Autoimmune, Connective Tissue Disorders & HIV

Is systemic lupus erythematosus systemic or local?

systemic

what is SLE characterized by?

Remission & exacerbations

what are the 3 key manifestations of SLE?

arthritis, arthralgia, and myalgia

what are some s/s of SLE?

• malar rash

• dry scaly rash

• discoid lesions

• photosensitivity

• fever and fatigue

what is the classic sign of a flare with SLE?

fever and fatigue

what may be indicative of organ involvement with SLE

proteinuria, RBC in urine, and pericarditis

what does the American Rheumatism Association say regarding the dx of SLE

4 or more of the s/s a dx of SLE is strongly suggested

what are the sx established by the American Rheumatism Association to dx SLE

• malar rash

• discoid rash

• photosensitivity

• arthritis

• pleuritis

• kidney abnormalities

• seizures

• decreased WBC, RBC, and platelets

• positive ANA

what are lab findings of SLE?

pancytopenia, Positive ANA, elevated ESR and CRP

what are medical interventions of SLE

Topical anti-inflammatories and corticosteroids

what is important to remember when stopping corticosteroids use

taper the drug

what are some risks of taking corticosteroids with NSAIDs

increased risk of: infection, hyperglycemia, and GI bleeding

what are some nursing interventions for pts with SLE

skin protection, prevention of fatigue and joint pain/deterioration, stress management,

what are signs of exacerbation of SLE

rash, fever, and mouth sores

how can you prevent joint pain and deterioration in pts with SLE

heat therapy

what is scleroderma?

excessive fibrous connective tissue causing hardening of the skin and potential organs

What are s/s of scleroderma?

• Calcinosis

• Raynaud’s

• Esophageal dysmotility

• Sclerodactyly

  • Telangiectasia

what is sclerodactyly

scleroderma of the digits and face

what are skin changes you can expect to see with scleroderma

edema, firm skin, pigmentation

how is scleroderma dx

ANA and skin biopsy

what are medical interventions for scleroderma

corticosteroids and immunosuppressants to treat sx

will drugs cure scleroderma

no, just help symptoms

what is rheumatoid arthritis

chronic, systemic, autoimmune disease that causes inflammation of joints synovial membranes

what are exacerbations of rheumatoid arthritis linked to?

physical or emotional stress

what are sx of rheumatoid arthritis

swollen joints, rheumatoid nodules, fatigue, low grade fever

is rheumatoid arthritis asymmetric or symmetrical?

symmetrical

where is rheumatoid arthritis most common

hands, wrists, elbows, shoulders, knees, feet

how is rheumatoid arthritis dx

ANA, Rheumatoid factor, CRP, CPC

what are medical interventions of rheumatoid arthritis

NSAIDs/ASA, glucocorticoids, DMARDs

when should NSAIDs be taken?

with meals

what are DMARDs used for?

slow disease progression and lessen permanent effects

what are non-pharm interventions for rheumatoid arthritis

heat, weight reduction, aerobic exercise, balance rest & activity

what is MS

chronic disease that affects the myelin and nerve fibers of the brain and spinal cord

what is myelin responsible for?

transmission of impulses between the brain, spinal cord and rest of the body

what are the 4 major types of MS?

Clinically isolated syndrome, relapsing-remitting, primary progressive, secondary progressive

When dealing with the 4 types of MS what is clinically isolated syndrome

an episode of sx lasting at least 24 hrs

When dealing with the 4 types of MS what is relapsing-remitting

mild to moderate sx that develop & resolve in a few weeks to months

When dealing with the 4 types of MS what is primary progressive

gradual neurologic deterioration without remission of symptoms

When dealing with the 4 types of MS what is secondary progressive

relapsing-remitting course that later becomes steadily progressive

what are sx of MS

• muscle weakness & spasticity

• fatigue

• flexor muscle spasms

• paresthesia

• cog changes

• dysesthesia

what is dysesthesia?

squeezing sensation around torso

how is MS dx

abnormal CSF, CSF electrophoresis, MRI

what will an MRI show in a pt with MS

plaques in at least 2 areas

what are pharm interventions of MS

meds to treat and control disease progression

what is an important teaching regarding pts with MS

avoid crowds and anyone with an infection

what are non-pharm interventions of MS

frequent PT and eliminate potential mobility hazards

What is Marfan’s syndrome genetically

a defect in the gene that produces fibrillin

what does fibrillin do?

prevented from interacting with collagen and elastin to provide recoil strength to tissue during and after stretching

what are s/s of Marfan’s syndrome

tall stature, deformities in long/major BV, spontaneous pneumothorax, hypermobility

what is Marfan’s syndrome dx

genetic testing and imaging

what are pharm interventions for pts with Marfan’s syndrome

beta blockers, angiotensin receptor blockers, Ca channel blockers, anti-inflammatories

what are angiotensin receptor blockers used in pts with Marfan’s syndrome

control of aortic root dilation

what are non-pharm interventions for Marfan’s syndrome

monitoring, avoid strenuous exercise, preventative surgical repair

what is a retrovirus

cell stops acting as an immune system cell and starts production of more copies of viral particles

what is the life cycle of HIV

binding, fusion, reverse transcription, integration, replication, assembly, budding

how is HIV transmitted

sexually, parenterally, perinatally

what are the stages of HIV

• Acute HIV infection

• Chronic HIV infection

• AIDS

what are the sx associated with stage one of HIV

flu like sx that occur 2-4 weeks after exposure

what are the sx associated with stage two of HIV

persistent fatigue, swollen lymph nodes, oral thrush, mouth sores

what are the sx associated with stage 3 of HIV

• Candidiasis

• Cervical cancer

• Kaposi sarcoma

• Non-Hodgkin lymphoma

• Tuberculosis

what is the seroconversion window?

3 week period after HIV exposure in which a test may provide a false neg

what does Chemiluminescent immunoassay (CLIA) detect?

HIV antibodies

why are point of service tests used in HIV

very quick

what is a normal CD4+ level

600-1500

what CD4+ level puts pts at risk for opportunistic infection

<200

what will CD4+ T levels look like in a pt with stage III HIV

lower CD4+T and normal number of CD8+T cells

when is PrEP used in pts with HIV

Uninfected adults to prevent infection after exposure to HIV

when is PEP used in pts with HIV

used in emergent situations after a potential exposure to HIV. Stops virus from replicating