EXAM 4 256 EXAM QUESTIONS WITH COMPLETE
ANSWERS GUARANTEED PASS
SLE medical management - ANSWER ->o Topical steroids for
skin lesions
o Acetaminophen or NSAIDS (caution with kidneys) - tx
joint & muscle pain & inflammation
o HYDROXYXHLOEOQUINE (anti-malarial agent) - dec
absorption of ultraviolet light by skin, dec skin lesions §
Frequent eye exams - b4 starting and q 6 mon o
GLUCOSTEROIDS - 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
SLE teaching - ANSWER ->· 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/
MOSIURIZERS, AND SUN PROTECTION, NO EXCESS
POWDER OR DRYING
SUBSTANCES
· MONITOR TEMP- 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) - ANSWER -
>***SWALOWING PROBLEM***
· Uncommon, chronic, inflammatory, autoimmune
connective tissue disease.
· Similar to SLE, but w/a higher mortality rate
· DOESNT RESPOND TO STEROIDS OR
IMMUNOSUPPRESANTS, WHY MORTALITY IS HIGHER
THAN SLE
· Inflamed tissue becomes fibrotic and then sclerotic
(hard) - renal involvement leading cause of death
· Women 25-55, most in 40s
,Diffues cutaneous scleroderma - ANSWER ->· *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 Limites
cutaneous scleroderma - ANSWER
->· *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
§ RAYNAUDS 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
Scleroderma medications - ANSWER ->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
allergy - ANSWER ->***EPI PEN, STOP INFUSION, LATEX
CONDOM USE***
· "Hypersensitivity" increased immune response to the
presence of an allergen "antigen"
scleroderma nursing managment - ANSWER ->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 &
ANSWERS GUARANTEED PASS
SLE medical management - ANSWER ->o Topical steroids for
skin lesions
o Acetaminophen or NSAIDS (caution with kidneys) - tx
joint & muscle pain & inflammation
o HYDROXYXHLOEOQUINE (anti-malarial agent) - dec
absorption of ultraviolet light by skin, dec skin lesions §
Frequent eye exams - b4 starting and q 6 mon o
GLUCOSTEROIDS - 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
SLE teaching - ANSWER ->· 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/
MOSIURIZERS, AND SUN PROTECTION, NO EXCESS
POWDER OR DRYING
SUBSTANCES
· MONITOR TEMP- 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) - ANSWER -
>***SWALOWING PROBLEM***
· Uncommon, chronic, inflammatory, autoimmune
connective tissue disease.
· Similar to SLE, but w/a higher mortality rate
· DOESNT RESPOND TO STEROIDS OR
IMMUNOSUPPRESANTS, WHY MORTALITY IS HIGHER
THAN SLE
· Inflamed tissue becomes fibrotic and then sclerotic
(hard) - renal involvement leading cause of death
· Women 25-55, most in 40s
,Diffues cutaneous scleroderma - ANSWER ->· *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 Limites
cutaneous scleroderma - ANSWER
->· *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
§ RAYNAUDS 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
Scleroderma medications - ANSWER ->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
allergy - ANSWER ->***EPI PEN, STOP INFUSION, LATEX
CONDOM USE***
· "Hypersensitivity" increased immune response to the
presence of an allergen "antigen"
scleroderma nursing managment - ANSWER ->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 &
