Chapter 15: Med Surg & Childhood Diseases

Question 1

how is HIV transmitted?

Answer 1

infected blood, semen, vaginal secretions, and breast milk

Question 2

risk by needle stick

Answer 2

high viral load, deep puncture, needle with hollow bore and visible blood, device used for venous or arterial access, or pt who dies within 60 days after you’ve been exposed

Question 3

what is HIV?

Answer 3

RNA virus (retrovirus) goes from RNA to DNA, during reverse transcriptase all daughter cells are effected since genetic material is duplicated and viral DNA in the genome will allow HIV to replicate

Question 4

viremia

Answer 4

initial infection with large amounts of it in blood

Question 5

normal CD4 count

Answer 5

800-1200, normal life is 100 days, but in HIV it’s about 2 days

Question 6

HIV CD4 cells

Answer 6

immune issues develop when levels are <200 (opportunistic diseases develop at this time)

Question 7

Acute infection

Answer 7

seroconversion occurs (when HIV antibodies form) and is often accompanied by swollen lymph glands, sore throat, headache, malaise, nausea, joint pain, diarrhea, and rash, high viral load is noted (lasts for few weeks-months)

Question 8

early chronic infection

Answer 8

about 11 years, seen as asymptomatic although fatigue, headache, low grade fever are noted, t cells are 500+ & viral load is low

Question 9

intermediate chronic infection

Answer 9

t cells drop to 200-500 and viral load is high, persistent fever, night sweats, chronic diarrhea, fatigue, oropharyngeal candidiasis (thrush), shingles, vaginal candidiasis, herpes, oral hairy leukoplakia

Question 10

late chronic infection

Answer 10

AIDS, T cells <200, opportunistic infection occurs, wasting syndrome, AIDS dementia complex, opportunistic cancer may be present

Question 11

oral hairy leukoplakia

Answer 11

painless, white, raised lesions on the lateral aspect of tongue

Question 12

how much of a delay before HIV antibodies can be detected?

Answer 12

2 months- window period refers to the time between infection and development of antibodies, can still transmit disease!

Question 13

rapid HIV-antibody test

Answer 13

results available in 20 minutes, if positive, need to be confirmed by western blot

Question 14

genotype assay

Answer 14

detects drug-resistant viral mutations that are present in reverse transcriptase and protease genes- very helpful in deciding new drug combinations for patients who do not respond to therapy

Question 15

phenotype assay

Answer 15

measures the growth of HIV in various concentrations of antiretroviral drugs- very helpful in deciding new drug combinations for patients who do not respond to therapy

Question 16

ART

Answer 16

should be used in combination and not alone, because resistance develops rapidly, decreases viral load up to 90%

Question 17

if a patient is asymptomatic, but is positive for HIV, when should you treat?

Answer 17

when t cells are less than 350, recommend treatment if t cells are 350-500

Question 18

health promotion

Answer 18

prevent HIV and detect HIV early, educate!

Question 19

acute intervention

Answer 19

promote health and limit disability & manage problems caused by HIV

Question 20

ambulatory and home care

Answer 20

maximize quality of life and resolve life and death issues

Question 21

what if I am exposed to HIV at work?

Answer 21

postexposure prophylaxis (PEP) measures should be taken- ART therapy based on extent of exposure, volume of exposure, and the status of pt

Question 22

negative effects of ART

Answer 22

prolonged use can cause fat deposits in tummy, upper back, breasts, and arms, legs, face due to lipodystrophy, hyperlipidemia, insulin resistance and hyperglycemia, bone disease, lactic acidosis, and cardiovascular disease

Question 23

bacteria

Answer 23

enter the cell and grow inside human cells or secrete toxins that damage cells

Question 24

viruses

Answer 24

do not have cellular structure, only reproduce in living organism

Question 25

fungi

Answer 25

similar to plants, lack chlorophyll, usually localized, but can spread in immunocompromised pt

Question 26

protozoa

Answer 26

single celled, animal like microorganisms that live in soil and bodies of water

Question 27

prions

Answer 27

infectious particles that contain abnormally shaped proteins and typically affect the nervous system

Question 28

highest risk for HAIs

Answer 28

surgery pt, immunocompromised, elderly

Question 29

chickenpox clinical manifestations

Answer 29

slight fever, malaise, and anorexia for the first 24 hours, rash is very itchy, rapidly progresses from macule to papule to vesicle, sparse on distal limbs

Question 30

chickenpox therapeutic management

Answer 30

Acyclovir (Zovirax), antihistamines to relieve itching, maintain standard, airborne, and contact precautions, don’t use aspirin

Question 31

diphtheria clinical manifestations

Answer 31

nasal- resembles common cold with serosanguineous nasal discharge; tonsil- malaise, anorexia, sore throat, smooth & adherent white or gray membrane, bulls neck; laryngeal- fever, hoarseness, dyspnea, cyanosis

Question 32

diphtheria therapeutic management

Answer 32

Equine antitoxin IV preceded by skin test to rule out sensitivity to horse serum, penicillin G, bed rest, follow standard and droplet precautions until 2 cultures are negative

Question 33

erythema infectiosum clinical manifestations

Answer 33

“fifth disease”, slapped cheek rash for 1-4 days, after 1 day after the rash goes away maculopapular spots appear on upper and lower extremities, then the rash subsides but reappears if skin is irritated

Question 34

erythema infectiosum therapeutic management

Answer 34

antipyretics, anti-inflammatory, possible blood transfusion if aplastic anemia (rash absent, fever, myalgia, tummy pain present), arthritis more common in older women, no isolation required unless suspected of HPV

Question 35

exanthema subitum clinical manifestations

Answer 35

“roseola”, persistent high fever for 3-4 days, drop in fever with rash, rash is discrete rose pink macules first on trunk, then spreading to neck and face and extremities, nonpruitic, fades on pressure

Question 36

exanthema subitum therapeutic management

Answer 36

nonspecific, recurrent seizures r/t latent infection of CNS so teach parents precautions, teach parents how to lower temperature

Question 37

measles clinical manifestations

Answer 37

“rubeola”, fever and malaise followed by cough, koplik spots (small, irregular spots with a bluish white center seen on buccal mucosa opposite molars 2 days before rash), rash appears 3-4 days after initial onset starts on face and goes down

Question 38

measles therapeutic manifestion

Answer 38

childhood immunization, vit A supplementation, bed rest, antibiotics to prevent secondary infection, maintain isolation until 5th day of rash, institute droplet precautions, keep skin clean use tepid baths as necessary

Question 39

mumps clinical manifestations

Answer 39

fever, head and anorexia for 24 hours followed by earache, by third day parotid glands enlarge and are accompanied by pain and tenderness

Question 40

mumps therapeutic management

Answer 40

childhood immunization, maintain isolation during period of communicability (before and after swelling), rest, encourage fluids and soft, bland foods, hot or cold compresses to neck, to relieve orchitis provide tight fitting pants

Question 41

pertussis clinical manifestations

Answer 41

“whooping cough”, begins as upper respiratory infection, symptoms continue for 1-2 weeks when dry, hacking cough becomes more severe, cough more at night, severity lasts about 4-6 weeks

Question 42

pertussis therapeutic management

Answer 42

immunization tdap, maintain isolation, institute droplet precaution in beginning, adequate oxygenation, humidified oxygen, standard precautions and mask

Question 43

poliomyelitis clinical manifestations

Answer 43

abortive- fever, uneasiness, sore throat, tummy pain lasting for hours to few days; nonparalytic- same as abortive, but more severe with pain in neck, back, and legs; paralytic- similar to nonparalytic, but recovery occurs and then CNS paralysis

Question 44

poliomyelitis therapeutic management

Answer 44

mild sedatives to relieve anxiety, physiotherapy (moist hot packs and ROMs), promote early ambulation, observe for respiratory paralysis (difficulty talking, ineffective cough, inability to hold breath, shallow and rapid respirations)

Question 45

rubella clinical manifestations

Answer 45

“german measles”, absent in children, present in adults and adolescents, low grade fever, headache, 1-5 days and subsides 1 day after rash appears, first appears on face and rapidly spreads down to neck, arms, etc, by end of first day entire body is covered with discrete, pinkish red maculopapular rash gone by third day

Question 46

rubella therapeutic management

Answer 46

benign nature of illness in child, avoid pregnant women

Question 47

scarlet fever clinical manifestations

Answer 47

abrupt high fever, pulse increased, headache, chills, tonsils enlarged, first 1-2 days tongue is coated with papillae and is white strawberry tongue, by fourth or fifth day the white coat sloughs off and is red strawberry tongue

Question 48

scarlet fever therapeutic management

Answer 48

standard and droplet precautions until 24 hours after initiation of tx, peniciilin G, avoid irritating liquids and rough foods, consult doctor if fever persists after therapy begins, discard toothbrush, avoid sharing drinks

Question 49

bacterial conjunctivitis clinical manifestations

Answer 49

“pink eye”, purulent drainage, crusting of eyelids, swollen lids

Question 50

bacterial conjunctivitis therapeutic management

Answer 50

topical antibiotics, fluoroquinolones in children over the age of 1, ointments not used in the day because they obstruct vision, keep the eye clean, wipe inner canthus downward and outward away from opposite eye

Question 51

stomatitis clinical manifestations

Answer 51

inflammation of oral mucosa, infectious or not infectious, local or systemic, aphthous- canker sore for 4-12 days, herpetic- fever, pharynx edematous, lesions on lips

Question 52

stomatitis therapeutic management

Answer 52

relief of pain, prevention of spread, frequent mouth care, careful handwashing, keep fingers out of mouth

Question 53

reye syndrome clinical manifestations

Answer 53

toxic encephalopathy associated with organ involvement, impaired coagulation, fever, impaired consciousness, decreased hepatic fx, profuse vomiting, personality changes, diagnosis established by liver biopsy, do not give children under 16 aspirin!!

Question 54

reye syndrome therapeutic management

Answer 54

early diagnosis and aggressive therapy, watch intake and output to watch for dehydration and cerebral edema, do not use aspirin or pepto bismol, check all prescriptions and OTC drugs for use of salicylates