PN 2 - EXAM 3 STUDY GUIDE
RHEUMATOID ARTHRITIS
o Chronic, progressive, systemic inflammatory autoimmune disease that primary affects
synovial joints
o Early S/S
Inflammation, low grade fever, fatigue, weakness, anorexia
o Late S/S
Osteoporosis, moderate to severe pain, deformities
o Sjogren’s Syndrome: dry eyes, dry mouth, and dry vagina
o Medications
First line: Methotrexate
Immunosuppressive
Once a week dose
Monitor patient for decrease in WBC and platelets (bone marrow
suppression)
Monitor patient for increase of liver enzyme or serum creatinine
Avoid alcohol – liver toxicity
D/C 3 months prior to pregnancy
Corticosteroids: prednisone
Can cause fluid/electryolte imblanace, DM, HTN, glaucoma
Non-pharmacoloigical
Heated paraffin wax dips
Grab bars / nonskid rugs
Rest, positioning, ice, heat
LUPUS ERYTHEMATOSUS
o Chronic, progressive, inflammatory connective tissue disorder that can cause major
organs to fail
o Spontaneous remissions and exacerbations
o Affects women 10x more than men, 20-40 years is onset
o Symptoms:
Butterfly rash, discoid lesions
Nephritis
Raynaud’s phenomenon
Pleural effusions, pneumonia
GI issues, abdominal pain
Joint inflammation (polyarthritis)
Fever, fatigue, anorexia, weight loss, weakness
o Medications
Topical cortisone- reduce inflammation
Tylenol/NSAIDS- joint/muscle pain or inflammation
, Anti-malarial Hydroxychloroquine- decrease UV light to decrease amount of skin
lesions
Rheumatrex or Imuran- immunosuppreant for renal or CNS lupus
HIV/AIDS
- Retrovirus: able to insert it’s single stranded RNA genetic material into the host’s DNA
- Testing
o ELISA
o Western Blot Analysis
- Most common infection: pneumonia
- HIV Progression
o Adults transfused with HIV contaminated blood, AIDS develops quickly
o Those who become HIV+ from a single sexual encounter, progression to AIDS takes
much longer
- Needlestick
o Wash location for 1 full minute and contact employee health
o Medication should be started within 24-36 hours of exposure
o Should be treated with same 3-drug regimen for 28 days
Tenofovir 300mg + Emtricitabine 200mg + Raltegravir 400mg bid
o HIV testing at 1, 3, and 6 months
ALLERGIC REACTIONS
Type Examples
Type I: Rapid/Immediate Hay fever, asthma, anaphylaxis,
angioedema
Type II: Cytotoxic Autoimmune hemolytic anemia,
Myasthenia gravis,
Goodpasture’s syndrome
Type III: Immune Complex- Serum sickness, vasculitis,
Mediated systemic lupus erythematosus,
RA
Type IV: Delayed Poison Ivy, Graft rejection,
positive TB skin test
- Anaphylaxis
o Most life-threatening of Type I
o Occurs rapidly and systemically
o EpiPen
Delivers 0.3mg of Epi per 2 IM, give q5-15 minutes
Constricts blood vessels, improves cardiac contraction, dilates bronchioles
o Interventions:
Antihistamines are 2nd line drugs
O2 via nonrebreather mask
ABG’s to determine effectiveness
RHEUMATOID ARTHRITIS
o Chronic, progressive, systemic inflammatory autoimmune disease that primary affects
synovial joints
o Early S/S
Inflammation, low grade fever, fatigue, weakness, anorexia
o Late S/S
Osteoporosis, moderate to severe pain, deformities
o Sjogren’s Syndrome: dry eyes, dry mouth, and dry vagina
o Medications
First line: Methotrexate
Immunosuppressive
Once a week dose
Monitor patient for decrease in WBC and platelets (bone marrow
suppression)
Monitor patient for increase of liver enzyme or serum creatinine
Avoid alcohol – liver toxicity
D/C 3 months prior to pregnancy
Corticosteroids: prednisone
Can cause fluid/electryolte imblanace, DM, HTN, glaucoma
Non-pharmacoloigical
Heated paraffin wax dips
Grab bars / nonskid rugs
Rest, positioning, ice, heat
LUPUS ERYTHEMATOSUS
o Chronic, progressive, inflammatory connective tissue disorder that can cause major
organs to fail
o Spontaneous remissions and exacerbations
o Affects women 10x more than men, 20-40 years is onset
o Symptoms:
Butterfly rash, discoid lesions
Nephritis
Raynaud’s phenomenon
Pleural effusions, pneumonia
GI issues, abdominal pain
Joint inflammation (polyarthritis)
Fever, fatigue, anorexia, weight loss, weakness
o Medications
Topical cortisone- reduce inflammation
Tylenol/NSAIDS- joint/muscle pain or inflammation
, Anti-malarial Hydroxychloroquine- decrease UV light to decrease amount of skin
lesions
Rheumatrex or Imuran- immunosuppreant for renal or CNS lupus
HIV/AIDS
- Retrovirus: able to insert it’s single stranded RNA genetic material into the host’s DNA
- Testing
o ELISA
o Western Blot Analysis
- Most common infection: pneumonia
- HIV Progression
o Adults transfused with HIV contaminated blood, AIDS develops quickly
o Those who become HIV+ from a single sexual encounter, progression to AIDS takes
much longer
- Needlestick
o Wash location for 1 full minute and contact employee health
o Medication should be started within 24-36 hours of exposure
o Should be treated with same 3-drug regimen for 28 days
Tenofovir 300mg + Emtricitabine 200mg + Raltegravir 400mg bid
o HIV testing at 1, 3, and 6 months
ALLERGIC REACTIONS
Type Examples
Type I: Rapid/Immediate Hay fever, asthma, anaphylaxis,
angioedema
Type II: Cytotoxic Autoimmune hemolytic anemia,
Myasthenia gravis,
Goodpasture’s syndrome
Type III: Immune Complex- Serum sickness, vasculitis,
Mediated systemic lupus erythematosus,
RA
Type IV: Delayed Poison Ivy, Graft rejection,
positive TB skin test
- Anaphylaxis
o Most life-threatening of Type I
o Occurs rapidly and systemically
o EpiPen
Delivers 0.3mg of Epi per 2 IM, give q5-15 minutes
Constricts blood vessels, improves cardiac contraction, dilates bronchioles
o Interventions:
Antihistamines are 2nd line drugs
O2 via nonrebreather mask
ABG’s to determine effectiveness
