Question

1. Discuss the influence of aging process on inflammation and immunity and how these increase health risks for older adults.

2. As a nurse how do you collaborate with other interdisciplinary team to ensure quality care for patients with connective tissue disease (CTD)?

3. How do you maintain safe and effective care environment in the acute care setting and at home for older patients with osteoarthritis and rheumatoid arthritis?

4. As a nurse, how do you educate patients diagnosed with HIV+ in the community in order to live a normal and healthy life?

5. As a nurse, how do you educate patients on how to protect themselves against harm from a hypersensitivity reaction?

Answer 1

1. The identification of the basis of the aging process that drives the multiple pathologies and loss of function typical of older individuals is a major challenge in current aging research. Among the possible system an impairement of immune system plays a major role. the modifications of cell-signalling and the remodelling of the immune response play during human aging and longevity pays particular attention to the phenomenon which are linked to the so called inflammaging process such as dysregulation of innate immunity, altered T-cell or B-cell maturation and differentiation

Inflamm-ageing is ahallmark of virtually every age related disease and phenotype . it is characterized by low level persistent infiltration of immune cells , primarily but not exclusively cells of the innate immune system and elevated levels of pro-inflammatory cytokines and chemokines, especially interleukin-6 and C-reactive protein are commonly used as indicators of inflammageing

Effects of aging on immunity

Because of clear and easily detectable effects of thymus involution and memory blood peripheral T-lymphocytes. T-cells are generated in thymus, a primary lymphoid organ that undergoes gradual decay with age. This process is referred to as thymic involution, and is characterized by the progressive deterioration and disappearance of functional thymic components. Age -ealted changes in the levels of thymostimulatory growth hormone or steroid hormones and inflammatory cyokines as well as oxidative-stress induced damages may play a role in this process

2.Collaborative therapy which includes in connective tissue disorder includes:

a.Nutritional and weight management counselling

b.Rest and joint protection by using assistive devices

c.Therapeutic exercise

d.Heat and cold applications

e.Complementary and Alternative therapies

• Herbs and nutritional supplements(e.g: Glucosamine)
• Movement therapies (e.g: yoga,Tai Chi)
• Transcutaneous Electrical nerve Stimulation (TENS)
• Acupuncture

f.Drug therapy

• acetaminophen
• NSAIDS
• Antibiotics
• Intraarticular hylauronic acid
• Intraarticular corticosteroids
• Opiod analgesics

h.Reconstructive joint surgery

Non-drug interventions are the foundation for connective-tissue disorder and should be maintained throughout the patient's treatment period

The patients are usually treated on an out-patient basis, often by an indisciplinary team of health care providers that may include an internal medicine physician or family health care provider, a rheumatologist, a nurse,an occupational therapist and a physical therapist

Health Assessment questionnaires are often used to pinpoint areas of decreased function. Complete questionnaires at regular intervals to document disease and treatment progression

Drugs are administered for the treatment plan and inflammation. Non-drug strategies to decrease pain and disability may include gentle exercise, application of heat or cold, relaxation or yoga. Splints may be prescribed to immobilize inflammed joints

Once an acute flare has subsided, aphysical therapst can provide valuable assistance in planning an exercise program

Patient and care giver teaching is very important

Provide information about the nature and treatment of the disease, pain management, body mechanics, correct use of assistive deives (cane,walker), principles of joint protection, energy conservation, nutritional choices, weight and stress management, exercise program

3.Home and work environment modification is essential for patient safety, accessibility and self care

Measures include

• removing scatter rugs
• providing rails at the stairs and bath tub
• Using night-lights
• Wering well-fitting supporting shoes

Assistive devices such as canes, walkers, elevated toilet seat and grab bars also reduce the load on the afected joint and promote safety

4.Patient and care giver teaching guide for patients with HIV+

Report immediately

• Any change in level of consciousness: lethargy, hard to arouse, unresponsiveness, unconsciousness
• Headache accompanied by nausea and vomiting , changes in vision
• Persistent shortness of breath related to activity and not relieved by rest
• Nausea and vomiting accompanied by abdominal pain
• Vomiting blood
• Yellow discolration of skin
• Any bleeding from the rectum not related to hemorrhoids
• Chest pain, seizures
• Severe depression, anxiety, hallucinations

Improving adherence to antiretroviral therapy

• Provide teaching on medication dosing, side effects of the drugs
• Assure that side effects can be treated . If not medications regimens can be changed
• Use teaching and memory aids including pictures, pill boxes and calender
• Use a team of nurse, physicians, pharmacists, case managers, mental health and peer counsellors to support the patients
• Engage family and friends in teaching process. Solicit their presence and help the patient to take treatment
• Help the patient integrate the medication regimen into his or her typical life activities and work schedule
• Simplify regimens,dosing and food requirements as much as possible