Different Types of Immunity - PDF

**Different types of immunity** 1. **Active immunity:** develops when the immune system produces antibodies in response to the entry of antigen into the body active immunity develops over several weeks to months and is long lasting. 2. **Passive immunity:** it\'s temporary and develops w...

**Different types of immunity** 1. **Active immunity:** develops when the immune system produces antibodies in response to the entry of antigen into the body active immunity develops over several weeks to months and is long lasting. 2. **Passive immunity:** it\'s temporary and develops when antibodies are created by another human or animal and then transferred to the client because the client does not independently develop antibodies passive immunity is temporary. **Components of an immune response and what each stage does** 1. **T cells:** WBC that play a central role in the adaptive immune response, primarily by signaling and activating other immune cells to fight infection, includes helper t cells and cytotoxic T cells. 2. **Cytotoxic cells:** Once activated by helper T cells, cytotoxic T cells directly destroy infected cells or cancerous cells by releasing toxic substances that cause cell death. 3. **Helper T cells**: "commanders" by recognizing antigens and releasing cytokines to activate other immune cells, including cytotoxic T cells and B cells, to launch a targeted attack against the pathogen, 4. **B cells**: These cells produce antibodies which are proteins that bind to specific antigens on pathogens, marking them for destruction by other immune cells. **Immunosuppressants: *[cyclosporin's]*** - **Adverse effects:** Gingival hypertrophy, hirsutism, hypertension hyperlipidemia and nephrotoxicity. - **Patient teaching:** patients should be encouraged to use effective contraception or contraceptives and wear protective clothing and use sunscreen to decrease exposure of skin to sunlight, which is therefore decreasing the risk of skin cancer. - **Nursing considerations:** - **Monitor WBC:** patients on immunosuppressants have a heightened risk of infections due to immune suppression. If levels drop too low, notify the provider so they can adjust the dose. - **Monitor for organ rejection symptoms:** signs of graft tenderness, fever, or other rejection symptoms should be reported immediately. - **Monitor for blood work:** cyclosporins have narrow therapeutic range, so frequently blood tests are required to monitor drug levels and prevent toxicity. - **Monitor for nephrotoxicity:** regular monitoring for kidney function (BUN/Creatinine) **MUGA** - Muga stands for a mitigated acquisition scan is a noninvasive nuclear imaging test that evaluates the heart's structure and function. The cardiotoxic effects will present as heart failure secondary to cardiomyopathy, and the risk of heart failure increases as the cumulative lifetime dose rises above 550 milligrams per square meter. **Adverse effects of monoclonal antibodies** - **Rituximab:** used to treat non Hodgkin's lymphoma, multiple myeloma and chronic lymphocytic leukemia. - **Adverse effects:** infusion reaction; rash, fever, fatigue, nausea, diarrhea, weight gain, bone marrow suppression, cough, increased ALT, hypotension, bronchospasm and angioedema. **Patho of multiple myeloma:** - Multiple myeloma is a disease process that involves the excessive production of plasma cells leading to an excessive number of immunoglobulins. Remember plasma cells are activated plasma B cells which produce immunoglobulins that normally protect the body. However, in multiple myeloma malignancy plasma cells infiltrate the bone marrow and produce abnormal and excessive amounts of immunoglobulins. Essentially, it is an incurable cancer of the bone marrow. **CRAB symptoms**: - **C**: high levels of calcium in the blood (***[hypercalcemia]***) - **R**: kidney problems, ***[renal failure]*** - **A:** low levels of RBC, known as ***[anemia]*** - **B: *[bone]*** ***[damage]*** such as fractures or weakened bones **Nursing considerations for Erythropoietin *[(Epoetin alfa) ]*** - **Check BP** bc can worsen high blood pressure - **Increase hematocrit:** can cause headache/seizures. - **Thrombosis** has been noted in some patients whose hemoglobin were raised to high levels. **What to do as a nurse based upon patients ANC count (less then 500 count)** During induction therapy, chemo destroys leukemic cells and healthy ones, due to severe and potentially life threatened side effects such as neutropenia. During this time, the patient is typically very ill. Management consists of administering blood products and promptly treating infections. The use of granulocytic growth factors, either granulocyte colony-stimulating factor (G-CSF; filgrastim) or granulocyte-macrophage colony-stimulating factor (GM-CSF; sargramostim), may be used during the induction phase only for patients who have a life-threatening infection in order to shorten the neutropenic period. ***[Nadir is lowerst ANC count ]*** - Administering growth factor (***[Filgrastim]***) severe ANC - Normal to mild neutropenia: hygiene to prevent infection **Nursing considerations for Leukemia medications** - **Bone marrow suppression (myelosuppression)** reduction of WBC, RBC, and platelets**.** Monitor for bleeding and monitor CBC and assess for neutropenia, anemia, and thrombocytopenia. - **GI (nausea/vomiting):** administer ondansetron in combination with dexamethasone. - **Immunocompromised:** increase risk of infection, good hygiene, avoid large crowds, fresh fruits and flowers. - **Tumor lysis syndrome:** rapid cell breakdown, causing electrolyte imbalances. Monitor electrolytes (potassium, phosphorus, calcium) and uric acid levels. - Administer ***[allopurinol]*** to prevent hyperuricemia. **Patho of different blood cancers** 1. **Acute myeloid leukemia:** defect in stem cells that differentiate them into all types of myeloid cells, including monocytes, granulocytes, erythrocytes and platelets. It is most common in nonlymphocytic leukemia and the prognosis is highly variable. It does affect all ages with the peak age being 67 years. 2. **Chronic myeloid leukemia:** there is a mutation in myeloid stem cells that causes uncontrolled proliferation and something called the philadelphia chromosome, which is when parts of the chromosomes 9 and 22 break off and trade places. 3. **Acute lymphocytic leukemia:** uncontrolled proliferation of immune cells from lymphoid stem cells. It is most common in young children, boys more than girls and the peak age is 4 years. The prognosis is good for children as there is an 85% chance for 3 year event free survival, but that drops with increased age. So,, it's actually less than 45% survival rate in adults. 4. **Chronic lymphocytic leukemia:** is a common malignancy of older adults and it is the most prevalent type of adult leukemia. It is derived from malignant clone B lymphocytes and the mean age of getting the disease is 72 years and the survival varies from 2 to 14 years depending on the stage. **Aids med and uses:** - **Ganciclovir:** improvement of findings (genital lesions decrease inflammation and pain and improvement in vision) **HIV**: - **Patho**: CD4 T cells are the target for HIV and the virus binds to these cells through fusion. - **Background**: HIV is a retrovirus, which must attach to whole cell in order to replicate RNA is changed into DNA using the enzyme reverse transcriptase. The protein on the outer surface of HIV (GP41 & GP120) connects the receptors of the cells when this happens. - **Associated metabolic disorder with HIV** - Hyperlipidemia - Insulin resistance - Bone disease - Renal disease - Hyperglycemia - Lactic acidosis - Cardiovascular disease - Lipodystrophy - **Medications**: antiretroviral *[Trimethoprim/Sulfamethoxazole]* - **Antivirals**: - Acyclovir - Ganciclovir - **Other meds:** - ***[Zidovudine]***: (NRTI"s) Nucleoside reverse transcriptase inhibitor - ***[Reduces HIV manifestations by inhibiting DNA synthesis and thus viral replication. It\'s the first line antiretroviral to treat HIV infections for short term care.]*** - Efavirenz: (NNRTI"s) Nonnucleoside reverse transcriptase inhibitor - ***[Acts directly on reverse transcriptase to stop HIV replication. Primary HIV one infection often used in combination with other antiretroviral agents to prevent medication resistance. ]*** - Saquinavir mesylate: protease inhibitor - ***[Protease inhibitors act against HIV one and HIV 2 to alter inactivate the virus by inhibiting enzymes needed for HIV replication. Used to treat HIV infections. ]*** - ***[Enfuvirtide]***: fusion/entry inhibitors - ***[decreases and limits the spread of HIV by blocking HIV from attaching and entering CD4T cells treatment of HIV that is unresponsive to other tie retrovirals]*** - - Raltegravir: integrase inhibitor - - ***[Maraviroc]***: CCR5 antagonist. - ***[Prevents HIV from entering lymphocytes by binding to CCR 5 on cell membranes treats HIV infection in conjunction with other antiretroviral medications]*** - **HAART**: an aggressive treatment method using three or more different medications to reduce the amount of virus and increase CD4 counts. - Trimethoprim sulfamethoxazole is the medication used - **Meds that are used for that purpose of having both HIV and cancer:** - ***[Maraviroc]***: HIV from entering lymphocytes by binding to CCR5 on cell membranes. **Statins:** - **Administration: orally** - administer *[lovastatin]* with evening meals other statins can be taken without food but evening dosing is best because most cholesterol is synthesized during the night. - these medications should be taken in the evening or at bedtime since cholesterol biosynthesis of the liver - **Adverse effects:** - Hepatotoxicity - Myopathy (muscle pain) - Rhabdomyolysis (most serious) - **Nursing considerations**: Risk category X. Lactation warning can alter metabolism of lipids and infants. Contraindicated in clients who have liver disorder. And use cautiously in clients who have liver disease. Dosage of several statins should be reduced for clients who have severe kidney impairment. - **Nursing interactions**: Monitor creatinine kinase and get baseline before starting statins because statins can cause muscle related side effects like myopathy (muscle pain or weakness), and rhabdomyolysis (severe muscle breakdown) **When vaccines should be administered ONLY ONES WE DISCUSSED** **Hep A**: Recommended to all children in the US with the first dose between 1-2 years and the second dose at least 6 months after the first dose. Recommended for children and adolescents aged 2-18 years who are international travelers. - *[Children]*: - *[Hep B]*: 24hr of birth - *[2 months]*: Hep b, Tetanus and Dtap - *[Adolescent]*: - 11-12 years: Tdap, HPV, Meningococcal (2^nd^ at 16-18) **Hep B**: **STEMI and NSTEMI protocols** - **STEMI** occurs due to a **complete blockage** of a major coronary artery, leading to significant muscle damage. - **Treatment Protocol**: - **Thrombolytic therapy**: Administer thrombolytics to dissolve the clot and restore blood flow. This is crucial to prevent further heart muscle damage. - **Percutaneous Coronary Intervention (PCI)**: The preferred treatment for STEMI patients. This involves reopening the blocked artery using a balloon angioplasty, often followed by stent placement​(Patho & Pharm II - Exam...). - **Medications**: Patients are typically given **aspirin**, **anticoagulants**, **beta-blockers**, and **ACE inhibitors** to manage symptoms and prevent further damage. - **Time is critical**: Immediate action is required to minimize muscle death. The goal is to **open the blocked artery as quickly as possible**, ideally within 90 minutes of first medical contact. - **NSTEMI** results from a **partial blockage** of a large artery or a blockage in a smaller artery. - **Treatment Protocol**: - **Cath Lab Intervention**: NSTEMI patients are still treated as emergencies and are sent to the **cath lab** for coronary angiography, but **thrombolytic therapy** is not needed since the artery is not fully occluded​(Patho & Pharm II - Exam...). - **Medications**: **Aspirin**, **anticoagulants**, **beta-blockers**, and **ACE inhibitors** are typically used to manage the clot and prevent further issues​(Patho & Pharm II - Exam...). - **Monitoring and Follow-up**: Close monitoring in the hospital is necessary, but the focus is on preventing further progression of the clot rather than immediate artery reopening like in STEMI. **Alteplase** **Patho:** The fibrinolytic system invitations the breakdown of clots and serves to balance the cloning process and this is done through a process called "fibrenalysis", which is the mechanism by which formed thrombi or lice to prevent excessive clot formation and blood vessel blockage. - Administration: IV infusion, ideally within 4-6 hrs of symptoms onset for MI - Protocol: used for acute treatment for STEMI as it breaks blood clots by converting plasminogen to plasmin, which then dissolves fibrin, Also used for acute ischemic strokes and PE. **Medications for MI and chest pain** **MI (MONA)** **Morphine, Oxygen, Nitroglycerin, and aspirin** - **Why it's given**: - **Nitroglycerin** is a potent **vasodilator** used to relieve chest pain (angina) by relaxing vascular smooth muscle, leading to the dilation of both venous and arterial blood vessels. This reduces myocardial oxygen demand by decreasing the workload on the heart. - **Aspirin: 80-325 mg a day** - **How it's administered**: - **Sublingual** (most common in emergency settings): 0.4 mg every 5 minutes for up to 3 doses. The onset is 1-3 minutes​. ***[3 DOSES WITHIN 15 MINUTES]*** - **Adverse Effects**: - **Severe headache** (due to vasodilation), **orthostatic hypotension**, and **reflex tachycardia**​ - **Contraindications: Nitrates and ED drugs such as Viagra are contraindicated** - Since nitrated work by dilating blood vessels (vasodilation) which lowers blood pressure, ED meds like Viagra cause vasodilation which in combination can cause hypotension. **Chest pain** - **Why it's given**: - **Nitroglycerin** is a potent **vasodilator** used to relieve chest pain (angina) by relaxing vascular smooth muscle, leading to the dilation of both venous and arterial blood vessels. This reduces myocardial oxygen demand by decreasing the workload on the heart. - **Beta blockers**: Prevent pain of stable angina by decreasing the HR and contractility of the heart, which decreases cardiac oxygen demand. NEVER STOP ABRUPTLY can cause MI. - Can mask early hypoglycemia so be cautious with diabetic patients. - **Calcium channel blockers** (-PINES): can help with chronic angina - ***[Nifedipine]***: shouldn't be given within 1-2 weeks following MI and grapefruit juice may enhance the absorption. - **Ranolazine**: 1^st^ line drug for chronic angina, used if beta blockers - **Aspirin:** used for prevention of MI - **Clopidogrel**: prevent platelet aggregation - **ACE inhibitor** to prevent Mi or death. - **How its administered** - **Sublingual** (most common in emergency settings): 0.4 mg every 5 minutes for up to 3 doses. The onset is 1-3 minutes​. ***[3 DOSES WITHIN 15 MINUTES]*** - **Adverse effects:** - **Severe headache** (due to vasodilation), **orthostatic hypotension**, and **reflex tachycardia**​ - **Contraindications: Nitrates and ED drugs such as Viagra are contraindicated** - Since nitrated work by dilating blood vessels (vasodilation) which lowers blood pressure, ED meds like Viagra cause vasodilation which in combination can cause hypotension. **What to do if patient has chest pain?** - Administer nitroglycerin, 0.4 mg every 5 minutes for up to 3 doses. The onset is 1-3 minutes​. Oxygen to assist with inadequate oxygen, Morphine for relaxation/anxiety and aspirin to break up the platelets sticking together. 1. Priority is to have the pt stop all activity instead of rest 2. Relax in a semi fowlers position 3. Assess vitals 4. Observe resp distress 5. Assess pain 6. EKG 7. Administer mediation as ordered or by protocol; Nitro, oxygen (2L) Adverse effects of antidysrhythmias - **Systemic lupus syndrome** - **Neutropenia, thrombocytopenia, agranulocytopenia** - **Cardiotoxicity** - Hypotension - Respiratory arrest - Bradycardia - Heart failure - Pulmonary toxicity Van Williams Classifications (4 main classes) **Class 1:** **Sodium channel blockers** (1a=quinidine, 1b=lidocaine, 1c= Flecainide) - MOA: block sodium channels, reducing the rate of depolarization in cardiac cells **Class 2: Beta blocker** Propranolol, sotalol, esmolol, and acebutolol - MOA: blcoks what gets you excited like epinephrine and norepinephrine in the body which will decrease the hearts excitement and decrease heart rate and reduced force of contraction. Decreased renin release from the Kidneys, reducing BP. **Class 3**: Potassium channel blockers: delay repolarization Amiodarone - MOA: It blocks both Alpha and beta and adrenergic receptors of the sympathetic nervous system. These drugs also block potassium channels and thereby delay repolarization of fast potentials **Class 4:** **Calcium channel blockers** Diltiazem, verapamil - MOA: It blocks the calcium channels in the heart therefore it slows AV node automaticity, delays AV node conduction and reduces myocardial contractility. it is used to control ventricular response A-Fib or A-flutter, as well as terminate SVT. it can also decrease the heart rate by as much as 20% **Beta blockers** - **MOA:** Decreases heart rate, myocardial contractility, and decreases cardiac output. - **Patient education**: causes orthostatic hypotension, so have the patient sit or lie down if experiencing dizziness or faintness, avoid sudden changes of position and rise slowly. Causes rebound myocardium excitation, do not stop abruptly, avoid in patients with asthma, and patients with diabetes are at risk of hypoglycemia, since it masks early set hypoglycemia. **Blood count ranges:** - aPPT - Normal range for aPPT: 40 seconds - Abnormal is \>80- seconds - We hold the drip for a few hrs, we start it at a reduced dose - Patient on heparin should be 1.5-2 times the normal range = approx.. 60-80 sec - Platelets: - Normal range: ***[1500,000 -- 300,000]*** - 50% below that number, notify provider and they will stop heparin **Heparin considerations:** can cause hemorrhage, low BP, abdominal pain, tachycardia heparin induced thrombocytopenia. Contraindicated for bleeding disorders, liver and kidney disease and patients taking aspirin. Report any bleeding from gums, skin, stool, sputum and urine. Interactions are ginger, garlic, green tea, ginko biloba can enhance bleeding. - INR: - Normal range: 1-2 seconds - Abnormal: 5 seconds you hold dose - 2.7 seconds = reduce dose - PT - Normal: 12 seconds - Pt on Warfarin: 2-3 seconds - Pt with heart valve or Afib - Normal 2.5-3.5 secs bc it prevents arterial thrombosis. - INR of 5 = hold dose - INR of 2.7 = reduce the dose **Warfarin**: **MOA:** inhibiting the action of vitamin K **Education/ Discharge info:** - Contraindicated in pregnancy cat X, interactions are NSAIDS, ginger, garlic, green team ginko biloba can enhance bleeding, avoid herbal remedies. Adverse effects are bleeding, nursing education is bleeding precautions. Avoid eating to much vitamin K **Anticoagulants**: When a drug inhibits the action of the formation of clotting factors, it prevents a clot from forming. *[(can't dissolve existing clots)!!!!!!!]* - Heparin: - LMWH = Enoxaparin (Lovanox) - Coumadin (Warfarin) - Rivaroxaban (Xarelto) **Antithrombotic**: When drug lysis or breaks down clots and thrombi that have formed   - tPA (alteplase) **Antiplatelet**: when a drug inhibits platelet aggregation, preventing platelet plugs from forming   - Aspirin: **What is HRT and why is it used?** - Hormone replacement therapy - is primarily used to manage and treat conditions caused by hormonal imbalances or deficiencies. It involves supplementing hormones, such as estrogen, progesterone, or testosterone, to restore hormonal balance and alleviate symptoms **Asthma**: Know corresponding classes - ***[Albuterol (Proventil)]***: short acting bronchodilator (beta 2 anergic agonist) - [First line drug for treatment of acute bronchoconstriction and can be used as a **RESCUE DRUG**]  - **MOA**: relieve the broncho spasms by stimulating the SNS. - **[*Salmeterol (servant* diskus]):** long-acting bronchodilator (beta 2 anergic agonist) - NEVER USE for acute asthma attacking sicne it's **NOT A RESCUE DRUG** - **MOA**: used for the maintenance and treatment of asthma, COPD - ***[Ipratropium/Acetylcholine]***: anticholinergic - allergen induced asthma and exercise induced bronchoconstriction **NOT USED FOR ACUTE SYMPTOMS**   - **MOA**: blocks acetylcholine receptors, preventing bronchoconstriction - ***[Beclomethasone:]*** corticosteroid - acute and chronic asthma as well as broncho constrictive disorders  - ***[Cromolyn]***: inhalants - Chronic asthma as an alternative to inhale glucocorticoids for the prevention of mild persistent asthma. Used also for prevention of seasonal allergies, before allergies and exposure - **MOA**: Suppresses bronchial inflammation and used prophylaxis in patients with mild to moderate asthma, doesn't provide quick relief. - ***[Montelukast]***: leukotriene blocker   - Long- term asthma and used to prevent acute asthma attacks that are induces by allergens, exercise, cold air hyperventilation, irritants and NSAIDS. **NOT EFFECTIVE IN ACUTE ATTACKS** - ***[Theophylline:]*** methylxanthine, it's a *[stimulant]* *[med]* and it works in the CNS for excitation and bronchodilation. - Oral administration is used for maintenance therapy of chronic stable asthma **Action plan:** zones and what meds to give in those zones **Green zone**: patient is symptom free and can perform normal activities. - **Meds**: fluticasone, salmeterol, montelukast, NOT albuterol **Yellow Zone:** Symptoms are worsening (coughing, wheezing, and mild SOB) Activities might be harder - **Meds**: *[**Rescue inhalers** ]* - **Albuterol** (short acting) - **Oral corticosteroid** of symptoms worsen **Red zone:** Severe symptoms like extreme SOB, chest tightness or difficulty speaking. Immediate attention needed. - **Meds: *[Rescue drugs]*** - **Albuterol** (short acting) - **Ipratropium** (extra bronchodilation) - **Prednisone** (Oral corticosteroids) - **Oxygen** **Inhalers**: **Administration** - Shake the inhaler well before each use (if applicable). - Attach a spacer if recommended (helps improve drug delivery and reduce side effects). - Exhale completely. - Place the mouthpiece between lips, forming a tight seal. - Press the inhaler and simultaneously inhale deeply and slowly. - Hold breath for 10 seconds to allow medication to settle in the lungs. - Exhale slowly. - Wait 1-2 minutes before a second dose, if prescribed. **Adverse effects:** - Tremors - Nervousness or anxiety - Rapid heartbeat (tachycardia) - Headache - Insomnia **Parts of the inhalers and purpose:** ***[Spacer or Holding Chamber]* (Optional Accessory)** - **Description**: A tube-like device attached to the mouthpiece (commonly used with MDIs). - **Purpose**: - Holds the medication after it is released, giving the user more time to inhale it. - Reduces medication loss in the mouth and throat, allowing more to reach the lungs. - Minimizes side effects like oral thrush when used with corticosteroids. **Patient teaching on inhalers:** - Shake the inhaler (if instructed). - Remove the cap and attach a spacer, if recommended. - Exhale fully away from the inhaler. - Place the mouthpiece in your mouth and form a tight seal with your lips. - Press the canister while inhaling slowly and deeply. - Hold your breath for 10 seconds, then exhale slowly. - Wait at least 1 minute before taking a second puff if prescribed. **Common Side Effects**: - For rescue inhalers: Tremors, nervousness, increased heart rate. - For inhaled corticosteroids: Oral thrush, hoarseness. **Levothyroxine: used for *[hypothyroidism ]*** - **Adverse effects:** hyperthyroidism, Tachycardia, tremors, dysrhythmia, angina, insomnia, MI, and HF - **Patient teaching:** take 30-60 minutes before breakfast **Thyroid storm: (Thyroid crisis)** - acute and life threatening basically associated with untreated or under treated hyperthyroidism. - **Manifestation: extremely** fast heart rate, extremely high BP, and extremely high temperature from the bodies hypermetabolic state that's being caused by the excessive number of thyroid hormones or in the patient's body **Post thyroidectomy manifestations:** **Hypocalcemia**: removal of parathyroids glands which regulate calcium balance are imbalanced. Give calcium supplements or vitamin D. - Calcium gluconate **Hypokalemia**: potassium supplementations **Hyponatremia:** - **Sodium supplementation**. - **Fluid restriction**. **Thyroid storm or crisis** - **Beta-blockers** (to manage symptoms like tachycardia). - **Antithyroid drugs** (such as methimazole or PTU). - **Cooling measures** for fever. - **Fluid and electrolyte management**. **Addison's disease: Treatment is hydrocortisone:** *[dexamethasone and prednisone ]* A cartoon of a person with a pressure gauge Description automatically generated  **Cushing's disease: Treatment is** *[Ketoconazole]* A cartoon of a person with a cane and text Description automatically generated Patient teaching on long-term Corticosteroid therapy: - *[Prednisone:]* induces apoptosis in melanoma cells and works to decrease bone pain. Long-term use can lead to infection, venous thromboembolism, muscle weakness, osteoporosis, and mood changes **Endocrine disorder:** **TSH** - High TSH is hypothyroidism - Low TSH : hyperthyroidism **T3**: measures the amount of triiodothyronine in your blood. T3 is a thyroid hormone that helps control your metabolism. **T4**: measures the amount of thyroxine in your blood. T4 is the main hormone produced by the thyroid gland **Lab values** ↓ TSH and ↑ T4= hyperthyroidism ↑ TSH and ↓ T4 = hypothyroidism Elevated **free T4** (the unbound, active form of T4) is a common laboratory finding in hyperthyroidism. **Hyperthyroidism**: Drug therapy: - 4 B's - Nonradioactive Iodine (Lugol's solution) - Methimazole - Propylthiouracil (PTU) - Beta-Blockers (Propranolol) A cartoon of a person with a fan Description automatically generated **Hypothyroidism**: - Myxedema (adults) - Congenital hypothyroidism (infancy) A cartoon of a person with headphones Description automatically generated **Endocrine meds that are contraindicated in pregnancy** - ***[Methimazole]*** - More dangerous than PTU in certain cases, during lactation and first trimester pregnancy., and may cause Agranulocytosis **Patho of esophageal varices and mediations that can help** - These are enlarged veins in the esophagus that can be life threatening if they rupture or a bleed. Its caused by hypertension which is high blood pressure in the portal vein that runs through the liver. The high pressure is often the result of cirrhosis, which as er talked about is a scarring of the liver. - **Treatment**: - If patient is in shock than we treat the shock and administer oxygen - IV fluids, electrolytes, volume expanders, blood, and blood products - **Vasopressin** (somatostatin) - **Octreotide** (sandostatin) - Drug of choice when immediate control of bleeding is needed bc it causes selective splanchnic vasoconstriction to the areas and splanchnic means the viscera of the abdominal organs. It will have bleeding eliminated in that site. - **Nitroglycerin w vasopressin** - **Propranolol/Nadolol :** decease portal pressure **Chronic cirrhosis and what are common abnormal lab values and what can happen based on those.** - **Abnormal Lab Levels:** - Elevated AST/ALT - Elevated Bilirubin - Low albumin - Prolonged PT and elevated INR - Elevated Ammonia - Thrombocytopenia - Complications: Portal hypertension, varices, and hepatic encephalopathy (*[lactulose is the medication) ]* Proper administration and adverse effects of acute and chronic pancreatitis medications **Acute pancreatitis:** there is a decrease in calcium levels, we need to monitor for tetany - **Medications:** - Morphine IV - Can cause constipation, n/v - Ondansetron IV or orally - Drowsy, headache, constipation - Antacids - Famotidine: decreases gastric acid **Chronic pancreatitis** - **Medication:** - Pancrelipase (Creon) - Abdominal pain, diarrhea, nausea - NSAIDS (Acetaminophen or opioids) - Hepatotoxicity, GI bleeds and kidney injury **Meningitis: *[treatment is cephalosporins]*** Risk factors: - Aseptic: - Caused by a viral infection SECONDARY to a weak immune system or cancer. - Septic: - Caused by bacteria - Spread by secretions or aerosol contamination - Most likely in dense communities like college dorms or jails. - Happens in the fall, winter, or early spring - Secondary to viral respiratory diseases - Mandatory reporting to the CDC - Untreated? 100% death rate **Ceftriaxone** (3^rd^ gen) - **MOA**: inhibits bacterial cell wall synthesis by binding to one or multiple penicillin binding proteins. **Nurse considerations for bacterial meningitis:** - [Nursing considerations:] - Assess: - Vital signs - LOC - Pain/ fever management - Protect patients from injury related to seizure activity or altered LOC - Monitor daily: - Weight - Electrolytes - Urine vol / specific urine gravity/ osmolality - Prevent complications with immobility - Ensure infection control precautions are in place - Offer supportive care - Initiate measure to facilitate coping of the patient and family - Administer antibiotics promptly (e.g., ceftriaxone) and maintain infection control measure **Causes of encephalitis and which 2 meds are given** - Causes: - viral infections such as herpes simplex, - vector borne viral infections such as West Nile - fungal infections. - Meds: - **Acyclovir** for HSV infection - **Amphotericin** or other antifungal agents for fungal infections. **Adverse effects to Amphotericin B** - **Adverse effects**: infusion reactions, nephrotoxicity, hypokalemia, hyponatremia, anemia and bone marrow suppression which can lead to leukopenia and thrombocytopenia. - **Infusion** **reactions**: fever, chills, rigors, which just means stiffness, nausea, and headache. **Neurotransmitters that are associated with mental disorders like anxiety, depression** - **Anxiety**: Increased norepinephrine and decreased GABA. - **Depression**: Imbalance in serotonin, norepinephrine, and dopamine levels **Lifestyle changes with hyperlipidemia** - Eat better, less salt, exercise - Reduce dietary saturated fats and cholesterol. - Increase fiber intake and exercise regularly. - Quit smoking and maintain a healthy weight **Nursing considerations and lab monitoring for patients on lithium** - **Nursing considerations**: monitor sodium levels closely and use caution for liver impaired patients. - **Lab monitoring:** creatinine and BUN to assess kidney function and electrolytes including sodium because lithium can affect sodium balance. - **Therapeutic range:** 0.5-1.2 **Contraindications of mental disorder medication like food are contraindicated.** - *[Phenylzine]*: 3^rd^ line antidepressant (rarely used) they have a risk of triggering hypertensive crisis if a patient eats food rich in tyramine like; aged cheese, chocolate, and sardine. **MOA of SSRI's** classes: blocks the reabsorption of neurotransmitter serotonin in the brain **Patient teaching and nursing considerations on benzos** ### Common Adverse Effects of Benzodiazepines - ### **Mild**: Drowsiness (don't let patient drive), dizziness, fatigue, confusion, blurred vision, headache. - ### **Severe**: Respiratory depression, hypotension, memory impairment, dependence, and withdrawal symptoms. **Interactions of insomnia medications** ***[BENZOS:] Diazepam or Lorazepam [ ]*** - have significant interactions with **CNS depressants**, such as **alcohol**, **opioids**, and **antihistamines**, which can lead to enhanced sedative effects, respiratory depression, and severe drowsiness. - Patients should avoid **grapefruit juice** because it can inhibit the metabolism of these medications, increasing their levels in the bloodstream **What is ascites: accumulation of fluid in the peritoneal cavity most commonly associated with liver dysfunction** - **Risk for it:** cirrhosis - Cirrhosis leads to portal hypertension (increased pressure in the portal vein) and reduced albumin production, both of which contribute to fluid leakage into the peritoneal cavity. **What is allopurinol** **Patho:** Xanthine oxidase is an enzyme involved in the conversion of **hypoxanthine** to **xanthine** and then to **uric acid** during purine metabolism. - By inhibiting this enzyme, allopurinol reduces uric acid production. - This leads to lower serum and urinary uric acid levels, reducing the formation of urate crystals. **Used for:** - Gout - Tumor lysis syndrome - Hyperuricemia (CKD) ### **Proper Administration and Labs to Monitor for Patients on Lactulose:** #### Proper Administration of Lactulose: - **Route**: Lactulose is typically administered **orally** or through a **nasogastric (NG) tube** if the patient cannot swallow. - **Dosage**: The initial dose is generally **15--30 mL** orally (or via NG tube) **1 to 3 times daily**, adjusted based on response and ammonia levels. - **Goal**: The aim is to reduce **ammonia levels** by increasing stool frequency (laxative effect), thereby excreting ammonia through the intestines. #### Labs to Monitor for Patients on Lactulose: 1. **Serum Ammonia Levels**: - Monitor ammonia levels to gauge the effectiveness of treatment. The goal is to reduce ammonia levels and improve mental status. - Normal range: **15--45 µg/dL** (varies by lab). Elevated levels indicate hepatic encephalopathy. 2. **Electrolyte Levels**: - **Potassium (K)**, **Sodium (Na)**, and **Chloride (Cl)** are crucial to monitor due to the risk of **electrolyte imbalances** from diarrhea caused by lactulose. - Normal ranges: - Potassium: **3.5--5.0 mEq/L** - Sodium: **135--145 mEq/L** - Chloride: **96--106 mEq/L** - Low levels, particularly of potassium, may need to be corrected to prevent complications such as **hepatic encephalopathy**. 3. **Fluid Balance**: - Monitor for signs of dehydration, as lactulose can cause significant fluid loss through frequent stools. Daily weights and input/output monitoring are important. 4. **Renal Function**: - **BUN (Blood Urea Nitrogen)** and **Creatinine** should be checked regularly to assess kidney function, as liver and kidney functions are closely related in these patients. ### **Summary:** - **Administer** lactulose orally or via NG tube, starting at 15-30 mL, adjusting based on response. - **Monitor** **ammonia levels**, **electrolytes** (especially potassium and sodium), **fluid balance**, and **renal function** to ensure proper treatment and avoid complications.