Exam 1 Flashcards
(273 cards)
1
Q
5 Lead EKG placement
A
R arm: White - 2nd ICS
R leg: Green (Snow over Grass) - Base of ribs
L arm: Black - 2nd ICS
L leg: Red (Smoke over Fire) Base of ribs
V1: Brown (Chocolate in the middle) - R sternal edge, 4th ICS
2
Q
3 Lead EKG placement
A
R arm: Red - 2nd ICS
L arm: Yellow - 2nd ICS
L leg: Green - Base of ribs
3
Q
SA node
A
R atria
Near superior vena cava
Pacemaker of heart
4
Q
AV node
A
R atrium near AV valve
Delays ventricular impulse
5
Q
What is next in the cardiac conduction after AV node
A
Bundle of HIS
6
Q
What comes after Bundle of HIS in cardiac conduction
A
Purkinje fibers
7
Q
P wave
A
SA node in the atrium depolarizes
8
Q
P-Q segment
A
Atrial systole/contraction
Time conduction takes from SA to AV node
9
Q
QRS complex
A
Ventricular depolarization
AV node fires
10
Q
Q
A
Intraventricular septum depolarizes
11
Q
R
A
Main mass of ventricles depolarize
12
Q
S
A
Depolarization at the base of ventricles
13
Q
When does atrial repolarization occur
A
It is hidden in the QRS complex
14
Q
ST segment
A
Plateau of myocardial action potential
Ventricles contract
15
Q
T wave
A
Ventricular repolarization
16
Q
Layers of lung
A
Parietal pleura: Outer layer
Pleural space: Serous fluid maintains negative pressure
Visceral pleura: Inner layer
17
Q
Pneumothorax
A
Air in pleural space/cavity
18
Q
Pleural effusion
A
Fluid in pleural space
19
Q
Hemothorax
A
Blood in pleural space
20
Q
Tension pneumothorax
A
Complication from obstruction in chest tube or trauma
Causes tracheal deviation and puts pressure on opposite side
21
Q
Mediastinal chest tube
A
Inserted into mediastinum to relieve pressure on heart to prevent cardiac tamponade
22
Q
Cardiac tamponade
A
Fluid in pericardial space
23
Q
Empyema
A
Infection in pleural space
24
Q
Wet suction (Chest tube)
A
Suction is regulated by the height of water
- Water evaporates
- Bubbling = normal
25
Dry suction (Chest tube)
Uses suction monitor bellow
- Adjust with dial knob
26
Normal amount of chest tube drainage
Less than 100 mL/hr
27
Normal suction type and amount for chest tube
regular continuous suction
-80 to -100 (usually -80)
28
What is normal for the water seal chamber
When pt breathes water will fluctuate
Light/intermittent bubbling is normal - caused by pneumothorax
29
What does excessive bubbling mean in chest tubes
Air leak
30
What do you do if chest tube becomes dislodged
Cover with sterile dressing
Tape on 3 sides (allow air to escape)
Notify MD
31
What to do if the chest tube system breaks
Insert tubing into 1 inch sterile water bottle and get a new system
32
**When to contact physician for chest tubes**
Bubbling increases over time
Bubbling returns after having stopped
Output more than 100-150mL/hr
33
**What to do when physician removes chest tube**
Tell pt to perform valsalva maneuver and bear down
34
How often to assess chest tube
Assess drainage amount Q1H for first 8 hr, then Q8H
Mark drainage amount with marker at end of shift
35
**K normal range**
3.5-5.5
36
**Calcium normal range**
8.5-10.5
37
**Magnesium normal range**
1.5-2.0
38
**Atelectasis**
Alveolar collapse due to obstruction
39
**S/Sx of Atelectasis**
Increased work of breathing - dyspnea
Decreased breath sounds
Crackles
Hypoxia
40
How to dx atelectasis
Chest X ray
41
**Tx for atelectasis**
Remove secretions
Frequent turning, early ambulation, lung volume expansion (incentive spirometer), deep breathing, coughing
42
**Surgical/procedural tx for atelectasis**
Endotracheal intubation, mechanical ventilations = last resort
Thoracentesis
43
**Pneumonia patho**
Movement of WBC's into alveoli leads to perfusion issues
Development of thick sputum leads to ventilation issues
44
**Community-Acquired Pneumonia**
Pt that have not been hospitalized/lived in long-term care within 14 days
45
**Hospital-Acquired Pneumonia**
Begins 48 hours+ after hospital admission
Ex. Ventilator-associated pneumonia (VAP)
46
**Tx for bacterial pneumonia**
Abx
47
**Aspiration pneumonia**
Entry of material from mouth into trachea/lungs
48
**Necrotizing pneumonia**
Rare complication
Lung tissue turns into thick/ liquid mass
49
**Opportunistic pneumonia**
Occurs in immunocompromised pts
- Malnutrition, HIV, chemotherapy
50
**Risk factors for pneumonia**
Smoking, COPD, immobility, depressed cough, NGT/other drains, old age, aspiration risks
51
**How is pneumonia dx**
S/sx, CXR, blood cx, **sputum cx**, bronchoscopy
52
**S/sx of pneumonia**
Cough, fever, chills
Dyspnea, tachypnea, chest pain
Confusion - elderly
Coarse crackles, purulent sputum - vocal fremitus
Elevated RR
Decreased SpO2
Elevated WBC, + sputum culture
Respiratory acidosis
53
**Infection goal of care**
Remove bacteria and clear purulent drainage/sputum
54
**Nursing interventions for infection (lung infection/pneumonia)**
Sputum culture
Abx administration
- Should be working by 48-72h
- Not for viral infections, but could be used for secondary bacterial infection
55
**Nursing interventions to promote airway clearance**
Oxygen therapy - continuous SpO2 (humidified)
Hydration
Chest PT (physiotherapy)
- Inventive spirometer, cough and deep breath (IS/CDB)
NT (nasotracheal) suction
56
Pt goals to increase fluid status during tachypnea
Fluid intake 2-3L/day
Monitor I/O's
- UOP >30mL/h
Monitor fluid and electrolytes
Continuous cardiac monitoring
57
**Medications for pneumonia**
Antipyretics
Cough suppressants
Mucolytics
58
**Long-term interventions for pneumonia**
Pneumococcal vaccine
Oral abx - once pt is stable
Assess for aspiration risk - NG/OG tube = increased risk
Prevent hospital acquired infection
Teach abx adherence
Follow up with PCP in 6-8 wks
59
Cause of pleural effusion
Typically secondary to pneumonia, HF or TB
Pulmonary edema or infectious process
60
Empyema
Accumulation of thick, purulent fluid in pleural space
61
Cause of empyema
Bacterial pneumonia, TB, or lung abscess
62
S/sx of empyema
Acute illness
Dyspnea, chest pain, decreased/absent breath sounds over affected area
63
Intervention for empyema
Abx
Percutaneous drainage
Chest tube insertion
64
Reason for thoracentesis
Lung abscesses
Effusion/empyema with severe SOB
65
Thoracentesis
One time insertion of needle to drain purulent fluid
Fluid sent for culture
66
Pleurisy
Inflammation of both layers of lung pleurae
67
Pleurisy s/sx
Severe inspiratory pain
**Pleural friction rub** heard
68
**Post thoracentesis nursing interventions**
Monitor HR and BP
Monitor for pneumothorax
69
Dx for pleurisy
CXR
Sputum analysis
Thoracentesis
70
**Tension (spontaneous) pneumothorax**
Accumulation of air in the pleural space under pressure, compressing the lungs and decreasing venous return to the heart
71
**Iatrogenic pneumothorax**
Traumatic pneumothorax secondary to an invasive procedure or surgery
72
Chylothorax
Rare but serious condition in which lymph formed in the digestive system (chyle) accumulates in your chest cavity
73
**S/SX of closed pneumothorax**
Sudden pain
Tachypnea, air hunger, accessory muscle use
Absent breath sounds
Tracheal shift
Hypotension
Jugulovenous distention (JVD) - thoracic pressure
Hypoxemia - can lead to cyanosis
74
**Tx for closed pneumothorax**
Cover with vent dressing
Chest tube
75
Lung abscess
Necrosis of lung tissue
Usually due to oral secretions
76
How to drain lung abscess
Postural drainage
Chest physiotherapy
77
Lung abscess nursing interventions
IV antibiotics
Educate deep breathing and coughing
Encourage high protein and calorie diet
78
Non-small cell vs small cell lung cancer
SCLC has higher morbidity and mortality
79
S/sx of lung cancer
Chronic cough, dyspnea, hemoptysis, chest pain
Fever, lobar pneumonias
80
Dx for lung cancer
CXR
CT scan
Pulmonary function tests
PET scan
81
Lung cancer tx
Surgery: Lung resection
Radiation
Chemo
82
Wedge resection
Removal of small lesion/tumor
83
Lobectomy
Removal of lung lobe
84
Segmentectomy
Removal of segment of the bronchial tree
85
Pneumectomy
Removal of an entire lung
86
**Tx and interventions for ineffective airway clearance**
IS/CDB
Suctioning
Bronchoscopy
Positioning - "good" lung down so "bad" lung can drain
Monitory for s/sx of PNA
87
Sleeve resection
Removal and resection of a part of the bronchial tree
88
Video assisted thorascopic
Allows surgeon to look at the thorax
Used for thoracotomy
89
Pre-op imaging for thoracic surgery
CT scan
MRI
Bronchoscopy
90
Nursing consideration post-op pneumectomy
AKA removal of entire lung
Do not fully turn pt to operative side
- Causes heart to fall into lung cavity
91
Pain management for thoracic surgery
Epidural or intervertebral blocks
Pt controlled analgesia (PCA)
Lidocaine patches
Splinting of chest
92
S/sx of hemorrhage post surgery
Increased HR
Decreased BP, CVP (central venous pressure), LOC
Cool, clammy extremities
93
**How is TB contracted**
Through air, person to person
Mostly effects immunocompromised
94
Primary TB
Inhalation of organism, walling off of the TB lesion
95
Latent TB
Positive TST (Tubercullin skin test) w/o s/sx of infection
- Unable to transmit
96
Active TB disease
Active infection that is able to be transmitted
97
**S/x of tuberculosis**
High fever, chills, flu-like symptoms
Extrapulmonary TB (outside of lungs)
98
INF-gamma assay
Blood test for TB antibodies
99
Tuberculosis dx
CXR + Mantoux
Sputum specimen and culture
100
**BCG vaccine**
Recommended for infants born in countries with high prevalence of TB - Africa, Asia, Eastern Europe
101
**BCG vaccine side effects**
Swollen lymph nodes
Fever (mild)
Headache
Injection site reactions
102
**TB precautions**
Airborne isolation with HEPA filter
Pt must wear surgical mask outside of room
103
**Rifampin nursing considerations**
Tx for TB
Orange urine/secretions
Liver failure - AE
Decreases hormonal birth control effectiveness
104
Pulmonary embolism patho
Blockage of one or more pulmonary arteries by thrombus, fat or air embolus, or tumor tissue
Obstructs alveolar perfusion
Most commonly in lower lobes
105
**Risk factors for pulmonary embolism (PE)**
**DVT**
Immobility
Surgery
Obesity
Smoking
HF
Pregnancy
Clotting disorders
A fib
Fx of long bones
106
S/Sx of PE
**Dyspnea**
Tachypnea, cough, chest pain, hemoptysis, crackles/wheezing, fever
Tachycardia, syncope, LOC changes
107
How to dx PE
D-Dimer
Spiral (helical) CT scan
Angiogram
Labs: ABG's, Troponin, B-type natriuretic peptide
108
D-Dimer
Lab test that measure a protein fragment that is present when a blood clot dissolves
109
Acute interventions/tx for pulmonary embolism
Heparin drips, fluids, diuretics, analgesics
IVC filters - inferior vena cava
Embolectomy - removal of clot
110
Laryngeal obstruction s/sx
Use of accessory muscles
Retractions in neck/intercostals
Increased WOB - work of breathing
111
Laryngeal obstruction tx
Remove airway edema - cricuthyroidotomy (trach replacement) or
remove obstruction - Heimlich, intubation, cricothyroidotomy - tracheostomy placement
112
**Risk factors for head and neck cancer**
Tobacco, ETOH, environmental exposure, HPV, over 50 men
113
S/sx of head and neck cancer
Hoarseness, cough, sore throat, dysphagia, dyspnea, foul breath - ulcerations in larynx
114
**Dx for head and neck cancer**
Laryngoscopy with biopsy of tumor
CT/MRI
Barium swallow
Pharyngoscopy and laryngoscopy
115
**Head and neck cancer tx**
Surgery - first line
- Stage 1&2: Partial laryngectomy
- Stage 3&4: Total laryngectomy
Radical neck dissection
Radiation therapy
116
**Radical neck dissection**
Removal of:
All cervical lymph nodes
Sternocleidomastoid muscle
Internal jugular vein
Spinal accessory muscle
- Tx for severe head/neck cancers
117
**Normal amount of drainage from JP drain**
80-120 mL in first 24 hours
118
**Central venous pressure**
Measures the amount of blood returning to the right atrium
- Decreased if blood volume is decreased
- 2-8 mm Hg (or 8-12?)
119
Nursing interventions for post op laryngectomy
Prevent/monitor for aspiration PNA
- Confirm feeding tube placement
- Assist with swallowing, thick liquids, tuck chin
Oral care
120
**Guillan Barre**
Autoimmune disorder that destroys myelin on nerve cells
121
**Causes of Guillan Barre**
Viral infection: Flu, mycoplasma, HIV/Epstein Barr, campylobacter (GI bug)
122
**Guillan Barre s/sx**
Paresthesia of hands/feet
**Weakness of respiratory muscles**
Can progress to blindness and dysphagia
No change in cognitive status
123
**Guillan Barre dx**
Lumbar puncture or electromyelogram
124
**Tx of Guillan Barre**
No tx - supportive measures until myelin regenerates
IVIG and plasmapheresis - reduces s/sx length
Monitor respiratory status
PT/OT for mobility
125
**Primary concerns for Guillan Barre**
Altered breathing pattern
- Decrease in ventilation
Impaired swallowing - nutrition
Physical mobility
Autonomic dysfunction - controls bradycardic responses, rapid changes in VS
126
**First symptoms of Guillan Barre**
Can't feel middle finger
Feet feel funny
Can no longer lift 20lb box
Falling
127
Trigeminal Neuralgia
Pain of the 5th cranial nerve (trigeminal nerve)
Pain with any stimulation (washing face, brushing teeth, eating)
128
Tx for trigeminal neuralgia
Antiseizure medications
Surgical: Microvascular decompression of the trigeminal nerve
Radiofrequency thermal coagulation
Percutaneous balloon micocompression
129
Bells Palsy
Facial paralysis caused by inflammation of 7th cranial nerve
130
Bells Palsy manifestations
Unilateral facial muscle weakness/paralysis
Most pts recover in 3-5 wks and doesn't recur
131
Bells palsy tx
Corticosteroid therapy to reduce inflammation
Protect eye from injury
Facial exercises and massage to maintain muscle tone
132
Antigen
Substance that creates an immune response
133
Antibodies
AKA B cells
Produced by immune system to fight disease
Created in response to antigens
134
Immunoglobulins
Binding sites on antibodies
135
Bone marrow
Responsible for creating B cells
136
Lymph nodes
Multiply immune cells and remove foreign material before it enters the blood stream
137
Thymus
Creates T cells
138
**Hypersensitivity Reaction Type 1**
Allergic response
Histamine release, itchy eyes, runny nose, rashes, edema, **anaphylaxis**
139
Hypersensitivity Reaction Type 2
Antibody response
Cytotoxic cells kill the bodies normal cells
Ex. Autoimmunity and Transfusion reactions
140
Hypersensitivity Reaction Type 3
Immune complexes
Too many antibody/antigen complexes clump together and deposit in joints, vessels, etc
141
Hypersensitivity Reaction Type 4
Delayed immune response
Takes a couple of days to kick in
Ex. TB skin test, poison ivy
142
Types of immunoglobulins on B cells
IgA
IgD
IgG
IgE
IgM
143
IgE
Involved in hypersensitivity reactions
144
IgG and IgM
Involved in blood transfusion reaction
145
What is secreted in response to antigen exposure
Histamines
Platelets
Eosinophils
Neutrophils
- On second exposure
146
Role of prostaglandins in anaphylaxis
Smooth muscle spasm - leads to larygneal obstruction
Vasodilation - hypotension
Increased capillary permeability - hypotension
147
**Passive immunity**
Receiving antibodies rather than making them
- Ex. Globulin injection, mother’s breast milk
148
**Anaphylaxis s/sx**
Tingling hands, flushing, oral swelling
Warm sensation, nasal congestion, periorbital swelling, difficulty swallowing, wheals
149
**Anaphylactic shock s/sx**
Bronchospasm
Laryngeal edema
Dyspnea
Hypotension
Cyanosis
150
**Anaphylaxis tx**
Epinephrine
Supplemental O2 with cooled water
Advanced airway
IV antihistamines
Corticosteroids
151
**Atopic reactions**
Most common type 1 hypersensitivity
AKA seasonal/environmental allergies
Ex. Hay fever
152
**Atopic reaction s/sx**
Allergic rhinitis
Atopic dermatitis
Urticaria - hives
Angioedema
153
**Atopic dermatitis**
Type 1 hypersensitivity
154
**Atopic dermatitis tx**
Avoid cause
Topical corticosteroid creams
NSAID's
Skin moisturizer
155
Dermatitis medicamentosa
AKA Drug reactions
Note rash, hives, itching, swelling when administering new medications, esp antibiotics
156
Contact dermatitis
Type 4 delayed skin reaction
D/t metals or rubber compounds
157
First line medications for allergic disorders
Antihistamines
- H1 antagonists (dipenhydramine - Benadryl) can cross BBB and cause CNS effects
- H2 antagonists (ceterizine, loratidine) fewer CNS effects
158
Second line medications for allergic disorders
Afrin
Cromolyn - decreases mast cell activity in nasal passages
Corticosteroids
Immunotherapy - severe cases, allergens injected to build tolerance
159
Apheresis
Machine removes blood stem cells or other parts of the blood from a person's bloodstream then returns the rest to the body
Can be used to collect cells for transplantation
160
Plasmapheresis
Removes IgG antibodies in autoimmune disorders
Removes inflammatory mediators
- Can lead to hypotension or hypocalcemia
161
How to determine anion gap
Sodium (Na+) - (Chloride (Cl-) + Bicarbonate (HCO3-)
162
**Parkinson's disease**
Slow, progressive neurologic movement disorder due to decreased dopamine levels
- Unknown cause
163
**Parkinson's risk factors**
Increased incidence with age
More common in men 3:2
Well water, pesticides, rural residence
164
**Parkinson's characteristics**
Tremor
Rigidity
Bradykinesia, akinesia
Postural instability
Hypokinetic dysarthria (speech abnormalities)
165
**Dx of Parkinson's**
4 symptoms + responds to pharm therapy
Presence of **Lewy bodies**: protein deposits in the brain
166
**Parkinson's tx**
Levadopa/carbidopa
Deep brain stimulator
Ablation: destruction of affected part of brain
167
**Multiple sclerosis**
Demyelinating disease of the CNS
T cells enter brain and cause inflammation, destroying myelin
Caused by virus
168
**Risk factors for multiple sclerosis**
Smoking
Vit D deficiency
Epstein Barr exposure
Women 30-35 yrs
169
**Multiple sclerosis cause**
Unknown
May be triggered by virus or northern climate
170
**What can multiple sclerosis lead to**
Chronic inflammation
Demyelination of nerves
Scarring of CNS
171
**Multiple sclerosis s/sx**
Initial: Poor coordination, loss of balance, double vision
Motor changes, sensory changes, cerebellar changes (nystagmus), changes in bowel/bladder/sexual function, cognitive changes, emotional changes
172
Multiple sclerosis dx
CSF analysis
MRI of brain and spinal cord
- Evidence of 2 lesions
173
**Multiple sclerosis drugs**
Muscle relaxants: Benzos, Baclofen, Dantrolene
CNS stimulants - for fatigue
Antiseizure drugs
Tricyclic antidepressants
174
**Multiple sclerosis complications**
Urine retention - bladder training, avoid fluids at night, catheterization
Constipation - stool softeners, activity, high fiber/fluid diet
175
**Myasthenia Gravis patho**
Antibodies attack acetylcholine receptors in nerve junctions
When nerves receive a signal they release ACH to stimulate muscle response
If there are no receptors, no signals get sent
Leads to weakness of voluntary muscles
176
**Myasthenia Gravis s/sx**
Facial/eyelid droop
Flat affect
Dysphonia
Peek sign - after closing eyes the eyes open slightly to show sclera
May progress to respiratory failure
177
Myasthenia Gravis dx
Tensilon test
Electromyelogram
178
Tensilon test
IV Tensilon should stop ACH breakdown and increase ACH binding
Facial weakness should resolve in 5 mins = dx of MG
179
**Pharmacological tx for Myasthenia Gravis**
Pyridostigmine bromide
IVIG - immune therapy
Plasmapheresis
Prednisone
180
**Surgical tx for myasthenia gravis**
Thymectomy: Reduces T cell production
181
**How does Pyridostigmine bromide work**
Inhibits ACH breakdown
Reduces symptoms of MG
182
**Pyridostigmine bromide AE**
Abdominal pain, diarrhea
183
**Purpose of plasmaphersesis in myasthenia gravis tx**
To remove antibodies to ACH
184
**Prednisone use for myasthenia gravis and AE**
Decreases overall immune response
AE: Leukopenia and hepatotoxicity
185
**Myasthenic crisis**
Exacerbation of MG symptoms
D/t extremely low ACH at neuromuscular junction from stressful event (URI, change in meds)
186
**S/sx of Myasthenic crisis**
Extreme weakness
Double vision
Drooping eyelids
187
**Huntington's disease**
Chronic progressive hereditary disease
Results in choreiform (jerking or writhing) movements and dementia
- Death after 10-20 yrs of dx
188
**Huntington's disease patho**
Premature death of cells in the striatum of the:
Basal ganglia – leads to poor movement control
Cerebral cortex – defects in thinking, memory and judgement
Cerebellum – defects in coordination
189
**Huntington's disease s/sx**
Motor dysfunction: jerky movements
Cognitive impairments: attention deficits
Behavioral changes: apathy, blunt affect
Facial ticks
Slurred speech
**Impaired swallowing**
Disorganized gait
190
**Huntington's disease dx**
Family hx
S/sx
CAG repeats: polymorphic nucleotide repeats present in the androgen receptor gene
191
**Huntington's disease meds**
Benzos - control jerky movement
SSRI's - psych symptoms
Antipsychotics - for late disease
192
Amyotrophic Lateral Sclerosis
“Lou Gehrig disease”
Loss of motor neurons in the anterior horn of the spinal cord and loss of motor nuclei of the lower brainstem
193
Amyotrophic Lateral Sclerosis risk factors
Smoking
Viral infections
Autoimmune diseases
Toxin exposure
- 40-60 yr olds
194
ALS s/sx
Progressive weakness/atrophy
Spasticity - brisk/overactive DTR
**Difficulty with speech, swallowing, breathing - ASPIRATION**
No loss of cognitive function
195
ALS dx
S/sx
Muscle biopsy
Electromyelogram
196
ALS tx
No cure
Riluzole: prolongs life 3-6 months
Baclogen, Dantrium, Valium - for spasms
Provigil - for fatigue
197
Pts at risk for aspiration
Seizure pts
Brain injury
Decreased LOC
Stroke
Swallowing disorders
198
Aspiration prevention
HOB > 30 degrees while eating
Avoid sedatives
Assess feeding tube placement - bowel sounds and residuals
Swallow evaluation
Bedside suction available
199
Primary immune deficiency dx
Multiple/unusual infections in early childhood
Low T cell and WBC count
200
Primary immune deficiency tx
Stem cell transplants
201
Emerging Infections
An infectious disease with an increase in the recent number of cases
Ex: Coronavirus
202
Re-emerging infection (w/ examples)
Infections that were once eliminated, but now recurring
Vaccine-preventable diseases - Polio
Disease associated with travel - Malaria
203
Resistant organisms (def. with examples)
Overprescription of antibiotics is a factor
MRSA, VRE (Vancomycin Resistant Enterococci), Enterobacter
- Skipping doses, not taking full course, self-prescribing abx
204
Airborne diseases
Measles
Chicken pox
Pertussis (Whooping cough)
- N95 respirator
205
Droplet diseases
Covid
Influenza
Strep Throat
- Surgical mask
206
Contact precaution diseases
C. diff
Scabies
Norovirus/Rotovirus
MRSA
VRE
207
**HIV Patho**
It is a retrovirus: attacks T cells and reproduces
Decrease in immune function (opportunistic infections)
208
**How is HIV transmitted**
Body fluids: Blood, semen, vaginal secretions, amniotic fluid, breast milk
209
**What populations are at risk for HIV**
Injection drug users
Sex with HIV+
HIV infected blood or organ transplant
Needlesticks - healthcare workers
210
**How to prevent HIV**
Condoms, dental dams, female condoms
Treat addictive disorders/mental health diagnoses
1 sexual partner
Early testing
No sharing blood contaminated items - razors, toothbrush
**Pre-exposure prophylaxis** - antiretroviral therapies
211
**Tx for healthcare worker exposed to HIV**
Post-exposure prophylaxis (PEP)
2-3 antiretroviral regimen taken within 72 hours of exposure
Taken for 28 days
212
Acute infection phase of HIV
2-4 weeks after exposure
**Virus can be transmitted**
Flulike symptoms
213
Asymptomatic infection
Vague/absent symptoms
**Virus can be transmitted**
T cells below 500
214
Symptomatic infection
Initial signs: AMS, fever, mouth infection
Night sweats, diarrhea, headaches, severe fatigue
T cell 200-499
215
AIDS
10+ years after untreated infection
Presence of systemic infection or complications of HIV: Infections, malignancies, wasting, cognitive changes
T cell count below 200
216
What happens if HIV is untreated
Destruction of T cells
CD4 + T cell count drop below 500 cells/mcL (normal = 800-1200)
Below 200 cells/mcL = opportunistic infections
217
Goal for CD4 count in HIV treatment
800-1200 CD4 count
Viral load "undetectable"
218
How is HIV progression monitored
CD4 + T cell count: marker of immune function
Viral load: lower = less active disease
219
Viral set point
When host's immune becomes outnumbered by the virus
220
Pre-exposure prophylaxis
PrEP
Used in conjunction with proven prevention interventions
Tenofovir/emtricitabine *do not need to know
- Ensure adherence (take the meds!)
221
Classes of medications used for antiretroviral therapy
Reverse transcriptase inhibitors
Protease inhibitors
Integrase inhibitors
222
Reverse transcriptase inhibitors
Prevent HIV DNA from forming in human cells
223
Protease inhibitors
Prevent HIV from exiting the cell into the bloodstream
224
Integrase inhibitors
Prevent HIV integration into human DNA
225
Goals of antiretroviral therapies
CD4 and T cells maintained
Viral load below mutation level
Viral load below level of detection
Adherence is key
226
HAART
Highly active anti-retroviral therapy
Medication regimen used to manage and treat human immunodeficiency virus type 1 (HIV-1)
227
Nucleoside reverse transcriptase (NRTI) used for HIV
zidovidine (Retrovir)
Prevents transmission of HIV to fetus
228
What is Retrovir often given with
Given in combo with Abacavir
229
Non-nucleoside reverse transcriptase (NNRTI) for HIV considerations
Give with water on empty stomach
Do not use in pregnancy or liver disease
230
Entry inhibitor drug for HIV
Miraviroc
231
Miraviroc AE
Cardiopulmonary side effects
232
Protease inhibitors AE
Increased BG
233
Side effects of antiretroviral therapy
Hepatotoxicity - LFTs
Nephrotoxicity - Creatinine
Osteoporosis
Increased risk for MI/CVD
Fat redistribution, increased truncal fat
Caution in pregnancy
234
Kaposi Sarcoma
Manifestation of herpesvirus
S/sx: Skin, GI, lung, and lymph node lesions - skin breakdown
235
Kaposi Sarcoma tx
Radiation therapy
236
AIDs-Complex Dementia
HIV virus interferes with neuron junctions and myelin
Progressive cognitive, behavioral, and motor decline
237
AIDs-Complex Dementia s/sx
Peripheral neuropathy, memory changes, headache, decrease attention span, psychosis, hallucinations, tremors, seizures
238
How to manage AIDs-complex dementia
Aid for communication and vision
**Prevent aspiration and falls**
Schedule activity and rest periods
Gabapentin or Lyrica for peripheral neuropathy pain
239
HIV wasting syndrome dx
10% total weight loss
+ chronic diarrhea, chronic weakness, fever
Occurs late in disease process
240
Pulmonary dysfunction
Starts as nonspecific cough, sputum may or may not be present
241
**Pneumocystis pneumonia**
PCP
Serious lung infection that affects people with weakened immune systems
242
Cytomegalovirus
Common virus, retained for life (no cure)
Spread through body fluids
S/sx: Fatigue, fever, sore throat, muscle aches
243
What can activate latent TB
Antiretroviral therapy (AVT)
244
**Active TB tx**
Four drug regimen:
Isoniazid, rifampin, pyrazinamide, and ethambutol
- Airborne precautions
245
Thrush
Oral Candida Albicans
Painful swallowing, decreased oral intake
May progress to esophagus and stomach
246
Thrush/candidiasis tx
Topical antifungals
Myclex troches or nystatin rinses
Ketoconazole
247
Diarrhea tx (r/t HIV infection or enteric pathogens)
Octreotide acetate - severe chronic diarrhea
248
Pneumocystis juirveci s/sx
Opportunistic infection
Cough, fever
Dyspnea with exertioin
249
Cryptococcus neoformans s/sx
Opportunistic infection
Viral infection of the eye
Cough, SOB
Double/blurred vision
Headache
250
Possible gynecologic manifestations of AIDs/HIV
Vaginal candidiasis
Genital ulcers/warts
Risk of cervical cancer, pelvic inflammatory disease
251
How to tx vaginal candidiasis
Topical agents - just like oral candidiasis
252
Bacterial meningitis
Inflammation of the membranes and fluid space surrounding the brain/spinal cord
Organism crosses the BBB, settles in CSF (increased ICP)
253
Types of meningitis
Septic meningitis - bacterial (Streptococcus pneumoniae, Neisseria meningitidis)
Aseptic - viral, lymphoma, leukemia, or brain abscess
254
How is meningitis transmitted
Secretions or aerosol contamination
255
Fulminant meningitis
Can lead to adrenal issues, circulatory collapse, and hemorrhage
256
Meningitis s/sx
Headache, fever
Changes in LOC, behavioral changes
**Nuchal rigidity** - positive Kernig's sign, positive Brudzinski's sign
Photophobia
Seizures and coma
257
Kernig's sign
Pain in opposite leg when one leg is extended at knee by 90 degrees
Positive indicates meningitis
258
Brudzinski's sign
Positive indicates meningitis
Raise neck, look for hips and knees the flex
259
Bacterial meningitis
Medical emergency
260
Bacterial meningitis dx
Swab of nares/lumbar puncture
CT scan
261
Bacterial meningitis tx
Abx - started BEFORE dx is confirmed
262
Bacterial meningitis prevention
Vaccines against Haemophilus influenzae and S. pneumoniae for all children and at risk adults
Meningococcal vaccine for adolescents and high risk groups
263
Complications of meningitis
Brain abscess - one sided weakness
Seizures
CN 3 palsy - oculomotor nerve
Bradycardia
Hypertensive coma
264
Viral meningitis
HIV or herpes-associated
265
Viral meningitis dx
CSF sample tested for enterovirus
266
Viral meningitis tx
Prophylactic Abx until viral or bacterial meningitis is confirmed
267
How is pt positioned after lumbar puncture
Lay flat for 6-12 hours post procedure
268
Encephalitis
Acute inflammatory process of brain tissue
269
Encephalitis causes
Viral infections - herpes simplex virus, vector-borne viral infections, fungal infections
270
Encephalitis s/sx
Headache, fever
Confusion, changes in LOC
Vector-borne: Rash, flaccid paralysis, Parkinson-like movement
271
Encephalitis tx
Acyclovir - for HSV infection
Amphotericin or other antifungals - for fungal infection
272
Central venous pressure
Blood pressure in the vena cava, which is near the right atrium of the heart
- Blood backs into R atrium
2-8 mm Hg
273
Empyema Question
Answer: Pneumonia
