Integ/Immune Systems GOUT Cause: Eating foods with too much PURINE Ex of foods: organ meats (kidney, liver);

sardines; fish; cheese; wine, etc. Lab to monitor: Serum Uric Acid Pt. Education: No ETOH; and lose weight (if needs to) Meds to tx: Colchicine; allopurinol; and probenecid

LUPUS Fact: It is an inflammatory process of connective tissue Fact: Exacerbation of SLE can be caused by STRESS Question: What could cause an exacerbation of Lupus? Ans: Any psychological or physiological stress (Ex: pregnancy, divorce, meds, surgery, etc.) GOLD NUGGETS: 1) Lupus pt typically has a butterfly shaped rash over nose & cheeks; 2) Can have discoid (coin-like lesions) on chest (or body) Fact: Lupus pt is photosensitive stay out of the sun; or wear long sleeves if outside Question: How would you know that your Lupus pt understands DC instructions? Ans: Pt states,I will wear a hat and long sleeves while I am outside. Fact: Lupus can damage the kidneys Kidney problem concerns: (these are the BIG 4): a) BUN b) Creatinine c) Albumin d) Protein ** There should be NO albumin or protein in the urine!!! ** Need to ensure pt has at least urine output of 30mL/hour (WNL range 5-20) a BUN of 50 would be of concern (WNL range .5 1.5) 2 or higher would be of concern (3+, 2+, or 1+ is abnormal)

PEDICULOSIS (Lice) & SCABIES Fact: Both are Contact Isolation (glove & gown) **The HH nurse needs to tell mom to wash ALL linens & clothing in HOT, soapy water or drycleaned FACT: If cant be washed in hot, soapy water or dry-cleaned, then bag ALL linens, clothing, stuffed animals, curtains, etc.) in plastic bag, tie tightly, and leave for 2 weeks. Recommended tx: Shampoo containing lindane (Kwell), RID, or R&C shampoo. After hair is rinsed, it is combed with a fine toothed comb dipped in vinegar to remove remaining nits. Pediculosis Capitis (Head lice) Pediculosis Corporis (Body lice) Pediculosis Pubis (Pubic lice) SCABIES: Is: infestation of the skin by the itch mite Sarcoptes scabei All bedding & clothing should be washed in hot, soapy water & dried on the hot dryer cycle.

HIV/AIDS FACT: An AIDS pt does not have to be placed in a room by themselves; just do not place them with an infection pt (b/c AIDS pt is neutropenic) HIV/AIDS pts can be placed with pts w/appendicitis, cholecystitis, diverticulitis, pancreatitis, lupus, Hep B,C,D pts. WHY? These are all Standard Precaution pts. The most common infection in AIDS pts is Pnemocystis Pneumonia (PCP) The most common HIV- related malignancy is Kaposis Sarcoma

RHEUMATOID ARTHRITIS Know the difference between osteoarthritis and rheumatoid arthritis Since RA involves hand contractures & deformity, do the following: Build-up drawer handles & eating utensils Have a firm mattress/lay in good alignment (not in fetal position) To avoid contractures, encourage extension!!

 Pt. education:

Place hand & wrist on a good, clean splint

Do NOT knit, crochet, quilt, drive too long, hold pencil. All of these are contracting activities Stress can cause exacerbation (flare-up) of RA

**Give pt Aspirin with food, plenty of H2O, & an antacid. Can cause a GI bleed if you dont Interventions for RA: Give pt warm bath in AM (why?) b/c pt has morning stiffness Place warm compresses on joints prior to exercise Advise the RA pt to do chores in early afternoon (WHY?) b/c they have AM stiffness

Rx Tx: Methotrexate: Used to tx RA b/c its an immunosuppressant *Also used in chemo tx TELL RA PT ON METHOTREXATE: Flush the commode 3 times after every use b/c drug is so toxic PSORIASIS Should a psoriasis pt use a tanning bed? YES its good for them BURNS Do NOT put a DRY dressing on a burn pt PRACTICE QUESTIONS: Pt has a 2nd degree burn. You need to change the dressing. You would: a) Place the medication on the dressing and then apply to burn NO b) Premedicate the pt before the dressing change WHY? b/c its going to hurt c) Wash area with hydrogen peroxide vigorously prior to applying medication NO d) Apply dry dressing NO. Never apply dry dressing b/c it will debride when you pull it off

You would know the pt who has been diagnosed with SLE (Lupus) understands your post-discharge instructions if she states: a) I will wear long sleeves when out in the sun. YES b/c SLE pt is photosensitive b) I will attend aerobic classes 2-3 times weekly - NO c) I will increase my fluid intake - NO d) I will have red circular lesions with a white center NO

You would know the parents of a child receiving a varicella vaccine understand if they state: a) This immunization guarantees my child will never get chickenpox NO b) My child can have the vaccine even if she is sick NO c) My child does not have to have the immunization true but the question states the child is receiving the shot d) My child may have a slight fever after immunization YES

**FYI: Chickenpox is CONTACT and AIRBORNE precautions Shingles is AIRBORNE only

Aspirin is ordered for the arthritis pt you would notify physician if: a) Change in the color of stool YES. Upper GI bleed can cause dark, tarry stools b) Pt states he has been taking aspirin with milk NO ok to do c) Pt states he has been taking aspirin with food NO ok to do d) Pt states she has been taking enteric-coated aspirin without crushing NO ok to do

In 8 weeks, Mrs. Jones discovers that she is pregnant. You would know a) She will have to take Heparin YES (see explanation below) b) She can no longer take Coumadin or Heparin NO c) The Coumadin needs to be increased NO d) She will now need the Vit K injections NO

Fact: Cannot take Coumadin when pregnant it crosses the placenta barrier CAN take Heparin it does NOT cross placenta barrier Why give Heparin to a pregnant & postpartum pt? She is at high risk for DVT Not a question: When making rounds what makes you feel your pt has a DVT? 1) Leg is edematous 2) Leg is painful 3) Leg is warm to touch (phlebitis) 4) Leg is slightly red

What are your nursing interventions of your pt with a DVT? 1) Measure both calves & thighs daily (leg is edematous/measure both for comparison) 2) Give pain med (to treat pain) 3) Apply warm compresses (to increase circulation) 4) Elevate leg (venous) 5) Give Heparin (monitor PTT lab)

When leg problems are Venous legs go UP / if Arterial legs go DOWN