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med surg ii > EXAM II > Flashcards

EXAM II Flashcards

1
Q

WHAT IS HIV

A

retrovirus, containing a single strand of RNA that causes immunosuppression, making persons more susceptible to infections

  • This virus destroys CD4 (helper T) cells by binding to them, eventually leading to AIDs (CD4 is low)
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2
Q

High risk behaviors of HIV

A
  • unprotected sex with infected partner, needle sharing/sticks
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3
Q

Patient teaching HIV

A
  • prevention

- early detection and ongoing treatment (antiretroviral therapy/ART) are important aspects of care

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4
Q

behavioral interventions HIV

A
  • dont reuse condoms, - avoid cervical caps or diaphragms without using a condom as well
  • use dental dams for oral genital/anal stimulation, avoid anal intercourse, avoid manual-anal intercourse (fisting)
  • avoid sharing needles, razors, toothbrushes, sex toys or blood contaminated articles, considere PrEP if in high risk behaviors
  • HIV testing
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5
Q

importance of treatment (antiretroviral therapy/ART)

A
  • take ART regularly to suppres virus
  • inform partners of status, avoid having unprotected sex with another HIV + person, do not donate blood, plasma, organs or sperm
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6
Q

Gerontological considerations of HIV

A

low rates of HIV and STI testing due to perception of risk of infection by older adults and providers (granted it’s a bias but still true)

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7
Q

Transmission of HIV

A
  • NOT THROUGH CASUAL CONTACT (kissing, touching etc); must use standard precautions, especially gloves and gown if bodily fluid/blood present

SEX: specifically greater risk is for the partner who receives the semen

o prolonged contact with infected fluids, women (higher risk), trauma increases likelihood of transmission

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8
Q

what is the most common means of work-related HIV transmission

A

PUNCTURE WOUNDS even though screening measures have improved blood supply safety

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9
Q

HIV From mother to child via amniotic fluid and breast milk

A
  • can occur during pregnancy, delivery OR breast feeding with 25% of infants born to women with HIV contracting it
  • treatment can reduce the rate of transmission to <2%
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10
Q

Diagnostic tests of HIV

A
  • Antibody Tests (blood: may not be conclusive after initial stage as HIV, other diseases and complications of therapy can result in similar/inconclusive results
  • Antigen/Antibody Tests via ELISA
  • RNA Tests
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11
Q

Lab values of HIV

A
  • Viral Load in Blood (def check to ensure ART is working if typing wasn’t done
  • Stage 1: highest point ( Drops around 8 weeks only to gradually rise over the course of years)
  • CD4 +T Cell Counts
    ▪ Stage 1: CD4+T drops from above 1500 down to 500-1500 cells/mm3 in blood
    ▪ Stage 2: 200-499
    ▪ Stage 3: <200
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12
Q

Disease progression of HIV

A

o If left untreated: Acute infection for the first 3 weeks with symptoms similar to the flu, for 3 weeks-3months can come back positive, then may develop into asymptomatic infection for months to years, eventually presenting symptoms and eventually AIDS develops

o Stage 0: Early HIV infection, inferred from lab testing (first 3 weeks)
o Stage 1: Period of infection with HIV to development of HIV specific antibodies
o Stage 2: occurs when T cells between 200-499 which could be months to years
o Stage 3: when CD4 drops below 200 and considered to have AIDS

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13
Q

stages of disease progression

A

o Stage 0: Early HIV infection, inferred from lab testing (first 3 weeks)
o Stage 1: Period of infection with HIV to development of HIV specific antibodies
o Stage 2: occurs when T cells between 200-499 which could be months to years
o Stage 3: when CD4 drops below 200 and considered to have AIDS

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14
Q

What is opportunistic Infections and what does this mean for the patient?

A
  • With HIV, patient is immunosuppressed so their body cannot fight infection well, leading to complications

o According to text: there are treatment guidelines based on NIH; opportunistic infections can cause considerable morbidity and mortality due to
▪ unaware of their HIV infection and present with opportunistic infection as initial indicator of disease
▪ some are aware of infection but forego taking ART therapy due to psychosocial/economic factors
▪ receive prescriptions but fail to attain adequate virologic and immunologic responses as a result of issues related to adherence, pharmacokinetics or unexplained biologic factors

  • pneumocystis pneumonia, mycobacterium avium complex, cryptococcal meningitis, CMV retinitis, are all infections that are mentioned
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15
Q

Complications of HIV

A
  • infection: blood tests will have dec WBC, low platelets (thrombocytopenia)
  • anemia due to ART
  • altered liver function/metabolic panel to check AST, ALT and bilirubin levels (see if elevated)
  • pneumocystis pneumonia, mycobacterium avium complex TB (will cause resp symptoms)
  • wasting syndrome/cachexia (loss of 10% of body weight that may include muscle loss)
  • onco = Kaposi Sarcoma (Human Herpesvirus 8 (HHV8), or AIDS-related lymphomas
  • neuro = peripheral neuropathy, HIV encephalopathy, fungal infection, cryptococcus neoformans, progressive multifocal leukoencephalopathy
  • herpes zoster, seborrheic dermatitis
  • gyno: genital ulcers, persistent recurrent vaginal candidiasis, PID
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16
Q

Nursing interventions while caring for HIV patient

A
  • Reducing the Risk of transmission to HCPs
  • Standard precautions when fluids present
    ● gloves, gown, [mask, eye protection and face shield]
    ▪ hand hygiene
  • PEP (post exposure prophylaxis) + testing at baseline, 6 weeks, 12 weeks and 6 months; CBC, renal and hepatic function tests at baseline and 2 weeks
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17
Q

Assessment of HIV patient

A
  • their potential risk factors, physical status, psychological status, immune system functioning, nutritional, respiratory, neurologic status, fluid and electrolyte balance and current knowledge of disease
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18
Q

Most important factor to consider before initiation of Meds for HIV

A
  • Patient readiness via their knowledge of the disease, ART therapy (can develop pill fatigue), prevention, barriers for nonadherence, factors to promote adherence, resources, current status, cost, side effects, positive reinforcement

o General side effects - fatigue

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19
Q

what is the ART (HAART therapy

A
  • goal is to suppress HIV replication which reduces HIV associated morbidity and prolong duration and QOL, restore and preserve immunologic function, suppress viral load and prevent transmission
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20
Q

what is Coronary Artery Disease (CAD) caused by

A

ATHEROSCLEROSIS- lipid deposits within intima of artery

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21
Q

Lab values of Coronary Artery Disease

A
  • elevated serum lipids

● triglycerides: >150mg/dL
● LDL >100 mg/dL
● HDL <30/45mg/dL (I think) anything below 60 is bad
▪ homocysteine is included in a slide (high levels increase risk as folate, B12, B6 lower it)

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22
Q

Modifiable risk factors of Coronary Artery Disease (CAD)

A 
●	hyperlipidemia (see lab values)
●	cigarette smoking
●	tobacco (raises LDL, lowers HDL and raises O2 radicals, CO) include 2nd hand smoke
●	hypertension (140/90+)
●	DM
●	metabolic syndrome
●	obesity
●	physical inactivity
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23
Q

Nonmodifiable risk factors of Coronary Artery Disease (CAD)

A

● family history 91st degree relative with CVD <55 men; <65 women
● increasing age: 45+ men; 55+ women
● gender: see above
● race: african americans >caucasian

24
Q

Treatment risk factors of Coronary Artery Disease (CAD)

A

▪ Prevention- manage comorbidities, follow heart healthy diet (DASH- low fat, low chol, low salt)

  • stay physically active, maintain med compliance, stop smoking, ID high risk based on non modifiable and modifiable factors

Antiplatelet therapy: blood thining

● ASA
● Clopidogrel (Plavix)

25
Q

Lipid-lowering treatment for Coronary Artery Disease (CAD)

A
  • HMG-CoA Reductase Inhibitors *STATINS
  • Bile Acid Sequestrants (BAS):
  • Cholesterol Absorption Inhibitor
  • Omega 3/Fish Oil=dec TG thru liver
26
Q

what is Stable angina

A

predictable and consistent pain that occurs on exertion and is relieved by rest and/or nitroglycerin

27
Q

Nitroglycerin for stable angina

A
  • vasodilation specifically coronary, reducing venous return to the heart and decrease oxygen demand, has a short half life
28
Q

dosage of Nitroglycerin for stable angina

A

1 dose, wait 5 min then another;
- max 3 doses, call 911 either before/after the 2nd dose so they’re there by 3rd. usually relieved by first, could mean unstable angina or MI if not relieved OR inadequate dose

29
Q

Medications for stable angina

A
  • Nitroglycerin
  • Beta Blockers
  • Calcium Channel Blockers
  • Lipid Lowering Drugs ( to prevent atherosclerosis )
  • Sodium channel blockers
  • MONA: morphine, oxygen, nitroglycerin, ASA
    ▪
30
Q

what can cause exacerbation of stable angina

A

▪ increased physical activity
▪ emotional excitement
▪ large meals

31
Q

adverse effects of nitroglycerin

A
  • headache, orthostatic hypotension and reflex tachycardia
32
Q

Acute Coronary Syndrome can branch off to??

A

Unstable Angina/NSTEMI or STEMI

33
Q

Explain the entire pathway including door to balloon and post cardiac cath lab procedures

A
  • Acute onset of myocardial ischemia that results in myocardial death (MI) if definitive interventions do not occur prombly
  • the stable plaque ruptures and platelets aggregate to form a thrombus resulting in either partial occlusion (UA/NSTEMI) of coronary artery or total occlusion (STEMI) of coronary artery
34
Q

Unstable Angina

A
  • its new in onset and occurs at rest (remember SA is relieved at rest), and increases in frequency, duration and with less effort that lasts more than 10 minutes requiring immediate treatment (underrecognized in women)
35
Q

STEMI & NSTEMI

A

result in an abrupt stoppage of blood flow through a coronary artery causing irreversible myocardial cell death, may involve pre existing CAD prior to the thrombus

36
Q

what does STEMI need

A

o STEMI = 90 min from door to cath lab, Needs MONA, then maybe ACE, ARB, D&D

37
Q

Red flags to be aware of post intervention of Unstable angina/NSTEMI or STEMI

A

▪ dysrhythmias can occur in 80-90% of MI patients caused by ischemia, electrolyte imbalances, SNS stimulation
● in particular VTach and VFib =>death

38
Q

what is heart failure

A
  • when pumping power of heart diminishes, can be right or left
39
Q

cardiogenic shock

A

due to severe left ventricular failure/wall rupture (loud systolic murmur)

  • ventricular septal rupture (loud systolic murmur→HF, cardiogenic shock needing repair)
40
Q

papillary muscle rupture/dysfunction leads

A

leads to mitral valve regurgitation

41
Q

right ventricular infarction

A

HIGH DEATH RATE

42
Q

left ventricular aneurysm

A

thin wall and bulges during contraction → HF dysrhythmias and angina

43
Q

acute pericarditis

A
  • inflammation of the visceral and/or parietal pericardium causing severe chest pain that increases with inspiration, coughing and upper body movement that is relieved by sitting in forward position
  • heard as a pericardial friction rub and there will be changes in the ECG
44
Q

Dressler Syndrome

A
  • pericarditis & fever that develop 1-8 weeks after MI with chest pain, fever, malaise, the rub and arthralgia, treated with high dose ASA
45
Q

Symptoms of MI

A

▪ pain in chest, neck, jaw and arms, that may be duly or heavy with squeezing sensation that is intense (elephant on chest), that lasts longer than 30 min, may perspire, be weak, nauseous with a pale gray color

  • if it is relieved by nitro (minimal relief may occur) or rest its ANGINA
    o CM of ACS:
46
Q

General side effects of HIV meds

A

fatigue

▪ pneumonia with enfuvirtide, hypersensitivity and DDIs are possible with other meds and supplements
▪ herpes simplex or zoster from some of the meds
▪ esophageal or oral candidiasis from others
▪ chronic refractor infections (thrush) or esophageal occasionally
▪ GI Distress, rash

47
Q

Patient teaching of drug users

A

▪ Drug User- needle exchange problems (we know they share) or supervised sites (think New Amsterdam- we know they use, at least its clean)
▪ as part of teaching, express to the patient the importance in reducing high risk behaviors
● # of partners, condom use, types of intercourse, circumcision (iffy), drug use (not necessarily drug user)
● nurse should practice self awareness when discussing sexual practices while providing education, and not to generalize but rather individualize the teaching, being culturally sensitive, inclusive and specified to the patient’s needs
▪ importance of adherence, complications, importance of adequate nutrition, current vaccinations, health habits, avoiding risky behavior and maintaining supportive relationships

48
Q

Who to assess first? HIV

A

check the neurovascular checks

49
Q

Clinical manifestations of left HF

A

mild dyspnea, restlessness, agitation, slight tachycardia initially, pulmonary congestion, crackles S3/ventricular gallop, dyspnea on exertion, low O2 sat, dry nonproductive cough, oliguria, blood tinged sputum, cyanosis, fatigue, some wt gain

50
Q

Priority interventions

A

▪ Effectiveness of Therapy-relief of symptoms via fluid loss, promotion of activity, reduction of fatigue, decreasing anxiety/increasing ability to manage anxiety, encourage pt to verbalize ability to make decisions
▪ Patient’s self management- any number of factors (diet, med adherence, $ and support)
▪ Physical Exam: mental status, lung sounds, crackles, wheezing, heart sounds (S3), fluid status or signs of overload, daily weight, I & O, assess responses to medications

51
Q

Right/Cor Pulmonale Heart Failure

A

JVD, hepatic congestion/hepatomegaly (portal hypertension?) lower extremity/dependent edema, viscera and peripheral congestion, ascites, weight gain, maybe some splenomegaly, anorexia and complaints of GI distress

52
Q

meds for heart failure

A

o A- ACE inhibitors (-pril) = first line for all heart failures

o B- Beta Blockers
o C- Calcium Channel Blockers = decrease contractility
o D & D- Diuretics
o Antiplatelet- heparin

53
Q

P wave

A

Atrial depolarization

54
Q

QRS complex

A

Ventricular depolarization

55
Q

T wave

A

ventricular repolarization

56
Q

U wave

A

some drugs/conditions

57
Q

PR interval, ST segment

A

indicative of ischemia, injury, MI

med surg ii (7 decks)

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