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Evcc 2nd Qtr Exam 5

Immune alterations, RA/OA, eyes/ears

What is an example of Alloimmunity? Transplant rejection
What is a RAST test? Blood test for allergies
How does histamine cause dyspnea? by causing smooth muscle contriction of the bronchioles
What is the most serious complication of Hydroxychloroquine? retinal damage (need eye exams every 6 months)
Which nutrients are very important for the immune system? Protein, Vitamins A & B12, Folic Acid, Zinc, Iron, Copper
Pathophysiology of blood transfusion reaction (Type II) Antibody reacts to antigen on donor RBCs-->hemolysis of donor RBCs-->inflammation/shock-->Lg amts HgB released-->Liver can't brkdwn to bilirubin-->HgB diffuses into tissues & renal tubules: vasoconstriction in kidney: ischemia & ARF!
Another name for "foreign invaders"? Antigen
At what age do T-cell functions decrease? Age 60
bone buckles, cracks from pressure along longitudinal plane compression fracture
bone ends remain in alignment non-displaced fracture
Bone fragments do not penetrate skin closed fracture
bone penetrates skin open (compound) fracture
Break across entire bone complete fracture
Clinical manifestations of Anaphylaxis? urticaria,angioedema,Upper airway swelling,pruritis,hypotension,tachycardia,N/V
Complement Proteins in blood that are activated by immune system (labeled C1-C9) and act to destroy targeted cells
Describe DRY macular degeneration atrophy to the retinal pigment epithelial layer below the retina...cells break down & leave yellow deposits (drusen) under retina
Describe WET macular degeneration Abnormal blood vessel growth in the choriocapillaries
Diagnostic criteria for RA? Morning stiffness, >1 hr,3 or more joints involved,Arthritis of wrists, MCP/PIP,Symmetrical joint involvement,Rheumatoid nodules,positive serum RF,X-rays of hands/wrists show RA changes (bony destruction)
Does Rh+ have an antigen or antibody? Antigen
Does Rh- have an antigen or antibody? Antibody
Early Phase Reaction (2nd exposure to antigen)*Allergen binds to IgE & attaches to mast cells. Mast cells degranulate & release histamine
Effects of Histamine Vascular permeability, Smooth muscle constriction (esp. bronchioles)Increased mucus production, Pruritis, Vasodilation, Increased gastric acid secretion
Example of a Type I reaction Anaphylaxis
Example of Cytotoxic or Tissue-specific Reaction (Type II)Blood transfusion reaction
Example of Non-Specific Immunity? Macrophages & WBCs
Example of Specific Immunity? Lymphocytes
Example of Type II reaction Blood transfusion
Example of Type III reaction Rheumatoid Arthritis
Example of Type IV reaction Poison Ivy/Oak (contact dermatitis)Rejection of transplanted organ
Examples of Immune Complex Diseases Rheumatoid Arthritis Systemic Lupus Erythematosus (SLE)
Explain Cytotoxic or Tissue-specific Reactions Antibody (IgM or IgG) binds w/antigen & activates the complement system, which destroys the cell where the antigen is bound (usually a circulating blood cell)
Explain Immune Complex Diseases *Formation of antigen/antibody complex (IgM or IgG)*Complexes precipitate in various tissues, causing inflammation
First choice DMARDs for RA Methotrexate, Plaquenil, Azulfidine
fracture ends out of alignment displaced fracture
fx encircles bone, from twisting force spiral fracture
fx line at 45 degree angle to long axis of bone oblique fracture
fx line at 90 degree angle transverse fracture
fx only through one cortex (outer layer) incomplete fracture
How do Cyclosporine drugs workd to prevent transplant rejection? Suppresses production of interleukin-2 which is needed for T-cell proliferationPrevents T-cell activation, preventing T-cells from attacking transplanted organ
How do you treat a checmial splash in the eyes? Irrigate for 10-20 minutes w/sterile saline (or water)Remove contactsPROMOTE GOGGLE USE!
How does histamine cause dyspnea? by causing smooth muscle contriction of the bronchioles
How does long-term use of corticosteroids increase your risk for osteoporosis? They decrease calcium absorption from kidneys and inhibit osteoblast function
How does the elimination test work? The suspected food is eliminated from the diet for several weeks and is then gradually reintroduced one at a time, observing for allergic reaction.
How does the patch test work? Antigen is taped to the skin under aluminum disks for 48 hours, then assessed for allergic changes by dermatologist
How does the RAST test work? Measures amount of specific IgE in blood to various allergens (can test for over 400 different allergens)
How long does it take for Hydroxychloroquine to take effect? 3-6 months
How long does it take for Methotrexate to take effect? 3-6 weeks
How long does it take for Sulfasalazine to take effect? about 1 month
How much bone mass can be lost in osteoporosis? up to 40%
How much more common is shingles as we age? 5 times more common after age 35
incomplete fx w/crack on one side, bone flexed or bowed on other side greenstick fracture
Lab findings in Lupus? Decreased Complement, AlbuminIncreased BUN, ANA, Sed Rate, CRP
Late Phase Reaction (Hrs to days later)not as severe as the initial reaction, but may require treatment
Meds for RA? NSAIDs, DMARDs, Glucocorticoids
more than one fx line/more than 2 bone fragments comminuted fracture
one bone fragment driven into another impacted fracture
Onset of RA? age 20-50
osteophyte bone cysts/spurs
pannus fibrous scar tissue in joint capsule & bone
Pathophysiology of Rheumatoid Arthritis (RA) IgG formed then Antibody Rheumatoid Factor (RF) forms against IgG. Complexes move to synovial membrane-->inflammation that destroys joint. Synovial membrane hypertrophies/thickens & invades surrounding tissue forming Pannus & joints become fixed.
Pathophysiology of SLE *Apoptosis exposes cellular antigens which increases the immune response*B cells produce too many autoantibodies*Immune complexes cause inflammatory responses affecting skin, kidneys, heart, blood vessels, lungs, joints & CNS
Purpose of cytotoxic T cells? To recognize self vs non-self cells, Directly kill the infected cells, Reject foreign tissues
Purpose of giving DMARDs in RA? start ASAP to alter the course of the disease
Second choice of DMARDs in RA Biologic Agents: TNF blockers(Enbrel, Remicade, Humira)
separation of ligament from bone, tearing piece of bone w/it avulsion fracture
Should the limb be elevated after amputation? yes w/in the first 24 hours only
Steps of Sensitization *B-cells produce IgE when exposed to antigen *IgE binds to mast cells
Treatment for a blood transfusion reaction? STOP THE TRANSFUSION! keep IV open w/NSNotify MDKeep blood bag & send to lab or evaluation!Monitor VS & urine outputDiuretics to increase urine output & flush kidneys
Treatment for Anaphylaxis Epi, Oxygen, antihistamines, corticosteroids, bronchodilators (neb tx), IV fluids for BP support, vasopressors, intubate/tracheostomy PRN
Type I (definition) IgE mediated
Type II (definition) Humoral: Cytotoxic/Tissue specific
Type III (definition) Immune Complex Disease
Type IV (definition) T Cell mediated
Upper airway sounds? stridors & wheezing
Urticaria Hives
What are clients advised to do prior to receiving an allergy skin test? Avoid antihistamines for 3 days prior to the test
What are examples of DMARDs? Methotrexate (most common), Hydroxychloroquine (Plaquenil), Sulfasalazine (Azulfidine)
What are immunoglobulin? antibodies (IgG, IgM, IgA, IgE)
What are interferons, interleukins, and TNF an example of? Cytokines
What are risk factors for developing osteomyelitis? Stage IV pressure ulcersDM (feet)ORIF hardware
What are some acute causes for amputation? TraumaThermal injuries (frost bite), PVD, Malignancy
What are some causes of Secondary Immunodeficiency HIV/AIDS, Neoplastic diseases, Nutritional deficiencies, Aging, Immunosuppresive meds, Bone marrow destruction from CHEMO
What are some chronic causes of amputation? PVD that results in necrosis/gangrene, DM that results in non-healing ulcers, Osteomyelitis
What are some common causes of sensorineural hearing loss? Loud noise, Trauma, Aging process, Disease, Congenital, Meniere's Disease
What are some common clues that someone may have a hearing loss? Irritable, hostile, Complaints of others mumbling, Asks for frequent repetition, Loss of sense of humor, Leans forward to hear, Shuns large or small groups, Aloof or "stuck up", Complains of ringin in the ears, Unusually soft or loud voice
What are some of the common complaints of people with cataracts? blurry vision, decreased vision, glares, halos
What are some ototoxic drugs? Aminoglycoside antibiotics (Gentamycin)Erythromycin, Vancomycin, Chemotherapeutic agents (Cisplatin, Bleomycin)Caffeine, Aspirin, NSAIDs, Loop diuretics (Lasix, Bumex) esp IV forms
What are some preventative measures for gout? Allopurinol (inhibits production of uric acid), Probenecid (promotes renal excretion)low purine diet, ample fluid intake, avoid alcohol (esp. beer)
What are some risk factors for glaucoma? DM, HTN, corticosteroid use
What are some things that cause compartment syndrome? cast too tight, bleeding or edema
What are the "master switches" Helper T cells
What are the 2 things that MUST always be done after a reduction? X-ray to confirm alignment, Neurovascular reassessment
What are the 3 early signs of pain after fracture repair? pain (unrelieved), paresthesia, pallor
What are the 3 later signs of problems with fracture repair? Polor, Paralysis, Pulses
What are the 5 p's of fractures? Pulses, Parasthesias, Pallor, Polor, Paralysis(pain too)
What are the 5 stages of bone healing? Hematoma formationFibrocartilage formationCallus formationOssificationRemodeling
What are the adverse effects of immunosuppressant drugs? risk of infectionrisk of neoplasm
What are the clinical manifestations of a blood transfusion reaction? Chills, Fever, HA, low back pain, Dyspnea, Chest pain, Hypotention, tachycardia, Anxiety, N/V, Hemoglobinuria (red colored urine)
What are the clinical manifestations of Otosclerosis? Hearing loss, Tinnitus, Dizziness
What are the clinical manifestations of retinopathy? spiders, cobwebs, tiny specks floating in their visiondark streaks / red film that blocks vision, vision loss, blurred vision that may fluctuate, dark/empty spot in center of vision, poor night vision, difficulty adjusting from bright to dim light
What are the consequences of compartment syndrome? loss of nerve & muscle function, infection from tissue necrosis, Renal Failure: release of myoglobin, Volkmann's contracture (scar tissue)
What are the DMARD II biologic Agents? TNF Blockers (Enbrel, Remicade, Arava)
What are the extra things that the RAST test can test for other than the scratch & patch tests? respiratory & food allergies
What are the goals of RA treatment? relieve pain, reduce inflammation, slow down joint destruction, improve (maintain) function
What are the manifestations of Conjunctivitis? cloudy or yellowish exudate, burning, gritty sensation
What are the most commonly used immunosuppressant drugs? Glucocorticoids, Cyclosporine
What are the most serious complications of Methotrexate? Liver inflammation, bone marrow suppression, pneumonitis
What are the risk factors for AMD? Women, Smoking, Obesity, Elevated serum lipids, Cardiovascular disease, DM, HTN, Caucasian, Light colored iris, Family history, Decreased consumption of fruits & veggies
What are the s/s of compartment syndrome? PAIN (unrelieved), paresthesia (numbness & tingling), Pallor (paleness)
What are the s/s of DVT? Calf pain, Swelling, Warmth, Redness (unilateral)
What are the s/s of fat emboli? Altered mental status/disorientation, Respiratory distress, Tachycardia, Fever, Petechial rash (2-3 days later!)
What are the s/s of osteomyelitis? bone painerythema, edema, fever, malaise
What are the s/s of pulmonary emboli? Pleuritic chest pain (worse w/mvmt)Dyspnea, Tachycardia (b/c hypoxemia)
What are the side effects of Glucocoriticoids? Increased risk for infection, Increased blood glucose, Increased risk of osteoporosis, Increased gastric acid secretion, Mood disturbances, Increased sodium & water retention, Cushingoid Syndrome, Increased risk of cataracts/glaucoma
What are the side effects of NSAIDs? GI upset, Increased risk for bleeding, Ulcers, Renal impairment, MI & CVA
What are the signs of increased occular pressure after cataract surgery? unrelieved pain, redness, N/V
What can prevent a fat emboli? Careful handling of long bone fractures (don't move too much), Adequate HYDRATION, Pain management, Oxygenation
What causes Labyrinthitis (Vestibular Neuronitis)? Virus (often follow an Upper Respiratory Infection)
What do IgG plasma cells do? Protect against infection of bacteria, viruses, and toxins
What does a stridor sound like? high-pitched harsh breathing
What does an increase in neutrophils indicate? acute infection, stress
What does DMARD stand for? Disease modifying anti-rheumatic drugs
What does Epinephrine do to help during anaphylaxis? Opens the airway(be careful w/people over age 50)
What does Humoral mean? antibodies are produced
What does increased Eosinophils / Basophils indicate? Allergic response
What does increased lymphocytes indicate? Viral & Chronic infections
What does RAST stand for? Radioallergosorbent Test
What does the increased sodium & water retention from glucocorticoids lead to? Increased weight, Increase BP, Electrolyte imbalances
What does vasodilation from histamine lead to? decreases BP and causes tachycardia
What immune changes occur as we age? Reactivation of latent diseases, Increased susceptibility to disease/infection, Decreased response to immunization, Increased risk of cancer, Increase in autoimmune diseases
What indicates a positive response in the elimination test? GI symptoms that occur within 24 hours
What is a cataract? Opacity in crystalline lens which interferes with transmission of light to the retina.
What is a common nursing diagnosis for someone with Meniere's Disease? High risk for injury r/t disturbance in balance
What is a D-Dimer? blood test to show clot products
What is a tophi? uric acid crystals
What is an example of subluxation? TMJ (articular cartilage is partially separated)
What is angioedema? non-pitting edema of mucus membranes causing facial swelling
What is Buck's Traction? Type of skin traction used for a hip fracture before surgery to relieve pain
What is compartment syndrome? Increased pressure in muscle compartment because facia is not very flexible
What is glaucoma's pathologic effect? Edema in retina, Optic nerve compression, Compression of the arteries around the optic nerve
What is Hemoglobinuria? HgB in the urine...red colored urine (or brownish)
What is Herpes simplex Keratitis? Inflammation of the cornea
What is important to remember when administering NSAIDs? Give with food to decrease GI irritation, Do NOT give if renal impairment, Consider COX 2 inhibitors for less GI side effects (such as Celebrex)
What is keratoconjunctivitis sicca? dry eyes
What is osteomyelitis? Infection/inflammation of bone
What is Otosclerosis? Repeated resorption and redeposition of abnormal bone (fixation of footplate of stapes that prevents transmission of sound vibration)
What is Pterygium? Wedge shaped fibrovascular growth of conjunctiva extends onto cornea
What is the 1st course of treatment for RA? NSAIDs to decrease inflammation/pain
What is the age range for being diagnosed with Lupus? Females ages 15-40
What is the Amsler Grid test? A test for macular degeneration
What is the clinical manifestation triad of Labyrinthitis? Vertigo, Nausea, Vomiting
What is the elimination test used for? Testing food allergies
What is the incidence of RA? 1-2% of US population, Women 2x>men
What is the most common cause of retinopathy? DM
What is the most common EARLY sign of DRY macular degeneration? Blurred vision
What is the most common site for avascular necrosis? femoral neck
What is the most serious complication of Hydroxychloroquine? retinal damage (need eye exams every 6 months)
What is the name for a fixation of footplate of stapes that prevents transmission of sound vibration? Otosclerosis
What is the prevention for DVT? Get them moving ASAP! Sequential compression devices (SCDs)Compression stockingsLMW heparin injections while on bedrest/min activity
What is the treatment for avascular necrosis? replacement with prosthesis
What is the treatment for compartment syndrome? Release external pressure (cut cast & notify PCP)Maintain diastolic BP (Keep hydrated)Fasciotomy Measure the pressure in the compartment
What is the treatment for conjunctivitis? Topical antibiotics (drops or ointment)
What is the treatment for fat embolus? supportive respiratory caresteroids to decrease inflammatory response
What is the treatment for Meniere's Disease? Low sodium diet, Avoid caffeine and alcohol (vestibular stimulant), Anticholinergic drugs for vertigo, Anti-nausea drugs, Diuretics, Balance exercises, Increased sleep, Smoking cessation, Surgery to decrease the endolymph
What is the treatment for osteomyelitis? surgery to debride the bone, Antibiotics
What is the treatment for pulmonary emboli? Respiratory support, Anticoagulants, Analgesics
What part of the body are most skin scratch/puncture allergy tests done? upper backinner surface of lower arm
What reduces the action of Ig against antigen? Suppressor T Cells(tell the B cells to back off)
What should you give along with Methotrexate? Folic acid to decrease side effects of oral ulcers, hair loss, and GI upset
What size of a reaction of an allergy skin test indicates a positive reaction? >5mm
What things can you do to slow down the progression of DRY macular degeneration? increase zinc, Vit A & C
What time-frame do most fat emboli occur? Within 48 hours of facture
What would the lab results indicate if someone has osteomyelitis? Increased WBC & Sed rate
When are cytotoxic T cells activated? During Autoimmune responses
When are mast cells present? during an allergic response (they release histamine)
When does the peak reaction occur in the allergy skin test? 20 minutes
When does the reaction occur after sensitization of T-cells, such as with poison ivy/oak? 24-72 hours after exposure to the antigen
When is the patch test used to test for allergies? They are used to detect delayed reactions such as contact dermatitis
When should glucocorticoids be administered? Early AM to mimic the body's own natural steroid surge (give w/breakfast or milk)
Where are IgA plasma cells located? GI & Respiratory secretions
Where do lymphocytes develop? From stem cells in bone marrow
Which 2 types of immunoglobulins respond to infections? IgG and IgM
Which allergy test must be done under the supervision of a doctor? Challenge or Provocative Test
Which antigen does Type A blood have? A antigen
Which cells secrete cytokines? Helper T cells
Which cranial nerve is damaged in sensorineural hearing loss? Eighth (8th) cranial nerve
Which DMARD does NOT slow down the progress of RA? Hydroxychloroquine. It only improves the long term outcomes
Which DMARD has an increased risk for infection? TNF blockers
Which DMARD is also an antimalarial drug? Hydroxycloroquine (Plaquenil)
Which drugs can cause cataracts? Long-term use of corticosteroids
Which immunoglobulins are the 1st to respond? IgM
Which immunoglobulins are the most common and last the longest? IgG
Which immunoglobulins attach to mast cells & release histamine? IgE
Which immunoglobulins protect against portals of entry? IgA (in the GI & Resp secretions)
Which is more common, wet or dry macular degeneration? dry is most common
Which is the 1st plasma cell to respond? IgM
Which is the most common antibody in response to infection? IgG (lasts the longest too)
Which is the only med that can alter the course of joint destruction in RA? DMARDs
Which mineral should clients with RA increase in their diet? Calcium
Which nutrients are very important for the immune system? Protein, Vitamins A & B12, Folic Acid, Zinc, Iron, Copper
Which one of the DMARDs acts as an immunosuppressant? Methotrexate
Which race is at highest risk of developing glaucoma? African-Americans
Which races are at higher risk for developing osteoporosis? Caucasion & Asian
Which red eye complaint can be caused by RA or SLE? Scleritis
Which side of the heart is affected by a fat embolus? Right side of heart
Which type antigen does Type AB blood have? NONE
Which type antigen does Type B blood have? B antigen
Which type antigen does Type O blood have? both A & B(universal donor)
Which type hearing loss is faint & distorted/muffled? Sensorineural
Which type hearing loss is faint but clear? conductive
Which type hearing loss is caused by frozen or sclerotic ossicles? Conductive
Which type hearing loss is caused by thickening or scaring of the tympanic membrane? Conductive
Which type hearing loss is improved by temporal bone stimulators? Conductive
Which type is cell-mediated (T or B)? T cells
Which type of glaucoma is more common...open angle or closed angle? Open Angle
Which type of hypersensitivity is an allergic reaction? Type I (IgE)
Which type of immunosuppresive medications cause secondary immunodeficiency? anti-rejections & corticosteroids
Which type of macular degeneration progresses SLOWLY? Dry
Which type plasma cell is responsible for hypersensitivity & allergic responses? IgE
Which type vision is lost in glaucoma? peripheral vision
Which type vision is lost in retinopathy? central vision
Which type vision is lost with retinal detachment? central vision
Which types of meds can SLIGHTLY decrease your risk for developing cataracts? statins (lipid-lowering meds)
Which works faster, heparin or cumadin? Heparin
Why are glucocorticoids used in RA? Anti-inflammatory & immunosuppressant effects, Temporary adjunct while waiting for DMARDs, Useful during exacerbations, Useful for those w/severe disease not controlled by NSAIDs and DMARDs
Why are glucocorticoids used to treat RA? Used while waiting for DMARDs to work, Used in severe disease cases or exacerbations, Used only short term, if possible
Why do glucocorticoids increase blood glucose levels? Because they decrease the USE of glucose by the cells and by the liver
Why do glucocorticoids increase the risk for osteoporosis? They inhibit bone building & absorption of Calcium
Why is activity initially restricted when a DVT is diagnosed? To allow the clot to adhere to the vessel wall
Why is gout treated with Cholchicine? it decreases the migration of leukocytes
Why is Sulfasalazine (Azulfidine) used to treat RA? Anti-inflammatory action, and it slows the progression of joint destruction
Why is the Challenge or Provocative Test so dangerous? Exposes person to suspected allergen which may provoke a serious allergic reaction
Why should aspirin be avoided after ear surgery? It is ototoxic
Why should glucocorticoids be tapered off? Stopping them suddenly can cause adrenal insufficiency because the body stops producing them when they are receiving the meds
Why should people with gout AVOID aspirin? because it interferes with uric acid excretion
Why should you NOT take aspirin after cataract surgery? because it increases the risk of bleeding
Created by: janetjp