Immunity

Systemic Lupus Erythematosus

Disorder of the connective tissue, antinuclear antibodies that causese widespread inflammation and tissue damage

RF: Female, 20-40, African American, Asian, Native American, fam hx of autoimmune disorders. Modifiable triggers: Sun expsure, chronic exhaustion/stress, poor sleep, over physical exertion, temp changes fast, illness infection, pregnancy,

S/S:BUTTERFLY RASH on face, fatigue, joint pain, fever, alopecia (hair loss), anemia, pericarditis, pleuritis, lymphadenopathy (swollen lymph nodes), Raynaud's phenomenon (white d/t lack of blood flow

Dx: POSTIVIE ANA titer (antinuclear antibody test), anti-DS DNA (specific biomarker for lupus) positve in 30-40%. decrease RBC/WBC/platelets. Increase BUN and creatine when kidney is involved. CRP, ESR - fnflammory markers which are elevated during a exacerbation. Anemia: low H&H

Tx: NSAIDs to decrease inflammation, plaquenil/HYDROXYCHLOROQUINE, prednisone, methotrexate, corticosteroids to reduce inflammation and immune suppression taper.

NC: moniotr of nephritis, pericarditis

PT: Avoid UV expsure, take infection prevention measures d/t increase risk of infection when taking immunosuppressants.

methotrexate DO NOT TAKE B/C it ABORTS

HIV

A retrovirus that inters the body through blood/bodily fluids and targers CD4+lymphocytes (helper T cells), causing immmunodeficienty, autoimmunity, and neurologic dysfunction

Spread: Bodily fluids, blood transfusion, infected needles, pregnancy, non-sterile tools

RF: Unprotected sex, multiple sexual partners, perinatal exposure/breastfeeding HIV + mother, IV durg use, healthcare workers, immunocompromised

S/S: Flu-like symptoms, lyphadenopathy, thrush, weakness, nigh sweats, fever, weight loss, rash

Labs: Decreased WBC, CD4+ count low?

Dx: Postivie ELISA test, confirmed with western blot test

Tx: Highley active antiretroviral therapy inhibit the virus from replicating at different stages of its life cycle to reduce viral load and preserve CD4 count, consisting of 3 or more meds used at the same time for the rest of thier life. HIV meds abacavir, lamivudine, emtricitabine, zidovudine, efavirenze, doravirine,

TAKE ON TIME everyday, compliance,

PreP: can help prevent HIV for exposed individuals, prevents entry of the virus.

PT: Safe sex, monitoirng CD4+ counts, prevent infection, use antimicrobial soap, avoid raw foods, dont clean litter box, avoid crowds and sick ppl

For AIDS the CD4+ cound is less than 200 cell which is caused d/t HIV being untreated

s/s: Kaposi’s sacroma, TB, pneumonia, wasting syndrom, candidiasis of the airway (fungal infection)

Organ transplant

RF: Genetic diseases, chronix hypoxia to organ tissue, lifestyle (smoking, ETOH, illicit drugs, sedentary →obesity, stress, lack of sleep, poor diet), autoimmune diseases, sun, cogenital defects/gentic defects, several viral infections

Requirements: Blood/tissue typing, severity of need, medical management & compliance, lifestyle modifications, comorbidities (can they survive the transplant), age, LifeNet RN calls for every death, psychological testing ( support system, coping skills, suicide risk, pharmacological compliance)

Can skip the list only if the person is donating to you directly

Post organ transplant

s/s of rejection flu-like symptoms (fatigue, chills, aches), pain at site, sudden weight gain, organ not functioning. Labs: organ function tests are not within the normal ranges a trend and improvement in organ function (not gonna see today but over time). Immediately s/s of infection, and bleeding, RR, LOC, neuro check, VS, abd assessment,

Pharmacology for post organ transplation:

TIME SENSTIVE SAME TIME EVERYDAY

corticosteroids (prednisone) suppress the immune response so they wont reject it, birth control is less effective. ,

calcineurin inhibitor (cyclosporine) inhibits the T-cell activation and immune response.

antiproliferative agents: mycophenolate mofetil sirolimus, azathiopine

Fluids, DVT prophylaxis, prophylactic antibiotics, pain medications.

Prednisone

Indications:

MOA: decreases inflammation, suppresses immune response

Interactions: NSAIDs

SE: bone loss, weight gain/fluid retention, hyperglycemia, hypokalemia, infection, PUD, adrenal glad suppression

NC: monitor for infection and PUD (coffee ground emesis, tarry stools)

PT: Periods of stress may require additional doses. DO NOT stop suddenly. Take vitamin D and calicum supplements.

Cyclosporine

Indications: Prevention of organ rejection in transplant patients, ulcerative colitis, rheumatoid arthritis, psoriasis

MOA: Inhibits T-cell activation

SE: Hepatotoxictiy, nephrotoxicity, GI upset, hirsutism, HTN, tremor

INFECTIONS and NEOPLASIA

NC: Monitor liver and renal function