MED.-SURG-123456789012456789-NOTES-4.pdf

Medical Surgical Nursing

1. IMMUNE SYSTEM
- Biochemical complex that
protects the body against
pathogenic organisms and
other foreign bodies. It
incorporates w/
 Humeral immune
response – produces
anti bodies to react
w/ specific antigen
 Cell – mediated
response – uses T
cells to mobili ze
tissue macrophages
in the presence of a
foreign body
INFECTIOUS DISORDERS FOR
ADULTS
PNEUMONIA
- Inflammation of the lung
parenchyma (alveolordax &
proctus) caused by a
microbial agent
- Difficulty of breathing
- Caused by S. Pneumoniae &
Virus
- 75% bacteria, 25% virus, 5%
fungi
- MOT: droplet, can be spread
through blood (rare)
CLASSIFICATION:
- Typical (expected, common):
bacteria
- Atypical (unexpected,
uncommon): walking
pneumonia
- Bronchopneumonia: starts in
the bronchioles
- Lobar Pneumonia:
ANOTHER CLASSIFICATION :
- Community Acquired
Pneumonia (CPA)
 Either in the
community setting or
w/in the first 48 hrs.
of hospitalization.
 S. Pneumoniae:
most common in CAP
 H. influenzae: CAP
that affects elderly
- Hospital Acquired Pneumonia
(HAP)
 More than 48 hrs.
after admission in
patients w/ no
evidence of infection
at the time
admission.
- Ventilator-associated
Pneumonia
 Type of nosocomial
pneumonia,
associated w/
endotracheal
intubation &
mechanical
incubation
 Develops in pts w/
acute respiratory
failure who have
been receivin g
mechanical
ventilation (40 hrs.)
- Pneumonia in the
Immunocompromised host
 Genetic immune
disorder
 AIDS
 Nutritional depletion
- Aspiration Pneumonia
 Pulmonary
consequence
resulting from the
entry of endogenous
or exogenous
substances into the
lower airway
 May occur: HAP &
CAP
 Bacterial infection
from aspiration of
bacteria that
normally resides in
the upper airway
CLINICAL MANIFESTATION
- Fever and Chills
- Nonproductive to productive
cough
- Rusty, blood-tinges spectrum
- Dyspnea, Tachypnea,
Orthopnea
- Positive whisp ered
pectroloquy
- Positive ego phony
- Unequal lung expansion
- Plenritic pain
- Tachycardia
- Headache
DIAGNOSTIC EXAMS
- History
- Blood culture
- Chest X-ray
- Sputum Examination
PREVENTION
- Pneumococcal Vaccine
 Against
pneumococcal
pneumonia caused
by S. Pneumoniae
Given to the ff.:
 65 y/o & above
 At risk for
pneumococcal
disease because of
chronic illness
 People w/
functional/anatomic
asplemia
 Living in
environment in
which the risk is high
2 TYPES OF PNEUMOCOCCAL VACCINE
- PCV 13 (13 subtypes of S.
pneumonia)
 Younger than 2 y/o
 65 y/o older
- PPSV 23 (23 subtypes of S.
pneumonia)
 65 y/o older
 2-64 y/o w/ certain
medication
 19-64 y/o who
smokes
MEDICAL MANAGEMENT
- Oxygen Administration
- Antipyretics
- Antitussives
- Decongestants
- Antibiotic therapy
 Vancomycin
(ototoxicity)
 Penicillin
 Macrolides
 Floroquinolones
 Tetracycline
(contraindicated:
pregnant & below 8
y/o)
 Cephalosporin
NOTE:
TINNITUS: ringing in the ear
NURSING MANAGEMENT:
- Improve airway patency
- Promote test and conserve
energy
- Maintain nutrition
- Promote knowledge
- Monitor and manage potential
complication
PULMONARY TUBERCOLOSIS
- Caused by Myobacterium
tuberculosis
- May be transmitted to other
parts: meninges, kidney,
bones and lymph nodes
- MOT: airborne transmission
CLASSIFICATON:
- Latent TB
 No signs &
symptoms
 Possible to h ave
Latent TB: Ghon
Focus (lungs), Ghon
Complex (lungs &
lymph nodes)
- Active TB
 Latent TB can be
active if immune
system is weak

RISK FACTORS
- Any w/out adequate health
care
- Immigration from countries
w/ high TB
- HIV infected
- Underweight
- Substance abuser
- w/ pre-existing medical
condition
- close contact w/ active TB
CLINICAL MANIFESTATION
- Low grade fever w/ night
sweats
- Anorexia
- Fatigue
- Body malaise
- Back pain
- Cough
- Hemoptysis
- Anemia
- Weight loss
- Dyspnea
- Chest pain
DIAGNOSTIC EXAM
- Chet X-ray
- Acid-fast bacillus Smear
- TB Skin test
- Interferon Gamma Release
Assay
NOTE:
- BGC – prevents TB meningitis
- TB Skin Test – standardized
intracutaenous injection
procedure
MANTOUX TEST INTERPRETATION
- Induration of 0-4 mm:
 Not significant (does
not exclude TB
Infection)
- Induration > 5mm considered
+ in:
 HIV advanced pts
 Recent contact w/ TB
pt

2.  Pips w/ fibrotic
changes consistent
w/ TB
 Pts w/ organ
transplant
- Induration of >10 mm is
considered + in:
 Recent immigrants
from places w/ high
TB
 Injection drug users
 Residents of jails,
health care facilities,
HIV facilities
 Children under 5 y/o
- Induration of >15 mm is
considered + in:
 Pips w/ no known
risk factor to TB
NOTE:
- PT WILL RETURN (48 – 72
HRS)
CLASSIFICATION:
- Class 0 – no exposure, no
infection
- Class 1 – exposure, no
evidence of infection
- Class 2 – latent infection, no
disease ( + PPO reaction but
no clinical evidence of active
TB)
- Class 3 – disease, clinically
active
- Class 4 – disease, not
clinically active
- Class 5 – suspected disease,
diagnosis pending
GERONTOLOGICAL CONSIDERATI ON
In elderly pts:
- Altered mental status
- Fever
- Anorexia
- Weight loss
- Tuberculin skin test produces
no reaction or delayed up to 1
week
-
FIRST-LINE ANTIBUCERLINE TEST
- Isontazid (INH)
 Adult daily dosage: 5
mg/ 300 mg max
daily
 Side effects:
peripheral neuritis,
hepatitis
 Drug interaction:
Phenytoin Antabuse
 Remarks:
Bactericidal (monitor
AST and ALT)
- Rifampin (Rifadin)
 Adult daily dosage:
10 mg (600 mg daily
max)
 Side effects: nausea,
vomiting, purpura
(rare)
 Drug Interaction:
increased
metabolism of oral
contraceptive, oral
hypoglycemic.
 Remarks: orange
urine, discoloring CE
contact lenses,
bactericidal
- Pyrazinamide
 Adult dosage: 15-30
mg (120 kg max
daily)
 Side effects: skin
rash, GI distress,
hyperurecemia,
hepatoxicity
 Remarks: monitor
uric acid AST and
ALT
- Ethambutol (Myambutol)
 Adult daily dosage:
15-25 mg (no max
daily dose)
 Side effects: optic
neuritis, skin rash
 Remarks:
bacteriostatic use w/
caution w/ renal
disease. Monitor
visual deity, color
discrimination.

NOTE:
R - Rifampin
I – INH
P - PZA
E – Ethambul
TO REMEMBER:
- DOT: Direct observation
therapy
- MDR – PTB: multidrug
resistance
- XDR – PTB: extreme drug
resistance, resistance to 1
st

line meds (2
nd
line)
- Rifampin: urine can be
orange
- Hyperumia - uric acid
2
ND
LINE ANTI-TB DRUGS
- Streptomycin
 Deep IM injection
 Other ototoxic drugs
should not be
administered to pts
receiving
streptomycin.
NURSING MANAGEMENT
- Promote airway clearance
- Advocate adherence to
treatment regime
- Promote activity and
adequate nutrition
- Prevent spread of infection
After 2 weeks of taking meds – patient
is not infectious.
PREVENTIVE MEASURES
- Prompt diagnosis & treatment
of infectious cases
- BCG vaccinations of newborn,
infants and grade 1
- Educate public of MOT and
methods of control
- Improve social conditions
- Maintain good pe rsonal &
environmental hygiene
- Adopt a healthy lifestyle
- Cover nose & mouth while
sneezing/coughing
- Seek treatment promptly if
symptoms similar to TB
appears, cough for 1 month
VIRAL HEPATITIS
- Inflammation of the liver that
is caused by infectious viruses
- Can be acute or chronic
- Factors: immune system,
complication
- Virus goes to the
hepatocytes.
PHASES OF VIRAL HEPATITIS
Pre- Icteric (Prodromal, brought by the
immune system)
- Headache
- Fatigue
- Anorexia
- Vomiting, Nausea
- Joint and muscle pain

Icteric
- Jaundice
- Dark Urine
- Clay-colored stool
- Hepatomegaly

Post-Icteric (Convalescent)
- Symptoms become mild &
generally improve.

Hepatitis A Virus
- Called as infectious hepatitis
- Liver infection caused by the
Hepa A Virus

MODE OF TRANSMISSION
- Fecal – oral route
- Incubation period: 15 – 50
days , average of 30 days
- Prevalent in countries w/
overcrowding w/ poor
sanitation
CLINICAL MANIFESTATION
- Anorexia
- Jaundice and Dark urine
- Indigestion
- Strong aversion to the taste
of cigarette or smell of it.
- Moderately enlarged liver and
spleen
- Usually acute infection
DIAGNOSTIC EXAMS
- ALT
- AST
- ALP
- Bilirubin
- Anti HAV IgM
- Anti HAV IgB
HAV PREVENTION
- Conscientious individual
hygiene
- Safe practice for preparing
and dispensing food
- Effective health supervision
- Community health educat ion
programs
- Mandatory reporting of
hepatitis to local health
department
- Vaccination of HIV vaccines
- Passive: Hepatitis A IgM
MANAGEMENT
- Bed Rest
- Small, frequent meals.
(restrict fat intake)
- Monitor fluid balance
- If anorexia, and nausea, and
vomiting persist, enteral
feeding may be needed.

3. - Alcohol is toxic to the liver,
prevent during illness and
after 6 months of recovery
- Advice pts to avoid substance
that may affect liver function.
Hepatitis B Virus
- Caused by Hepatitis B Virus
(percutaneous and per
mucosal route)
- MOT: body fluids
- Incubation period: 90 days
- Replicates in the liver and
remains in the serum for a
long period.
CLINICAL MANIFESTATION
- Fever
- Loss of appetite
- Dyspnea
- Abdominal pain
- Generalized aching
- Malaise
- Arthralgia
- Rashes
- Jaundice
- Liver may be tender and
enlarged
- Spleen is enlarged and
palpable
DIAGNOSTIC TEST
- HBSAg (anti-host)
 Hepatitis B surface
androgen (Blood)
- HBCAg (anti – HBC)
 Hepatitis B envelope
androgen
- Anti-HBC
- HBV DNA
NOTE:
- Anti: anti bodies
- Ag: Androgen
RISK FACTORS
- Exposure to blood, other
bodily fluids.
- Hemodialysis
- Healthcare workers, staff and
oncology, and chemotherapy
- Male homosexual and
bisexual activity
- IV injection drug use
- Close contact w/ carrier of
HBV
- Multiple sexual partners
- Recent history of STI
- Receipt of blood
- Travel to area w/ uncertain
sanitary conditions
PREVENTION
- Continued screening of blood
donors
- Used of disposable syringes,
introduction of needleless IV
administration system
- Universal precaution
- Active immunization: Hepa B
Vaccine
- Passive Immunity: Hep a B
Immunoglobulin
MEDICAL MANAGEMENT
- Alpha interferon
- Anti-Viral Agent (Iamivudine,
Adefovir)
- Antacids, Antiemetic
NURSING MANAGEMENT
- Bed Rest
- Restrict Activity until the
hepatic enlargement,
elevated levels of serum
bilirubin, and liver enzymes
have disappeared.
- Maintain adequate nutrition:
protein is restricted when
liver is impaired.
Hepatitis C Virus
- Chronic
- Known as non-A and non-B
- MOT: blood transfusion &
sexual contact, body fluids
- Incubation period: 15 – 160
days
-
CLINICAL MANIFESTATION
- Similar to Hepa B
- Increased risk of chronic liver
disease (liver cancer,
cirrhosis)
MANAGEMENT
- Interferon (Intron A) &
Ribavirin (Pebetol)
Hepatitis D Virus
- Delta agent, occurs in some
cases of Hepa B
- Incubation Period: 21 -40
days
- Symptoms are similar to
Hepa B, except pts are more
likely to develop fulminant
hepatitis & progress to
chronic active hepatitis.
- No vaccine
Hepatitis E Virus
- MOT: fecal – oral route,
contaminated water
- Incubation period: 14 – 145
days
- Has a self-limiting course w/
an abrupt onset.
- Jaundice is nearly always
present
- Chronic forms do not develop
Hepatitis G and GB Virus – C
- Chronic liver disease, it
remains cryptogenic.
- Have 2 diff. escalates of the
same virus
- Body fluid
- Incubation period: 14 -145
days
- Risk factors are same w/
Hepa C



SEXUALLY TRANSMITTED
INFECTION
Trichomniasis
- Causative agent: Protozoan
- Cause: protozoan parasite,
trichomonus vaginalis
- Cannot live outside the GI
tract
- Infected vagina, urethra,
urinary bladder
- Inflammation in the vagina,
cervicitis
- Cystitis ( bladder)
CLINICAL MANIFESTATION
- 70% of males are
asymptomatic
- Thin vaginal discharge
(sometimes frothy) yellow to
yellow green, malodorous
(stinky), & very irritating
- Vulivitis w/ vulvovaginal
burning or itching
- Vaginal & cervical erythema w
multiple small petechae
(strawberry spots)
- pH testing of a trichomonal
discharge will demonstrate a
pH greater than 4.5
- baby could have nasal
discharge
MEDICAL MANAGEMENT
- metronidazole –
contraindicated to pregnant
women & breastfeeding
NURSING MANAGEMENT
- Relieves discomfort
- Reduce anxiety: active
listening
- Prevent re infection or spread
of infection
Human Papillomavirus
- Causes cervical cancer
- Most common STD, among
young sexually active person
- More than 80 strains
- Warts - medical term:
papilloma
- Condyloma acccuminata –
warts ( painless )
Cutaneous HPV – warts: foot, face &
hands)
Mucosa HPV – warts: genital area,
mouth, nose)
CLINICAL MANIFESTATION
- Strain 6 and 11 (usually
causes condylomata)
- Strains 16, 18, 31, 33, 35
and 45 (cervical changes that
may appear as koilocytosis on
pap smear.
- Strain 16 & 18: most
common to cause cervical
cancer.
NOTE: Can be transmitted to the baby
MEDICAL MANAGEMENT
- Topical application of
thricoloreacetic acid,
podophilyn, Bleomycin
- Electro cautery and Laser
therapy, cryotherapy, surgical
excision.
- Interferon Injection
- Regular Pap Smear
- Podofilox (Condylox),
Imiquimod (Aldara)
PREVENTION
- HPV Vaccines
 9 – valent HPV
Vaccines (Gardasil 9,
9vHPV): Can protect
9 strains of HPV.
 Quadrivalent HPV
Vaccine (Gardasil
4vHPV): can protect
from 4 strains of HPV
 Bivalent HOV
Vaccine (Cervix,
2vHPV)

4. NOTE:
All of these are:
- Recommended to children (11
to 20 y/o) F & M
- Can be as early as 9 y/o (9 to
26 y/o)
- 2 doses below 15 y/o (3
doses for 15 y/o above)

HPV type 2 Infection
- Herpes Genitalis, Herpes
Simplex Virus
- Recurrent, life-long infection.
Causes herpetic lesions on
the cervix, vagina, and
external genitalia
- Recurrence is associated w/
stress, sunburn, dental
works, or inadequate rest
- Genital area blisters; mouth
blisters ( Herpes T1)
- MOT: skin to skin
- Painful in the genital area
CLINICAL MANIFESTATION
- Itching & pain
- Blisters, which later
coalesces, ulcerates &
encrusts
- Influenza – like symptoms
- Painful urination
- Dysuria
NOTE: pt should also test for
gonorrheal (chlamydia)
DIAGNOSTIC EXAM
- Smear & scraping from the
lesions to examine
microscopically using special
stains to confirm the clinical
impressions.
 Can be transmitted
to the baby
 Baby can be blind,
can have seizure or
die
MEDICAL MANAGEMENT
- Antiviral agent (Acyclovir,
Valacyclovir, Famciclovir
NURSING MANAGE MENT
- Relieve pain (wash
frequently)
- Prevent infestation & its
spread
- Relieve Anxiety
- Increase knowledge abt the
disease
Chlamydia (bacteria)
- Most common and fastest the
spread bacterial STI
- CAUSATIVE AGENT:
chlamydia trachomatis
- CAN CAUSE: trachoma &
ineffective, reactive arthritis.
- Results in serious
complication ( PID, ectopic
pregnancy, infertility)
- Can transmit the
microorganism to the baby
during birth
- Vaginal discharge infected
- Can cause PID
CLINICAL MANIFESTATION
- Sparse, clear urethral
discharge
- Redness & irritation of the
infected tissue
- Burning in urination
- Lower abdominal pain in
women and testicular pain in
men
MEDICAL MANAGEMENT
- Anti-microbial drugs, such as
single oral dose of
azithromycin or a 7 day
regimen of doxycycline
- Erythromycin, oflox cicin,
levlofloxacine


NURSING MANAGEMENT
- Obtain sexual history
- Explain the course of
treatment
- Discuss methods of
preventing transmission &
reinfection
Gonorrhea (2
nd
most common)
- CAUSED BY: bacterium,
Neisseria gonorrhea
- Invades urethra, vagina,
rectum depending on nature
of sexual contact
- Chlamydial infection and
gonorrhea after co-exist
- Highest incidence: 15 – 24
y/o
- Also major cause of PID
- Meningitis and pneumonia to
the baby
CLINICAL MANIFESTATION
- White/yellow discharge,
intermenstrual bleeding
- urethritis w/ a purulent
discharge & pain in urination
& epididymis on men
- painful bowel elimination &
purulent rectal discharge if w/
anal infection
- skin rash, fever & painful
joints
- 50% of women have no
symptoms, but w/out
treatment 40% may cause
PID
MANAGEMENT
- Single intramuscular dose of
broad spectrum (spholosporin
or oral dosing w/ cefixime)
 Single dose of oral
azithromycin
(Zithromax), or oral
doxycycline for 7 –
10 days
 Hospitalization &
treatment w/ IV
multiple drug
therapy for
complicated
gonococcal infection.
Syphilis (Bacterial)
- Treponema Pallidum
- MOT: sexual contact, direct
contact from the lesions, or
across the placenta to an
unborn infant
- Effect to the baby is fetal.
CLINICAL MANIFESTATION
- Primary
 Chancre appears on
the genital, anus,
cervix, or other parts
of the body
- Secondary
 Rash accompanied
by condylomalata
fever, malaise,
headache, sore
throat, and lymph
nodes enlargement
- Tertiary
 Infect diff. parts of
the body (cannot
transmit)
 Gamma
 Argyll Robertson
Pupil
 Neuro syphilis (
tabes dorsalis,
weakness/paralysis,
mental disorder)
 Cardio syphilis (
aortitis, aortic
aneurysm)
Before it goes to the tertiary stage, it
has early and late latent
- Early – does not exceed on 1
year, no symptoms
- Late – more than 1 year, no
symptoms
NOTE:
Gumma: graniolom a in the external
part
Argyll: no light reflex
DIAGNOSTIC EXAM
- Non-treponimal test
 RDR and VDRL test:
presence of antibody
in blood
- Treponimal test
- Dark filed Microscopy
- Treponima Pallidum
Hemoglutination Assay
- FTA-Abs
MEDICAL MANAGEMENT
- Primary & Secondary
 Single dose of
parentarelly
administered
penicillin G
 14 days regimen of
tetracycline/
doxycycline (If
allergic to penicillin)
- Tertiary
 3 doses of penicillin
at 1 wk interval
NOTE: watch out for Juricsh –
Herxheimer Reaction (hypotension 1 to
2 hrs)
NURSING MANAGEMENT
- Gather health info, sexual
history and allergic history
- Prepare client for diagnostic
lab. Test
- Support the client emotionally
AGENTS USED TO TREAT STI
- Penicillin G
 Nursing
Contraindication/
Consideration: give
IM into the gluteus
Maximus only.
 Massage Bite
 Have Client wait for
30 min. after
injection in case of
allergic reaction.

5. - Erythromycin
 Reassure the client
- Doxycycline
 SE: Allergy,
anorexia, nausea,
vomiting, diarrhea
liver failure
 NC: taking w/ meals
if GI upset occurs.
 Inform client to
report dark – colored
urine or light –
colored stools
 Use sunscreen
 Encourage pt to
return for all follow –
up visits
- Ceftriaxone
 NC: avoid alcohol
during and for 3
days after drug
therapy
 Inform pts for
possible side effects
to report unusual
fatigue.
- Tetracycline
 NC: take on empty
stomach, avoid anti-
acids, dairy products
 Do not use outdate
drugs because they
are nephrotoxic
 Use sunscreen
 Report of oral and
vaginal yeast
infection
- Ciprofloxacin
 NC: take on empty
stomach and avoid
antacids w/in 2 hrs.
of antibiotic dose
 Drink plenty of water
 Report any SE
- Antiviral (Acyclovin)
 NC: inform client
that drug does not
cure. Pt should avoid
sexual activity during
outbreaks & wear a
condom at other
times.

EBOLA VIRUS
- Cause: Ebola Virus
- Incubation Period: 2-21 days
(ave: 10 days)
- Biological Women
- Ebola hemorrhagic disease
- Result: Hemorrhagic fever
infection
- Host: Fruit bats (West African
Forest)
- Attacks the WBC first, the
infiltrates every type of cell in
the body
CLASSIFICATION:
Most common: first three
- Sudan
- Zaire
- Bundibugyo
- Ivory Coust Ebola Virus
- Reston Ebola Virus
MODE OF TRANSMISSION:
- BATS TO HUMAN: raw,
uncooked meat, butchering
- HUMAN TO HUMAN:
 Bodily fluid that is
sick w/ or has died
from Ebola V.
 Objects
contaminated w/ the
virus
 Infected Animals
CLINICAL MANIFESTATION:
- EARLY STAGE (7-9 days)
 Sore throat
 Fatigue
 Fever
 Headache
 Muscle Pain
- ADVANCED STAGE
 Diarrhea
 Vomiting
 Impaired liver and
Kidney
 Rashes
 Internal and External
Bleeding
- DAY 10 – Sudden High fever,
vomiting, passive
- DAY 11 – Bruising, Brain
damage, bleeding from nose
- DAY 12 – Seizure, massive
internal bleeding, death
DIAGNOSTIC EXAMS:
- Real time polymerase chain
reaction (RT-PCR)
- Rapid Ebola Antigen Test
- Ebola anti-body testing, IgM
and IgG
MEDICAL MANAGAMENT :
- Symptomatic and Supportive
 Isolation
 Oxygen
 Fluid Substitute
(dehydration)
 Broad Spectrum
Antibiotics (prevent
2ndary infection)
 Antipyretics and
Analgesics
MEDICATION:
- Ebola Zaire Vaccine (Ervebo)
 Approved in the US
and Europe to
prevent disease
caused by Zaire EV
(18 y/o older)
NURSING MANAGEMENT:
- Prevent bleeding
- Restore normal fluids and
electrolyte balance
- Prevent Shock
- Relieve pain
- Restore normal fluid volume
MIDDLE EAST RESPIRATORY
SYNDROME CORONAVIRUS (MERS -
COV)
- Cause: Novel Coronavirus
- Saudi Arabia
- From dromedary camels
-
MODE OF TRANSMISSION:
- CAMELS TO HUMAN: raw,
uncooked meat,
unpasteurized milk
- HUMAN TO HUMAN: droplet
infection
CLINICAL MANIFESTATION:
- Fever
- Cough
- Rhinorrhea
- Diarrhea
- Pulmonary findings, including
hypoxemia, rhonchi, and riles
( some may have normal
auscultation)
- Shortness of breath
DIAGNOSTIC EXAMS:
- RT-PCR (nose)
- Imaging Studies
MEDICAL MANAGEMENT:
- Hydration
- Antipyretic
- Analgesic
- Respiratory Support
- Antibiotics
NURSING MANAGEMENT:
- Vital Signs
- Educate the patient
- Reduce increase in
temperature (TSV)
- Ensure patent airway
- Reduce Anxiety
H1N1
- type of influenza A virus
- also known as swine virus
- can cause seasonal flu
- USUAL: influenza A and B
- MOT: Droplet Infection
CLINICAL MANIFESTATION
- Cough
- Sore throat
- Fever
- Fatigue
- Chills
- Headache
- Body aches
- Runny nose
- Diarrhea
- Nausea and vomiting
COMPLICATION:
- Pneumonia
- Respiratory Failure
HIGH RISK OF FLU:
- People in hospital, nursing
home and long term clinical
facility
- Younger than 5 y/o, younger
than 2 y/o
- 65 y/o older
- Pregnant or w/in 2 weeks of
delivery, women w/
pregnancy loss
- Younger than 19 y/o receiving
long term aspirin therapy
- BMI: above 40
- Have certain chronic medical
condition
- Immunosuppressed
- American Indian or Alaska
Native Heritage
DIANOSTIC EXAMS:
- Polymerase Chain Reaction
(PCR)
- Chest Radiography
MANAGEMENT :
- Oseltamivir (Tamiflu)
- Peramivir (Rapivab)
- Zanamivir (Relenza)
PREVENTION:
- Annual Flu Vaccination (6
months and older)
- Priority: 49 y/o
- CONTRAINDICATED:
 Below 2-4 y/o w/
asthma
 49 y/o older

6.  Children taking
aspirin
 Pregnant women
- Wash hands thoroughly
- Cover mouth and nose when
coughing
- Avoid touching face
- Clean Surfaces
- Stay away from crowds

INFLAMMATORY DISORDERS OF
THE BODY SYSTEM (GI TRACT)
APPENDICITS
- Appendix become inflamed
and edematous
- Cause: being occluded, blood
clots, food, fecal lithe (most
common)
- Most common in adolescent
and young adults
- Appendix: located below the
sacrum (part of the intestine)
 Storage of healthy
bacteria
- 42-72 hours rupture
CLINICAL MANIFESTATION:
- Vague epigastric/per umbilical
pain which progresses to RLQ
accompanied by l ow-grade
fever, nausea, and vomiting
- Loss of appetite
- Constipation (never give
lacsatives susceptible of
appendicitis) may cause
rupture.
- If ruptured; the pain becomes
more diffused; abdominal
distention develops as a
result of paralytic ileus.
- Fever: 37.7 or higher, toxic
appearance, continued
abdominal pain, tenderness if
perforation occurs.
- Local tenderness elicited to
Mcburney’s tenderness
- Rovsing’s Sign (LLQ, pain in
RLQ)

DIAGNOSTIC EXAMS:
- CBC – 10,000 (normal)
- Abdominal X -ray films,
ultrasound studies, and CT
Scans
MEDICAL MANAGEMENT:
- Appendectomy: removal, to
prevent perforation
- Antibiotics
- Intravenous Fluids
- Nasogastric Tube: if there is
evidence of paralytic ileus
NURSING MANAGEMENT:
- Prepare pt for surgery
- Semi-fowlers position after
surgery
- Discharge Teaching: make an
appointment to remove
suture between the 5
th
and 7
th

day after surgery. Incision
care and activity guidelines
(normal activity will be
resumed w/in 2 to 4 wks.)
POTENTIAL COMPLI CATION AND
NURSING INTERVENTION:
Nursing Intervention for:
- Peritonitis
 Observe for
abdominal
tenderness, fever,
vomiting,
tachycardia,
abdominal rigidity
 Constant Nasogastric
suction
 Correct dehydration
as prescribed
 Administer antibiotic
agents
- Pelvic Abscess
 Evaluate for
anorexia, chills,
fever, and
diaphoresis
 Observe for diarrhea,
may indicate pelvic
abscess
 Prepare pt for rectal
exam
 Prepare pt for
surgical drainage
procedure
- Sub phrenic Abscess: under
the diaphragm
 Chills, fever and
diaphoresis
 X-ray exam
 Surgical drainage
- Ileus ( paralytic and
mechanical)
 Assess for bowel
sounds
 Employ nasogastric
intubation and
suction
 Replace fluids and
electrolytes by IV
 Surgery (mechanical
ileus)
PREITONITIS
- Inflammation of peritoneum
- Cause: rupture of
appendicitis, bacteria from
the GI tract, trauma
- Just a complication
CAUSES:
- Injury or trauma
- Bacterial Infection:
Escherichia coli, Klebsiella,
Proteus and Pseudomonas’
- Abdominal surgical
procedures and peritoneal
dialysis (insertion of catheter,
to cleanse/remove metabolic
waste)
CLINICAL MANIFESTATION :
- Diffuse type of pain (tends to
become constant), localized
and more intense near the
site of infection
- Nausea and Vomiting
- Distended Abdomen
- Diminished Peristalsis
- Increased temperature
- Elevated leukocyte count
DIAGNOSTIC EXAM:
- Abdominal X-rays
- CT Scans
- Peritoneal Aspiration, culture
and sensitivity, studies the
aspirated fluids
MEDICAL MANAGEMENT:
- IV Administration
- Analgesic
- Antiemetic
- Intestinal Intubation &
Suction
- Oxygen therapy
- Massive antibiotic therapy
- Surgery
NURSING MANAGEMENT:
- Report the nature of pain
- Administer Analgesic
Medication
- Position pt for comfort
- Record intake & output &
central venous pressure
- Observe & record the
character of drainage post
operatively.
INFLAMMATORY BOWEL DISEASE
- Ulcerative Colitis, Chron’s
Disease (chronic inflammation
CHRON’S DISEA SE
- Called as grancilomatous
colitis, ileitis, & regional
enteritis
- Chronic inflammation extends
through all layers (Trans
mural lesions) of the
intestinal mucosa.
- Can occur anywhere in the GI
tract, most common: distal
ileum and colon
- Not continuous
- Prone: family w/ history of
the disease, those who are
white w/ a European and
Jewish Ancestry
- Seen 2 times more in pts who
smoke than non-smokers
- Characterized: period of
remissions and exacerbations
- Common in women, occurs
frequently in older population
(between the age of 50 and
80)
CLINICAL MANIFESTATION:
- Prominent LRQ abdominal
pain unrelieved by defecation
- Chronic diarrhea
- Cramp abdominal pains after
meals
- Nutritional deficiency &
secondary anemia
- Steotorrhea
- Cobblestone appearance
- Symptoms extended beyon d
the GI tract, include joint
involvement, skin lesions,
ocular disorder, & oral ulcers
DIAGNOSTIC EXAMS:
- Proctosigmoidoscopic Exam
- Stool Exam
- Barium study of the upper GI
tract
- CT Scan
Chron’s Disease (+)
- Stool contains a lot of mucus
COMPLICATIONS:
- Intestinal Obstruction or
stricture formation
- Perinatal Disease
- Fluid and Electrolyte
Imbalance
- Malnutrition
- Fistula and Abscess Formation
- Colon Cancer
ULCERATIVE COLITIS
- Recurrent ulcerative and
inflammatory disease of the
mucosal and sub mucosal
layers of the colon
- Cause: unknown

7. - Factors that trigger: genetic
predisposition, infection,
allergy
- Clinical course: exacerbation
and remissions
- Peak incidence: 30 to 50 y/o
CLINICAL MANIFESTATION:
- LLQ abdominal pain
- Tenesmus
- Rectal bleeding
- Passage of 10 to 20 liquid
stool each day
- Anorexia
- Weight loss
- Fever
- Vomiting
- Dehydration
- Extra intestinal symptoms:
skin lesions, eye lesions, join
abnormalities, and liver
disease
- CHRONIC DIARRHEA
DIANOSTIC EXAMS:
- Sigmoidscopy/ Colonoscopy
- Barium enema
- CT Scanning, magnetic
resonance imaging,
ultrasound
- Leukocyte scanning
- Stool exam
COMPLICATION:
- Toxic mega colon
- Perforation & bleeding
- Vascular engorgement
- Osteoporotic Fractures
MANAGEMENT OF CIBD:
- Pharmacological
 Antidiarrheal
 Amino salicylate
 Corticosteroids
 Immuno-mudolators
- Surgical Management
 Total colectomy &
Ileostomy
 Proctocolectomy w/
Ileostomy
 Intestinal transplant
 Strictureplastry
- Nursing Management
 Maintain normal
elimination pattern
 Relieve Pain
 Maintain fluid intake
 Maintain optimal
nutrition
 Promote rest
 Reduce Anxiety
CHOLECYSTITIS
- Inflammation of the
Gallbladder
2 types:
- CALCULOUS CHOLECYSTITIS
 Gallbladder stone
obstruct bile outflow
 2 types of gallstone:
composed
predominantly of
pigment & those
made of cholesterol
- ACALCULOUS
CHOLECYSTITIS:
 Gallbladder
inflammation in the
absence of
obstruction by
gallstones.
 After major surgical
procedure, trauma or
burns.
 Other factors:
torsion, cystic duct
obstruction, bacterial
infection of
gallbladder.
CLINICAL MANIFESTATION:
- Biliary Colic: pain,
tenderness, rigidity of the
upper right abdomen that
may radiate to the mid
sternal area/right shoulder,
nausea and vomiting.
- Epigastric distress ff. a meal
rich in fired/fatty food
- Jaundice
- Changes in urine/stool color
- Vitamin Deficiency
- Empyema of the gallbladder
 Pus formation
Murphy’s Sign
- Ask patient to exhale, place
hand below costal margin on
the right side at the
midclavicular line, pt is
instructed to inspire.
DIAGNOSTIC EXAM :
- Abdominal X-ray
- Ultrasonography
- Cholescintigraphy
- Cholecystography
- Endoscopic Retrogade
Cholangiopanceatogrpahy
(ERCP)
- Percutaneous Transhepatic
Cholangiography
MANAGEMENT:
- Nutritional & Supportive
Therapy
 Rest
 IV Fluid
 Nasogastric Suction
 Low-fat liquids
- Pharmacological Therapy
 Ursodeoxycholic Acid
(UDCA)
 Chenodeoxycholic
Acid
(Chenodiol/CDCA)
 Analgesic
 Antibiotic Agents
- Non-surgical removal of
Gallstones
 Extracorporeal
Shock-Wave
Lithotripsy
- Surgical Removal of
Gallstones
 Cholecystectomy
 Choledochostomy
 Surgical
Cholecystectomy


PANCREATITIS
- Inflammation of the pancreas
- Acute/chronic w/ a long
history of relapse &
reoccurrences
- PANCREAS: releases insulin,
and digestive enzymes
Acute Pancreatitis
- may result in complete
recovery, may recur w/out
permanent damage, may
progress to chronic
pancreatitis
 MILD ACUTE
PANCREATITIS:
edema &
inflammation
confined to the
pancreas
 SEVERE ACUTE
PANCREATITIS:
more widespread &
complete enzymatic
digestion to the
pancreas.
 CAUSE: Self -
digestion of the
pancreas by its own
protolithic enzymes
CLINICAL MANIFESTATION:
- Pain in the mid-epigastrium
(24-48 hrs. after a very
heavy meal/alcohol ingestion)
- Decreased Peristalsis
- Bulk, pale & foul-smell stool
- Cullen’s sign: bluish
discoloration in the umbilicus
- Gray Turner’s Sign- bluish
discoloration in the flank.
DIAGNOSTIC EXAMS:
- Blood test (WBC, serum
amylase & lipase, bilirubin,
blood glucose)
- X-ray studies of the abdomen
& chest
- Ultrasound & contrast –
enhanced computed
tomography scans.
MEDICAL MANAGEMENT
- NPO
- Parental Nutrition
- Nasogastric Suction
- Histamin-2 (H2) antagonist
- Antiemetic agents
- Meperidine
- Biliary drainage
- Surgical intervention
POST-ACUTE MANAGEMENT
- Antacids
- Oral feedings low in fat &
protein
- Caffeine and Alcohol are
eliminated from the diet
NURSING MANAGEMENT
- Relieve pain & Discomfort
- Improve nutritional status
- Monitor and Manage Potential
Complication
Chronic Pancreatitis
- Inflammatory disorder:
progressive anatomic &
functional destruction of the
pancreas
- Causes: Alcohol consumption
in western societies &
malnutrition worldwide
CLINICAL MANIFESTATON:
- Recurring stacks of severe
upper abdominal & back pain
w/ vomiting
- Weight loss
- Steothorrhea
DIAGNOSTIC EXAM
- ERCP
- Magnetic Resonance Imaging,
Computed tomography &
ultrasound
- Glucose tolerance test
- Serum amylase levels & WBC
count

8. MANAGAMENT
- Endoscopy: removal of
pancreatic duct stones &
stent stricture
- Pancreaticduodenectomy
(whipple procedure)
- Pancreaticjejunostomy
(referred to Roux-en-y)
- Partial/total pancreatectomy
URINARY SYSTEM
CYSTITIS
- Inflammation of the urinary
bladder
- CAUSE: bacterial infection
- Common in girls: shorter
urethra
CLINICAL MANIFESTATION
- Frequent pain & burning in
urination
- Urgency
- Low Back Pain
- Supra pubic pain
- Hematuria
- Fever & chills
DIAGNOSTIC EXAMS
- Urinalysis
- Culture & Sensitivity studies
- Repeated episodes: IVP or
cystoscopy w/ or w/out
retrograde pyeolograms.
MEDICAL MANAGEMENT
- Antibacterial agents
 Single-dose
administration,
short-course (3 -4
days), or 7-10 days
therapeutic course.
NURSING MANAGEMENT
- Apply heat to perineum
- Encourage to drink liberal
amount of fluids
- Encourage frequent voiding
- Advice cranberry juice/ Vit. C
CLIENT & FAMILY TEAC HING TO
PREVENT CYSTITIS
- Increase fluid intake (2 to 3
days)
- Avoid coffee, teas, colas &
alcohol
- Shower rather than bath in a
tub
- Cleanse perineum after each
bowel movement w/ front to
back motion
- Avoid irritating substances
- Wear cotton underwear
- Void every 2 to 3 hrs. while
awake
- Empty bladder w/ each
voiding
- Void after sexual intercourse
- NOTIFY: urgency, frequency,
burning w/ urination,
difficulty urinating, blood in
urine
- Take medication as
prescribed
Interstitial Cystitis (IC)
- Chronic inflammation:
bladder mucosa in the
absence of infection
- Also called as Painful bowel
syndrome
- More common in women
- Cause: unknown
CLINICAL MANIFESTATION
- Painful, frequent urination
and passing a small volume of
urine
- Painful intercourse
DIAGNOSTIC EXAM
- Cystoscopy
- Voiding cytouresthogram
- Biopsy of the bladder mucosa
MEDICAL MANAGEMENT
- Elmiron (pentosan
polysulfate)
- Antidepressant drugs
- Laser
- Urinary Diversion
- Bladder instillation of DMSO
(dimethyl sulfoxide)/silver
nitrate
NURSING MANAGEMENT
- Advice to avoid spicy & acidic
food
- Psychological support
TYPES OF URINARY DIVERSION
- Ilea conduit Urinary Diversion
- Indiana Pouch Reservoir
- Neobladder to urethra
diversion
UROTHIASIS
- Refers to stones (calculi) in
the urinary tract
- Called as renal stones
- May form in the bladder or
originate in the upper UT &
travel to & remain in the
bladder.
TYPES OF URINARY STONES
- Ca Oxolate Stone: most
common
- Uric Acid Stone: increase in
uric acid (sardines, beans)
- Cysteine Stone (problem in
the cysteine) very rare
- Struvite Stone: common w/
pts w/ recurrent UTI
- Calcium Phosphate – common
who have problems in renal
tube.
Can occur in the kidney, bladder,
ureters, and bladder
CLINICAL MANIFESTATION
- Stones in the renal pelvis
 Intense, deep ache
in the cost vertebral
region.
 Hematuria
 Pyuria
- Stone lodge in the ureter
 Acute, excruciating
wavelike pain.
 Scanty urine
 Hematuria
- Stones lodge in the bladder
 Irritation w/ UTI and
hematuria
 Urinary retention if
the stone obstructs
the bladder neck.
DIAGNOSTIC EXAM
- KUB
- Ultrasonography
- Blood Chemistries
- 24- Hrs. urine test
- Chemical Analysis of the
stone
MANAGEMENT
- Opiod Analgesic
- Electrohydraulic lithotripsy
- Ureteroscopy
- Extracorporeal Shock Wave
Lithotripsy (ESWL)
- Percutaneous Nephrostomy
NURSING MANAGEMENT
- Calcium Stone
 Restrict calcium in
the diet
 Liberal fluid intake
 Dietary sodium
restrictions
 Cellulose Sodium
Phosphate
(Calcibind)
- Uric Acid
 Low purine diet
 Allopurinol
(Zyloprim)
- Cysteine Stones
 Low protein diet
 Administer
penicillamine



REPRODUCTIVE SYSTEM
PELVIC INFLAMMATORY DISEASE
- Inflammatory condition of the
pelvic cavity (uterus:
endometritis, fallopian tube:
salpingitis, ovaries:
oophoritis)
- CAUSE: bacteria, may be
virus, fungus or parasite
- Can be caught from IE, and
IUD
CLINICAL MANIFESTATION
- Infectious discharge
(malodorous)
- Dysaparencuia – pain during
sexual intercourse
- Menorrhagia – heavy
menstruation
- Fever and dysmenorrhea
- General malaise
- Nausea and vomiting
- Abdominal or pelvic pain
DIAGNOSTIC EXAM
- Magnetic Resonance Imaging
- Ultrasonography
MEDICAL MANAGEMENT
- IV fluids
- Antipyretics
- Nasogastric intubation &
suction if the pt has
abdominal distress or ileus
- Emergency Surgery (ruptured
pelvic abscess)
NURSING MANAGEMENT
- Position for comfort
- Provide diversion activities
- Wash perineum w/ soap and
water every 4 hrs.
- Bed rest
- Apply heat to the abdomen
- Strict infection control
COMPLICATION
- Adhesions

9. - Abscesses
- Generalized peritonitis
- Stricture & fallopian tube
obstruction
BENIGN PROSTATIC
HYPERTENSION
- Enlargement of prostate
gland ( near bladder)
- Most common: older men
- CAUSE: DHT
(Dihydrostestosterone)
- All disease associated w/
DHT, have difficulty of
urinating
CLINICAL MANIFESTATION
- Frequency of Urination
- Nocturia: frequent urination
in night time
- Decrease in the volume and
force of the urinary stream
- Urgency, hesitancy urinating
- Dribbling: patak-patak
- Acute urinary retention
- Recurrent UTI
DIAGNSOTIC EXAM
- Urinalysis
- Cystoscopy
- Renal function test
- Trans rectal ultrasonography
MEDICAL MANAGEMENT
- Immediate catheterization (if
pt cant void)
- Watchful waiting
- Antiandrogen agents
- Saw Palmetto – prevents
conversion of DHT
- Microwave thermotherapy
- Prostatectomy – last resort,
removal of prostate gland
AGENTS FOR BPH
- Hermonal Agents (Proscar,
Avodart)
 MOA: Inhibit the
conversion of
testosterone into
DHT, causes the
gland to shrink
 SE: Loss of libido,
impotence,
decreased ejaculate
 NC: Avoid handling
drugs to patient, use
condom, sexual
changes are
reversible after drug
use, it may take 6
months to achieve
full benefit.
- Alpha-adrenergic blockers
(terazosin, poxasozin,
tasolusin, alfuzosin)
 MOA: reduce the
tone of smooth
muscles
 SE: hypotension,
dizziness, nausea,
urine frequency,
edema, fatigue,
headache
 NC: administer drug
at bedtime to reduce
orthostatic
hypotension, change
position slowly
INVASIVE PROCEDURE FOR
PROSTATIC ENLARGEMENT
- Transcystoscopic
Urethroplasty
 Balloon tip of the
catheter for 10 to 20
min. is inflated to
stretch prostatic
urethra
- Urethral stouter coils
 Flexible tube is
permanently placed
in the urethra to
dilate the lumen
- Thermotherapy
 Heated instrument
inserted in a urethral
catheter (destroys
prostatic tissue)
- Transurethral Resection of the
Prostate (TURP)
 Part of the prostate
is removed through
an endoscope
- Transurethral Incision of the
prostate (TRIP)
 No tissue removed;
bladder outlet is
enlarged making an
incision in the
prostate
- Transurethral laser incision of
the prostate (TULIP)
 Laser is used to
destroy prostate
tissue
- Transurethral needle ablation
(TUNA)
 Needles w/in the
prostate delivers
low-level
radiofrequency
energy to remove
excess tissue.
NURSING MANAGEMENT
- Void often
- Valve Maneuver (lea ning
forward & bearing down)
- Crede’s Maneuver (pressing
down bladder while seated)
- Drink small volumes of oral
fluid
- Limit alcohol and caffeine
MULTIPLE SCLEROSIS
- Immune - mediated
progressive demyelinating
disease of the CNS.
- Spinal cord and brain: myelin
sheet
- Present: 20 to 40 y/o
- Affects women than men
- Highest in northern Europe,
Southern Australia, Northern
US, & Southern Canada
TYPES OF MS:
- Relapsing – Remitting (RRMS)
– most common
- Secondary – Progressive
(SPMS) – throughout the time
it severe
- Primary Progressive (PPMS) –
nawawala pero bumabalik
ang symptoms
- Progressive – Relapsing
(PRMS) – continuous, hindi
nawawala, symptoms are
spiking
CLINICAL MANIFESTATION
- Fatigue
- Depression
- Weakness
- Numbness
- Ataxia – loss of coordination
- Loss of Balance
- Pain, Lhermitte’s Sign
(electric sensation from feet
to thighs)
- Diplopia, scotoma
- Spasticity
- Memory loss
- Uthoff’s Sign –
- Bladder incontinence – cannot
control urine
DIAGNOSTIC EXAM
- MRI
- Electrophoresis of CSF (
presence of olligiclonal
banding)
MEDICAL MANAGE MENT
- “ABC” (&R) drugs – beta – 1a
(Avorex), beta – 1b
(Betaseron), Glatiramer
Acetate (Copaxone), Rebif
- Mitoxantrone (Novantrone)
- Corticosteroids
- Baclofen
- Dantrolene
- NSAIDS
NURSING MANAGEMENT
- Promote physical mobility
- Prevent injury
- Manage speech and
swallowing difficulties
- Manage bowel and bladder
control


ACUTE GLOMERULONEPHRITIS
- Inflammation of the
glomeruli: kidney (releases
nephrons, filtrates metabolic
waste from blood)
- CAUSE: group A beta
hemolytic streptococcal
infection of the throat ( 2 – 3
weeks)
- Followed by empetiyo & acute
viral infection
- Affected: 2 y/o, but can occur
at any age
CLINICAL MANIFESTATION
- Hematuria
- Proteinuria
- Decrease Urine Output
- Anemia
- Increase BUN & Serum
creatinine
- Edema
- Headache
- Hypertension
- Flank pain
- Malaise
DIAGNOSTIC EXAM
- Percutaneous Renal Biopsy
- Electron microscopy
MEDICAL MANAGEMENT
- Penicillin ( if residual
streptococcal infection is
suspected)
- Corticosteroids &
immunosuppressant
- Restriction of dietary protein
(renal insufficiency develops)
- Restriction of sodium (when
patient has hypertension,
edema and heart failure)
- Oral iron supplements
- Diuretics
NURSING MANAGEMENT
- Liberal carbohydrate intake
(energy)
- Intake 7 output
- Bed rest (BP is elevated)

10. SYSTEMIC LUPUS ERYTHEMATUS
(SLE)
- Disturbed immune regulation
that causes an exaggerated
production of antibodies
- Combination of genetic,
hormonal (b/ween 15 to 45
y/o) and environmental
factors (sunlight, UV rays)
- Action of macrophages is slow
- Anti-seizure medication have
been implicated in
chemical/induced SLE
CLINICAL MANIFESTATION
- Musk skeletal
 Arthralgia’s –
Arthritis (synovitis)
- Integumentary
 Lesions – Malar Rash
(butterfly shaped
rash across the
bridge of the nose &
cheeks), Discoid
Rash (Round rash,
Disc shape)
- Cardiac
 Atherosclerosis –
Pericarditis
NOTE: some have ver y light
symptoms, some are abrupt
CLINICAL MANIFESTATION
- Ulcers in the mouth, & nose
- Pneumonia, pleuritis,
pulmonary hemorrhage
DIAGNOSTIC EXAM
- No test confirms SLE ( lab
tests)
- ANA test- presence of
antibody
MEDICAL MANAGEMENT
- NSAIDS
- Corticosteroids
- Antimalarial medication
(reduce skin problem)
- Immunosuppressive agents
(alkalytic agents & purine
analogs)
NURSING MANAGEMENT
- Avoid sun exposure & UV
light, use sunscreen &
clothing
- Routine periodic screening
- Dietary recommendations
(depending on their
complication)
RHEUMATOID ARTHRITIS
- Systematic inflammatory
disorder of connective tissue
& joints characterized by
chronicity, remissions and
exacerbations
- 70-80% w/ RA have a
substance called rheumatoid
factor (RF)
- Incidence Rate: 3% w/ 2 -3
times in women
- RF: antibody, not all people
who have RA have RF
 Attaches on the IgG,
forming an immune
complex
- Inflammation is symmetrical
STAGES OF RA
Healthy joint

Synovitis (gradually eroded)

Pannus (extra growth of joints) clinical
sign of RA

Fibrous Ankylosis (invaded by fibrous
connective tissue)

Bony Anykylosis (bones & joints fuse
together)
CLINICAL MANIFESTATION
- Joint pain, swelling, warmth,
erythema, & lack of function
- Joint stiffness
- Rheumatoid nodules
- Deformities of hands & feet
- Palpation of joints reveals
spongy/ boggy tissue
- Raymund’s phenomenon – if
exposed to cold enviro, the
hands become cyanotic
- Sjogren’s syndrome – dryness
of eyes
DEFORMITIES
- Ulnar deviation:
Metacarpophalengeal joints
(MCP) becomes swollen,
fingers bend abnormally
towards the little finger
- Boutonnierre Deformity:
finger is flexed at the
proximal interphalengeal joint
(PIP) & hyperextended at the
distal interphalengeal joint
(DIP)
- Swan-neck deformity :
hyperextension of the PIP
joint, flexion of the DIP joint,
and sometimes flexion of the
MCP joint
DIAGNOSTIC EXAM
- RF test
- ESR
- C- reactive protein test
- Radiographic films
MEDICAL MANAGEMENT
- Early stage
 Balance rest &
exercise
 Methotrexate
(control symptoms)
 Heat & cold
application
 NSAIDS
- Moderate, erosive RA
 Physical therapy
 Cyclosporine –
enhances the effect
of methotrexate
- Persistent, erosive RA
 Reconstructive
surgery &
corticosteroids
 Synovectomy
- Advanced, unremitting RA
 Immunosuppressed
agents
 Low-dose
antidepressant
meds.
 Apheresis – removal
of presence of RF
NURSING MANAGEMENT
- Intake of food high in
vitamins, protein & iron
- Encourage to move affected
parts even during acute
episodes

HIV AND AIDS
- Human immunodeficiency
virus (HIV)
- Attacks immune system, if
not treated can lead to AIDS
Subtypes:
- HIV 1 – mutates easily &
frequently, producing multiple
sub strains (common)
- HIV 2 – less transmittable,
interval between initial
infection w/ HIV 2 &
development of AIDS is
longer (Africa)
INFECTION & REPLICATION
- When HIV encounters a T-cell
lymphocyte, the binding
protein gp120 fuses w/ the T
cell receptors, called a CD4
receptor
- To replicate, HIV becomes a
parasite of helper T cells. HIV
alters the helper T cells
genetic code to make more
viral particles.
- Gp120 – exactly matches on
T-cells.
HIV LIFE CYCLE
Binding

Fusion

Reverse transcription

Integration

Replication

Assembly

Budding
STAGES OF HIV
- Primary Infection: Acute HIV
infection/ Acute HIV
syndrome for 2-4 weeks (a lot
of virus in the body, flu like
symptoms)
- HIV Asymptomatic: CDC
category A – more than 500
CD4 + T Lymphocytes / MM3
for 8 to 10 yrs. (nakakahawa)
- HIV symptomatic: CDC
Category B – 200 to 499 CD4
+ T Lymphocytes / MM3
(frequent infection)
- AIDS: CDC Category C – less
than 200 CD4 + T
Lymphocytes / MM3

11. MODE OF TRANSMISSION
- Body fluids
 Unprotected sex
 Contact w/ blood
during medical,
surgical, dental
procedure
 Sharing IV
needles/fluids
 Receiving non -
autologous
transfusion of blood
 Shared body
piercing, tattoo
needle and dental
equipment
 From mother to
infant during
pregnancy, birth,
and breastfeeding
DIAGNOSTIC TEST
- EIA (enzyme immune assay )
referred to ELISA (enzyme
linked immunosorbent assay)
 Antibody detected,
positive & marking
the end of the
window period
- Western Blot – detects
antibody to HIV, to confirm
EIA
- Viral load – measures HIV
RNA in plasma
- CD4/ CD8 ratio –
lymphocytes. HIV kills CD4
cells (result in impaired
immune system)
(+) TEST RESULT
- Antibodies to HIV are present
in blood
- HIV is active in the body (pt
can transmit virus to others)
- Despite HIV, doesn’t mean
they have AIDS
- Pt is not immune to AIDS


(-) TEST RESULTS
- Antibody to HIV is not present
in blood (body has not yet
produced antibodies which
takes from 3 weeks to 6
months or longer)
- Should continue taking
precautions, test result does
not mean that the pt is
immune to the virus. It mean
that the body may not have
produced antibodies yet.
MEDICAL MANAGEMENT
- Combination therapy,
sometimes referred to as a
drug cocktail or highly active
antiretroviral therapy (HAART)

- Adjunct drug therapy –
prevent the replication of virus
 Hydroxyurea
 Interferon
 Interleukin – 2
DRUG CATEGOR Y
- Early Inhibitor
 Enfuvistide
 Maravirol
- Reverse Transcriptase
Inhibitors
 NRTIs (didanosine)
 NNRTIs (nevirapine)
- Integrase Inhibitors
- Protease Inhibitors
OPPURTINISTIC INFECTIONS
- Pneumocystis Pneumonia
(CAUSE: protozoan)
- Candidiasis: yeast infection
- Cytomegalovirus Infection:
lead to blindness
- Cryptosporidiosis (CAUSE:
severe dehydration/diarrhea)
- Tuberculosis
- Kaposis Sarcoma – common
cancer for pts w/ AIDS


NURSING MANAGEMENT
- Explain action of each anti-
retroviral drug & develop a
sched for the client’s se lf-
administration
- Referral of HIV (+) clients to
support groups
- Obtain a thorough history
- Prevent 2ndary infection
C.T
- understand anti-viral drugs
do not cure AIDS but may
slow the progression
- Follow medication schedule.
- Comply w/ the timing of anti-
viral meds. Around meals
- Eat small, frequent meals
- Drink plenty of water
TRANSPLANT REJECTION
- Transplant recipient’s immune
system attack s the
transplanted organ/tissue.
TYPES OF REJECTION
- Hyper acute Rejection –
occurs a few min. after the
transplant when the antigens
are completely unmatched.

- Acute Rejection – may occur
anytime from the 1
st
week
after the transplant to 3 mon.
afterwards

- Chronic rejection – can take
place over many years
GRAFT VS. HOST DISEASE (GvHD)
- Systematic disorder that
occurs when the graft ’s
immune cells recognize the
host as foreign & attack the
recipient’s body cells.
TYPES OF TRANSPLANT
- Auto graft - (transplant of
tissue to the same person)
- Allograft - transplant of an
organ/tissue b/ween 2
genetically non -identical
member of the same species

- Isograft (synegic) – a subset
of allografts from a donor to a
genetically identical recipient

- Xenograft – transplant of
organ/tissue from one species
to another
FINDING AN ELIGIBLE DONOR -
RECIPIENT MATCH:
- ABO blood group compatibility
- Tissue typing
- Cross matching
CLINICAL MANIFESTATION
- Organism function may start
to decrease
- General discomfort;
uneasiness or ill feeling
- Fever (rare)
- Flu-like symptoms
MANAGEMENT
- Immunosuppressed drugs
COOMPLICATION:
- Certain cancer
- Infxn
- Loss of function in the
transplanted
HYPERSENSITIVITY
- Abnormal heightened reaction
to any type of stimuli
TYPE I HYPERSENSITIVITY
- CAUSE: IgE antibodies
- Immediate reaction beginning
of exposure to an antigen
- Characterized by edema in
tissue (larynx accompanied
by hypotension)

CYTOTOXIC (TYPE II)
HYPERSENSTIVITY
- Involves binding of IgG or
IgM antibody to the cell
bound antigen
- Occurs when system
mistakenly identifies a normal
constituent of the body ’s
foreign.
- May be a result of a cross –
reacting antibody, leading to
a cell and tissue damage
IMMUNE COMPL EX (TYPE III)
HYPERSENSITIVITY
- Involve immune complexes
formed when antigen bind to
antibodies
- Associated w/ systemic lupus
erythematous, certain types
of nephritis & some types of
bacterial endocarditis
DELAYED TYPE (TYPE IV)
- Meditated by sensitive T-cells
& macrophages
- Also known as cellular
hypersensitivity, 24 -72 hrs
after exposure to an allergen.
- Itching, erythema, raised
lesions
DAIGNOSTIC EXAMS
- Skin test
- ELISA
- Provocative testing
- Eosinophil count
TYPES OD SKIN TEST
- Scratch or prick test
- Patch test
- Intradermal Injection test
MANAGEMENT
Desensitization - Immunotherapy in
w/c a person receives injection of
dilute but inc reasingly higher
concentration (1 or 2 times a week)