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blood and lymphII
blood and lymph
| Question | Answer |
|---|---|
| Complete Blood Count (CBC): | Detects many disorders of the hematological system & provides data for the diagnosis and evaluation of disorders in other body systems; |
| Complete Blood Count (CBC): | red and white cell counts, hematocrit and hemoglobin level, erythrocyte (RBC) indices, differential white cell count, and examination of the peripheral blood cells |
| Red Cell Indices | Mean corpuscular volume (MCV);Mean corpuscular hemoglobin (MCH);Mean corpuscular hemoglobin concentration (MCHC) |
| Red Cell Indices | Measurements of the size and hemoglobin content of erythrocytes |
| Mean Corpuscular Volume (MCV): | The average volume or size of a single RBC. |
| Mean Corpuscular Hemoglobin (MCH): | The average amount of (weight) hemoglobin within an RBC. |
| Mean Corpuscular Hemoglobin Concentration (MCHC): | The average concentration or the percentage of hemoglobin within an RBC |
| Differential Count | A differential WBC count is an examination in which the different kinds of WBCs are counted and reported as percentages of the total examined. They may also be reported as absolute (actual number). |
| Actual cell count of leukocytes: | Identifies the number and percentage of individual WBC types and provides the physician with diagnostic information. |
| WBC | 5000-10,000/mm3 |
| Neutrophils | 60%-70%(3000-7000X109/mm3) |
| Eosinophils: | 1%-4%(50-40X109/mm3); |
| Basophils: | 0.5%-1%(25-100X109/mm3) |
| Lymphocytes | 20%-40% (1000-4000X109/mm3); |
| Monocytes: | 2%-6%(100-600X109/mm3) |
| Peripheral Smear: | Often accompanies the differential WBC count and permits examination of the size, shape, and structure of individual RBCs, WBCs and platelets; |
| Peripheral Smear | Most informative of all hematologic tests |
| Peripheral Smear. The test for a measure of the packed cell volume of red cells expressed as a percentage of the total blood volume is | hematocrit |
| Schilling Test and Megaloblastic Anemia Profile: | Laboratory test that identifies the etiology of pernicious anemia |
| Schilling Test and Megaloblastic Anemia Profile: | May involve multiple stages of testing to determine whether B12 intake is low, or B12 absorption is altered |
| Absorption in the stomach is dependent on | intrinsic factor, which is produced by the gastric mucosa |
| Patients with large resections of the stomach | may not produce adequate intrinsic factor to prevent pernicious anemia; |
| Schilling Test and Megaloblastic Anemia Profile: | Measures the excretion of Vitamin B12 after parenteral administration |
| Schilling Test and Megaloblastic Anemia Profile | Normal findings are excretion of 8% to 40% of radioactive vitamin B12 within 24 hours |
| Gastric Analysis | Evaluates presence of intrinsic factor; |
| In pernicious anemia the gastric | secretions are minimal and the pH remains elevated, after injection of histamine |
| Bone Marrow Aspiration or Biopsy | Bone marrow aspiration or biopsy is specific for establishing the diagnosis and for treatment response |
| Bone Marrow Aspiration or Biopsy | Iliac crest most commonly used, although the sternum can also be used; |
| Bone marrow aspiration is most commonly performed in persons with | marked anemia, neutropenia, acute leukemia, and thrombocytopenia |
| What is the most common site for bone marrow aspiration or biopsy? | Iliac Crest |
| Before any diagnostic testing, | Determine the client's knowledge of the procedure; Reviews the test procedure with the client |
| Before any diagnostic testing, | Teaches/assesses understanding of tasks patient must participate in before and during procedure and discomfort that might be experienced |
| When tests involve a puncture, | assesses the area for excessive bleeding and applies pressure or pressure dressing to the site as needed; Monitors vital signs |
| Lymph Node Biopsy | Patient may receive conscious sedation for this procedure |
| Lymphangiography | A radiological examination used to detect metastatic involvement of the lymph nodes; Contrast medium is injected into a lymphatic vessel of the foot or hand |
| Lymphangiography | Patient may receive conscious sedation for this procedure |
| Lymphangiography | Contrast will be injected into the lymph system to identify any blockage |
| What must be checked before performing lymphangiography | Renal function and Allergies. |
| Ultrasonography, CT, MRI | Performed to visualize size, structure and flow through the spleen or lymph nodes; No special preparation is required |
| Bone scan | Performed to identify bone metastasis |
| Bone scan | Radioactive isotope injected into vein and body scans performed in Nuclear Medicine |
| Bone Marrow Aspiration | Teach and assess understanding of the plan and approximate time for the bone marrow aspiration |
| Bone Marrow Aspiration | Identify site for sample and position the client on back or side to access aspiration site |
| Bone Marrow Aspiration | Suggest techniques to avoid focusing on pressure or discomfort associated with puncturing the bone |
| Bone Marrow Aspiration The Nursing Process | (1) Anxiety, related to diagnosis (actual/potential) or diagnostic test |
| Bone Marrow Aspiration Nursing Interventions | Patient verbalizes understanding for procedure, has a manageable anxiety level; Provide privacy, reassurance and information to all patients |
| Bone Marrow Aspiration Nursing Interventions | Let the patient know that there will be a brief, sharp pain during the aspiration |
| Blood:Characteristics | Normal volume is approximately 5 to 6 liters |
| Blood:Characteristics | Plasma—light yellow fluid that comprises 55% of blood |
| Blood:Characteristics | Contains 90% water and other 10% includes proteins, clotting factors, pigments, vitamins, glucose, electrolytes, lipids, minerals, enzymes and hormones |
| Blood:Blood cells (Formed) | Compose 45% of blood |
| Erythrocytes (RBC) | Contains cytoplasm and hemoglobin (transports oxygen and carbon dioxide) |
| Erythrocytes (RBC) | Produced in the red bone marrow |
| Erythrocytes (RBC | Proper production depends on healthy bone marrow and adequate vitamins and minerals |
| Normal hemoglobin level | 14 to 18 g/dl for males and 12 to 16 g/dl for females |
| Leukocytes (WBC) | Conduct body defense from foreign invaders; Produced in the bone marrow |
| Leukocytes (WBC): | Granulocytes and agranulocytes |
| Granulocytes: Neutrophils | make up 60%—70% of WBC; The initial responder to any invasion |
| (Neutrophils are also called | Phagocytes—cells that surround and "eat" invaders) |
| Basophils | (0%—1% of WBC): key in the inflammatory response |
| Eosinophils | (1%—5% of WBC): key in allergic responses |
| Agranulocytes | Monocytes-Macrophages-Lymphocytes-Platelets: |
| Monocytes | phagocytes that circulate in the blood stream and work similarly to neutrophils |
| Macrophages | mature monocytes that live in tissue (i.e., alveolar macrophages in the lung and Kupffer cells in the liver) |
| Lymphocytes | T cells and B cells that directly kill invaders and produce antibodies, respectively |
| Platelets | Produced in the red bone marrow; Assist in clotting formation |
| Anemia | Reduction of RBCs |
| Anemia | deficiency in hemoglobin and hematocrit |
| Anemia | Loss of RBCs from hemorrhage; An increased destruction of RBCs (hemolytic anemia) |
| Anemia | Impaired production of RBCs; or Nutritional deficiencies; Causes insufficient delivery of O2 to cells and tissues |
| Anemia Clinical Manifestations Typical symptoms | Anorexia/Cardiac dilation/ Disorientation/Dyspnea/Dyspepsia/ Fatigue/Headache/Insomnia/Pallor/ Palpitation (Systolic murmur); Shortness of breath;Tachycardia; and Vertigo |
| CBC/Iron/Reticulocyte count/Bone marrow biopsy/Peripheral blood smears/Vitamin B12 level | Anemia Diagnostic tests |
| Depends on cause; Bone marrow transplant; Avoid blood transfusions if possible; Splenectomy | Anemia Medical management |
| replace: fluid/blood; Control bleeding, B12, Iron and folic acid | Anemia Drug therapy |
| Anemia The Nursing Process | Activity intolerance, related to inadequate tissue oxygenation |
| Anemia The Nursing Process | engage activities on progressive basis as symptoms improve; Encourage patients to explore feelings associated with fatigue |
| Anemia nursing diagnosis | Nutrition, imbalanced—less than body requirements, related to Glossitis |
| Anemia | Encourage a diet high in vitamins, iron and protein |
| Anemia | Administer medications to stimulate bone marrow |
| Anemia Nursing Diagnosis | Pain, related to thrombotic crisis |
| Jehovah's Witnesses may accept what types of blood products? | Autologous transfusions and certain volume expanders |
| Hypovolemic Anemia (Blood Loss Anemia) | Decreased RBC, hemoglobin, and hematocrit resulting from hemorrhage |
| Hypovolemic Anemia (Blood Loss Anemia) | Blood loss of 1000 ml or more in adult can be severe. |
| Hypovolemic Anemia (Blood Loss Anemia) | ) Loss of blood decreases oxygen carrying capacity, therefore delivery of oxygen to tissues is decreased |
| Hypovolemic and Hypoxemia signs and symptoms | 1)Weakness/2) Stupor, irritability; 3) Pale, cool, clammy (moist) skin with poor peripheral pulses; |
| Hypovolemic and Hypoxemia signs and symptoms | Hypotension with increased capillary refill/5)Tachycardia/6) Hypothermia/7) Decreased hemoglobin and hematocrit levels |
| Hypovolemic Anemia (Blood Loss Anemia) Assessment: | 1) Thirst; 2) Weakness, irritability, and restlessness. |
| Hypovolemic Anemia (Blood Loss Anemia)Objective | 1) Hypotension/2)Increased respiration/3)Skin condition/4) Oliguria/5) Mental disorientation |
| Hypovolemic Anemia (Blood Loss Anemia)Diagnostic tests: | CBC—decreased RBC, hemoglobin and hematocrit. Lab results may not be accurate indicator until hours after injury |
| Hypovolemic Anemia (Blood Loss Anemia)Medical management: | (a) Controlling hemorrhage, Replace volume,Plasma (Fresh frozen plasma and cryoprecipitate, as needed to replace clotting factors); c) Dextran or other volume expanders; d) Crystalloid |
| Hypovolemic Anemia (Blood Loss Anemia): Nursing interventions | (a) Control bleeding/(b)blood and fluid restoration/(c)Prevent injury/ (d)Patient teaching |
| Pernicious Anemia | Autoimmune disorder resulting from the destruction of parietal cells and eventual gastric mucosa atrophy |
| Pernicious Anemia | Parietal cell damage leads to decreased gastric HCL and intrinsic factor production. |
| Pernicious Anemia | Intrinsic factor is essential for absorption of Vitamin B12 (cyanocobalamin) |
| Pernicious Anemia | A condition capable of causing great injury, destruction, or death unless treated. |
| Pernicious Anemia | If intrinsic factor is not available to combine with B12, systemic absorption in the ileum is prevented. |
| Vitamin B12 is needed for | Growth and maturation of all body cells/B12 deficiency leaves erythrocyte membrane fragile and easy to rupture. |
| Nerve myelination. B12 deficiency | results in progressive demyelination and degeneration of nerves and white matter |
| Patients with pernicious anemia | many large immature red blood cells. |
| pernicious anemia | Primarily affects older adults |
| pernicious anemia Clinical manifestations | Skin may appear slightly icterus (jaundiced) due to increased destruction of RBCs.Edema of legs; Constipation and diarrhea. |
| pernicious anemia | (a) Subjective: 1) Palpitations; 2) Nausea, dysphagia, flatulence and indigestion; 3) Soreness and burning of the tongue |
| pernicious anemia Neurological symptoms | Paresthesia (tingling of hands and feet) may develop |
| pernicious anemia Objective | Observation of smooth and erythematous tongue; 2) Infection of teeth and gums |
| Pernicious Anemia Objective | Mental disorientation, personality changes and behavior problems/4) Partial or total paralysis due to destruction of the nerve fibers of the spinal cord |
| Pernicious Anemia Diagnostic tests | Schilling test, Megaloblastic anemic profile,Bone marrow aspiration, Gastric analysis, Peripheral smear |
| Pernicious Anemia Medical management | Life-long B12 replacement (Vitamin B12,IM injections of B12,Intranasal B12)Folic acid and iron supplements |
| Pernicious Anemia Nursing interventions: | Monitor vitals every four hours/special mouth care several times a day/high protein, vitamins, and minerals |
| Pernicious Anemia Nursing interventions: | Conserve energy and prevent injury and assistance with ADLs,Perform special mouth care several times a day; (d) Diet should be high in protein, vitamins, and minerals |
| Aplastic Anemia | Failure of the normal process of cell generation and development |
| Aplastic Anemia | Immunological injury resulting in a decrease of bone marrow function |
| Secondary aplastic anemia | Viral infection/b) Medications/c) Chemicals (benzene, insecticides, arsenic, alcohol)/d) Radiation/e) Chemotherapy |
| Secondary aplastic anemia | RBC production is defective/Patients are usually pancytopenic (low RBCs, platelets and WBCs). |
| Secondary aplastic anemia Clinical manifestations | Repeated infection with high fever/Weakness, fatigue, general malaise/Dyspnea, palpitations |
| Secondary aplastic anemia | Bleeding tendencies (petechiae, ecchymoses, Nose/GI/GU bleeding) |
| Secondary aplastic anemia | Bone marrow biopsy (low cell content with increased fatty marrow is called a "dry tap") |
| aplastic anemia Medical management: | (a)Identify cause and remove(b) Blood transfusions are avoided,if possible1) Prevention of iron overloading |
| aplastic anemia Medical management: | Prevention of antibody development. Necessary for the potential bone marrow transplant candidate |
| aplastic anemia Medical management: | Platelet transfusions for the thrombocytopenic patient should be HLA typed. |
| aplastic anemia Medical management: | Splenectomy may be required if that is the cause of thrombocytopenia. |
| aplastic anemia Medical management: | Steroids and androgens to stimulate bone marrow; |
| aplastic anemia Medical management: | Antithymocyte globulin |
| Antithymocyte globulin | To stimulate bone marrow; b) Used for patients who are not candidates for bone marrow transplant. |
| aplastic anemia Medical management: | Granulocytic—macrophage colony-stimulating factor (GM-CSF); Used to control the cause of aplastic anemia. |
| aplastic anemia Nursing interventions | Proper observation and care after bone marrow study |
| aplastic anemia Nursing interventions | avoiding IM injections and avoid administration of rectal medications or rectal temperatures |
| aplastic anemia Nursing interventions | Use protective devices, such as egg crate mattress |
| aplastic anemia Nursing interventions | In the presence of thrombocytopenia, observe carefully for any signs of bleeding |
| Why are blood transfusions avoided in patients with aplastic anemia? | Prevention of iron overloading; Prevention of antibody development for transplant candidates; Platelet transfusion, as needed—must be HLA typed |
| Iron Deficiency Anemia: | RBCs contain decreased levels of hemoglobin/Excessive iron loss/ Chronic GI/genitourinary tract bleed |
| Iron Deficiency Anemia: | (common in infants, adolescents and pregnant women,) Subtotal gastrectomy |
| Iron Deficiency Anemia | Pallor—most common finding; (b) Glossitis (inflammation and soreness of the tongue |
| Iron Deficiency Anemia | Signs and symptoms typical to angina and heart failure may also occur |
| Iron Deficiency Anemia Assessment: | 1)Glossitis(inflammation of the tongue)and pagophagia (desire to eat ice)/2) Headache, Paresthesia, burning sensation of tongue (all due to iron depletion in tissues). |
| Iron Deficiency Anemia Assessment | Finger nails are fragile and may assume the shape of a spoon with a central depression and raised borders/Stomatitis (inflamed mucous membranes of the mouth)/ Lips are erythemic with cracking at the angles |
| Iron Deficiency Anemia Diagnostic tests | CBC=hemoglobin (less than 12 g/dl)) Decreased serum iron levels. |
| Iron Deficiency Anemia Drug therapy | Iron replacement as ordered, of not stopping or omitting medications unless directed by physician |
| Iron Deficiency Anemia Drug therapy | Iron supplements are contraindicated in peptic ulcer disease |
| Iron Deficiency Anemia Side effects include | GI upset (nausea, vomiting), constipation or diarrhea, and green to black stools |
| Iron Deficiency Anemia Side effects include | Elixir may stain teeth/Iron is best absorbed in acidic environment. |
| Iron Deficiency Anemia Side effects include | Do not administer with antacids/Iron may interfere with oral antibiotic absorption. |
| Foods high in iron include | fish; organ meats, dry beans, green leafy vegetables, raisins, molasses, dry fruits, egg yolk,and whole grains. |
| Bence Jones protein | Folate deficiency anemia can be distinguished from vitamin B12 deficiency (pernicious) anemia by |
| Sickle Cell Anemia | Occurs predominantly in the African-American population/1 out of 10 has Sickle Cell trait/1 out of 500 has Sickle Cell disease |
| sickled cell | an abnormal, crescent-shape RBC containing hemoglobin S (Hg-S)—a defective hemoglobin molecule |
| Normal hemoglobin | hemoglobin A (Hg-A) |
| Anemia | severe, chronic and incurable in patients homozygous (having one identical gene from each parent ) for Hg-S |
| Sickle Cell crisis | An episode of acute "sickling" of erythrocytes which causes occlusion in distal blood vessels |
| Sickle Cell crisis | Resulting in tissue hypoxia and ischemia/development of pain and edema. |
| Sickle Cell crisis Precipitated by | Dehydration/Infection/ Overexertion/Weather changes (cold)/Ingestion of alcohol/6) Smoking/Emotional stress. |
| Sickle Cell Clinical manifestations | Usually asymptomatic for first 10-12 weeks of life. |
| Sickle Cell Clinical manifestations | Typical patient is anemic by asymptomatic except during painful episodes/Loss of appetite / irritability/Abdominal enlargement with pooling of blood in the liver, spleen, and other organs/ jaundice (due to RBC destruction). |
| Sickle Cell AnemiaAssessment: | Fatigue when anemia is severe/Pain description/location, intensity, character, duration |
| Sickle Cell Anemia Assessment: | Accelerated RBCs breakdown with jaundice and elevated serum bilirubin levels |
| Sickle Cell Anemia Assessment: | Hemoglobin electrophoresis—80% of hemoglobin is Hg-S/Peripheral blood smear/CBC/) WBCs are increased with infection |
| Sickle Cell Anemia | Morphine and Dilaudid are the opioids of choice |
| Sickle Cell Anemia | Patients should receive pneumovax and flu vaccine annually |
| Sickle Cell Anemia | Hydroxyurea—to increase Hgf/bone marrow transplant |
| Sickle Cell Anemia | Monitor fluid and electrolyte balance/Maintain hydration with IV fluids/Monitor patients closely for prevention of volume overload/ Monitor and maintain pain control. request medication before pain is unbearable. |
| Polycythemia (Erythrocytosis): | Polycythemia Vera/Secondary polycythemia |
| Polycythemia Vera | Myeloproliferative disorder with hyperplasia of bone marrow causing increased circulating erythro-cytes/granulocytes and platelets/ |
| Secondary polycythemia | May result from high altitude, pulmonary disease/cardiovascular disease/or tissue hypoxia |
| Secondary polycythemia | body tries to compensate for a hypoxic problem, not pathologic |
| Polycythemia (Erythrocytosis): Multiorgan system involvement may be caused by hypervolemia and hyperviscosity | predisposing the patient to infarctions of vital organs. |
| Polycythemia (Erythrocytosis)Clinical Manifestations: | Venous distention and platelet dysfunction cause esophageal varices, epistaxis, GI bleeding, and petechiae; |
| Polycythemia (Erythrocytosis)Clinical Manifestations: | Hepatomegaly and splenomegaly from organ engorgement may contribute to patient complaints of satiety and fullness |
| Polycythemia (Erythrocytosis) | Sensitivity to hot and cold; Pruritus; Headaches, vertigo, tinnitus and blurred vision |
| Polycythemia (Erythrocytosis) | Eczema and dermatological changes, including erythema; Hypertension with ventricular hypertrophy and angina (due to hypervolemia and hyperviscosity). |
| Polycythemia (Erythrocytosis) | Arterial blood gases (ABGs); CBC; Bone marrow examination; BMR (Basic Metabolic Rate) is increased |
| Polycythemia (Erythrocytosis) | Directed at decreasing blood volume and viscosity and bone marrow activity; Repeated phlebotomy to maintain hematocrit between 45 and 48%; |
| Polycythemia (Erythrocytosis) | Drug therapy—all decrease bone marrow response |
| Treatment of polycythemia Vera | may be therapeutic phlebotomy with removal of 800 ml of blood. |
| Polycythemia vera: | Monitor fluid balance |
| Secondary polycythemia | Encourage ambulation/ROM exercises. |
| Secondary polycythemia | Maintain adequate oxygenation to prevent secondary polycythemia; |
| Secondary polycythemia | Control pulmonary disease and avoid high altitudes |
| What is the major complication of polycythemia vera? | Thrombosis due to the abnormal increased number of circulating RBCs and platelets. |
| What are the two priorities in treating patients with a Sickle Cell Crisis? | Fluid management and pain control |
| Disorders of Leukocytes: AGRANULOCYTOSIS: | A severe reduction (potentially fatal) in the number of granulocytes (basophils, eosinophils, and neutrophils allowing infection |
| Extremely low WBC count in the blood | (Leukopenia aka Leukocytopenia) |
| (Neutropenia) | Differential neutrophil count—less than 200/mm3 |
| Bone marrow suppression | Fatality may result from severe bacterial infections |
| (Neutropenia) | Adverse medication reaction or toxicity; Neoplastic disease; Chemotherapy and radiation therapy; Viral and bacterial infections; Heredity |
| Neutropenia) | Fever over 100.60 F; |
| Neutropenia) | WBC w/differential—decreased WBC; Bone marrow biopsy—suppressed activity; Cultures to identify possible infective organism. |
| Neutropenia) | Medical Management: Main objective—alleviate bone marrow depression and treat infections; |
| Neutropenia) | Protect against infection; Institute bleeding precautions |
| Leukemia: | Malignant disorder of the hematopoietic system in which an excess of leukocytes accumulates in the bone marrow and lymph nodes—Immature and abnormal white cells replace bone marrow |
| Leukemia: | Immature and abnormal white cells replace bone marrow |
| Leukemia: | Abnormal concentration and forms of immature cells found in circulation; These cells infiltrate lymph nodes, spleen and liver and cause damage. |
| Leukemia: | hepatomegaly, splenomegaly, lymphadenopathy, bone pain, meningeal irritation, and oral lesions |
| Leukemia: | (a) According to the type of proliferating cells (i.e., myeloid, lymphoid), clinical course and duration of illness. |
| Leukemia: | CBC,Bone marrow biopsy,Lymph node biopsyChest radiograph,Peripheral smear,CT/Lumbar punctur |
| Leukemia: | Pain in bones or joints; (b) Fatigue, malaise, and irritability |
| Leukemia: | Presence of infection; (b) Occult blood in stools and urine; (c) Petechiae, ecchymosis, bleeding of mucous membranes; (d) CBC |
| Leukemia: | Treatment is aimed at eradicating the leukemia with chemotherapy or bone marrow transplant. |
| Autologous: | Bone marrow removed from the patient and irradiated; 2 Patient receives chemotherapy; 3 Irradiated bone marrow is reinfused. |
| Allogenic | from donor. |
| Occurs almost exclusively in adults | Chronic leukemia |
| Leukemia | Chlorambucil (Leukeran); b) Hydroxyurea; c) Corticosteroids; d) Cyclophosphamide (Cytoxan |
| Leukemia | PRBCs, platelets, FFP; (b) Blood products are irradiated and CMV negative |
| Leukemia | Monitor for feelings of abandonment and loneliness. |
| Which type of leukemia has the longest median survival rate | type of leukemia has the longest median survival rate |
| Humoral immunity is mediated by | B lymphocytes; In the primary immune response, the principal early antibody seen is IgM |
| IgG | the most abundant antibody that opsonizes bacteria, may cross placenta. |
| Cell-mediated immunity is mediated by | T lymphocytes—a delayed reaction—important in viral, fungal and intracellular infections and in transplant rejection |
| Medical interventions for primary immunodeficiencies involve | B cell and T cell replacement therapy or bone marrow transplantation |
| warrant immunoglobin infusion | IgG levels of less than 300 mg/dl |
| Pancytopenic | Reduction or absence of all three major blood elements (red blood cells, white blood cells and platelets) from the bone marrow |
| Excessive bone marrow production of myeloid cells (RBC, platelets, granulocytes and agranulocytes | Myeloproliferative/Does not include B and T cells. |
| Coagulation Disorders: | Release of blood from the vascular system/(impairment of clotting mechanism). |
| Coagulation Disorders: | Any manifestation that alters the hemostatic process predisposes the body to hemorrhage. |
| Coagulation Disorders: | The disorder may be congenital or acquired, possibly secondary to other disease or medication toxicity |
| Coagulation Disorders: | Petechiae and ecchymoses; Epistaxis and gingival bleeding |
| Coagulation Disorders: | Hypotension; Hypovolemia; Pallor, cool, clammy skin, Tachycardia; GI tract bleeding |
| Coagulation Disorders: | Platelet count (low)/RBC count(low with decreased Hg level)/Altered coagulation time/Bone marrow study(may show abnormal cells) |
| Coagulation Disorders: | Heparin; Antibiotics; Bone marrow transplant; Blood transfusion. |
| The clotting cascade is stimulated after damage to a blood vessel or massive tissue damage;fibrinolytic system is activated | Hemostasis (Clotting mechanism): |
| fibrinolytic system=more non-thrombogenic than thrombogenic | ensure clotting does not become uncontrolled to dissolve the clot to reestablish perfusion |
| Three Stages of Hemostasis: | Vessel spasm=lasts for about 30 minutes/ Platelet plug/Clotting cascade |
| Dependent on clotting factors and calcium; Intrinsic and extrinsic pathways both lead to activation of factor X, | the clotting cascade |
| Fibrinolysis: | Process which breaks down a clot (clot dissolution) |
| Coagulopathies or Platelet Disorders | Condition which component that is necessary to control bleeding is missing/inadequate= Thrombocytopenia; Hemophilia;(DIC). |
| Thrombocytopenia | Platelet disorder exhibiting a deficiency of the number of circulating platelets |
| Thrombocytopenia | platelets is reduced below 100,000/mm3 (Normal is 150,000 to 450,000/mm3) |
| Thrombocytopenia | Accelerated destruction (purpura) of platelets alters coagulation/Infection or viral invasion |
| B LYMPHOCYTES | The circulating antibodies |
| T LYMPHOCYTES | These lymphocytes detect & destroy invading agents |
| CD4 | These T helper cells tell us what's going on in the immune system |
| CD4 | These T helper cells are Killer Cells. They are major regulators of our immune system. |
| CD4 | These T helper (killer) cells are what we base a diagnosis and progression of AIDS on. It's the depletion of CD4 cells that is the clue |
| CD8 | These T helper cells are suppressor cells. They suppress the functions of other cells |
| CYTOTOXIC | These T cells kill cells infected with the HIV virus |
| HUMAN IMMUNODEFICIENCY VIRUS | HIV |
| ACQUIRED IMMUNODEFICIENCY SYNDROME | AIDS is a Retrovirus. The AIDS stands for what? |
| 1000 | Normal CD4 count is |
| <500 | CD4 count that diagnose AIDS in the early stages |
| EARLY AIDS | Count of CD4<500 presents with fever, night sweats, enlarged lymph nodes, persistent infections. This is the count that is used to diagnose AIDS in what stage? |
| 200 | CD4 count which is full blown AIDS. This is when opportunistic infections start to set in |
| ELISA | Basic screening to detect HIV antibodies, if POSITIVE, retest |
| 2:1 | CD4:CD8 Normal Ratio |
| EARLY HIV | CD4 <500, fever, night sweats, enlarged lymph nodes, persistent infections |
| 400 | CD4 count - see skin disorders, lymphoma, dementia |
| 100 | CD4 count, will see cryptoccocal meningitis, CMV, toxoplasmosis & wasting |
| CD4 | This count is used to establish stage of HIV infection |
| WESTERN BLOT | Test used to confirm HIV status |
| ELISA | Enzyme Linked Immunosorbent Assay. This is a Basic Screening to detect HIV antibodies, IF POSITIVE, RETEST. This is NOT the diagnostic test. Western Blot confirms HIV. |
| RETROVIRUS | Aids is what type of a virus? |
| CD4 | AIDS diagnosis is based on a depletion of what cells? |
| HIV | You can be ____ Positive and not have the disease. |
| DOCTOR | You (the nurse) can help interpret the test results for a patient tested for AIDS, however the _____ provides the confirmation. |
| BLOOD, SEMEN, VAGINAL FLUIDS, BREAST MILK, STDs, CSF & SYNOVIAL FLUIDS | The AIDS virus has to be exchanged thru body fluids via a percutaneous route (break in the skin). What fluids can carry the virus? |
| PERCUTANEOUS | Aids has to be exchanged in body fluids via a ________ route. |
| BLOOD | There is no evidence of spread thru Sweat, tears, urine, feces & saliva unless they contain what? |
| INCIDENT REPORT | An accidental needle stick requires an ______ _______. |
| ANTIRETROVIRALS | Treatment for AIDS starts at seroconversion and keeps the disease from replication |
| AZT, RETROVIR, VIDEX, HIVID | These are antiretrovirals (Neucleoside Reverse Transcriptase Inhibitors. They inhibit the replication of the HIV virus |
| VIRAMUNE & RESCRIPTOR | These antiretrovirals (Nonnucleoside Reverse Transcriptase Inhibitors are used in combination with NRTI's & protease inhibitors and are used in the treatment of AIDS |
| NORVIR & VIRACEPT | These antriretrovirals are Protease Inhibitors. They bond with protease to block the function of the enzyme & result in the production of immature noninfectious viral particles. Used in combination with antiviral drugs. |
| OPPORTUNISTIC INFECTIONS | HIV/AIDS is treated NOT cured. The goal is to SLOW progression of the disease. We treat the ______ ______ that come with the disease. |
| HART THERAPY | This therapy is a combination of drugs. They have the benefit of synergy, decreased side effects and minimize toxicity. |
| COMPLIANCE | The most difficult part of the medicinal therapy for patients with HIV/AIDS at home is _________, because some of the drugs must be taken around the clock. |
| PCP | abbreviation for Pneumocystisis Carinii Pneumonia |
| SPUTUM CULTURE | Confirmation for PCP (Pneumocystisis Carinii Pneumonia is: |
| PCP | Most common opportunistic infection seen with HIV/AIDS |
| PCP | Fever, chest pain, dyspnea, cough; is data collection for: |
| BACTRIM (tremethoprim/sulfamethoxazole) | Med given for PCP (Pneumocystisis Carinni Pneumonia). This drug is from the sulfa family. |
| SULFA | Before dispensing Bactrim, check for allergies to what? |
| PENTAM | If allergic to Sulfa, treat with what drug? |
| HISTOPLASMOSIS | Fungal infection from bird droppings, chicken coops, mushrooms, & Mississippi mud. Similar to Pneumonia. It lands in the lungs. |
| SPUTUM CULTURE | Used to diagnose histoplasmosis is Biopsy/culture of bone marrow, blood, lymph nodes, lungs, skin and ___________ __________. |
| FUNGIZONE (Amphotericin B aka Amp B) | Treatment for Histoplasmos (which is a fungal infection). |
| AMPHOTERICIN B (Amp B) | Antifungal med, drug of choice for histoplasmosis, cover with foil (keep shielded from light when in IV form), don't give with foscavir |
| NEPHROTOXICITY | You should monitor for __________ when giving fungicidal medications (like Amp B) |
| NIZORAL | Antifungal med given for as a maintenance therapy drug for histoplasmosis, after the Fungizone (Amp B) therapy is completed. Avoid with antacids, monitor hepatic levels. Can give w/food or milk of client experiences GI upsets. |
| Tuberculosis | Caused by acid fast bacillea, diagnosed with chest x-ray, fever, chills, night sweats seen on data collection. Is a bacterial infection acquired through inhalation. Keep client in Fowlers position and on Reverse flow isolation. |
| RIFAMPIN | Med given for TB, monitor liver enzymes |
| MAC | Abbreviation for Mycobacterium Avium Complex |
| MYCOBACTERIUM AVIUM COMPLEX(MAC) | Organisms found in contaminated soil or water cause this disease. Affects the lungs and sometimes GI tract. |
| TISSUE BIOPSY | Used to diagnose mycobacterium Avium complex (MAC) |
| BIAXIN | Antibiotic used to treat MAC (Mycobacterium Avium Complex) |
| CIPRO | Anti-infective used to treat MAC (Mycobacterium Avium Complex) |
| CMV | Abbreviation for Cytomegalovirus |
| CMV | Herpes virus family that lies dormant waiting to be reactivated in immunosuppressed. Attacks the brain, retina, lungs & liver |
| BRAIN, RETINA, LUNG & LIVER | CMV (Cytomegalovirus) attacks what parts of the body? |
| RETINITIS | Complication/symptom of cytomegalovirus (CMV) (affecting the eyes) |
| BIOPSY OF ORGAN | This is required to diagnosis CMV (Cytomegalovirus) |
| CYTOVENE | Med given for CMV that can cause retinal detachment, eye exams recommended before and during treatment. S/E are also Thrombocytopenia, mehaturia, nephrotoxicity & Leukopenia. |
| FOSCAVIR | Med given for CMV, don't give with Amphotericin B (combination is HIGHLY NEPHROTOXIC). |
| CYTOVENE & FOSCAVIR | Anti-virals used to treat Cytomegalovirus (CMV) |
| CRYPTOSPORIDIOSIS | Protozoan (microorganisms that live on dead matter in water & soil) that INFECTS EPITHELIAL CELLS OF GI TRACT, transmission is fecal-oral route, but can be spread from animal to person as well as person to person and ingesting contaminated food & water. |
| STOOL SPECIMEN | Used to diagnose cryptosporidiosis |
| CRYPTOSPORIDIOSIS | Watery profuse diarrhea, weight loss, electrolyte imbalance, dehydration. These are data collection for what? |
| LOMOTIL | Antidiarrheal given for cryptosporidiosis. This is given along with fluids & electrolyte replacements. |
| HEPATITIS B,C & D | This liver disease is more common in HIV, causes malaise, n/v, RUQ pain. Risk factors are contaminated needles, transfusion, multiple sex partners. |
| BLOOD TESTS | What kind of tests are done to diagnose hepatitis? |
| INTERFERON | What drug is used to treat Hepatitis. Be careful, can only be used 1 time! |
| INTERFERON | What drug used to treat Hepatitis can only be used 1 time? |
| HIV WASTING SYNDROME | Weight loss of >10% of body weight and weakness, diarrhea, or fever for greater than 30 days |
| HIV WASTING SYNDROME | Data collection: Anorexia, diarrhea, n/v, alteration in taste and smell, mouth ulcerations, LOOKS CACHETIC & ANEXORIC. |
| MEGACE | This appetite stimulator will be prescribed to clients with HIV Wasting Syndrome |
| HIV WASTING SYNDROME | Clients with this will be prescribed Megace (appetite stimulator), anti-emetics, TPN, & calorie dense, lactose free supplements and are at RISK FOR FLUID VOLUME DEFICIT. |
| THRUSH | Fungal infection, candidiasis, most common fungal infection. Presents as Creamy white plaques on tongue, gums, or other mucus membranes if wiped away leave bleeding. IS PRESENT THROUGHOUT THE ORAL CAVITY. |
| 90% | What percentage of HIV patients get Thrush (throughout the oral cavity)? |
| DIFLUCAN | Antifungal med used to treat candidiasis. Can cause hepatoxicity which is exacerbated in HIV patients. |
| CARAFATE | Anti-ulcer med used as slurry (paste to coat the mouth) to relieve mouth pain prior to eating. Can cause constipation because the slurry (as it melts & is ingested) binds. |
| MYCOSTATIN | Antifungal med used to treat thrush that contains sugar, monitor glucose I the diabetic patient! |
| GLUCOSE | Mycostatin is an antifungal med used to treat thrush that contains sugar, you should monitor _____ in a diabetic patient. |
| MYCOSTATIN | When giving this drug to a diabetic, you need to monitor glucose, because it contains sugar. |
| ORAL HAIRY LEUKOPLAKIA | Caused by Epstein Barr virus, white patches on side (lateral edges) of tongue that resemble hair |
| ZOVIRAX (Acyclovir) | Oral Hairy Leukoplakia is USUALLY NOT TREATED, however it may be treated with this Antiviral med |
| VAGINAL CANDIDIASIS | Most common initial fungal infection occurring in HIV infected women |
| GYNELOTRIMIN, NIZORAL & DIFLUCAN | Antifungals used to treat Vaginal Candiadiasis in HIV women. |
| CERVICAL INTRAEPITHELIAL NEOPLASIA | Form of cervical cancer in HIV women. Diagnosed with PAP smear. |
| PAP SMEAR | Use to diagnose cervical intraepithelial neoplasia |
| AIDS DEMENTIA | Infection of Glial cells of brain which result in ________ ________, because HIV/AIDS affects the Immune AND Central Nervous systems. |
| LUMBAR PUNCTURE | AIDS Dementia is diagnosed how? |
| PSYCHOTIC BEHAVIORS | This happens in Advanced stage of AIDS dementia |
| RETROVIR | Antiretroviral which inhibits replication of HIV virus by interfering with transcription of RNA |
| RETROVIR | This is used to treat AIDS Dementia |
| RETROVIR | This is an antiretroviral, used to treat AIDS Dementia and must be GIVEN AROUND THE CLOCK. It can cause Bone Marrow Depression. |
| RETROVIR | What antiretroviral (for HIV/AIDS) can cause bone marrow depression? |
| TOXOPLASMOSIS | Protozoan found in cat litter and raw or undercooked meat. Shows up as lesions on the brain and altered mental status. Will require life-long drug therapy |
| ALTERED MENTAL STATUS | Data collection seen with toxoplasmosis |
| DARAPRIM (pyrimethamine) | Antiprotozoal med given as life-long therapy for toxoplasmosis |
| DARAPRIM | This antiprotoxoal contributes to Folic Acid deficiency, so check H & H (RBCs & Hemoglobin) frequently during (life-long) therapy. Can cause bleeding/bruising. Give with food & with folic acid. |
| CRYPTOCOCCOSIS MENIGITIS | Fungal infection found in bird/pigeon droppings, soil, fruit, and fruit juices. IS FATAL if not treated quickly. Starts out in the lungs and then can infect the brain & meninges. |
| NUCHAL RIGIDITY | (Stiff neck) will be present in clients with Cryptococcosis meningitis |
| AMPHOTERICIN B & DIFLUCAN | Meds given for cryptococcosis meningitis. First is given for 2 weeks and the second is given for 10-12 weeks. |
| AMP B (fungizone) | Drug given for the first two weeks (IV) for patients with cryptococcosis meningitis |
| DIFLUCAN (fluconazole) | Drug given as second step (for 10-12 weeks) in patients with cryptococcosis meningitis |
| LUMBAR PUNCTURE | Diagnosis of Cryptococcosis Meningitis is done by: |
| KAPOSI SARCOMA | Only vascular malignancy that may develop in person with HIV/AIDS. Is a lymphatic endothelial malignancy. Presents as red-purple lesions, palpable and painless and NONBLANCHING. Look like bruises. Can be found in Face, trunk, oral cavity & internal organs |
| KAPOSI SARCOMA | Most common cancer related to AIDS |
| TISSUE BIOSPY | This is used to diagnose Kaposi Sarcoma |
| LASER, RADIATION, CHEMO & CRYOTHERAPY | These therapies are used to treat Kaposi Sarcoma in addition to Intralesional thereapy with interferon. |
| NON-HODGKINS LYMPHOMA | Malignant tumors of immune system B cells. If a person is in advanced stages of HIV, we do not treat because drug treatments are worse than the disease. |
| RETROVIRUS | Uses RNA to make copies of DNA that becomes genetic makeup of cells |
| STEVEN JOHNSON SYNDROME | Adverse side effect of Bactrim. Bulbous forming of erythema multiform on large areas of body, |
| BLOOD DYSCRASIAS | Side effect of Retrovir |
| NOSCOMIAL INFECTIONS | Priority concern when taking care of patients with HIV/AIDS |
| VIRAL LOAD TEST | Measures copies of HIV RNA |
| immunity | the quality of being insusceptible to or unaffected by a particular disease or condition |
| immunology | study of the immune system |
| immunologist | MD who specializes in the field of immunology |
| antigens | substances stimulating formation of antibodies |
| antibodies | protein substance developed by the body in response to the presence of an antigen |
| Innate and adaptive | what are the two major subclasses of immunities? |
| innate immunity | which immunity is natural,unspecific,1st line of defense against infection,involves the skin,mucous membranes,cilia,acid,tears,secretions and flora |
| adaptive immunity | which immunity involves B&T cells,it is acquired,specific, second line of defense against infection,involves the thymus,lymph,spleen,bone marrow,blood |
| Humoral Immunity | this immunity is( adaptive,b-cell) a type of immunity that responds to antigens such as bacteria and foreign tissue ,it is mediated by B-cells |
| cellular immunity(cell mediated immunity) | this immunity is an acquired immunity characterized by the dominant role of the T-lymphocytes,T-cells protect against viruses,fungi,parasites |
| functions of the immune system | 1. protects from outside invasions 2. protects from internal threats 3. maintains internal environment by removing damaged or dead cells |
| species resistant, racial/group resistant, individual resistant | what are the three types of nonspecific resistance(Innate) |
| species resistant immunity | type of immunity-one species of animal that is resistant to diseases that affects another.(ex.man to animal) |
| racial/group resistance immunity | type of immunity-the continued exposure to a certain disease gradually increases their immunity |
| individual resistance immunity | type of immunity-genetic or inherited,age (very young or old) and stress affects |
| acquired adaptive (active) immunity | immunity-when antigens are introduced and antibodies are made,may last years or whole life |
| naturally acquired active immunity | immunity-when you have the disease |
| passive immunity | immunity-when antibodies developed by another are introduced,may be temporary |
| naturally acquired passive immunity | immunity- means mom to baby |
| artificially acquired passive immunity | immunity-means vaccines |
| allergy(hypersensitivity) | this means an immune response to a foreign antigen,resulting in inflammation and organ dysfunction |
| allergy(hypersensitivity) | what can range from mild to life threatening, usually occurs on 2nd or subsequent contacts with the allergen,can be associated with emotions |
| 1.identify foreign bodies 2. to repel with toxic defenses | what are the 2 main functions of the immune system? may include..dust,mites,moles,roaches,spores,food,stings,animal,plants,dyes,chemicals |
| signs and symptoms of an allergy | theses are signs and symptoms of what.....itchy watery eyes,runny nose,increased mucous production,rash itching,bronchospasm , stridor, shock |
| patch test, scratch test, ID method | 3 types of skin tests for allergies |
| question anything new, eliminate foods, start back one at a time, | what are the three things the nurse does to eliminate the cause of allergies? |
| avoid allergen,meds,and desensitization(allergy shot) | what is the treatment for allergies? |
| Anaphylaxis (severe hypersensitivity) | a serious allergic reaction with the release of histamine from the damaged cells,can cause shock and death if not treated immediately |
| skin redness, rash, edema,dyspnea ,dysphagia | what are the s/s of anaphylaxis ? |
| identify allergen,watch for and control shock, give meds,emotional support, | what is the tx( nursing care) for anaphylaxis? |
| a medical ID bracelet | if an allergy is known what does pt need to wear? |
| autoimmune disorder | a disorder where the body is unable to recognize its own cells as part of itself( sees as foreign and attacks itself) can affect almost any body cell or tissue |
| autoimmune disorder | the etiology of this disorder is not fully understood its linked to genetic predisposition(family hx), influence of certain antigens,abnormalities in immune cells that lead to inappropiate immune response,interaction with physical/chemical/biological agen |
| organ specific- auto immune disorder | which auto immune disorder affect one organ ex.graves disease,thyrotoxicosis,thyroid affected,or IDDM(pancreas affected) |
| systemic-auto immune disorder | which auto immune disorder affects entire body ex. systemic lupus,erythematasus(SLE), rhematoid arthritis,myosenthia gravis |
| non-organic specific-auto immune disorder | which auto immune disorder affects 1 or more organs...ex.biliary cirrhosis,chronic active hepatitis |
| transfusion reaction | this is known as an allergic reaction caused by blood type or RH incompatibility more commonly seen in people with a hx of allergies?(can be an immediate or delayed reaction) |
| s/s of transfusion reaction | these are s/s of what? chills,diaphoresis,rapid weak pulse,pallor and or cyanosis,muscle aches,back ache ,chest pain,h/a,tingling numbness,dyspnea,cough wheezing,nausea,vomiting,diarrhea,abdominal cramps,rash,hives,itching and swelling |
| transfusion reaction | delayed responses of this can occur 3-14 days after a transfusion,fever,mild jaundice,decreased Hgb levels,as complicates may have resp difficulty,renal necrosis and death |
| Transplant reaction | the destruction of transplanted material at the cellular level by the hosts immune system,controlled primarily by T-cells,but macrophages and B-cells also play a part |
| Autograft | transplantation of tissue from one site to another on an individual |
| Isograft | transplantation of tissue between genetically identical individuals |
| Allograft | transplantation of tissue between members of the same species(most common) ex...(a pt that passes away and another pt getting those organs) |
| retrovirus | what kind of virus is HIV |
| through blood and body fluids | how is HIV transmitted? |
| CD4 + lymphocytes (T-cells or T-lymphocytes) | what type of cells does HIV target? |
| 7-10 days after blood supply is established | Transfusion doesn't always happen immediately it can occur up to how many days after? |
| Immunosuppressive therapy | how can blood transfusion rejection be slowed down? |
| Immunodeficiency disorders | The absence of or inadequate production of immune bodies,can be primary(congenital) or secondary (acquired) |
| protective isolation | what type of isolation does the nurse use for immunodeficiency disorders? |
| AIDS | An infectious disease characterized by severe deficits in cellular function,manifested clinically by opportunistic infection and or unusual neoplasms,manifestations may not appear until late in the infection |
| HIV | What is a retrovirus,meaning its genetic material contains RNA rather than the more common DNA,both are which found in our bodys cells |
| invade a living host cell, lymphocytes-T4 cells | to replicate, what must HIV do? and what cells are the targets? |
| The Master of Mutation | what is HIV known as? (another name) |
| AIDS | theses are symptoms of what?....malaise,fatigue, and wt loss,Lymphadenopathy,Leukopenia,diarrhea,night sweats,presence of opportunistic infections,kaposi's sarcoma |
| Kaposi's Sarcoma | purpilish red lesions of internal organs and skin |
| PHIV (primary HIV infection) | this is the first stage of infection in HIV,as the virus begins to replicate,the person develops an acute retroviral syndrome.. |
| PHIV | this is defined as the period of time between initial exposure to the virus and the appearance of the HIV antibodies |
| PHIV (primary HIV) | these are symptoms of what stage of HIV....flu-like symptoms,fever,fatigue,rash,headache,and lymphadenopathy,also may see pharangitis,myalgia,diarrhea,n/v..s/s appear within days to wks of the HIV exposure and lasts days to months |
| PHIV stage | HIV antibodies cannot be detected at what stage? |
| seroconversion stage | this is the 2nd stage of HIV infection,during this phase s/s of PHIV resolve and the viral load decrease which means that specific HIV antibodies are now detectable in the peripheral blood (8-10 wks after onset) |
| seroconversion stae | in this stage the pt may seem well but the HIV virus is hard at work busily replicating itself and spreading the uninfected cells ,if no tx is received pt begins losing t-cells |
| AIDS | the third stage of HIV is known as what? this is when the pt moves from a dx of HIV to....usually occurs 10-13 years after primary inf |
| AIDS | pt must be HIV + and have a CD4 cell count that is either below 200/mm3or less than 14% of all lymphocytes or be HIV + and have an AIDS defining illness..this is the def of what |
| EIA (enzyme immunoassay) | this is usually first blood test,taken by venipuncture,if +, pt must return for another test this does not mean positive for Hiv |
| western blot test | the second test done after an EIA test is positive,done to confirm the EIA test |
| OraQuick rapid HIV-1antibody test | what test uses blood from finger stick,gives result in 20 minutes,99% accurate |
| UniGold Recombigen | this test produces results within 10 minutes,finger stick ,100% success rate in detecting HIV |
| OraQuick Rapid HIV 1/2 Antibody test | this test uses saliva for the specimen,results within 20 min,99% accuracy |
| chronic infection | HIV infection is considered what type of infection |
| ARV (antiretro viral ) regimen | HIV is usually started on what type of regimen? |
| ARV regimen | this regimen is also known as "reverse transcriptase inhibitors" |
| Kaletra | lopinavir + ritonavir + Protease Inhibitor |
| Invirase | saquinavir, hard gel, Protease Inhibitor |
| Crixivan | Indinavir, Protease Inhibitor |
| Norvir | ritonavir, Protease Inhibitor |
| Agenerase | Amprenavir, Protease Inhibitor |
| Viracept | nelfinavir, Protease Inhibitor |
| Ziagen | abacavir, Antiviral |
| Combivir | lamivudine + zidovudine, Antiviral |
| Sustiva | efavirenz, Antiviral |
| Videx | didanosine, Antiviral |
| Zerit | stavudine, Antiviral |
| Viramune | nevirapine, Antiviral |
| Viread | tenofovir disoproxil fumarate, Antiviral |
| Hivid | zalcitibine, Antiviral |
| Epivir | lamividune, Antiviral |
| Fuzeon | enfuvirtide, Antiviral |
| Rescriptor | delavirdine, Antiviral |
| Retrovir | zidovudine, Antiviral |
| Emtriva | emtricitabine, Antiviral |
| Mepron | atovaquone, Antiprotozoal |
| Acyclovir | guanosine analogue-chain terminator and viral DNAase inhibitor |
| Valacyclovir/Valtrex | guanosine analogue (prodrug of another popular drug) |
| Famiciclovir/Penciclovir | guanosine analogue |
| Ganciclovir/Valganciclovir | guanosine analogue, hematologic myelosuppression toxicity, possibly additive with zidovudine (HIV) |
| Cidofovir | nucleotide analogue, also inhibit viral DNAase-long intracellular half-life (24-65 hours)renal toxicity (proteinuria, increased serum creatinine) |
| Foscarnet/PFA | pyrophosphate analogue-block pyrophosphate binding site of DNAase-active against reverse transcriptase, RNAaserenal, metabolic toxicity (hyperphosphatemia, hypercalcemia) |
| Ribavirin | guanosine analogue-aerosol, drug precipitation in ventilator, anemia |
| Amantadine, Rimantadine | cyclic amines inhibit M2 protein proton ion channel, uncoating-more fx with amantadine-reversible CNS effects (DA interference), additive with antihistamines |
| Zanamavir, Oseltamavir | neuraminidase inhibitor, cleaves terminal sialic acid from glycoconjugates-former is an inhalant |
| Pegylated Interferon alpha | somehow ?? block viral transcription, translation (immunomodulator)-subcutaneous, lesion injection,influenza-like symptoms, CNS disorders, hematologic toxicities |
| Acyclovir | major treatment for HSV, VZV |
| Valacyclovir/Valtrex | treatment for HSV, VZV |
| Famiciclovir/Penciclovir | treatment for mucocutaneous HSV (with HIV), VZV |
| Ganciclovir/Valganciclovir | treatment for life-threatening CMV (retinitis, pneumonitis) in immunocompromised hosts |
| Cidofovir | treatment for significant CMV disease (CMV) retinitis IV only(topical for HPV) |
| Foscarnet/PFA | treatment for-ganciclovir-resistant CMV-acycovir-resistant HSV, VZV |
| Fomivirsen sodium | treatment CMV retinitis in AIDS |
| Ribavirin | treatment for-RSV pneumonitis (paramyxo)-with pegylated interferon for Hep C |
| Amantadine, Rimantadine | treatment for -prophylaxis, treatment of influenza A-Parkinson's Disease |
| Zanamavir, Oseltamavir | prophylactic for influenza A, B |
| Pegylated Interferon alpha | treatment for-Hep B, replaced with lamivudine, adefovir, entecavir-Hep C with ribavirin-(HPV) |
| when was aids discovered | 1980's, many scientist believe it came from chimpanzees because they carry the virus |
| universal precautions | used only on aids patients back then but now called standard precautions which are used for everyone |
| how is aids transmitted | through blood, semen, or urine, dirty needles, from mom to baby during pregnancy |
| difference between HIV and AIDS | hiv is the virus and aids is the terminal stage of it from an infection and in aids the number of T cells drops below 200 |
| Tx of AIDS | antiretrovirals |
| complications of AIDS | susceptible to infections, viral, bacterial, fungal, parasitic, because of a decreased immune system |
| blood tests for AIDS | 1st is ELISA if that is positive then they run the western blot test if that one is positive then they have the HIV virus, they test for HIV antibodies |
| transplantation and rejection syndrome | caused by normal antigen and antibody reaction, reduced by tissue typing and immunosuppresants |
| allergy | a tendency to react unfavorably to substances that are normally harmless |
| types of allergies | allergen exposure, tissue sensitization, antigen and antibody reaction, histamine release |
| hypersensitivity reaction | another name for allergy |
| urticaria | another name for hives |
| Ige | elevated during an allergic reaction |
| latex allergies | person can also be allergic to bananas, kiwi, avacado, tomatoes, potatoes, chestnuts, should wear a med alert bracelet |
| how do you give a person with latex allergy meds from a multi use vial? | give them the first dose from a new vial |
| 0.1, 0.3 | adult dose of epi |
| 0.01 | infant dose of epi |
| transfusion reaction | reaction to a blood transfusion could be a rash, fever, chills, chest pain, back pain, cough, SOB, decreased BP, stop transfusion immediately |
| autoimmunity | abnormal reactivity to one's own tissues, no cure, |
| factors of autoimmunity | disease or loss of immune system control |
| Tx for autoimmunity | immune suppressing drugs, chemo, stem cell replacement |
| immune deficiency diseases | failure of immune system, may involve any part of system, vary in severity, congenital or acquired |
| categories of immune deficiency disorders | drug induced, stress, malnutrition, radiation, surgery, hodgkins disease |
| chronic fatigue syndrome | on going fatigue greater than 6 months, worsens with physical activity, no improvement with rest, debilitating fatigue, interfers with persons ability to work/play |
| S/S of chronic fatigue syndrome(must have at least four to have the syndrome) | low grade fever, sore throat, tender cervical or axillary lymph nodes, muscle weakness, myalgia, headache, joint pain without redness or swelling, neurologic symptoms |
| Tx for CFS | no cure, relieve symptoms, balance activity and rest, avoid overexertion, ASA tylenol or NSAIDS, low doses of anti depressants (elavil) |
| immunization | vaccine |
| immunotherapy | allergy shots, small doses of antigens (desensitization) |
| lymphatic disorders | can be occlusive, inflammatory, infectious, or malignant, all result in fluid distribution problems, tender lymph nodes, compromised immune system, or a combination of them |
| S/S of lymphangitis | fine red streaks from affected area distal to proximal |
| Tx for lymphangitis | warm soaks(epsom salt or soapy water), antibiotics, elevation, |
| lymphedema | accumulation of fluid in soft tissue, can be primary(hereditary) or a complication(mastectomy, pregnancy, burns) |
| S/S of lymphedema | swelling of affected area, skin eventually becomes firm, tight, shiny,, and discolored, can be painful |
| Dx test for lymphedema | lymphangiography |
| Tx for lymphedema | compression pumps, elastic stockings/sleeves on affected extremity, diuretics, low sodium diet, massage therapy from distal to proximal |
| goal for Tx of lymphedema | increase lymph drainage and avoid trauma |
| Mono(infectious mononucleosis) | viral caused by epstein bar, contagious spread by direct contact with saliva and pharyngeal secretions most comonly affects young adults |
| 30-50 days | incubation period for mono |
| S/S of mono | fatigue, sore throat, headache, fever, lymph node enlargement, tonsils ooze whit or greenish exudate, trouble swallowing, liver or spleen enlargement |
| Dx tests for mono | lymphs, rise in EB virus antibody titer(done on 2 separate occasions) |
| Tx for mono | self limiting, fluids, rest, analgesia, possible use of corticosteroids, usually keep from PE or sports for several wks because of enlarged spleen |
| lymphoma | group of cancers that affect lymph system, hodgkins or non hodgkins |
| hodgkins disease and NHD | painless swelling in one or more of the lymph nodes(cervical and spleen) |
| reed sternberg cells | characteristic of HD, cell in lymph nodes |
| stages of HD | 1-4 based on the degree of lymph node involvement and wether involvement is above or below the diaphragm |
| Dx tests for HD and NHD | bone marrow biopsy, liver and spleen biopsy, CT, PET scans |
| Tx for HD | based on the stage and how far it has progressed 1-2 is ABDV therapy, 3-4 is MOPP therapy |
| stages of NHD | also 1-4 based on number and location of affected lymph nodes, wether the nodes are on 1 or both sides of the diaphragm and wether the disease has spread to other tissues |
| Tx for NHD | depends on the stage, bone marrow transplant, stem cell transplant, CHOP meds, surgery, monoclonal antibodies |
| antiretrovirals | only used for HIV and AIDS pt, disable proteins needed for replication of HIV, prevents the virus from being released from infected CD4 cell |
| HAART | highly active antiretroviral therapy (combination of antiretroviral meds) |
| side effects of antiretrovirals | anxiety, headache, N/V, fatigue, muscle aches, neutropenia, increased cholesterol, pancreatitis |
| nursing for antiretrovirals | expensive, meds need to be taken on schedule missed doses will lower serum drug level, which allows the HIV virus to mutate and build a resistance toward the med |
| immunosuppressants | prevents transplant rejection, methotrexate(corticosteroid), cyclosporin, imuran |
| side effects of immunosuppressants | reduced resistence to infection(greates threat), leukopenia, thrombocytopenia, hepatoxic, nephrotoxicity, bone marrow depression, lots of blood tests frequently |
| nursing for immunosuppressants | monitor for subtle signs of infection, pt teaching of importance of taking meds and keeping follow up appointments |
| antihistamines | actifed, benadryl(diphenhydramine), dimetapp, used to counteract effects of histamine |
| side effects of antihistamines | drowsiness, dry mouth, urinary retention or frequency, sleep disturbances, nervousness |
| nursing care for antihistamines | no driving or operating machinery until affects are known |
| nonsedating antihistamine | zyrtec, allegra, claritin, used to counteract affects of histamine |
| corticosteroids | used to treat allergic reactions, collagen disease, skin conditions, shock, anti inflammatory activity makes them valuable for suppressing inflammation |
| decadron(dexamethasone), hydrocortisone, methylprednisolone | corticosteroids |
| side effects of corticosteroids | retention of water and sodium, loss of potassium, elevated BG, HTN, GI bleeding, mood swings, impaired healing, increased appetite |
| nursing for corticosteroids | give deep IM to prevent tissue damage, don't stop abruptly reduce dose gradually (medrol dospak) |
| epinephrine | emergency drug, strengthens cardiac contractions, increases BP and cardiac output |
| nursing care for epi | monitor VS continuously, available in several concentrations, be sure to check |
| meds given for allergic reactions | antihistamines, corticosteroids, epi, bronchodilators, nonsedating antihistamines |
| CD4 cells | HIV enters these cells |
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SGT.MOSS
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