Ch.13/14 Opportunistic Infections/hiv

Front 1

Mycobacterium Tuberculosis
CM

Back 1

low grade fever, cough, night sweats, fatigue, weight loss.
IHN with Vit B for neuropathy
 Rifampin
 Pyrazinamide
 Streptomycin

Front 2

Mycobacterium avium complex medical trtmnt

-bacterial-

Back 2

Clarithromycin, trtmnt usually takes 12 months,

Front 3

Mycobacterium avium complex nursing management

Back 3

infection is curable. control diarrhea & prevent dehydration. Pt. TCDB, Postural percussion

Front 4

Mycobacterium avium complex FYI

Back 4

found in soil. better trtmnt has lowered incidence of infections in HIV pt's, however resistance is on the rise. Almost half of those w/ late-stage HIV(AIDS) are infected w/ MAC. Not all show s/s of MAC. MAC & drugs used are hard on body. Pt might consider visiting a nutritionist to keep body weight up.

Front 5

Mycobacterium avium complex
definition

Back 5

opportunistic infection caused by mycobacterium(acid-fast bacilli. commonly causes respiratory illness but can also affect the liver, spleen & bone marrow.

Front 6

MAC
-CM-

Back 6

night sweats, weight loss, abd pain, anemia, diarrhea, swollen lymph glands, fever, increased liver enzyme alkaline phosphatase, weakness

Front 7

Salmonellosis
-definition

Back 7

Bacterial food poisoning caused by samonella
Unpasteurized milk, undercooked chicken, raw eggs. Any food can become contaminated during prep.

Front 8

Salmonellosis
CM

Back 8

Appear 1-2 days after infection, fever(50%), N&V, diarrhea, abdominal pain/cramps.
Diarrhea= very liquid-y, lasts approx 4-7 d, rarely contains mucus or blood.

Front 9

Salmonellosis
medical trtmnt

Back 9

even though salmonella food poisoning is a bacterial infection, most practitioners don't tx simple cases w/ botics, but severe, chloramphenicol(bactrium) be given IV or po. Lactibacillus acidophilus to restore essential bacteria in GI, fasting or liquid only diet.

Front 10

Salmonellosis
RN management

Back 10

prevention involves proper handling & cooking of foods. Careful handwashing!

Front 11

 Fungal Infection

 Candidiasis
-definition-

Back 11

Yeast infection/ Thrush: Abnormal levels of any candida species normally present in body.

Front 12

Candidiasis
-CM

Back 12

redness, itching, dysuria,dyspareuria sorness, or burning in the area of infection, a watery, thick, cottage chesse like d/c that sticks to epithelium & smells like yeast. PH is low(4.5)

Front 13

Candidiasis
-med. trtmnt

Back 13

oral antifungal meds: fluconazole. creams, suppositories. avoid OTC unless certain.

Front 14

Candidiasis
-RN managment

Back 14

relieve discomfort, use entire prescription to avoid reoccurance. swab, then intubate culture for several days

Front 15

Oral Candidiasis
What it precedes?

Back 15

precedes other life-threatening infection due to immunosuppression

Front 16

Oral Candidiasis
CM

Back 16

creamy-white patches/cheesey white plaque in oral cavity. a/w painful swallowing. babies get this alot.

Front 17

Oral Candidiasis
med trtmnt

Back 17

antifungal meds: nystatin, amphotericin B

Front 18

Oral Candidiasis
RN care

Back 18

when using meds as suspension swish vigorously for 1 min then swallow. Provide a bland diet, avoids food that irritate sore areas in oral cavity

Front 19

 Cryptococcosis

Back 19

fungal infection acquired via inhalation. From fungus cryptococcus neoformans. Affects the meninges of CNS & PNS

Front 20

 Cryptococcosis
-CM

Back 20

severe progressive pneumonia w/ acute dyspnea & an xray pattern suggestive of Pneumocystis infection.

Front 21

 Cryptococcosis
med trtmnt

Back 21

a 2 weeks regimine w/ Amphotericin B & flucytosine. Oral Fluconazole can be used thereafter. weekly doses of IV amphotericin B can prevent relapse.

Front 22

 Cryptococcosis
RN care

Back 22

monitoring pt. for s/s confusion, depression, HA, blurred vision, agiatation, & other behavoriala/w cryptococcal meningitis & are attributable to brain swelling. Renal & hematologic function should be performed pretrtmnt & monitored through out course of trtmnt

Front 23

 Cryptococcosis
FYI

Back 23

to prevent relapse trtmnt should be completed & cultures should become & remain neg. for at least 2 weeks before trtmnt is ended.

Front 24

 Histoplasmosis
overview

Back 24

 Caused by histoplasma capsulatum, fungus
 Produces spores that can be inhaled when they are in the air.

Front 25

Histoplasmosis
cm

Back 25

Most have no symptoms, symptoms can vary widely.
if end up w. infection Acute lung infection: tiredness, fever, chills, chest pains, dry cough. Liver/spleen enlargement. Sores in GI tract (including mouth).

Front 26

histoplasma
med trtmnt

Back 26

usually get better on own.
severe cases treated w/ fungus killing medicines.

Front 27

histoplasma
rn care

Back 27

pt. education is most important; avoid areas where the fungus might be growing; esp. where bird/bat droppings. avoid dust from contaminated sites. wear disposible clothes, dust mask(nose & mouth) if in high r/f area

Front 28

histoplasma
fyi

Back 28

often grows around chicken coops and around starling & blackbird roosts. it's on rise due to growing # ofpeople w/ weakened immune sys.

Front 29

Coccidioidomycosis
overview

Back 29

this disease is endemic only in regions of western hemisphere: s.arizona, central cali, s. new mexico, w texas. climate: arid, hot summers, few freezings. outbreaks occur-dust storm -earthquakes -earth excavation

Front 30

Coccidioidomycosis
50% asymptomatic
 Pulmonary Syndrome:

Back 30

Pulmonary Syndrome: Cough, chest pain, SOB, fever, fatigue

Front 31

Coccidioidomycosis
50% asymptomatic
 Pulmonary Syndrome:
med trtmnt

Back 31

almost always goes away w/o trtmnt. bedrest & trtmnt of flu like cm. until fever dissapears

Front 32

Coccidioidomycosis
Diffuse pneumonia affects immunosupressed: CM

Back 32

 Fine papularrash, erythema, nodosum, erythema multiforme, occasional migratory arthralgias and fever.

Front 33

Coccidioidomycosis
Extrapulmonary/Disseminated varieties: cm

Back 33

Chronic skin disease: keratotic, varicose ulcers, subQ fluctuant abscesses.  Joints/Bones
 Severe synovitis, effusion of knees, wrists, feet, ankles and or pelvis, lytic lesions commonly affecting axial skeleton.

Front 34

Coccidioidomycosis
Disseminated or severe varieties: drug trtmnt

Back 34

amphotericin, ketoconazole, itraconazole

Front 35

Coccidioidomycosis
Meningeal disease

Back 35

most feared. classic s/s of meningeal.

Front 36

coccidioidomycosis
 Hydrocephalus

Back 36

most common complication.
RN care: as condition worsens, ICP will rise. early I.D. is necessary to ensure early control & management.

Front 37

coccidioidomycosis
signs & tests to confirm

Back 37

sputum culture & smear, cbc w/ differential shows elevated eosinophils, chest xray, coccidioidin or spherulin skin test(specific to this fungus)

Front 38

coccidioidomycosis
rn care

Back 38

pain managment is a issue, meds to administer: administration of amphotericin B s/e fever, chills, & body aches(think flu), give benadryl & acetaminophen apx. 30min before to minimize s/e. monitor labs: renal(b/c of toxicity):serum creatinine & BUN.

Front 39

coccidioidomycosis
other areas it can effect

Back 39

pericardium, peritoneum, thyroid, gu, gu, adrenal

Front 40

coccidioidomycosis
patho

Back 40

acquired from inhalation of the spores. once in lungs multiply. then an acute respiratory infection occurs 7-21 days after exposure & typically resolves rapidly. however, the infection may alternatively result in COPD or disseminate to the meninges, bone jts.

Front 41

Protazoal Infections

Pneumocystosis(PCP)
overview
like pneumonia gone really bad

Back 41

 P. carinii, Most common opportunistic infection & will develop in 80% of all HIV pts s prophylasis. originally classified as a protozoan, but RNA suggests it's a fungus

Front 42

Pneumocystosis(PCP)
cm

Back 42

CM: Nonproductive cough, fever, chills, SOB, Dyspnea, chest pain. severe s/s severe hypoxemia, cyanosis, tachypnea, aletred LOC

Front 43

Pneumocystosis(PCP)
med trtmnt

Back 43

TMP-SMZ(bactrium or septra). it's a combo of 2 botics:trimethoxazole & sulfamethoxazole. Dapsone is a botic, if can't tke bactrum, almost as effective as TMP/SMZ

Front 44

Pneumocystosis(PCP)
rn care

Back 44

focus on hyperthermia, impaired gas exchange, altered respiratory function, fatigue, & altered nutrtion. also focus on effects of trtmnt: n/v, & hypoglycemia. early relapses are common. all pt's whose CD4 count is below 200, should be taking an anti-PCP drug

Front 45

 Cryptosporidiosis
overview

Back 45

Diarrheal disease caused by cryptosporidium parvum. Can live in intestines of humans and animals. it's protected by an outer shell called an oocyst.

Front 46

Cryptosporidiosis
cm

Back 46

appear 2-10 d following ingestion of oocyst.
 Most commonly watery diarrhea; dehydration, wt loss, stomach cramps/pain, fever, N&V.
Some have no symptoms, those with a healthy immune system have symptoms for 2weeks or less.
even those that recover can still pass it in their stool for up to 2 months. diagnosed by lab exam of stoll for oocysts

Front 47

Cryptosporidiosis

med trtmnt

Back 47

no specific trtmnt. trtmnt for diarrhea. people w/ weakened immunity need special attention to replace fluids losts.

Front 48

Cryptosporidiosis
rn care

Back 48

teach pt good hygeine, don't drink recreational water from lakes, ponds, swimmin gpools, wash all raw food & avoid eating undercooked foods. avoid fecal exposure during sexual activity

Front 49

Viral Infections

CMV

Back 49

Herpes virus family, spread through saliva, blood, sexual contact

Front 50

CMV
-cm-

Back 50

Mild: sore throat, fatigue, fever, diarrhea, N&V, night sweats, splenomegaly
Immunocompromised: high temperature, jaundice, coma, hepatitis, pneumonia, retinitis

Front 51

CMV
med trtmnt

Back 51

can go into remission w/i 6 weeks on own. anitvirus meds(ganciclovir) to stop spreading throughout the body, & analgesics for pain.

Front 52

cmv
rn care

Back 52

make pt comfortable, reduce anxiety, increase compliance w/ condom. most poeple are exposed to cmv early in life & it stays there. s/s usually don't show unless severly immunocompromised. this is very bad for developing fetus.

Front 53

Herpes Simplex-2
(genital)
cm

Back 53

: May be asymptomatic
Itching, burning, soreness and small blisters in genital area; small ulcers when the blister breaks, local pain, enlarged lymph nodes (groin), HA, fever, malaise

Front 54

Herpes Simplex-2
(genital)
med trtmnt

Back 54

oral antiviral meds: acyclovir(zovirax), famciclovir(famvir), valacyclovir(valtrex). no cure:to prevent symptoms from returing or to makerecurrences less severe only.

Front 55

Herpes Simplex-2
(genital)
rn care

Back 55

pt education: disease transmission risks: apropriate condom use.
keep lesions clean, dry. encourage dry,loose, soft cotton clothing, promote stress free zone, make sure pt gets rest

Front 56

Herpes Simplex-2
(genital)
fyi

Back 56

pregnant women w/ ACTIVE herpes simplex infect at time of delivery, a c-section is recommended to decrease the risk of infecting newborn. it can be transmitted by touching lesion & making contact w/ another area. an estimated 50,000 people in US have. resurrences presipatated by sunlight overexposure, fever, stress, acute illnes, & meds or conditions that weakend immune sys(cancer, HIV/AIDS, corticosteroid)

Front 57

Progressive Multifocal Leukoencephalopathy (PML)

Back 57

 Rare, usually fatal: progressive damage or inflammation of the white matter of the brain at multiple locations. Caused by polyomavirus called JC virus (JCV). Found in approx. 70% of general population, but generally latent causing disease only when immune system is severely weakened.

Front 58

Progressive Multifocal Leukoencephalopathy (PML)
cm

Back 58

mental deterioration, vision loss, speech disturbances, ataxia, paralysis, coma, death. Rarely seizures

Front 59

Progressive Multifocal Leukoencephalopathy (PML)
med trtmnt

Back 59

there are no trtmnts that have been proven. have been unsuccessful trials. research going on to see if antiretrovirals will help to slow progression of disease.

Front 60

Progressive Multifocal Leukoencephalopathy (PML)
rn care

Back 60

PALLITIVE. die w/i 1-4 months. personality changes & dementia first signs. diagnosis by MRI & CT scans.

Front 61

Opportunistic Neoplasms

Kaposi’s Sarcoma
CM

Back 61

most common in HIV. Bluish, red, flat, raised lesions with irregular shape surrounded by ecchymosis and edema. Bleeding from GI lesions, SOB and bloody sputum from lung lesions

Front 62

Kaposi’s Sarcoma
med trtmnt

Back 62

antiretrovirals to shrink AIDS virus lesions. radiation therapy, cryotherapy, & chemotherapy.

Front 63

Kaposi’s Sarcoma
rn care

Back 63

best trtmnt:supportive care! nutrional support, electrolyte replacement, & skin care. turn pt., cleanse, & apply medicated ointments & dressings to lesions. O2 & relaxationcan help.

Front 64

Kaposi’s Sarcoma
fyi

Back 64

used to be seen only in elderly jewish & italian men before AIDS epidemic. rare in elderly women. AIS population it develops aggressively & involves the skins, lungs, & GI

Front 65

Non-Hodgkin’s lymphoma
overview

Back 65

Originates predominately from malignant growth of B lymphocytes that invade lymphoid tissue (not just lymph nodes). may spread to multiple sites as well as outside lymphoid sys.(extranodal tissue)

Front 66

Non-Hodgkin’s lymphoma
cm

Back 66

Asymptomatic in early stages.
 Usually more advanced (stage III or IV) when diagnosed. Lymphadenopathy present. 1/3 with “B symptoms” fever, night sweats. Unintentional wt loss.

Front 67

Non-Hodgkin’s lymphoma
med trtmnt

Back 67

depends on stage. intermediate forms treated by combo chemotherapy & radiation for stage 1& II. aggressive forms that have invaded the CNS are treated by cranial radiation in addtion to systemic chemo.

Front 68

Non-Hodgkin’s lymphoma
rn care

Back 68

disease is curable. most care occurs in out pt. setting. teach pt. how to minimize r/f infection & recognize s/s of infection. secondary tomalignancies may now occur as survival rates are increased. pt. screened for AML& MDS.

Front 69

Invasive cervical Ca
cm

Back 69

Asymptomatic in early stages.
As it spreads: blood tinged vaginal discharge, spotting after intercourse, abnormal bleeding.
Symptoms not unique to cervical Ca.
Advanced: Pelvic pain, appetite loss, wt loss, anemia

Front 70

Invasive cervical Ca
med trtmnt

Back 70

depends on stage. most cases are cured and controlled by a combo of surgery and chemo, radiation. when tumor invasion is less than 3mm hysterestomy is sufficient. greater than 3 mm, radical hysterectomy w/ pelvic mode dissection & assessment.some pt's. w/ recurrences are considered for pelvic exenteration of pelvic contents is removed.

Front 71

Invasive cervical Ca
fyi

Back 71

virtually all cefvical cancer is caused by infection w/ certain types of HPV. HPV is very common among sexually active women.

Front 72

AIDS Dementia &
Wasting Syndrome
overview

Back 72

 Toxins released that result in cellular dysfunction or interference with neurotransmitter function.

Front 73

AIDS Dementia
cm

Back 73

 Cognitive dysfunction: can’t concentrate, poor judgment
 Motor impairment: Ataxia, clumsiness, weakness
 Behavior changes: apathetic, irritable, anxious, delirious, spontaneous

Front 74

AIDS Dementia
med trtmnt

Back 74

haldol, high dose antiretroviral

Front 75

AIDS Dementia
rn care

Back 75

assess mental satus, LOC. decrease enviromental stimuli and encourage independence.

Front 76

Wasting Syndrome, AIDS

Back 76

Hyper-metabolic: excessive calories are burned and lean body mass is lost. people less educated tend to get this. unknown exactly why.

Front 77

Wasting Syndrome, AIDS
cm

Back 77

involuntary, profound wt loss of 10% of base body weight, chronic diarrhea (30days), chronic weakness with fever.

Front 78

Wasting Syndrome, AIDS
med trtmnt

Back 78

human growth hormone works best
drug for diarrhea

Front 79

Wasting Syndrome, AIDS
rn care

Back 79

monitor wt., encourage them to eat even if not hungry(small frequent meals & fluid restriction to decrease diarrhea.)