Dr. Robinson final exam content

neutropenia

decrease in the number of mature infection-fighting neutrophils

count is less than 1,000

diagnosed through CBC or biopsy

neutropenic precautions

wash hands

monitor daily temp

avoid crowds

avoid sick people

wash fruits and veggies

avoid humidifiers

avoid rectal temps and enemas

no live plants or flowers

private room

immediate medical treatment for illness

sickle cell anemia

genetic disorder of hemoglobin

50% of children live to adulthood

SCA complications

Pulmonary infarctions

Cerebrovascular accidents

Infection - leading cause of hospitalization

SCA crisis types

1. Acute vaso-occlusive crisis

2. Aplastic Crisis

3. Sequestration crisis

SCA crisis management

Oxygen therapy

Aggressive hydration with oral and parenteral fluids

Analgesia - opiates

polycythemia vera

Increase in RBC production

Either a genetic tendency or a response to hypoxia

Disease is slow to progress

Hyperviscocity makes it difficult for the heart to pump, leads to hypoxia

polycythemia vera manifestations

SOB

Pruritis, especially after a warm bath

Flushing of the face

Splenomegaly

disseminated intravascular coagulation

Abnormal blood clotting

DIC stage 1

Overactive clotting

all platelets and clotting factors are used, creating thrombi throughout the body

DIC stage 2

Spontaneous bleeding from every orifice due to no platelets/clotting factors

DIC causes

Cancer

Sepsis

Pregnancy/Delivery

Injury

Blood transfusion reaction

DIC stage 1 treatment

Anticoagulants

DIC stage 2 treatment

Plasma and platelet transfusions

O2

fibrinogen to replace clotting factors

tumor lysis syndrome

Rapid cancer cell breakdown, most often 2-3 days after chemo treatment

Leads to hyperuricemia, hyperkalemia, hyperphosphatemia

Risk for heart block and tachypnea; renal failure

tumor lysis syndrome treatment

Large volume IV fluids with diuretics

Allopurinol for hyperuricemia

Dialysis

superior vena cava syndrome

Tumor compression of the SVC

causes reduced return of blood flow to the heart and venous congestion

Dyspnea, edema of the upper body

superior vena cava syndrome treatment

Immediate chemotherapy

Corticosteroids

SVC stent

spinal cord compression

Tumor compression of spinal cord

Symptoms depend on level of compression

spinal cord compression treatment

Radiation therapy

Corticosteroids

leukostasis

WBC count >100,000

Excessive immature WBC

Congestion and organ dysfunction

Mainly in brain, lungs, kidney

Increased risk of bleeding, stroke, dyspnea

leukostasis treatment

Immediate chemotherapy

Leukapheresis - removal of WBC

peritonitis

Inflammation of the peritoneum and lining of the abdominal cavity secondary to infection of the peritoneum

Due to puncture (surgery or trauma) or rupture of the GI tract

peritonitis manifestations

Rigid, board like abdomen (hallmark sign)

N & V

Tachycardic

Elevated temp (100-101)

Rebound tenderness

peritonitis interventions

Fowlers or semi-fowlers

NG tube to low-intermittent suction

O2

Monitor I&O

dumping syndrome

Can occur from any surgery that reduces the size of the stomach.

Rapid emptying of the stomach  with partially digested food entering the small intestine

Causes inappropriate gut hormone release and rapid glucose absorption

dumping syndrome management

small, frequent meals

separate drinking and eating

esophageal varices

Swollen, fragile blood vessels in the submucosa of the esophagus

Result of portal hypertension

Hemorrhaging is a medical emergency with a high mortality rate

esophageal varices risk factors

Alcoholic cirrhosis

Viral hepatitis

avoid with esophageal varices

Valsalva maneuver

Lifting heavy objects

Coughing or sneezing

Alcohol consumption

gastritis

inflammation of the lining of the stomach

acute gastritis

Rapid onset

Healing is spontaneous and may occur in a few days

Ingestion of irritating foods and alcohol

acute gastritis treatment

GI rest (6-12 hrs. NPO)

Antacids

chronic gastritis

Prolonged, persistent or intermittent inflammation.

most common cause is H. Pylori

chronic gastritis treatment

Antibiotics

H2RA's

PPI's

Antacids

erectile dysfunction

inability to achieve and maintain an erection for sexual intercourse

cause can be physical or psychological

ED physical causes

Aging

Type 2 diabetes

Hypertension

Cardiovascular disease

Smoking/Alcohol

Low testosterone levels

Nerve or spinal cord damage

ED psychological causes

Stress

Performance anxiety

ED lifestyle changes

Healthy diet

Smoking cessation

Limit or stop drinking alcohol

Increase exercise

Stress management

radical prostatectomy

Removal of entire prostate and seminal vesicles

TURP

Interior of the prostate is removed

Leaves the outer layer

BPH

Prostate enlarges

Obstructs bladder outlet

non-cancerous **DIFFERENT FROM PROSTATE CANCER

menopause

Permanent cessation of menstruation after 12 months with no menstruation

Ovaries fail and estrogen production declines

Usually occurs at age 41-59

perimenopause

Beginning of irregularity to end of 12 months of amenorrhea

type 1 hypersensitivity

Anaphylaxis

Severe allergic reaction

Occurs after sensitization

Affects multiple body systems

sedating anaphylaxis medications

Diphenhydramine

nonsedating anaphylaxis medications

Loratadine

Cetirizine

type 2 hypersensitivity

Cytotoxic

Result of mistaken identity when a normal constituent of the body is identified as foreign

leads to cell lysis and tissue damage

type 2 hypersensitivity examples

Transfusion reactions

Myasthenia gravis

Goodpasture syndrome

febrile nonhemolytic transfusion reaction

Chills

1° C elevation temperature (at least)

Typically begins within 1 hour of the transfusion

acute hemolytic transfusion reaction

most dangerous, incompatible blood

Fever

Chills

Dyspnea

Low back pain

Nausea

Anxiety

Hypotension

Bronchospasm

Hemoglobinuria

Vascular collapse

allergic transfusion reaction

Hives

Flushing

Wheezing

Decreased BP

Increased anxiety

transfusion reaction treatment step 1

Stop the transfusion

transfusion reaction treatment step 2

Begin infusion of NS with new tubing

transfusion reaction treatment step 3

Contact MD and Blood Bank

transfusion reaction treatment step 4

Continue to monitor patient; especially VS, cardiac, respiratory, and renal function

transfusion reaction treatment step 5

Return blood and tubing to the blood bank for testing

lupus

Chronic autoimmune disease

two types

Systemic lupus erythematosus (SLE)

Most common

Affects tissues of multiple organs

Discoid lupus erythematosus (DLE)

Affects skin

Can progress to SLE

lupus risk factors

females, ages 15-44=most common

Hormones - estrogen

Genetics

Infection

Stress

Medications

Toxins

Epstein-Barr virus (Mono)

UV light

Silica dust

lupus in kidneys

Lupus Nephritis

If severe can require dialysis or transplant

lupus in CNS

Memory loss

confusion

behavioral changes

headaches

fever

stroke

seizures

lupus in CV

Increase risk of heart attack

type 3 hypersensitivity

Immune Complex

Inflammatory reaction:

- Insoluble immune complexes form and are too large to clear from circulation

- Deposited in tissues and cause inflammation

serositis

Inflammation of the serous membranes that line cavities and surround organs

lupus manifestations

Skin rash (butterfly)

Arthritis

Inflammation of feet and eyes

Fatigue

Low grade fever

type 3 hypersensitivity examples

Rheumatoid arthritis (deposits in joints)

Lupus

type 4 hypersensitivity

Delayed

T-cell mediated reaction to an antigen

type 4 hypersensitivity examples

Poison ivy

Mantoux test for TB

Latex allergy (can also be a Type I Immediate reaction)

HIV prevention

Education

Use of condoms and dental dams

Lubrication use, especially during anal sex

Do not share needles

Circumcision for men who top

Up to date vaccinations (flu + pneumonia)

Pre-exposure prophylaxis (PreP)

Pre-exposure prophylaxis (PreP)

for serodiscordant couples and those with high risk lifestyles

must follow up every three months with provider.

acute and chronic hepatitis B + HIV must be ruled out prior to use

ART therapy

Recommended for all HIV+ patients

Patients must commit to 100% adherence for life

MUST maintain a 95% adherence rate to minimize viral resistance

Viral suppression within 12-24 wks

Only 55% of HIV+ pts maintain viral suppression due to compliance issues

respiratory AIDS defining illness

Pneumocystis jirovecii pneumonia

Mycobacterium tuberculosis

Recurrent pneumonia

Pneumocystis jirovecii pneumonia

dyspnea

fever

non-productive cough

chest discomfort

GI AIDS defining illness

Herpes simplex: chronic ulcers lasting >1 month

Candidiasis of the esophagus, bronchi, trachea, or lungs

HIV Wasting Syndrome

HIV wasting syndrom

the loss of at least 10% of body weight along with diarrhea/nausea and fever lasting over 30 days

neurological AIDS defining illness

HIV encephalopathy

HIV encephalopathy

progressive decline in cognitive, behavioral, and motor functions directly associated with HIV

HIV is found in the cerebrospinal fluid

oncologic AIDS defining illness

Kaposi's sarcoma

Burkitt's lymphoma

HIV stage 1

acute infection

CD4+ count ≥500 cells/µL

no AIDS defying conditions

HIV stage 2

chronic infection

CD4+ count 200-499 cells/µL

no AIDS defying conditions

HIV stage 3

AIDS

CD4+ count = less than 200 cells/µL

AIDS defying conditions present