MEDSURG 2100 Immune Disorders Exam (2020) – MCPHS University | MEDSURG 2100 Immune Disorders Exam (2020)

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MEDSURG 2100 Immune Disorders Exam (2020) – MCPHS University HIV/AIDS Dignosed • CD4 count: o normal =500-1600 o Under 400= HIV o Under 200 = AIDS o Can bounce between HIV/AIDS b... ased on CD4 count • Viral load: o Measure the number of HIV viral particles (copies), in a mm of blood o Low viral load: maintain a low amount through medications or the body so it doesn’t damage us infectively o High viral load: immune system needs to kick in in order to o Undetected: goal – body doesn’t recognize HIV (40-70 copies/mm) Clinical manifestations: • • Dependent on clinical disease process • Emotional distress • Wt. loss/anorexia • Skin lesions • Orla sores • Difficulty swallowing • Altered taste • Night sweats • Peripheral neuropathy • Dizziness • Impaired mobility • Nightmares (HIV = neurologic fxn & emotional upset) • Difficulty concentrating • Sexual dysfxn • Change in mental status (in advanced = encephalopathic) Transmission: • • Serious fluids (BLOOD) needle sticks • Breast milk • Iv drug users • Blood transfusions (especially from the late 80s) • Splashes of blood Four Phases 1. Infection & seroconversion phase: 3 months long, from exposure to converting it to positive • If exposed to HIV – you can get false-negative 2. Asymptomatic phase: could last a very long time (years), • immunocompromised individuals will have shorter asymptomatic phase (depends on the person) 3. Symptomatic phase: seeing CD4 counts (between 400-500) • HIV medication treatment • Poor adherence to medication 4. AIDS: can piggy back and forth from symptomatic and AIDS • CD4 less than 200 • death within 2-5 years Nursing Role: • Education on medication compliance • Symptom management – treatment is targeted • Ethics and confidentiality • Consent for HIV testing • Monitor for opportunistic infections o CDF 400-200 - pneumococcal pneumonia, TB go hand in hand, Kaposi sarcoma black brown lesions on body, herpes zoster, thrush [white candidias – nystatin swish and swallow o CD4 less than 200 - black hairy tongue, toxoplasmosis, histoplasmosis, meningitis, herpes simplex ) o CD4 less than 50: cytomegaly virus, death HAART treatment: highly active antiretroviral treatment (HIV specific) • Decrease viral load and increase CD4 count – slow down the HIV copies from replicating so immune system can try and fight the infection • Will take 2-3 classification of meds (cocktail) • Nurses role: assessment/analysis/education Mechanism of actions: 1. Block viral entry into cells 2. Inhibit enzymes required for HIV replication 
How to know HAART is working: 1. Increased appetite 2. Increase in body weight 3. Decrease in complaints related to therapy and symptoms RHEUMATIC DISEASE Systemic Lupus Erythematous Lab values: • ANA (antinuclear antibody) – normal 1:40 to 1:60, anything higher = 99% positive for SLE • Anti DS DNA antibodies: greater than 10 (antibodies are attacking DNA) – 100% chance of having SLE • Direct Coombs Test: + = antibodies are attacking red blood cells • ESR: normal: males (0-15mm/hr), females (0-29mm/hr) anything greater = inflammatory process • CRP: less than 3.0 mg/L – greater = more inflammation • CBC, BMP, LFT, urinalysis Clinical manifestations: • • Butterfly rash (cutaneous lupus) • Oral rashes • Alopecia • Morning sickness • Pericardial pain for more than 1 day • Renal lab changes (proteinuria) • Psychosis (neuro changes) • Seizures • Leukopenia • Thrombocytopenia • Hemolytic anemia • Endocarditis • Headache • depression - - - - - - - - - - - - - - - - - - - - - - Medication ⎫ ⎫ Epi ⎫ Benadryl ⎫ Corticosteroids ⎫ IV fluids ⎫ Vasoconstrictors NEUROGENIC SHOCK ⎫ Caused by anything the disrupts the sympathetic nervous system ⎫ Can last about 6 weeks ⎫ Interrupted impulse transmission and/or blockage of sympathetic outflow from the medulla all deals with perfusion ⎫ Decreased effect of sympathetic pathway loss of vasomotor tone & decrease innervation of the heart vasodilation of blood vessels pooling of blood leading to HOTN and bradycardia (tissue perfusion) 
Etiology ⎫ Can occur within 30 mins of spinal cord injury – can least 6 weeks ⎫ ** MUST BE AT AN INJURY HIGHER THAN T5/T6 ** Spinal shock Absence of all voluntary and neurologic activity below level of activity – 24 hrs. death Causes Spinal cord injuries Spinal anesthesia Opioids – drug users Benzos Neurological disorders – neurofibromatosis, seizures Diagnosis Spinal/cervical x ray ** Triade: 1. HOTN 2. BRADYCARDIA 3. HYPOTHERIA Nursing Interventions ⎫ ⎫ Inability to regulate temperature – poikilothermia (hot to cold) ⎫ Dry skin ⎫ Bladder dysfxn ⎫ Flaccid paralysis ⎫ Loss of reflex activity ⎫ Bowel dysfxn ⎫ *** decreased CO/CI Nursing management • PREVENTION • Spinal precautions/stabilization • Slight bed elevation post-op • O2 • Assess neuro status & document hourly (looking for trends) • Monitor vitals q 1 hr (temp, BP, HR) • IV fluids • Vasopressors • Norepinephrine * - used to keep cerebral perfusion for pt. with increase ICP • Atropine – increase CO (perfusion) [Show More]

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