Chapter 8: Infections Flashcards
What is HIV?
- Retrovirus
- attacks and destroys T lymphocytes (WBC)
- causing immunosuppression
How can HIV be transmitted?
- perinatally through placenta
- Postnatally through breast milk
When should testing for HIV be done?
- Early prenatal period
- Third trimester
-Rapid testing during labor if HIV status is unknown
What procedures should be avoided to prevent maternal blood exposure if patient is HIV positive?
- aminocentesis
- episiotomy (vaginal incision)
What procedures should be avoided to prevent fetal bleeding if fetus is HIV positive?
- internal fetal monitors
- vacuum extraction
- forceps
Risk factors for HIV/AIDS?
- IV drug use
- multiple sex partners
- maternal hx of STIs
- blood transfusions (rare)
- men who have sex with men
Expected findings of someone who has HIV/AIDS:
-fatigue + flu-like sxs
- fever, diarrhea, weight loss
- anemia
- lymphadenopathy (swelling of lymph nodes)
- rash
Tests that screen for HIV?
Antibody screening such as:
- immunoassay
- confirmation of positive results is confirmed by Western blot test or immunofluorescence assay
What additional lab testing should be done to check for infections?
-STIs (gonorrhea, chlamydia, syphilis, and Hep B)
What lab tests should be done frequently throughout pregnancy?
- viral load levels (amount of HIV In blood)
- CD4 cell counts (WBC, T cells)
What immunizations are contraindicated in patients with HIV?
- Hep B
- Pneumococcal Infection,
- Haemophilus Influenza Type B
- Viral Influenza
What type of barrier could be used to minimize the transmission of HIV?
Condoms
What does viral load refer to?
The amount of HIV in the blood
A C-section maybe necessary for a viral load of more than….
1000 copies/mL
You should bathe the infant after birth before remaining with mother. True/false?
True
When can blood testing and administration of injections be done on a newborn?
After his/her first bath
What would most likely be administered to a patient with HIV?
- antiviral prophylaxis
- triple medication antiviral
- highly active antiretroviral
What is Retrovir?
-Antiretroviral agent
Nucleoside reverse transcriptase Inhbitor
When should Retrovir be administered?
- At 14 weeks gestation
- Throughout pregnancy
- Before onset of labor or c-section
For infant:
- At delivery
- for 6 weeks after birth
It is the responsibility of the provider to report cases of HIV to their local health department.
True/False?
True
A patient who is positive for HIV is still able to breastfeed. True/False
False
HIV is a commonly reported condition. True/false?
True
What are TORCH infections?
- Group of infections
- Able to cross placenta
- teratogenic effects on fetus
Toxoplasmosis Other infections (hepatitis A/B, syphilis, varicella-zoster, mumps, parvovirus B19) Rubella Virus Cytomegalovirus Herpes simplex
What is toxoplasmosis?
- parasitic infection
- caused eating raw or undercooked meat; handling cat feces
S/S of toxoplasmosis includes:
-Flu-like sxs:
(fever, sore throat, cough, muscle ache, fatigue, chills, diarrhea)
-Lymphadenopathy
(swollen lymph nodes, night sweats)
Other infections such as Hep A/B, syphilis, varicella-roster, mumps, and parvovirus B19 is associated w/
congenital anomalies (birth defects)
Rubella is also known as the
German Measels
Rubella is contracted through
- children w/ rashes
- neonates born to women who had rubella “during” pregnancy
Cytomegalovirus is a member of what family of viruses?
herpes
How is cytomegalovirus transmitted? Where is found?
- droplet
- found in semen/cervical + vaginal mucus, breast milk, placental tissue, urine/feces, and blood
- latent virus can be reactivated
- can cause disease to fetus in utero or during passage through birth canal
How is herpes simplex virus (HSV) transmitted
- direct contact w/ oral or genital lesions
- transmission greatest during vag birth if woman has active lesions
S/S of Rubella includes
- rash
- joint + muscle pain
- mild lymphedema
S/S of cytomegalovirus includes
- asymptomatic
- mononucleosis-like manifestations
S/S of herpes simplex virus (HSV) includes
- painful blisters
- tender lymph nodes
Fetal consequences of Rubella includes
- congenital anomalies
- miscarriage
- death
Fetal consequences of the the herpes simplex virus (HSV) includes
- preterm labor
- miscarriage
- intrauternine growth restriction (IUGR)
It is recommended that patients in labor who have active genital herpes or exhibit sxs of impeding outbreak such as vulvar pain and itching, should consider delivering through a
c-section
Medication to for toxoplasmosis
- sulfonamides
- pyrimethamine and sulfadiazine combo
*potentially harmful for fetus but parasitic tx is ESSENTIAL!
Most torch infections can be treated with
ABXs
Treatment for cytomegalovirus
None
What is GBS?
Group B strep
-bacterial
-can be passed down to
fetus during L&D
Risk factors for GBS includes
- Positive with previous/current pregnancy
- <20yrs old
- African American, Hispanics
- low birth weight
- preterm delivery
- use of intrauterine fetal monitoring
- prolonged rupture of membranes
- intrapartum maternal fever >100.4 F
Expected findings inpatients with GBS
- premature rupture if membranes
- preterm labor and delivery
- chorioaminonitis
Medication to for toxoplasmosis
- sulfonamides
- pyrimethamine and sulfadiazine combo
*potentially harmful for fetus but parasitic tx is ESSENTIAL!
Expected findings inpatients with GBS
-premature rupture if membranes
-preterm labor & delivery
Chorioaninonitis
Risk factors for GBS includes
-Positive with previous/current pregnancy
-<20yrs old
-African American & Hispanics
-low birth weight
-preterm delivery
-use of intrauterine fetal monitoring
-prolonged rupture of membranes
-intrapartum maternal
Fever greater than 100.4 F
What is GBS?
Group B strep
- bacterial infection
- can be passed down to fetus during L&D
When should GBS testing be done?
vag + rectal cultures @ 35-37 weeks
Administration of intrapartum abx prophylaxis is given to the following clients with GBS:
- during pregnancy
- unknown GBS status delivering at <37 weeks
- fever >100.4 F
- rupture of membranes for 18 hrs or longer
Drug commonly prescribed to clients w/ positive GBS?
-penicillin or ampicillin
Penicillin: 5 mil. Units initially IV bolus followed by 2.5 mil. Units intermittent IV bolus q4h
Ampicillin: 2g IV bolus initially, followed by 1g q4h
Most commonly reported bacterial STI in American women.
Chlamydia
Chlamydia can be difficult to diagnose because it is often asymptomatic.
True/False
True
Recommendations for chlamydia screening:
-yearly if sexually active (<25 yrs, older women)
- 1st prenatal visit
- 3rd trimester (if at continued high risk)
Risk factors of chlamydia includes:
- multiple sex partners
- unprotected sex
Expected findings of chlamydia in men
- Dysuria
- mucoid/watery discharge
Expected findings of chlamydia in women
- Dysuria
- Urinary frequency
- Spotting or postcoital bleeding
- Mucopurulent endocervical discharge
- Easily induced endocervical bleeding
Lab testing for chlamydia in men and women:
- urine culture (men)
- endocervical culture (women)
Medications used to treat chlamydia during pregnancy
- Azithromycin
- Amoxicillin
What should be given to ALL infants following delivery to treat ophthalmia neonatorum which also provides prophylaxis against Neisseria gonorrheae (gonorrhea) and Chlamydia trachomatis (chlamydia)?
Erythromycin
Azithromycin or amoxicillin is a
Broad/narrow spectrum abx
Bactericidal /bacteriostatic action
Bactericidal = kills bacteria Bacteriostatic = prevents growth
Broad-spectrum
Bactericidal
When using azithromycin or amoxicillin, there is a possibility that it can decrease the effectiveness of:
Oral contraceptives
Educating clients about Chlamydia
- safe sex practices
- condoms
- importance of mutual monogamous relationships
What is gonorrhea and how is it spread?
- bacterial infection
- genital/ora/anal - to genital contact
- to newborns during delivery
Untreated gonorrhea in women can cause
-PID (pelvic inflammatory disease) –> infertility
Expected findings of gonorrhea in women
- dysuria
- yellow/greenish discharge
- easily induced endocervical bleeding
Expected findings of gonorrhea in men
- dysuria
- urethral discharge
Lab testing for gonorrhea in men and women
- urine culture (men)
- endocervical culture (women)
Recommendations for gonorrhea screening:
-yearly if sexually active (<25 yrs or older women)
- 1st prenatal visit
- 3rd trimester (if continued high risk)
Medication to treat gonorrhea
- Ceftriaxone (IM)
- Azithromycin (PO)
Ceftriaxone and azithromycin is a
broad/narrow spectrum abx
w/ bacterialcidal/bacteriostatic action
broad-spectrum
bacterialcidal
Syphilis is and STI cause by what bacteria
Treponema pallidum
Risk factors for gonorrhea
- multiple sex partners
- unprotected sex
How is syphilis transmitted?
- oral
- vag
- anal
-to unborn child
Black, Hispanics, and other racial/ethnic minorities are disproportionately affected by syphilis.
True/False
True
Risk factors for STIs such as chlamydia, gonorrhea, and syphilis
- unprotected sex
- multiple sex partners
Stages of syphilis:
- Primary: presence of chancre (ulcer)
- Secondary: skin rashes on palms of hands, soles of feet
- Tertiary: damage to internal organs
Expected findings of syphilis
- Primary: chancre/sore in genital area
- Secondary: rashes on palms of hands, soles of feet
- Tertiary: damage to internal organs (manifestations include difficulty coordinating muscle movements and blindness)
Lab testing for syphilis:
Serology tests:
1) nontreponemal- used for screening (VDRL and rapid plasma reagin)
2) treponemal - test for antibodies specific for syphilis to confirm diagnosis (enzyme immunoassay, immunoassays)
Medications to treat syphilis
Penicillin G (IM) in a single dose
Client education about syphilis
-no sexual contact until sores have completely healed
- safe sex practices
- condoms
- importance of mutual monogamous relationships
Most common STI in both men and women
HPV (Human papilloma virus)
HPV can cause
- genital warts (aka condyloma acuminata)
- cancers
HPV is spread through
-oral
-vag
-anal
(vag + anal most common)
Complications of vaginal delivery is usually d/t to presence of ____________ in clients with HPV therefore, a c-section can be recommended
warts
Lab testing for HPV`
- Pap-smears w/ or w/o HPV co-testing
- 21-29: Pap smear q 3 years
- 30 - 65: Pap smear + HPV q 5 years (preferred) or pap smear alone q 3 yrs
- 65+: should not be screened if client has had regular screenings w/ normal unless they have cervical precancer in which they should continue to be screened for 20 years after the precancer diagnoses
Genital warts are diagnosed by the provider based on
appearance
Based on the Pap test result, a colposcopy and biopsy can be performed to diagnose _________-
cervical pre-cancer and cancer
Medications to treat genital warts
- imiquimod (client-applied cream)
- trichloroacetic acid (provider-administered therapy)
Treatments that can be performed for precancerous changes on the cervix (HPV)
- laser therapy
- cone biopsy
- otherwise, tx can be deferred until after birth
Client education on HPV
-recommend vaccinations to protect against low + high risk types of HPV (ages 9-26; ideally age 11-12 yr olds)
- safe sex practices
- correct use of condoms
- importance on mutual monogamous relationships
At what age can the HPV vaccine be given?
9-26 yrs old
11-12 years old (ideal)
What is trichomoniasis?
- protozoan parasite
- spreads from penis/vagina - to - vagina
Untreated trichomoniasis can lead to
-PID (pelvic inflammatory disease) –> infertility
Risk factors for trichomoniasis
- unprotected sex
- multiple sex partners
Expected findings of trichomoniasis in men and women
MEN:
- dysuria
- discharge
- penile itching or irritation
WOMEN:
- dysuria
- yellow/green, frothy vag discharge (in vag. vault) w/ foul odor
- itching
- dyspareunia (painful sexual intercourse)
- strawberry spots on cervix (petechiae)
- cervix that bleeds easily
Lab testing for trichomoniasis
sample of discharge applied to pH paper, and wet mount + whiff test performed
Interpreting lab results for trichomoniasis
positive for trichomoniasis
- pH >4.5
- presence of trichomonads on wet mount w/ saline prep
- whiff (smell) test “positive” for foul odor
Medications to treat trichomoniasis
- Metronidazole
- Tinidazole
(PO in a single dose; anti-infective)
Client education about taking Metronidazole or tinidazole
- DO NOT take w/ alcohol d/t disulfiram-like rxs (N/V)
- take medication as prescribed
- decreases effectiveness of oral contraceptives
- treat all sexual partners
Client education on trichomoniasis
- safe sex practices
- condoms
- importance of monogamous relationships
Bacterial vaginosis is cause by what bacterias?
-Haemophilus + gardnerella vaginalis
Bacterial vaginosis is a common/uncommon vag. infection in women ages __________ and is related/not related to_____________.
15-44 years old
not related to sexual activity
Type of bacterial infection NOT related to sexual activity
bacterial vaginosis (haemophilus, gardnerella)
Untreated bacterial vaginosis can cause
-PID (pelvic inflammatory disease) –> infertility
Why is it important that bacterial vaginosis be treated especially in pregnant women
can cause preterm labor + low birth weight (<5.5 lbs)
Risk factors for bacterial vaginosis
- multiple sex partners
- unprotected sex
-altered pH balance of vagina (caused by douching)
Expected findings of bacterial vaginosis
-thin, white/gray discharge w/ fish-like odor esp. after sex
Lab testing for bacterial vaginosis
- sample of discharge applied to pH paper
- wet mount
- whiff test
Interpreting lab results for bacterial vaginosis
positive for bacterial vaginosis if
- pH >4.5
- wet mount w/ saline prep indicates presence of clue cells
- “positive” whiff test
Medications to treat bacterial vaginosis
Metronidazole (anti-infective)
Client education on bacterial vaginosis
- avoid tight-fitting clothes
- wear cotton-lined underwear
- avoid douching
- treatment not indicated for men
- safe sex practices
- condoms
- importance of monogamous relationships
What is Candidiasis (candidiasis albicans)?
-yeast/fungal infection or vulvovaginal candidiasis
Second most common type of vaginal infection in the U.S?
candidiasis (yeast infection)
Risk factors for candidiasis
- pregnancy
- obesity, DM, diet high in refined sugars
- oral contraceptives
- recent abs tx
Expected findings in candidiasis
- vulvar and vaginal pruritus (itching), erythema + inflammation
- thick, creamy, white cottage-cheese-like vag. discharge
- white patches on vag. wall
- gray-white patches on the tongue and gums (neonates)
Lab testing for candidiasis
- sample of discharge to pH paper
- wet mount
- whiff test
Interpreting lab results for candidiasis
- pH <4.5 (normal pH)
- wet mount w/ potassium hydroxide indicates presence of yeast buds, hyphae, and pseudo-hyaena
- “negative” whiff test
Medications to treat candidiasis
Fluconazole
- single low dose
- topical (recommended for pregnant-women)
- antifungal agent
- fungicidal action
OTC treatments for candidiasis
Clotrimazole
*important for provider to diagnose candidiasis initially
Client education on candidiasis
- avoid tight-fitting clothing
- wear cotton-lined underwear
- avoid douching
- limit wearing damp clothing
- increase dietary intake of yogurt w/ active cultures
