Type III

Question 1

Immune Complex Reactions

Answer 1

• Antigen-antibody complexes formed in circulation & deposited later in vessel walls or other tissue (kidney, vessels, skin, joints)
  > IgG & IgM antibody-antigen immune complexes in circulation
• Harmful effects caused by complement cascade activation
  > attracts neutrophils
  > unsuccessful phagocytosis
  > release of lysosomal enzymes into inflamm site; incrs inflamm reaction
• EX: rheumatoid arthritis, lupus

Question 2

Autoimmune Diseases

Answer 2

• Production of antibodies against the body’s own cells; destructed inflammatory process
  > both antibody and cell-mediated responses & products are directed against normal body cells
• Autoimmune disorders overlap
  > more than one disorder tend to occur
• Women most commonly affected
  > can affect all ages and gender

Question 3

Autoimmune - Connective Tissue Disorders

Answer 3

• Primary target 2 major structural protein molecules
  > Elastin: major component of ligaments & skin
  > Collagen: component of tissues & blood vessels

Question 4

Connective Tissue Disorders - Classic Diseases

Answer 4

• Rheumatoid Arthritis
• Systemic Lupus Erythematosus
• Scleroderma
• many others

Question 5

Rheumatoid Arthritis (RA)

Answer 5

• Damage to joints bilaterally & symmetrically
  > women of child bearing years
  > phases of exacerbations & remission
  > triggers (physical & emotional stress)

Question 6

Rheumatoid Arthritis (RA) - CMs

Answer 6

• Difficult to rise in AM
  > pain, stiffness
• Joint pain/deformities
• Rheumatoid nodules
• Systemic

Question 7

Rheumatoid Arthritis (RA) - Diagnosis Criteria

American Rheumatism Association

Answer 7

• 4 of 7 for diagnosis
  > morning stiffness greater than 1hr for 6wk duration
  > soft tissue swelling of wrist, metacepophalangeal or proximal interphalangeal joints for 6 wk duration
  > symmetric soft tissue swelling
  > rheumatoid nodules
  > positive serum rheumatoid factor test
  > radiographic changes in hands or wrist joints

Question 8

Systemic Lupus Erythematosus

Answer 8

Red = Erythematosus Lupus = Wolf (Red Wolf)
- Immune complexes invade organs
- Characterized by variability
> mild to severe
> women in childbearing yrs
> phases of exacerbation & remissions

Question 9

Systemic Lupus Erythematosus - Triggers

Answer 9

• Hormones
  > menses/pregnancy exacerbate disease
• Sun exposure
• Infections
• Drugs/meds

Question 10

Systemic Lupus Erythematosus - Diagnosis Criteria

Answer 10

• 4 or more serially or simultaneously
  > malar rash (butterfly)
  > discoid tash
  > photosensitivity
  > oral ulcers
  > arthritis (usually non-deforming)
  > ANA titer abnormal (>20)
  > Serositis (pleuritis/pericarditis)
  > other organ involvement

Question 11

Scleroderma (systemic sclerosis)

Answer 11

“Disease turns pt to stone”
- Inflammation & progressive tissue fibrosis & occlusion of microvasculature by collagen
> african american
> women middle age
> exacerbation/remissions

Question 12

Scleroderma (systemic sclerosis) - 2 Types

Answer 12

• Limited cutaneous disease
  > most common
  > symmetric skin thickening limited to distal extremities & face
• Diffuse cutaneous disease
  > organ involvement

Question 13

Scleroderma (systemic sclerosis) - CMs

Answer 13

• Raynaud’s
  > early sign 90%
• Skin hardening
  > sclerodactyly (stiff fingers)
• Telangiectasias
  > dilated superficial blood vessels
• Heartburn/dysphagia
• Joint pain
• Pulmonary fibrosis
• Anti-centromere antibody
  > SCL-70 (scleroderma antibody 35%)

Question 14

Autoimmune Connective Tissue Diseases - Diagnostic Tests

Answer 14

• Specialized blood tests
  > RA factor, ANA, LE prep, complement lvls
• CBC/chemistry
• Liver/renal function
• X-ray joints
• Chest x-ray
• ECG

Question 15

Autoimmune Connective Tissue Disease - Medical Treatment

Answer 15

• NO cure
• Pain control
• Meds: immunosuppressive
• Physical therpay
• Diet high in calories / vits
• Joint support
• Surgery
  > correct deformity, restore function

Question 16

Autoimmune Connective Tissue Diseases - Nursing Diagnosis

Answer 16

• Anxiety
• Fatigue
• Pain
• Impaired mobility
• Ineffective coping
• Potential for infection
• Body image
• Knowledge deficit
• Readiness for enhanced self-care

Question 17

Autoimmune Connective Tissue Diseases - Interventions

Answer 17

• Assess for organ involvement
• Prevent infection
• Joint protection
• Pain management
• Skin protection
• Manage fatigue/energy conservation
• Enhance body image
• Compliance w/ therapeutic regimen
• Manage meds & side effects
• Maintain optimal role function & self image

Question 18

Autoimmune Connective Tissue Diseases - Nursing Counseling

Answer 18

• Psychological issues
  > assist w/ coping
  > hereditary concerns
  > pregnancy & sexual counseling
  > ability to work
  > physical changes may cause problems for body image & social isolation

Question 19

Autoimmune Connective Tissue Diseases - Education

Answer 19

• Coping w/ chronic illness
• Avoidance of stress
• Protection from infections
• Establish exercise program
• Diet & nutrition counseling
• Sun restriction/physical limits
• Pregnancy