Exam 1 Flashcards
5 Lead EKG placement
R arm: White - 2nd ICS
R leg: Green (Snow over Grass) - Base of ribs
L arm: Black - 2nd ICS
L leg: Red (Smoke over Fire) Base of ribs
V1: Brown (Chocolate in the middle) - R sternal edge, 4th ICS
3 Lead EKG placement
R arm: Red - 2nd ICS
L arm: Yellow - 2nd ICS
L leg: Green - Base of ribs
SA node
R atria
Near superior vena cava
Pacemaker of heart
AV node
R atrium near AV valve
Delays ventricular impulse
What is next in the cardiac conduction after AV node
Bundle of HIS
What comes after Bundle of HIS in cardiac conduction
Purkinje fibers
P wave
SA node in the atrium depolarizes
P-Q segment
Atrial systole/contraction
Time conduction takes from SA to AV node
QRS complex
Ventricular depolarization
AV node fires
Q
Intraventricular septum depolarizes
R
Main mass of ventricles depolarize
S
Depolarization at the base of ventricles
When does atrial repolarization occur
It is hidden in the QRS complex
ST segment
Plateau of myocardial action potential
Ventricles contract
T wave
Ventricular repolarization
Layers of lung
Parietal pleura: Outer layer
Pleural space: Serous fluid maintains negative pressure
Visceral pleura: Inner layer
Pneumothorax
Air in pleural space/cavity
Pleural effusion
Fluid in pleural space
Hemothorax
Blood in pleural space
Tension pneumothorax
Complication from obstruction in chest tube or trauma
Causes tracheal deviation and puts pressure on opposite side
Mediastinal chest tube
Inserted into mediastinum to relieve pressure on heart to prevent cardiac tamponade
Cardiac tamponade
Fluid in pericardial space
Empyema
Infection in pleural space
Wet suction (Chest tube)
Suction is regulated by the height of water
- Water evaporates
- Bubbling = normal
Dry suction (Chest tube)
Uses suction monitor bellow
- Adjust with dial knob
Normal amount of chest tube drainage
Less than 100 mL/hr
Normal suction type and amount for chest tube
regular continuous suction
-80 to -100 (usually -80)
What is normal for the water seal chamber
When pt breathes water will fluctuate
Light/intermittent bubbling is normal - caused by pneumothorax
What does excessive bubbling mean in chest tubes
Air leak
What do you do if chest tube becomes dislodged
Cover with sterile dressing
Tape on 3 sides (allow air to escape)
Notify MD
What to do if the chest tube system breaks
Insert tubing into 1 inch sterile water bottle and get a new system
When to contact physician for chest tubes
Bubbling increases over time
Bubbling returns after having stopped
Output more than 100-150mL/hr
What to do when physician removes chest tube
Tell pt to perform valsalva maneuver and bear down
How often to assess chest tube
Assess drainage amount Q1H for first 8 hr, then Q8H
Mark drainage amount with marker at end of shift
K normal range
3.5-5.5
Calcium normal range
8.5-10.5
Magnesium normal range
1.5-2.0
Atelectasis
Alveolar collapse due to obstruction
S/Sx of Atelectasis
Increased work of breathing - dyspnea
Decreased breath sounds
Crackles
Hypoxia
How to dx atelectasis
Chest X ray
Tx for atelectasis
Remove secretions
Frequent turning, early ambulation, lung volume expansion (incentive spirometer), deep breathing, coughing
Surgical/procedural tx for atelectasis
Endotracheal intubation, mechanical ventilations = last resort
Thoracentesis
Pneumonia patho
Movement of WBC’s into alveoli leads to perfusion issues
Development of thick sputum leads to ventilation issues
Community-Acquired Pneumonia
Pt that have not been hospitalized/lived in long-term care within 14 days
Hospital-Acquired Pneumonia
Begins 48 hours+ after hospital admission
Ex. Ventilator-associated pneumonia (VAP)
Tx for bacterial pneumonia
Abx
Aspiration pneumonia
Entry of material from mouth into trachea/lungs
Necrotizing pneumonia
Rare complication
Lung tissue turns into thick/ liquid mass
Opportunistic pneumonia
Occurs in immunocompromised pts
- Malnutrition, HIV, chemotherapy
Risk factors for pneumonia
Smoking, COPD, immobility, depressed cough, NGT/other drains, old age, aspiration risks
How is pneumonia dx
S/sx, CXR, blood cx, sputum cx, bronchoscopy
S/sx of pneumonia
Cough, fever, chills
Dyspnea, tachypnea, chest pain
Confusion - elderly
Coarse crackles, purulent sputum - vocal fremitus
Elevated RR
Decreased SpO2
Elevated WBC, + sputum culture
Respiratory acidosis
Infection goal of care
Remove bacteria and clear purulent drainage/sputum
Nursing interventions for infection (lung infection/pneumonia)
Sputum culture
Abx administration
- Should be working by 48-72h
- Not for viral infections, but could be used for secondary bacterial infection
Nursing interventions to promote airway clearance
Oxygen therapy - continuous SpO2 (humidified)
Hydration
Chest PT (physiotherapy)
- Inventive spirometer, cough and deep breath (IS/CDB)
NT (nasotracheal) suction
Pt goals to increase fluid status during tachypnea
Fluid intake 2-3L/day
Monitor I/O’s
- UOP >30mL/h
Monitor fluid and electrolytes
Continuous cardiac monitoring
Medications for pneumonia
Antipyretics
Cough suppressants
Mucolytics
Long-term interventions for pneumonia
Pneumococcal vaccine
Oral abx - once pt is stable
Assess for aspiration risk - NG/OG tube = increased risk
Prevent hospital acquired infection
Teach abx adherence
Follow up with PCP in 6-8 wks
Cause of pleural effusion
Typically secondary to pneumonia, HF or TB
Pulmonary edema or infectious process
Empyema
Accumulation of thick, purulent fluid in pleural space
Cause of empyema
Bacterial pneumonia, TB, or lung abscess
S/sx of empyema
Acute illness
Dyspnea, chest pain, decreased/absent breath sounds over affected area
Intervention for empyema
Abx
Percutaneous drainage
Chest tube insertion
Reason for thoracentesis
Lung abscesses
Effusion/empyema with severe SOB
Thoracentesis
One time insertion of needle to drain purulent fluid
Fluid sent for culture
Pleurisy
Inflammation of both layers of lung pleurae
Pleurisy s/sx
Severe inspiratory pain
Pleural friction rub heard
Post thoracentesis nursing interventions
Monitor HR and BP
Monitor for pneumothorax
Dx for pleurisy
CXR
Sputum analysis
Thoracentesis
Tension (spontaneous) pneumothorax
Accumulation of air in the pleural space under pressure, compressing the lungs and decreasing venous return to the heart
Iatrogenic pneumothorax
Traumatic pneumothorax secondary to an invasive procedure or surgery
Chylothorax
Rare but serious condition in which lymph formed in the digestive system (chyle) accumulates in your chest cavity
S/SX of closed pneumothorax
Sudden pain
Tachypnea, air hunger, accessory muscle use
Absent breath sounds
Tracheal shift
Hypotension
Jugulovenous distention (JVD) - thoracic pressure
Hypoxemia - can lead to cyanosis
Tx for closed pneumothorax
Cover with vent dressing
Chest tube
Lung abscess
Necrosis of lung tissue
Usually due to oral secretions
How to drain lung abscess
Postural drainage
Chest physiotherapy
Lung abscess nursing interventions
IV antibiotics
Educate deep breathing and coughing
Encourage high protein and calorie diet
Non-small cell vs small cell lung cancer
SCLC has higher morbidity and mortality
S/sx of lung cancer
Chronic cough, dyspnea, hemoptysis, chest pain
Fever, lobar pneumonias
Dx for lung cancer
CXR
CT scan
Pulmonary function tests
PET scan
Lung cancer tx
Surgery: Lung resection
Radiation
Chemo
Wedge resection
Removal of small lesion/tumor
Lobectomy
Removal of lung lobe
Segmentectomy
Removal of segment of the bronchial tree
Pneumectomy
Removal of an entire lung
Tx and interventions for ineffective airway clearance
IS/CDB
Suctioning
Bronchoscopy
Positioning - “good” lung down so “bad” lung can drain
Monitory for s/sx of PNA
Sleeve resection
Removal and resection of a part of the bronchial tree
Video assisted thorascopic
Allows surgeon to look at the thorax
Used for thoracotomy
Pre-op imaging for thoracic surgery
CT scan
MRI
Bronchoscopy
Nursing consideration post-op pneumectomy
AKA removal of entire lung
Do not fully turn pt to operative side
- Causes heart to fall into lung cavity
Pain management for thoracic surgery
Epidural or intervertebral blocks
Pt controlled analgesia (PCA)
Lidocaine patches
Splinting of chest
S/sx of hemorrhage post surgery
Increased HR
Decreased BP, CVP (central venous pressure), LOC
Cool, clammy extremities
How is TB contracted
Through air, person to person
Mostly effects immunocompromised
Primary TB
Inhalation of organism, walling off of the TB lesion
Latent TB
Positive TST (Tubercullin skin test) w/o s/sx of infection
- Unable to transmit
Active TB disease
Active infection that is able to be transmitted
S/x of tuberculosis
High fever, chills, flu-like symptoms
Extrapulmonary TB (outside of lungs)
INF-gamma assay
Blood test for TB antibodies
Tuberculosis dx
CXR + Mantoux
Sputum specimen and culture
BCG vaccine
Recommended for infants born in countries with high prevalence of TB - Africa, Asia, Eastern Europe
BCG vaccine side effects
Swollen lymph nodes
Fever (mild)
Headache
Injection site reactions
TB precautions
Airborne isolation with HEPA filter
Pt must wear surgical mask outside of room
Rifampin nursing considerations
Tx for TB
Orange urine/secretions
Liver failure - AE
Decreases hormonal birth control effectiveness
Pulmonary embolism patho
Blockage of one or more pulmonary arteries by thrombus, fat or air embolus, or tumor tissue
Obstructs alveolar perfusion
Most commonly in lower lobes
Risk factors for pulmonary embolism (PE)
DVT
Immobility
Surgery
Obesity
Smoking
HF
Pregnancy
Clotting disorders
A fib
Fx of long bones
S/Sx of PE
Dyspnea
Tachypnea, cough, chest pain, hemoptysis, crackles/wheezing, fever
Tachycardia, syncope, LOC changes
How to dx PE
D-Dimer
Spiral (helical) CT scan
Angiogram
Labs: ABG’s, Troponin, B-type natriuretic peptide
D-Dimer
Lab test that measure a protein fragment that is present when a blood clot dissolves
Acute interventions/tx for pulmonary embolism
Heparin drips, fluids, diuretics, analgesics
IVC filters - inferior vena cava
Embolectomy - removal of clot
Laryngeal obstruction s/sx
Use of accessory muscles
Retractions in neck/intercostals
Increased WOB - work of breathing
Laryngeal obstruction tx
Remove airway edema - cricuthyroidotomy (trach replacement) or
remove obstruction - Heimlich, intubation, cricothyroidotomy - tracheostomy placement
Risk factors for head and neck cancer
Tobacco, ETOH, environmental exposure, HPV, over 50 men
S/sx of head and neck cancer
Hoarseness, cough, sore throat, dysphagia, dyspnea, foul breath - ulcerations in larynx
Dx for head and neck cancer
Laryngoscopy with biopsy of tumor
CT/MRI
Barium swallow
Pharyngoscopy and laryngoscopy
Head and neck cancer tx
Surgery - first line
- Stage 1&2: Partial laryngectomy
- Stage 3&4: Total laryngectomy
Radical neck dissection
Radiation therapy
Radical neck dissection
Removal of:
All cervical lymph nodes
Sternocleidomastoid muscle
Internal jugular vein
Spinal accessory muscle
- Tx for severe head/neck cancers
Normal amount of drainage from JP drain
80-120 mL in first 24 hours
Central venous pressure
Measures the amount of blood returning to the right atrium
- Decreased if blood volume is decreased
- 2-8 mm Hg (or 8-12?)
Nursing interventions for post op laryngectomy
Prevent/monitor for aspiration PNA
- Confirm feeding tube placement
- Assist with swallowing, thick liquids, tuck chin
Oral care
Guillan Barre
Autoimmune disorder that destroys myelin on nerve cells
Causes of Guillan Barre
Viral infection: Flu, mycoplasma, HIV/Epstein Barr, campylobacter (GI bug)
Guillan Barre s/sx
Paresthesia of hands/feet
Weakness of respiratory muscles
Can progress to blindness and dysphagia
No change in cognitive status
Guillan Barre dx
Lumbar puncture or electromyelogram
Tx of Guillan Barre
No tx - supportive measures until myelin regenerates
IVIG and plasmapheresis - reduces s/sx length
Monitor respiratory status
PT/OT for mobility
Primary concerns for Guillan Barre
Altered breathing pattern
- Decrease in ventilation
Impaired swallowing - nutrition
Physical mobility
Autonomic dysfunction - controls bradycardic responses, rapid changes in VS
First symptoms of Guillan Barre
Can’t feel middle finger
Feet feel funny
Can no longer lift 20lb box
Falling
Trigeminal Neuralgia
Pain of the 5th cranial nerve (trigeminal nerve)
Pain with any stimulation (washing face, brushing teeth, eating)
Tx for trigeminal neuralgia
Antiseizure medications
Surgical: Microvascular decompression of the trigeminal nerve
Radiofrequency thermal coagulation
Percutaneous balloon micocompression
Bells Palsy
Facial paralysis caused by inflammation of 7th cranial nerve
Bells Palsy manifestations
Unilateral facial muscle weakness/paralysis
Most pts recover in 3-5 wks and doesn’t recur
Bells palsy tx
Corticosteroid therapy to reduce inflammation
Protect eye from injury
Facial exercises and massage to maintain muscle tone
Antigen
Substance that creates an immune response
Antibodies
AKA B cells
Produced by immune system to fight disease
Created in response to antigens
Immunoglobulins
Binding sites on antibodies
Bone marrow
Responsible for creating B cells
Lymph nodes
Multiply immune cells and remove foreign material before it enters the blood stream
Thymus
Creates T cells
Hypersensitivity Reaction Type 1
Allergic response
Histamine release, itchy eyes, runny nose, rashes, edema, anaphylaxis
Hypersensitivity Reaction Type 2
Antibody response
Cytotoxic cells kill the bodies normal cells
Ex. Autoimmunity and Transfusion reactions
Hypersensitivity Reaction Type 3
Immune complexes
Too many antibody/antigen complexes clump together and deposit in joints, vessels, etc
Hypersensitivity Reaction Type 4
Delayed immune response
Takes a couple of days to kick in
Ex. TB skin test, poison ivy
Types of immunoglobulins on B cells
IgA
IgD
IgG
IgE
IgM
IgE
Involved in hypersensitivity reactions
IgG and IgM
Involved in blood transfusion reaction
What is secreted in response to antigen exposure
Histamines
Platelets
Eosinophils
Neutrophils
- On second exposure
Role of prostaglandins in anaphylaxis
Smooth muscle spasm - leads to larygneal obstruction
Vasodilation - hypotension
Increased capillary permeability - hypotension
Passive immunity
Receiving antibodies rather than making them
- Ex. Globulin injection, mother’s breast milk
Anaphylaxis s/sx
Tingling hands, flushing, oral swelling
Warm sensation, nasal congestion, periorbital swelling, difficulty swallowing, wheals
Anaphylactic shock s/sx
Bronchospasm
Laryngeal edema
Dyspnea
Hypotension
Cyanosis
Anaphylaxis tx
Epinephrine
Supplemental O2 with cooled water
Advanced airway
IV antihistamines
Corticosteroids
Atopic reactions
Most common type 1 hypersensitivity
AKA seasonal/environmental allergies
Ex. Hay fever
Atopic reaction s/sx
Allergic rhinitis
Atopic dermatitis
Urticaria - hives
Angioedema
Atopic dermatitis
Type 1 hypersensitivity
Atopic dermatitis tx
Avoid cause
Topical corticosteroid creams
NSAID’s
Skin moisturizer
Dermatitis medicamentosa
AKA Drug reactions
Note rash, hives, itching, swelling when administering new medications, esp antibiotics
Contact dermatitis
Type 4 delayed skin reaction
D/t metals or rubber compounds
First line medications for allergic disorders
Antihistamines
- H1 antagonists (dipenhydramine - Benadryl) can cross BBB and cause CNS effects
- H2 antagonists (ceterizine, loratidine) fewer CNS effects
Second line medications for allergic disorders
Afrin
Cromolyn - decreases mast cell activity in nasal passages
Corticosteroids
Immunotherapy - severe cases, allergens injected to build tolerance
Apheresis
Machine removes blood stem cells or other parts of the blood from a person’s bloodstream then returns the rest to the body
Can be used to collect cells for transplantation
Plasmapheresis
Removes IgG antibodies in autoimmune disorders
Removes inflammatory mediators
- Can lead to hypotension or hypocalcemia
How to determine anion gap
Sodium (Na+) - (Chloride (Cl-) + Bicarbonate (HCO3-)
Parkinson’s disease
Slow, progressive neurologic movement disorder due to decreased dopamine levels
- Unknown cause
Parkinson’s risk factors
Increased incidence with age
More common in men 3:2
Well water, pesticides, rural residence
Parkinson’s characteristics
Tremor
Rigidity
Bradykinesia, akinesia
Postural instability
Hypokinetic dysarthria (speech abnormalities)
Dx of Parkinson’s
4 symptoms + responds to pharm therapy
Presence of Lewy bodies: protein deposits in the brain
Parkinson’s tx
Levadopa/carbidopa
Deep brain stimulator
Ablation: destruction of affected part of brain
Multiple sclerosis
Demyelinating disease of the CNS
T cells enter brain and cause inflammation, destroying myelin
Caused by virus
Risk factors for multiple sclerosis
Smoking
Vit D deficiency
Epstein Barr exposure
Women 30-35 yrs
Multiple sclerosis cause
Unknown
May be triggered by virus or northern climate
What can multiple sclerosis lead to
Chronic inflammation
Demyelination of nerves
Scarring of CNS
Multiple sclerosis s/sx
Initial: Poor coordination, loss of balance, double vision
Motor changes, sensory changes, cerebellar changes (nystagmus), changes in bowel/bladder/sexual function, cognitive changes, emotional changes
Multiple sclerosis dx
CSF analysis
MRI of brain and spinal cord
- Evidence of 2 lesions
Multiple sclerosis drugs
Muscle relaxants: Benzos, Baclofen, Dantrolene
CNS stimulants - for fatigue
Antiseizure drugs
Tricyclic antidepressants
Multiple sclerosis complications
Urine retention - bladder training, avoid fluids at night, catheterization
Constipation - stool softeners, activity, high fiber/fluid diet
Myasthenia Gravis patho
Antibodies attack acetylcholine receptors in nerve junctions
When nerves receive a signal they release ACH to stimulate muscle response
If there are no receptors, no signals get sent
Leads to weakness of voluntary muscles
Myasthenia Gravis s/sx
Facial/eyelid droop
Flat affect
Dysphonia
Peek sign - after closing eyes the eyes open slightly to show sclera
May progress to respiratory failure
Myasthenia Gravis dx
Tensilon test
Electromyelogram
Tensilon test
IV Tensilon should stop ACH breakdown and increase ACH binding
Facial weakness should resolve in 5 mins = dx of MG
Pharmacological tx for Myasthenia Gravis
Pyridostigmine bromide
IVIG - immune therapy
Plasmapheresis
Prednisone
Surgical tx for myasthenia gravis
Thymectomy: Reduces T cell production
How does Pyridostigmine bromide work
Inhibits ACH breakdown
Reduces symptoms of MG
Pyridostigmine bromide AE
Abdominal pain, diarrhea
Purpose of plasmaphersesis in myasthenia gravis tx
To remove antibodies to ACH
Prednisone use for myasthenia gravis and AE
Decreases overall immune response
AE: Leukopenia and hepatotoxicity
Myasthenic crisis
Exacerbation of MG symptoms
D/t extremely low ACH at neuromuscular junction from stressful event (URI, change in meds)
S/sx of Myasthenic crisis
Extreme weakness
Double vision
Drooping eyelids
Huntington’s disease
Chronic progressive hereditary disease
Results in choreiform (jerking or writhing) movements and dementia
- Death after 10-20 yrs of dx
Huntington’s disease patho
Premature death of cells in the striatum of the:
Basal ganglia – leads to poor movement control
Cerebral cortex – defects in thinking, memory and judgement
Cerebellum – defects in coordination
Huntington’s disease s/sx
Motor dysfunction: jerky movements
Cognitive impairments: attention deficits
Behavioral changes: apathy, blunt affect
Facial ticks
Slurred speech
Impaired swallowing
Disorganized gait
Huntington’s disease dx
Family hx
S/sx
CAG repeats: polymorphic nucleotide repeats present in the androgen receptor gene
Huntington’s disease meds
Benzos - control jerky movement
SSRI’s - psych symptoms
Antipsychotics - for late disease
Amyotrophic Lateral Sclerosis
“Lou Gehrig disease”
Loss of motor neurons in the anterior horn of the spinal cord and loss of motor nuclei of the lower brainstem
Amyotrophic Lateral Sclerosis risk factors
Smoking
Viral infections
Autoimmune diseases
Toxin exposure
- 40-60 yr olds
ALS s/sx
Progressive weakness/atrophy
Spasticity - brisk/overactive DTR
Difficulty with speech, swallowing, breathing - ASPIRATION
No loss of cognitive function
ALS dx
S/sx
Muscle biopsy
Electromyelogram
ALS tx
No cure
Riluzole: prolongs life 3-6 months
Baclogen, Dantrium, Valium - for spasms
Provigil - for fatigue
Pts at risk for aspiration
Seizure pts
Brain injury
Decreased LOC
Stroke
Swallowing disorders
Aspiration prevention
HOB > 30 degrees while eating
Avoid sedatives
Assess feeding tube placement - bowel sounds and residuals
Swallow evaluation
Bedside suction available
Primary immune deficiency dx
Multiple/unusual infections in early childhood
Low T cell and WBC count
Primary immune deficiency tx
Stem cell transplants
Emerging Infections
An infectious disease with an increase in the recent number of cases
Ex: Coronavirus
Re-emerging infection (w/ examples)
Infections that were once eliminated, but now recurring
Vaccine-preventable diseases - Polio
Disease associated with travel - Malaria
Resistant organisms (def. with examples)
Overprescription of antibiotics is a factor
MRSA, VRE (Vancomycin Resistant Enterococci), Enterobacter
- Skipping doses, not taking full course, self-prescribing abx
Airborne diseases
Measles
Chicken pox
Pertussis (Whooping cough)
- N95 respirator
Droplet diseases
Covid
Influenza
Strep Throat
- Surgical mask
Contact precaution diseases
C. diff
Scabies
Norovirus/Rotovirus
MRSA
VRE
HIV Patho
It is a retrovirus: attacks T cells and reproduces
Decrease in immune function (opportunistic infections)
How is HIV transmitted
Body fluids: Blood, semen, vaginal secretions, amniotic fluid, breast milk
What populations are at risk for HIV
Injection drug users
Sex with HIV+
HIV infected blood or organ transplant
Needlesticks - healthcare workers
How to prevent HIV
Condoms, dental dams, female condoms
Treat addictive disorders/mental health diagnoses
1 sexual partner
Early testing
No sharing blood contaminated items - razors, toothbrush
Pre-exposure prophylaxis - antiretroviral therapies
Tx for healthcare worker exposed to HIV
Post-exposure prophylaxis (PEP)
2-3 antiretroviral regimen taken within 72 hours of exposure
Taken for 28 days
Acute infection phase of HIV
2-4 weeks after exposure
Virus can be transmitted
Flulike symptoms
Asymptomatic infection
Vague/absent symptoms
Virus can be transmitted
T cells below 500
Symptomatic infection
Initial signs: AMS, fever, mouth infection
Night sweats, diarrhea, headaches, severe fatigue
T cell 200-499
AIDS
10+ years after untreated infection
Presence of systemic infection or complications of HIV: Infections, malignancies, wasting, cognitive changes
T cell count below 200
What happens if HIV is untreated
Destruction of T cells
CD4 + T cell count drop below 500 cells/mcL (normal = 800-1200)
Below 200 cells/mcL = opportunistic infections
Goal for CD4 count in HIV treatment
800-1200 CD4 count
Viral load “undetectable”
How is HIV progression monitored
CD4 + T cell count: marker of immune function
Viral load: lower = less active disease
Viral set point
When host’s immune becomes outnumbered by the virus
Pre-exposure prophylaxis
PrEP
Used in conjunction with proven prevention interventions
Tenofovir/emtricitabine *do not need to know
- Ensure adherence (take the meds!)
Classes of medications used for antiretroviral therapy
Reverse transcriptase inhibitors
Protease inhibitors
Integrase inhibitors
Reverse transcriptase inhibitors
Prevent HIV DNA from forming in human cells
Protease inhibitors
Prevent HIV from exiting the cell into the bloodstream
Integrase inhibitors
Prevent HIV integration into human DNA
Goals of antiretroviral therapies
CD4 and T cells maintained
Viral load below mutation level
Viral load below level of detection
Adherence is key
HAART
Highly active anti-retroviral therapy
Medication regimen used to manage and treat human immunodeficiency virus type 1 (HIV-1)
Nucleoside reverse transcriptase (NRTI) used for HIV
zidovidine (Retrovir)
Prevents transmission of HIV to fetus
What is Retrovir often given with
Given in combo with Abacavir
Non-nucleoside reverse transcriptase (NNRTI) for HIV considerations
Give with water on empty stomach
Do not use in pregnancy or liver disease
Entry inhibitor drug for HIV
Miraviroc
Miraviroc AE
Cardiopulmonary side effects
Protease inhibitors AE
Increased BG
Side effects of antiretroviral therapy
Hepatotoxicity - LFTs
Nephrotoxicity - Creatinine
Osteoporosis
Increased risk for MI/CVD
Fat redistribution, increased truncal fat
Caution in pregnancy
Kaposi Sarcoma
Manifestation of herpesvirus
S/sx: Skin, GI, lung, and lymph node lesions - skin breakdown
Kaposi Sarcoma tx
Radiation therapy
AIDs-Complex Dementia
HIV virus interferes with neuron junctions and myelin
Progressive cognitive, behavioral, and motor decline
AIDs-Complex Dementia s/sx
Peripheral neuropathy, memory changes, headache, decrease attention span, psychosis, hallucinations, tremors, seizures
How to manage AIDs-complex dementia
Aid for communication and vision
Prevent aspiration and falls
Schedule activity and rest periods
Gabapentin or Lyrica for peripheral neuropathy pain
HIV wasting syndrome dx
10% total weight loss
+ chronic diarrhea, chronic weakness, fever
Occurs late in disease process
Pulmonary dysfunction
Starts as nonspecific cough, sputum may or may not be present
Pneumocystis pneumonia
PCP
Serious lung infection that affects people with weakened immune systems
Cytomegalovirus
Common virus, retained for life (no cure)
Spread through body fluids
S/sx: Fatigue, fever, sore throat, muscle aches
What can activate latent TB
Antiretroviral therapy (AVT)
Active TB tx
Four drug regimen:
Isoniazid, rifampin, pyrazinamide, and ethambutol
- Airborne precautions
Thrush
Oral Candida Albicans
Painful swallowing, decreased oral intake
May progress to esophagus and stomach
Thrush/candidiasis tx
Topical antifungals
Myclex troches or nystatin rinses
Ketoconazole
Diarrhea tx (r/t HIV infection or enteric pathogens)
Octreotide acetate - severe chronic diarrhea
Pneumocystis juirveci s/sx
Opportunistic infection
Cough, fever
Dyspnea with exertioin
Cryptococcus neoformans s/sx
Opportunistic infection
Viral infection of the eye
Cough, SOB
Double/blurred vision
Headache
Possible gynecologic manifestations of AIDs/HIV
Vaginal candidiasis
Genital ulcers/warts
Risk of cervical cancer, pelvic inflammatory disease
How to tx vaginal candidiasis
Topical agents - just like oral candidiasis
Bacterial meningitis
Inflammation of the membranes and fluid space surrounding the brain/spinal cord
Organism crosses the BBB, settles in CSF (increased ICP)
Types of meningitis
Septic meningitis - bacterial (Streptococcus pneumoniae, Neisseria meningitidis)
Aseptic - viral, lymphoma, leukemia, or brain abscess
How is meningitis transmitted
Secretions or aerosol contamination
Fulminant meningitis
Can lead to adrenal issues, circulatory collapse, and hemorrhage
Meningitis s/sx
Headache, fever
Changes in LOC, behavioral changes
Nuchal rigidity - positive Kernig’s sign, positive Brudzinski’s sign
Photophobia
Seizures and coma
Kernig’s sign
Pain in opposite leg when one leg is extended at knee by 90 degrees
Positive indicates meningitis
Brudzinski’s sign
Positive indicates meningitis
Raise neck, look for hips and knees the flex
Bacterial meningitis
Medical emergency
Bacterial meningitis dx
Swab of nares/lumbar puncture
CT scan
Bacterial meningitis tx
Abx - started BEFORE dx is confirmed
Bacterial meningitis prevention
Vaccines against Haemophilus influenzae and S. pneumoniae for all children and at risk adults
Meningococcal vaccine for adolescents and high risk groups
Complications of meningitis
Brain abscess - one sided weakness
Seizures
CN 3 palsy - oculomotor nerve
Bradycardia
Hypertensive coma
Viral meningitis
HIV or herpes-associated
Viral meningitis dx
CSF sample tested for enterovirus
Viral meningitis tx
Prophylactic Abx until viral or bacterial meningitis is confirmed
How is pt positioned after lumbar puncture
Lay flat for 6-12 hours post procedure
Encephalitis
Acute inflammatory process of brain tissue
Encephalitis causes
Viral infections - herpes simplex virus, vector-borne viral infections, fungal infections
Encephalitis s/sx
Headache, fever
Confusion, changes in LOC
Vector-borne: Rash, flaccid paralysis, Parkinson-like movement
Encephalitis tx
Acyclovir - for HSV infection
Amphotericin or other antifungals - for fungal infection
Central venous pressure
Blood pressure in the vena cava, which is near the right atrium of the heart
- Blood backs into R atrium
2-8 mm Hg
Empyema Question
Answer: Pneumonia
