma

severe fibroproliferative vasculopathy that affects small arteries and arterioles

vasicants

severe local tissue breakdown and necrosis

compartment syndrome causes

severe pain that does not go away when you take pain medicine or raise the affected area. Decreased sensation Numbness and tingling Paleness of skin Weakness

glucosamine is prepared from

shells of crabs and other shellfish

are side effects from immunosuppressive reversible

side effects are dose-dependent and are generally reversible by reducing the dose or stopping the medication

Colchicine

sig. side effects- ab cramps, diarrhea, NV given within first few hours after onset of symptoms

toxic exposures r/t lupus include

silica and mercury

MOA of sirolimus

similar suppressive effect on immune system inhibits IL-2 and other cytokines blocking activation of T and B cells

what to assess for SLE r/t CP manifestations

skin color and temperature lesions cap. refill edema/pain in extremities

acute tele therapy side effects

skin irritation or tissue damage fatigue nausea (especially with abdomen and brain)

Thalidomide MOA

sleep aid rx skin manifestations of lupus by inhibiting inflammatory cytokines in the skin and underlying blood vessels

Mechanism of fatigue is unknown but associated with a variety of factors such as:

sleep disturbance biochemical changes related to disease and treatment psychosocial factors level of activity Nutrition other environmental and physical factors

remission-inducing agents

slow acting drugs effects begin after 2 months gold salts (Ridaura) penicillamine (Depen)

morre severe latex allergy

sneezing, runny nose, itchy, watery eyes, scratchy throat, difficulty breathing, wheezing, cough

do all pts with SLE take medications

some never require medications others only as needed many require constant therapy with variable doses

grade 1

soreness and erythema

cytotoxic precautions include what equipment

special gowns gloves masks goggles special waste containers red linen bags special clean up kits for big spills

Anti-Sm

specific for SLE but only 30 percent of patients with SLE have a positive anti-Sm test

pregnancy complications r/t lupus

spontaneous abortion and premature delivery more common for women with SLE

when is chemotherapy used

spread of malignant cells risk of recurrence systemically is high

medications that shouldn't be consumed with grapefruit juice

statins, antihstamines (fexofenadine and terfenadine), calcium channel blockers, psychiatric medications (buspirone, triazolam, carbamazepine, diazepam, midazolam, sertraline) intestinal medications (cisapride) immune suppressants (cyclosporine and tacrolimus) methadone (pain), sildenafil-viagra (impotence drug), HIV medication (saquinavir), antiarrhythmics- amiodarone (cordarone) and disopyramide (norpace)

what is heat therapy especially useful for

stiffness

side effects of leukotriene modifiers

stomach pain or stomach upset heart burn fever stuffy nose cough rash HA

side effect of condroitin

stomach upset nausea allergic bc made from cow sources

how do mast cell stabilizers work?

stop release of histamine from mast cells some have important anti-inflammatory effects

Rheumatology

sub-specialty in internal medicine and pediatrics, devoted to diagnosis and therapy of rheumatic diseases. Clinicians who specialize in rheumatology are called rheumatologists. Rheumatologists deal mainly with clinical problems involving joints, soft tissues, autoimmune diseases, vasculitis, and heritable connective tissue disorders.

what is xerostomia

subjective symptom dry mouth

CM of gout

sudden onset, night affected great toe assymmetric fever common to 39 C swollen, very tender with overlying skin tense, warm, and dusky red local desquamation and pruruitus tophi on external ears, hands, feet, elbow and pre patellar bursa

medications that increase the risk of lupus flare

sulfonamide antibiotics

things to kelp with mild to moderate OA

supervised waling program weight reduction assistive devices warm compresses rest and reduction to stress PT and OT collaboration referrals preparation for surgery

rx for perineal nerve injury

surgery, repairing, taking pressure off, grafting new nerve PT Orthotics- ankle and foot brace

Describe the joints in RA

symmetric joint swelling feels warm and boggy ruddy and cyanotic color thin and shiny skin

why is SLE so difficult to diagnose?

symptoms may be vague easily confused with other disorders transient or prolonged severe symptoms with few abnormal lab test results

first joint tissue involved in RA

synovial membrane

Danazol

synthetic derivative of testosterone, inhibits pituitary secretion of LH and follicle-stimulating hormone (FSH), which decreases estrogen synthesis from the testicles. The dose used for gynecomastia is 200mg twice daily. Complete resolution of breast enlargement has been reported in 23% of cases. Adverse effects include weight gain, acne, muscle cramps, fluid retention, nausea, and abnormal liver function test results.

advantages of chemo

systemic useful against disseminated

disadvantages of chemo

systemic adverse effects myelopsuppression; infection; bleeding;anemia leukopenia, infection anorexia, mucositis, NV, diarrhea alopecia reproductive dysfunction

how to care for oral mucosa

systemic assessment of oral cavity to identify lesions early oral hygiene and other supportive care measures assessment scales to grade the level of stomatitis

RA

systemic disorder in which immune cells attack and inflame the membrane around joints heart, lungs, and eyes

CM of RA may begin with

systemic manifestations fever, fatigue, weakness, anorexia, weight loss, generalized aching and stiffness

scleroderma is also known as

systemic sclerosis

side effects of bronchodilators

tachycardia and HTN

issues with chemo and radiation

target actively reproducing cells of malignancy but also suppress activity of: skin, hair, mucus membranes (alopecia and impaired first line of defense), bone marrow (panyctopenia), reproductive cells (sterility)

recommendations for people with SLE and fever

teach to monitor temp. look for s/s of infection- urinary and respiratory cardinal signs may be masked bc of medications

fibrous connective tissue

tendons and ligament closely packed collagenous fibers

can polymyositis be treated

tends to respond well to treatments

what is CRP used for in lupus and RA?

test effectiveness of treatment and monitor periods of disease flareup

how to confirm diagnosis of compartment syndrome

the doctor or nurse may need to directly measure the pressure in the compartment. This is done using a needle attached to a pressure meter, which is placed into the body area. The test must be done during and after an activity that causes pain.

how do doses differ for drugs comparing cancer to RA

the doses are significantly lower and the risks of side effects tend to be considerably less than when prescribed in higher doses for cancer treatment.

What may cause leukopenia

the lupus itself or the prednisone

who shouldn't receive Bevacizumab (Avastin)

those scheduled for soon voluntary surgery those who have recently coughed up blood or have serious bleeding

who among cancer pts. is at most risk for hypercalcemia

those with bone metastasis

side effects of mast cell stabilizers

throat irritation, coughing, skin rashes with inhaled Tilade- bad taste eye drops- burning, stinging or blurred vision

what to avoid

tobacco or alcohol products spicy, salty, acidic, dry, rough, hard food hot liquids denture use all day (only with meals)

when does osteoarthritis develop

too much load or biomaterial properties of the articular cartilage are inferior repetitive impact loading

how are corticosteroids administered

topical cream or ointment for skin rashes injectable- intramuscular or IV admin

autotransplants

transfer of tissue or organs from one part of an individual to another part of the same individual. They are the most common type of transplants and include skin grafts and vein grafts for bypasses.

preop care

transfer techniques practiced beforehand muscle exercises to maintain tone

what to do before hair falls out?

treat it gently, wash it with mild shampoo and pat it dry with a soft towel cut your hair short shave your head with an electric shaver get a wig

acute gouty arthritis

triggers: trauma, drugs, alcohol great toe (50%) vulnerable heel, ankle, foot instep, wrist, elbow severe pain- noticed at night, hot, tender, red, swollen, lasts few hours mainly lymphanigitis and systemic signs of infection- leukocytosis, fever, elevated ESR

disadv. of radiation therapy

tumor must be radiosensitive large tumor cells not easily treated localized rx with limitations

what is cachectin?

tumor necrosis factor role in regulation of autoimmune responses selective destruction of malignanct cells

tylox

tylenol and oxycodone

what is the most common type of hypersensitivity?

type I

organ transplantation acute graft rejection=

type IV hypersensitvity reaction

blood

type of CT extrcellular matrix plasma and erythrocytes, leukocytes, and platelets

polymyositis

type of chronic inflammatory myopathy r/t dermatomyositis and myositis many muscle inflammation

grade 3

ulcers, extensive erythema pts can't swallow solid diet

etiology of cachexia

unclear related to a complex network of inflammatory cytokines activated by the malignancy

what does primary got result from

under excretion of uric acid

when are corticosteroids used for RA

unremitting disease with extra-articular symptoms prednise, hydrocortisone

long-acting bronchodilator

up to 12-hour of relief for asthma symptoms

cytoxan/cyclophosphamide what would you monitor?

urine dipstick for blood!! hemmorhagic cystitis potential

how does medication leave the body

urine, bowel movements, blood, phlegm, sweat, semen, vaginal fluid, vomit, saliva

epipen

used in community

bronchodilator therapy

used to control asthma therapy prescription short-acting and log-acting

prophylactic antimicrobial for CMV

valacyclovir/valtrex

rx of SLE

varied no one cure 1) rest 2) protection from direct sunlight 3) healthful diet 4) treatment of infections 5) avoidance of aggravating factors 6) pregnancy- planned for times when disease is under control

mixed CT disease

various CTDs coexist and overlap: SLE, systemic sclerosis, dermatomyositis, polymyositis, Sjorgen syndrome chronic and usually milder

aldosterone hormone production

vasoconstriction- high BP hypokalemia hypernatremia, high fluid volume

some types of bronchodilators

ventolin- albuterol, proventil, pro-air, xopenex, maxair douneb- ipratropium bromide/salbutanol- atrovent (anticholinergic) and albuterol (sympathomimetic

heliotrope or lilac rash

violaceous eruption on the upper eyelids and in rare casues on the lower eyelids often w/ itching and swelling) most specific rash in DM only present in a minority of patients

4) topical anesthetics

viscous lidocaine, benzocaine sprays/gels, dyclonine rinses, diphenhydramine solutions

typical post op for TKA

vitals frequently circulation and sensation in legs and feet large dressing applied to surgical area hemovac IV- adequate fluids antibiotics administered every 8 hours until drains are removed foley catheter 1-2 days DVT prophylaxis: TEDs, SCD, heparin, lovenox PCA and anti-nause med. clear liquids to diet as tolerated coughing and deep breathing 10 times hour IS CPM- slowly and smoothly bends and straighten knee PT- pain meds 30 min. before

unregulated production of cachectin leads to

wasting cachexia inflammatory and/or autoimmune diseases septic shock

what to rinse mouth with

water of NS, or 1/2 strength peroxide/NS frequently

1) bland rinses

water, NS, NaHCO3

dehydroepiandrosterone (DHEA) MOA

weak male hormone benefits worm by restoring balance of male-femal hormones improves bone mineral density in women with lupus receiving corticosteroids not approved by FDA- need compounding pharmacist- medical grade and monitor response

esophageal disease

weakness of the striated muscle of the upper 1/3 of the esophagus and/or oropharyngeal muscles can lead to nasal regurgitation, dysphagia, aspiration more common in elderly pts leads to increased incidence of bacterial pneumonia

many patients with SLE experience changes in _________

weight 1/2 of patients report weight loss- decreased appetite, side effects of medications, GI problems, or fever weight gain r/t medications or fluid restrictions from kidney disease

CPM machine

well padded cycle and ROM every 8 hours joint moving properly on machine confused- controls placed out of reach assess response to the machine turn off when having a meal in bed

diet and nutrition r/t

well-balanced diet is essential in maintaining good health low-fat and low-cholesterol- increased risk of heart disease restricted diet r/t fluid rention, HTN, kidney disease and other problems diet counseling especially for pts who struggle with weight loss, weight gain, GI distress, or food intolerances

NV r/t opioids

when beginning using opioids, usually goes away anti-emetics zofran (ondansetron) seratonin antagonist and kytirl (granisetron)

when are intra-articular steroids used for RA

when no more than 2 joints are involved 4 injections per year per joint

when are SLE patients given a corticosteroid

when they do not improve or who are not expected to respond to NSAIDs or antimalarials may be given a corticosteroid

when to use systemic analgesics for oral mucositis

when topical anesthetic strategies are not sufficient

administration of corticosteroids

with food or milk (to decrease GI symptoms)

administration of NSAIDs

with food or milk to decrease gastric irritation

when does mucositis typically heal

within 2-4 weeks after cessation of cytotoxic chemotherapy

hyperacute rejection

within minutes bc of presence of antibodies in the recipient, antibodies that are specific to the donor DIC swollen, darkened graft, which undergoes ischemic necrosis

anti-B2 glycoprotein I

won't detect caridolipin unless B2 glycoprotein I is present

is immunosuppression required for allotransplants?

yes, to prevent rejection

do these lupus symptoms resolve?

yes, when the drug is stopped

ZAP

zero acceptance of pain; pain assessment and management guide; patient self-assessment form; patient journal communication between health care provider and patient

purchasing capsaicin cream

zostrix, capzasin-P and capsin w/ and w/o prescription 0.025 to 0.075% burning sensation, diminish after several applications don't touch eyes wash hands after using

over the counter decongestants

zyrtec-D, sudafed tablets or liquid neo-synephrine and afrin nasal spray visine eye drops