Exam 2 Blueprint Flashcards
How long does it take for acute HIV symptoms to appear?
2-4 weeks from exposure
What are the symptoms of acute HIV?
Flu like symptoms:
Fatigue
Headache
low-grade fever
Night sweats
persistent generalized lymphadenopathy (swollen lymoh nodes)
What happens for your CD4 and viral count during acute HIV infection?
High viral load (very contagious)
Low CD4+ T count ( 200 to 500 cells/μl)
(T/F) In acute HIV infection, bone marrow is still able to produce enough CD4+ T cells
True
(T/F) Once HIV develops to AIDS, your immune system is severely compromised
True
What is the five criterias of AIDS?
Not all have to be met to be diagnosed with AIDS
- CD4+ T-cell count drops less than 200 cells/μL,
- specific opportunistic infections,
- specific opportunistic cancers,
- wasting syndrome, or
- AIDS dementia complex.
- Wasting syndrome, also called cachexia, is a complicated metabolic syndrome related to underlying illness and characterized by muscle mass loss with or without fat mass loss
What are the ways HIV is transmitted?
There are three ways
Sexual (semen, vaginal secretions, bloof)
Blood and blood products (Needle sharing, needle stick, transfusions (usually not from the U.S due to protocol)
Perinatal (pregnancy or delivery, breastfeeding)
What are the two diagnostic tests for HIV/AIDS?
ELISA
Western Blot
Blood or saliva tests, early false negatives are possible
What is the normal range for CD4?
500-1500
Anything below indicates poor immune system status (200)
What are the goals of ART?
There are five
Think what are does for the viral load, CD4 count, and HIV symptoms/transmission
(1) decrease the viral load
(2) maintain or increase CD4 cell counts
(3) prevent HIV-related symptoms and opportunistic diseases
(4) delay disease progression
5) prevent HIV transmission
What education should be given to patients about ART?
Early intervention, drug adherence, family planning, psychological factors/support (social stigma)
What viral load count makes it so HIV cannot be transmitted
200 and less
What is an example of an ART drug?
There is only one
Biktarvy (Bictegravir/entricitabine/tenofovir)
(T/F) ART kills the virus
False
It helps stop viral replication in the body by blocking different stages in virus life cycle
What are adverse reaction/side effects of ART?
There are seven, two important
Hepatitis B exacerbation
Autoimmune disorders
Nephrotoxicity. hepototxicity
Neutropenia
Pancreatitis
Nausea/vomiting/diarrhea
What are contraindications of ART?
There are three
Hepatitis B
Poor kidney or liver function
Breast feeding
(T/F) There are no concerns with drug interactions between OTC drugs and ART
False
Many drug interactions, beware OTC and supplements used with ART
(T/F) SLE (Systemic Lupus Erythematosus) is an autoimmune disease
True
Chromic multisystem inflammatory autoimmune disease with alternating remission and exacerbation
What are clinic manifestations to SLE?
Two important ones
Butterfly rash
Alopecia
Fever,
Weight loss,
Joint pain,
Excessive fatigue precede worsening disease
activity
Alopecia is hair loss
What systems of the body does SLE affect?
There are six
Skin
Muscles
Lining of lungs
Heart
Nervous tissue
Kidneys
What are the symptoms of SLE in the skin
Alopecia
CCLE (discoid (round) lesions on scalp and face)
SCLE (red, ring-shaped lesions where disease active; butterfly rash) (these lesions do not scar or itch, and are not thick or scaly)
Oral or nasopharyngeal ulcers
What are muscoskeletal symptoms in SLE?
- Polyarthralgia (pain in multiple joints)
- Deformities like:
Swan neck deformity in fingers
Ulnar deviation
Subluxation with hyperlaxity of joints - Increased risk of bone loss and fracture
What are cardiopulmonary symptoms involved in SLE?
Tachypnea and cough
Pleurisy (inflammation of the pleura)
Dysrhythmias (leading cause of death in SLE patients)
What are renal symptoms of SLE?
Nephropathy
Mild proteinuria to rapidly progressive glomerulonephritis
Scarring, permanent damage can lead to ESRD (End-Stage Renal Disease)
Proteinuria is a condition where an excessive amount of protein is present in the urine
Glomerulonephritis is inflammation and damage to the filtering part of the kidneys (glomeruli).
What is the goal of treatment for renal problems in SLE?
Slow progression of nephropathy and preserve renal function
What are treatments for renal problems in SLE?
There are four
Corticosteroids and immunosuppresive agents
Belimumab (human monoclonal antibody)
Voclosporin
What are nervous system problems associated with SLE?
Neuropsychiatric (Ranging from headaches to cerebrovascular disease)
NPSLE
* Focal: Caused by clots; Stroke or aseptic meningitis may occur;
Headaches are common;
Can be severe during a flare-up;
Vasculopathy in chronic disease
* Diffuse
Inflammatory process;
Psychosis, anxiety, depression, confusion, cognitive problems
NPSLE stands for Neuropsychiatric Systemic Lupus Erythematosus
What are hematological problems associated with SLE?
Anemia
Leukopenia
Thrombocytopenia
Coagulation disorders
What medication can help decrease risk of clots?
Hydroxychloroquine
(T/F) Vaccinations are safe for patients with SLE
True
(T/F) Patients receiving corticosteroids or cytotoxic drugs must avoid live virus vaccines
True
What medications will you use for SLE?
There are six
Think about symptoms of SLE and what you would use to treat/manage. Honestly not THAT important to remember
NSAIDs
Antimalarial drugs
Corticosteriods
Immunosuppresive drugs
Anticoagulants
Topical immunodilators
What will you monitor for when taking immunosuppresive drugs?
Toxicity and side effects
Suppresses immune system, reduce end-organ damage
What do topical immunodilators do and what symptoms of SLE do they manage
Lesions and butterfly rash
Suppresses immunity activity of the skin
What should SLE patients avoid to avoid flare ups?
Fatigue,
Sun exposure
Emotional stress
Infection
Drugs,
Surgery
What are the early/first symptoms of Guillain-Barre Syndrome (GBS)?
Weakness, paresthesia, and hypotonia of limbs
Reflexes in affected limbs may be weak or absent
Maximum weakness occurs at 4 weeks
(T/F) There is symmetric weakness of limbs with GBS
True
What clinical signs do you look for for diagnosis of GBS?
Progressive weakness of more than 1 limb
Decreased or absent reflexes
What tests will you order to help diagnose GBS?
Not that important to know, be more aware of clinical signs for diagnosis
Electrolytes, liver function tests, CPK, ESR
CSF analysis
EMG and NCS
Electromyography (EMG) and Nerve Conduction Study (NCS)
Cerebrospinal Fluid (CSF) Analysis
What interventions wil you use for the acute phase of GBS?
Ventilatory support
ICU–hemodynamic monitoring
Immunomodulating treatments (PE and High dose IVIG)
PE: Plasma Exchange (plasmapheresis)
IVIG: IV immunoglobulin
When is IVIG and PE most effective?
In the first 2 weeks on symptom onset
(T/F) PE and IVIG therapies have little value after 4 weeks past disease onset
True
What assessment will you conduct for patients with GBS?
There are five
Neurological assessment (motor and sensory evaluation)
Respiratory assessment
Cardiac assessment
Fever
Nutrition
Motor: ascending paralysis, reflexes, CN function (gag, cornea, swallow), and LOC
Respiratory: Monitor ABGs and vital capacity
Cardiac: Monitor BP and heart rate and rhythm
Fever: Sputum and blood cultures; antibiotics
Nutrition: Delayed gastric emptying, paralytic ileus, risk for aspiration; Enteral or parenteral nutrition
How is the recovery process for GBS patients?
Recovery starts at approc 28 days
80% walk independently at 6 months
60% have full recovery in 1 year
What asculation findings will you find in pneumonia patients?
Fine or coarse crackles over affected region
What asculation findings will you find in pneumonia patients with consolidation?
Bronchial breath sounds
Egophony
Increased fremitus
What asculation findings will you find in pneumonia patients with pleural effusion?
Dullness to percussion over affected area
What are the goals for patients with pneumonia?
There are six
1. No signs of hypoxemia
2. Normal breathing patterns
3. Clear breath sounds
4. Normal chest x-ray
5. Normal WBC count
6. No complications
What are risk factors for pneumonia?
There are five
Advanced age
Immunosuppression
History of antibiotic use
Prolonged mechanical ventilation
Contact with high population numbers
What are diagnostic tests for TB?
TST skin test (aka Mantoux test) (PPD)
Blood test
Chest x-ray (cannot make definitive diagnosis and only suggestive)
TB sputum culture x3
PPD: Immunocompromised: >/= 5mm is positive
Risk factor for TB: >/= 10 mm positive
No risk factor for TB: >/= 15 mm positive
IGRAs for blood testing
Sputum culture x3 is golden standard
How long is a TB patient infectious?
First two weeks after starting treatment if sputum is positive (Restrict visitors and public exposure; have strict hand and oral hygeine)
What infection control measures will you take with TB patients?
Teach patient to prevent spread
◦ Cover nose and mouth with tissue when coughing, sneezing, or producing sputum; dispose in trash or flush
◦ Hand washing after handling sputum-soiled tissues
Patient wears face mask if outside of negative-pressure room
Identify and screen close contacts
Airborne precautions
What is the Bacille-Calmette-Guerin (BCG) Vaccine for regarding TB?
Live, attenuated strain of Mycobacterium bovis
Given to infants in parts of world with high prevalence of TB
The important part is it’s a live strain and given to infants in parts of world with high prevalence of TB
What is the medication adherence used for patients with active TB?
Acryonym RIPE
The first phase is intensive medication treatment with 4 drugs: Rifampin, Isoniazid, Pyrazinamide, and Ethambutol)
Second phase is continuation of two drugs (Isoniazid and rifapin)
First phase is RIPE, second is RI
Isonizaid increases risk for what?
Hepatoxicity
When do you exclude Pyrazinamide from treatment?
When pregnant and/or with hepatitis
When would you stop Ethambutol?
If susecptible for all 4 drugs
How can you ensure adherence to treatment for TB patients?
DOT (directly observed treatment)
Teach adverse effects and when to seek medical care (Baseline LFTs and every 2-4 weeks)
Liver function tests
What is medication treatment for latent TB?
What is the standard, those not infected with MDR bacill, those resistant to isoniazid, and those with HIV and fibrotic lesions
Standard - Isoniazid for 9 months (or 6 months if medical adherence is an issue)
Alternative 3-month regimen of Isoniazid and rifapentine for those not infected with MDR bacill
4 months of rifampin for those resistant to isoniazid
HIV patients and those with fibrotic lesions on chest x-ray should take Isoniazid for 9 months
What is COPD?
Chronic obstructive pulmonary disease
(T/F) COPD is a progressive lung disease characterized by persistent airflow limitation
True
What are the main causes of COPD?
Smoking
Noxious particles and gases
What is the difference between chronic bronchitis and emphysema?
