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Flashcards in Immunological Dx Deck (38):
1

Scleroderma & 3 main comps

Rheumatic, conn tissue dx associated w impaired immune responses; Vascular: Raynauds, constant recurrent restriction of BVs=pulm HTN & decreased esophageal motility. Fibrotic: thick/burning skin, restrictive lung disease. Autoimm: B-cell prod antibodies > genetic/environmentallty induced; most often women

2

Limited Scleroderma

Skin involvement w good prognosis & linear scleroderma=bands of thicker skin w good prognosis

3

Systemic Scleroderma

Of internal organs=life threatening; CREST syndrome w good prognosis: Calcinosis, Raynauds, Esophageal dysfun; Sclerodactyly of fingers/toes & Telangiectasis or red spots covering hands/feet/forearms/face/hips

4

Tx for Raynauds (Scleroderma)

Dress in layers - clothing modification (fingers/toes); Biofeedback - guided imagery to focus on distal circulation; Edu on skin inspection; Activity mod to prevent trauma to fingers/toes

5

Tx for Contractures rel to Scleroderma

Splint at optimal resting length for hands/wrists to slow development; Silicone gel in plams; Electrical/mechanical muffled vibration to stim rapidly adapting A-type nerve fibers & decrease burning sensation

6

Gen tx for Scleroderma

Nasal O for pulmonary artery probs, diet mods for Gi probs, cessation of exercise if myositis, protective gloves(cotton, insulated, mildly compressive) if fibrosis skin probs

7

AIDs: Acquired Immunodeficiency Disease

Acquired through unprotected sex/blood or body fluids.

8

HIV: Human Immunodeficiency Disease

Retrovirus (DNA); Attacks lymphatic system (immunity system) - T cells/CD4 attack body

9

4 Stages of HIV Infection

Acute: flu-like. Asymptomatic: HIV replicated and affects imm system but does not show signs other than blood abnormalities. Symptomatic: signs/symptoms appear. Advanced: severely compromised immunity; CD5 (T cell) levels drop

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HIV Symptoms

Enlarged lymph nodes, fatigue, weight loss/malabsorption of nutrients, fever, diarrhea, decreased act tol, neurolog impairment: cog, affective, sensory, ADL impairments, myelopathy, peripheral neuropathy, visual impairment

11

Hep A/B

Viral infections. A= contaminated seafood/protective imm possible. B/C/Others= body or blood borne exposure/protective imm possible for B. HC workers are most susceptible to B. Fever, fatigue, decreased act tol & cirrhosis (liver degen)

12

Methicillin-Resistant Staphylococcus Aureus: MRSA

Usually mild infections (pimps/boils) > can be more serious including in surgical wounds. Can be local or systemic thru bloodstream affecting lungs or urinary tract. Risks: Weakened immune system, hosp confinement, close quarter living, direct contact (sports) or secondary (towels). Resists most antiboticis

13

MRSA Signs/Symptoms

Red/swelling/pain at wound, drainage, fever, skin abscess, chest pain, cough, fatigue, head/mus ache, rash, SOB - chance of reoccurring in future

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Tx for Acute Hosp of Imm System Disorders

Early mobilization, preservation of function, positioning, psychological/emo support, prevent LT disability

15

Tx for In Pt Rehab of Imm System Disorders

Eval/restoration of fx'al abilities: ADL, IADL, econ, work simp, restoration of activity/ex tol, achievement /maintenance of QOL, role adjustment intervention, plan comm re-integ

16

Home Care for Imm System Disorders

Collab assessment (COPM) to set goals, eval/restore of fx'al ability, restore act/ex tol, comm mobility

17

Type 1 Diabetes

Insulin-dependent (only 5-10%); Autoimmune, genetic & environmental factors contribute

18

Type 2 Diabetes

Non-insulin dependent (90%); Older age, obesity, fam hx, prior hx of gestational dx, impaired glucose tolerance, physical inactivity, race

19

Other Diabetes

Gestational (2-5% of all pregs-40% may develop Type 2): usually resolves after preg, obesity/race are risk factors. Genetic syndromes, surgery, drugs, malnut, infections.

20

Signs/Symptoms of Diabetes

Frequent urination, excessive thirst, unexplained weight loss, extreme hunger, visual changes, sensory changes in hands/feet, fatigue, very dry skin, slow healing wounds, increased rate of infections > Hypoglycemia: vagueness, dizzy, tachycardia, pallor, weakness, diaphoresis, seizures and/or coma

21

Hyperglycemic Crisis

Ketoacidosis: dehydration, rapid/weak pulse, acetone breath. Hyperosmolar coma: stupor thirst, polyuria, neurolog abnorms. IV fluids/insulin req - call 991

22

Tx for Diabetes

Preventative ther ex, edu on compliance/med mngt for condition, psychosoc/emo support, lifestyle mod to complications, protective issues regarding peripheral neuropathy, early attn to wound mngt, edu on how to notice fx'al changes and edu on what to do

23

BMI: Body Mass Index

Calc by dividing weight in kilos by square of persons height in m. Overweight BMI=25-29.9, obesity=>30, morbidly obese=>40.

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Health Risks Associated w Obesity

Metabolic syndrome, HTN, HLD, Type 2 DM, cardiovas disease, stroke, glucose intol, sleep apnea, gallbladder disease, menstrual irregs/infertility, Ca, and chronic LBP

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Tx for Obesity

Lifestyle redesign, activity focused ex program, self monitoring ex responses, supportive coaching/counseling,, AT to max participation

26

Co-morbidities w Obesity

Cardiopulmonary: angina, SOB, increased BP, joint pain/altered biomechanics, increase risk of pressure ulcers d/t shear forces, increased occurrence of lymphedema, cellulitis, skin fold dermatitis/other skin infections, increased heat intol=risk of hyperthermia/heat exhaustion & increased risk of th. injury when using body mechanics

27

Symptoms of Lyme Disease

Fatigue, headache, chills/fever, mus/joint pain, swollen lymph nodes, rash, arthritis, numb, pain, bells palsy=weak on one side of face, meningitis

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Tx of Lyme

Edu on arthritic flares, rest, anti-inflams, splinting/wrapping to protect/prevent overstretching, energy conservation, work simplification, safety assessment, coping w chronic pain, PAMs to reduce pain, stress mngt techs, neutral warmth, adaptive techs to avoid tigger mvmts, facial splint, e-stim to stim denervated mus, edu on using fingers to help close mouth, counseling on body image, pluse-ox

29

Conditions that Predispose pt to Decubitus Ulcers

Immobility/altered mobility, weight less, edema, incont, sensory deficiencies, circulation abnorms, dehydration, inadequate nutrition, obesity, patholog conditions/multiple co-morbidities and/or age related skin changes

30

Suspected Deep Tissue Injury

Localized discoloration of intact skin or blood blister resulting from damage of underlying soft tissue - could evolve, rapidly

31

Stage 1 Pressure Ulcer

Skin in tact w visible nonblanchable redness over localized area (bony prom), may be softer/firm or cooler/warmer than surrounding area, area may be painful/itchy, may be "at risk" but difficult to detect

32

Stage 2 Pressure Ulcer

Involves dermis w partial thickness loss which presents as a shallow, open ulcer that is shiny or dry or as a blister. Wound bed is red-pink w/o slough or bruising

33

Stage 3 Pressure Ulcer

Involves full thickness tissue loss w subcutaneous fat possible visible, Slough (dead matter) may be present, bone/tendon/mus not exposed, can range from shallow to very deep depending on location

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Stage 4 Pressure Ulcer

Full thickness tissue loss w bone/tendon/mus visible or directly palpable. Can range from shallow to very deep depending on location.

35

Unstageable Pressure Ulcers

Invloves full thickness loss which the wound bed has slough and or eschar (scab/dark crusted ulcer) which covers base of ulcers

36

Tx for Pressure Ulcers

Prevention is most effective. Group 1: cushions/mattresses w non-elec means (air, foam, gel or h20), Group 2: dynamic, elec-powered devices (alternatinf and low air loss mattresses) for full thick/mod-high risk ulcers & Group 3: dynamic, elec-powered devices (air-fluidize beds) for pts w nonhealing, full thick ulcers, weight shifting and skin care

37

Heat Exhaustion is Characterized By

Rapid pulse, decreased BP, nausea, vom, cool pallid skin, mental confusion, headache and/or giddiness but no fever

38

Heat Stoke is Characterized By
*med emergency

Hot, dry, red skin; body temp higher than 104; slow deep respiration; tachycardia; dilated pupils; confusion > seizures/LOC