Chapter 15: Med Surg & Childhood Diseases Flashcards Preview

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Flashcards in Chapter 15: Med Surg & Childhood Diseases Deck (54):

how is HIV transmitted?

infected blood, semen, vaginal secretions, and breast milk


risk by needle stick

high viral load, deep puncture, needle with hollow bore and visible blood, device used for venous or arterial access, or pt who dies within 60 days after you've been exposed


what is HIV?

RNA virus (retrovirus) goes from RNA to DNA, during reverse transcriptase all daughter cells are effected since genetic material is duplicated and viral DNA in the genome will allow HIV to replicate



initial infection with large amounts of it in blood


normal CD4 count

800-1200, normal life is 100 days, but in HIV it's about 2 days


HIV CD4 cells

immune issues develop when levels are <200 (opportunistic diseases develop at this time)


Acute infection

seroconversion occurs (when HIV antibodies form) and is often accompanied by swollen lymph glands, sore throat, headache, malaise, nausea, joint pain, diarrhea, and rash, high viral load is noted (lasts for few weeks-months)


early chronic infection

about 11 years, seen as asymptomatic although fatigue, headache, low grade fever are noted, t cells are 500+ & viral load is low


intermediate chronic infection

t cells drop to 200-500 and viral load is high, persistent fever, night sweats, chronic diarrhea, fatigue, oropharyngeal candidiasis (thrush), shingles, vaginal candidiasis, herpes, oral hairy leukoplakia


late chronic infection

AIDS, T cells <200, opportunistic infection occurs, wasting syndrome, AIDS dementia complex, opportunistic cancer may be present


oral hairy leukoplakia

painless, white, raised lesions on the lateral aspect of tongue


how much of a delay before HIV antibodies can be detected?

2 months- window period refers to the time between infection and development of antibodies, can still transmit disease!


rapid HIV-antibody test

results available in 20 minutes, if positive, need to be confirmed by western blot


genotype assay

detects drug-resistant viral mutations that are present in reverse transcriptase and protease genes- very helpful in deciding new drug combinations for patients who do not respond to therapy


phenotype assay

measures the growth of HIV in various concentrations of antiretroviral drugs- very helpful in deciding new drug combinations for patients who do not respond to therapy



should be used in combination and not alone, because resistance develops rapidly, decreases viral load up to 90%


if a patient is asymptomatic, but is positive for HIV, when should you treat?

when t cells are less than 350, recommend treatment if t cells are 350-500


health promotion

prevent HIV and detect HIV early, educate!


acute intervention

promote health and limit disability & manage problems caused by HIV


ambulatory and home care

maximize quality of life and resolve life and death issues


what if I am exposed to HIV at work?

postexposure prophylaxis (PEP) measures should be taken- ART therapy based on extent of exposure, volume of exposure, and the status of pt


negative effects of ART

prolonged use can cause fat deposits in tummy, upper back, breasts, and arms, legs, face due to lipodystrophy, hyperlipidemia, insulin resistance and hyperglycemia, bone disease, lactic acidosis, and cardiovascular disease



enter the cell and grow inside human cells or secrete toxins that damage cells



do not have cellular structure, only reproduce in living organism



similar to plants, lack chlorophyll, usually localized, but can spread in immunocompromised pt



single celled, animal like microorganisms that live in soil and bodies of water



infectious particles that contain abnormally shaped proteins and typically affect the nervous system


highest risk for HAIs

surgery pt, immunocompromised, elderly


chickenpox clinical manifestations

slight fever, malaise, and anorexia for the first 24 hours, rash is very itchy, rapidly progresses from macule to papule to vesicle, sparse on distal limbs


chickenpox therapeutic management

Acyclovir (Zovirax), antihistamines to relieve itching, maintain standard, airborne, and contact precautions, don't use aspirin


diphtheria clinical manifestations

nasal- resembles common cold with serosanguineous nasal discharge; tonsil- malaise, anorexia, sore throat, smooth & adherent white or gray membrane, bulls neck; laryngeal- fever, hoarseness, dyspnea, cyanosis


diphtheria therapeutic management

Equine antitoxin IV preceded by skin test to rule out sensitivity to horse serum, penicillin G, bed rest, follow standard and droplet precautions until 2 cultures are negative


erythema infectiosum clinical manifestations

"fifth disease", slapped cheek rash for 1-4 days, after 1 day after the rash goes away maculopapular spots appear on upper and lower extremities, then the rash subsides but reappears if skin is irritated


erythema infectiosum therapeutic management

antipyretics, anti-inflammatory, possible blood transfusion if aplastic anemia (rash absent, fever, myalgia, tummy pain present), arthritis more common in older women, no isolation required unless suspected of HPV


exanthema subitum clinical manifestations

"roseola", persistent high fever for 3-4 days, drop in fever with rash, rash is discrete rose pink macules first on trunk, then spreading to neck and face and extremities, nonpruitic, fades on pressure


exanthema subitum therapeutic management

nonspecific, recurrent seizures r/t latent infection of CNS so teach parents precautions, teach parents how to lower temperature


measles clinical manifestations

"rubeola", fever and malaise followed by cough, koplik spots (small, irregular spots with a bluish white center seen on buccal mucosa opposite molars 2 days before rash), rash appears 3-4 days after initial onset starts on face and goes down


measles therapeutic manifestion

childhood immunization, vit A supplementation, bed rest, antibiotics to prevent secondary infection, maintain isolation until 5th day of rash, institute droplet precautions, keep skin clean use tepid baths as necessary


mumps clinical manifestations

fever, head and anorexia for 24 hours followed by earache, by third day parotid glands enlarge and are accompanied by pain and tenderness


mumps therapeutic management

childhood immunization, maintain isolation during period of communicability (before and after swelling), rest, encourage fluids and soft, bland foods, hot or cold compresses to neck, to relieve orchitis provide tight fitting pants


pertussis clinical manifestations

"whooping cough", begins as upper respiratory infection, symptoms continue for 1-2 weeks when dry, hacking cough becomes more severe, cough more at night, severity lasts about 4-6 weeks


pertussis therapeutic management

immunization tdap, maintain isolation, institute droplet precaution in beginning, adequate oxygenation, humidified oxygen, standard precautions and mask


poliomyelitis clinical manifestations

abortive- fever, uneasiness, sore throat, tummy pain lasting for hours to few days; nonparalytic- same as abortive, but more severe with pain in neck, back, and legs; paralytic- similar to nonparalytic, but recovery occurs and then CNS paralysis


poliomyelitis therapeutic management

mild sedatives to relieve anxiety, physiotherapy (moist hot packs and ROMs), promote early ambulation, observe for respiratory paralysis (difficulty talking, ineffective cough, inability to hold breath, shallow and rapid respirations)


rubella clinical manifestations

"german measles", absent in children, present in adults and adolescents, low grade fever, headache, 1-5 days and subsides 1 day after rash appears, first appears on face and rapidly spreads down to neck, arms, etc, by end of first day entire body is covered with discrete, pinkish red maculopapular rash gone by third day


rubella therapeutic management

benign nature of illness in child, avoid pregnant women


scarlet fever clinical manifestations

abrupt high fever, pulse increased, headache, chills, tonsils enlarged, first 1-2 days tongue is coated with papillae and is white strawberry tongue, by fourth or fifth day the white coat sloughs off and is red strawberry tongue


scarlet fever therapeutic management

standard and droplet precautions until 24 hours after initiation of tx, peniciilin G, avoid irritating liquids and rough foods, consult doctor if fever persists after therapy begins, discard toothbrush, avoid sharing drinks


bacterial conjunctivitis clinical manifestations

"pink eye", purulent drainage, crusting of eyelids, swollen lids


bacterial conjunctivitis therapeutic management

topical antibiotics, fluoroquinolones in children over the age of 1, ointments not used in the day because they obstruct vision, keep the eye clean, wipe inner canthus downward and outward away from opposite eye


stomatitis clinical manifestations

inflammation of oral mucosa, infectious or not infectious, local or systemic, aphthous- canker sore for 4-12 days, herpetic- fever, pharynx edematous, lesions on lips


stomatitis therapeutic management

relief of pain, prevention of spread, frequent mouth care, careful handwashing, keep fingers out of mouth


reye syndrome clinical manifestations

toxic encephalopathy associated with organ involvement, impaired coagulation, fever, impaired consciousness, decreased hepatic fx, profuse vomiting, personality changes, diagnosis established by liver biopsy, do not give children under 16 aspirin!!


reye syndrome therapeutic management

early diagnosis and aggressive therapy, watch intake and output to watch for dehydration and cerebral edema, do not use aspirin or pepto bismol, check all prescriptions and OTC drugs for use of salicylates