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Nur 265 Exam 4 Study Guide

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Labs • Hbg 12-18 • Hct 37-52% • WBC 5-10 • RBC 4.2-6.1 • PLT 150-400 • PT 11-12.5 sec (1.5-2.5x normal on Coumadin = 16.5-31.25 sec) • INR 0.9-1.2 sec (Therapeutic level 2-3x norm... al = 1.8-3.6 sec) • PTT 60-70 sec (1.5-2.5x normal on Heparin = 90-175) • Na 135-145 • K+ 3.5-5 • Creatinine 0.5-1.2 • BUN 10-20 • Albumin 3.5-5 • Mg 1.5-2.5 • Ca 9-10.5 • Cl 98-106 • Phosphorus 2-4.5 • Specific Gravity 1.005-1.030 Discoid lupus • Affects only the skin and is not lethal - Caused by UV rays • Macular Rash & Discoid Rash • Skin biopsy to dx Systemic Lupus Erythematosus (313-317) ***TEMPERATURE*** • Chronic, progressive, inflammatory connective tissue disorder that affects multiple body systems &organs o REMISSIONS/EXACCERBATIONS (can end up in the ICU) - Autoimmune o Attracted to KIDNEY’s—Lupus Nephritis is leading cause of death; this is direct damage to the kidneys • Poor survival associated with high creatinine, low hematocrit, proteinuria o Young Women of child bearing age 20-40 Y (primary AA women) o SLE & DLE both share a disfiguring and embarrassing rash!! • Clinical manifestations o Malar rash – red flat or raised rash over cheeks sparing nasolabial folds “butterfly rash” o Discoid rash – Red raised patches with scaling follicle plugging o Photosensitivity– discoid skin rash from sun exposure - pt should wear sunscreen or protective clothing o Oral ulcers–usually painless o Polyarthritis-multiple joints affected • Small joints and knees inflamed • Osteonecrosis from chronic steroid use (5y+) o Pleuritis with pleural effusion or pericarditis o Fever is the major sign of exacerbation o Generalized weakness, fatigue, anorexia, weight loss o Renal disorders–proteinuria, cellular casts o Neurologic disorders – seizures, psychosis and also peripheral neuropathies o Raynaud’s phenomena • Exposure to cold or extreme stress – red, white, blue & pain of digits o Alopecia or hair loss common • Diagnostic Tests o ANA most sensitive but antinuclear antibodies not specific to SLE o C reactive protein can help differentiate SLE flare from an infection (remains normal if SLE flare) o CBC shows pancytopenia (a decrease in all cell types) • Medical Management o Topical steroids for skin lesions o Acetaminophen or NSAIDS (caution with kidneys) – tx joint & muscle pain & inflammation o Hydroxychloroquine (anti-malarial agent) – dec absorption of ultraviolet light by skin, dec skin lesions ▪ Frequent eye exams – b4 starting and q 6 mon o Glucocorticoids – 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 • Teaching • 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/ moisturizers and sun protection, no excess powder or drying substances • Monitor temperature – 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 ..............................................................CONGTINUED................................................... [Show More]

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