SLE, Arthritis, HIV, Cancer: Study Notes

• Study notes on Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis, Scleroderma, Hypersensitivity, Pneumocystitis jirovecii Pneumonia, HIV, Leukemia, Lymphoma, Metastatic Cancer, Chemotherapy and common Labs.

Systemic Lupus Erythematosus (SLE)

• Auto-antibody production is more common in women
• Results from an impaired immune and phagocytic system that reduces self-tolerance
• Glomerulonephritis indicates kidney involvement, suggesting the patient's SLE is systemic
• Clinical signs include malar rash and inflammation of the cardiac/respiratory systems
• Diagnosed via ANA and LE Cell Tests
• Report chest pain with breathing/ movement to the doctor
• Instruct patient to wear sunscreen to prevent exacerbating the malar rash

Rheumatoid Arthritis

• Autoimmune, inflammatory condition causing immune cells to accumulate in small joints
• Clinical signs include bilateral-symmetrical polyarthritis, bone deformities, and fatigue
• Diagnosis is done via labs and x-rays
• Educate the patient about medications
• Encourage activity with rest periods
• Encourage the use of adaptive equipment
• Glucose levels should be monitored, as corticosteroids may be part of the treatment

Scleroderma

• Collagenous tissue is deposited in the body's connective tissues
• Genetic and triggered by infection
• Can affect the skin or be systemic/diffuse, involving internal organs
• Clinical signs include CREST syndrome (calcinosis, Raynaud's, esophageal dysfunction, sclerodactyly, telangiectasias)
• Vascular lesions present on the lips

Hypersensitivity Reactions

• Type 1: anaphylaxis
• Type 2: tissue-specific IgG/IgM reactions (blood transfusion or medication administration)
• Type 3: antigen-antibody immune complex (Strep which leads to glomerulonephritis)
• Type 4: contact reaction
• A positive Mantoux skin test is a hypersensitivity reaction

Pneumocystitis jirovecii Pneumonia

• Fungal infection in the lungs
• More common in those with weakened immune systems (HIV/Cancer)
• Clinical sign is hypoxemia

Human Immunodeficiency Virus

• Viral infection affecting CD4, lymphocytes, and macrophages
• RNA retrovirus that converts to DNA to replicate
• Transcriptase, integrase, and protease are required for viral replication
• GI tract is the primary site of replication
• Risk factors: healthcare work, unprotected sex, STIs, being born to a mom with HIV which can occur in utero, during delivery, or breastfeeding
• Initially asymptomatic
• Females may experience vaginal itching with discharge
• AIDS presents as difficulty swallowing, SOB, productive cough, weight loss, chest pain, night sweats, and low CD4 count
• Wasting syndrome may occur, so monitor electrolytes
• Allow the patient to rest/ nap before meals
• Because the patient is immunosuppressed they should not clean the litterbox
• Insist raw foods need to be cleaned and cooked thoroughly before eating.
• Surfaces need to be disinfected
• Monitor temperatures

Chronic Myeloid Leukemia (CML)

• Gradual onset, typically in ages 40-50
• Poor prognosis due to low chemo response
• Clinical signs include fatigue, weight loss, bleeding, discomfort, sweating with a high granulocyte count
• Bone marrow aspiration and CBC with differential are diagnostic tools
• Treatment is with Tyrosine kinase inhibitor (PO)
• Compliance with prescribed medications is important

Acute Myeloid Leukemia (AML)

• Acute Onset with Median age 64
• Problem with chromosomes leads to blast cell proliferation/mutation
• Assorted chromosomal translocations or inversions cause the disease to present in many ways
• Responds well to treatment
• Clinical signs include splenomegaly, bone pain, anemia, and thrombocytopenia
• Bone marrow aspiration, CBC, and blood smear are diagnostic tools
• Aggressive chemotherapy starts with induction therapy

Multiple Myeloma

• Antibody-secreting B Lymphocytes (Plasma) disorder
• Antibodies destroy healthy cells
• Clinical signs include bone lesions/issues and hypercalcemia
• Spinal fracture and risk for spinal cord compression
• Bone Marrow Biopsy and Urinalysis are performed
• Bence-Jones Protein in urine indicates diagnosis
• Treatments involve steroids, chemo, stem cell transplant, and radiation
• Increase daily water intake and maintain high UOP

Acute Lymphoblastic Leukemia

• Childhood cancer with malignant transformation of B (lymphoblast) cells
• Clinical signs include abrupt onset of symptoms (fever, infection, anorexia), severe headache, vomiting, and increased immature WBC count
• Bone Marrow Aspiration, CBC, and Blood Smear confirm diagnosis
• Treatment consists of Chemo and Steroids
• High remission rates
• Normal Expected labs after treatment are platelet 150,000-400,000 and WBC 5,000- 10,000
• Encourage slow weight gain (1lb a week)

Hodgkin’s Lymphoma

• Lymphoid neoplasms that start in lymph nodes and spread to tissues and organs
• Clinical signs include Lymphadenopathy, B Symptoms (systemic  fever, sweating, weight loss), pruritus, jaundice, and Herpes Zoster
• Biopsy shows Reed-Sternberg Cells and normal platelets
• Treatment involves Chemo, stem cell transplant, and radiation
• Avoid irritating soaps/lotions
• Should wear cotton clothing
• Use electric razor rather than straight edge blade.

Non-Hodgkin’s Lymphoma

• Clinical signs include Lymphadenopathy with fever, sweating, weight loss/anorexia
• Lymphadenopathy in abdomen, chest, or neck
• Can present with spinal cord compression
• Diagnosed at late stage as it is less aggressive
• Treatment includes chemo, antibiotics, antifungals, antivirals, and pain management
• Exercise x 30 min 5x a week.

Metastatic Cancer

• Pattern depends on circulatory flow
• Cell survival is not guaranteed after entering circulation
• Grading/ staging is standard for all tumors

Chemotherapy

• Monitor WBC daily
• Low WBC (critical levels) can occur
• Helps shrink and destroy all cells
• Administer via central venous access device
• Can be administered orally, IV, or directly into spinal fluid

Common Lab Values

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