SU & medical complications Flashcards
reasons disease is a common complication of SUD
- IV injection
- drugs have pathogens
- contamination of needles
- chronic alcohol and drug use decreases immunity
- malnutrition: an issue in SUD clients
- bacteria such as Neisseria and Streptococcus on needle surfaces
- SUD clients living in close proximity in unclean settings, increasing risk of communicable diseases such as TB
bacterial infections seen in intravenous drug abusers
- endocarditis
- Necrotizing fasciitis
- Skin abscesses/Cellulitis
what is endocarditis
- When bacteria infect the valves of the heart
- Bacteria normally found on the skin
- Higher in IVDU
- Treatment with ABX
what is Necrotizing fasciitis
- Special danger to cocaine users
- An infection in which subcutaneous tissues are attacked by bacteria normally found on the surface of the skin
what bacterial infection is a special danger to cocaine users
Necrotizing fasciitis
Skin abscesses/Cellulitis
Use of dirty needles, risk of sepsis if not treated with antibiotics.
what is pneumonia
Acute infection of the lung tissue, normally caused by bacteria
fungal pneumonia
Common complication of HIV infection and of heroin abuse/addiction
aspirate pneumonia
strong relationship to alcohol use.
Community-acquired pneumonia (CAP)
- 20% with this condition will require hospitalization
- 45,000 die annually
- Pneumovax vaccination
- Poor living conditions
- Higher is clients with co-morbid medical conditions such as diabetes who have poor immune system
What is tuberculosis
- Not just a bacterial infection of the lungs
- Other factors:
- Intensity of exposure
- Poor health
- Malnutrition
- SUD
How is tuberculosis transmitted, and how does it kill?
- TB kills by invading the pulmonary system and can also infect virtually every organ in the body
- transmitted through droplets via sneezing/coughing
- bacteria can be dormant or become active if immune system low.
- Clients entering treatments centers for SUD need medical clearance for TB
symptoms of TB
- productive coughing (mucous, blood)
- dry cough
- poor appetite
- GI symptoms
- SOB,
- chest pain
- flushed face,
- chronic fever
- night swears
- weight loss
- weakness
treatment of TB
- Regimens can take as long as 12-24 months
- Lifestyle of typical alcohol/drug abusers often makes treatment compliance for TB very difficult
- Almost 20% of those with Tb also had SUD
- Remains potentially fatal
- Mantoux test- Skin test to assess if exposed to TB
- X-ray and sputum tests to confirm Dx
Acquired Immune Deficiency Syndrome (AIDS)
- a constellation of symptoms, most important of which is the destruction of the individual’s immune system
- HIV destroys CD4 cells of immune system
- Person can remain asymptomatic before opportunistic infections appear.
How does AIDS kill?
- HIV infects the very cells sent out by the body to destroy typical pathogens
- Can remain asymptomatic for 10+ years
- In 20% of the cases, the development of an opportunistic disease is the first outward sign of HIV infection
- In many cases the individual’s death is the result of one of the opportunistic infections
The chain of HIV infection
- Male-to-male sex is most common form of transmission in the US (57% of cases)
- Unprotected heterosexual intercourse is 2nd most common
- Sharing IV needles (40% of IV drug users are infected with HIV)
- Less common is “vertical transmission” infection of baby during childbirth
Life expectancy for people with HIV-1 infection
- HIV infected person is thought to lose 10 years of potential life
- Those with HIV and SUD lose approximately 20 years of potential life
The treatment of HIV infection
- Nutritional status (IV drug users often have inadequate nutrition)
- Antiviral therapy
(Slow, but do not eliminate replication of HIV + High cost)
AIDS and suicide
Period of greatest risk appears to be the period immediately after the individual learns they are infected
RPN role with pt with AIDS
Suicidal risk – assess & provide education on how HIV is not a death sentence
How frequentlyshould you repeat an HIV test for patients with substance use disorders?
every 3-6 months
what is usually the first type of infection we see in untreated HIV
PCP pneumonia
Viral hepatitis “A”
- inflammation of the liver
- hepatitis “A” virus
- 5% of cases thought to involve sharing needles
- 1% of cases develop acute liver failure
-Chronic alcohol use
- Oral fecal transmission
- Vaccine
Viral hepatitis “B”
- 100 times as contagious as HIV
- Can live on surfaces for up to a week
- Transmitted by toothbrush, razor, IV drug use, sexual contact, even kissing
- 45-90% of IV drug users are exposed within a year of starting
- 90-95%recover completely acute live failure in less than 1%
- 20% will develop cirrhosis
- Vaccine
hepatitis “C”
- 3 million people in the US
- 45% attributed to IV drug use
- Slowly destroys liver over 20-30 years
- Alcohol and/or marijuana users experience increased progression through stages
- no vaccine
true or false: If an individual is found to have a positive hepatitis C antibody, they are infected with hep C
false it only indicates a previous exposure to hepatitis C.
true or false: 15 - 30% of people initially infected with hepatitis C will spontaneously clear the virus within 6 months without any treatment
true
true or false: you need a positive hepatitis C antibody test to confirm diagnosis
false
- a positive hepatitis C antibody test MUST be followed up with a hepatitis C RNA PCR to confirmactive infection.They will be antibody positive for hepatitis C for life, however, this does not provide protection from re-infection with hepatitis.
true or false: there is a cure for hep c
true
- A cure is possiblewith the appropriate treatment regimen and all patients are eligible for treatment.
true or false: Daily smoking of tobacco or marijuana increases the risk for the development of hepatocellular carcinoma amongst patients with chronic hepatitis C infection
true
Signs and Symptoms of Hepatitis
Fever
Headache
Malaise
GI symptoms
Dark urine
Jaundice
Tender liver
Increased LFT
Self limiting or chronic
Complete resolution to chronic state
Antibodies detected in blood
Fulminant hepatitis (hepatic failure)
recommended Vaccinations for SUD clients
- hep A
- hep B
- influenza
- pneumovax 23
- tetanus & diphtheria
Syphilis
- Curable bacterial infection
- Treponema Pallidum
- Painless chancre sore on penis and vagina
- VDRL Labs
- Teaching/harm reduction
- Antibiotic treatments
- Cardiac
- Ophthalmic
- Auditory damage
- CNS infections
- Regular assessment and screening
Gonorrhea
- bacterial infection
- Neisseria Gonorrhea
- Urethritis and proctitis
- Infertility
- Treatment with antibiotics
- Regular screening through labs and swabs
- Center for disease control/Public Health
chlamydia
- bacterial infection
- Chlamydia Trachomatis
- Urethritis and proctitis
- Infertility
- Treatment with antibiotics
- Regular screening through labs and swabs
- Center for disease control/Public Health
Genital Herpes/Human Papilloma Virus
- Genital herpes type 2 virus
- Usually asymptomatic
- Antiviral treatments-acyclovir, valtrex
- Cervical cancer risk
- Transmitted via sex
- HPV vaccine-Gardasil
