ADVANCED MED SURG STUDY GUIDE FINAL
Unit 9: Infection (HIV/AIDS), Immunity & Autoimmunity
Immune Disorders
Systemic Lupus Erythematosus (SLE)
Pathophysiology A progressive autoimmune disorder in which inflammatory and
immune attacks occur against multiple cell tissues and organs.
Circulating autoantibodies attack tissues, causing a type III
hypersensitivity reaction. This results in some degree of impaired
tissue integrity. These actions cause systemic inflammation and attracts
other immune cells and products to the sites, which then stimulate
chronic tissue injury and destruction.
A less common form of lupus is cutaneous lupus erythematous (CLE)
in which only the skin is affected by autoimmune attack. However,
about 70% to 80% of patients initially diagnosed with CLE eventually
develop SLE, suggesting that CLE may not be a distinct disorder from
SLE (pg. 353).
Clinical Butterfly rash (dry, scaly, raised rash on face), photosensitivity,
Manifestations/ intermittent fever, chronic fatigue, arthritis; muscle aches,
Complications inflammation, and pain; painful, red, and swollen joints, inflammation
of serosal membranes (pericarditis and pleurisy), seizures or psychosis.
Complications: CKD and cardiovascular damage.
Etiology/ Risk Triggers for expression of SLE: Injury, drugs, hormones (estrogen),
factors exposure to environmental substances (UV light).
RF: Genetics, African-American women, women between 30- 44 years
old.
Tests/ Presence of antinuclear antibodies (ANAs), proteinuria, elevated ESR.
Diagnostics
Hematologic problems with hemolytic anemia: leukopenia,
, lymphopenia, thrombocytopenia.
Therapeutic PRIORITY: Managing pain/ inflammation, fatigue, psychosocial
Management needs!
Drug therapy:
Acetaminophen, NSAIDS, corticosteroids (teach to never stop
abruptly), antimalarial drugs hydroxychloroquine and chloroquine
(teach to have frequent eye exams w/ visual field testing before starting
drug and every 6 months after), immune modulators methotrexate and
azathioprine, and monoclonal antibodies.
Drug alert QSEN pg. 358:
All immunosuppressants reduce protective immunity to some degree
and increase the pts. risk for new infections and reactivation of
dormant infections such as TB. Teach pts. Taking these drugs to
practice social distancing and contact Rheumatologist at the first sign
of infection.
Teaching:
Teach patient to accept fatigue as a continuing but manageable
condition of SLE, teach patient to avoid self-blame for the need to alter
activity, establish good sleep patterns and healthy diet from more
energy, make rest time a priority, avoid nicotine, ask family for
support, join a support group, accept help from others.
Teach pts to avoid prolonged expose to sunlight, UV lighting, and
fluorescent light and to wear protective clothing and SPF 30 or higher
(QSEN pg. 358).
Lyme Disease
Pathophysiology Systemic infectious disease caused by the spirochete Borrelia
burgdorferi. The organism is common in rodents and is spread to
humans through the bite of an infected deer tick. Antibodies are
generated in response to the infection- and the continuing attack
on the organism causes chronic inflammation with the release of
cytokines.
, Clinical Stage I (localized stage): Occurs within 3 to 30 days of the tick bite,
Manifestations/ but most present in 7 to 14 days. Sxs: Flu like symptoms, erythema
Complications migrans, and pain and stiffness in the muscles and joints.
Stage II (early disseminated stage): Occurs 2 to 12 weeks after the tick
bite. Sxs: Carditis with dysrhythmias, dyspnea, dizziness, palpitations,
CNS disorders such as meningitis, facial paralysis, and peripheral
neuritis.
Stage III (chronic persistent stage): Occurs months to years after tick
bite. Sxs: Arthritis, chronic fatigue, memory and thinking problems.
Etiology/ Risk Most common vector-borne disease in North America and Europe;
factors most at risk during the summer months.
Tests/ Clinical presentation.
Diagnostics
Therapeutic Drug therapy:
Management
Stage I: Doxycycline, amoxicillin, or erythromycin for 14 to 21 days.
Stage II: IV ceftriaxone or cefotaxime for at least 30 days.
Stage III: In some cases, the disease may not respond to antibiotics in
any stage, and the pt. develops permanent damage to joints and the
nervous system.
PRIORITY: Prevention and early detection of Lyme disease!
Patient and family education (pg. 360):
• Avoid heavily wooded areas or areas with thick underbrush,
especially in the spring and summer months.
• Walk in the center of the trail.
• Avoid dark clothing. Lighter-colored clothing makes spotting ticks
easier.
• Use an insect repellent (DEET) on your skin and clothes when in an
area where ticks are likely to be found.
• Wear long-sleeved tops and long pants; tuck your shirt into your pants
and your pants into your socks or boots.
• Wear closed shoes or boots and a hat or cap.
•Bathe immediately after being in an infested area and inspect your
body for ticks (about the size of a pinhead); pay special attention to
your arms, legs, and scalp.
• Check your pets for ticks.
• Gently remove with tweezers or fingers covered with tissue or gloves
any tick that you find (do not squeeze). Dispose of the tick by flushing
Unit 9: Infection (HIV/AIDS), Immunity & Autoimmunity
Immune Disorders
Systemic Lupus Erythematosus (SLE)
Pathophysiology A progressive autoimmune disorder in which inflammatory and
immune attacks occur against multiple cell tissues and organs.
Circulating autoantibodies attack tissues, causing a type III
hypersensitivity reaction. This results in some degree of impaired
tissue integrity. These actions cause systemic inflammation and attracts
other immune cells and products to the sites, which then stimulate
chronic tissue injury and destruction.
A less common form of lupus is cutaneous lupus erythematous (CLE)
in which only the skin is affected by autoimmune attack. However,
about 70% to 80% of patients initially diagnosed with CLE eventually
develop SLE, suggesting that CLE may not be a distinct disorder from
SLE (pg. 353).
Clinical Butterfly rash (dry, scaly, raised rash on face), photosensitivity,
Manifestations/ intermittent fever, chronic fatigue, arthritis; muscle aches,
Complications inflammation, and pain; painful, red, and swollen joints, inflammation
of serosal membranes (pericarditis and pleurisy), seizures or psychosis.
Complications: CKD and cardiovascular damage.
Etiology/ Risk Triggers for expression of SLE: Injury, drugs, hormones (estrogen),
factors exposure to environmental substances (UV light).
RF: Genetics, African-American women, women between 30- 44 years
old.
Tests/ Presence of antinuclear antibodies (ANAs), proteinuria, elevated ESR.
Diagnostics
Hematologic problems with hemolytic anemia: leukopenia,
, lymphopenia, thrombocytopenia.
Therapeutic PRIORITY: Managing pain/ inflammation, fatigue, psychosocial
Management needs!
Drug therapy:
Acetaminophen, NSAIDS, corticosteroids (teach to never stop
abruptly), antimalarial drugs hydroxychloroquine and chloroquine
(teach to have frequent eye exams w/ visual field testing before starting
drug and every 6 months after), immune modulators methotrexate and
azathioprine, and monoclonal antibodies.
Drug alert QSEN pg. 358:
All immunosuppressants reduce protective immunity to some degree
and increase the pts. risk for new infections and reactivation of
dormant infections such as TB. Teach pts. Taking these drugs to
practice social distancing and contact Rheumatologist at the first sign
of infection.
Teaching:
Teach patient to accept fatigue as a continuing but manageable
condition of SLE, teach patient to avoid self-blame for the need to alter
activity, establish good sleep patterns and healthy diet from more
energy, make rest time a priority, avoid nicotine, ask family for
support, join a support group, accept help from others.
Teach pts to avoid prolonged expose to sunlight, UV lighting, and
fluorescent light and to wear protective clothing and SPF 30 or higher
(QSEN pg. 358).
Lyme Disease
Pathophysiology Systemic infectious disease caused by the spirochete Borrelia
burgdorferi. The organism is common in rodents and is spread to
humans through the bite of an infected deer tick. Antibodies are
generated in response to the infection- and the continuing attack
on the organism causes chronic inflammation with the release of
cytokines.
, Clinical Stage I (localized stage): Occurs within 3 to 30 days of the tick bite,
Manifestations/ but most present in 7 to 14 days. Sxs: Flu like symptoms, erythema
Complications migrans, and pain and stiffness in the muscles and joints.
Stage II (early disseminated stage): Occurs 2 to 12 weeks after the tick
bite. Sxs: Carditis with dysrhythmias, dyspnea, dizziness, palpitations,
CNS disorders such as meningitis, facial paralysis, and peripheral
neuritis.
Stage III (chronic persistent stage): Occurs months to years after tick
bite. Sxs: Arthritis, chronic fatigue, memory and thinking problems.
Etiology/ Risk Most common vector-borne disease in North America and Europe;
factors most at risk during the summer months.
Tests/ Clinical presentation.
Diagnostics
Therapeutic Drug therapy:
Management
Stage I: Doxycycline, amoxicillin, or erythromycin for 14 to 21 days.
Stage II: IV ceftriaxone or cefotaxime for at least 30 days.
Stage III: In some cases, the disease may not respond to antibiotics in
any stage, and the pt. develops permanent damage to joints and the
nervous system.
PRIORITY: Prevention and early detection of Lyme disease!
Patient and family education (pg. 360):
• Avoid heavily wooded areas or areas with thick underbrush,
especially in the spring and summer months.
• Walk in the center of the trail.
• Avoid dark clothing. Lighter-colored clothing makes spotting ticks
easier.
• Use an insect repellent (DEET) on your skin and clothes when in an
area where ticks are likely to be found.
• Wear long-sleeved tops and long pants; tuck your shirt into your pants
and your pants into your socks or boots.
• Wear closed shoes or boots and a hat or cap.
•Bathe immediately after being in an infested area and inspect your
body for ticks (about the size of a pinhead); pay special attention to
your arms, legs, and scalp.
• Check your pets for ticks.
• Gently remove with tweezers or fingers covered with tissue or gloves
any tick that you find (do not squeeze). Dispose of the tick by flushing
