Process of antibody Production

Sensitization

Acts as a potent vasoconstrictor and causes contraction of bronchial smooth muscle.

Serotonin

Chemical mediators that initiate the inflammatory response. Cause smooth muscle contraction, bronchial constriction, mucus secretion in the airways, and the typical wheal-and-flare reactions of the skin.

Leukotriene

Can be obtained from blood samples or smears of secretions. A level greater than 5% to 10% is considered abnormal and may be found in patients with allergic disorders .

Complete blood count with differential

Results from a rapid release of IgE-mediated chemicals, which can induce a severe, life-threatening reaction

Anaphylaxis

Aka allergy vaccine therapy, involves the administration of gradually increasing quantities of specific allergens to the patient until a dose is reached that is effective in reducing disease severity from natural exposure.

allergen immunotherapy

The most common method of treatment which consists of the serial injection of one or more antigens that are selected in each particular case on the basis of skin testing.

subcutaneous immunotherapy

This acts as a cushion and lubricant

Synovial Fluid

Involves the deeper layers of the skin, resulting in more diffuse swelling rather than the discrete lesions characteristic of hives.

Angioedema

Uric acid deposits; develop in cartilage tissue, tendons, and soft tissues.

Tophi

_________ destroys cartilage and erodes the bone.

Pannus

is a blood test that that can show if you have inflammation in your body.

erythrocyte sedimentation rate

Prevent inflammation and joint damage; immunosuppresant.

DMARD Therapy

A chronic rash with erythematous papules or plaques and scaling and can cause scarring and pigmentation changes.

Discoid rash

Occurs due to a buildup of antibodies and immune complexes that cause damage to the nephrons.

nephritis

Hardening/stiffening of an artery related to presence of atheromal plaque.

Atherosclerosis

Approximately two thirds of body fluid is in the ICF compartment

Intracellular space

Approximately one third is in the ECF compartment .

Extracellular space

Electrolytes help:

• Balance the amount of water in your body • Balance your body's acid/base (pH) level • Move nutrients into your cells • Move wastes out of your cells • Make sure that your nerves, muscles, the heart, and the brain work.

Major cation in the ECF

Sodium

Major cation in the ICF

Potassium

Major anion ion the ECF

Chloride

Combination of fluids and electrolytes

Plasma

Movement of fluid from an area of lower solute concentration to an area of higher solute concentration with eventual equalization of the solute concentrations.

Osmosis

Movement of solutes from an area of greater concentration to an area of lesser concentration, leading ultimately to equalization of the solute concentrations.

Diffusion

A membrane that allows certain molecules or ions to pass through; exchange of fluid

Semipermeable membrane

is the ability of all solutes to cause an osmotic driving force that promotes water movement from one compartment to another.

Tonicity

Movement of water and solutes occurs from an area of high hydrostatic pressure to an area of low hydrostatic pressure.

Filtration

By product / waste product of muscle

Creatinine

The usual daily urine volume in the adult.

30 - 60 / 1 hr or 0.5 - 1 ml/kg/hr

Major functions in maintaining normal fluid balance:

• Regulation of ECF volume and osmolality by selective retention and excretion of body fluids • Regulation of normal electrolyte levels in the ECF by selective electrolyte retention and excretion • Regulation of pH of the ECF by retention of hydrogen ions • Excretion of metabolic wastes and toxic substances.

This manufactures ADH, which is stored in the posterior pituitary gland and released as needed to conserve water.

Hypothalamus

a mineralocorticoid secreted by the zona glomerulosa (outer zone) of the adrenal cortex, has a profound effect on fluid balance.

Aldosterone

embedded in the thyroid gland, regulate calcium and phosphate balance by means of parathyroid hormone (PTH).

Parathyroid glands

This influences bone reabsorption, calcium absorption from the intestines, and calcium reabsorption from the renal tubules.

parathyroid hormone (PTH)

Fight and flight responses

Glucocortisoid

It occurs when water and electrolytes are lost in the same proportion.

Hypovolemia / Fluid Volume Deficit

Clinical manifestations of hypovolemia

Acute weight loss, decreased skin turgor, dizziness, weakness, thirst, confusion, sunken eyes, nausea

Contains waste products, electrolyte; The normal id 1.005 - 1.030

Urine specific Gravity

Fluids to administer in hypovolemia

Isotonic electrolyte solutions such as Lactated Ringer Solution, 0.9% sodium chloride

Nursing Management for Hypovolemia

• The nurse observes for a weak, rapid pulse and orthostatic hypotension. • A decrease in body temperature often accompanies FVD, unless there is a concurrent infection. • Assessing skin turgor • Assessing tongue turgor: Additional longitudinal furrows and the tongue is smaller because of fluid loss.

Refers to an isotonic expansion of the ECF caused by the abnormal retention of water and sodium in approximately the same proportions in which they normally exist in the ECF.

Hypervolemia / Fluid volume Excess

Clinical manifestations of hypervolemia

peripheral edema and ascites, crackles, SOB, bounding pulse and cough, increase urine output

This block sodium reabsorption in the distal tubule, where only 5% to 10% of filtered sodium is reabsorbed. Ex. hydrochlorothiazide (Microzide)

Thiazide diuretics

such as furosemide (Lasix) or torsemide (Demadex), can cause a greater loss of both sodium and water because they block sodium reabsorption in the ascending limb of Henle loop, where 20% to 30% of filtered sodium is normally reabsorbed.

Loop Diuretics

Used when renal function is so severely impaired that pharmacologic agents cannot act efficiently; Hemodialysis or peritoneal dialysis may be used to remove nitrogenous wastes and control potassium and acid–base balance, and to remove sodium and fluid.

Dialysis

contain potassium and must therefore be used cautiously by patients taking potassium-sparing diuretics

Salt substitutes

Nursing management for Hypervolemia

 Measures I&O at regular intervals to identify excessive fluid retention.  Weighed daily.  Breath sounds  Degree of edema. Evaluated on a scale of 1+ (minimal) to 4+ (severe).  Measuring the extremity

a type of edema in which fluid accumulates in the peritoneal cavity; it results from nephrotic syndrome and cirrhosis.

Ascites

Serum sodium level that is less than 135 mEq/L (135 mmol/L).

Hyponatremia

Excessive ADH activity, with water retention and dilutional hyponatremia, and inappropriate urinary excretion of sodium in the presence of hyponatremia. Key word: Soak Inside

SIADH

Clinical Manifestations for Hyponatremia

anorexia, nausea and vomiting, headache, lethargy, dizziness, seizures, edema, weight gain

Pharmacologic management for hyponatermia

Arginine vasopressin (AVP)receptor antagonists: IV conivaptan hydrochloride (Vaprisol)

Serum sodium level higher than 145 mEq/L (145 mmol/L). It can occur in patients with normal fluid volume or in those with FVD or FVE.

Hypernatremia

Pathophysiology of Hypernatremia

 Fluid deprivation in patients who cannot respond to thirst (Very old, very young, and cognitively impaired)  Administration of hypertonic enteral feedings without adequate water supplements.  Watery diarrhea  Greatly increased insensible water loss (e.g., hyperventilation, burns)  Diabetes insipidus  IV administration of hypertonic saline

Clinical manifestations of Hypernatermia

thirst, restlessness, simple partial or tonic-clonic seizures, twitching

Medical management for Hypernatremia

 Gradual lowering of the serum sodium level by the infusion of a hypotonic electrolyte solution (e.g., 0.3% sodium chloride) or an isotonic nonsaline solution (e.g., dextrose 5% in water [D5W]).  Diuretics also may be prescribed to treat the sodium gain.  Desmopressin acetate, a synthetic ADH, may be prescribed to treat diabetes insipidus if it is the cause of hypernatremia

Nursing Management for Hypernatremia

 Assess for abnormal losses of water or low water intake  Assess for large gains of sodium (diet, OTC medications,etc.)  Assess for changes in behavior, such as restlessness, disorientation, and lethargy  Prevent hypernatremia by providing oral fluids at regular intervals, particularly in patients who are unable to perceive or respond to thirst.

Binge - eating

Bulimia

Patho of Hypokalemia

 Hyperaldosteronism increases renal potassium wasting and can lead to severe potassium depletion.  Patients with persistent insulin hypersecretion because insulin promotes the entry of potassium into skeletal muscle and hepatic cells

An elevated ___________ is specific to hypokalemia.

U wave

A wave that can be seen for atrial contraction

P wave

A wave that can be seen fir ventricular contraction

Q, R, S Complex

A wave that can be seen for ventricular depolarization (relaxation)

T-Wave

Diuretic that should be avoided in Hypokalemia

Potassium Sparring diuretic

Serum potassium level greater than 5 mEq/L [5 mmol/L.

Hyperkalemia

Pathophysiology of Hyperkalemia

 Decreased renal excretion of potassium.  Rapid administration of potassium.  Movement of potassium from the ICF compartment to the ECF compartment.  Commonly seen in patients with untreated kidney injury (AKI or CKD)  Patients with hypoaldosteronism or Addison disease  Extensive tissue trauma (burns and crushing injuries).

Clinical manifestations for Hyperkalemia

muscle weakness, intestinal colic, cramps, abdominal distention,

ECG for Hyperkalemia

Tall tented or Peaked T wave, Wide PR interval, wide QRS duration

Emergency Pharmacologic Therapy for hyperkalemia

 Ca gluconate  Beta-2 agonists  IV administration of regular insulin and a hypertonic dextrose solution  Peritoneal dialysis or Hemodialysis.

Nursing management for Hyperkalemia

 When measuring vital signs, an apical pulse should be taken.  The presence of paresthesias and GI symptoms such as nausea and intestinal colic are noted.  Encouraging the patient to adhere to the prescribed potassium restriction.  Potassium-rich foods to be avoided.  Administer and monitor potassium solutions closely.

This inhibits the Calcium in the bone.

Calcitonin

Acts as anticoagulant; eliminates calcium

Citrated blood

Serum calcium is controlled by PTH and calcitonin.  As ionized serum calcium decreases, the parathyroid glands secrete PTH.

• Increases calcium absorption from the GI tract • Increases calcium reabsorption from the renal tubule • Releases calcium from the bone.

is a symptom that involves involuntary muscle contractions and overly stimulated peripheral nerves.

Tetany

Twitching of muscles enervated by the facial nerve

Chvostek Sign

ECG for hypocalcemia

A prolonged QT interval

Non vesicant fluid; Can cause tissue and cell damage

Infiltration

Vesicant fluid; Irritating; cellulitis and necrosis

Extravasation

Nutritional therapy for hypocalcemia

 Vitamin D therapy  Increasing the dietary intake of calcium to at least 1000 to 1500 mg/day in the adult is recommended.  Calcium supplements must be given in divided doses of no higher than 500 mg to promote calcium absorption. Calcium-containing foods include milk products; green, leafy vegetables; canned salmon; canned sardines; and fresh oysters.

Serum calcium value greater than 10.2 mg/dL [2.6 mmol/L]).

Hypercalcemia

Pathophysiology of hypercalcemia

Hyperparathyroidism Excessive PTH secretion associated with hyperparathyroidism causes increased release of calcium from the bones and increased intestinal and renal absorption of calcium. Bone mineral is lost during immobilization

Clinical Manifestation of hyercalcemia

 Muscle weakness  Constipation  Nausea and Vomiting  Polyuria and Polydipsia  DHN  Hypoactive DTR  Calcium stones  Shortened ST segment and QT interval, bradycardia

Most abundant an ion in intracellular

Phosphate

Serum magnesium concentration (1.3 mg/dL [0.62 mmol/L]) and is frequently associated with hypokalemia and hypocalcemia.

hypomagnesemia

Pathophysiology if hypomagnasemia

 Any disruption in small bowel function  Chronic alcohol abuse:

Clinical Manifestations of hypomagnasemia

 Neuromuscular irritability.  Tetany: Trousseau sign and Chvostek sign  Insomnia  Mood changes  Increased DTR  ECG: PVCs, flat or inverted T waves, depressed ST segment, prolonged PR interval, and widened QRS

Medical Management for hypomagnasemia

 Mild magnesium deficiency can be corrected by diet alone. Principal dietary sources of magnesium include green leafy vegetables, nuts, seeds, legumes, whole grains, seafood, peanut butter, and cocoa.  Overt symptoms of hypomagnesemia are treated with parenteral administration of magnesium.  Vital signs must be assessed frequently during magnesium administration to detect changes in cardiac rate or rhythm, hypotension, and respiratory distress.

Serum magnesium level higher than 3.0 mg/dL [1.25 mmol/L].

Hypermagnasemia

Clinical Manifestations of hypermagnasemia

Flushing Hypotension Muscle weakness Drowsiness Hypoactive reflexes Depressed respiration ECG: Prolonged PR interval and QRS, peaked T waves

Formula for Flow rate

Volume (ml)

Time (hrs)

ml per hour

Formula for Droprate

Volume (ml) divide Time (hrs) X Drop factor = IV flow rate per minute (gtt/min)

Immunosuppressive Agents

Methotrexate, azathioprine, cyclophosphamide

Scleroderma

An autoimmune disorder that involves hardening and tightening of the skin. It may also cause problems in the blood vessels, internal organs and digestive tract.

CREST syndrome

Calcinosis, Raynaud’s phenomenon, Esophageal Dysfunction, Sclerodactyly, Telangiectasis

group of diseases that are termed idiopathic inflammatory myopathies

Polymyositis

related condition, is most commonly identified by an erythematous smooth or scaly lesion found over the joint surface, which often occurs prior to symptoms of weakness.

Dermatomyositis

Diagnostic procedure to assess the health of muscles and the nerve cells. Can reveal nerve dysfunction, muscle dysfunction or problems with nerve-to-muscle signal transmission.

Electromyography

MedSurg

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