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40 Cards in this Set
- Front
- Back
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To decrease incidence of HIV what would nurse prioritize?
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1) HIV testing should be a part of routine health care
2) Rapid HIV testing should also be used to diagnose HIV outside of traditional care settings 3) Providers should work with HIV infected patients and their partners to change risky behavior and decrease the risks of HIV transmission 4) Perinatal transmission should be further reduced by universally offering HIV tests to pregnant women and appropriate treatment to those found to be infected. |
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ART is working ….evaluate
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Goal of drug therapy is to decrease the amount of virus in your blood (viral load) to get your vial load below detectable levels, maintain or raise CD4+ T cell counts, and delay the development of HIV related symptoms and opportunistic diseases
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Drugs listed in someone with HIV to administer to someone with HIV at the right time.
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1 Nucleoside reverse transcriptase inhibitors (NRTI’s);
2 Nonnucleoside reverse transcriptase Inhibitors (NtRTI’s) work by inhibiting the activity of reverse transcriptase. 3 Protease inhibitors (PI’s) work by interfering with the activityh of the enzyme protease. 4 Entry inhibitors interfere with HIV CD4 receptor site binding and entry into the cell. |
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know about microbacterium Avian complex (MAC)
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Clinical manifestation- gastroenteritis, watery diarrhea, weight loss
Prophylaxis and treatment- Initiate when CD4+ T cells < 50/ul; rule out disseminated diseases or TB: clarithromycin (biaxin) or azithromycoin (zithromaz), rifabutin (Mycobutin). Prophylaxis may be stopped when CD4+ T cell count of > 100 ul is documented for 6-12 mo; restart if CD4+ Tcell count falls to <50/ul |
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Prevent HIV w/ drug users
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1) do not use drugs
2) if you use drugs do not share equipment 3) do not have sexual intercourse when under the influence of any drug the impairs the decision making ability |
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know most common method of HIV transmission
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•In developing countries the major route of transmission is heterosexual sex and women and children bear a large part of the burden of the illness
•Transmission of HIV occurs thru sexual intercourse with an infected partner, exposure to HIV infected blood or blood products, and perinatal transmission during pregnancy, at the time of delivery or thru breast feeding. |
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Resistance to ART drugs is a major problem in RX of HIV infection. To decrease the risk of developing resistance:
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•3 different ART drugs from 2 different classes.
•Know your drugs. Some have to be taken w/ food and some on empty stomach and some cannot be taken together. Nur: write instruct.clearly •Take full dose & on schedule Rpt. To health provider if you have side effects that do not allow you to take med. •Take all drugs as prescribed. Don’t stop one. • Tell health care provider all drugs/herbs to prevent interactions •Goal is to decrease viral load. Most HCP (health care providers) will check your blood on a regular basis whether you take drugs or not •2 to 4 weeks after start or cg. of therapy, viral load will be tested. If it drop 1 unit, 90% of viral load has been eliminated. If your viral load drops by 2 units, viral load decreased by 95%. 3 units, 99%. •Undetectable viral load means amount of virus is low and viruses cannot be found in the blood using the current technology. It doesn’t mean the virus is gone. Much of the virus will be in the lymph nodes and organs that can’t be tested It doesn’t mean you can’t transmit HIV. Keep using protection with sex and drug us. |
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Cell counts and drug therapy
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CD4+ T cells counts play a key role in the ability of the immune system to recognize and defend against pathogens …. counts 800-1200 are normal normal life of cd4 cell is 100 days with aids 2 days; immune problems start to occur when the count drops below 500 CD4 and severe problems develop below 200 CD4 (when AIDS develops)
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HIV Drug therapy…when starting…when using it
Clinical Category-CD4+ T cell count-Plasma HIV RNA-Recommendation |
1.Symptomatic/ AIDS Defining illness or Severe symptoms- Any Value-Any Value-Treat
2.Asymptomatic-<200/ul-any value-Treat 3.Asymptomatic-200/ul-350/ul-Any value- Treatment should be Offered following full Discussion of pros-cons of treatment 4.Asymptomatic->350/ul->100,000-Most clinicians Recommend deferring Therapy, but some clinicians will treat 5.Asymptomatic->350/ul-<100,000-Defer therapy |
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Who is the highest risk for HIV to get a needle stick
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Health care workers have a very low risk of acquiring HIV at work even after a needle stick injury, the risk of infection after a needle stick exposure to HIV infected blood is .3 to .4 %, the risk is higher if the exposure involves blood from a patient with a high viral load; a device used for venous or arterial access or a patient who dies within 60days.
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Health promotion w/ HIV
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HIV infection is preventable. Avoiding and/or modifying risky behaviors are the most effective prevention tools. Provide education and behavior change.
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What to talk to pregnant woman about when they come in for HIV testing
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If pregnant woman are appropriately treated during pregnancy the rate of perinatal transmission can be decreased from 25 to less that 2%.......Current standards of care is that all women who are pregnant or contemplating pregnancy should be counseled about HIV infection, informed of their choices, routinely offered access to voluntary HIV antibody testing and if offered optimal ART
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How to talk to someone with Karpossi sarcoma (vascular lesions of the skin like the man at pine manor “Florian”) and death thoughts.
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Instruct them that the lesions are caused by HHV8 and that dependent on severity chemotherapy, a-interferon, local radiation or cryotherapy can be sensitive to the pt. feels of disfigurement and self image help them with possible ways to cover them if they desire. If the pt. is having thoughts of death nurses should evaluate suicide risks, provide resources’ for medical and emotion support, encourage optimism, remind them that effective treatment are available, review health habits that can be beneficial, educate them on the disease and listen above all else
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Know how to talk to someone in Post test HIV counseling
Posttest Counseling |
1. If test is neg, reinforce pretest counseling and prevention education. Remind patient that test needs to be repeated at intervals for up to 6 months after the most recent exposure risk.
2. If the test is positive, understand that the patient may be in shock and not hear much of what you say. 3. Provide resources for medical and emotional support to help the patient get immediate assistance. 4. Remind patient that effective treatments are available; HIV is not a death sentence. 5. Review health habits that can improve the immune system. 6. Arrange for patient to speak to HIV infected people who are willing to share with and assist newly diagnosed patients during the transition period. 7. Reinforce that a positive HIV test means that the patient is infected, but does not necessarily mean that the patient has progressed to AIDS. 8. Educate to prevent new infections. HIV infected people should be instructed to avoid donating blood, organs, or semen; to avoid sharing razors, toothbrushes, or other household items that may contain blood or other body fluids; and to protect sexual and needle sharing partners from blood, semen, and vaginal secretions. |
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If you see someone with PCP (Pneumocystis jirovecii pneumonia ) where in HIV do you see this?
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HIV PCP… Pneumocystis jiroveci pneumonia, for example, nursing interventions will be required to assure adequate oxygenation. AIDS is diagnosed. Chest x-ray usually shows a diffuse bilateral alveolar pattern of infiltration. CD4 T lymphocyte counts < 200/ ul.
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What happens if people have …low CD4 cell counts.
Low CD4 cell counts: What are you going to see? |
As the cell count drops to 200 to 500 cells and the viral load increases, HIV advances to more active stage. Persistent fever, frequent drenching night sweats, chronic diarrhea, recurrent headaches, and fatigue severe enough to interrupt normal routines. You can see candidisis, other infections include shingles, persistent vaginal candidal infections, outbreaks of oral or genital herpes, bacterial infections. Opportunistic diseases that occur in immunosuppressed patients can lead to disability, disease, and death.
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HIV testing…initial test, confirming tests
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All HIV testing should be accompanied by pretest and posttest counseling. 4 facts for the nurse to talk about.
1. A highly sensitive enzyme immunoassay (EIA) is done to detect serum antibodies that bind to HIV antigens on test plates. 2. If the blood is EIA antibody positive, the test is repeated. |
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Know testing for people with previous anaphylactic testing when they’ve already had a reaction
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How do you test for an anaphylactic reaction. A CBC with WBC differential is required, with an absolute lymphocyte count and eosinophill count. IgE level is also generally elevated in type I hypersensitivity reactions and serves as a diagnostic indicator of atopic disease. RAST is an in vitro diagnostic test for IgE antibodies to specific allergens. Sputum, nasal, and bronchial secretions also be tested for presence of eosinophils. Skin tests can be done.
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Know what to anticipate when someone is admitted to hospital in rejection
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In a hyperacute rejection (rejection in a few minutes) the organ is removed
In a acute rejection (happing in a matter of days or months) is usually reversible w additional immmosupressive therapy In chronic rejection(occurs in months to yrs & irreversible & usually from recent bouts of acute rejection) the pt. is put on different immmosupressive therapy drugs such as tacrolimus (prograf) or mycophenolate moftil (cellCept) and placed back on the trans plant list |
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What would nurse do when people ask about genetic testing What to tell pts.
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Genetic testing includes any procedure done to analyze chromosomes, genes, or any gene product that can determine a mutation or a predisposition to a condition. The nurse can assist the patient and family in making critical decisions related to genetic issues, such as genetic testing. The nurse also needs to collaborate with the team or physician to involve a genetics counselor. The nurse should be able to give patients and their family’s accurate information pertaining to genetics, genetic diseases, and probabilities of genetic disorders. Inheritance patterns can be assessed by the nurse and explained to the patient and family through the use of Punnett squares. The patients values and beliefs are critical since the information from the counselor may have a major implication for many persons who are involved. Genetic counseling is recommended prior to and after obtaining genetic testing because of the complexity of the information and the emotional issues involved
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Cyclosporine
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Calcineurin Inhibitors: Compound present in grapefruit juice prevents metabolism of drug. Consuming grapefruit juice while using drug could increase it toxicity. This drug prevents a cell mediated attack against the transplanted organ. Used in combination with corticosteroids and mycophenolate mofetil. Dose related side effects. Potentially nephrotoxic. Drug levels followed closely. Neoroal and Sandimmune are not biocompatible and should never be interchanged for one another.
Cyclosporine (Sandimmune, Neoral, Gengraf) Route PO, IV Acts on T helper cells to prevent production and release of IL-2 and y-interferon; inhibits production of T catatonic lymhocytes and B cells. Side effects: Nephrotoxicity, Up risk for infection, hepatotoxicity, lymphoma, hypertension, tremors, hirsutism, leukopenia, gingival hyperplasia. |
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Know when we treat people with immuno-suppressant therapies what we should
teach them. |
Used to treat autoimmune diseases such as rheumatoid arthritis, anemia, MS, myasthenia gravis, rheumatic fever, Addison’s disease, hypothyroidism, type 1 diabetics, autoimmune hepatitis pg 234 and to prevent transplant rejection. Teach the pt. that taking the drug increases their risk for infection and malignancies also in transplant pt. there is a risk off toxicity that continue throughout their life. One other thing that u should teach s that these drugs must not be stop abruptly some pt. can be weaned off of them but the process should be slow and gradual
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Bone marrow transplant. What are we looking for with rejection…what are the stages…Organ Rejection
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In bone marrow transplantation, HLA matching is important. The rejection can be prevented by closely matching ABO, Rh, and HLAs
Organ rejection stages:Hyperacute Rejection: (antibody-mediated, humoral) this occurs mins to hrs after transplantation. NO Treatment and the transplant is removed. Acute Rejection: most commonly occurs days to months after transplantation. Mediated by the recipient’s T cytotoic lymphocyes, It is common to have at least one rejection episode, especially with organs of the deceased. Usually reversible with additional immunosuppressive therapy (corticosteroid doses or polyclonal or monoclonal anitibodies). But it does increase the risk of infection. Chronic Rejection: occurs over months or years and is irreversible. The transplanted organ is infiltrated with large #s of T and B cells. Lung rejections are more common then other in chronic rejection. NO DEFINITIVE THERAPY. Changing immunosuppressive therapy to include tacrolimus (Prograf) or mycophenolate mofetil (CellCept) has brought some improvement. Treatment is mainly supportive.pt. with chronic rejection should be put on the transplant list. |
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When you are getting health history, what alerts you to immune deficiency disorder?
What is it? |
When the immune system does not adequately protect the body. In the health history I could be alert by age (infant/older adults), stress (chronic stress/emotional trauma), the use of therapies ( radiation/surgery/anesthesia), Disease/Disorders, Drug-InducedImmunodeficiency (Chemo/Cortcosteroids).
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Teaching about plasmaphoresis.What is it, What do we monitor for?
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It is the removal of plasma containing components causing or thought to cause disease. Monitor for complication with hypotension and citrate toxicity. Hypotension is usually the result of vasovagal reaction or transient volume changes. Citrate is used as an anticoagulant and may cause hypocalcaemia, which may manifest as headache, paresthesais, and dizziness. We want the patient to be able to describe plasmaphoresis to us continuous separation of plasma and blood cells; continuous plasma removal and replacement. Also make sure they are aware of the anticoagulant used which is citrate. Make sure the patient is aware of side effects.
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If someone misses an allergy shot, when should they have the next one
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(immunotherapy) the nurse is responsible for giving it on a weekly to biweekly bias it may take up to five years to gain immunity and if allergy is to insect bite it may not be discontinued pg 231 & 232, if a shot is missed Depending on the time interval between injections, the next dose may need to be reduced. Make sure the nurse is aware of the time lapse before receiving the next injection. If you need to miss doses often, immunotherapy should not be started or continued
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If a person is receiving immunotherapy, if there are certain things presented, when would you call the provider…what is the concern?
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Immunotherapy-indicated only in individuals w anaphylactic reactions to insect venom it involves administration of small titers of an allergen extract increasing strengths until hyposensitivity to the specific allergen is achieved. IF THE INJECTION SITE IS LARGER THEN A QUARTER the primary care provider should be notified so that the allergen dose can be reduced. Immunotherapy carries the risk of a severe anaphylactic reaction so emergency equipment & drugs should be available any time the injection is given
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If someone has testing scratch test…what does the nurse do to stop or slow the reaction?
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For skin testing….pt. should never be left alone during the testing period… if a severe reaction does occur, the extract is immediately removed and anti-inflammatory topical cream is applied to the site. For intra-cutaneous testing, the arm is used to that a tourniquet can be applied during a severe reaction. A subcutaneous injection of epinephrine may also be necessary.
The cardinal principle in therapeutic management is speed in 1. Recognition of signs and symptoms of an anaphylactic reaction, 2. Maintenance of a patent airway, 3. Prevention of spread of the allergen by using a tourniquet, 4 administration of drugs and 5. Treatment for shock….here is the summary of the emergency treatment of anaphylactic shock. |
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What 1st action do you take when someone has an allergic reaction to a bee sting?
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commercial bee sting kits containing injectable epinephrine and a tourniquet are available. The nurse instructs the patient about the technique of applying the tourniquet and self-injection the sub Q epinephrine. Wear Medic Alert bracelet and care bee sting kit whenever outdoors.
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epinephrine IV
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epinephrine is produced by the adrenal medulla…. Given for allergic reactions…Vasoconstriction of peripheral blood vessels. When given IV admin 0.5 ml of epinephrine, diluted 1:10,000 at 5 to 10 min intervals; volume expanders; and vasosopressor agents such as dopamine (Intropin) if intractable hypotension occurs. Oxygen via a non-rebreather mask should be administered. Endotracheal intubationor a tracheostomy is mandatory for O2 delivery if progressive hypoxia exists. Other second line agents are used, inc. an antihistamine such as diphenhydramine (Benadryl) IV or intramuscularly for urticaria and angioedema.
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Angioedema
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Is a localized cutaneous lesion similar to urticaria but involving deeper layers of the skin and the submucosa. The eyelids, lips, tongue, larynx, hands feet, GI tract and genitalia are affected. Swelling usually begins in the face and then progresses to the airways and other parts of the body. Outer skin appears normal or has a reddish hue. The lesions may burn, sting, or itch and can cause acute abdominal pain if in the GI tract. The swelling may occur suddenly or over several hours and usually lasts for 24 hours
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Prevent anaphylaxis…with allergy testing what reaction is monitored initially?
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INITIAL INTERVENTIONS
•Ensure patent airway •Remove insect stinger if present •Epinephrine 1:1000, 0.2-0.5 ml subcutaneously for mild symptoms; repeat at 10-15 min intervals •Epinephrine 1:10,000, 0.5 ml IV at 5 to 10 minute intervals for severe reactions •Administer high-flow oxygen via no-rebreather mask. •Place recumbent and elevate legs •Keep warm •Administer diphenhydramine (Benadryl) IM or IV •Admin histamine H2 blockers such as cimetidine (Tagamet) •Maintain blood pressure with fluids, volume expanders, vasopressors (dopamine (Intropin), norepinephrine bitratrate (Levophed) ONGOING MONITORING •Vital signs, respiratory effort, O2, level of consciousness, and cardiac rhythm •Anticipate intubation with severe respiratory distress •Anticipate cricothyrotomy or tracheostomy with severe laryngeal edema |
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why explain to people why we have cancer screenings
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Early detection can improve prognosis, early treatment has high success, screening can help elevate concern and over the person who is screened has a higher chance of survival if cancer is detected also people should realize cancer is not a death sentence.
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If a pt. has atopic dermatitis what levels of the immune system
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This a humoral immunity (meaning its antibody mediated) atopic dermatitis Type 1:IgE- mediated reaction meaning it occurs in people who are susceptible to specific allergens this reaction is chronic, characterized by exacerbations & remissions affects the skin has unknown exact cause. Type 1 reaction are identified by the wheel-and-flare skin tests.
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What does an infant get from colostrums
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Receives immunoglobulin IgA which lines mucous membranes and protects body surfaces it’s a natural passive immunity.
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Punnet square for someone who has a disease
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1.tosomal recessive- if both parents have the recessive gene 1 out of 4 kids will have the disease & 2 out of three will be carriers
2.Autosomal dominant- if one parent expresses the disease and the other doesn’t then half the children will have the disease and half will not. 3.Sex linked recessive-If 1 parent carriers a recessive gene (a female) then the 1 female will be a carrier and 1 male will have the disease (because they only have 1 Xchomosone) the other two children will be unaffected. •The disease is always expressed in the male child and only expressed in the female if the father or the mother or both have the disease, remember in sex linked is only if the mother is the carrier because if the male has the gene he has the disease and the punnit square you use him is for autosomal dominant |
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Deficiency involving T. lymphocytes.
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Primary immunodeficiency disorder r 1. Digeorge syndrome (thymic hypoplasia) effects T cells some r sex linked 2. severe combined immunodeficiency disease, effect stem B & T cells, sex linked or autosomal resessive, 3. Atixia-telangiectic, effects B & T cells, autosomal recessive 4. Wiskott-aldrich syndrome, effects B & T cells, sex linked 5. Graft-versus disease, effects B & T cells happens in transfusions & transplanted organ cells T cells of donor attach the recipients t-cell in general (They derive from the thymus gland) live from a few months to a few yrs, primary responsible for immunity for intercellur viruses, tumor cells and fungi are either cytotoxic cell or T helper cells
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BRCA…counseling a woman with this gene…what kind of teaching would you give.
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Genetic testing for BRCA mutations can be done in women believed to be at risk for developing breast cancer. A genetic mutation in these genes has been found in 5% to 10% of all breast cancer patients. There women can be tested if they develop breast cancer at a young age or have a first degree relative with breast or ovarian cancer. Presymptomatic testing allows physicians to take prophylactic steps such as performing a mastectomy or oophorectomy, to avoid the development of cancer.
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Mild genetic diseases when they worry about passing it on…how to respond…under nursing management
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Will be mainly supportive, early detection of treatable conditions and complications is a priority. Provide support and education. Discuss genetic counseling. Referral to appropriate resources is essential
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Monitor pt. with IM injection…precautions.
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Monitor for signs of localized redness, swelling, bleeding, or inflammation at injection site. Observe the patient for at least 15 minutes following the injection for signs of reaction to the drug.
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