Exam 3 Study Guide

PN2 Exam 3: Modules 6-8 IMMUNE RESPONSE Pathophysiology: Most important function of inflammation and immunity is to provide protection against invading organisms. - 5 cardinal signs of inflammation: Redness, warmth, pain swelling, decreased function Natural (Innate) Immunity: Present at birth; immediate response to foreign invaders - Skin, chemicals in the blood and immune system cells (inflammatory response) - Phagocytes (macrophages, neutrophils, and dendritic cells), mast cells, eosinophils (increase during allergic reaction and parasitic invasion), basophils, and natural killer cells o These cells identify and eliminate pathogens and are also important mediators in the activation of the adaptive immune system Acquired (adaptive or specific) Immunity: Not present at birth; As the immune system encounters foreign substances (antigens) a memory is developed for that antigen - Lymphocytes like B cells and T cells o Derived from hematopoietic stem cells in the bone marrow - Two types: o Active: Your body has been exposed to the antigen by disease or immunization o Passive: You DON’T produce the antibodies; mother passes them through the placenta OSTEOARTHRITIS Pathophysiology: Most common arthritis; Progressive loss of cartilage where bone and cartilage “float” into joint causing crepitus Treatment: Drug therapy, rest, immobilization, positioning, thermal modalities, weight control, integrative therapies (glucosamine and chondroitin), surgery (total joint arthroplasty/replacements, arthroscopy, osteotomy) Expected findings: Joint pain (loss of function with progressive deterioration), osteophytes (bone spurs), stiffness, crepitus, Heberden’s nodes, Bouchard’s nodes, joint effusions, atrophy of skeletal muscle Abnormal findings Patient teachings: Obesity can lead to OA- LOSING WEIGHT CAN HELP PREVENT OA Medications: - Acetaminophen (Tylenol) DRUG OF CHOICE - Glucosamine: Can increase blood glucose levels - NSAIDS (short term use) - Methotrexate - Leflunomide (Arava) - Corticosteroids - Biological response modifiers - Other immunosuppressive agents RHEUMATOID ARTHRITIS Pathophysiology: Common connective tissue disease; chronic, progressive, systemic inflammatory autoimmune disease affecting primarily synovial joints. Transformed autoantibodies (rheumatoid factors) form and attack healthy tissue, causing inflammation. Treatment: Adequate rest, proper positioning, ice & heat application (paraffin wax), plasmapheresis, complementary therapies, promotion of self-management, management of fatigue, enhance body image - Adaptive devices: Grab bars, long handles on brushes, built up handles on silverware and toothbrushes - Address psychosocial as well Expected findings: Joint stiffness, swelling, pain, fatigue, generalized weakness, as it progresses inflammation and pain become more common Systemic Complications: Weight loss, fever, extreme fatigue, exacerbations, subcutaneous nodules, respiratory & cardiac complications, vasculitis, periungual lesions (fingernails & toenails), paresthesia, - Associated syndromes o Sjogren-dry eyes, dry mouth “xerostomia”, dry vagina, & visual disturbances ▪ A humidifier will relieve many symptoms o Felty- diagnosed by the presence of 3 conditions: RA, enlarged spleen & abnormally low WBC o Caplan-Combination of RA and pneumoconiosis that manifests as intrapulmonary nodules, which appear homogenous ad well-defined on CXR Medications: - DMARDs (Disease-Modifying AntiRheumatic Drugs) o Methotrexate: Monitor liver function, avoid alcohol or meds that affect liver (i.e. acetaminophen), takes several weeks to be affective on pain, AVOID breastfeeding and pregnancy, causes immunosuppression, folic acid supplements can help with side effects o Sulfasalazine: Urine/tears can be yellow/orange, AVOID taking on empty stomach or w/antacids o Hydroxychloroquine (Plaquenil): Increase the risk of damage to the retina of the eye o Cyclosporine: Pt’s should have BP and kidney function monitoring on a regular basis - NSAIDS (Like Celebrex) o Can cause GI stress, may need an H2 blocker (ranitidine- zantac) - Glucocorticoids (Like prednisone) o Long term use can lead to DM, impaired or decreed immunity, fluid & electrolyte imbalances, HTN, Osteoporosis, osteonecrosis, Glaucoma - BRMs (Biological Response Modifiers) o Etanercept (Enbrel): Redness can occur at the site o Tofacitinib (Xejianz): Black box warning about opportunistic infections, TB, and cancer o Golimumab (Simponi): May cause immunosuppression, in an injectable form, s/s include HTN, GI distress, and risk for infection LUPUS ERYTHEMATOSUS (SLE) Pathophysiology: Chronic, progressive, inflammatory connective tissue disorder. Can cause major body organs/ systems to fail. Can have spontaneous remission and exacerbations. It is an autoimmune process which tends to be attracted to glomeruli of the kidneys, often some degree of kidney involvement. Treatment Expected findings: BUTTERFLY RASH, polyarthritis, osteonecrosis, muscle atrophy, fever, fatigue, renal involvement, Pes, pericarditis, Raynaud’s, neurological manifestations, Serositis (refers to inflammation of the serous tissues of the body, the tissues lining the lungs-pleura, heart-pericardium, and the inner lining of the abdomen-peritoneum, and organs within) Medications: - NSAIDS or Tylenol - Hydroxychloroquine (Plaquenil) - Topical cortisone drugs - Chronic steroid therapy - Immunosuppressive agents ......................................CONTINUED.....................................