Immune System
Allergies, Anaphylaxis & Angioedema
Inflammatory Rheumatic Disorders
Rheumatoid Arthritis
Lupus
100

Type of immunity gained from a prior exposure to antigen, can be active or passive

What is Acquired Immunity?

100

The nurse is administering intravenous vancomycin. What is a priority nursing assessment if the patient begins to experience a possible allergic reaction?

What is airway assessment, monitoring, and management. 

The initial nursing assessment and intervention needs to be directed toward evaluating breathing and maintaining an open airway, so the initial assessment will be for dyspnea, bronchospasm, and laryngeal edema. Hypotension, pruritis, and flushing may occur, but the airway is most important.

100

Painful phenomenon associated with scleroderma that causes exaggerated contraction of small blood vessels in fingers and toes. Patients often endorse severe pain in their digits. 

What is Raynaud's Phenomenon?

100

RA attacks this part of the body, causing swelling and pain

What are Joints?

100

Lupus is a type of _________ disease

What is Autoimmune?

200

What organ is considered lymphoid tissue?

Lymphoid tissues, such as the thymus gland, tonsils and adenoids, spleen, and lymph nodes, play a role in the immune response and prevention of infection.

FYI- The pancreas, intestines, and liver are not lymphoid tissue.

200

The nurse is caring for a patient exposed to peanuts with a known allergy. What assessment is considered the most serious manifestation of angioneurotic edema?

A. Abdominal Pain

B. Conjunctivitis 

C. Laryngeal swelling

D. Urticaria 

What is C- Laryngeal swelling

Diffuse swelling can affect many regions: lips, eyelids, cheeks, hands, feet, genitalia, tongue, larynx, bronchi, and the gastrointestinal canal. The most serious is the larynx because of the potential for compromised breathing. Abdominal pain, conjunctivitis and urticaria are not the most serious manifestations.

200

This Inflammatory Rheumatic Disease is characterized by impairment of the endothelial lining of the blood vessels resulting in vasculitis.

What is Giant Cell Arteritis

GCA - is the most common form of vasculitis in adults impacting medium and large arteries. One of the most common vessels impacted are the temporal arteries (running along the temples in front of the ears) giving the disease the nickname "temporal arteritis"

200
Patients with RA often experience impaired _______, and the nurses must assess the need for PT/OT to assist

What is Mobility?

200

It is important for patients with lupus to avoid ____ __________

What is Sun Exposure?

Will also accept:

What is stress? What is individuals with transmissible infections/illnesses?

300

A 25-year-old female is admitted to the ER in anaphylactic shock due to a bee sting. According to the patient's mother, the patient is severely allergic to bees and was recently stung by one. This type of anaphylactic reaction is known as a?

 A. Type I Hypersensitivity Reaction

 B. Type II Hypersensivity Reaction

 C. Type III Hypersensivity Reaction

 D. Type IV Hypersensivity Reaction

The answer is A.

Rationale: Type I Hypersensitivity Reactions are immediate and cause anaphylaxis. It occurs when an antigen (the allergen….in this case bee venom) attaches to immunoglobulin E (IgE) antibodies. These antibodies are created due to this allergen and attach to the mast cells and basophils. This leads to a system-wide release of inflammatory mediators (histamine and other inflammatory substances). It is important to note a patient must be sensitized (meaning the immune system has seen the allergen before and produced IgE antibodies in response to the allergen). When the person comes into contact with the foreign substance AGAIN (at a later time) the allergen will attach to that previously created IgE antibody on the mast cell. This will lead to a massive release of histamine and other inflammatory substances that will cause anaphylaxis and lead to anaphylactic shock.

300

A patient is given a dose of ketorolac, a nonsteroidal anti-inflammatory (NSAID) drug for complaints of abdominal pain. Ten minutes after receiving the medication, the client’s eyes, lips, and face begin to swell, and the nurse hears stridor. What priority intervention should the nurse anticipate/prepare to do?

A. Intubate client

B. Obtain an EKG

C. Assess VS

D. Administer Epinephrine

What is D Administer Epinephrine 

Anaphylaxis is a rapid and profound type I hypersensitivity response. A massive release of histamine causes vasodilation; increased capillary permeability; angioneurotic edema (acute swelling of the face, neck, lips, larynx, hands, feet, genitals, and internal organs); hypotension; and bronchoconstriction. A nurse must administer 0.3 mg of epinephrine subcutaneously to a patient experiencing a severe allergic reaction. It is outside of the nurse’s practice to intubate a patient. Performing an ECG and assessing the vital signs delays the treatment of the patient and can have negative outcomes.

300

Class of medication that is often prescribed to patients experiencing an exacerbation or "flare" of an inflammatory rheumatic disorder.

What is a Corticosteroid?

FYI: most often this is either Prednisone or Methylprednisolone.

300

These are two inflammatory markers you would expect to be elevated during RA exacerbation (flare)

What are ESR & CRP

The ESR and CRP tend to be significantly elevated in the acute phases of most inflammatory rheumatic diseases, especially RA & SLE, and are therefore useful in monitoring active disease and disease progression.

300

Roughly 40-50% of patients diagnosed with SLE will have systemic involvment of this organ system

What is Renal system

Will also accept cardiac or hematologic 

Most often mortality for those with SLE involves renal failure. 

Other commonly impacted organ systems with lupus include the vascular system and almost all patients have joint involvement

400

What are the primary participants in the immune system?

What are Lymphocytes, which are either T-cell or B-cell lymphocytes, comprise 20% to 30% of all leukocytes. T-cell and B-cell lymphocytes are the primary participants in the immune response.

400

A patient asks the nurse if it would be okay to take an over-the-counter (OTC) antihistamine for the treatment of allergic rhinitis. (A mild type I hypersensitivity reaction) What should the nurse educate the patient is a major side effect of antihistamines?

What is drowsiness, fatigue, sedation

Antihistamines are the major class of medications prescribed for the symptomatic relief of allergic rhinitis. The major side effect is sedation, although H1 antagonists are less sedating than earlier antihistamines.

400

Initiation of treatment with any Biologic DMARD will take roughly this long to ilicit therapuetic effects?

What is 6 weeks

Patients generally report a beneficial effect w/in 6 wks but response is patient specific. It is important to educate patients on this and that therapuetic effects may take as long as 3 months

400

Prior to starting on adalimumab (Humira) the provider will most likely order this to ensure safe initiation of the medication?

What are serum lab tests (labs/blood tests)

Patients should be tested for tuberculosis (TB) before beginning this medication. Patients should also complete baseline lab work that includes CBC and CMP. If a tuberculosis test comes back postivite (or indeterminate) a chest x-ray will be ordered to rule out TB,

400

This is an exageration of symptoms often provoked by stressors like illness or injury

What is an exacerbation or "flare"

500

The abrupt cessation of this classification of medication may result in adrenal crisis, a life-threatening condition characterized by circulatory collapse.

What are corticosteroids?

500

This assessment finding (especially heard without the use of a stethoscope) is indicative of upper airway obstruction and warrants immediate life-saving medical attention.

What is stridor.


Stridor is continuous, high-pitched, musical sound heard on inspiration, best heard over the neck; may be heard without use of a stethoscope, secondary to upper airway obstruction

Wheezes are continuous musical sounds associated with airway narrowing or partial obstruction

500
Symptomatic control in generally the goal of treatment for patients with this disease. One systemic manifestation often treated with ACEIs is the scerlosing of renal blood vessels leading to malignant hypertension.

what is scleroderma 

Manifestations: dry skin, stiffness & declining mobility

Systemic: esophagus & intestines become sclerosed, lungs becomes scarred, vascular involvement of kidneys leads to malignant HTN & renal insufficiency

500

Common medication for RA, known for causing immunosupression, hepatotoxicity, interactions with several antibiotics, and severe GI discomfort

What is Methotrexate?

Methotrexate (MTX) often the 1st line treatment option for RA (also useful in SLE) MTX may be given orally or by intramuscular or subcutaneous injection.

Assess for: bone marrow suppression, GI ulcerations & upset, skin rashes, alopecia, bladder toxicity, increased infections. Educate pt on these side effects

Monitor CBC, liver enzymes (hepatotoxic), creatinine (baseline, 6 wk after start, then q2–3 mo or as ordered)

Advise/educate on contraceptive measures because of teratogenicity

500

Common medication used to decrease the antibodies attacking the body for long term control of lupus, also an anti-malarial

What is Hydroxychloroquine?

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