ADDISONS DISEASE

is a disorder that affects the adrenal glands, causing decreased production of adrenocortical hormones (cortisol, aldosterone, and dehydroepiandrosterone).
Pathophysiology Signs and Symptoms Hyponatremia, hyperkalemia Water loss, dehydration, hypovolemia Muscular weakness, fatigue Hyperpigmentation Anorexia, nausea Autoimmune: e.g. TB, Fungal Infections, AIDS) Destruction of own tissue Affects functioning of Adrenal Cortex Decrease production of Mineralocorticoid and glucocorticoids Cortisol deficiency causes altered metabolism, decreased stress tolerance, and emotional ability.

Diagnostics
Blood chemistry- decreased glucose, decrease sodium, increased potassium Increased lymphocytes on complete blood count Low plasma fasting cortisol levels; low aldosterone levels ACTH stimulation test- no rise in plasma cortisol and urinary 17 ketosteroids.

Medications Celestone (Bethamethasone) Cortone, Cortistan (Cortisone) Decadron (Dexamethasone) Florinef (Fludrocortisone) Cortef (Hydrocortisone) Medrol, Depo-Medrol, Solu-Medrol (Methylprednisolone) Delta-Cortef, Prelone, Orapred, (Prednisone)

Aldosterone deficiency causes urinary loss of sodium, chloride, and water, resulting in dehydration and electrolyte imbalances. Androgen deficiency leads to the loss of secondary sex characteristics.

Nursing Management: Decrease stress in the environment. Prevent exposure to infection. Provide rest periods to prevent fatigue. Provide diet high in protein, Na and carbohydrates; low K Administer steroids after meals or with milk. Monitor neurological status, noting irritability and confusion. Administer IV fluids (5% dextrose in saline, plasma) as ordered to treat vascular collapse Administer IV glucocorticoids as ordered

ADDISONS DISEASE

BRONCHIAL ASTHMA
Is characterized by variable, recurrent, reversible airway obstruction clinically manifested by intermittent episodes of wheezing and dyspnea

Diagnostics Pathophysiology Signs and Symptoms Episodes of coughing Wheezing Dyspnea Feeling of chest tightness Risk factors for development of asthma (smoking, air pollution, respiratory infections etc.) Inflammation Airway hyperresponsiveness Laboratory- increased levels of IgE are usually seen in atopic asthma Pulmonary function testingdecreased- forced expiratory volume Sputum and nasal cytology increased eosinophilia Chest x-ray to exclude other lung diseases

Airflow limitation

Medications cromolym sodium (Intal ) budesonide (Pulmicort) ipratropium bromide (Atrovent) salbutamol (Vertolin) Terbutaline (Bricanyl)

Symptoms (shortness of breath, cough, wheeze)

Nursing Management

Monitor vital signs, skin color, and degree of restlessness which may indicate hypoxia Provide nebulization and oxygen therapy as prescribed Encourage intake of fluids to liquefy secretions Instruct patient on positioning to facilitate breathing. Use chest physiotherapy/ postural drainage to mobilize secretions.

SYSTEMIC LUPUS ERYTHEMATOSUS

Is a chronic, multi- system disease that is most likely a failure of immune regulation.

Diagnostics Pathophysiology Signs and Symptoms Butterfly rash Ring-shaped lesions Oral ulcers Weight loss Fatigue Epilepsy Pleural effusion Triggering agents Abnormal immune regulation CBC-leukopena, anemia ANA- positive ESR- generally elevated Complement levelsgenerally decreased when disease is active Urinalysis- hematuria, proteinuria Chest x-ray may show changes

T cells B cells Autoantibody formation

Immune complex formation Medications ibuprofen (Motrin) naproxen (Naprosyn) ansulindac (Clinoril) Hydroxychloroquine (Plaquenil Complement activation

Nursing Management

Tissue injury and damage

Instruct patient in avoidance of factors that may exacerbate disease. Encourage good nutrition, sleep habits and exercise, rest and relaxation to improve general health and help prevent infection. Assist with monitoring of urinary status as indicated by degree of renal involvement. Encourage good oral hygiene and inspect mouth for ulcers. Teach relaxation techniques such as deep breathing, progressive muscle relaxation.

RHEUMATOID ARTHRITIS
is a chronic, systematic autoimmune disorder that causes the immune system to attack the joints, where it causes inflammation (arthritis) and destruction
Diagnostics Pathophysiology Signs and Symptoms Joint Pain Swelling Warmth Erythema Lack of function Join stiffness in the morning Predisposing Factor Gender (female) Age (20-50 y/o)
The ESR is significantly elevated in RA. The Red Blood Cell count and C4 complement component are decreased. C-reactive protein and anti-nuclear antibody (ANA) test result may also be positive Arthrocentesis shows synovial fluid that is cloudy, milky, or dark yellow and contains numerous inflammatory components

Presentation of antigen T cells T and B cell proliferation, Angiogenesis in synovial lining Neutrophil accumulation in synovial fluid. Cell proliferation. No cartilage invasion Subchondral bonde erosin, pannus invasion of the cartilage. Chondrocyte proliferation. Laxity of ligaments

Medications Naproxen (Naprosyn) Ketorolac (Toradol) Gold sodium thiomalate (Myocrisine) Prednisone (Orasone) Hydrocortisone (Cortef)

Nursing Management

RHEUMATOID ARTHRITIS

Apply local heat or cold to affected joints for 15 to 20 minutes three to four times a day. Encourage warm bath or shower in the morning on arising Encourage exercise consistent with degree of disease activity. Provide pain relief before self care activities Schedule adequate rest periods Reinforce effective coping mechanisms.

HODGKINS DISEASE
a type of lymphoma. it is a cancer of the lymph tissue found in the lymph nodes, spleen, liver, and bone marrow

Diagnostics Signs and Symptoms Swollen lymph nodes (that do

not hurt) in the neck, underarms, or groin Becoming more sensitive to the effects of alcohol or having painful lymph nodes after drinking alcohol Weight loss for no known reason Fever that does not go away Soaking night sweats Itchy skin

Pathophysiology Epstein barr virus, infection Immunoglobulin gene, mutation of B cell

Production of B-cell with crippled immunoglobulin Formation of malignant cell type, Reed Sternberg cells Release of chemicals (Cytokine)

FBC with differential- low Hb, WCC count, and platelets Metabolic panel- normal ESR- elevated Chest x-ray- mediastinal mass; large mediastinal adenopathy Lymph node biopsyHodgkin's cells within an appropriate background cellular milieu

Nursing Management

Medications Activation, inflammatory regeneration Prednisone (Orasone) Chlorambucil (Leukeran) Cyclophosphamide (Cytoxan)

Pain and fever

Hodgkins Disease

protect the skin receiving radiation, avoid rubbing, powders, deodorants, lotions, or ointments (unless prescribed) or application of heat or cold encourage patient to keep clean and dry, and to bathe the area affected by radiation gently with tepid water and mild soap encourage wearing loose-fitting clothes and to protect skin from exposure to sun, chlorine, and temperature extremes protect oral and gastro-intestinal tract mucous

membranes, encourage frequent, small meals, using bland and soft diet at mild temperatures o teach the patients to avoid irritants such as alcohol, tobacco, spices, and extremely hot or cold foods

CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Is a term that refers to a group of conditions characterized by continued increased resistance to expiratory airflow.

Diagnostics Pathophysiology Signs and Symptoms Presence of productive cough lasting at least 3 months a year for 2 successive years Production of thick, gelatinous sputum Wheezing and dyspnea Cigarette smoking Respiratory tract infecton Environmental pollutants Inflammation Bradykinin, histamine, prostaglandin Increase capillary permeability PFTs demonstrate airflow obstruction- reduced FEV1, FEV1 to FVC ratio; increased residua volume to total lung capacity ABGs- decreased PaO2, Ph and increased CO2 Chest x-ray- in late stages, hyperinflation, flattened diaphragm, possible bullae

Fluid/ cellular exudation Medications Theophyline (Theodur) Metaproterenol (Alupent) Ipratropium bromide (Atrovent) Prednisone (Orasone) Edema of mucous membrane Hypersecretion of mucus

Persistent cough

Nursing Management Eliminate all pulmonary irritants, particularly cigarette smoke. Smoking cessation usually reduces pulmonary irritation, sputum production, and cough. Keep the patients room as dust-free as possible. Use postural drainage positions to help clear secretions responsible for airway obstructions. Teach controlled coughing. Encourage high level of fluid intake ( 8 to 10 glasses; 2 to 2.5 liters daily) within level of cardiac reserve. Give inhalations of nebulized saline to humidify bronchial tree and liquefy sputum. Add moisture (humidifier, vaporizer) to indoor air

POLYARTERITIS NODOSA
Is characterized by an inflammation of small to medium- sized blood vessels.

Diagnostics Signs and Symptoms Palpable purpura Myalgias Testicular pain Hematemesis Hematuria Peripheral neuropathy CBC- decreased hemoglobin and hematocrit ESR- generally elevated Serum albumin- decreased Complement levelsdecreased RF- sometimes positive Arteriography- aneurysms

Pathophysiology Deranged immunologic processes vascular lesions occur mainly at bifurcations and branch points inflammation way start at the vessel intima and to the entire arterial wall fibrinoid necrosis occurs aneurysms develop in the weakened vessel

Nursing Management

Medications Cyclophosphamide (Cytoxan) Azathioprine (Imuran)

thrombi develop in the site of lesion

proliferations of the intima or media may result in obstruction subsequent tissue ischemia and infarction

Advise patient to avoid known sources of infection Practice and teach frequent handwashing. Monitor CBC results for leukocyte and absolute neutrophil counts. Inspect skin for rash, ulcers, ischemic digits. Administer anti-inflammatory and immunosuppressive agents as ordered. Provide small, high- caloric meals.

ANAPHYLAXIS
Is an immediate, life-threatening systemic reaction that occurs on exposure to a particular substance.

Diagnostics Pathophysiology Signs and Symptoms Laryngeal edema Hypotension Tachycardia Urticaria Nausea and vomiting bloating Primary exposure to allergens IgE production, sensitization Serum tryptase- elevated Serum histamine levels- >10 nanomol/L In vitro Ige testing > 0.35 international units/L

Reexposure IgE mediated degranulation of mast cells and basophils

Nursing Management

Tissue effects Medications Epinephrine (adrenalin) Dipenhydarmine (Benadryl) Ranitidine (Zantac) Albuterol (Proventil HFA) Methylprednisolone (Solu-medrol)

Continually monitor respiratory rate and depth and breathe sounds for respiratory effort and effectiveness of ventilation. Monitor blood pressure using continuous automatic cuff. Monitor central venous pressure to ensure adequate fluid volume and to prevent fluid overload. Insert indwelling catheter and monitor urine output hourly to ensure kidney perfusion. Establish and maintain an adequate patent airway. If epinephrine has not stabilized

bronchospasm, assist with endotracheal intubation, emergency tracheostomy, or cricothyroidotomy as indicated

Provide oxygen by nasal cannula at 2 to 5 liters per minute or by alternate means, as ordered.

PEMPHINGUS VULGARIS
Is a serious autoimmune disease of the skin and mucous membranes characterized by the appearance of blisters (bullae) of various sizes on apparently normal skin and mucous membranes (mouth, esophagus, conjunctiva, vagina)

Pathophysiology Signs and Symptoms Bullae enlarge and rupture Eroded ski heals slowly Positive Nikolskys sign Infection

Diagnostics Skin biopsies of blisters and surrounding skindemonstrates acantholysis Immunofluorescent studies of serum- reveal circulating antibodiees

Production of antibodies by immune system Autoantibodies against desmosomes proteins

Separation of keratinocytes from the basal layer of the epidermis Medications Cyclophosphamide (Cytoxan) Azathioprine (Imuran) Transudative fluid accumulates in between the keratinocytes and basement membranes

Nursing Management

Formation of blisters

Inspect oral cavity daily; note and report any changes Keep oral mucosa clean and allow regeneration of epithelium Keep skin clean and eliminate debris and dead skin. Evaluate for fluid and electrolyte imbalance. monitor serum albumin and protein levels. Monitor vital signs for hypotenson or tachycardia. Weigh patient daily.

SCLERODERMA
is a multi-system, auto-immune disease, characterized by functional and structural abnormalities of small blood vessels, fibrosis of skin and internal organs, and
production of auto-antibodies. Diagnostics Pathophysiology Signs and Symptoms Bilateral symmetric swelling of the hands and sometimes the feet Esophageal dysmotility Joint pain Flexion contractures Interstitial fibrosis Mononuclear cells cluster on the skin and stimulate lymphokines to stimulates procollagen CBC and ESR- generally normal RF- positive ANA- generally positive with speckled X-ray of hands and wristsmuscle atrophy, osteopenia Endoscopy- to biosy for Barretts metaplasia Barium swallow- esophageal dysmotility

Insoluble collagen formed

Tissue accumulates excessively Inflammation result Medications Edema formation with resulting taut, smooth and shiny skin appearance fibrotic changes in skin colors leads to loss elasticity and movement

Nursing Management

Penicillamine (Depen) Omeprazole (Prilosec) Metacloporamide (Reglan) Cisapride (Propulsid)

tissue degenerates and becomes nonfunctional

Teach patient to identify Raynauds phenomenon. Characteristic color change of the fingers-blue, white, red Protect ulcerated digits and observe for signs of infection. Advise patient to avoid using of drying soaps. Inspect skin daily for cracking, ulceration and signs of infection. Encourage patient in proper position for meals to avoid aspiration. Provide smaller, more frequent feedings of well-balanced diet.

HIV/ AIDS
Is defined as the most severe form of a continuum of illnesses associated with human immunodeficiency virus infection.

Pathophysiology

Diagnostics ELISA test- result is positive Lymphocyte panel shows decreased CD4 count. CBC- may show anemia and a low white blood cell count. Presence of indicator disease (eg., P. carinii pneumonia, Kaposis sarconoma etc.)

Signs and Symptoms Persistent cough with and without sputum production Diarrhea, weight loss, anorexia, abdominal cramping White plaques on oral mucosa Cryptococcal meningitis Kaposis sarconoma

Predisposing Factors: >Age: Young adults >Gender: both male and female, male homosexuals, >Transplacental Transmission Exposure to HIV virus HIV infection Anti-HIV antibodies are produced but they dont appear immediately HIV circulates in the system Invade several types of cells; lymphocytes, macrophages, langerhans cells and neurons

Nursing Management

Medications edovudine (ZDV) Retirvir Zalcitabine Havid Stavudine Zerit Lamivudine Epivir Nevirapine Viramune Didanosine Videx Saquinavir Invarase Ritonavir Norvir cIndinavir Crixivan

HIV attacks the immune system The organism attaches to the protein molecule called CD4 whihc is found in the surface of T4 cells HIV enters the T4 Inserts its genetic materials inot the T4 cells nucleus taking over the cell tp replicate itself T4 cells die after having been used ti replicate HIV Virus matures rapidly making ti more difficult for the bodys immune system to recognize the invaders Progresses through several stages

Maintain nonjudgmental attitude and nonpreudicial approach. Provide careful discussion and clarification of treatment options. Follow universal precautions for all patients. Maintain cleanliness of environment. Monitor nutritional sttaus by weighing, recording dietary intake and caloric count. Examine mouth for oral candidiasis and other lesions. Administer fluids and electrolytes as prescribed.

LATEX ALLERGY
a reaction to certain proteins found in natural rubber latex, a product manufactured from a milky fluid that comes from the rubber tree.

Signs and Symptoms

Pathophysiology Exposure to certain proteins in natural latex rubber

Diagnostics ELISA test or level of hevea latex- specific IgE antibody in the serum. Skin patch testing- is the preferred method for patients with contact allergies

Itching Skin redness Hives or rash Sneezing Runny nose Itchy, watery eyes Scratchy throat Difficulty breathing Wheezing Cough

Hypersensitivity takes place

Signs and symptoms persist and become severe

Nursing Management if the patient has a confirmed latex allergy, bring a cart with latex-free supplies in his room. Document in the patients chart that he has a latex allergy. If the patient will have an I.V. line makes sure that that I.V. access is accomplished using all latex free products. Place a warning label on I.V. bags that says Dont use latex injection ports. Use nonlatex tourniquet. If none are available, use a

Medications adrenaline (epinephrine) prednisone (deltasone) loratadine, claritin

Anaphylactic shock

latex tourniquet over clothing. Use latex free oxygen administration equipment.
Wrap your stethoscope with non-latex product to protect the patient form latex contact.

IMMUNODEFICIENCY
a state in which the immune system's ability to fight infectious disease is compromised or entirely absent. Immunodeficiency may also decrease cancer
immunosurveillance

Signs and Symptoms Frequent and recurrent ear infections, pneumonia, meningitis, bronchitis, sinus infections or skin infections Blood infections Inflammation and infection of internal organs, such as the liver Autoimmune disorders, such as lupus, rheumatoid arthritis or type 1 diabetes

Pathophysiology
Immune system detects an antigen

Diagnostics Low white blood cell count NBT test to assess how effectively phagocytes produce hydrogen peroxide to kill bacteria Low antibody or immunoglobulin levels Low T (thymus derived) lymphocyte count Low Complement levels

Antibodies are produced

Immune responseoveractive (underactive) Immune system does not fight T/B lymphocytes does not work Impairment in the development or function f cell Disruption of the normal communication system of B cells and T cell Impaired immune response

Nursing Management

Medications Trimethoprim and sulfamethoxazole (Septra DS, Bactrim DS)

Primary immunodeficiency Multiple infection, immunocompromised Natural and acquired immunity is affected Secondary immunodeficiency

The nurse assesses and monitors the patients for signs and symptoms of infection. Promote to have a good dental hygiene to diminish oral discomfort and complications that frequently result In inadequate nutritional intake. Monitor vital signs, neurologic signs, cough, skin and oral lesions. Count pulse rate and respiratory rat for a full minute.

GOOD PASTURES SYNDROME

is a rare disease that can affect the lungs and kidneys. Also called anti-glomerular basement antibody disease, it is an autoimmune disease-a condition in which the
body's own defense system reacts against some part of the body itself. Diagnostics Pathophysiology Signs and Symptoms burning sensation when urinating. fatigue, nausea, difficulty breathing, or skin pallor Antigens anti-GBM antibody titer, bronchoscopy and renal biopsy may provide a definitive diagnosis of GS carbon monoxide uptake- increased total lung capacity- decreased vital capacity- decreased serum urea nitrogen- elevated serum creatinine- elevated hemoglobin hematocrit- normal or decreased

Formation of antibodies

Attacks basal cell membrane

Attacks kidney and lungs

Nursing Management

Medications Azathioprine (Imiuran) Cyclophosphamide (Cytoxan) Trimethoprim and sulfamethoxazole (Septra DS, Bactrim DS)

Basement membrane leaking

elevate the head of the bed and administer humidified oxygen to promote adequate oxygenation. Encourage the patient to observe his energy. Assist with plasmapheresis as ordered. Administer blood transfusions to treat severe iron deficiency anemia, and administer corticosteroids, as ordered. Prepare the patient for dialysis or kidney transplantation to manage renal failure. Assess the respiratory rate and breath sounds regularly.

HYPERSENSITIVITY/ ALLERGY
Refers to undesirable reactions produced by the normal immune system, including allergies and autoimmunity.

Pathophysiology Signs and Symptoms Itching Mucous membrane congestion Palatal itching Nonproductive cough Edema (eyes)
Genetic, antigens, drugs such as antibiotics, biological, ACTH and insulin, certain food and skin testing solutions Antigen interaction and all bound IgE bodies Chemical mediators release Chemical mediators bind to specific receptors on smooth muscle and blood vessels Vasodilation Vascular permeability Edema

Diagnostics Nasal smear- the presence of an increased number of eosinophils suggests allergic disease Skin testing- confirms a hypersensitivity to certain allergens RAST- positive for offending allergens Rhinoscopy- for better visualization of the nasopharynx

Nursing Management

Medications fluticasone (Flonase) fluticasone (Flovent Diskus, Flovent HFA) hydrocortisone (Cortaid) prednisone (Prednisone Intensol) loratadine (Claritin) pseudoephedrine (Sudafed)

Increased mucus gland secretion Contraction of smooth muscles Mild flushing, urticarial, itching, severe respiratory distress Acute anaphylaxis Anxiety, dyspnea, chest tightness, wheezing, vascular collapse

Identification of the specific allergens Management of the symptoms with antihistamines, anti-inflammatory agents, or corticosteroids Ointments, creams, wet compresses, and soothing baths for local reactions. Desensitization programs may be recommended.

Catanduanes State Colleges College of Health Sciences DEPARTMENT OF NURSING Virac, Ctanduanes

Submitted by: Patricia Dawn G.Molina BSN 3A Submitted to: Dr. Alvin C. Ogalesco Professor