ADH2 Exam 2: Inflammatory diseases

define lupus:

AI disease where immune system attacks healthy tissue→ chronic inflammation

3 types of lupus and which is most common?

1. Discoid (DLE): Skin only

2. Systemic (SLE): multiple organs and connective tissue → risk organ failure ***most COMMON

3. Drug-Induced Lupus: caused by meds and can goes away after stopping

• hydralazine

• isoniazid!! (TB pts take this)

Whos mostly at risk for lupus? (4) What drug increases risk?

When does incidences stop after?

1. women 20-40

2. AA

3. Asian

4. Native Americans

• stops after menopause

Corticosteroid therapy increases risk for osteoporosis and fractures!!

Whats the hallmark symptom of Lupus? And what are some others? (8)

Butterfly rash

1. raynaud’s

2. pleuritic CP!!

3. Pericarditis!!

4. Malaise

5. fever (major indication of exacerbation)

6. anemia

7. Myalgia

8. joint pain, swelling, stiffness

9. cognitive changes

What are diagnostic tests for Lupus? (3)

1. Skin biopsy:

• confirms DLE!!!

2. Increased BUN/Cr, proteinuria, hematuria

• d/t RENAL involvement

3. CBC

• pancytopenia common w/ systemic 

Nursing management Lupus:

• assess/monitor (5)

• supportive care (2)

1. Assess/Monitor:

• VS: 50% Lupus pts have increased BP!!

• Kidney function (BUN/Cr)

• Urine output

• Monitor Pleural Effusion!!

  • decreased breath sounds

• Monitor Pericarditis!!

  • sharp CP, tachycardic

2. Supportive Care:

• small frequent meals if anorexic!

• limit sodium intake if Cardiac or Renal issue

Meds for Lupus! (4)

and examples

1. NSAIDS

• ibuprofen, naproxen

2. Immunosuppressants

• methotrexate

• azathioprine

3. Corticosteroids

• prednisone

4. Antimalarials

• hydroxychloroquine

Cornerstone drug for Lupus:

• 2 things it helps with

• the nursing considerations of it (1)

Hydroxychloroquine (Antimalarial)

1. decrease synovitis (inflamed synovium of joint)

2. decrease fever and fatigue

3. get baseline and q6months eye exam!!!

• risk of retinal toxicity!!

Nursing consideration for taking NSAIDs for Lupus? (4)

1. reduce inflammation and arthralgia

2. Monitor GI upset

3. Monitor RENAL function

4. contraindicated w/ impaired kidney function

• ibuprofen

Nursing consideration for taking Immunosuppressants for Lupus? (3)

1. monitor for infx

2. is liver toxic (So frequent Liver Function Tests)

3. Monitor Bone Marrow Suppression (get baseline CBCs)

Nursing consideration for taking Corticosteroids for Lupus? (3)

1. decrease inflammation and immune response

2. Monitor glucose, weight, infx risk

3. watch for impaired kidney function

• HTN

• fluid retention

• Gradually TAPERED!!!—not stopped abruptly

Pt education for Lupus: Lifestyle (3), Infx prevention (2), When to contact provider (3)

• Lifestyle:

1. no prolonged sun exposure

2. use sunscreen

3. use gentle hair and skin products 

• Infx Prevention:

1. no crowds and sick contacts

2. stay up to date on vax

• When to call provider:

1. new edema/ weight gain

2. decreased urine output

3. new/ worsening CP or dyspnea

• d/t heart or kidney issue

Complications from Lupus: (4)

1. Lupus nephritis:

• progressive CKD

  • so needs dialysis or kidney transplant (Selenurrr has this)

2. Pericarditis/Myocarditis:

• inflamed heart tissue → CP and dysrhythmias

3. Increased risk for thromboembolic events

4. Accelerated Atherosclerosis

Primary and secondary cause of Gout:

Primary: overproduction and Underproduction of uric acid

Secondary: 2ndary to other diseases: CKD

• excessive diuretic use

• renal insufficiency

• caner tx

Acute Gout s/s: (2)

Chronic s/s: (3)

acute:

1. severe joint pain (big toe)

2. redness, warm, swelling

Chronic:

1. Tophi (hard uric acid deposits under skin in chronic gout)

2. Joint deformities

3. limited mobility

What labs are increased in Gout? (3)

1. Serum uric acid duh

2. ESR (inflammation)

3. Urinary uric acid

• assess BUN/Cr too

Acute Gout meds: (3)

1. NSAIDs

• decrease inflammation/pain

2. Colchicine

• most effective if started 24-48 hrs

• mainly used for gout

• caution impaired kidney!!

3. Corticosteroids

Chronic gout meds: (2)

what are its considerations?

1. Allopurinol

• med of choice!

2. febuxostat (xanthine oxidase inhibitors)

• promote uric acid secretion

• 2/3 L fluids/day! flush it out

What med may initially trigger gout flare but prevents long-term gout?

Allopurinol!!

What is Probenecid (uricosuric) med?

helps kidneys excrete uric acid

• contraindicated if kidney impaired

Pt education Gout:

• dietary mods: (2)

• med adherence: (2)

• lifestyle/prevention: (2)

• diet mods

1. no purine-rich foods!!!

• alc

• fish

• seafood/shellfish (anchovies, sardines, herring, mussels, codfish, scallops, torut, haddock)

• meats (bacon, turkey, veal, venison, liver)

2. limit alcohol and high fructose drinks

• Med adherence:

1. take allopurinol AFTER meals w/ water!

2. continue it even if flare up occurs

• lifestyle/prevention!

1. hydrate 2-3L/day

2. no starvation diets or high stress situations

Fibromyalgia is what?

chronic NON-inflammatory pain disorder from abnormal pain processing in the brain

What usually triggers fibromyalgia? (4) and where are the trigger points?

1. stress

2. infx

3. trauma

4. hormonal changes

• above/below waist

• around neck, chest, shoulders, hips. knees

Clinical findings of fibro—affects 5 body systems:

1. neuro (2)

2. cardiac (3)

3. autonomic (1)

4. GI/GU (5)

5. musculoskeletal (3)

1. neurological/cognitive:

• sleep disturbance

• memory problems (fibro-fog)

2. cardio:

• CP

• dyspnea

• dysrhythmias

3. autonomic:

• sensitivity to noise, light, temperature

4. GI/GU:

• IBS

• heart burn

• urinary frequency/urgency

• dysuria

• pelvic pain

5. musculoskeletal:

• widespread pain

• stiffness

• tender points

Other: fatigue, HA, depression/anxiety

4 classes of meds for fibro:

1. SNRIs

2. Anticonvulsant

3. Tricyclic antidepressants

4. NSAIDs

2 SNRIs meds and what to consider/monitor? (3)

• duloxetine

• milnacipran

→ reduce pain perception

→ improve mood (bc increases serotonin)

→ monitor SS!!

What to avoid when on SNRIs? 

1. alcohol!! → causes sleepiness and drowsiness

2 Anticonvulsants and what do they do for fibro? (2)

• pregabalin

• gabapentin

1. calm overactive nerves

2. lowers pain signals

2 Tricyclic Antidepressant meds and what does it do for fibro? (2)

• Amitriptyline

• Trazadone

1. help sleep better

2. reduce pain

Amitriptyline can cause what in older pts and whats the better choice of meds for them?

cause orthostatic hypotension and confusion in elderly

• Trazadone is medication of choice d/t decreased side effects

What do NSAIDs do for fibro?

short term pain relief only

• ibuprofen and naproxen

Pt ed for fibromyalgia:

1. lifestyle (3)

2. avoid (3)

3. therapies (3)

4. self-management (1)

1. lifestyle

• regular LOW-impact exercises

• balanced sleep

• stress reduction

2. avoid

• caffeine

• alcohol

• nicotine

3. therapies

• Cognitive-Behavioral Therapy (CBT)

• massage

• acupuncture

4. Self-management:

• ID and avoid known triggers (weather, overexertion)

Key points:

1. Lupus is systemic, so watch for what? (2)

2. What lupus drug needs regular eye exams?

3. What are the 2 meds for gout?

4. What meds wouldn’t work for fibro bc its non-inflammatory?

1. Cardiac involvement

• Renal involvement

2. Hydroxychloroquine

3. Allopurinol for prevention of gout

• Colchicine for acute gout!!

4. Steroids!!