systemic lupus erythematosus

March 1, 2008 · Filed under MS-immunologic disorder · Tagged , , , , , ,

main problem: exaggerated production of autoantibodies as a result of disturbed immune regulation

pathophysiology: abnormal suppressor T-cell function -> immune complex depostion -> tissue damage -> inflammation -> antigens stimulated -> stimulation of more antibodies -> cycle repeats

OR

             immune system attacks the body’s cells & tissue -> tissue damage -> inflammation

related to:

     1.) genetic

     2.) hormonal – onset during childbearing years

     3.) drug-induced – antiseizure, hydralazine, isoniazid, chlorpromazine, procainamide

outstanding signs and symptons: malar rash (aka butterfly rash) across the bridge of the nose and cheeks

signs & symptoms: systemic manifestations

     skin – alopecia, chronic rash that has erythematous papules or plaques & scaling, oral ulceration

     cardio – inflammation of various parts of the heart 

     respi – pleurisy

     musculoskeletal – joint swelling, stiffness, tenderness, warmth and pain movement

     renal – painless hematuria, proteinuria, glomerulonephritis

     neurologic – subtle changes in behaviour patterns or cognitive ability, seizure, chorea, depression, psychosis

     hematologic – moderate to severe anemia, thrombocytopenia, leukocytosis or leukopenia

diagnostic tests:

     (1) erythrocyte sedimentation rate (ESR) – elevated

     (2) WBC and platelet – decreased

     (3) Anti Nuclear Antibody Test , LE prep, anti DNA - positive

     (4) chronic false (+) for syphyllis    

classic signs & symptoms: fever, fatigue, weight loss, pleurisy, possible arthritis, pericarditis

medical management: goal is to prevent progressive loss of organ function

     (1) treatment: management of acute and chronic diseases

     (2) medicines:

                   (a) NSAIDS

                   (b) corticosteroids

                   (c) immunosuppressive agents

                   (d) antimalarial agents – for arthritis like symptoms

nursing management:

     (1) do a thorough systemic physical assessment. inspect for erythematous rashes, cutaneous erythematous plaques with scale on scalp, face and neck

     (2) note area of hyperpigmentation or depigmentation

     (3) inspect scalp for alopecia and mouth and throat for ulceration

     (4) provide appropriate oral care

     (5) note pericardial friction rub and abnormal lung sounds

     (6) observe for signs of musculosceletal involvement. note joint swelling, tenderness, warmth and pain on movemend and stiffness

     (7) observe for signs indicative of renal involvement. note edema and hematuria

     (8) do a direct neurological assessment. ask family members or signifcant other regarding behavioral changes

     (9) note and report signs of depression, seizure and chorea

 

 

 

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varicose veins / varicosities

March 1, 2008 · Filed under MS-circulator disorder · Tagged , , , , , , , ,

main problem: turtuous, abnormally dilated, superficial veins due to incompetent venous valves

pathophysiology: reflux of venous blood —> venous statis                                                                                                     

     (1) primary – no involvement of deep veins

     (2) secondary – result from obstruction of deep veins

outstanding signs & symptoms: dilated veins and feeling of heaviness of the legs

signs & symptoms: nocturnal muscle cramps, dull aches, increased fatigue in lower legs and ankle edema

diagnostic tests:

     (1) duplex scan – anatomic site & measure severity of reflux

     (2) air plethysmography – measures venous blood volume changes

     (3) venography – injection of x-ray contrast used to evaluate valvular reflux

medical management:

     (1) surgery – ligation and stripping of saphenous vein

     (2) sclerotherapy – may be performed after vein ligation or stripping and only for small varicosities

                 how? – sclerosing agent is injected –> irritates the venous endothelium –> localized phlebitis & fibrosis –> lumen of the vein obliterates

nursing management:

(1) post surgery

          (a) bed rest for 24 hours

          (b) after 24 hours, patient is encouraged to walk every 2 hours for 5 to 10 minutes

          (c) elastic compression bandage is worn for about 1 week

          (d) foot of bed elevated

          (e) administer analgesics as ordered

          (f) inspect dressing for bleeding

          (g) encourage patient to report hypersensitivity to touch and and sensation of “pins and needles“

          (h) discourage standing still and sitting

          (i) instruct patient to dry the incisions well with a clean towel using the patting technique rather than rubbing after shower

          (j) avoid applying lotion to incision site to avoid infection

(2) post sclerotherapy – educate patient that a burning sensation in the injected leg may be experienced for 1 to 2 days.

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diabetes insipidus

February 26, 2008 · Filed under MS-endocrine disorder · Tagged , , , , , , , ,

diabetes insipidus – disorder of the posterior lobe of the pituitary gland

main problem: deficiency of antidiuretic hormone or vasopressin

related to: (1) secondary to head trauma (2) brain tumor (3) surgical ablation (4) irradiation of the pituitary gland (5) infection of the CNS (6) failure of the renal tubules to respond to ADH

outstanding symptoms: 3Ps – polyuria, polydipsia, polyphagia AND large volume of dilute urine

signs and symptoms: (1) craves cold water (2) patient tend to drink 2 to 20liters daily (3) hypernatremia (4) severe dehydration (5) weight loss

diagnostic test:     fluid deprivation test – plasma and urine osmolality study done before and at the end of the test

          how? – fluid intake is withheld for 8 to 12 hours or until 3% to 5% of the body weight is lost

          (+) diabetes insipidus – failure to increase specific gravity and osmolality of urine

          stop! - if patient experiences tachycardia, hypotension and excessive weight loss

nursing management:

     (1) admin medicines as ordered: (a) desmopressin – intranasal administration (b) lypressin – intranasal administration (c) vasopressin tannate in oil – intramascular administration (d) Clofibrate & Chlorpropamide

     (2) administer vasopressin with caution if patient with coronary artery disease – has vasoconstrictive action 

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hypopituitarism

February 24, 2008 · Filed under MS-endocrine disorder · Tagged , , , , , , , , , ,

function: the pituitary gland secretes hormones that control the secretion of hormones by the other endocrine glands. it is also know as the mother gland.

main problem: disease of the hypothalamus or the pituitary gland itself can result to the hypofunction of the pituitary gland. It may be due to the destruction of the anterior lobe of the pituitary gland.

          Simmond’s disease (panhypopituitarism) - total absence of all pituitary secretions

          Sheehan’s syndrome - post-partum pituitary necrosis. it is likely to happen to women with  severe blood loss, hypotension and hypovolemia during delivery

signs and symptoms: weight loss, emaciation, atrophy of all endocrine glands and organs, hair loss, impotence, amenorrhea, hypometabolism, hypoglycemia

complication: coma and death if missing hormone not replaced

        

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Hello world!

February 24, 2008 · Filed under Uncategorized

hello fellow nurses and to those who are interested to know about certain disorders, this site is for you! i recently thought of doing this because i myself needed some reminders about certain diseases, disorders or anything related to nursing. i will do my best to make notes here at least one topic each day. i hope that this can help you too.

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