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HONDROS - MED SURG II - QUIZ #4
Terms in this set (53)
Carcinogenesis and Primary Prevention of Cancer
: The process by which normal cells are transformed into cancer cells.
: Substances known to increase the risk for the developoment of cancer.
: Smoking. Dietary habits. Exposure to radiation. Exposure to environmental carcinogens. Smokeless tobacco. Frequent and heavy consumption of alcohol.
About 90% of cancers are NOT inherited
: Breast cancer - higher in women with a family history of this disease. Lung cancer - higher in smokers with a family history of this disease. Leukemia - greater in an identical twin. Neuroblastoma - increased frequency among siblings. Colon cancer - likely to occur in women with history of breast cancer.
Cancer Risk Assessment and Cancer Genetic Counseling
First step toward identifying hereditary cancer predisposition.
Provides education, health promotion, informed consent, support.
Cancer Prevention and Early Detection (
C - Change in bowel and bladder.
A - A lesion that does not heal.
U - Unusual bleeding or discharge.
T - Thickening or lump in breast or elsewhere.
I - Indigestion or difficulty swallowing.
O - Obvious changes in wart or mole.
N - Nagging cough or persistent hoarseness.
Planned periodic examination and recognition of cancer's warning signs. Colorectal tests. Prostate cancer detection. Pelvic examination with Pap smear for women. Breast cancer detection - self exams. Skin examinations.
Patho of Cancer - Cell Mechanisms and Growth
: When cells are destroyed, cells of the same type reproduce until the correct number have been replenished.
: Instead of limiting their growth to meet specific needs, they continue to reproduce in a disorderly and unrestricted manner.
: Uncontrolled or abnormal growth of cells.
- not recurrent or progressive, nonmalignant.
- growing worse and resisting treatment, cancerous growths, tumors.
: Tumor cells spread to distant parts of the body.
Patho of Cancer - Description, Grading, and Staging of Tumors
Carcinoma: malignant tumors composed of epithelial cells, tend to metastasize.
Sarcoma: malignant tumor of connective tissues, such as bone or muscle.
Tumors are classified as grade 1 to grade 4
Grade 1 - least malignant
Grade 4 - most malignant
Tumor, nodes, metastasis (TNM) staging system for cancer is used to indicate tumor size, spread to lymph nodes, and extent of metastasis.
CLINICAL STAGING CLASSIFICATION
Stage 0: Cancer in situ
Stage 1: Tumor limited to the tissue origin
Stage 2: Limited local spread
Stage 3: Extensive local and regional spread
Stage 4: Metastasis
Diagnosis of Cancer
: Incisional (partial removal). Excisional (removal of a complete lesion). Needle aspiration (sucking out tissue or fluid).
: Bone scanning. Tomography. Computed Tomography (CT). Radioisotope studies. Ultrasound testing. Magnetic resonance imaging.
: Serum alkaline phosphatase-elevated with metastasis to bone or live. Serum calcitonin-NPO night before test. Carcinoembryonic antigen (CEA). PSA (prostatic-specific antigen) and CA-125. Stool examination for blood.
: Preventive. Diagnostic. Curative. Palliative.
: External radiation therapy. Internal radiation therapy.
: Side effects:
Leukopenia (reduction of circulating WBCs).
Anemia. Thrombocytopenia. Alopecia (hair loss). Stomatitis (ulcers/lesions in mouth). Nausea, vomiting, and diarrhea. Tumor lysis syndrome.
Tumor Lysis Syndrome (TLS)
: Oncologic emergency. Rapid lysis of malignant cells. Intracellular content from cell put into the bloodstream.
: Chemo (most common) and radiation
Leads to hyperkalemia, hyperphosphatemia, and hyperuricemia, hypocalcemia
Occurence: 24 hours to 7 days after therapy.
: Nausea. Vomiting. Anorexia. Muscle Weakness. Cramping. Seizures. Cardiac arrest.
: Observation. Lab tests.
: Prevention is the best
: Hydration. Diuretics (promotes excretion of phosphate and uric acid). Allopurinol (prevents uric acid formation). Renal dialysis if all measures fail.
: Resolves within 7 days if treated appropriately.
If fails, the patient may have to go on kidney dialysis!
Cancer Therapies - Biotherapy
Three major mechanisms of biological response modifiers (BRMs).
1. Increases, restores, or modifies the host defenses against the tumor.
2. Toxic to tumors.
3. Modifies the tumor biology.
Cancer Therapies - Bone Marrow Transplantation
Process of replacing diseased or damaged bone marrow with normally functioning bone marrow.
Cancer Therapies - Peripheral Stem Cell Transplantation
Alternative to bone marrow transplant.
This procedure is based on the fact that peripheral or circulating stem cells are capable of re-populating the bone marrow.
Advanced Cancer - Pain Management
: Morphine, hydromorphone, fentanyl, methadone.
: MS Cintin, Roxanol SR
: IV drips, intrathecally, and epidurally. Avoid peaks and valleys.
Patient Self Control
: Distraction, massage, relaxation, biofeedback, hypnosis, and imagery.
* Patients should not be subjected to severe suffering from potentially controllable pain.
* Fear of addiction should not be a factor when considering pain relief for the terminally ill.
Advanced Cancer - Nutritional Therapy
: Malnutrition. Anorexia. Altered taste sensation. Nausea/vomiting. Diarrhea. Stomatitis. Mucositis.
Advanced Cancer - Communication and Psychological Support
Factors which may determine how the patient copes
Ability to cope with stressful events in the past.
Availability of significant others.
Ability to express feelings and concerns.
Age at the time of diagnosis.
Extent of disease.
Disruption of body image.
Presence of symptoms.
Past experience with cancer.
Attitude associated with cancer.
Advanced Cancer - Terminal Prognosis
Most patients with advanced cancer know they are dying.
Honesty and openness are the best approaches.
Spiritual activities may provide mental and emotional strength.
Social worker assists the patient and family in planning for home care.
Hospice services can be arranged - efforts are directed toward relief from pain and other problems.
Nursing Diagnoses for Cancer
Coping, compromised family. Activity intolerance, R/T malaise. Risk for infection, R/T inflammation of protective mucous membranes. Pain, acute. Pain, chronic. Self-care deficit. Knowledge, deficient. Nutrition, less than body requirements, imbalanced, R/T anorexia. Risk for Infection. Fluid volume, deficient risk for. Fluid volume, excess.
Pituitary gland. Thyroid gland. Parathyroid glands. Adrenal glands. Pancreas. Testes. Ovaries
. Secrete hormones (chemicals) into blood or lymph that circulates to all parts of the body. Affect cells different than the gland that secretes the hormone. May affect only one type of cells (TSH) or the entire body (thyroid).
It is the size of a cherry/pea.
Has an anterior and posterior lobe
. It is called the
Anterior Pituitary Hormones
Growth hormone (GH)
- afffects growth of individual.
Thyroid stimulating hormone (TSH)
- stimulates the thyroid gland to make thyroxine.
Adrenolcorticotropin hormone (ACTH)
- stimulates adrenal cortex to make cortisol.
Gonadotrophic Hormones (other anterior hormones)
Follicle stimulating hormone (FSH)
- stimulates growth of ovarian follicles in females. Stimulates growth of testes and sperm cells in males.
Lutenizing hormone (LH)
- stimulates corpus luteum in ovary and testosterone production in males.
Melanocyte stimulating hormone (MSH) - seasonal affective disorder.
Hyper-pituitarism (or gigantism)
Too much growth hormone before the child's epiphyseals closes
. Results in an overgrowth of the long bones resulting in height of over 8 feet. Normal body proportions. Increased muscle and visceral development.
Hypo-pituitarism (or dwarfism)
Lack of growth hormone inhibits growth of all cells in a child
. Below 2 inches a year. Normal body proportions.
Acromegaly - Hyperpituitary
: Overproduction of growth hormone (serum somatotropin) in the adult.
: X-rays, MRI, physical exam, oral glucose challenge test (level does not decrease)
: Increased ICP, enlarged tumor, increased blood sugar.
: Enlarged pituitary gland. Headache. Visual disturbances. Slanting bulging forehead. Coarse facial features. Protruding jaw. Increased BP and CHF. Menstrual changes. Sleep apnea. Hypertrophy of soft tissue such as tongue, skin and visceral organs. Enlargement of small bones in the hands and feet. Large head circumference. Overgrowth of lips, nose, tongue, and jaw. Separation and malocclusion of the teeth. Males - impotence. Females - deepened voice, increased facial hair, amenorrhea. Enlarge heart, liver and spleen.
: Surgical removal of tumor (cryotherapy). Radiation therapy (proton beam). Octreotide administration to suppress secretion of growth hormones (sub q). Medical treatment cannot diminish the height already attained, can only retard further growth.
Shaped like a butterfly. 2 lobes - one on each side of trachea
. Iodine is necessary for the formation of the thyroid hormones. Stimulated by thyroid stimulating hormone (TSH) from the pituitary.
: Acquired dysfunction of thyroid gland. Insufficient secretion of thyroid hormones. Slowing of all metabolic processes.
: Hair loss. Apathy. Lethargy. Extreme fatigue. Dry coarse and scaly skin. Muscle aches and weakness. Constipation. Intolerance to cold. Receding hairline. Facial and eyelid edema. Dull blank expression. Thick tongue, slow speech. Anorexia. Brittle nails and hair. Menstrual disturbances.
: subnormal temp, bradycardia, weight gain, decrecreased LOC, thickened skin, cardiac complications, hypotension.
: Replacement therapy - Synthroid or levothroid. Assess appetite and intake and output. Assess bowel status and temperature. Assist with energy conservation. Assess mental status. Assess physical comfort. Provide emotional support. Keep room warm (above 70 degrees). Take meds for life.
Enlarged thyroid due to low dietary iodine levels
Dysphagia. Hoarseness. Dyspnea.
: potassium iodide. Diet high in iodine (table salt). Thyroidectomy.
: Graves Disease. Overproduction of thyroid hormones. Autoimmune condition. Second most prevalent endocrine disorder with gradual onset. Triggering event.
: Voracious appetitie, wide eyed staring expression, exophthalmos (protruding eyeballs), insomnia, difficulty in concentrating, decreased work or school performance. Finger clubbing, tremors, diarrhea, menstrual changes (amenorrhea), fine straight hair, facial flushing, enlarged thyroid, tachycardia, increased systolic BP, breast enlargement, weight loss, muscle wasting, localized edema.
: Anti-thyroid drugs (tapazole), prophylthiouracil. Beta blocking agents (propanolol). Radioactive iodine - ablation therapy, oral and thyroidectomy.
: May not want to cough. No talking for 48 hours. Turn with head neutral (hands behind head). Check for hoarseness or say "ah". Head of bed elevated. Suction and trach care at bedside. Humidifier. Check swallowing before fluids given. Check dressing for drainage. Cool liquids, then progressing to soft, then as tolerated.
POST OP COMPLICATIONS
: Hemorrhage, tetany, edema which causes low levels of sodium, numbness and tingling of finger tips, toes, and around lips. Laryngeal spasm and stridor.
: Nutrition (high protein, high calorie diet), emotional support, assess body temperature, assess heart rate and BP, assess for thyroid storm, assess for hypothyroidism, education of disease process, education of medications.
Abnormal spasm of the facial muscles.
Radioactive Iodine Therapy (RAI)
Most unused RAI will be eliminated in 2 days via urine, sweat, feces, and saliva. Shower 2 to 3 times per day and washing hair will assist in elimination of RAI through perspiration. Wear hospital gown and slippers. Dispose of all plastic plates and eating utensils. Do not bring a computer to the hospital, as the computer may become contaminated. No visitors in the first 24 hours. Visitors must wear a gown, gloves, and shoe covers. Visitors must sit by the door. Visitors may not use the bathroom in the patient's room. Minimize contact above 3 feet for 5 days. No more than 1 hour closer than 3 feet. Separate bedroom, bed linen and towels and underwear for one week. Flush 3 times. Men sit while urinating. Wash hands with soap and water thoroughly after using bathroom. Use separate (disposable) eating utensils and wash separately for one week.
Thyroid Storm (thyrotoxicosis)
Sudden release of hormone
: severe irritability and restlessness, vomiting and diarrhea, hyperthermia, hypertension, severe tachycardia, usually occurs 12 hours after surgery. Leads to delirium coma and death. This is life threatening! This requires emergency treatment. Administer IV fluids, corticosteroids (Decadron), antipyretics, antithyroid (PTU), oxygen therapy, beta blockers. Prevent cardiovascular collapse. Lower body temperature. Diet is high protein, high calorie.
4 glands are on posterior surface of the thyroid gland. They secrete parathyroid hormone. Regulates calcium and phosphorus reabsorption to the bone. (Phosphorus is inversely related to calcium. As calcium increases, phosphorus will decrease). Stimulates vitamin D which stimulates calcium absorption in the gastrointestinal tract.
: Inadvertent removal or destruction during thyroidectomy.
: Decreased calcium, increased phosphorus, neuromuscular hyperexcitability, tetany (because of decreased calcium), laryngeal spasms, stridor (becomes an emergency), cyanosis. Positive Chvostek's and Trousseau's signs. Numbness and tingling.
: Goal is to maintain normal serum calcium and phosphorus levels. Immediate treatment: IV calcium gluconate (give slow, it burns veins. side effect is tongue burning. Also give vitamin D (helps with calcium absorption).
: Over activity of the parathyroid, with increased production of parathyroid hormone.
: Increased calcium (hypercalcemia), bone decalcification and become brittle, fatigue, skeletal pain, pain on weight bearing, pathological fractures (bones fracture easily), kidney stones.
: Hydration, mobility, cardiac assessment and monitoring (pulse-bradycardia), oral phosphates, calcitonin, stool softeners, strain urine. Lasix.
: Daily lab draws, diet low in calcium and dairy, assess pain, give pain meds, teach body mechanics, mild exercise.
Adrenal Gland Hormones
(Glucocorticoids) - cortisol (prednisone)
(Mineralcorticoids) - aldosterone
(Androgens) - testosterone and estrogen
Adrenal Hyperfunction - Cushing's Syndrome
: Plasma levels of adrenocortical hormones are increased. Hyperplasia of adrenal tissue due to overstimulation by the pituitary gland. Tumor of the adrenal cortex. Adrenocorticotropic hormone (ACTH) secreting tumor outside the pituitary. Overuse of corticosteroid drugs. Too much sugar, salt, sex!
: Moonface, buffalo hump, thin arms and legs, hypokalemia, proteinuria, increased urinary calcium excretion (stones), susceptible to infections, depression, loss of libido, osteoporosis, personality changes, gynecomastia (breasts in males), fat deposits on face and back of shoulders, hyperglycemia, CNS irritability, edema, GI distress, amenorrhea and hirsutism (excessive hair) in females, thin skin, purple striae, bruises and petechiae, weight gain, abdominal enlargement, deepening of the voice, delayed wound healing.
: Treat causative factor - adrenalectomy for adrenal tumor, radiation or surgical removal for pituitary tumors. Lysodren (suppresses cortisol production). Dietary recommendations: low sodium and high potassium.
Adrenal Hypofunction - Addison's Disease
: Adrenal glands do not secrete adequate amounts of glucocorticoids and mineralocorticoids. May result from adrenalectomy, pituitary hypofunction, long standing steroid therapy. Not enough sugar, salt, and sex!
: Related to imbalances of hormones, nutrients, and electrolytes. Nausea, anorexia, postural hypotension (hypostatic), headache, disorientation, abdominal pain, lower back pain, anxiety, craves salt, changes in distribution of body hair, GI disturbances, weakness, hypoglycemia, hyponatremia, hyperkalemia, darkly pigmented skin and mucous membranes (seen primarily on palmer creases of hands or over joints). Assess for adrenal crisis. Medical emergency caused by stress or withdrawal from corticosteroids. Destruction of the pituitary gland.
: Restore fluid and electrolyte balance. Large amounts of D5 or normal saline for crisis. Reverses hypotension. Replacement of adrenal hormones. Diet high in sodium and low in potassium. Adrenal crisis: IV corticosteroids in a solution of saline and glucose. Fluoronet. Daily weights. Monitor I's and O's. Provide calm environment. Medic alert bracelet. Carry 100mg of hydrocortison in an emergency kit.
: Chromaffin cell tumor, usually found in the adrenal medulla. Causes excessive secretion of epinephrine and norepinephrine. Usually always benign, rarely malignant.
: severe hypertension
: surgical removal of tumor
: Systemic metabolic disorder that involves improper metabolism of carbs, fats, and proteins.
: Heredity, environment and lifestyle, viruses, malignancy or surgery of pancreas.
- insulin dependent (IDDM), and
- non insulin dependent (NIDDM)
: Type 1 and 2: 3 P's (polyuria, polydipsia, polyphagia)
: Type 1: sudden onset, weight loss, hyperglycemia, under 40 years old.
: Type 2: slow onset, may go undetected for years, the 3 P's are usually mild. If untreated, may have skin infections and arteriosclerotic conditions. Average years - 50 years old. Fasting blood sugar more than 126. Increased BP, fatigued, decreased energy, obese.
: Fasting blood glucose (FBG), Oral glucose tolerance test (OGTT), 2 hour postprandial blood sugar, patient self monitoring of blood glucose (SMBG), glycosylated hemoglobin (HbA), C-peptide test.
: balanced diet should include proteins, carbs, and fats. Type 2 may be controlled by diet alone. Type 1 diet is calculated and then insulin is required to metabolize if needed. American Diabetes Association recommends 7 exchanges and a quantitative diet. 3 regular meals with snacks between meals and at bedtime to maintain constant glucose levels.
: promotes movement of glucose into the cell, lowers blood glucose, lowers insulin needs.
STRESS OF ACUTE ILLNESS AND SURGERY
: extra insulin may be required, increased risk of ketoacidosis (hyperglycemia), glucose must be monitored closely.
. Classified by action: Regular (Lente), and NPH (Ultralente). Classified by type: beef (Humulin), pork (Novolin), injection site should be rotated to prevent scar tissue formation. Use sliding scale.
Oral hypoglycemic agents
- stimulate islet cells to secrete more insulin, only for Type 2.
: good skin care, report any skin abnormalities to doctor, special foot care is crucial (do not trim toenails - see podiatrist, no hot water bottles or heating pads), assess for symptoms of hypoglycemia.
: Coma: diabetic ketoacidosis, hyperglycemic hyperosmolar nonketotic, hypoglycemic reaction. Infection.
LONG TERM COMPLICATIONS
: diabetic retinopathy, cardiovascular problems, renal failure.
Onset over 4-10 hours. Breath smells like juicy fruit gum. PT will be experiencing Kussmaul respirations, will be thirsty, dehydrated, tachycardic, hypotension, acidosis, high blood sugar of more than 240, hyperkalemia. PT needs hydration, insulin, and electrolyte replacement.
: Transient or permanent metabolic disorder of the posterior pituitary. Defiency of antidiuretic hormone (ADH). Primary or secondary.
: Polyuria, polydipsia, may become severely dehydrated, lethargic, dry skin, poor skin turgor, constipation. Diluted urine. Specific gravity 1.003-1.030. Urine output may exceed 5-20 liters in a 24 hour period. Increased levels of sodium in blood. (If untreated, may cause hypovolemic shock)
: ADH preparations, limit caffeine due to diuretic properties.
Syndrome of Inappropriate Antidiuretic Hormone
: Pituitary gland releases too much ADH. Kidneys reabsorb more water, decreasing urine output and expanding body's fluid volume.
: hyponatremia, hemodilution, fluid volume overload without peripheral edema, water retention that progresses to water intoxication (s/s appear when sodium levels fall below 125mEq/L.
FACTS OF SIADH
: ADH is released in response to stress. ADH regulates the body's water balance. ADH is stored in posterior pituitary gland. This syndrome occurs more often in older adults.
RISK FACTORS OF SIADH
: Tumor on pituitary gland. Stress and stressful procedures. Medications are thiazide diuretics, oral hypoglycemics, and oxytocin. Malignancies include small cell carcinoma, Hodgkins lymphoma; prostate, colorectal, pancreatic, and duodenal cancers. Head trauma, pulmonary diseases, adrenal insufficiency.
TREATMENT FOR SIADH
: Fluid restriction. Hypertonic solution may be ordered at a slow rate. Treat underlying problem: surgical resection, radiation or chemotherapy for malignant neoplasms. Discontinue causative medications. Early intervention is key to success. Prognosis without treatment is coma and death.
Clinical Manifestation of Aids
: Low white cell counts CDT4 count less than 200/mm3. Opportunistic infections. Lymphadenopathy. Fatigue.
: Poor wound healing, skin lesions, night sweats.
: Cough, shortness of breath.
: Diarrhea, weight loss, nausea, vomiting.
: Confusion, dementia, headache, visual changes, personality changes, pain, seizures.
: Kaposi's Sarcoma, Non-Hodgkin's Lymphoma, Hodgkin's Lymphoma, Invasive Cervical Carcinoma.
AIDS DEMENTIA COMPLEX
: Cognitive, motor, and behavioral impairments in 70% of AIDS clients.
: Pneumocystis Carinii Pneumonia, Toxoplasmosis (Encephalitis), Cryptosporidiosis (GI).
: Candidiasis - stomatitis, esophagitis, vaginal.
: Mycobacterium complex, tuberculosis.
: Cytomegalovirus, Herpes Simplex Virus, Varicella Zoster Virus.
Transmission of HIV
HIV is an obligate virus. It cannot survive very long outside of the human body. It is transmitted from human to human; by blood, semen, cervicovaginal secretions, or breast milk. Other body fluids contain HIV but there is no evidence that they are capable of transmission; saliva, urine, tears, feces.
: anal or vaginal intercourse.
: contaminated drug injecting equipment and paraphernalia, transfusion of blood and blood products, occupational exposure.
Perinatal (vertical) transmission
: transmission from mother to child.
Pathophysiology of HIV
Normal immune response
: Foreign antigens interact with B cells. B cells initiate antibody development. B cells and T cells initiate cellular immune response (B cells reduce virus in blood. T cells reduce virus in lymph nodes).
: T cells or CD4+ lymphocytes are destroyed by HIV. HIV is then able to reproduce in the lymphatic system and eventually "spills over" into the blood. Decreases resistance to life threatening infections.
CD4+ (600-1200) - normal
CD4+ (200-499) - minor immune problems
CD4+ (below 200) - severe immune problems
Spectrum of HIV
Acute Retroviral Syndrome
Primary HIV infection
: flu-like symptoms, develop antibodies to HIV in 1-12 weeks.
Asymptomatic HIV infection
: HIV seropositivity (seroconversion), positive HIV antibody test. 95% within 3 months and 99% within 6 months. Infectious with no illness.
Early HIV disease
: Signs and symptoms may not appear until 10-14 years after exposure.
: Persistent unexplained fever, night sweats, diarrhea, weight loss, fatigue.
Advanced HIV Disease
Early Symptomatic Disease
: CD4+ cell count drops below 500 cells/mcl, persistent unexplained fevers, drenching night sweats, chronic diarrhea, headaches, fatigue, lymphadenopathy (swollen glands), recurrent or localized infections, neurological manifestations.
: An acquired condition that impairs the body's ability to fight disease. The end-stage, or terminal, phase of the HIV infection. HIV positive and CD4+ (T4) count below 200 or one or more AIDS-indicator conditions.
Diagnostic Studies of HIV
HIV antibody testing
- detects the presence of HIV antibodies. If positive, ELISA is done a second time.
- done if second ELISA is positive. More sensitive than ELISA
- All 3 tests are positive (ELISA x 2 and Western blot). Does NOT mean the person has AIDS.
- Not an assurance that an individual is free from HIV infection. Seroconversion may not have occured yet.
CD4+ lymphocyte count
- Normally 600-1200mcl. Decreases as the disease progresses. Best marker for the immunodeficiency associated with HIV infection.
Viral load monitoring
- Level of virus in the blood. Provides significant information toward predicting the course of the disease.
Therapeutic and Pharmacological Management of HIV
Therapeutic management focus
Monitoring HIV disease progression and immune function
Preventing the development of opportunistic diseases.
Initiating and monitoring antiretroviral therapy.
Detecting and treating opportunistic diseases.
Preventing complications of treatment.
Most common opportunistic diseases associated with HIV
Pneumocystis carinii pneumonia (PCP)
Most common infection
: fever, night sweats, productive cough, short of breath.
: Bactrim or Septra, pentamidine, steroids. Wear gown, mask, and gloves during patient care.
- Most common neoplasm found in HIV infected patients.
: reddish purple spots on the skin.
: Radiation and chemotherapy.
: stomatitis and colitis.
: Gancyclovir and Foscarnet.
: fever and headache.
: Amphotericin B and Fluconazole.
: fever, headache, seizures, and mental changes.
: Pyrimethamine and folic acid, Sulfadiazine, Clindamycin.
Mycobacterium (avium complex and tuberculosis)
: fever, chills, sweats, abdominal pain, bone pain, fatigue, diarrhea, nausea, weight loss.
: Rifampin, INH, ciprofloxacin.
- Combination therapy prevents development of resistance. Must be given around the clock. Usually initiated when CD4+ count is below 350 or when viral load is greater than 30,000 copies/ml.
Alternative and complimentary therapies
- Massage, acupuncture, acupressure, biofeedback, nutritional supplements, herbal remedies.
- Adhering to a prescribed regimen is of paramount importance to survival and the success of treatment.
- The active, total care of patients whose disease is not responsive to curative treatment.
- Uncertainty, isolation, fear, depression, and limited financial resources.
Assisting with coping
- Educate about HIV, encourage patients to participate in their own care, encourage patients to face life a day at a time, live each day to the fullest, listen to them, maintain sources of psychological support.
- Clarification and education about HIV and AIDS, include patient and support person in planning care, encourage talking about feelings or relaxation and meditation, assess for suicidal ideation, support groups.
Minimize social isolation
- Social stigma (associated with homosexuality, drug use, and sexual transmission), sharing diagnosis with others (need to choose carefully), support groups (for patients and significant others).
Assisting with grieving
- Listening. Explore feelings, fears, and treatment options. Significant others and family members that may experience fear, anger, embarrassment, and shame.
- Diagnosis should be carefully protected. Need to know basis. Not every health care worker needs to know diagnosis. Universal precautions should be used with every patient.
Duty to treat
- Health care professionals may not pick and choose their patients. Rehabilitation Act of 1973 prohibits discrimination against the handicapped and the disabled (HIV and AIDS are included).
Acute and Later Interventions
Good nutritional habits. Elimination of smoking and drug use. Elimination or moderation of alcohol intake. Regular exercise. Stress reduction. Avoidance of exposure to new infectious agents. Mental health counseling. Involvement in support groups. Safer sexual practices.
Treat opportunistic diseases. Diarrhea is often a long term problem. Low fat, low fiber, high potassium diet. Adequate fluid intake. Good skin care. Encourage nutritional supplements. Increase protein. Enteral supplements (NG tube). TPN.
Prevention of HIV Infection
- best means of prevention,
about HIV testing, risk behaviors and how to reduce or eliminate them, teaching about barriers to prevention, decreasing risks related to sexual transmission, decreasing risks related to drug use, decreasing risks of occupational exposure.
Advise them to not give blood, donate organs, or donate semen
. Do not share razors, toothbrushes, or other household items that may contain blood or other body fluids. Take a shower instead of a bath. Avoid infecting sexual and needle-sharing partners.
Do not breastfeed.
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