Systemic Lupus Erythematosus

- is an autoimmune disease in which a person's immune system attacks various organs or cells of the body, causing damage and dysfunction.

Pathophysiology Precipitating factors (UV exposure, Microbial response, drugs)

Diagnostic Exam CBC-leukopenia, anemia ANA- positive ESR- generally elevated Complement levels- generally decreased when disease is active Urinalysis- hematuria, proteinuria Chest x-ray may show changes

disturbed immune regulation

Hyperactivity of Tcells and bcells

high ratio of CD4:CD8 Tcells

Medications ibuprofen (Motrin) * naproxen (Naprosyn) * ansulindac (Clinoril) * Hydroxychloroquine (Plaquenil)

exagerated production of autoantibodies

Tissue injury and damage

Nursing Management * Instruct patient in avoidance of factors that may exacerbate disease. * Encourage good nutrition, sleep habits and exercise, rest and relaxation to improve general health and help prevent infection. * Assist with monitoring of urinary status as indicated by degree of renal involvement. * Encourage good oral hygiene and inspect mouth for ulcers. * Teach relaxation techniques such as deep breathing, progressive muscle relaxation

Addisons Disease
Chronic adrenocortical insufficiency secondary to dysfunction of the adrenal glands

Pathophysiology Destruction/ dysfunction of entire adrenal cortex (Adrenal dygenis, impaired steroidogenisis, adrenal dysfunction, corticosteroid withdrawal)

Diagnostic Exam
Blood chemistry- decreased glucose, decrease sodium, increased potassium * Increased lymphocytes on complete blood count * Low plasma fasting cortisol levels; low aldosterone levels * ACTH stimulation test- no rise in plasma cortisol and urinary 17 ketosteroids

Impaired glucocorticoids and mineralocorticoids function

decrease aldosterone being produced

Medications
Celestone (Bethamethasone) * Cortone, Cortistan (Cortisone) * Decadron (Dexamethasone)

cortisol deficiency, aldosterone deficiency

* Florinef (Fludrocortisone) * Cortef (Hydrocortisone)

Nursing Management * Decrease stress in the environment. * Prevent exposure to infection. * Provide rest periods to prevent fatigue. * Provide diet high in protein, Na and carbohydrates; low K * Administer steroids after meals or with milk

Bronchial Asthma
is the common chronic inflammatorydisease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm

Pathophysiology Predisposing factors ( genetics, age, sex, race), Precipitating factors ( environment, pollutants, allergens)

Diagnostic Exam * Laboratory- increased levels of IgE are usually seen in atopic asthma * Pulmonary function testing- decreasedforced expiratory volume * Sputum and nasal cytology increased eosinophilia

IgE stimulations

* Chest x-ray to exclude other lung diseases

Mast cells degranulation

Medications

altered immunologic response , increased airway resistance, increase lung comliance, impaired mucocillary function, altered o2 and co2 exchange

* cromolym sodium (Intal ) * budesonide (Pulmicort) * ipratropium bromide (Atrovent) * salbutamol (Vertolin) * Terbutaline (Bricanyl)

asthma attack
Nursing Management * Monitor vital signs, skin color, and degree of restlessness which may indicate hypoxia * Provide nebulization and oxygen therapy as prescribed * Encourage intake of fluids to liquefy secretions * Instruct patient on positioning to facilitate breathing.

Chronic Obstructive Pulmonary Disease

is the co-occurrence of chronic bronchitis and emphysema, a pair of commonly coexisting diseases of the lungs in which theairways become narrowed

Pathophysiology
Precipitating factors (age, sex, genetic) predisposing factors (environment, work, smoking, pollutants)

Diagnostic Exam * PFT s demonstrate airflow obstructionreduced FEV1, FEV1 to FVC ratio; increased residua volume to total lung capacity * ABG s- decreased PaO2, Ph and increased CO2 * Chest x-ray- in late stages, hyperinflation, flattened diaphragm, possible bullae

primary infection

Mucosal inflammation

increase secretion mucosal edema

Narrowing of bronchial lumen

Medications
Bronchospasm

* Theophyline (Theodur) * Metaproterenol (Alupent)

Obstruction of airflow

* Ipratropium bromide (Atrovent) * Prednisone (Orasone)

Impaired lung clearance

Alveolar hypoventilation

Nursing Management * Eliminate all pulmonary irritants, particularly

Weakened disruption

cigarette smoke. Smoking cessation usually reduces pulmonary irritation, sputum production, and cough. Keep the patients room as dust-free as possible. * Use postural drainage positions to help clear secretions responsible for airway obstructions. * Encourage high level of fluid intake ( 8 to 10 glasses; 2 to 2.5 liters daily) within level of cardiac reserve.

small airway collapse

Chronic bronchitis, emphysema

* Give inhalations of nebulized saline to humidify

bronchial tree and liquefy sputum. Add moisture (humidifier, vaporizer) to indoor air

Polyarteritis Nodosa
systematic vasculitis characterized by necroting inflammatory lesions that affect medium sized and small muscular arteroes, preferential at vessel bifurcations, resulting microaneurysm formation, aneurysmal formation w/ hemorrhage, thrombosis and consequently, organ ischemia.

Pathophysiology
Diagnostic Exam Deranged immunologic processes * CBC- decreased hemoglobin and hematocrit * ESR- generally elevated vascular lesions occur mainly at bifurcations and branch points * Serum albumin- decreased * Complement levels- decreased inflammation way start at the vessel intima and to the entire arterial wall

fibrinoid necrosis occurs Medications aneurysms develop in the weakened vessel * Cyclophosphamide (Cytoxan) * Azathioprine (Imuran)

thrombi develop in the site of lesion

Nursing Management proliferations of the intima or media may result in obstruction subsequent tissue ischemia and infarction * Advise patient to avoid known sources of infection * Practice and teach frequent handwashing. * Monitor CBC results for leukocyte and absolute neutrophil counts. * Inspect skin for rash, ulcers, ischemic digits. * Administer anti inflammatory and immunosuppressives agensta s ordered. * Provide small, high- caloric meals.

Anaphylaxis
defined as "a serious allergic reaction that is rapid in onset and may cause death .

Pathophysiology
Diagnostic Exam Exposure to allergens * Serum tryptase- elevated * Serum histamine levels- >10 nanomol/L interaction of foreign antigen w/ specific IgE antibodies * In vitro Ige testing > 0.35 international units/L

release of histamine prostglandin inflammatory leukotrines (vasoactive mediators)

vascular permiability, flushing, urticaria, angioedema, hypotension, angioedema, hypotension and bronchospasm

Medications
* Epinephrine (adrenalin) * Dipenhydarmine (Benadryl) * Ranitidine (Zantac) * Albuterol (Proventil HFA)

Nursing Management * Continually monitor respiratory rate and depth

and breathe sounds for respiratory effort and effectiveness of ventilation. * Monitor blood pressure using continuous automatic cuff. * Monitor central venous pressure to ensure adequate fluid volume and to prevent fluid overload. * Insert indwelling catheter and monitor urine output hourly to ensure kidney perfusion.

Pemphingus Vulgaris
autoimmune, intraepithelial, blistering disease affecting the skin and mucous membranes and its mediated by circulating autoantibodies directed against keratinocyte cell surfaces

Diagnostic Exam * Skin biopsies of blisters and surrounding skindemonstrates acantholysis * Immunofluorescent studies of serum- reveal circulating antibodies

Pathophysiology
infection binding of autoantibodies to keratinocyte cell surface molecules loss of cell to- cell adhesion (acantholysis) Blistering of skin w/o complement or inflammatory cells , mucotaneous erosions

Medications
* Cyclophosphamide (Cytoxan) * Azathioprine (Imuran)

Nursing Management * Inspect oral cavity daily; note and report any changes * Keep oral mucosa clean and allow regeneration of epithelium * Keep skin clean and eliminate debris and dead skin. * Evaluate for fluid and electrolyte imbalance. monitor serum albumin and protein levels. Monitor vital signs for hypotenson or tachycardia. Weigh patient daily.

HIV/AIDS
- a condition in humans in which progressive failure of the immune system allows lifethreatening opportunistic infections and cancers to thrive.

Diagnostic Exam * ELISA test-serologic test for detecting antibody to HIV

Pathophysiology
Predisposing factors (age, young adults, gender, transplacental transfer) 1. glycoprotein envelope surrounds the virus, w/c carries its genetic material in RNA 2. Retrovirus 3. Consist of proteins GP120 and GP41 protrude from the envelope Binds the virus to the CD4 and thrombocytes attachment of the HIV virus to a CD4 and receptor internalization and unicity of the viruses w/ the viral RNA and reverse transcriptase reverse transcriptaseproduces mirror image of the viral RNA and double strande DNA molecule Integration of the viral DNA into host DNA using the integrase enzymes transcription of the inserted viral DNA to produce viral mRNA Translation of the viral mRNA to create viral polyprotein cleavage of polyprotein into the individual viral proteins that make-up the new viruses Release of hte new virus from the host cell

* Lymphocyte panel shows decreased CD4 count. * CBC- may show anemia and a low white blood cell count. * Presence of indicator disease (eg., P. carinii pneumonia, Kaposi s sarconoma etc.)

Medications
* edovudine (ZDV) Retirvir * Zalcitabine Havid * Stavudine Zerit * Lamivudine Epivir * Nevirapine Viramune

Nursing Management * Maintain nonjudgmental attitude and nonpreudicial approach. * Provide careful discussion and clarification of treatment options. * Follow universal precautions for all patients. * Maintain cleanliness of environment. * Monitor nutritional sttaus by weighing, recording dietary intake and caloric count.

Scleroderma
systemic disease characterized by skin induration and thickening accompanied by various degrees of tissue fibrosis and chronic inflammatory infiltration in numerous visceral organs, prominent fibroproliferative vasculopathy, and humoral and cellular immune alterations.

Diagnostic Exam
* CBC and ESR- generally normal * RF- positive * ANA- generally positive with speckled * X-ray of hands and wrists- muscle atrophy, osteopenia * Endoscopy- to biosy for Barretts metaplasia

Pathophysiology Stimulation of lympokines production of collagen Insoluble fibrinogen is formed and accumulates excessively inflammation (edema, smooth, taut, shinny skin) skin undergone fibrotic changes loss of elasticity and movement tissue becomes non-functional hard skin

Medications
* Penicillamine (Depen) * Omeprazole (Prilosec) * Metacloporamide (Reglan) * Cisapride (Propulsid)

Nursing Management
* Teach patient to identify Raynauds phenomenon. Characteristic color change of the fingers-blue, white, red * Protect ulcerated digits and observe for signs of infection. * Advise patient to avoid using of drying soaps. * Inspect skin daily for cracking, ulceration abd signs of infection. * Encourage patient in proper position for meals to avoid aspiration.

Latex Allergy
> a reaction to certain proteins found in natural rubber latex, a product manufactured from a milky fluid that comes from the rubber tree.

Diagnostic Exam

Pathophysiology exposure to latex products Hypersensitivity happens anaphylactic shock

Medications
* adrenaline (epinephrine) * prednisone (deltasone)

Nursing Management * if the patient has a confirmed latex allergy, bring a cart with latex-free supplies in his room. * Document in the patients chart that he has a latex allergy. * If the patient will have an I.V. line makes sure that that I.V. access is accomplished using all latex free products. * Place a warning label on I.V. bags that says Dont use latex injection ports. * Use nonlatex tourniquet. If none are available, use a latex tourniquet over clothing.

Rheumatoid Arthritis
. is a chronic,systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints.

Diagnostic Exam * The ESR is significantly elevated in RA. * The Red Blood Cell count and C4 complement component are decreased. * C-reactive protein and anti-nuclear antibody (ANA) test result may also be positive * Arthrocentesis shows synovial fluid that is cloudy, milky, or dark yellow and contains numerous inflammatory components

Pathophysiology Predisposing factors (age,sex) Presentation of antigen tcells T-cell and b -cells proliferation phagocytosis in synovial tissue produce of enzyme that breaks down collagen edema, proliferation and pannus formation pannus destroys cartilage and erodes the bone loss of articular surfaces and joint motion

Medications
* Naproxen (Naprosyn) * Ketorolac (Toradol) * Gold sodium thiomalate (Myocrisine) * Prednisone (Orasone) * Hydrocortisone (Cortef)

Nursing Management * Apply local heat or cold to affected joints for 15 to 20 minutes three to four times a day. * Encourage warm bath or shower in the morning on arising * Encourage exercise consistent with degree of disease activity. * Provide pain relief before self care activities * Schedule adequate rest periods

Latex Allergy
> a reaction to certain proteins found in natural rubber latex, a product manufactured from a milky fluid that comes from the rubber tree.

Diagnostic Exam

Pathophysiology

Medications
* adrenaline (epinephrine) * prednisone (deltasone)

Nursing Management * if the patient has a confirmed latex allergy, bring a cart with latex-free supplies in his room. * Document in the patients chart that he has a latex allergy. * If the patient will have an I.V. line makes sure that that I.V. access is accomplished using all latex free products. * Place a warning label on I.V. bags that says Dont use latex injection ports. * Use nonlatex tourniquet. If none are available, use a latex tourniquet over clothing.

Latex Allergy
> a reaction to certain proteins found in natural rubber latex, a product manufactured from a milky fluid that comes from the rubber tree.

Diagnostic Exam

Pathophysiology

Medications
* adrenaline (epinephrine) * prednisone (deltasone)

Nursing Management * if the patient has a confirmed latex allergy, bring a cart with latex-free supplies in his room. * Document in the patients chart that he has a latex allergy. * If the patient will have an I.V. line makes sure that that I.V. access is accomplished using all latex free products. * Place a warning label on I.V. bags that says Dont use latex injection ports. * Use nonlatex tourniquet. If none are available, use a latex tourniquet over clothing.

Latex Allergy
> a reaction to certain proteins found in natural rubber latex, a product manufactured from a milky fluid that comes from the rubber tree.

Diagnostic Exam

Pathophysiology

Medications
* adrenaline (epinephrine) * prednisone (deltasone)

Nursing Management * if the patient has a confirmed latex allergy, bring a cart with latex-free supplies in his room. * Document in the patients chart that he has a latex allergy. * If the patient will have an I.V. line makes sure that that I.V. access is accomplished using all latex free products. * Place a warning label on I.V. bags that says Dont use latex injection ports. * Use nonlatex tourniquet. If none are available, use a latex tourniquet over clothing.

Latex Allergy
> a reaction to certain proteins found in natural rubber latex, a product manufactured from a milky fluid that comes from the rubber tree.

Diagnostic Exam

Pathophysiology

Medications
* adrenaline (epinephrine) * prednisone (deltasone)

Nursing Management * if the patient has a confirmed latex allergy, bring a cart with latex-free supplies in his room. * Document in the patients chart that he has a latex allergy. * If the patient will have an I.V. line makes sure that that I.V. access is accomplished using all latex free products. * Place a warning label on I.V. bags that says Dont use latex injection ports. * Use nonlatex tourniquet. If none are available, use a latex tourniquet over clothing.