SLE and Rheumatoid Arthritis

• The notes below provide key information about various diseases and disorders, along with their clinical manifestations, diagnostic methods, and treatments.

Systemic Lupus Erythematosus (SLE)

• Auto-antibody production occurs primarily in women with SLE.
• An abnormal immune and phagocytic system leads to decreased tolerance to self.
• Glomerulonephritis, indicating kidney involvement, signals systemic SLE.
• Malar rash and cardiac/respiratory inflammation are clinical signs.
• Diagnosis involves ANA and LE Cell Tests.
• Advise patients to seek medical attention for chest pain with breathing/movement.
• Education includes wearing sunscreen to prevent malar rash exacerbation.

Rheumatoid Arthritis

• An autoimmune, inflammatory response causes immune cells to accumulate in small joints.
• Bilateral-symmetrical polyarthritis, bone deformities, and fatigue are clinical manifestations.
• Diagnosis is confirmed through labs and X-rays.
• Educate patients about medications, encourage activity with rest, and adaptive equipment use.
• Monitor glucose levels due to potential corticosteroid treatments.

Scleroderma

• Collagenous tissue deposits occur in the body's connective tissues due to genetic factors and infection.
• The condition can affect the skin or present systemically with internal organ involvement.
• CREST (calcinosis, Raynaud's, esophageal dysfunction, sclerodactyly, telangiectasias) and vascular lesions on the lips are clinical signs.

Hypersensitivity Reactions

• Type 1: Anaphylaxis
• Type 2: Tissue-specific IgG/IgM (blood transfusions, medication transfusions)
• Type 3: Antigen-antibody immune complex (strep leading to glomerulonephritis)
• Type 4: Contact reaction
• A positive Mantoux skin test for TB indicates a hypersensitivity reaction.

Pneumocystitis jirovecii Pneumonia

• It is a fungal infection in the lungs, often seen in those with weakened immune systems (HIV/cancer).
• Hypoxemia is a key clinical manifestation.

Human Immunodeficiency Virus (HIV)

• Caused by a viral infection affecting CD4, lymphocytes, and macrophages.
• As an RNA retrovirus, HIV converts to DNA to replicate and infect cells.
• Transcriptase, integrase, and protease are essential for viral replication.
• The primary replication site is the GI tract.
• Risk factors include being a healthcare worker, unprotected sex, STIs, and being born to an infected mother (intrauterine, delivery, or breastfeeding).
• Initially asymptomatic; females may experience vaginal itching with discharge.
• Advanced HIV/AIDS symptoms include difficulty swallowing, SOB, productive cough, weight loss, chest pain, night sweats, and low CD4 count.
• This can cause wasting syndrome, so monitor electrolytes.
• Immunosuppressed patients: advise rest before meals, avoid cleaning litterboxes, thoroughly clean and cook raw foods, disinfect surfaces, and monitor temperatures.

Chronic Myeloid Leukemia (CML)

• Gradual onset typically occurs between ages 40-50, with a poor prognosis due to chemo response.
• Clinical signs: fatigue, weight loss, bleeding, discomfort, sweating, and high granulocyte count.
• Diagnosis: bone marrow aspiration and CBC with differential.
• Treatment: Tyrosine kinase inhibitor (PO), with emphasis on medication adherence.

Acute Myeloid Leukemia (AML)

• Acute onset with a median age of 64.
• Chromosomal problems lead to blast cell proliferation/mutation.
• AML presents in myriad ways due to assorted chromosomal translocations or inversions.
• Responds well to treatment.
• Clinical signs: splenomegaly, bone pain, anemia, and thrombocytopenia.
• Diagnosis: bone marrow aspiration, CBC, blood smear.
• Treatment: Aggressive chemotherapy, starting with induction therapy.

Multiple Myeloma

• Plasma cell disorder in antibody-secreting B lymphocytes.
• Antibodies destroy healthy cells.
• Clinical signs: bone lesions/issues and hypercalcemia.
• Complications: spinal fracture and risk for spinal cord compression.
• Diagnostic testing: Bone marrow biopsy and urinalysis for Bence-Jones protein.
• Treatments: steroids, chemo, stem cell transplant, radiation.
• Recommendations: increased daily water intake and maintain high UOP.

Acute Lymphoblastic Leukemia

• Childhood cancer with malignant transformation of B (lymphoblast) cells.
• Clinical presentation: Abrupt onset of symptoms (fever, infection, anorexia), severe headache, vomiting, and increased immature WBC count.
• Diagnostic methods: bone marrow aspiration, CBC, and blood smear.
• Treatment: Chemo and steroids.
• High remission rates are typical.
• Expected normal labs post-treatment: platelet 150,000-400,000 and WBC 5,000-10,000.
• Encourage slow weight gain (1lb a week)

Hodgkin’s Lymphoma

• It is a lymphoid neoplasm starting in lymph nodes, spreading to tissues/organs.
• Clinical signs: Lymphadenopathy (cervical, supraclavicular, mediastinal, i.e., neck, shoulder, chest); B symptoms (fever, sweating, weight loss); pruritus; jaundice; herpes zoster.
• Diagnostic identification: Biopsy showing Reed-Sternberg Cells with normal platelets.
• Treatment: Chemo, stem cell transplant, and radiation.
• Education: avoid drying soaps/lotions, wear cotton clothing, use electric razor.

Non-Hodgkin’s Lymphoma

• Clinical signs: lymphadenopathy (abd, chest, neck) with fever, sweating, weight loss/anorexia; potential spinal cord compression.
• Diagnosis often occurs at a late stage due to its less aggressive nature.
• Treatment includes chemo, antibiotics, antifungals, antivirals, and pain management.
• Education: exercise x 30 min 5x a week.

Metastatic Cancer

• Pattern related to circulatory flow.
• Cell survival is not guaranteed after entering circulation.
• All tumors should undergo grading/staging.
• Monitor WBC daily during chemotherapy; a critical drop is a complication.
• Chemotherapy shrinks/destroys all cells.
• Administration routes: Orally, IV, or directly into spinal fluid via central venous access device.

Laboratory Values

• WBC: 5,000-10,000
• PLT: 150,000-400,000
• Prothrombin Time: 11-12.5 seconds
• HCT: Male 42-52%, Female 37-47%
• BUN: 10-20 mg/dL
• Potassium: 3.5-5 mEq/L
• Sodium: 135-145 mEq/L