NR 324 FINAL EXAM
Methotrexate
DMARD
Humoral response
B cells – antibody mediated
Cell mediated
t cells and CD4, specific antigen recognized
Vaccines
active immunity
Varicella vaccine
live vaccine – do not give give vaccine to pt. who is immune compromised
IgE reaction
-quick onset
-allergic reaction
-release of mast cells and histamines
-massive vasodilation (shock – BP drops)
-give epi
-mostly concerned about airway – oxygen will not help much since airway is constricting
- have oral airway nearby, then give epi and IV fluids to help with tachycardia and
hypotension
IgG reaction
-antibody mediated
-blood transfusion reaction
-hemolytic anemia
Immune Complex Mediated Reaction
-inflammatory response
-SLE, Acute glomerular nephritis, RA, hyperacute graft rejection
Hyperacute graft rejection
-will need to take transplant out
Chronic Rejection
-s/s: malaise, fatigue, low grade fever, tenderness at graft site, BUN and creatinine
increasing
-give medications for rejection: more immune suppressants and solumedrol (1000mg IV
- watch blood sugar since it will increase by a large amount)
Cell Mediated Reaction
-delays, people that get chronic graft rejection or someone who has a positive PPD,
latex allergies, or poison ivy
Latex Allergy
-if patient is allergic to bananas, avocados, papayas, they could also be allergic to latex
Cellular Response with inflammation
-neutrophils and monocytes go to site of injury since can now go through capillary walls
Rheumatoid Arthritis
-not a joint problem, it is an inflammation of synovial fluid so synovial membrane is
inflamed, then membrane can become fibrotic
-goal for tx: prevent or minimize the # of deformities
-will have ulnar deviation and swan neck deformities
-affects fingers and toes bilaterally a lot
-joints get stiff with limited movement
-morning stiffness that lasts more than hour
-put heat on joints that stiff to relax the joint and increase ROM
-do heat and cold therapy
-dont completely limit movement
-complications: pleural and lung problems, pericarditis, cataracts, contractures, nodules
-get OT AND PT
-ESR: <30%
-CRP: <1 (to see if inflammation is present in body)
-RF: <15 -specific to arthritis
-ANA: positive with RA
Drug Therapy RA
-NSAIDS (watch for ulcers)
-COX 2 inhibitors: celebrex