Final Ex am Study Tip s
Lupus(SLE)Ch.18 pg.326
Patho: A chr onic pr ogressiv e inflamma tory connectiv etissue disor der/ can cause body or gans &systems t o fail
-SLE t end t o be mos t attracted to the glomeruli of the kidne ys; causing kidne y involvemen tcalledlupus nephritis
-women ar e 10x mor e likely t o get this / w omen of c olor
Expect ed S/S:-But terfly r ash: dr y, scaly, raised r ash-Polyarthritis: small join ts & knees ar e mor e commonly in flamed-Osteonecr osis: bone necr osis fr om lack of o xygen/ seen in long s teroid use 5+ yr s-Fever & F atigue-Nephritis-Pleur al effusions/PNA-Pericarditis/Ra ynaud’ s phenomenon-CNS lupus-Decr ease in all cell types (CBC: pancy topenia)
S/S of impending e xacerba tion: new onse t of f ever/fatigue
Lupus Diagnosis:
a.) Immunologic-based lab t ests:-Rheuma toid f actor-Antinuclear an tibody-CBC (oft en sho ws pancy topenia-decr ease of all cell types)
b.) Skin biop sy: confirms diagnosis
Treatmen t:-Topical Cortisonereduces in flamma tion & pr omot efading of skin lessons-TYN/NS AIDshelp s join t pain t-Hydro xychloroquinedecr ease the ab sorp tion of UVlight by the skin & decr eases risk f or skinlessons. (TE ACH p t. to ha ve eye exams be fore tx & e very 6 mon ths a fter)-Chronic s teroidstreats systemic in flamma tion-Immunosuppressan ts(methotr exate- Rheuma trex or az athioprine-Imur an) used incombina tion w/ s teroids f or se vere renal in volvemen t and c ardiac-Belimumab (Benlys ta): Teach p t. this drug incr easesrisk of in fection & DO NO T receiv e livevaccines f or 30 da ys prior tr eatmen t- Ex. FL U (nasal spr ay) or MMR Teaching:
-When p t. are taking s teroids/immunosuppr essan ts, p t. needs t o avoid lar ge crowds/ill people-Report early s/ s of in fection t o PCP-Take meds early in the morning be fore breakf ast b/c body ’s natural cortic osteroid le vel is thelowest.-Hydroxychlor oquine: Ha ve eye exam be fore treatmen t & Q6 mon ths!-Avoid pr olong ed e xposur e to sun/t anning bed-Wear long slee ves and a lar ge-brimmed ha t when outside-Use sunblock SPF 30 or higher-Mild soap-lotion t o dry skin-Avoid po wder /rubbing alc ohol-mak eup w/ mois turiz er-INSPE CT SKIN D AILY-Inform p t. about pr egnancy is high risk & t o tell PCP if tr ying t o get pregnan t-Check t emp Q da y – (1ochang e)-fatigue is normal but not incr eased f atigue-hair loss is c ommon-plan r est periods-iden tify trig gers-dietician-lupus support
Scleroderma(Systemic Scler osis)Ch. 18 pg.329
Patho:chronic, in flamma tory aut oimmune c onnectiv etissue disor der, but not alw aysprogressiv e. (these people do not r espond w ell to steroids/immunosuppr essan ts)
-scler oderma means har dening of the skin
-women ar e mor e affected than men; ag es 25-55
-renal in volvemen t leading c ause of dea th
-mort ality r ate is higher than SLE
Expect ed S/S:-join t pain t (arthr algia)-stiffness-pitting edema of hands & fing ers/ sausag e-like (early s tages) -loss of elas ticity & R OM is limit ed (la ter stages)-GERD s/ s in early s tage which pr ogress t o dy sphagia- S wallow evalua tion be fore eating-diarrhea-Raynaud’ s phenomenon-Cardiac dy srhythmias & ches t pain along with m yocardial fibr osis c an be pr esen t & de tectedwith EK G
Signs f or impending or gan failur e: chang es in urineoutput and incr eased blood pr essur e
Unexpect ed S/S:-s/s of choking-aspir ation
Treatmen t:-steroids & immunosuppressan ts: often unsuccess ful-Bosen tan (T racleer): impr oves br eathing during e xercisebut pot ential f or liv er damag e/birthdefects. Monit or liv er enz ymes and f ollow up appoin tmen ts.-Oral TKIs (nilotinib- T asigna & imatinib- Glee vec):decr ease in flamma tion and slo w pr ogression,iden tify early or gan in volvemen t and tr eatmen t before irreversible-Skin prot ective measures: mid soap s/lotions and t eachpt. to check skin daily-Comf ort: CNA c an use a bed cr adle & f oot boar d tokeep c overs away from the skin/ adjus troom t emp t o prevent chills
Nursing In terventions:-Keep head ele vated a t leas t 60oduring meals & f orat leas t 1 HR a fter meals-Provide small, fr equen t meals-Give small amoun ts of f ood f or each bit e & che wing be fore swallowing- Semi-soft f oods (mashed pot./pudding); liquids will mos t likely c ause choking-Collabor ate with Die titian-No c affeine, spicy f oods, and ET OH-Give an tacids/his tamine ag ents PRN-Avoid smoking & e xtreme emotional s tress-> c an cause s ymp toms t o recur-Collabor ate w/ speech & languag e pa thologis t for swallow evalua tion-inspect & pr otect skin
Fibromyalgia SyndromeCh. 18 pg.333
Patho:Chronic pain, not an in flamma tory disease-pts. oft en g et frus trated due t o being misdiagnosed & in c onstant pain
Precipit ating f actors:CFS, Lyme disease, tr auma,flu-lik e illness
Lupus(SLE)Ch.18 pg.326
Patho: A chr onic pr ogressiv e inflamma tory connectiv etissue disor der/ can cause body or gans &systems t o fail
-SLE t end t o be mos t attracted to the glomeruli of the kidne ys; causing kidne y involvemen tcalledlupus nephritis
-women ar e 10x mor e likely t o get this / w omen of c olor
Expect ed S/S:-But terfly r ash: dr y, scaly, raised r ash-Polyarthritis: small join ts & knees ar e mor e commonly in flamed-Osteonecr osis: bone necr osis fr om lack of o xygen/ seen in long s teroid use 5+ yr s-Fever & F atigue-Nephritis-Pleur al effusions/PNA-Pericarditis/Ra ynaud’ s phenomenon-CNS lupus-Decr ease in all cell types (CBC: pancy topenia)
S/S of impending e xacerba tion: new onse t of f ever/fatigue
Lupus Diagnosis:
a.) Immunologic-based lab t ests:-Rheuma toid f actor-Antinuclear an tibody-CBC (oft en sho ws pancy topenia-decr ease of all cell types)
b.) Skin biop sy: confirms diagnosis
Treatmen t:-Topical Cortisonereduces in flamma tion & pr omot efading of skin lessons-TYN/NS AIDshelp s join t pain t-Hydro xychloroquinedecr ease the ab sorp tion of UVlight by the skin & decr eases risk f or skinlessons. (TE ACH p t. to ha ve eye exams be fore tx & e very 6 mon ths a fter)-Chronic s teroidstreats systemic in flamma tion-Immunosuppressan ts(methotr exate- Rheuma trex or az athioprine-Imur an) used incombina tion w/ s teroids f or se vere renal in volvemen t and c ardiac-Belimumab (Benlys ta): Teach p t. this drug incr easesrisk of in fection & DO NO T receiv e livevaccines f or 30 da ys prior tr eatmen t- Ex. FL U (nasal spr ay) or MMR Teaching:
-When p t. are taking s teroids/immunosuppr essan ts, p t. needs t o avoid lar ge crowds/ill people-Report early s/ s of in fection t o PCP-Take meds early in the morning be fore breakf ast b/c body ’s natural cortic osteroid le vel is thelowest.-Hydroxychlor oquine: Ha ve eye exam be fore treatmen t & Q6 mon ths!-Avoid pr olong ed e xposur e to sun/t anning bed-Wear long slee ves and a lar ge-brimmed ha t when outside-Use sunblock SPF 30 or higher-Mild soap-lotion t o dry skin-Avoid po wder /rubbing alc ohol-mak eup w/ mois turiz er-INSPE CT SKIN D AILY-Inform p t. about pr egnancy is high risk & t o tell PCP if tr ying t o get pregnan t-Check t emp Q da y – (1ochang e)-fatigue is normal but not incr eased f atigue-hair loss is c ommon-plan r est periods-iden tify trig gers-dietician-lupus support
Scleroderma(Systemic Scler osis)Ch. 18 pg.329
Patho:chronic, in flamma tory aut oimmune c onnectiv etissue disor der, but not alw aysprogressiv e. (these people do not r espond w ell to steroids/immunosuppr essan ts)
-scler oderma means har dening of the skin
-women ar e mor e affected than men; ag es 25-55
-renal in volvemen t leading c ause of dea th
-mort ality r ate is higher than SLE
Expect ed S/S:-join t pain t (arthr algia)-stiffness-pitting edema of hands & fing ers/ sausag e-like (early s tages) -loss of elas ticity & R OM is limit ed (la ter stages)-GERD s/ s in early s tage which pr ogress t o dy sphagia- S wallow evalua tion be fore eating-diarrhea-Raynaud’ s phenomenon-Cardiac dy srhythmias & ches t pain along with m yocardial fibr osis c an be pr esen t & de tectedwith EK G
Signs f or impending or gan failur e: chang es in urineoutput and incr eased blood pr essur e
Unexpect ed S/S:-s/s of choking-aspir ation
Treatmen t:-steroids & immunosuppressan ts: often unsuccess ful-Bosen tan (T racleer): impr oves br eathing during e xercisebut pot ential f or liv er damag e/birthdefects. Monit or liv er enz ymes and f ollow up appoin tmen ts.-Oral TKIs (nilotinib- T asigna & imatinib- Glee vec):decr ease in flamma tion and slo w pr ogression,iden tify early or gan in volvemen t and tr eatmen t before irreversible-Skin prot ective measures: mid soap s/lotions and t eachpt. to check skin daily-Comf ort: CNA c an use a bed cr adle & f oot boar d tokeep c overs away from the skin/ adjus troom t emp t o prevent chills
Nursing In terventions:-Keep head ele vated a t leas t 60oduring meals & f orat leas t 1 HR a fter meals-Provide small, fr equen t meals-Give small amoun ts of f ood f or each bit e & che wing be fore swallowing- Semi-soft f oods (mashed pot./pudding); liquids will mos t likely c ause choking-Collabor ate with Die titian-No c affeine, spicy f oods, and ET OH-Give an tacids/his tamine ag ents PRN-Avoid smoking & e xtreme emotional s tress-> c an cause s ymp toms t o recur-Collabor ate w/ speech & languag e pa thologis t for swallow evalua tion-inspect & pr otect skin
Fibromyalgia SyndromeCh. 18 pg.333
Patho:Chronic pain, not an in flamma tory disease-pts. oft en g et frus trated due t o being misdiagnosed & in c onstant pain
Precipit ating f actors:CFS, Lyme disease, tr auma,flu-lik e illness
