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62 Cards in this Set
- Front
- Back
1 L =
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2.2 kg = 1lb
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normal level of sodium
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135- 145
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HYPERnatremia
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restlessness, agitation, twitchings, seizures, coma, thirst, dry swollen tongue, weakness lethargy, may have edema, bp changes. Caused by insensible H2O loss, diarrhea, DM, cushings, DM, diabetes insipidus, near drouning in salt water. Hypernatremia causes hyperosmolality, which causes a shift of H2O out of cells... dehydration. primary protection is the thirst center.
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HYPOnatremia
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irritablity, apprehension, confusion, dizziness, personality changes, tremors, seizures, coma, tachycardia, thready pulse, cold clammy skin, HA, muscle spasms, Caused by diarhea, vomiting, NG suction, diuretics, renal disease, fasting diets, excessive hypotonic IV fluids, heart failure. Causes H2O shift into cells. neurological problems. Possible fluid restrictions. give hypertonic solutions. check for fluid overload and pulmo edema.
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normal potassium level
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3.5- 5.0
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HYPERkalemia
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98% of body's K+ is in cells. neuromuscular and cardiac functions. diet is primary source of K+. Caused by excessive parenteral admin, excess K+ containing drugs, K+ salt substitute, acidosis, crash injury, fever, sepsis, burns, renal disease, K+ sparing diuretics, ACE inhibitors (prils). S/SX: irritability, anxiety, abd cramping, diarrhea, weak lower extremities, paresthesias, irregular pulse, cardiac arrest if hyper sudden or severe, tall peaked T wave, prolonged PR interval, ST depression, loss of P wave, widening QRS, V-fib, ventricular standstill.
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HYPOkalemia
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tx for diabetic ketoacidosis can cause hypoK+, digoxin levels can become toxic(TEST), K+ very caustic to veins- always dilute!, potassium chloride given to death row inmates. caused by diarrhea, vomiting, diuretics, magnesium depletion, diaphoresis, dialysis, increased insulin, alkalosis, tissue repair, epinephrine, starvation, if NPO need to include K+ in parenteral fluids. S/SX: fatigue, muscle weakness, leg cramps, nausea, vomiting, soft flabby muscles, weak irregular pulse, polyuria, hyperglycemia, ST segment changes, flattened T wave, presence of U wave, ventricular dysrhythmias, bradycardia, enhanced Dig effects
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normal level of calcium
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8.5-10.5
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HYPERcalcemia
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stored in skeletal sys, regulates heart function, muscles, nerves, can be caused by hyperparathyroidism or tumor, controlled by PTH, calcitonin lowers CA levels, give 3-4 L to help excrete, Caused by MS, malignancies with bone metastasis, prolonged immobilization, hyperparathyroidism, vit D overdose, thiazide diuretics, acidosis. S/SX: lethargy, weakness, depressed reflexes, decreased memory, confusion, personality changes, anorexia, bone pain, fractures, polyuria, dehydration, stupor, coma, shortened ST segment, shortened QT interval, ventricular dysrhythmias, increased digitalis effect
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HYPOcalcemia
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damaged Parathyroid gland, pancreatitis, tetany can occur,calcium gluconate given,Caused by chronic renal failure, elevated phosphorus, hypoparathyroidism, vit D deficiency, magnesium deficiency, furosemide, chronic alcoholism, diarrhea, decreased serum albumin, alkalosis. S/SX: easy fatigability, depression, anxiety, confusion, numbness and tingling in extremitites and around mouth, hyperreflexia, muscle cramps, chvosteks sign (contraction of face), trousseaus sign(carpal spasm), tetany, seizures, elongationi of ST segment, prolonged QT interval, ventricular tachycardia.
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normal range for magnesium Mg++
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1.7-2.2 , proper level is important for cardiac function
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HYPERmagnesemia
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causes: renal failure, excess administration of magnesium give for eclampsia, adrenal insufficiency, can be r/t CA and K+ imbalances. Magnesium is in: green veggies, chocolate, PB. increased Mg++ is and emergency treated with calcium chloride. check deep tendon reflexes. s/sx: depression of neuromuscular and CNS function.
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HYPOmagnesemia
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Causes: diarrhea, vomiting, chronic ETOH use, impaired GI absorption, malabsorption syndrome, prolonged malnutrition, large urine output, NG suction, poorly controlled DM, hyperaldosteronism. s/sx neuromuscular and CNS hyperirritability
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normal range of pH
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7.35-7.45
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normal range of PaO2
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80-100
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normal range of PaCO2
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32-48
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normal range of HCO3
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22-26
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what is metabolic alkalosis?
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loss of acid or increase in bicarb. s/sx: dizziness, irritability, confusion, nervousness, tachycardia, dysrhythmias, nausea, vomiting, anorexia, tetany, tremors, tingling of fingers/ toes, muscle cramps, seizures, hypoventilation. R/T: loss of acid (prolonged vomiting or gastric suction) or a gain in bicarb (ingesting baking soda)
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what is metabolic acidosis?
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bicarb deficit, accumulation of acid (diabetics: ketones) s/sx: drowsiness, confusion, headache, dysrhythmias, decreased bp, warm flushed skin, nausea, vomiting, kussmaul respirations(deep quick)
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what is respiratory alkalosis?
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hyperventilation; CO2 is released- often with anxiety. s/sx: lethargy, light headedness, confusion, tachycardia, dysrhythmias, nausea, vomiting, tetany, numbness, tingling of extremities, hyperreflexia, seizures, hyperventilation.
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what is respiratory acidosis?
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hypoventilation CO2 build up; often seen in COPD. s/sx: drowsiness, disorientation, dizziness, headache, decreased BP, warm flushed skin, dysrhythmias, seizures, coma, hypoventilation.
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ROME
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respiratory= opposite;
· pH is high, PCO2 is down (Alkalosis). · pH is low, PCO2 is up (Acidosis). metabolic= equal; · pH is high, HCO3 is high (Alkalosis). · pH is low, HCO3 is low (Acidosis). |
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fluid volume deficit s/sx
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restlessness, drowsiness, lethargy, confusion, thirst, dry mouth, decreased skin turgor, decreased cap refill, postural hypotension, increased pulse, decreased output, concentrated urine, increased resp rate, weakness, dizziness, wt loss, seizures, coma
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fluid volume overload s/sx
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headache, confusion, lethargy, peripheral edema, distended neck veins, bounding pulse, increased BP, polyuria, dyspnea, crackles(rales), pulmo edema, muscle spasms, wt gain, seizures, coma
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tx for fluid deficit
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correct underlying cause and replace lost H2O and electrolytes. balanced IV solutions such as LR or isotonic (0.9%) sodium chloride or blood when indicated.
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tx for fluid excess
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removal of fluid without affecting electrolyte composition or osmolarity of ECF. primary cause identified and treated, diuretics, fluid restriction, restricted Na+ at times.
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tx for HYPERnatremia
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treat underlying cause, iv 0.5% dextrose in H2O or hypotonic saline. rapid correction can cause cerebral edema. diuretics given. Na+ restriction.
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tx for HYPOnatremia
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fluid restriction, at times small amts of hypertonic saline given (0.3%). give sodium containing solutions.
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tx for HYPERkalemia
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eliminate K+ oral intake, increase elimination of K+ (diuretics, dialysis, kayexalate), force K+ from ECF to ICF by using insulin along with glucose, IV sodium bicarb, give calcium gluconate
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tx for HYPOkalemia
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giving K+ chloride supplements, increase K+ dietary intake, KCL supplements may be given orally or IV. KCL is NEVER given unless there is urine output of at least 0.5ml/kg. KCL given slowly to prevent hyperkalemia and cardiac arrest. VERY CAUSTIC TO VEINS
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tx for HYPERcalemia
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promotion of excretion by loop diuretic(Lasix) and hydration with isotonic saline. drink 3000-4000ml of fluid a day. synthetic calcitonin may be given.
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tx for HYPOcalemia
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primary tx is to treat the cause. tx with oral or IV CA supplements. CA not given IM b/c it may cause severe local reactions such as burning, necrosis, tissue sloughing. calcium carbonate may be used PO when diet isn't high enough in CA.
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tx for HYPERmagnesemia
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focus on prevention... persons with kidney diseases shouldn't use magnesium containing drugs such as MOM. emergency tx is IV admin of calcium chloride or calcium gluconate to oppose effects of Mg++. Renal impaired pt. may need dialysis.
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tx for HYPOmagnesemia
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oral supplements increased dietary intake of foods high in Mg++ (green veggies, nuts, bananas, oranges, PB, chocolate) . if severe IV or IM mag sulfate may be given SLOWLY r/t chance of cardiac or respiratory arrest.
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risk factors for laryngeal CA
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90% in people 50 years or older after prolonged use of tobacco and ETOH. other factors- diet poor in fruits and veggies, and infection by HPV. males are affected 2-5x greater rate than women.
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s/sx of laryngeal CA
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vary with location. laryngeal rarely produce early s/sx. usually diagnosed in late stages. pt may complain of persistent unilateral soar throat or otalgia (ear pain). hoarseness may be an early sign. may have lump in throat or change in voice.
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tx for laryngeal CA
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radiation with early stages, chemo for later stages, cordectomy(partial removal of cord), hemilaryngectomy(full removal of one cord or part of cord, requires temp trach.), supraglottic laryngectomy (removing structures above the true cords- the false cords and epiglottis, left as high risk for aspiration and requires temp trach), total laryngectomy, radical neck dissection(to decrease chance of lymphatic spread), or modified neck dissection.
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osteoarthritis risk factors and s/sx
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old age, female, decreased estrogen, genetics, obesity, ACL injury. s/sx: joint pain that worsens with use, in advanced disease may be present at rest and interfere w/ sleep, crepitation, usually involves DIP and PIP and MCP joints of hands, hips, knees, and MTP joint of foot, cervical and lumbar vertebrae.
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heberden's and bouchard's nodes
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heberden's: DIP
bouchard's: PIP |
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diagnostics for osteoarthritis
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CT, MRI, xray, synovial fluid studies
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tx for osteoarthritis
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rest and joint protection, heat and cold application, nutritional therapy and exercise, wt loss, drug therapy- APAP 3000mg/day max, capsaicin, bengay, aspercream, NSAID such as Motrin(IBU), Celebrex, doxycycline(vibramycin). complementary therapies: yoga, massage, glucosamine
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RA risk factors and s/sx
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occurs globally, affecting all ethnic groups, incidence increases with age, women 3x more likely. cause is unknown. autoimmune etiology is most widely accepted. genetic predisposition. s/sx: fatigue, anorexia, wt loss, stiffness(general). - bone and cartilege erosion, breakdown of synovial membrane, contractures, subluxation. 4stages. systemic s/sx: 1. rheumatiod nodules-high tiders of RA antibodies can break down et become infected. 2. Sjogren's syndrome: 10-15% of RA pts; diminished salivary et lacrimal secretions. 3. Felty syndrome: Most often with pts with nodules; enlarged spleen, lymphnodes, blood disorders, etc.
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complications of RA
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joint destruction, contractures and deformities, decreased grasp strength, nodular myositis and muscle degeneration, pain, cataracts, nodule ulceration
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diagnostics for RA
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Rheumatoid factor, ESR et CRP (indicate inflammation), ANA (antinuclear antibody titers)
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drug therapy for RA
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methotrexate(rapid antiinflammatory effects), Sulfasalazine, plaquenil
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normal phosphate level
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3.0-4.5
opposes calcium! calcium up: phosphate down helps with function of RBCs and nervous sys. Source: dairy. renal failure can lead to hyperphosph. |
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HYPERphosphatemia
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hypocalcemia, tetany, calcium phosphate deposits in tissues. tx: finding underlying cause, restricting dairy, correction of hypocalcemic condition, hydration.
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HYPOphosphatemia
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cns dysfunction, muscle weakness, wasting, cardiac problems
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ankylosing spondylitis
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HLA- B27 antigen 80-90% of cases. more common in men, milder in women. onset 15-35 y.o. s/sx: low back pain, stiffness, limited motion, uveitis (intraocular inflammation). affects axial skeleton. eventually neck remains fixed with rigid lumbar and thoracic kyphosis
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psoriatic arthritis
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arthritis involving small joints of hands and feet, asymmetric arthritis in joints of extremities, symmetric polyarthritis resembling RA, arthritis of sacroiliac joins and spine, or arthritis mutilans(rare but deforming)
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reactive arthritis
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(reiter's syndrome) more common in men. associated w/ a symptom complex that includes urethritis, conjunctivitis, and mult mucoutaneous lesions. also cervicitis. can be caused by chlamydia. usually a symmetric. Doxycycline given- ABX for up to 3 months
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septic arthritis
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microorganism in joints, staph most common. knee and hip joint most common. treat quickly to avoid damage. culture and treat with ABX. monitor fever, joint pain, inflammation. immobilization helps with pain.
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Lyme disease
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spirochetal infection caused by borrelia burgdorferi and transmitted by deer ticks. s/sx: erythema migrans- skin lesion that occurs @ site, starts as red macule and expands to a lg round lesion with bright red border and central clearing. viral like symptoms: swollen nodes, fever, chills, stiffness, HA, joint and muscle pain. diagnosis: EIA positive with western blot confirmation. TX: ABX; doxycyline, amox, seftin, iv rocephin.
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Gout
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Uric acid level NOT diagnostic! accumulation of uric acid or under excretion or increased intake of purine rich foods. Primary gout: hereditary or overproduction of uric acid (90% of pts). can occur when taking HCZ lasix. can be transplant reaction. Secondary gout: chemo, meds, diet intake. Risk factors: obesity, HTN, thyozide diuretics, ETOH use, prolonged fasting, impaired kidney function. Purines: fish, seafood, meats, sweetbreads. TX:bed rest, joint immobilization, foot cradle, antiinflammatory drugs, colchicine, corticosterroids, allopurinol.
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podagra.
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buildup of uric acid in big toe
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tophi
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sodium urate crystal deposits
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SLE
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multi sys inflam disease. skin, joints, serous membranes, neuro, hepatic, et renal sys. hormones play lg role. sun exposure and burns: triggers for flare up. overprod of self antibodies.ANA test NOT diagnostic. diagnosed by Anti Smith antibody but it only occurs in 30-50%. attacks RBC and Coag factors, lymphocytes, et platelets. 50% have butterfly rash. excessive fatigue, arithomas, patchy hair loss, polyarthralgia et morning stiffness, diffuse swelling of joints, 50% renal probs. s/sx: cognition change, memory problems, HA, anemia, susseptible to infection, can die from infections, mood disorders. TX: NSAIDS, antimalarial, corticosteroids short term, immunosuppressants, targeted therapy drugs and hormones. should not recieve live vaccinations such as varicella
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systemic sclerosis
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2 types: limited cutaneous disease (80%) and diffuse cutaneous disease. overproduction of collagen. connective tissue disorder. risk factors: coal, plastics, cilica dust, african american, women. S/SX: CREST: calcinosis, raynaud's phenomenon(abnormal blood flow in cold), esophageal dysfunction, sclerodactyly, telangiectasia(red spots on body). dry eyes et mouth, dental caries, gingivitis, pulmofibrosis, pleura thickening, dyspnea, kidney disease, pericarditis. DX: SCL-70(scleroderma antibody), distal esophageal hypomotility, bilat pulmo fibrosis. TX: no specific tx. possibly cardizem or ditazelam.
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sjorgrens syndrome
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90% women. dry mouth, dry eyes, autoimmune, associated with SLE, RA, thyroid disorders. RISK of developing lymphoma.
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methotrexate (rheumatrex)
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can lead to birth defects also can cause bone marrow reduction
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hydroxycholorquine (plaquenil)
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can cause vision changes
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corticosteriods (-sones)
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cataracts, wt gain, increased risk of infection, high BP and BG, hypokalemia, muscle atrophy, weakness, mood and behavior changes, protein depletion decreases bone formation.
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