Immune & Infectious Disease

T or F Family history is a risk factor for RF

F NO

The clinic nurse is completing a health history for a client with suspected rheumatic fever (RF). Which question is most important for the nurse to ask to establish a diagnosis?

"Have you recently had a streptococcal throat infection" RF is an acute inflammatory disease of the heart. It is a complication that occurs 2-3 weeks after a streptococcal pharyngitis. RF is caused by a delayed-onset autoimmune reaction involving anti-streptococcal antibodies that cross-react with the antigens in the heart and other organs. Recurrent, untreated streptococcal pharyngitis will lead to faster onset and increased severity of rheumatic heart disease due to increased autoimmune activity. RF affects the heart, skin, joints, and central nervous system. The presence of 2 major criteria or 1 major and 2 minor criteria and evidence of a preceding streptococcal infection indicate a high probability of RF.

The nurse prepares to administer IV vancomycin to an 80-year-old client with a methicillin-resistant Staphylococcus aureus infection. The nurse should notify the health care provider about which serum laboratory results before administering the drug? Select all that apply.

-Blood urea nitrogen is 60 mg/ml -creatinine is 2.1 Vancomycin is a glycopeptide antibiotic that is excreted by the kidneys. It is used to treat serious infections with gram-positive microorganisms (Staphylococcus aureus [methicillin-resistant Staphylococcus aureus]) and diarrhea associated with Clostridium difficile. Serum vancomycin trough level is monitored before the 4th dose (15-20 mg/L [10.4-13.8 µmol/L] is optimal). Blood urea nitrogen (BUN) and creatinine levels are monitored regularly (usually 2-3 times/week) in clients receiving the drug due to increased risk of nephrotoxicity, especially in those with impaired renal function, receiving aminoglycosides, and who are >60 years old. The health care provider (HCP) can lower the dose, decrease the drug administration frequency, or discontinue vancomycin. It is important to know the baseline values of BUN and creatinine to monitor trending and identify if there is an increase. Before administering this drug, the nurse should notify the HCP that the client's BUN (60 mg/dL [21.4 mmol/L]) and creatinine (2.1 mg/dL [185.6 µmol/L]) are both increased. The normal range for BUN is 6-20 mg/dL (2.1-7.1 mmol/L) and creatinine is 0.6-1.3 mg/dL (53-115 µmol/L). As nephrotoxicity can occur, monitoring of vancomycin trough level to maintain optimal drug level and renal function is indicated in clients receiving vancomycin, especially in those with impaired renal function and who are >60 years old.

Acute Rheumatic Fever Minor S/S

-Fever -Arthralgias -Elevated erythrocyte sedimentation rate/ C reactive protein -Prolonged PR interval

Manifestations of septic shock include

-Fever or hypothermia (>100.4 F [38 C]; <96.8 F [36 C]) - Either fever or low body temperature is found in sepsis and septic shock. Fever occurs in response to infection, whereas low body temperature can occur as shock worsens due to metabolic alterations and inadequate tissue perfusion -Hypotension - Systolic blood pressure <90 mm Hg or mean arterial pressure <65 mm Hg in a client with infection may indicate septic shock. Altered perfusion from hypotension may cause lactic acid accumulation and metabolic acidosis -Prolonged capillary refill - A refill time >3-4 seconds in adults indicates inadequate tissue perfusion as a result of altered peripheral circulation and hypotension -Tachycardia - A resting heart rate >90/min is common in septic shock to compensate for decreased systemic vascular tone and hypotension. -WBC count >12,000/mm3 (12 x 109/L) or immature neutrophils (bands) of >10% - An increased WBC count, especially with bands, indicates severe infection (Option 5). - Clients with septic shock typically develop decreased urine output (ie, <0.5 mL/kg/hr) due to inadequate organ perfusion.

Anaphylaxis triggers

-Food (eg, nuts, shellfish) -Medications (eg, β-lactam antibiotics) -Insect stings

Acute Rheumatic Fever (ARF) Clinical feature: Major

-Joints (migratory arthritis) -Carditis -Nodules (Subcutaneous) -Erythema marginatum -Sydenham chorea

Cholecystectomy potential post-op infection

. Pneumonia can occur when atelectasis (alveolar collapse) prevents clearing of secretions, promoting bacterial growth. Symptoms include cough with or without sputum, tachypnea, and shortness of breath. Postoperative incentive spirometry, ambulation, and cough/deep breathing exercises help keep alveoli open and prevent pneumonia . Surgical site infections present with localized redness, warmth, swelling, and purulent drainage. Proper wound care and sterile dressing changes help prevent infection . Urinary tract infections (UTIs), caused by the use of indwelling urinary catheters during surgery, can present with frequency, urgency, and dysuria. Prompt removal of catheters after surgery helps prevent UTIs. . Peritonitis (peritoneal infection) presents with rebound tenderness, boardlike abdominal rigidity, and shallow breathing related to abdominal distension. Peritonitis may lead to sepsis and death if untreated

Scleroderma associated complication

. Raynaud phenomenon can develop secondary to scleroderma. It is characterized by vasospasm-induced color changes in the fingers, toes, ears, and nose. This requires urgent treatment (eg, immersing hands in warm water) but is not life-threatening. . Pulmonary fibrosis is a progressive complication of scleroderma that is defined as scarring of lung tissue, which then causes reduced function, dry cough, and dyspnea. Some clients may be placed on oxygen. This is not immediately life-threatening. . Heartburn and dysphagia (difficulty swallowing) are common symptoms associated with scleroderma. This is due to the disease process of internal scarring, and it is not life-threatening.

The nurse is caring for a client who had a laparoscopic cholecystectomy 3 days ago. The client's WBC count has increased from 11,200/mm3 (11.2 × 109/L) to 14,600/mm3 (14.6 × 109/L) over the last 24 hours. The nurse understands that which of the following assessment findings indicate potential infection? Select all that apply.

. greenish-gray drainage noted on surgical dressing . productive cough with thick, green sputum . stiff abdomen with rebounded tenderness on palpation .warm, reddened area around the incision site

Pathogenesis of Histoplasmosis

1) H. capsulatum spores become airborne from bird/bat feces and contaminated soil 2)inhaled fungal spores can cause pulmonary histoplasmosis 3) rarely, disease is disseminated to other organs via blood/lymphatics

Management of Anaphylactic shock

1) Stop the infusion that is causing the reaction and call for help (eg, rapid response team) 2)Ensure patent airway, then administer oxygen via a high-flow nonrebreather mask and prepare for intubation if needed 3) Give epinephrine intramuscularly. Epinephrine counteracts the effect of the histamines released, dilating bronchial smooth muscles and providing vasoconstriction. Most deaths from anaphylaxis are due to delaying epinephrine. 3) Maintain blood pressure with normal saline IV fluid 4) Administer adjunctive therapies: Bronchodilators (eg, albuterol) to dilate the small airways and reverse bronchoconstriction, antihistamines (eg, diphenhydramine) to modify the hypersensitivity reaction, and corticosteroids (eg, methylprednisolone) to decrease airway inflammation and swelling associated with the allergic reaction 5) Continue to reassess vital signs for any changes (Option 4).

Client teaching for Sjogren syndrome

1) chewing sugar-free gum or using artificial saliva 2) scheduling regular dental examinations 3) showering with lukewarm water and avoiding harsh soaps 4)Don't use OTC decongestants to alleviate nasal symptoms d/t worsening the dryness 5) using OTC lubricants to ease vaginal dryness Treatment is focused on alleviating symptoms as there is currently no cure for Sjögren's syndrome. Over-the-counter or prescribed drops are used to relieve itching, burning, dryness, and gritty sensation in the eyes. Wearing goggles may offer further protection from drying caused by the wind. Dry mouth is treated with sugarless gum and candy or artificial saliva. Regular dental appointments to prevent dental caries are recommended. Lubricants (eg, K-Y Jelly) help to ease vaginal dryness. Use of lukewarm water and mild soap when showering can prevent dry skin. Avoiding low-humidity environments (eg, centrally heated houses, airplanes) and using humidifiers to maintain adequate humidity (mainly at night) are also recommended. (Option 4) Clients with Sjögren's syndrome are advised to avoid decongestants as they cause further dryness to the mouth and nasal mucosa. These clients should also avoid oral irritants (eg, coffee, alcohol, nicotine) and acidic drinks (eg, carbonated beverages, juices) and instead sip water frequently.

Active TB diagnosis

1) positive TB skin test & interferon-y release assay 2) Abnormal chest x ray 3) positive sputum smear/culture

systemic lupus erythematosus client teaching

1) take annual influenza vaccination 2) avoid situations that cause physical and emotional stress 3) avoid sun exposure and UV light 4) notify MD if have fever

The management of anaphylactic shock includes:

1. Call for help (activate emergency management systems) - first action 2. Maintain airway and breathing - administer high-flow O2 via non-rebreather mask 3. Epinephrine, intramuscular - the drug of choice and should be given next. Epinephrine stimulates both alpha- and beta-adrenergic receptors, dilates bronchial smooth muscle (beta 2), and provides vasoconstriction (alpha 1). The IM route is better than the subcutaneous route. The dose should be repeated every 5-15 minutes if there is no response. 4. Elevate the legs Volume resuscitation with IV fluids Bronchodilator such as albuterol is administered to dilate the small airways and reverse bronchoconstriction 5. Antihistamine (diphenhydramine) is administered to modify the hypersensitivity reaction and relieve pruritus 6. Corticosteroids (methylprednisolone [Solu-Medrol]) are administered to decrease airway inflammation and swelling associated with the allergic reaction

What you can think of by finding this? "Client who is 1 month post kidney transplant with a urinalysis showing WBCs and bacteria"

Almost all post kidney transplant clients are prescribed immunosuppressant drugs (eg, cyclosporine, azathioprine, prednisone) to help prevent organ rejection. This client's immunocompromised condition increases the risk for developing infection. Therefore, early recognition and prompt treatment of infection are critical to survival. The nurse should notify the health care provider (HCP) immediately of any signs or symptoms of an infection as well as abnormal urinalysis findings.

Anaphylactic shock

Anaphylactic shock has an acute onset (20-30 minutes) caused by a systemic IgE-mediated hypersensitivity allergic reaction to drugs (eg, antibiotics), foods (eg, shellfish, peanuts), diagnostic agents (eg, contrast), biologic agents (eg, blood, vaccines), and venom (eg, bees, snakes) and results in circulatory failure, laryngeal edema, and severe bronchoconstriction.

Anaphylactic shock

Anaphylactic shock has an acute onset, and manifestations usually develop quickly (20-30 minutes). It is caused by a systemic IgE-mediated hypersensitivity allergic reaction to drugs, foods, and venom. Anaphylactic shock results in hypotension and respiratory manifestations, including laryngeal edema (from inflammation) and bronchoconstriction (primarily from release of histamine); these can lead to cardiac and respiratory arrest

To prevent tick bites during outdoor activities, clients should:

Apply an insect repellent spray that contains tick-repelling ingredients (eg, DEET, picaridin) Avoid tall grass and thick underbrush, and hike only in the center of the trails Wear long-sleeved shirts tucked into pants, long pants tucked into socks or boots, and closed-toed shoes Covering attached ticks with petroleum jelly or nail polish is a folk remedy that actually increases the chance of infection by keeping the tick on the skin. Ticks should be promptly removed using tweezers, being careful to grasp the tick close to the attachment site and not crush it during removal.

-what is bacterial meningitis? -S/S -causative agent -precaution

Bacterial meningitis is an inflammation of the membranes that cover the brain and spinal cord and is caused by bacterial infection. Symptoms include headache, neck stiffness, nausea, vomiting, photophobia, fever, and altered mental status. The client with meningitis is at risk for seizure due to increased neuroirritability from fever and alterations in intracranial pressure. Bacterial meningitis is frequently caused by Neisseria meningitidis (meningococcus) in adults. Meningococcal meningitis is highly infectious and requires strict droplet isolation precautions (eg, surgical mask, private room, client masked during transport)

Oral Candidiasis (Thrush)

Candida yeast infection of the oral mucosa Oropharyngeal candidiasis, or thrush (moniliasis), is an infection of the mucous membranes generally caused by the yeastlike fungus Candida albicans. The fungus causes pearly, "milk-curd" lesions on the oral or laryngeal mucosa that may bleed when removed.

Anaphylaxis S/S

Cardiovascular · Vasodilation → hypotension & tissue edema--lightheadedness · Tachycardia Respiratory · Upper airway edema → stridor & hoarseness · Bronchospasm → wheezing Cutaneous · Urticarial rash, pruritus, flushing Gastrointestinal · Nausea, vomiting, abdominal pain

Cellulitis

Cellulitis is a bacterial infection (eg, Staphylococcus aureus, streptococci) that causes inflammation of the subcutaneous tissues. An increased WBC count (normal 4,000-11,000/mm3 [4.0-11.0 × 109/L]) would be expected in this client

Cholecystectomy

Cholecystectomy (removal of the gallbladder) is performed through laparoscopic or open surgery. Signs of postoperative infection typically appear 3-7 days after surgery. Systemic signs may include fever, elevated WBC count, and fatigue.

Why pt who had Cholecystectomy may experience left shoulder pain?

Clients recovering from laparoscopic surgery may experience referred left shoulder pain during the first few postoperative days. This is due to diaphragmatic nerve irritation caused by the carbon dioxide used to inflate the abdomen during laparoscopic surgery.

Lyme disease

Clients should be taught to prevent tick bites while hiking by using insect repellent; avoiding tall grass and thick underbrush; and wearing long-sleeved shirts, long pants, and closed-toed shoes. Ticks should be promptly removed with tweezers, keeping them intact. Flulike symptoms and a bull's-eye rash should be reported immediately to the health care provider.

Client teaching for HIV

Clients with HIV who are sexually active are at increased risk for sexually transmitted infections (STIs). Regular testing (≥1 time annually) and treatment for STIs are recommended. Latex or polyurethane barriers should be used during sex to prevent STI transmission, as nonbarrier contraception and natural skin condoms (eg, lambskin) offer poor protection against HIV and STI transmission. IV drug use is a common source of HIV infection. Although abstinence from IV drugs is preferred, clients who continue to use them should be instructed to avoid sharing needles and receive information about needle and syringe exchange programs. Educational objective: Clients with HIV must be educated to strictly adhere to prescribed antiretroviral therapy to prevent disease progression. Clients with HIV who are sexually active should seek testing for sexually transmitted infections and use latex condoms/barriers during sex. Clients with HIV should use a needle exchange program if using IV drugs.

Pt teaching for IE

Clients with IE usually have fever for several days during the initial stages of antibiotic therapy. By the time they are discharged, fever subsides or becomes occasional and low-grade. The nurse should teach the client to monitor temperature regularly at home. Persistent temperature elevations may mean that the antibiotic therapy is ineffective or complications have developed. The client should notify the HCP if a fever persists at home. A client who has had IE is at risk for reoccurrence. This client should receive prophylactic antibiotics for certain high-risk procedures (eg, manipulation of gingival tissue). IE causes the formation of vegetations on valve and endocardial surfaces. Embolization to various organ sites can occur. Slurred speech could indicate that embolization has caused a possible stroke. IE can require IV antibiotics for up to 4-6 weeks. The client may be discharged home once hemodynamically stable, and a home health nurse will come to administer the antibiotics through the client's PICC line.

The client with suspected active pulmonary tuberculosis (TB) has a positive tuberculin skin test (TST). Which prescription from the health care provider does the nurse anticipate will confirm the diagnosis in this client?

Collect an early morning sterile sputum specimen on 3 consecutive days Bacteriologic testing is performed in clients with suspected TB disease to confirm the diagnosis. A stained sputum smear is examined microscopically for the presence of Mycobacterium tuberculosis (tubercle bacillus), and a culture identifies the growth of the microorganisms. Collect an early morning sputum sterile specimen on 3 consecutive days for an acid-fast bacilli (AFB) smear and culture. Fluids and/or expectorants can be given at bedtime to help liquefy secretions. It is usually easier for clients to produce a specimen upon awakening as secretions collect in the airways during the night. The QuantiFERON-TB blood test is performed to screen for TB and can be used as an alternate to the TST. The advantages it offers include the following: there are fewer false-positive results, only a single client visit is required, and results are available in 24 hours. However, it is more expensive. Educational objective:An AFB sputum culture and smear test are performed to detect the presence of M. tuberculosis and confirm a diagnosis of TB.

The spouse of an immunocompromised client is diagnosed with influenza virus infection. The spouse asks the office nurse how long contact with the client should be avoided to prevent the infection from spreading. What is the nurse's most appropriate response?

Correct >"Avoid close contact for about a week" Incorrect >"It is impossible to avoid contact with the client. Just wash your hand often" >"You're sick already, and so you are not contagious anymore" >"You don't have to worry as long as the client has received the influenza vaccination" The influenza virus has an incubation period of 1-4 days, with peak transmission starting at about 1 day before symptoms appear and lasting up to 5-7 days after the illness stage begins Influenza is transmitted by inhaling droplets that an infected individual exhales into the air when sneezing, coughing, or speaking. If contact with others is unavoidable, wearing a mask can offer some protection against virus transmission. Individuals with the influenza virus can transmit the virus during the incubation period and illness stage of the infection. It is not appropriate to assume that the spouse can no longer transmit the infection. Although vaccination provides immunity against influenza in about 2 weeks after inoculation, it does not offer complete protection against all virus strains. Therefore, close contact with others should be avoided during the illness stage, especially those with an impaired immune system.

HIV + pt says, "I started to use lambskin condom during sex, as I have a latex allergy"

FALSE Clients with HIV should use latex or synthetic condoms and/or dental dams during sexual activity involving mucous membrane exposure (ie, oral, vaginal, anal) to semen or vaginal secretions. Natural barriers (eg, lambskin) do not prevent transmission of STIs due to the presence of small pores

Thickening of the skin

Scleroderma

Multiple tender points are characteristic

Fibromyalgia

hepatitis A or typhoid (enteric) fever precaution

Food and water precautions are emphasized for infectious diseases contracted through contaminated water or food, such as hepatitis A or typhoid (enteric) fever.

Pt care for bacterial meningitis

For clients with meningitis, a restful, reduced stimulus environment (eg, quiet, dimly lighted, cool temperature) promotes healing and reduces neuroirritability and seizure risk The client should be on bed rest with the head of the bed elevated 10-30 degrees to promote venous return from the brain and reduce sudden changes in intracranial pressure

Hepatitis A

Hand washing Fecal oral route Hepatitis A is spread via the fecal-oral route. Therefore, hygienic practices (eg, hand hygiene, sanitation) are the fastest and most readily available interventions available to prevent the spread of the hepatitis A virus. Needle sharing and unprotected sex should be discouraged, and all children age at least 1 year should receive the hepatitis A vaccine. Vaccination against hepatitis A is recommended for all children at age 1 and for adults at risk of contracting the virus (health care workers, men who have sex with men, drug users, those who travel to areas with a high prevalence, those with clotting disorders, and those with liver disease). (Options 1 and 2) Hepatitis A is secreted in bile and is more often transmitted via the fecal-oral route. However, the virus can also be spread through needle sharing between intravenous drug users and unsafe sexual practices. These practices should be discouraged and hand hygiene encouraged as the most important intervention for prevention. (Option 3) Vaccination is an important means of preventing infection. However, hygienic measures (eg, hand washing, sanitation, cleanliness, avoiding sharing personal items) are readily implemented by all clients regardless of means.

Herpes zoster

Herpes zoster (shingles) can occur in clients with a history of chickenpox (varicella-zoster virus exposure). The vesicular rash has a characteristic, linear dermatomal distribution and can present with severe pain. Vaccination prevents shingles.

Difference between herpes zoster and chicken pox

Herpes zoster, or shingles, has a characteristic unilateral, linear pattern of fluid-filled blisters. Affected clients commonly report pain and itching. Herpes zoster infection is due to the varicella-zoster virus (VZV), which also causes chickenpox. After initial VZV infection (chickenpox) in early childhood, the virus remains dormant in the sensory nerves. Reactivation of VZV when the immune system is compromised (eg, aging, immunosuppression) results in the formation of lesions along the distribution of one or more such nerves (dermatomal distribution). Vaccination can prevent shingles. If this rash is determined to be due to shingles, the affected area should be covered to prevent the spread of infection. Therefore, it is a priority to ask if this client has had chickenpox. (Options 1, 2, and 4) This client's linear rash has a dermatomal distribution that is characteristic of herpes zoster. These questions should be addressed, but assessing a history of chickenpox is the priority.

-Which group of people are most susceptible to Histoplasmosis? -What are the S/S?

Histoplasmosis is an opportunistic fungal infection that most commonly occurs in clients with compromised immunity due to medical conditions (eg, HIV, malnutrition) or immunosuppressant medications (eg, TNF-α inhibitors [infliximab], corticosteroids [prednisone]) Histoplasmosis infection results from inhaling Histoplasma capsulatum spores that are typically found in soil that contains bird or bat droppings. In most clients, histoplasmosis infection is either asymptomatic or results in mild, pneumonialike symptoms (eg, fatigue, fever, dyspnea, cough). However, clients with substantial or recurrent exposure to Histoplasma capsulatum spores or who are immunocompromised may develop chronic pulmonary infection or disseminated infection, which requires treatment and/or hospitalization. Histoplasmosis is an opportunistic fungal infection that results when fungal spores from soil that contains bird or bat droppings is inhaled. Histoplasmosis is usually asymptomatic or mild, but can result in widespread, life-threatening infections in immunocompromised individuals. Histoplasmosis infection is typically asymptomatic or self-limiting and usually does not require treatment.

Oral Candidiasis (Thrush) dangerous group

Immunosuppressed individuals such as those taking corticosteroid medications, clients undergoing chemotherapy or radiation, or clients with immune deficiency states (eg, AIDS) have an increased incidence. Clients receiving prolonged or high-dose antibiotic treatment are at increased risk as the normal microbial flora of the mouth is reduced, allowing other opportunistic infections to arise Individuals with dentures and infants also commonly experience monilial infections. Treatment is antifungal medications (eg, nystatin) and proper oral hygiene. Inhaled beta-2 agonists (eg, albuterol) do not increase the risk for fungal infections. However, individuals taking an inhaled corticosteroid (eg, budesonide, fluticasone) are at increased risk for oral candidiasis. To reduce this risk, the client should rinse the mouth after each inhaled dose and maintain good oral hygiene. (Options 3 and 4) Proper oral hygiene and nutrition are important in prevention of oral candidiasis. However, the client with braces or poor hygiene and inadequate nutrition is at lower risk than one who is immunosuppressed or taking antibiotics.

TB skin test What is latent TB? why is laten? When it become active? TB skin test in elderly

In a healthy client, an induration >15 mm indicates a positive TST; this means that the client was exposed to TB, developed antibodies to the disease, and has a TB infection. Additional tests are needed to determine if the client has latent TB infection (LTBI) or active TB disease. Clients with LTBI are asymptomatic and cannot transmit the microorganism to others. Clients with active TB disease usually are symptomatic and can transmit the microorganisms through the air. The elderly have decreased immunity and may be unable to develop antibodies to react to the tuberculin; this can result in a false-negative TST reaction. A positive reaction to TST means that the client is infected with TB bacteria. The infectious bacteria are concealed by the body's defense and do not lead to active TB disease in most individuals. When the client has a decreased immunity (eg, immunosuppression), bacteria cause an active TB disease. Additional diagnostic tests (eg, chest x-rays, bacteriologic sputum smear for acid-fast bacilli and culture) are needed to determine if this client has active TB disease. A positive reaction indicates a TB infection only. Further evaluation and bacteriologic testing is necessary. If active TB is suspected before testing is completed, airborne transmission precautions will then be initiated.

Active TB

Infected, symptomatic and contagious

-influenza is a viral infection or bacterial infection? -How does it transmitted? -How to prevent? -what are the sign and symptoms?

Influenza (flu) is a contagious viral infection that affects the respiratory tract. Symptoms include fever, chills, severe muscle aches, headache, cough, sore throat, nasal congestion, and malaise. I nfluenza treatment includes rest, hydration, humidified air, and antipyretics/analgesics. Antiviral medications (eg, zanamivir [Relenza], oseltamivir [Tamiflu]) are given to clients with symptom onset within the last 48-72 hours. These medications inhibit viral reproduction and can shorten the duration of the illness. Annual vaccination is recommended to prevent influenza . To prevent spreading influenza, infected clients should be on droplet precautions (eg, surgical mask, private room), wear a mask when being transported out of the room, and be taught to cover the mouth and nose while coughing or sneezing. Hand hygiene should also be emphasized as the influenza virus can persist on unwashed hands and surfaces. Oseltamivir is an appropriate antiviral medication for this client who reports onset of influenza symptoms 36 hours ago. The influenza virus is spread via droplet transmission when infected persons cough or sneeze. Hospital personnel caring for clients with influenza should adhere to droplet precautions in addition to standard (universal) precautions.

Kaposi sarcoma

Kaposi sarcoma, not histoplasmosis, is a form of cancer typically affecting immunocompromised clients who are infected with human herpesvirus 8. Kaposi sarcoma is commonly identified when immunocompromised clients develop pink or purple lesions all over the skin.

ringworm, a superficial fungal skin infection--pet

Limiting contact with infected pets is classic advice for avoiding ringworm, a superficial fungal skin infection.

systemic lupus erythematosus

Lupus nephritis (Lab: Increased creatinine) Systemic lupus erythematosus (SLE) is an autoimmune disorder in which an abnormal immune response leads to chronic inflammation of different parts of the body. SLE ranges in severity from mild (eg, affecting skin, muscles, joints) to severe (eg, affecting kidneys, heart, lung, blood vessels, central nervous system) disease. Increased creatinine (normal 0.6-1.3 mg/dL [53-115 µmol/L]), increased blood urea nitrogen (normal 6-20 mg/dL [2.1-7.1 mmol/L]), and an abnormal urinalysis (eg, protein, red blood cells, cellular casts) can indicate the presence of lupus nephritis (occurring in 50%), a potentially serious complication of SLE. Early recognition and aggressive immunosuppressive treatment are essential to preserve renal function and prevent irreversible kidney damage

A bull's-eye rash is associated with

Lyme disease Lyme disease develops after a bite from a deer tick infected with Borrelia burgdorferi. Clients initially develop flulike symptoms (eg, headache, fever, myalgia, fatigue). Many clients develop erythema migrans, a bull's-eye rash; however, it is not always present. Any of these symptoms should be reported immediately to a health care provider (Option 4). The client will likely be prescribed antibiotics (eg, doxycycline, amoxicillin) to treat Lyme disease and prevent it from causing complications (eg, carditis, chronic arthritis, meningitis, facial paralysis)

What conditions can convert latent TB to active TB?

Malignancy, immunosuppressant medications, including chemotherapy, and prolonged debilitating disease (eg, HIV), can convert LTBI to active disease. A client with LTBI who begins treatment with a corticosteroid (Prednisone) is at increased risk for conversion to active TB disease. T

The nurse assesses the site where a client received an intradermal purified protein derivative (ie, Mantoux) test 48 hours ago and notices a 16-mm area of induration. The client has no symptoms. Which action will the nurse take next?

Obtain a prescription for the client to have a chest x ray The intradermal purified protein derivative (PPD) test, or Mantoux test, is administered to screen for tuberculosis (TB). The forearm is injected with 0.1 mL of the PPD, and the client returns in 48-72 hours to have the site assessed for induration (a raised area). Redness alone is not read as a positive response. An area of induration >15 mm is considered a positive response in any client (Option 1). However, a positive PPD test does not mean that the client has active TB infection but rather that the client has been exposed to TB and has developed an immune response. Positive sputum cultures, chest x-rays, and the presence of symptoms confirm that the client has active disease(Option 3). (Option 2) A second injection is not needed when the client has a positive PPD. (Option 4) Placing the client in airborne precautions before confirming the presence of active TB is premature. Only clients with active TB (eg, symptoms, positive chest x-ray or sputum stain/culture) require isolation.

Latent TB

Positive PPD, negative CXR, negative sputum smear/culture no symptoms. Receive 9 months INH therapy non-infectious, no TB transmissions

The nurse cares for a client with an exacerbation of inflammatory bowel disease (IBD). The client tells the nurse about being infected with tuberculosis (TB) 10 years ago but never being medicated. Which prescription is of concern and prompts the nurse to notify the health care provider (HCP)?

Prednisone Tuberculosis is an infection caused by the Mycobacterium tuberculosis microorganism. A client with active, primary TB disease has a positive tuberculin skin test (TST), usually feels sick, has symptoms, and can spread the disease to others if not treated with medications. A client with a latent TB infection (LTBI) has a positive TST, negative chest x-ray, is asymptomatic, cannot transmit the disease to others, and can complete a full course of treatment to prevent activation of the disease. Malignancy, immunosuppressant medications, including chemotherapy, and prolonged debilitating disease (eg, HIV), can convert LTBI to active disease. A client with LTBI who begins treatment with a corticosteroid (Prednisone) is at increased risk for conversion to active TB disease. Therefore, the nurse should notify the HCP.

Scleroderma

Scleroderma is caused by collagen overproduction; it is a lifelong disease without a cure. Treatment is aimed at controlling symptoms and preventing further complications. Renal crisis is life-threatening and should be recognized and treated immediately. Renal crisis is a life-threatening complication that causes malignant hypertension due to narrowing of the vessels that provide blood to the kidneys. Early recognition and treatment of renal crisis is needed to prevent acute organ failure. Even with treatment, this can be fatal.

Bacterial meningitis

Seizure precaution

Sepsis and septic shock

Sepsis is an overwhelming response to infection that causes impaired organ function. Septic shock occurs when sepsis causes cardiovascular collapse and/or impairs the body's ability to maintain normal metabolic and cellular processes.

What is Sjögren's syndrome ? What will you experience? and what are the complication?

Sjögren's syndrome is a chronic autoimmune disorder in which moisture-producing exocrine glands of the body are attacked by white blood cells. The most commonly affected glands are the salivary and lacrimal glands, leading to dry eyes (xerophthalmia) and dry mouth (xerostomia). Dryness in these areas can lead to corneal ulcerations, dental caries, and oral thrush. Other areas that can be affected and their symptoms include: >Skin - dry skin and rashes >Throat and bronchi - chronic dry cough Vagina - vaginal dryness and painful intercourse

Sulfasalazine (Azulfidine)

Sulfasalazine (Azulfidine) is a gastrointestinal anti-inflammatory medication used to treat IBD

Systemic lupus erythematosus (SLE) Defination and S/S

Systemic lupus erythematosus (SLE) is an autoimmune disorder (the body's immune system erroneously attacks body tissues) that results in inflammation and damage to many body parts. Symptoms vary widely among affected individuals, but most experience painful/swollen joints, extreme fatigue, skin rashes, and kidney problems. The symptoms typically appear for periods of time (called flares) alternating with periods of remission.

How TB transmitted? what PPE you need?

TB disease is spread from person to person via inhalation of airborne droplets containing tubercle bacilli bacteria. These droplets are coughed, sneezed, or exhaled (eg, breathing, singing, talking, laughing) into the air by an individual with active TB disease. The probability of becoming infected is related to sharing airspace and the amount of time spent with the client. All health care workers caring for clients with TB disease must follow standard and airborne transmission precautions and wear high-efficiency particulate or N95 respirator masks. Pulmonary TB is not spread via contact with the client's blood, urine, or soiled clothing, bed linens, or eating utensils. Educational objective: Mycobacterium tuberculosis microorganisms from a client with active pulmonary TB disease are transmitted to another person via airborne droplets.

Treatment for SLE What need to teach to pt with SLE?

There is no cure for SLE, but it can be treated with immunosuppressants (eg, corticosteroids) or immunomodulators (eg, hydroxychloroquine). Pneumonia and annual influenza vaccinations are recommended for those with SLE as they are more susceptible to infections. These individuals should avoid contact with sick people and report fever to their health care provider Both physical and emotional stress can exacerbate SLE. Therefore, clients should follow a healthy lifestyle (eg, 7-8 hours of sleep, no smoking). Balanced exercise with alternating periods of rest is recommended Sunlight is known to worsen the rash of SLE and should be avoided when possible (especially between 10 AM-4 PM); protective clothing and sunscreen application are recommended during periods of sun exposure The rash of SLE should be cleansed only with mild soap. Harsh soap and chemicals should be avoided. The rash is not due to bacterial infection. Clients with SLE should be advised to avoid harsh sunlight and ultraviolet light exposure as well as harsh soaps and chemicals. These clients often receive corticosteroids and are susceptible to infection; therefore, annual influenza vaccination (eg, killed vaccines) is important.

-What is UTI? -Cystitis and Pyelonephritis

Urinary tract infections (UTIs) are usually bacterial in origin and are most often caused by Escherichia coli. The microorganisms from the perineal area enter the urethra, causing inflammation and infection (urethritis). They ascend to the bladder, where they multiply, causing inflammation and infection (cystitis). The bacteria may continue to ascend the urinary tract to the ureters and kidneys, causing inflammation and infection in the kidneys (pyelonephritis). A UTI is classified as upper or lower according to its location within the urinary tract. Cystitis is the most common community-acquired UTI. It is an infection of the lower urinary tract and involves inflammation of the bladder mucosa, leading to hyperemia, tissue hemorrhage, and pus formation. This inflammatory process leads to burning with urination (dysuria), urinary frequency and urgency, hematuria, and suprapubic discomfort When the infection ascends to the kidneys (pyelonephritis), clients become very ill. They develop nausea, vomiting, fever with chills, and flank pain. Assessment shows costovertebral angle tenderness. If the infection is not recognized and treated, clients can become septic.

Client teaching for Immune thrombocytopenic purpura (ITP

Use soft-bristle toothbrushes, gentle flossing, and nonalcoholic mouthwashes. These prevent periodontal disease and gingival bleeding. Avoid activities that may cause trauma (eg, high-intensity sports). Appropriate exercise includes low-impact activity (eg, walking) while wearing nonskid footwear to help prevent falls Take prescribed stool softeners and laxatives as needed. These medications prevent hard stools and straining, which can cause anorectal fissuring, bleeding, and hemorrhoids Clients with ITP should use electric razors instead of safety or straight razors. Electric razors have a more complete guard, reducing the risk of accidentally nicking the skin. Clients with ITP should avoid nonsteroidal anti-inflammatory drugs (eg, aspirin, ibuprofen, ketorolac), which further impair platelet function. Acetaminophen and opiates are better options for pain management. Educational objective: Clients with immune thrombocytopenic purpura (ITP) have low platelet counts and an increased risk of bleeding. Appropriate care for clients with ITP includes safe exercise; using stool softeners, electric razors, and soft-bristle toothbrushes; and avoiding nonsteroidal anti-inflammatory drugs.

Mites or scabies-laundry

Washing bedding in hot water is a classic instruction to help reduce allergies/asthma (eg, commonly from mites) or scabies (a contagious skin infection caused by mites).

What is West Nile virus? How to prevent it?

West Nile virus is a mosquito-borne disease (encephalitis) that occurs mainly during the summer months, especially during humid weather. Prevention focuses on avoiding mosquitoes and using an insect repellent. Prevention also includes wearing long sleeves, long pants, and light colors and avoiding outdoor activities at dawn and dusk when mosquitoes are most active

Antiretroviral therapy (ART)

a combination of several medications prescribed for people who are HIV-positive to delay the onset of AIDS Antiretroviral therapy (ART) is a medication regimen consisting of multiple drugs for managing and preventing progression of HIV infections. ART impairs viral replication at multiple points, which leads to decreased viral loads and increased CD4+ (ie, helper T) cell counts. When educating clients about ART, it is critical to explain that treatment is lifelong and requires strict adherence (Option 1). Even clients with undetectable viral loads remain infected with HIV. The discontinuation of, or poor adherence to, ART results in the progression of HIV (which may lead to AIDS) and promotes viral drug resistance

Lansoprazole (Prevacid)

a proton pump inhibitor used to treat ulcer disease, erosive esophagitis, and gastroesophageal reflux disease

Metronidazole (Flagyl)

an antimicrobial medication used to treat IBD

what is Immune thrombocytopenic purpura (ITP)?

an autoimmune condition in which antibodies bind to and cause destruction of platelets. Clients with ITP have a platelet count <150,000/mm3 (150 x 109/L) and are at increased risk of bleeding.

Early-morning low back stiffness is seen

ankylosing spondylitis

infective endocarditis

inflammation of endothelium that lines heart and cardiac valves. most commonly damages mitral valve, then aortic and tricuspid valves. commonly caused by bacteria that are normally present in the body. can also occur after an invasive medical or dental procedure. symptoms: valvular dysfunction, may affect organ systems, chest pain, CHF, clubbing, meningitis, low back pain, arthralgia, arthritis

Cystitis

inflammation of the bladder . Burning on urination . Frequency . Urgency . Suprapubic discomfort . Hematuria Cystitis is an infection of the bladder mucosa. Clients develop burning with urination (dysuria), urinary frequency and urgency, hematuria, and suprapubic discomfort. However, if the infection extends to the kidneys (pyelonephritis), clients become seriously ill with nausea, vomiting, fever with chills, and flank pain.

pyelonephritis S/S

inflammation of the renal pelvis and the kidney . nausea & vomiting . Fever and chills . Flank pain . Costovertebral tenderness