Exam Review Notes

The final exam will consist of approximately 150 questions.
- About 95-100 questions will be from past semesters.
- The remaining 50 questions will cover material from the last 6 topics.
The format and style of questions will be similar to previous exams, with no significant changes.

There might be some repeat questions from previous tests or in-class discussions.
Avoid publicizing exam questions to maintain fairness.

Focus on nursing considerations and the rationale behind drug administration instead of memorizing dosages.
For drugs like insulins, know peak times and durations.
- Example: Understand when to check blood sugar levels after insulin administration based on peak times.
Be familiar with normal ranges for basic components of a Complete Blood Count (CBC), but don't get bogged down in specifics.

For lab values like platelets, understand the implied scaling (e.g., a platelet count of 24 means 24,000).
Be careful with trailing zeros in lab values.
- Example: a white blood cell count of 9 is likely 9,000, not 9.

Patient Joanne Mitchell presents with painful hands and feet (Raynaud's phenomenon) and acid reflux.
Health history includes hysterectomy and is apoptotic.
Differential diagnosis: Scleroderma.
Scleroderma is a systemic connective tissue disorder characterized by excessive collagen production and thickening of the skin and internal organs.
Signs and symptoms include Raynaud's phenomenon, GERD, and calcinosis (calcium buildup in the skin).
Raynaud's phenomenon involves sudden obstruction of blood flow in distal extremities.
Risk factors include GERD and decreased mobility.
Potential causes of scleroderma include environmental and autoimmune factors.
Diagnosis is confirmed via skin biopsy, which would show excessive connective tissue.
Lab values to consider: ESR, CRP, ANA (if antibodies are present), white blood cells, and possibly thrombocytopenia and low hematocrit (anemia).
Treatment goals focus on slowing progression and managing symptoms.

Corticosteroids: Manage inflammation; taper dosage to avoid adrenal issues, monitor for hyperglycemia and infection
NSAIDs: For inflammation; monitor for GI issues (e.g., black tarry stools).
Immunosuppressants: Slow down the immune system's attack on the body.

Right-sided heart failure due to stiffening of the lungs $ \text{stiff lungs lead to back up to the } \text{Rt side of the heart}$ .
Dysrhythmias due to hardening of the cardiac wall.
GI problems and urinary complications due to tissue stiffening.

Focus on early and late signs and symptoms.
Early signs and symptoms include:
- Low-grade fever (below 100°F or < 37.8^{\circ}C ).
Late signs and symptoms include:
- Muscle atrophy and weakness.
- Nodules.
- Sjogren's syndrome (reduced saliva production, causing increased aspiration risk).
Diagnosis involves labs, radiology (X-ray, CT, MRI, bone scan), and arthrocentesis.
Treatment is similar to Systemic Lupus Erythematosus (SLE).
Focus on physical therapy and weight management.
Low-impact activities like swimming are preferred.
Synovial membrane inflammation is a key characteristic.

Complications include:
- Hyperglycemia
- Muscle cramps
- Hypernatremia
- Osteoporosis

Patient Clarence tests positive for HIV.
The seroconversion window (3 weeks) may lead to false-negative results early after infection; retesting is necessary.
Potential transmission circumstances include unsafe sex.
HIV-1 is the primary type discussed; HIV-2 is mainly in West Africa.
Signs and symptoms within the first 2-4 weeks may include fever and chills.

Diagnostic tests include monitoring CD4 and CD8 cell counts and viral load testing.
Normal CD4/CD8 ratio is greater than 1; a ratio less than 1 indicates disease.
Viral load indicates the amount of virus in the body; a low viral load means less virus.
An undetectable viral load is less than 50 copies/mL.

Acute phase: Flu-like symptoms occur days to weeks after contracting HIV.
Chronic (latent/asymptomatic) phase: Lasts for several years.
AIDS: Occurs when CD4 cell counts fall below 200, making the person vulnerable to opportunistic infections.

Protease inhibitors: Bind to protease, blocking HIV replication.
Non-nucleoside reverse transcriptase inhibitors: Directly bind to and inhibit HIV reverse transcriptase.
Monoclonal antibodies (MABs): Interfere with conformational changes required for virus-free cell fusion.
Strict adherence to antiviral medication is crucial; missing even one dose can increase viral replication.

Pre-exposure prophylaxis (PrEP): Used by uninfected individuals to protect against potential exposure.
Post-exposure prophylaxis (PEP): Used after potential exposure; requires a doctor's prescription; must be started with 72hours.

Stage 3 (AIDS) presents as opportunistic infections based on low CD4 count
Universal precautions should be used to handle body fluids: disinfect surfaces with appropriate cleaning materials (e.g., soap, cleaning rags, sponges, and mops in a one to 10 ratio bleach solution for five minutes.) And wear gloves at all times with body fluid is present.