wk2 i n i lec
-
Upload
byox-ohlee -
Category
Documents
-
view
216 -
download
0
Transcript of wk2 i n i lec
-
8/6/2019 wk2 i n i lec
1/50
-
8/6/2019 wk2 i n i lec
2/50
Hypersensitivity
y abnormal heightened reaction to a stimulus of any
kindy a state of altered reactivity in which the body reacts
with an exaggerated immune response to what isperceived as a foreign substance.
-
8/6/2019 wk2 i n i lec
3/50
Assessment
-
8/6/2019 wk2 i n i lec
4/50
. Health History
CONFIDENTIAL MEDICAL INFORMATION/FAX COMPLETED FORM TO 647-4768 FOR EVALUATION
The University of Michigan Occupational Health and Safety ProgramFor Personnel Working with AnimalsRisk Assessment Form and Health Surveillance QuestionnaireFirst Name: _____________________ MI: ______ Last Name: _________________________________Gender: M F D.O.B.: ___/___/___ Social Security # _____/____/_________Primary Language: Email:Home Address: Home phone: / /
City: State: Zip:
Student Temporary Faculty Staff Primary Investigator:Projected Duration of project/duties involving animals:Non-Human Primate Contact1) Requires TB testing at MWorks Occupational Health Clinic.
Contact Donna Capron @ [email protected] if you need more information.2) Requires proof of immunity for RUBEOLA (Measles):
- Live-virus vaccine dates. First Second(First dose received after first birthday and second dose at least one month later.)
- Laboratory evidence of immunity date.- Adult born before 1957 can be considered immune.
What other species of animals will you be exposed to?
[This includes direct contact with animals, animal tissues and/or wastes, and animal enclosures.]What kind of contact will you have? [Check all that apply.]Direct contact with animalsDirect contact with non-fixed or non-sterilized animal tissues, fluids, or wastesDirect contact with non-sanitized animal caging or enclosures
Service support to animal equipment, devices, and/or facilities
-
8/6/2019 wk2 i n i lec
5/50
Do you have contact with animals outside of work? Yes NoIf yes, please list the species
Allergy HistoryList any allergies to medications:
Do you have any of the following? (Check all that apply)Chronic cough Hay fever Skin rash AsthmaChronic allergies (food, pollens, dust) Allergic rhinitis (runny nose due to allergy)
Allergic conjunctivitis (itchy, watery eye from allergy)A natural parent or sibling with allergies to animals or their substancesAre you allergic to?Dog Cat Farm Animals Bird (feathers) Sheep (wool) PrimatesRabbit Swine Rats or mice Guinea Pigs Alfalfa Weeds
Latex Grasses Trees Wood Chemicals OtherDo you have any of the following symptoms that you feel are caused by, or made worse, because of
your work with laboratory animals? Watery, burning, or itchy eyes Runny nose Sneezing Shortness of breathCough Chest tightness Wheezing Hives RashPlease list any concerns or other information the provider should know:
I verify that all information is accurate and that I have referred to and read all pertinentinformation relatedto the animals that I come in contact with. I have reviewed all of the risk related documentsposted on theOSEH web site that refer to my current work status.Signature: Date:Print Name: Dept: __________________________
-
8/6/2019 wk2 i n i lec
6/50
Nursing Responsibilities in diagnostic
evaluation/ tests
y skin testing entails intradermal injection orsuperficial application of solutions.
Three Methods:y Scratch test/prick test
- performed when contact dermatitis is suspected.
- uninvolved skin such as the upper back are used for
testing- skin is superficially scratched/ pricked with anallergen for an immediate reaction. Wheal formationmeans [+] result.
-
8/6/2019 wk2 i n i lec
7/50
y NSG. Responsibilities:
- Shave the hair of the area to be tested.
- Resuscitation equipment at bedside or within reach
-
8/6/2019 wk2 i n i lec
8/50
Patch testy delayed hypersensitivity reaction develops in 48-96 hrs
y the allergens are applied under occlusive tape patches.
Removed after 2 days after rxn is noted.y NSG. Responsibilities
- Test site must dry, free from moisture and oils.
-
8/6/2019 wk2 i n i lec
9/50
Intradermal Testingy Injecting a small amount of antigen into the ID layer of the
skin.
y Most accurate but severe reaction could occur.
y [-] result: ab have not formed to this antigen. Antigen
deposited in the subcutaneous layer. Immunosuppressed.y NSG. Responsibilities:
- Ask for allergic history
- Apply cold compress topical steroids for minor
itchiness.
- Keep injection site clean and dry if ulceration
occurs.
- Prepare O2, epinephrine, antihistamine IV prn as
ordered.
-
8/6/2019 wk2 i n i lec
10/50
Food Allergy Testingy a. Food Challenges
- suspected foods are given to the client in
progressively larger doses until reaction occurs.
- manifestation: erythema, itching, rash, vomitingand diarrhea.
y b. Elimination Diet
- foods are eliminated from diet one by one untilthe manifestation are relieved.
- this ma indicate allergies to food additives or the
food themselves
-
8/6/2019 wk2 i n i lec
11/50
Nu
rsing Management
-
8/6/2019 wk2 i n i lec
12/50
DISEASE /
CLASSIFICATION
CAUSE MODE OF
ENTRY/EXIT
MODE OF
TRANSMISSION
SIGNS AND
SYMPTOMS
NSG MANAGEMENT
ALLERGY (HYPER-SENSITIVITY)1.Anaphylaxis
Antigen-antibodyresponsethatprecipitatethe releaseof
vasoactivesubstances(histaminecausingprofoundvasodilation& increasecapillarypermeability
Respiratory,integumentary,GIT absorbingthe bloodstream
Antigen,allergen,contagious
1.Hypotension tovascular collapse2.Urticaria,diffuseerythema,periorbital edema3.Hoarseness,wheezing
4.Bronchospasmto respiratoryfailure5.Vomiting6.Generalizedburning/itching7.Sense ofimpending doom
1.Impaired gasexchange R/Tbronchoconstriction2.Anxiety r/t difficulty ofbreathing3.Fluid volume deficitr/t increased capillary
permeability4.Decreased cardiacoutput r/t hypovolemia5.Assess clientshx,skin test medicationbefore administration6.Position comfortably7.Maintain adequateventilation & patent
airway.8.Carefully titrate fluidwith v/s9.Monitor carefully asfluid begins to shiftback into the vascularutilization of airwayadjuncts(airways & ET.Intubation)
-
8/6/2019 wk2 i n i lec
13/50
-
8/6/2019 wk2 i n i lec
14/50
DISEASE /
CLASSIFICATION
CAUSE MODE OF
ENTRY/EXT
MODE OF
TRANSMISSION
SIGNS AND
SYMPTOMS
NSG MANAGEMENT
2. TransplantRejection
Graft/organincompatiblewith recipientand recognizedas non-self .
1.Necrosis,inflammation andbleeding at thesite of transplant.2.Unstable V/S inmajor organtransplant.
1.monitoring of V/S,site for inflammation,necrosis and bleeding
3. Contact Dermatitis 1.poison ivyand poison oak2.fabric, wool,polyester
3.cosmetics4.detergents,soap, hair dye5.paints, dyes,
insecticides,rubbercompounds( sskin reaction ,usually a
delayedhypersensitivityreaction )
due to anantigen)
skin Non-communicable
1.pruritusespecially whenexposed under
the sun.2.hive-likepapules &plaques3.edema
4.sharplycircumscribedareas withoccasionalvesicle formation
1.health education toavoid contact withspecific allergen.
2.Provide cool, tepidbath, trim fingernails &utilize measures tocontrol itching3.Avoid irritating the
affected area, removebulky clothing
-
8/6/2019 wk2 i n i lec
15/50
-
8/6/2019 wk2 i n i lec
16/50
-
8/6/2019 wk2 i n i lec
17/50
4. Hay fever(allergicrhinitis Pollinosis)
Airbornepollens(seasonal)
nose 1.edematousclosed nostrils2.nasal mucous
membranes itch,burn & secrete thinirritating discharge3.sneezing-violentparoxysms4.eyes-red,
burning,lacrimating
1.advise pt to considermoving to an areawhere pollen count is
low, howeverimpractical2.remove irritatingsubstances(pets,stufftoys, feather pillows)3.avoid outside
allergens by remainingindoor as much aspossible, using airconditioning.
-
8/6/2019 wk2 i n i lec
18/50
-
8/6/2019 wk2 i n i lec
19/50
-
8/6/2019 wk2 i n i lec
20/50
-
8/6/2019 wk2 i n i lec
21/50
DISEASE /
CLASSIFICATION
CAUSE MODE OF
ENTRY/EXIT
MODE OF
TRANSMISSION
SIGNS AND
SYMPTOMS
NSG MANAGEMENT
6. Bronchial Asthma-a hyperresponsivestate of the bronchi,
which may beantigen-mediated(allergic)
AllergensPrecipitating-
1.streptococcusrespiratory
infection2.intolerance to aspirin,indomethacin3.cold &
suddenbarometricchanges4.exercise
5.emotionalupset6.airpollutants-industrial
chemicals
respiratory Non-communicable
Early episodes:drycough, mild chesttightness
Severe episodes-wheezing,coughing, SOB,
laborious &prolongedexpiration thaninspirationDyspnea becomesapparent,
inspiratorywheezing & use ofaccessorymuscles(bronchos
pasm)Weak pulse,sweating, coughbecomesproductive
Anxiety,restlessness &apprehensionFatigues stato mayfollow leading torespiratory failure
with hypercapnia,respiratoryacidosis &
hypoxemia
1.never overusebronchodilators toavoid excessive drying
of tracheo-bronchialtree & cardiacarrhythmias2.elevate head of bed.
3.Regulate temp.&humidity to comfortablelevels4.Increase oral fluid5.Chest physiotherapy
6.Act calmly, reassurept during attack7.Stay with pt untilattack subsides.8.Avoid crowds &
sources of infections.9.Reduce number ofallergens @home(dust, pets,
plants, etc.)10.Promote goodnutrition adequate rest11.Avoid otudoors onhigh humidity days12.Avoid cigarette
-
8/6/2019 wk2 i n i lec
22/50
-
8/6/2019 wk2 i n i lec
23/50
7. Stinging insectallergy
Sting of aninsect is aforeignprotein thatstimulates
immuneresponse,thus
inflammation occurs.
Skin andmucousmembrane
Bite of an insect. 1.Skin rashes2.Macule3.Redness/heat4.Itciness5.Bronchospasm
followed byshortness ofbreath and
cyanosis in severecases.
1.monitor V/S closelyincluding level ofconsciousness2.prepare O2 andintubation set at
bedside3.prepare forvenoclysis.
4.Position patient onmoderate high backrest for airwayclearance.
8. Blood TransfusionReaction
ABO/Rhincompatibility. An
antigen-antibodyreaction.
Blood stream Transfusion 1.generalized skinrashes (flare)2.urticaria
3.heat4.Shortness ofbreath andcyanosis in severecases.
1.same as above2.stop/discontinuetransfusion
immediately.
-
8/6/2019 wk2 i n i lec
24/50
-
8/6/2019 wk2 i n i lec
25/50
Type I ( immediate, Ig E-antibodies involved)
y Person sensitized by prior exposure to a particular antigen.
y When same antigen reappears, it interacts with the IgE whichinitiates mast cell degranulation. The mast cell degranulationactivates the release of chemical mediators, primarilyhistamines.
y Histamine major chemical mediator.y spasm of bronchial muscles.y Capillary vasodilationy Increased capillary permeabilityy Decreased blood pressurey Increased nasal stuffiness and bronchial secretionsy Peak effect in 1 2 minutes and last for about 10 minutesy Disorders associated with Type 1.y Anaphylaxis( most severe)y Atopic reactions ( most common)y allergic rhinitisy urticaria
-
8/6/2019 wk2 i n i lec
26/50
Type II ( cytotoxic, IgG and IgM-antibodies involved)
y complementary system is activated causing
cytotoxic effects against the bodys own cells.y The normal process of phagocytosis begins to
damage normal body tissue.
y Disorders associated with Type II.
y hemolytic disease of the newborny myasthenia gravis
y acute graft rejections
-
8/6/2019 wk2 i n i lec
27/50
y Type II hypersensitivity Type II hypersensitivity reactions arecaused by antibody-mediated cell damage or lysis. The actualmechanisms underlying cell destruction are multiple:
y (i) complement-dependent red blood cell lysis occurs forexample in haemolytic transfusion reactions (HTR) caused byABO incompatibility and in other forms of haemolyticanemias.
y (ii) antibody-dependent red blood cell degradation occurs,
for example. as the result of binding of antibodies to the redcell membrane which fail to activate complement butpromote macrophage uptake and catabolism. This occurs forexample in the haemolytic disease of the newborn (HDN)caused by Rh incompatibility.
y (iii) antibody-dependent cell-mediated cytotoxicity (ADCC)occurs when cytotoxic antibodies become fixed on the surfaceof cytotoxic T cells and subsequent antigen binding induceperforin-dependent cell lysis of the cell bearing the antigen
-
8/6/2019 wk2 i n i lec
28/50
Type III (immune complex, IgG and IgM antibodies
involved)
y circulating immune complexes (antibody/antigen complex) aredeposited in the body tissue.
y When the immune complex is deposited in the body tissue, thecomplement factors may be activated. This causes local tissueinflammation and cell wall damage.
y Categories of immune complex formation
y persistent infections ( streptococcal infections) combined with a poorantibody response may lead to the formation of immune complex thateventually deposits in an affected organ.
y endocarditisy acute glomerulonephritisy serum sickness (injection with foreign serum)
y the body produces antibodies that attack the bodys own cells (autoantibodies)
y rheumatoid arthritisy systemic lupus erythematosusy repeated inhalation of allergens causes immune complex formation to
be deposited in the lungs and on other body surfaces.
-
8/6/2019 wk2 i n i lec
29/50
Type IV ( cell mediated , delayed
hypersensitivity)
y The T-cells are sensitized to an antigen from aprevious exposure.
y The sensitized T-cells initiate the inflammatoryresponse leading to cellular damage and damage tothe surrounding tissue.
y Disorders associated with Type IV.y tuberculosisy contact dermatitisy graft vs hosty transplant rejection
-
8/6/2019 wk2 i n i lec
30/50
Nursing Management of
patients with Rheumatic
Disorders
-
8/6/2019 wk2 i n i lec
31/50
Rheumatic Disease
y - is a group of conditions where there is damage
caused to thejoints of the body. Arthritis is the leadingcause of disability in people over the age of 55.
-
8/6/2019 wk2 i n i lec
32/50
Diffuse Connective Tissue DiseasesyA chronic syndrome characterized by nonspecific,
usually symmetric inflammation of the peripheral
joints, potentially resulting in progressive destructionof articular and periarticular structures; generalizedmanifestations may also be present
-
8/6/2019 wk2 i n i lec
33/50
-
8/6/2019 wk2 i n i lec
34/50
-
8/6/2019 wk2 i n i lec
35/50
Degenerative Joint Disease(osteoarthritis)
Spondyloarthopaties
y is a condition in which low-grade inflammationresults in pain in the joints, caused by wearing of
the cartilage that covers and acts as a cushioninside joints. As the bone surfaces become less wellprotected by cartilage, the patient experiences painupon weight bearing, including walking and
standing. Due to decreased movement because ofthe pain, regional muscles mayatrophy, andligaments may become more lax. OA is the mostcommon form ofarthritis
-
8/6/2019 wk2 i n i lec
36/50
-
8/6/2019 wk2 i n i lec
37/50
Fibromyalgiay is a chronic syndrome (constellation ofsigns and
symptoms) characterized by diffuse or specific muscle,joint, or bone pain, fatigue, and a wide range of other
symptoms. It is not contagious, and recent studiessuggest that people with fibromyalgia may begeneticallypredisposed.[1] It affects more females thanmales, with a ratio of 9:1 by ACR (American College ofRheumatology
-
8/6/2019 wk2 i n i lec
38/50
-
8/6/2019 wk2 i n i lec
39/50
Arthritis Associated with Infectious
Organismsy Some inflammation of the joints and tendons is
directly related to infections caused by bacteria, virusor fungi.Bacterial arthritis is the most rapidlydestructive form of infectious arthritis
-
8/6/2019 wk2 i n i lec
40/50
-
8/6/2019 wk2 i n i lec
41/50
Assessment
-
8/6/2019 wk2 i n i lec
42/50
Assessment:
y past & present symptomsy fatigue
y weakness
y pain
y stiffnessy fever
y anorexia
y effects to patients lifestyle and self image.
-
8/6/2019 wk2 i n i lec
43/50
y Psychological, and mental status and social supportsystems re assessed
y
Ability to participate in daily activitiesy Comply with the treatment regimen and managed
self care.y assess
y patient understandingy motivationy knowledgey coping abilityy past experiencesy
fearsy effects of the disease on the patients self concepty Assist patient in managing stress and lifestyle modification
-
8/6/2019 wk2 i n i lec
44/50
Nursing Diagnoses
-
8/6/2019 wk2 i n i lec
45/50
y Acute and chronic pain r/t inflammation and increase
disease activity, tissue damage, fatigue or loweredtolerance level.
y Fatigue r/t increased disease activity, pain, inadequatesleep/rest, deconditioning, inadequate nutrition,emotional stress/ depression
y Self care deficit r/t contractures, fatigue, or loss ofmotion
-
8/6/2019 wk2 i n i lec
46/50
Planning and Goalsy relief of pain and discomfort
y increase mobility
y
maintenance of self carey effective coping
y absence of complications
-
8/6/2019 wk2 i n i lec
47/50
Nursing Interventionsa. Relieving pain and discomforty medications
y weight reduction program
y warm bath
y canes and crutchesy muscle relaxation technique
b. Decrease fatigue
y rest periods
y
napsy gradual progression of activities
-
8/6/2019 wk2 i n i lec
48/50
c. Increase mobility
y
proper body positioningy active ROM exercises, if not possible: passive ROM
d. Facilitating self care
- adaptive equipment
e. Monitoring & managing potential complicationsy avoid medication-induced complications
- teach patient with correct administration
-
8/6/2019 wk2 i n i lec
49/50
Evaluationy Experiences relief of pain or improved comfort level
y Experiences reduction in fatigue
yImprove sleep pattern
y Increase mobility
y Maintain self care
y Experiences absence of complications
-
8/6/2019 wk2 i n i lec
50/50
Thats all for today!