NR 324 Comprehensive Exam with
Complete Solutions
methotrexate - ✔✔DMARD
humoral response - ✔✔B cells - antibody mediated
cell mediated - ✔✔t cells and CD4, specific antigen recognized
vaccines - ✔✔active immunity
varicella vaccine - ✔✔live vaccine - do not give give vaccine to pt. who is immunocompromised
IgE reaction - ✔✔-quick onset
-allergic reaction
-release of mast cells and histamines
-massive vasodilation (shock - BP drops)
-give epi
-mostly concerned about airway - oxygen will not help much since airway is constricting - have
oral airway nearby, then give epi and IV fluids to help with tachycardia and hypotension
IgG reaction - ✔✔-antibody mediated
-blood transfusion reaction
-hemolytic anemia
Immune Complex Mediated Reaction - ✔✔-inflammatory response
,-SLE, Acute glomerular nephritis, RA, hyperacute graft rejection
Hyperacute graft rejection - ✔✔-will need to take transplant out
Chronic Rejection - ✔✔-s/s: malaise, fatigue, low grade fever, tenderness at graft site, BUN and
creatinine increasing
-give medications for rejection: more immunisuppressants and solumedrol (1000mg IV - watch
blood sugar since it will increase by a large amount)
Cell Mediated Reaction - ✔✔-delays, people that get chronic graft rejection or someone who
has a positive PPD, latex allergies, or poison ivy
-
Latex Allergy - ✔✔-if pt. is allergic to bananas, avocados, papayas, they could also be allergic to
latex
Cellular Response with inflammation - ✔✔-neutrophils and monocytes go to site of injury since
can now go through capillary walls
Rheumatoid Arthritis - ✔✔-not a joint problem, it is an inflammation of synovial fluid so
synovial membrane is inflamed, then membrane can become fibrotic
-goal for tx: prevent or minimize the # of deformities
-will have ulnar deviation and swan neck deformities
-affects fingers and toes bilaterally a lot
-joints get stiff with limited movement
-morning stiffness that lasts more than hour
-put heat on joints that stiff to relax the joint and increase ROM
-do heat and cold therapy
-dont completely limit movement
, -complications: pleural and lung problems, pericarditis, cataracts, contractures, nodules
-get OT AND PT
-ESR: <30%
-CRP: <1 (to see if inflammation is present in body)
-RF: <15 -specific to arthritis
-ANA: positive with RA
Drug Therapy RA - ✔✔-NSAIDS (watch for ulcers)
-COX 2 inhibitors: celebrex
-DMARDS: methotrexate (really bad for kidneys - monitor kidney function throughout tx.)
-Immune modulators: Embrel, Remicade -> do not take if recently had the flu or infection
-Corticosteroids: watch for decrease in K and increase in glucose
-NO CURE FOR RA
Osteoarthritis - ✔✔-from injury to joints and wear and tear (athletes)
-problem: bone on bone - dont have synovial membrane
-will have joint crepitus
-joints get big and swollen, decreased ROM, pain gets worse, decreased cartilage
Osteoarthritis Tx - ✔✔-replace joints
-first thing you will do: big risk if higher weight since really tough on joints so lifestyle changes
are important particularly weight loss
Osteoarthritis Drug Therapy - ✔✔-NSAIDS
-Cortisone injection
Complete Solutions
methotrexate - ✔✔DMARD
humoral response - ✔✔B cells - antibody mediated
cell mediated - ✔✔t cells and CD4, specific antigen recognized
vaccines - ✔✔active immunity
varicella vaccine - ✔✔live vaccine - do not give give vaccine to pt. who is immunocompromised
IgE reaction - ✔✔-quick onset
-allergic reaction
-release of mast cells and histamines
-massive vasodilation (shock - BP drops)
-give epi
-mostly concerned about airway - oxygen will not help much since airway is constricting - have
oral airway nearby, then give epi and IV fluids to help with tachycardia and hypotension
IgG reaction - ✔✔-antibody mediated
-blood transfusion reaction
-hemolytic anemia
Immune Complex Mediated Reaction - ✔✔-inflammatory response
,-SLE, Acute glomerular nephritis, RA, hyperacute graft rejection
Hyperacute graft rejection - ✔✔-will need to take transplant out
Chronic Rejection - ✔✔-s/s: malaise, fatigue, low grade fever, tenderness at graft site, BUN and
creatinine increasing
-give medications for rejection: more immunisuppressants and solumedrol (1000mg IV - watch
blood sugar since it will increase by a large amount)
Cell Mediated Reaction - ✔✔-delays, people that get chronic graft rejection or someone who
has a positive PPD, latex allergies, or poison ivy
-
Latex Allergy - ✔✔-if pt. is allergic to bananas, avocados, papayas, they could also be allergic to
latex
Cellular Response with inflammation - ✔✔-neutrophils and monocytes go to site of injury since
can now go through capillary walls
Rheumatoid Arthritis - ✔✔-not a joint problem, it is an inflammation of synovial fluid so
synovial membrane is inflamed, then membrane can become fibrotic
-goal for tx: prevent or minimize the # of deformities
-will have ulnar deviation and swan neck deformities
-affects fingers and toes bilaterally a lot
-joints get stiff with limited movement
-morning stiffness that lasts more than hour
-put heat on joints that stiff to relax the joint and increase ROM
-do heat and cold therapy
-dont completely limit movement
, -complications: pleural and lung problems, pericarditis, cataracts, contractures, nodules
-get OT AND PT
-ESR: <30%
-CRP: <1 (to see if inflammation is present in body)
-RF: <15 -specific to arthritis
-ANA: positive with RA
Drug Therapy RA - ✔✔-NSAIDS (watch for ulcers)
-COX 2 inhibitors: celebrex
-DMARDS: methotrexate (really bad for kidneys - monitor kidney function throughout tx.)
-Immune modulators: Embrel, Remicade -> do not take if recently had the flu or infection
-Corticosteroids: watch for decrease in K and increase in glucose
-NO CURE FOR RA
Osteoarthritis - ✔✔-from injury to joints and wear and tear (athletes)
-problem: bone on bone - dont have synovial membrane
-will have joint crepitus
-joints get big and swollen, decreased ROM, pain gets worse, decreased cartilage
Osteoarthritis Tx - ✔✔-replace joints
-first thing you will do: big risk if higher weight since really tough on joints so lifestyle changes
are important particularly weight loss
Osteoarthritis Drug Therapy - ✔✔-NSAIDS
-Cortisone injection
