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HIV/AIDS
Med-surg intro
| Question | Answer |
|---|---|
| Group most at risk for contracting HIV | IV drug users |
| primary host cell for HIV | CD4+ T lymphocyte |
| time body takes to recognize immune response problems and programs antibodies to fight HIV | clinical latency period |
| when AIDS is diagnosed (symptomatic period) | CD4+ T-lymphocyte count <200 or when opportunistic diseases occur |
| HIV antibody testing pattern | ELISA test done - if positive, it is repeated. If still positive, Western blot test done. If all positive = HIV+ dx |
| Western blot test | HIV antibody test, positive if 2+ antibodies out of 4 present |
| viral load testing | measures amount of HIV RNA in plasma, important for determining prognosis/monitoring response to antiretroviral therapy |
| NNRTis (Non-nucleoside reverse transcriptase inhibitors) | block active site of HIV reverse transcriptase. Example - nevirapine (Viramune) |
| NRTIs (nucleoside/nucleotide reverse-transcriptase inhibitors | inhibit production of reverse transcriptase and viral replication. Example - combivir (lamivudine, 3TC, AZT) |
| protease inhibitors (PIs) | bind to active site of HIV protease enzyme, which cuts reproduced HIV strands. Interrupts formation of mature viral particles & reduce viral replication, rapid resistance developed if not taken as directed Example - agenerase (Amprenavir) |
| deadly symptom associated with bactrim (trimethoprim-sulfamethoxazole) | rash |
| deadly symptom associated w/ zidovudine (AZT, Retrovir) | abdominal pain |
| AIDS Related Complex (ARC) | HIV antibodies and 2+ signs of immunodeficiency. T cell count <200, WBC <5000, increased serum globulin level, anemia, wt loss, night sweats, fatigue etc |
| AIDS Dementia Complex (ADC) s/s | most common neurosyndrome in HIV, S/S memory loss, cognitive impairment, speech problems, inability to concentrate, apathy, flat effect, lethargy, psychomotor retardation, tremors, poor balance |
| Dx for AIDS Dementia Complex (ADC) | physical exam, blood test to rule out STD, meningitis, toxoplasmosis, tumor. CT scan of head, spinal tap to check CS fluid |
| most common life threatening opportunistic infection in HIV pts | PCP - pneumocystic carinii pneumonia |
| PCP (pneumocystic carinii pneumonia) caused by? | protozoan fungus, usually affects lungs |
| S/S of PCP | slow onset - fever, chills, dry mouth, sweats, chest tightness, dypsnea, tachypnea, SOB, progressive fatigue |
| Dx PCP | biopsy of lung tissue, H&P, protozoal cysts in sputum, bronchial lavage |
| Tx of PCP | O2, Bactrim/Septra, Pentam (pentamidine) if allergic to sulfa, Prednisone (increases exercise tolerance, decreases inflammation), Dapsone (if allergic to Septra + pentamidine) |
| Toxoplasmosis - caused by | protozoa called toxoplasma gondii, present in raw meats, in cat poop, also found in birds/other mammals, toxo spores found in respiratory tracts of those infected |
| S/S toxoplasmosis | cerebral lesions, severe headaches, N/V, lethargy, malaise, muscular pain, seizures, decreased motor & sensory perception, coma, confusion, neuro deficits, personality changes, brain deterioration |
| Dx toxoplasmosis | post-death lesion biopsy, spinal tap showing trophozoites on stains of spinal fluid, CT of brain w/ contrast, increased toxoplasma serotology titers |
| Tx toxoplasmosis | Pyrimethamine - anti malarial med, Sulfadiazine - antibiotic used w/ pyrimethamine to treat toxo, Clindamycin - antibiotic used most often for HIV/AIDS, Spiramycin - antiobiotic used most often in preg women to prevent infecting child, Folinic acid |
| Cryptosporidiosis | parasitic disease caused by cryptosporidium - protozoan parasite, affects intestines of mammals, spread thru fecal-oral route, often through contaminated water |
| sx Cryptosporidiosis | severe diarrhea, abdominal cramping, N/V, fever, headache, loss of appetite, wt loss, can be fatal in HIV pts |
| Tx Cryptosporidiosis | treat sx, fluid & electrolyte replacement, antibiotic/anti-diarrheal meds |
| Dx Cryptosporidiosis | test stool for ova and parasites |
| Cryptococcus Neoformans | fungal infection, 4th most common in HIV pts, yeast-like fungus. Found in pigeon/bird poop, contaminated soil, enters lungs through inhalation of spores |
| Sites usually infected with Cryptococcus Neoformans | CNS, circ. system, lungs, heart, GI tract, bone, blood, prostate, eyes, skin, lymphatic system. |
| Cryptococcus Neoformans can spread to the CNS and cause what that can be fatal? | meningitis |
| S&S Cryptococcus Neoformans | Fever, increased intracranial pressure, N/V, stiff neck (nuchal), mental status changes, lethargy, coma, photophobia |
| Dx Cryptococcus Neoformans | elevated cryptococcal antigen titer in blood/CSF by spinal tap, elevated protein/WBCs, India Ink stain/culture for visualization |
| Tx Cryptococcus Neoformans | Amphotericin B - antifungal IV (cryptomeningitis), Flucoazole (Diflucan) PO or IV |
| side effects of Amphotericin B and what it's used for | renal toxicity, rigor/shakes, anaphylaxis, anemia (thrombocytopenia), affects magnesium/K+ levels. Tx for Cryptococcus Neoformans |
| Kaposis Sarcoma | most common tumor in AIDS pts |
| S/S Kaposis Sarcoma | brown/purple-blue/reddish-purple nodular/flat/rounded/oval lesions, painless unless over bony prominences |
| Dx of Kaposis Sarcoma | biopsy of lesion followed by CT scan to see if metastasized, H&P/clinical observation |
| Tx Kaposis Sarcoma | HAART best tx. Radiation, chemo - slows progression of lesions |
| Non-Hodgkin's Lymphoma | Group of malignant, solid tumorsof lymphoid tissue originating in lymph gland/lymphoid tissue |
| S/S non-Hodgkin's Lymphoma | painless enlargement of lymph nodes, IICP, increased liver enzymes, SOB, chills, fever, night sweats, cough |
| Dx Non-Hodgkin's Lymphoma | tissue biopsy |
| Tx Non-Hodgkin's Lymphoma | depends on type/grade/stage. Cytoxin, Vincristine Sulfate, methotrexate steroids. Radiation/surgery |
| Malignant lymphoid tumor | B-cell lymphoma common in HIV pts, tumors involve lymphatic/other organ systems. Associated w/ Epstein-Barr virus |
| S/S malignant lymphoid tumor | headache, focal deficits, altered mental status, N/V, seizures |
| Dx maligant lymphoid tumor | CT scans of head, tumor biopsy |
| Tx malignant lymphoid tumor | radiation, sx management |
| Burkitt's Lymphoma | B-cell lymphoma, similar to non-Hodgkin's, most common in children in Africa, linked to Epstein-Barr virus. S/S r/t organ involvement |
| Epstein-Barr virus | glandular fever or infectious mononucleosis |
| Candida albicans | most frequent fungal infection in HIV pts, seen as oral thrush, esophagitis, also affects skin and nails, commonly found in respiratory/vaginal/lower GI tract |
| S/S candida albicans | sore throat/tongue/mouth, foul taste, cottage cheesy patches on mucosa of mouth, lump in throat, dysphagia, odynophagia, skin lesions |
| Dx candida albicans | microscopic exam, endoscopy w/ biopsy, GI culture, C & S (organ, blood) |
| Tx candida albicans | Nystatin, Mycostatin (swish & swallow), Clotrimazole (genital area/breasts), Nystatin vaginal suppositories, Ketoconazole, amphotericin B |
| Mycobacterium tuberculosis (MTB) | transmitted by droplet infection, found in lungs, slow growing aerobic bacteria |
| S/S mycobacterium TB | fever/nightsweats, wt loss, chills, N/V, diarrhea, headache, confusion,mental status change, abd pain |
| Dx mycobacterium TB | chest xray, PPD, CT lung scan, C&S - blood, sputum, spinal fluid, organ bx. Main dx based on sputum culture results |
| Tx mycobacterium TB | Isoniazid (INH), Pyridoxine (B6) - given w/ INH to prevent potential neuro sx to counter side effects of drug. Rifampin (causes orange urine), Pyrazinamide (PZA), Ethambutol hydrochloride |
| Herpes simplex | HSV-2 common in HIV+ pts |
| S/S herpes simplex | ulcers of nose/mouth/pharnyx/esophagus/skin, c/o burning lesions, dysphagia, odynophagia, burning lesions on genitals/perineal/perianal areas |
| Dx herpes simplex | H&P, cultures, visual observation |
| Tx herpes simplex | Acyclovir - Zovirax IV/PO/cream |
| Cytomegalovirus (CMV) | herpes family, transmitted via respiratory system, intimate contact, in utero, during birth process |
| CMV can cause infections of? | retina, bowel, lung, liver, blood, eyes, esophagus, pancreas, CNS |
| general S/S cytomegalovirus | fever ,sweats, chills, malaise, fatigue, eye infections, blurred vision, flashing lights |
| GI s/s cytomegalovirus | colitis, esophagitis, dysphagia, odyophagia, severe diarrhea, wt loss |
| pulmonary s/s cytomegalovirus | prolonged cough w/ sputum, SOB |
| CNS s/s cytomegalovirus | parasthesia, muscle weakness, paralysis, lethargy, sensory loss, discoordination, personality changes, headaches |
| Dx cytomegalovirus | clinical presentation, H&P, retinal changes, C&S test for virus (secretions, tissue) |
| Tx for cytomegalovirus | Ganciclovir |
| Adenovirus | most commonly causes respiratory illness depending on serotype, may cause gastroenteritis, conjunctivitis, cystitis, rash |
| Dx adenovirus | antigen detection, virus isolation, serology, biopsy & culture body fluid can be used to identify |
| Tx adenovirus | none |
| Hepatitis B | serum hepatitis, 17-98 day incubation period |
| Hep B early sx | 1-2 months fatigue, malaise, anorexia, low grade fever, nausea, headache, abd pain, muscle ache or no sx |
| Hep B later sx | jaundice, rashes |
| preventative vaccine for Hep B | immune globulin (HBIG) |
| groups at risk for Hep B | IV drug abusers, homos, healthcare workers, transplant/hemodialysis pts |
| mode of transmission for Hep B | blood/body fluids - saliva, semen, breast milk, blood contaminated equipment |
| what is hepatitis | inflammation of cells of liver, resulting from infection of viral agents or exposure to drugs toxic to liver or occasionally from bacterial infection. |
| anti-motility med given for diarrhea in HIV pts | Lomotil |
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