NUR 265 EXAM 4 STUDY GUIDE (100% Correct)

NUR 265 EXAM 4 STUDY GUIDE (100% Correct) Discoid lupus  Affects only the skin and is not lethal - Caused by UV rays  Macular Rash & Discoid Rash  Skin biopsy to dx Systemic Lupus Erythematosus (313-317) ***TEMPERATURE***  Chronic, progressive, inflammatory connective tissue disorder that affects multiple body systems &organs o REMISSIONS/EXACCERBATIONS (can end up in the ICU) - Autoimmune o Attracted to KIDNEY’s—Lupus Nephritis is leading cause of death; this is direct damage to the kidneys  Poor survival associated with high creatinine, low hematocrit, proteinuria o Young Women of child bearing age 20-40 Y (primary AA women) o SLE & DLE both share a disfiguring and embarrassing rash!!  Clinical manifestations o Malar rash – red flat or raised rash over cheeks sparing nasolabial folds “butterfly rash” o Discoid rash – Red raised patches with scaling follicle plugging o Photosensitivity– discoid skin rash from sun exposure - pt should wear sunscreen or protective clothing o Oral ulcers–usually painless o Polyarthritis-multiple joints affected  Small joints and knees inflamed  Osteonecrosis from chronic steroid use (5y+) o Pleuritis with pleural effusion or pericarditis o Fever is the major sign of exacerbation o Generalized weakness, fatigue, anorexia, weight loss o Renal disorders–proteinuria, cellular casts o Neurologic disorders – seizures, psychosis and also peripheral neuropathies o Raynaud’s phenomena  Exposure to cold or extreme stress – red, white, blue & pain of digits o Alopecia or hair loss common  Diagnostic Tests o ANA most sensitive but antinuclear antibodies not specific to SLE o C reactive protein can help differentiate SLE flare from an infection (remains normal if SLE flare) o CBC shows pancytopenia (a decrease in all cell types)  Medical Management o Topical steroids for skin lesions o Acetaminophen or NSAIDS (caution with kidneys) – tx joint & muscle pain & inflammation o Hydroxychloroquine (anti-malarial agent) – dec absorption of ultraviolet light by skin, dec skin lesions  Frequent eye exams – b4 starting and q 6 mon o Glucocorticoids – Chronic steroid therapy  Take in the am b4 breakfast  Take Ca to prevent osteoporosis  Maintain skin integrity o Immunosuppressants – methotrexate, azathioprine o Belimumab – do not receive live vaccines for 30 days b4 tx  Teaching  Protect the skin o Limit sun/ultraviolet light exposure to prevent exacerbation (fluorescent light too)  Long sleeves, lg-brimmed hat, SPF 30+ o Clean skin with mild soap, pat dry and apply lotion o Cosmetics ok w/ moisturizers and sun protection, no excess powder or drying substances  Monitor temperature – first sign of exacerbation  Avoid large crowds and people who are ill, bc immunosuppressed  Avoid harsh hair tx (permanents or highlights)  Pregnancy can cause exacerbation Systemic Sclerosis (Scleroderma) ***SWALOWING PROBLEM***  Uncommon, chronic, inflammatory, autoimmune connective tissue disease.  Similar to SLE, but w/a higher mortality rate  Doesn’t respond to steroids or immunosuppressants, why mortality higher than SLE  Inflamed tissue becomes fibrotic and then sclerotic (hard) – renal involvement leading cause of death  Women 25-55, most in 40s  Diffuse cutaneous *Major organ problems o First sx – hand and forearm edema w/ or w/o bilateral carpal tunnel syndrome o Skin thickening on trunk, face, and proximal and distal extremities (most of the body) o Painless symmetric pitting edema of hands & fingers (sausage like fingers) o Changes of pigmentation with loss of skin folds & face can become mask like o Develop early problems w/ GI tract (GERD to dysphagia), heart(myocardial fibrosis), lungs (fibrosis & PAH), & kidneys (malignant HTN) o Complications can be rapid  Limited cutaneous *Esophagus o Skin thickening limited to sites distal to face, neck and distal extremities o Organ changes rare or late o CREST Syndrome  Calcinosis – calcium deposits in tissues  Raynaud’s Phenomenon – intermittent vasospasm of finger tips - first CREST symptom that develops  Esophageal dysmotility - **Dysphagia**  Sclerodactyly – scleroderma of digits – fingers stiff, shiny, and no skin folds  Telangiectasia – capillary dilations that form vascular lesions on face, lips & fingers  Medical Management o Medications – Tx sx  Vasoactive agents – CCB for Raynaud’s symptoms  Anti – inflammatory meds - steroids  Immunosuppressants o Reduce renal complications  ACE inhibitors and HTN control o Treat PAH (Pulmonary Artery Hypertension)  Bosentan - endothelin receptor antagonist – Liver toxic  Nursing Management o Keep HOB elevated 60 degrees during meals and at least an hour after o Maintain skin integrity– esp with steroids & vasospasm o Small frequent meals w/semisoft foods – avoid liquids (thickit) due r/f choking – small amounts & chew well o Teach to avoid foods that inc gastric secretion–spices, caffeine, pepper o Promote bowel elimination – have both constipation & diarrhea  Client Education o How to dress in cold weather-gloves, socks, etc. o Eliminate alcohol, cigarettes, extreme stress, and caffeine (vasoconstrictive) o Biofeedback for stress management o Disease process – Only gets worse Fibromyalgia ***SLEEP & STRETCHING***  Chronic pain syndrome, NOT inflammatory or autoimmune  Pain stiffness and tenderness in trigger points – back of neck, upper chest, trunk, low back, and extremities  Burning and gnawing that comes and goes, worsen w/stress, inc activity, and weather conditions  Women between 30 -50 years, Lyme disease, trauma, & flu-like illness  Clinical Manifestations o Fatigue – most common manifestation o Morning stiffness o Non refreshing sleep because of lack of stage 4 sleep- most do not get REM sleep o Post exertional muscle pain o 1/3 of patients have irritable bowel, tension headaches, PMS, numbness & tingling & Raynaud’s phenomena o Depression – common with chronic pain  Medical Management—Directed at symptom relief o L tryptophan-used to enhance sleep o TCAs (amitriptyline, nortriptyline) inhibit serotonin uptake - antidepressant o Benzodiazepines for anxiety associated w/ depression o NSAIDS for pain control but may need stronger meds if pain not well controlled o Pregabalin (Lyrica) – FDA approved for fibromyalgia pain o **LOW INTENSITY EXERCISE WILL DECREASE PAIN**  Stretching, walking, swimming, rowing, biking, and water exercise o Anticonvulsants like carbamazepine (Tegretol) & gabapentin (Neurontin) to help w/ chronic pain mgmt o Biofeedback– esp. helpful with pain syndrome o Oral Mag helpful with muscle pain Lyme’s Disease ***NO DARK CLOTHING***  Tick born disease  Considered a connective tissue disease because the skin, joints, nervous system, and heart are involved  Sx begin w/i 3-30 days post bite  Easy to treat when found in time  Signs and Symptoms o 1 st - Red flat rash that clears in the center (bulls-eye lesion)- near the area of the bite o Flu-like sx - Severe HA, Fever, Chills, Severe malaise, Fatigue, Stiff neck, & Joint pain  Medical Management o Doxycycline is the most common antibiotic used to treat (14-21 days) o Severe disease- IV antibiotics for 30 days (ceftriaxone or cefotaxime) o Neurologic abnormalities may occur if tx is ineffective o Intra-joint steroids & NSAIDS may be used for joint inflammation & pain o Long term effects include fatigue & arthralgias for many years after initial infection  Prevention & Early Detection o Avoid dark clothing, long-sleeved tops and long pants, tuck in shirt and pants into boots o Insect repellant w/DEET o Remove with gloves or tissue, do not squeeze or burn, flush down the toilet. Clean area with alcohol o Wait 4-6 weeks after being bitten b4 being tested, testing b4 is not reliable Allergy (348-358) ***EPI PEN, STOP INFUSION, LATEX CONDOM USE***  “Hypersensitivity” inc immune response to the presence of an allergen “antigen”  Diagnosis o Allergy skin testing – Has to be red & raised  avoid antihistamines & corticosteroid inhalers 2 weeks before testing  Emergency equipment (resuscitation bag, suction, IV, drugs) for anaphylaxis o RAST (radioallerosorbent test) or fluroenzyme blood tests used to measure IgE levels to specific allergens o Pulmonary function measurements for allergic asthma o Blood test measuring levels of IgE (normal 39 IU/ml) o CBC may show inc eosinophils (normal 1-2%)  Allergic Disorders o Allergic Rhinitis  Histamine causes capillary leak, nasal & conjunctival mucus secretion, & itching w/redness  Allergic rhinitis has rhinorrhea (runny nose), stuffy nose, & itchy, watery eyes  Clear or white nasal drainage, HA or feel pressure o Food allergy vs food intolerance  8 foods 90% of true food allergies – milk, eggs, peanut, tree nuts, shellfish, fish, soybeans & wheat  Diagnosis & treatment are avoidance o Atopic dermatitis  No cure but goal is to control symptoms with antihistamines & topical steroids  Lesions red, itchy, contain exudates – may be drier in elderly  Lesions typically found on cheeks, scalp, & forehead o Urticaria “hives”  Papules or plaques that often fade within 24 hrs.  If hives last over 6 weeks – chronic urticaria  ASA & NSAIDS can exacerbate hives-  Antihistamines mainstay of treatment o Anaphylaxis (Distributed Vasodilated Shock)  Most common causes drugs, food, latex exposure, insect bites & stings (BEES)  Symptoms  Often present with hives, angioedema, dyspnea & wheezing  Syncope, hypotension  N&V, diarrhea, abd pain  Flushing, headache, rhinitis, itching  CV collapse, shock, resp tract obstruction  Symptoms can begin 5-30 min after encountering trigger or be delayed an hour or more  Treatment  Assess respiratory status, airway & O2 sat (do not run and get a probe)  Call the Rapid Response Team  Oxygen via non rebreather 90-100% and have intubation/tracheostomy equipment ready........................................