Rasmussen Nursing 2 exam 3 ALL SOLUTION LATEST SOLUTION 2023/24 EDITION GUARANTEED GRADE A+

What is cART therapy? Post-exposure prophylaxis (PEP) for HIV for adults: 1.) those who have had an occupational exposure (needlestick injury) 2.) those who have had a nonoccupational exposure (such as a consensual sexual exposure with an adult of unknown HIV status) 3.) those who have suffered a sexual assault What information is important to provide clients who are on cART therapy? Significant exposures should be treated with the same three-drug regimen for 28 days or until the HIV status of the source has been determined to be negative (The window of opportunity for best outcome closes when prophylaxis is started after 72 hours). What HIV tests are done to measure HIV antibodies? Enzyme-linked immunosorbent assay (ELISA) and Western blot analysis Values of CD4 T cells, WBCs, viral load WBC: Leukopenic 3500 (normal ) lymphopenic (1500 lymphocytes/mm3) Viral load: Will test positive if infected with HIV and can be greater than 80,000 HIV particles/mL (will test negative for viral load if not infected with HIV) CD4 T cells: 200/mm3 (0.2 × 109/L) Values associated with the stages of HIV/AIDS Stage 0: a patient who develops a first positive HIV test result within 6 months after a negative HIV test result. Stage 1: CD4+ T-cell count of greater than 500 cells/mm3 or a percentage of 29% or greater. An adult at this stage has no AIDS-defining illnesses. Stage 2: CD4+ T-cell count between 200 and 499 cells/mm3 a percentage between 14% and 28%. An adult at this stage has no AIDS-defining illnesses. Stage 3: CD4+ T-cell count of less than 200 cells/mm3 or a percentage of less than 14%. Stage Unknown CDC Case Definition is used to describe any patient with a confirmed HIV infection but no information regarding CD4+ T-cell counts, CD4+ T-cell percentages, and AIDS-defining illnesses is available. Infections that can occur as a result of HIV Opportunistic infections: Toxoplasmosis Tuberculosis Candidiasis Cytomegalovirus Infection Herpes simplex virus infection Varicella-zoster virus infection HIV-1 NAT (nucleic acid test) Differentiates between HIV-1 and HIV-2 if HIV+ Type I: Rapid or Immediate Hypersensitivity Helps to remember: ALLERGIES/IgE Reaction of IgE antibody on mast cells w/ antigen -- release of mediators (especially histamine) *MOST COMMON TYPE *"ATOPIC ALLERGY" Examples: 1.) Hay fever 2.) Allergic Asthma 3.) Anaphylaxis 4.) Angioedema Type II: Cytotoxic Reactions Helps to remember: BLOOD TRANSFUSION RXNS/IgG Reaction of IgG w/ host cell membrane or antigen adsorbed by host cell membrane *Body makes autoantibodies directed against self cells that have a form of foreign protein attached to them Examples: 1.) Hemolytic transfusion rxn (e.g. transfusing the wrong blood) 2.) Autoimmune hemolytic anemia 3.) Goodpasture's syndrome 4.) Myasthenia Gravis Type III: Immune Complex-Mediated Helps to remember: INFLAMMATION & AUTOIMMUNE Antigen-antibody complex forms in walls of blood vessels -- inflammation *Circulating complexes lodge in glomeruli of kidneys (glomerulonephritis), blood vessels (vasculitis), joints (arthritis), and skin *Many autoimmune disorders caused by type 3 rxns Examples: 1.) Serum sickness 2.) Vasculitis 3.) Systemic lupus erythmatosus (SLE) 4.) Rheumatoid arthritis Type IV: Delayed Hypersensitivity Helps to remember: Reaction of sensitized T cells w/ antigen and release of lymphokines -- turns on macrophages and induces inflammation *T cells tell macrophages to destroy antigen *Response occurs hours to days after exposure *Benadryl is NOT helpful (histamine NOT the mediator--give corticosteroids instead) Examples: 1.) Poison IV (contact dermatitis) 2.) Positive TB skin test (rxn doesn't show up until 48-72h later) 3.) Tissue transplant rejections (e.g. graft rejection) 4.) Sarcoidosis 5.) Local response to insect stings (e.g. mosquito bites and you don't see a wheal until hours later) What is systemic lupus erythmatosus (SLE)? -Chronic, progressive, inflammatory connective tissue disorder -Can cause multiple organs and systems to fail -Can have flare-ups What causes SLE? Complex combination of genetic and environmental factors What is the treatment goal for SLE? Reducing tissue inflammation caused by the disease What education would you give a patient who has SLE? Protect the skin: -Clean w/ mild soap (e.g. Ivory) -Dry skin by patting, not rubbing -Apply lotion liberally to dry skin -Avoid powder & drying agents -Use cosmetics w/ moisturizer -Avoid direct sunlight & UV -Wear large-brim hat, long sleeves, long pants in sun -Use sun-blocking agent of at least 30SPF -Inspect skin daily for open areas and rashes What exacerbates SLE? Sunlight Infections Stress What are two differences between SLE and RA? 1.) Protecting the skin 2.) Monitoring temp (fever is major sign of exacerbation) What education would you give a patient with rheumatoid arthritis? Exercises: Exercises have been specifically tailored to you, so follow them Exercise on good and bad days (consistency is key) Respect pain. Reduce the # of repetitions when inflammation is severe and there's more pain Use ACTIVE ROM rather than passive Avoid resistive exercises the joints are severely inflamed Do not substitute normal activities or household tasks for prescribed exercises Joint protection: Use large joints instead of small (e.g. hang purse on shoulder and not in hand) Do not turn a doorknob clockwise (turn counterclockwise to avoid twisting arm -- ulnar deviation) Use 2 hands to hold an object Sit in chair that has a high, straight back Don't push off w/ fingers getting out of bed: use entire palm of both hands Don't bend @ waist; bend at knees while keeping back straight Use long-handed devices such as hairbrush w/ extended handle Do not use pillows in bed except small one under head Avoid twisting or wringing hands Energy conservation: Balance activity w/ rest. Take 1-2 naps each day Pace yourself. don't plan too much for 1 day. Set priorities. Determine which activities are most important and do them 1st Delegate responsibilities to fam and friends Plan ahead Learn activity tolerance Osteoarthritis risk factors Primary: aging, genetic factors Secondary (less common): Joint injury Obesity Excessive use Trauma, or other joint disease (RA) Heavy manual occupations, Athletes (football players, runners, gymnast) Certain metabolic disorders (diabetes, Paget's disease of the bone) Blood disorders (hemophilia, sickle cell disease) Lice treatments Chemical killing of the parasites w/ topical sprays, creams and shampoos Permethrin (Emilite) Lindane (Bio-Well) Topical Malathion (Ovide) Clothing and bed linens washed in hot water S/S Primary Open-Angle Glaucoma Early signs: Effects both eyes Early stages no s/s Develops slowly w/ gradual loss of visual fields Foggy vision Mild eye twitching Headaches Late signs: Seeing halos around lights Losing peripheral vision Decreased visual sensory perception that does not improve w/ eyeglasses S/S of Acute Angle-Closure Glaucoma Sudden severe pain around eyes that radiates to face Headache Brow pain N/V Colored halos around lights Sudden blurred vision w/ decreased light perception S/S Cellulitis Localized area of inflammation (may enlarge rapidly if not treated -Redness -Warmth -Edema -Tenderness -Pain -Sometimes blisters -Accompanied by lymphadenopathy and fever -Typically in the lower legs, areas of persistent lymphedema, areas of skin trauma (leg ulcer, puncture wound) Contact Dermatitis Treatment Acute or chronic rash caused by direct contact w/ irritant or allergen CONTINUED...