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253 Cards in this Set
- Front
- Back
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What are considered respiratory problems?
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COPD, Asthma, Sleep apnea
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What is COPD?
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- chronic bronchitis, emphysema
**Treat this as one disease** |
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What are the causes of COPD?
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*most common= smoking, pollution.
-rare enzyme deficiency (alpha protease inhibitor) |
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What happens to the lung tissue in pts with COPD?
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-fibrosis, inflammation
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What happens to lung tissue in pts with emphysema?
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-you get big bulged sacs which leads to decreased surface (lung) for gas exchanged and inflammation which that causes obstruction.
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What are early signs and symptoms of COPD?
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-considered chronic
-cough -shortness of breath -persistent |
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Signs and symptoms of early asthma
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-considered acute b.c it goes away.
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Exacerbations of COPD?
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-any kind of virus (ex. pneumonia)
-increased inflammmation caused by progressive disease. |
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What are the common complications of COPD?
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-Respiratory failure, respiratory acidosis hypoxia, hypercapnia.
-Cor Pulmonale=typer of rt sided heart failure b.c pt has decreased O2 levels in pulmonary vascular system which leads to hypertension which leads to increased overload. |
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What do you really have to watch for in pts with COPD?
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Cor Pumonale
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The basic standard for evaluating the severity of COPD has primarily been?
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With spirometry
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What offers better insight into outcomes (ex: survival) with a pt with COPD?
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Functional dyspnea test
BMI FEV1 from spirometry |
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What % of normal lung function, when measured with spirometry diminishes after age 35?
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approximately 5%
**therefore it is rare for a pt over age 35 to have a 100%! |
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What varies depending on age, height, sex and race?
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FVC & FEV (2 of the measurements in a pulonary function test.
-#'s are higher w/ 35 vs 65 year olds, taller, men, caucasian. |
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PFT/ Spirometry
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-pulmonary diffusion capacity
-ability of gas to diffuse against the alveolar capillary membrane -decreased in emphysema |
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Medications: Anti-inflammatory
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-Corticosteroids
-Bronchodilators |
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Corticosteroids
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-used more w/ asthma
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Oral Prednisone: Corticosteroid
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-works well w/ inflammation but has really bad side effects
-long term low doses or short term high doses cause fewer problems -problems w/ moderate doses over time **cannot just suddenly dc this med! |
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IV Solu-Medrol (methylprednisone
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Corticosteroid
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Inhaled Corticosteroids
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Azmacort, Flovent
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BRONCHODILATORS
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-are beta agonists (helps with bronchodilation)
-Short acting= albuterol (inhaled or nebulizer); Xonopex (levalbuterol)= used w/ kids. -Long acting= Severent (salmetrol)- safety issues when not taking with corticosteroid(runners use this) |
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BRONCHODILATORS [CONTINUED]
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-Anticholinergic (produces bronchodilations)
-Atrovent=short acting -Spiriva=long acting; 1x a day dosing |
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Mucolytic Agents
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-helps bring secretions up
-Mucomyst, Humibid -Increased hydration may be better -Aerosol therapy (albuterol, atrovent) |
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Theophylline
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-oral medication
-has multiple drug interactions -HAVE to monitor drug levels |
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Combination Products
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-Combivent: Albuterol+Atrovent
-Advair: Hovent+Serevent (corticosteroid and long-lasting beta agonist..comes in dry powder formation |
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Patient Teaching:
Use of Medications for corticosteroids and bronchodilators |
-Inhalers: 2 inches away or use a spacer
-Alternative: directly in mouth -common errors is when pts forget to prime before use or long duration of disuse and they do not hold their breath for 10 seconds. -rinse mouth afterwards |
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Dry Powder Inhalers
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-ex:(Advair)
-do not exhale into device b/c of spit -need to inhale fast enough -close mouth tighly around inhale *FRAIL PTS CANNOT USE THIS* -rinse mouth afterwards |
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What happens if you do not rinse mouth out after inhalation of corticosteroid?
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-you can get oral thrush/fungal infection
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Patient teaching w/ corticosteroid and bronchodilators
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-report increased symptoms (resp. infections, depression, sleep difficulties
-ask about non RX drugs (what else are they on?) -Need flu vaccine, pneumovax -smoking cessation |
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What is an example of long lasting beta agonists that causes bronchodilation?
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SERIVENT
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What type of drug is Atrovent (ipratopium) and what does it do?
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-Anticholinergic and Bronchodilator
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What IV anti inflammatory drug is used for acute exacerbations of asthma and COPD?
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Solumetrol
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WHEN should you teach a pt about inhaler use?
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-when it is prescribed
-anytime you come across it |
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Complications of COPD
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*most common is resp. failure
-r/t infection, d/c bronchodilators or cortisone -Beta blockers=may cause resp. failure -Sedatives/Narcotics=decreased ventilative drive produces CO2 retention (hypercapnia)...these pts do not do well w/ narcotics |
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BIPAP
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-Noninvasive mechanical vent.
-use face or nasal mask -positive ventilation to supplement spontaneous breathing -can be set to different levels for inspiration and expiration -disadvantage= mouth dries out |
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Complications of COPD
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Spontaeous pneumothorax= weakened lung tissue
-Cor pulmonale=can lead to lt sided heart failure w/COPD -pulmonary hypertension that causes rt sided CHF -Low PO2 causes vasoconstriction leads to pulmonary hypertension -leads to rt ventricular hypertrophy leads to Cor Pulmonale |
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Assessment findings for Cor Pulmonale
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-same as rt sided heart failure
-peripheral edema, wt. gain, distended neck veins -change in heart sound and ECG |
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Management for Cor Pulmonale
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-O2 therapy to prevent progression...usually at night
-tx of rt sided heart failure -smoking cessation (5% quit 1st time trying) -hydration -nutrition |
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Hydration for pts with respiratory problems
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-3,000 cc/day unless contraindicated (cor pulmonale and heart failure)
-helps keep secretions thin |
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Nutrition for pts with respiratory problems
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-pt. can be under or overweight
-underweight is most common r/t just trying to breathe -calorie deficiency, muscle protein destruction -pt reports anorexia, early satiety and dyspnea |
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What can you educate about nutrition with pts with respiratory problems (underwt)
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-eat small frequent meals with high calories, high protein, and avoid fatigue
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Respiratory treatment for pts with respiratory problems
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-postural drainage
-percussion -cough *these help move secretions along* |
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Oxygen treatment for pts with respiratory problems
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-low flow O2 (2L)
-prevent cor pulmonale -nasal prongs to facilitate eating -have back up power for outages -w/ air travel check with airlines...may require use of airline O2 |
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Patient with experience in dyspnea does not always?
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-correlate with oxygen levels
-may have to go with objective information |
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Why should you use low flow?
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-CO2 levels stimulate to breathe
-with COPD they have CO2 retainers |
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Trans tracheal catheter
(SCOOP trach) |
-bypasses dead space of upper airway
Care: Call respiratory therapy, ask the pt how he feels -important to find out how to take care of this. |
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What can happen if SCOOP trach is not properly taken care of?
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-respiratory distress
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Pulmonary Rehab
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-may walk pt down hall and check O2 sats and respiratory rate
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Positioning with pts with respiratory problems
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-High Fowlers= they don't want to lay down
-Tripod= opens up airway |
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Fatigue with pts with respiratory problems
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-space out tasks
-simplify tasks -wt bearing exercises to increase endurance (still recommended to keep muscle mass up) |
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Environmental modifications for pts with respiratory problems
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-avoid falls (tripping over O2 cords)
-Ease ADL'S |
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How does pursed lip breathing help pts with respiratory problems?
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-with patients with COPD,this helps get the air out.
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How does diaphragmatic breathing help?
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- used more for relaxation...patients with respiratory problems have increased risk for anxiety.
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Other exercises pts with respiratory problems can do
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-blow through a straw
-bend candle flame -blow ping ping ball (all will aid in pushing air out) |
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Other problems to consider with pts with respiratory problems?
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-depression is common
-sleep disturbances -repeated hospitlizations -hospice care -treating air hunger...with morphine. |
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Asthma
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-increased rates in African Americans.
-used to be considered a part of COPD but now is separate. -can be a risk factor for COPD |
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Patho for Asthma
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-reversible in chronic inflammatory disease
-course is unpredictable -lack of tx leads to increased morbidity and mortality |
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Patho for Asthma
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-Hypersensitivity of bronchi/trachea to stimuli produce antibodies
(IgE...produce histamine) |
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Patho for Asthma
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-constriciton of large and small airway cause bronchospasms
- increased capillary permeability -cause massive mucous production 30-60 min after exposure |
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Asthma Triggers
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-Allergic(extrinsic)
-Respiratory Infection (most common trigger) -Sinus problems: 30% of pts w/ asthma have noth-usually related to allergies |
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Exercise induced Asthma
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-very common
- should use inhaler before exercise |
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Asthma induced triggers
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-drugs, food additives
-20% of pts with asthma are allergic to aspirin -GERD: irritation of trachea by food relux -emothional stress: not a psychogenic illness -can trigger panic attacks |
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Clinical S/S/ of Asthma
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-chest tighness, SOB, wheezing, cough, diaphoresis, anxiety, dyspnea
-RR above 30, cough at night and early AM |
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Clinical S/S of Asthma
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-wheezing is not a good indicator of severity
-decreased blood sugar indicated status asthmaticus -use assessory muscles to breathe |
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COPD T/F:
Atrovent is a beta agonist that causes bronchodilation? |
False, it is an anticholinergic
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COPD T/F:
Theophylline is an inhaled medication that causes bronchodilation and has a narrow therapeutic range? |
True
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COPD
-An example of a short acting beta agonist bronchodilator is? |
Albuterol
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COPD
-An example of an inhaled anti-inflammatory agent is? |
Flovent (asthma corticosteroid)
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Combivent contains?
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Albuterol + Atrovent
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A life threatening condition in severe asthma is?
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Status asthmaticus
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Right sided heart failure caused by decrease O2 levels in COPD is?
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Cor Pulmonale
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Sleep Apnea
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-cessation of breathing during sleep
-increases risk for cardivasular disease |
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What causes sleep apnea?
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-CNS damage (lack of stimulation)
- Obstructive problems: tongue, soft palate fall back during sleep and obstruct airway -person wakes up, breathes, goes back to sleep. - |
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What are the risk factors for sleep apnea?
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-short neck
-obesity |
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How is sleep apnea diagnosed?
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-family may first notice problem
-c/o frequent waking, excessive daytime sleepiness -loud snoring -sleep labs -in hospital, remote location, at home test |
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What is the treatment for sleep apnea?
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-avoid sedatives
-weight loss -Use of CPAP |
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Concerns when hospitalized with pt with sleep apnea?
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-bring own machine
-help to hook up -need to use when napping and at night |
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Tuberculosis
"Consumption" |
-grows slowly
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What causes mycobacterium tuberculosis?
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-slow growing, latent; found in the lungs
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How is Tuberculosis spread?
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-droplets
-coughing, sneezing or laughing -airborne |
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Is Tuberculosis easily spread?
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No, it requires close, frequent contact
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Is tuberculosis spread through fomites?
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No. You have to be able to inhale it through the air.
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Where can you find fomites?
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-towels, paper, books, dishes, etc,
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Is tuberculosis ever seen outside the lungs?
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-Yes, you can get it in different places in the body
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What is military TB?
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When TB is found spread through body through blood stream
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Incidence of Tuberculosis
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-world wide problem
-increased incidence in areas of Asia, Africa, Latin America -goes together w/ AIDS incidence(decrease resources to meds, poverty stricken areas |
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Incidence of Tuberculosis
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-Kills 2 million a year
--one billion newly infected in the next 20 years -linked w/ malnourishment and poverty -more common in LTC and prisons -common w/ IV drug use |
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Contributing factors of Tuberculosis
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-HIV accelerating spread of TB
*opportunistic infections *can mimic PCP(pneumocystic pneumonii) |
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What other contributing factors for increase in TB?
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-poorly mananged programs threaten to make TB incurable
-MDR-TB:multidrug resistant TB -XDR-TB: extensively drug resistant TB |
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Movement of people spreads TB
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-global trading
-refugees/ displaced persons -homeless |
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Patho of TB
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-tubercle bacilli is inhaled and produces infection
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What is the worst case scenario with TB?
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-the disease progresses
*Necrotic degeneration (caseation) develops and causes exudates and cavity (eats at it) *can drain into the trach/bronchus and be expelled into the air |
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Another worst case scenario with TB
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-Primary tubercle heals leaving Ghon tubercles
*sensitivity develops in 2-6 wks *aquired immunity stops the disease process |
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Secondary infection of TB
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-either re-infection a second time
-or dormant TB become active disease |
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TB Infection
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Latent- means always has chance of turning into disease
-no s/s -cannot spread TB -have + skin test -can develop TB later if no tx |
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Active Disease of TB
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-does have s/s
-can spread disease -have + skin test |
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Classification 0 of TB
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No TB exposure
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Classification 1 of TB
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TB exposure no infection
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Classification 2 of TB
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Latent TB infection
-no disease -+ TB test w no other findings |
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Classification 3 of TB
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TB clinically active
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Classification 4 of TB
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-TB, but not clinically active
-Hx of TB |
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Classification 5 of TB
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-TB suspected
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Diagnosis of TB
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-Skin testing
*ask if previously +: (Why? because will always be positive!) -Not test if positive reactor -Use MANTOUX not TINE |
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Mantoux/PPD
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-given intradermal
-Read 48-72 hours later--must have induration to be positive |
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What is an induration?
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-hard bump
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Two Step testing for TB
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-TB skin test, then test again one week later
-recommended for elderly, r/t decreased immune system -may be used as initial test for healthcare workers |
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Blood test screening for TB
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-QFT Gold Test- newest, only test you have to receive.
-one blood draw required -less false positives, no reture visit -Disadvantage: more expensive |
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BCG Vaccine for TB
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-not widely used in US
-used in countries with increased rates of TB -Cause+reaction |
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Chest X-Ray for TB
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-need to specify no TB
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Sputum Smears test for TB
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-acid fast bacillus smear: stain and look and it will specify AFB
-look at stain specimen under microscope(need about a teaspoon) |
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Collecting Sputum
Direct Method |
-rinse mouth, cough not spit
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Collecting Sputum
Indirect Method |
-suction cath with sputum trap
-can be collected after nebulizer tx label sputum specimen -trans tracheal aspiration (sticking needle through) -Gastric lavage (stomach) -Bronchoscopy..disadvantage b/c high risk procedure |
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Culture specimen for TB
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-for active TB
-need to be dx'ed with TB -results in 36-48 hr but may take up to 6 wks. -usually need daily specimen fore 3-5 days |
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Culture specimen for TB
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-drug susceptibility testing done at same time
-during tx: culture may be negative but bacilli may still be present |
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S/S of Active TB
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-insiduous onset
-low grade fever, fatigue, anorexia, wt. loss, morning cough -night sweats, chest pain, progressive (usually non productive cough |
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Cough with active TB
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-become productive mucopurulent sputum with hemoptysis(blood)
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Management of active TB
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-antituberculosis agents -1st line Drugs
-3-4 first line drugs for 6 months (longer with HIV) -usually short term |
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Nursing management of TB
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-check for symptoms early
*health hx *cough/sputum (color?quality?) -night sweats, fever -wt loss -chest pain |
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Prevent transmission of TB
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-DOT program (direct observation)
-observe taking drugs 2-3 x's a wk |
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In hospital guidelines for TB
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-private room w/ negative airflow room
-masks special fit -pt wear mask when out of room -special precautions for high risk procedures (bronchoscopy) -hand washing, gowns -teach pt to cover mouth when coughing, dispose of tissues |
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Treatment adherence and knowledge of TB
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-Rx need to be taken on empty stomach one hr before eating
-GI upset can be a problem -INH: avoid foods w/ tyramine (tuna, aged cheese, red wine, soy) -avoid alcohol |
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Treatment information for TB
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-monitor liver enzymes, bilirubin, (INH,Rifampin,PZA), BUN, Creatinine
-monitor for other SE neuritis, hepatitis, skin rashes, deafness |
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Activity with TB
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-as tolerated
-rest frequently as needed -avoid exposure to others for 2-3 wks. |
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Nutrition for TB
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-increase B vitamins
-high protein |
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Cause for Histoplasmosis
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-fungal infection caused by inhalation of dust contaminated with excreta
-bats, birds, (ex: Chicken pox) -common in Midwest |
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Patho of Histoplasmosis
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-inhaled spores are phagocytize by alveolar macrophages
-spores then germinate and form yeast cells (similar to TB causing necrosis, encapsulation |
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Patho of Histoplasmosis
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-bud and then forms cysts in lung
-resembles TB with necrosis and healing by fibrosis and encapsulation |
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S/S for Histoplasmosis
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Intial infection= self limiting with no tx
-Pneumonitis=nonproductive cough, fever, malaise, dispread -lung infection -self limiting, often not treated |
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Progressive disseminated histoplasmosis
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-immunocompromised (ex. lymphoma)
-fever, weakness, wt loss, leukopenia, oral ulcers, hepatomegaly -can be fatal without treatment -50% develop adrenal insufficiency |
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Disseminated forms of Histoplasmosis
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TX: Oral antifungals-Nizoral, Diflucan, Sporanox
IV: Amphotericin B...many SE -pretreat with Benedry and aspirin -LFT |
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Rheumatoid Arthritis
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-have problems get up and going in the morning
-pain during night -pain lasts longer than OA -arthritis is bilateral |
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Who gets RA?
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-Females, African Americans
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Patho of RA
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-body attacks the joint which leads to damage.
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Early s/s of RA
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Fever, wt. loss and morning stiffness
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S/S later in the course of RA
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Symmetrical joint involvement
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S/S of RA
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-Stiffness usually in morning and after inactivity.
-Fatigue |
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Clinical Manifestations of RA
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-typical deformities
*Ulnar drift *Swan neck *Boutonniere Cause is jt destruction, muscle atrophy and destructions of tendons |
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Clinical Manifestations of RA
Extra-articular |
-blood vessels inflammed
-Raynaud's Phenomenon |
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Diagnosis of RA
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-no lab is conclusive
-ESR=measure of inflammation -RF=rheumatoid ractor -ANA= antinuclear factor -Joint aspiration -Xray |
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ESR test measures what?
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erythrocyte sedimentation rate
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Joint aspiration with RA patient will show what?
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-synovial fluid indicates increased WBC's
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Xray of joint
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-early view shows bone demineralization, soft tissue swelling
-later view shows more bone destruction shown |
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Medication for RA
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NSAIDS
Corticosteroids DMARDS |
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NSAIDS for RA
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-high doses than used for normal aches and pains
-monitor renal functions and GI bleeds |
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Corticosteroids for RA
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-works very well
-symptoms controlled -Injection into jt or oral -Bridge therapy=given until longer acting drug becomes effective -Burst therapy= used for flair up *need to wean off these slowly |
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DMARDS for RA
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Methotrexate(Rheumatrex)
Sulfasalzine (Azulifidine) |
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Methotrexate (Rheumatrex)
used for RA |
-given PO or injection
-given at lower doses than for cancer -Cytotoxic..can be given w/ folic acid to decrease toxicity -need to know renal function before given -SE: bone marrow supression, hepatotoxic -Monitor: LFT, CBC |
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Sulfasalzine (Azulifidine)
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-S.E.: GI, skin reactions
-lesson common: hepatitis, bone marrow suppression -monitor: LFT, CBC |
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DMARDS-TNF(tumor necrosing factor)
BLOCKERS |
-blocks one type of cytokines (TNF) that produces inflammation and jt destruction
-many are given w/ methotrexate -all increase risk for infection, esp. TB -no live virus vaccine when on meds ex: nasal spray for flu vaccine |
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DMARDS-Entanercept (Enebrel) for RA
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-given SQ, 2x's weekly
-very beneficial in preventing bone destruction |
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DMARDS- Infliximab (Remicade) for RA
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-given IV
Others: Humira, Arava, Kineret -very beneficial in preventing bone destruction |
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Problems with DMARDS for RA
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-cost
-infection |
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Nursing Management for RA
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Acute measures
*reduce inflammation *non pharmacological tx -heat/cold -rest -relaxation techniques *Adapt activities |
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RA gets better when?
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during pregnancy
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Home care for RA
|
-realize RA is unpredictable
-rest(regularly scheduled periods) -minimize fatigue producing activites -good body alignment |
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Home care for RA
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-Joint protection
-change way task is done -energy conservation -splints |
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Home care for RA
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-daily heat/cold for short periods of time
-monitor for tissue damage -exercise/gentle stretches -psychological support |
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Symptoms of Ulcerative Colitis?
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-bloody diarrhea and abdominal pain. Significant urgency and left sided abd. pain. As scarring occurs sensation to defecate decreases leading to involuntary leakage of stool.
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What is seen on a colonoscopy with ulcerative colitis?
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Edema and shallow ulceration, pseudopolyps
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What are the symptoms of Crohn's Disease?
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Diarrhea and abd. pain and steatorrhea
-Colicky, severe pain that occurs after eating and tenderized that may be diffuse or localized to rt lower quadrant pain |
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What is seen in Crohn's disease?
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-Skip lesions
-mucosal granulomas -luminal narrowing -thickened intestinal wall |
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What are common medications for inflammatory bowel disease?
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-Aminosalicylates (oral and rectal)
-Corticosteroids -Immune Modifiers |
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Aminosalicylates (Oral)
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-assess for allergy to sulfa and aspririn
SE: anorexia, N/V, headache |
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Aminosalicylates (Rectal)
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-give enema while pt is on left side and teach pt to retain as long as possible
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Corticosteroids
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-take with food or fluid
-monitor wt gain\-assess for edema -have BP checked regularly -be alert for s/s of infection |
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Immune Modifiers
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-report s/s of infections
-be alert to bruising -return for lab work -maintain liberal daily fluid intake (2.5-3.0 L/day) |
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What would you teach the client about diet and fluids and elimination with inflammatory bowel disease?
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-eat high calorie, well balanced diet. Avoid foods that increase symptoms (fresh fruits, raw veggies, fatty foods, spicy foods and alcohol. Assess effect of dairy. Take multivitamin; ensure liberal fluid intake; drink gatorade to replace electrolytes; use salt liberally during flare ups
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What are common s/s of IBS?
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-abd. pain, diarrhea, constipation or an alternating pattern of the two; mucous in stool; sensation of incomplete evacuation and relief of discomfort; excessive gas and bloating, dyspepsia.
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Wht can exacerbate s/s of IBS?
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-psychological stress
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Nursing Management of IBS
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-assess pt and family's coping skills
-assess home environment (adequate bathroom facilities, opportunity to rest) -assess ability to self manage therapeutic regimen including drug therapy, nutritional therapy, availability of community resources, importance of follow-up care |
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What types of infectious disease precautions should be taken related to TB hospitalization?
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Hand washing
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If you had a pt come in with hemoptosis, night sweats, cough and wt loss, what should you test for?
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Tuberculosis
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SLE
Sysyemic Lupus Erthematosus |
-chronic inflammatory disease of autoimmune origin that affects primarily the skin, joints, and kidneys, but can effect every origin of the body.
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What is the most common cause of death with pt with SLE?
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Kidney failure
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s/s of SLE
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-Butterfly rash
-photosensitivity -fatigue -discoid lesions of skin and mucous membranes -alopecia -jt deformities -arthralgia |
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Tests for SLE
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-ANA
-anti-SM antigen -LE cell test |
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Common medications for SLE
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-Cyclophosphamide
-Dexamethasone -Azathioprine -NSAIDS - first line of treatment but may cause hepatitis with this. -Antimalarials (for skin) Corticosteroids |
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Nursing care for SLE
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-during exacerbations the nurse should monitor the pt for the effects of medications and for renal dysfunction.
-Assess neurologic status freq. for development of cognitive dysfunction. |
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Chronic Fatigue
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-hx of chronic pain>3 months in all 4 quadrants of body.
-Bilateral tender jts sites include occiput, low cervical, trapezius, supraspinatus, 2nd rib, gluteal, knee |
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S/S of Chronic Fatigue
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-nonspecific, weakness or muscle pain
-impaired memory, insomnia -HA, sore throat -Post exertional fatigue>6 mos -Severe Chronic Fatigue>6 mos *need to rule out thyroid, DM, renal metabolic syndromes. |
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Labs that should be monitored for Chronic Fatigue
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-CBC
-ESR -Protein -Albumin-rule out liver, tissue damage and renal disease. -Creatinine -TSH -Glucose. |
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Adrenal Steroid Hormones
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*Glucocorticoids
-regulate metabolism -increase blood glucose levels -stress response -EX: Cortisol |
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Mineralcorticoids
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-regulate sodium and potassium
Ex: Aldosterone |
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Androgen
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* Sex hormone
-estrogen -progesterone -testosterone |
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What do hormones regulate?
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-sugar(glucocorticoids)
-Salt (mineral corticoids) -Sex (androgens |
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Cushing's Syndrome
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-cortisol hypersecretion
-seen in pts with depression or obesity -more common in females |
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Diagnostic Tests for Cushings
(24 Hour Urine) |
-24 hr urine test
(discard 1st void then collect all urine for 12-24 hours. -cortisol will also be elevated during high stress, infection, and pregnancy |
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Diagnositic Test for Cushings
(Dexamethasone Suppression Test) |
-given on a schedule (usually pm) then compared with an expected norm.
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What are the normal Cortisone levels in body?
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low at night, high in morning
-dexamethasone causes decreased levels in am |
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What are the abnormal cortisol levels in body?
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-level in am is the same
-there is no feedback to decreased levels |
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Treatment for Cushing's
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*Surgery-transsphenoidal surgical removal of pituitary gland
-adrenal gland removal |
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Medications for Cushing's
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-supress cortisol
-Adrenal clocking agents -ACTH reducing agents |
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Nursing Management for Cushing's
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-Monitor for infection
-surgical care -post op cortisone replacement -emotional support r/t depression, liability |
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Cause for Addison's disease?
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-decrease in all 3 adrenal steroid hormones
** MOST COMMON CAUSE IS AUTOIMMUNE -May be caused by TB |
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Clinical manifestations of Addison's Disease
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-decreased BP/Na/BS
-dehydration -elevated K+ -weakness |
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Nursing Care: Prrevention of HIV
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-counseling r/t sex practices
-abstinence or mutual monogamous relationship with non infected person are only way to absolutely prevent prevention.-safe sex practice esp. during anal intercourse are 2nd best method -sharing of needles -pregnancy |
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Nursing Care: Prrevention of HIV
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-counseling r/t sex practices
-abstinence or mutual monogamous relationship with non infected person are only way to absolutely prevent prevention.-safe sex practice esp. during anal intercourse are 2nd best method -sharing of needles -pregnancy |
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Managing AIDS manifestations
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-Infection prevention
-Controlling fatigue -Nutrition -Effective home management |
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Managing AIDS manifestations
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-Infection prevention
-Controlling fatigue -Nutrition -Effective home management |
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Tests for HIV
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-ELISA
-Western Blot -Oralquick Rapid HIV-1 Antibody test -Orasure HIV-1, HIV-2, and HIV-1&2 test -absolute CD4 cell count -Plasma viral load test |
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Tests for HIV
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-ELISA
-Western Blot -Oralquick Rapid HIV-1 Antibody test -Orasure HIV-1, HIV-2, and HIV-1&2 test -absolute CD4 cell count -Plasma viral load test |
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Nursing Care: Prrevention of HIV
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-counseling r/t sex practices
-abstinence or mutual monogamous relationship with non infected person are only way to absolutely prevent prevention.-safe sex practice esp. during anal intercourse are 2nd best method -sharing of needles -pregnancy |
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HIV World Wide Problem
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-high incidence areas are Africa, Eastern Europe, Asia r/t lack of education, money, prevention measures, cultural practices
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HIV World Wide Problem
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-high incidence areas are Africa, Eastern Europe, Asia r/t lack of education, money, prevention measures, cultural practices
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Managing AIDS manifestations
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-Infection prevention
-Controlling fatigue -Nutrition -Effective home management |
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How is HIV transmitted?
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-body fluids (blood, semen, vaginal secretions)
-Not urine or sweat or kissing |
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How is HIV transmitted?
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-body fluids (blood, semen, vaginal secretions)
-Not urine or sweat or kissing |
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Tests for HIV
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-ELISA
-Western Blot -Oralquick Rapid HIV-1 Antibody test -Orasure HIV-1, HIV-2, and HIV-1&2 test -absolute CD4 cell count -Plasma viral load test |
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HIV World Wide Problem
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-high incidence areas are Africa, Eastern Europe, Asia r/t lack of education, money, prevention measures, cultural practices
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How is HIV transmitted?
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-body fluids (blood, semen, vaginal secretions)
-Not urine or sweat or kissing |
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Fragile Virus
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-transmitted only in body fluids
-not by casual contact (urine, sweat) |
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HIV 1
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* Most common in US and Europe unless hx of travel
- 10 subtypes A-J |
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HIV1-O (Outlier)
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-not in US
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Sexual transmission of HIV
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-most common method
-heterosexual exposure |
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Who are most at risk for HIV?
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-anal intercourse or partner receiving semen (male or female)
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Perinatal transmission of HIV
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-pregnancy, delivery, breastfeeding
Tx mother/babies with antivirals. This greatly decreases transmission rate (CDC-2%) |
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Screening recommendations for HIV
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-opt in/opt out= must give consent to be tested
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What subtype is HIV is seen in the U.S.?
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HIV1
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Where is subtype B (2) seen?
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Africa
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Patho affect on lymph system with HIV
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-immune system loses ground
-virus reproduces and spills into blood -virus load goes up |
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T Cells
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-cell mediated immunity for some bacteria, virus, fungus and tumors
-cell will attack anything foreign -are infected with HIV and replicate |
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B Cells
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-produce immunoglobulins that produce antibodies that produce immune response
-can take over for T cells |
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Primary HIV 1 infection
Stage 1 |
-2-4 wks after exposure
-similar to flu or mono -antibody tests are negative (not developed yet) -pt may benefit from antivirals |
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Asymptomatic infection
Stage 2 |
-no symptoms(or mild recurrent sinus inf., HA, fatigue, lymphadenopathy)
-HIV tests are positive after 12 wks of infection -Last months to more than 10 years |
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AIDS
Stage 3 |
-Opportunistic infections and Cancer
-Death 3-5 years if not tx |
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Long-Term Non Progressor
Magic Johnson |
-HIV+ greater than 10 yrs w/ stable immune system
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What are some reasons a person w/ HIV might be a long term non-progressor?
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-lifestyle
-genetics -support immune system |
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Long Term Survivor of AIDS
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-AIDS greater than 8 years
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What are some reasons a person w/ AIDS might be a long term survivor?
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-TX
-Antivirals meds |
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What does the ELISA test do?
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-diagnose and plan tx
-screens for HIV-1 -Positive 2 wks to 6 months after infection -False positives are possible |
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Western Blot
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- used to confirm the ELISA test
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Viral Load
(HIV/RNA cell count) |
-helps determine when to initiate therapy/and effectiveness of tx
->55,000/mm3 indicates high risk of progression to AIDS in 3 years - high levels increase risk to transmit disease |
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CD4 Counts
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- moniitor immune function
- <200 High risk of AIDS progression ->500 few s/s are present |
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CD4/CD8 ratio
(helper cells/suppressor cells) |
-may be a more accurate measure
-less variable than CD4 alone |
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HAART/ART
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ART- antiretroviral therapy
-rationale: works on different stages of the cell cycle |
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NRTI's
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Nucleoside Reverse Transcriptase Inhibitors
-interferes with viral replication at an early stage -ex: AZT |
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NNRTI's
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Non-Nucleoside Reverse Transcriptase Inhibitors
- also interferes with viral replication ex: emtricitabine |
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Protease Inhibitors
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-interferes w/ viral replication by inhibiting the enzyme protease-works at late stage of replication
-causes CV problems w. long term use |
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Fusion Inhibitor
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Fuzeon
-interferes with entry of HIV-1 into cell -2x a day SC injections, injection site reaction, cost |
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Combination drugs
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-once daily drug now available
-atriplia for HIV 1 -Combines Sustive, Emtriva and Viread |
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Opportunistic Disease
(Bacterial) |
MAC (Mycobacterium avium complex)
-most common bacterial inf. -high fever, night sweat, wt loss -lung, GI symptoms -tx w. long term antibiotics |
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Bacterial Infection:
Tuberculosis |
-treat with INH, other anti TB drugs
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Protozoan (Now atypical fungus)
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Pneumocystis carinii
- lung infection w/ s/s dyspnea, nonproductive cough, fever -treat w/ long term Bactrim |
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How do you diagnose Pneumocystis carinii? (PCP)
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Xray
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Fungal Infection
Candida Albicans |
-yeast
-white patches in mouth, GI tract, skin, vagina -can cause extreme dysphagia Tx: antifungals |
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Viral Infection
Herpes Simplex |
viral infection that affects the skin
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Viral Infection
Cytomegalovirus (CMV) |
-leading cause of blindness
-Tx: antivirals |
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Neoplasms
Kaposi's Sarcoma (KS) |
-most common cancer seen in HIV
-lesions on skin and mucous membranes (brown to purple) -can be disseminated throughout body |
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Neoplasms
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Chronic lymphocytic leukemia
(CLL) -Lymphoma -Invasive cervical cancer |
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Wasting Syndrome
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-ARC is the old term
-defined as 10% wt loss and chronic diarrhea in more than 30 days |
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Management of wasting Syndrome?
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-chronic diarrhea-anti diarrheal Sandostatin
-Appetite stimulant: Megace and Marinol |
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Managing Aids manifestations
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Infection prevention
-pt family teaching Controlling fatigue Nutrition Effective home management Support family/pt education |
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Crisis Times
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-initial dx w/ HIV
-AIDS dx -change in condition -reoccurrence -terminal stage |
