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med surge 2 exam 2
| Question | Answer |
|---|---|
| What is allergic rhinitis? | The result of an antigen/antibody reaction, Ciliary action decreases- mucous increase,Vasodilation and local tissue edema occur |
| What are S/S of allergic Rhinitis | s- allergic shiners (caused by venous congestion in the maxillary sinuses) , sneezing, itchy red eyes, rhinorrhea |
| what are some complications for allergic rhinitis? | sinusitis, asthma, nasal polyps, chronic bronchitis |
| what test identies IGE antibodies? | test (RAST)- |
| difference between Gen1 and Gen 2 Antihistamines? | Gen 2's are a lot less sedating |
| What is Atopic dermatitis?(Ecsema) | s/s first pruritic, edema, and very dry skin,second red, weeping lesions that break open, crust over, and fall off |
| Gen 1 antihistamines | Benadryl, Sedating, give at night, Avoid prolonged exposure to sun, Avoid alcohol, CNS depressant, and additional OTC antihistamines |
| Second Generation antihistamines | Second Generation, Cetirizine/Zyrtec, Loratadine/Claritin, Fexofenadine/ Allegra Less sedating |
| common causes of Anaphylaxis? | Common causes are antibiotics- cephalosporins, penicillin, sulfonamides Anticonvulsants, venom from insects/bees, NSAIDS, food such as shellfish/nuts |
| s/s of anaphylaxis | Mental status changes- drowsiness, HA, restlessness, seizures. |
| Nursing actions for pt with Anaphylaxis? | Epinephrine is given IM IMMEDIATELY, IV access Priority for vasopressor drugs and fluids to regulate BP,,Oxygen therapy started, Mechanical ventilation may be needed (tracheostomy or endotracheal,Antihistamines and corticosteroids |
| Why is Epi given before Oxygen? | think ABC's |
| Causes of Urticaria (Hives) | Causes- numerous- stress a unique cause |
| People at risk for hives? | Chronic conditions such as SLE(systemic lupus), lymphoma, hyperthyroidism, and cancer are more susceptible to urticaria |
| Treatment for hives. | Severe: epinephrine, Corticosteroids – oral, topical, iv,Antihistamines and histamine (H2) blockers- given together to resolve symptoms faster,Ige monoclonal antibody therapy (Xolair),Acupuncture as an adjunctive may be effective |
| Where are T cells found? | In red bone marrow. |
| Where are B cells found? | In red bone marrow. |
| How do T cells fight off foreign invaders? | By launching a direct attack. |
| How do B cells fight off foreign invaders? | By differentiating into plasma cells, that release antibodies for an indirect approach. |
| What are Antibodies? | ANTIBODIESGLYCOPROTEINS PRODUCED BY PLASMA CELLS IN RESPONSETO FOREIGN ANTIGENS., ALSO CALLEDIMMUNOGLOBULINS (IG),ANTIBODIES DO NOT DESTROYFOREIGN ANTIGENS,THEY ATTACH AND LABELTHEM FOR DESTRUCTION,EACH ANTIBODY IS SPECIFIC FOR ONE ANTIGEN, 5 CLASSES |
| What is IGG? | PROVIDES LONG TERM IMMUNITY AFTER A VACCINATION OR ILLNESS RECOVERY. |
| Where can IGG be found? | BLOOD, LYMPH, EXTRACELLULAR FLUID |
| What does IGA do? | PROVIDES PASSIVE IMMUNITY FOR BREAST FED INFANTS |
| s/s of Hemolytic reaction | s/s sudden onset of flank (back) pain or chest pain, hypotension, fever rise of more than 1.8 *F, chills, tachycardia, tachypnea, wheezing, urticaria, dyspnea, HA, nausea |
| What can confirm a hemolytic reaction ? | Direct coombs test. |
| How do you prevent transplant rejection? | Adherence to antirejection medication regiment |
| Can someone who had a recent organ replacement take immune boosters such as Vitamin C and why? | No, a stronger or supplemented immune system can increase the risk for organ rejection. |
| How is HIV transmitted? | Transmission through infected body fluids- blood, semen, breast milk, vaginal secretions, rectal fluids. Casual contact like hugging, closed mouth kissing, shaking hands, sharing utensils. Standard precautions |
| Risk Factors for HIV? | Unprotected sex,Multiple sex partners, Occupational exposers (Healthcare workers), Perinatal exposure drug use with contaminated needle, Blood transfusions (not a significant source in USA) |
| HIV prevention medications | Prep with Arv is an effective way to prevent HIV transmission in high-risk scenarios, Truvada and Descovy are approved to be used as prep and taken once daily. |
| What is Aids wasting syndrome? | Involuntary loss of more than 10% of baseline body weight plus chronic weakness, fever, or diarrhea |
| S/s of Aids wasting Syndrome | Decreased appetite, oral lesions, altered metabolism, malabsorption, GI infections, diarrhea, medication side effects, and cognitive impairment all play a role |
| Early pt teaching regarding progression of HIV? | Educate on proper nutrition and maintaining body weight. Serve at least 6 small feedings with high protein value. |
| HIV associated Malignancies. | Kaposi’s sarcoma, Hodgkin's lymphoma ,Non- Hodgkins lymphoma, and Squamous cell carcinoma |
| What diet education will be given to a patient with a cd4 t cell count of 50? | drink bottled water, wear protective equipment if gardening, and cook all foods thoroughly. |
| Fungal Complications. | Pneumocystis pneumonia (PCP): Caused by fungus pneumocystis Jiroveci |
| S/s of fungal complications: | SOB, fever, dry cough |
| When is prophylaxis given? | When T cell counts drop below 350 |
| What is given for treatment if a fundal complication develops? | Treatment involves tmp-smx (Bacterium) |
| Bacterial complications | Bacterial infection caused by mycobacterium tuberculosis |
| What is systemic Lupus | Autoimmune disease with flare ups, remissions, and exasturbations. |
| S/s of lupus | Butterfly rash, swollen enlarged lymph nodes, anemia |
| Common triggers for Lupus | Emotional crisis, allergies, fluorescent lights, hormones, immunizations, infection, injury, overwork, pregnancy, sunlight, stopping medications suddenly, surgery |
| Nursing actions for pt with Lupus | limit salt intake, monitor pain, instruct to wear sun protection, apply lotion, be on alert for Lupus Nephritis check kidney function. |
| Testing for Autoimmune disorders. | A combination of a positive ANA titer and high ESR can indicate an autoimmune disorder. |
| Immunosuppressant agents. | Methotrexate and Hydroxychloroquine (Antimalarial) |
| Methotrexate considerations | Increase hydration, monitor for bone marrow suppression, Increased risk for infection, bleeding, and anemia, Monitor LFTs for liver toxicity, No breast feeding,Avoid Live vaccine for 30 before beginning immunosuppressant therapies (and during |
| Hydroxychloroquine | Client needs frequent eye examinations, May take weeks/ months for effects to be noticed, can cause retinitis and may lead to retinal detachment |
| What is contact dermatitis? | No reaction with first contact, in 7-10 days T memory cells are formed, Subsequent exposures, the t memory cells quickly activate t cells and secrete chemicals causing the reaction |
| S/s of contact dermatitis | s/s red, pruritic, fragile vesicles |
| Antiretroviral therapy (ART) | A 6-medication cocktail designed to stop different phases of HIV replication |
| How does HIV invade the CNS? | They attach to the CD4 receptors in the macrophages of the brain and spinal cord |
| How long does it take to develop HIV antibodies. | 3 months |
| Stage 1 of HIV | CD4 count 500/mm or above. |
| Stage 2 | CD4 count 200-400 |
| Stage 3 | Aids defining condition or CD4count less than 200 |
| Aids defining conditions? | Karposi's Sarcoma, HIV r/t encephalopathy, Pneumocystis pneumonia, Wasting syndrome, Salmonella Septicemia, TB, |
| Wasting syndrome dietary considerations? | 6 small feeds with high protein value. |
| HIV associated malignancies? | Karposi's Sarcoma, Hodgkins's lymphoma, Squamous cell carcinoma |
| Testing for HIV? | Western blot, IFA, ELISA |
| 3 reasons for a Spleenectomy? | HIB, meningitis, pnuemonia. |
| ptt? | Heparin |
| pt/inr | range: 0.8-1.0. Larger the number larger the clot |
| non Heem iron sources. | Fortified cereal, nuts, seeds, enriched bread, and tofu |
| Heem iron sources. | Fish, chicken, meat |
Created by:
Cartoy890