NUR 265 EXAM 4 STUDY GUIDE
NUR 265 EXAM 4
STUDY GUIDE
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 normal = 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
,NUR 265 EXAM 4 STUDY GUIDE
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
,NUR 265 EXAM 4 STUDY GUIDE
• 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
Systemic Sclerosis (Scleroderma) ***SWALOWING PROBLEM***
• Uncommon, chronic, inflammatory, autoimmune connective tissue disease.
• Similar to SLE, but w/a higher mortality rate
• Doesn’t respond to steroids or immunosuppressants, why mortality higher than SLE
• Inflamed tissue becomes fibrotic and then sclerotic (hard) – renal involvement leading cause of death
• Women 25-55, most in 40s
• Diffuse cutaneous *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
• Limited cutaneous *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
▪ Raynaud’s 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
, NUR 265 EXAM 4 STUDY GUIDE
▪ Telangiectasia – capillary dilations that form vascular lesions on face, lips & fingers
• Medical Management
NUR 265 EXAM 4
STUDY GUIDE
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 normal = 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
,NUR 265 EXAM 4 STUDY GUIDE
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
,NUR 265 EXAM 4 STUDY GUIDE
• 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
Systemic Sclerosis (Scleroderma) ***SWALOWING PROBLEM***
• Uncommon, chronic, inflammatory, autoimmune connective tissue disease.
• Similar to SLE, but w/a higher mortality rate
• Doesn’t respond to steroids or immunosuppressants, why mortality higher than SLE
• Inflamed tissue becomes fibrotic and then sclerotic (hard) – renal involvement leading cause of death
• Women 25-55, most in 40s
• Diffuse cutaneous *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
• Limited cutaneous *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
▪ Raynaud’s 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
, NUR 265 EXAM 4 STUDY GUIDE
▪ Telangiectasia – capillary dilations that form vascular lesions on face, lips & fingers
• Medical Management
