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Nursing 210: Module IV, Unit B
HIV, Shock, Bioterrism
70
Nursing
Undergraduate 2
10/20/2009

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Cards

Term
What is immunity?
Definition
body's specific protective response to an invading foreign organism or agent
Term
What are the two types of immunity?
Definition
Natural (non-specific and physical/chemical barriers and Acquired (active and passive)
Term
What is non-specific immunity?
Definition
nuetrophils and monocytes attack disease without prior exposure
Term
What are some physical and chemical barriers in the immune system?
Definition

skin, mucous membranes, tears, cilia, saliva,

 

gastric acid, body pH

Term
What is acquired immunity?
Definition
disease specific, develops after birth
Term
What is difference b/t active natural and active artificial acquired immunity?
Definition

active natural develops from exposure to disease, most effective and longest lasting

 

active artificial develops from vaccination

Term
What are examples of acquired passive natural immunity and acquired passive artificial immunity?
Definition

in utero, breastfeeding

 

immunoglobulin

Term
What are the three immunity divisions?
Definition

inflammation

humoral

cellular

Term
How does inflammation aid the immune response?
Definition
foreign bodies invade, body attemps to dispel
Term
What is the humoral (antibody mediated) immune response?
Definition

- antibodies build up and circulate in body fluid

- purpose is to nuetralize or eliminate foreign organism

- usually carried on plasma protein

- B lymphocytes (plasma cells and memory cells)

Term
Where do B lymphocytes develop?
Definition
bone marrow, activitated in lymph nodes and spleen in memory/plasma cells
Term
What is cell mediated (cellular) immunity?
Definition

- body cells that offer protection/destruction of foreign cells (bacterial phagocytosis, plasma cells produce immune response, anaphalactic response)

- helper T cells (T4/CD4)

- killer (cyototoxic) T cells

- suppressor T cells (T8/CD8)

- memory cells

Term
Which T cells regulate the immune response?
Definition
CD4
Term
Where do T-lymphocytes mature?
Definition
lymph nodes and spleen
Term
What are some factors that can affect the immune system?
Definition

age (very young/elderly - decreased T cell, decreased plasma cell, decreased protein, decreased febrile response)

current state of health (chronic health problems decrease immunity)

gender

nutrition

stressors

occupation (health care worker, day care worker, high stress job)

autoimmune diseases

medications (steriods, NSAID, antibiotics, immunosuppressor)

sedentary lifestyle

Term
What is the pathophysiology of HIV?
Definition

- HIV is retrovirus

- is a parasite that contains RNA and reverse transcriptase

- binds to receptors on CD4 cells

- CD4 cells become encoded to replicate as HIV

- HIV cells replicate with each division of CD4 cell

- rate of immune system destructio varies

Term
About how many people are living with HIV worldwide? How many people die each year? What number cause of death is it for people in the USA b/t 25-45?
Definition

33 million

2.1 million deaths (2007)

5th

Term
What are risk factors for HIV?
Definition

homosexual

IV drug user

bisexual

heterosexual (prostitutes, teen runaways)

Term
What is the male/female ratio of HIV incidence?
Definition
70/30
Term
How is HIV transmitted?
Definition

intimate sexual contact

blodo and blood products (IV drug use, blood transfusions, puncture wounds)

perinatal

Term
What makes HIV a fragile virus?
Definition

- not transmitted by casual contact

- does not live long on inanimate surfaces

- not transmitted via tears, urine, emesis, sweat, feces

Term
How quickly and for how long can someone transmit HIV?
Definition

- infectious immediately

- life-long ability to transmit virus

Term
What are variables in transmission of HIV?
Definition

- viral load

- portal of entry

- frequency of contact

- host's immune status

Term
How quickly should a baby born to a HIV positive mother begin AZT therapy?
Definition
within 12 hours of birth
Term
What are some means of preventing HIV?
Definition

- safe sex practices

- no IV drug use

- pregnant women should be tested

- no blood donation if HIV +

- standard precautions for all patients

Term
What should be done in case of HIV occupational exposure?
Definition

- rate

- risk should be evaluated: viral load, port of entry, host

- prophylactic meds

- retesting at 3 and 6 months

Term
What are some HIV opportunistic infections?
Definition

- candida albicans

- CNS lymphoma

- cryposporidium muris (sever diarrhea from protozoa found in water)

- cytomegalovirus

- Hep B/C

- Herpes Simplex, HSV I and HSV II

- varicella-zoster (usually found on one side of body)

- Kaposi's sarcoma (can spread to lungs, lymph nodes, and GI)

- PCP (requires bactrum for life)

- myobacterium avium complex (MAC)

- myobacterium tuberculosis

Term
How long can the early chronic HIV infection last and what are the symptoms?
Definition
2-4 months to 7-8 years
Term
What CD 4 level indicates AIDS?
Definition
< 200
Term
What is the usual CD4:CD8 ratio?
Definition
2:1
Term
What are some diagnostic tests that monitor HIV?
Definition

- skin sensitivity tests

- bone marrow biopsy

- CBC with diff, coags, hep b&c, tests for STD's

Term
What is the treatment course for a pregnant patient with HIV?
Definition

prepartum: AZT oral, combination therapy; avoid amniocentesis, internal fetal monitoring

intrapartum: transmission most common later in pregnancy, and with vaginal delivery; AZT IV; C-section

postpartum: breast feeding contraindicated

Term
What are the chances of a mother passing HIV on to her child?
Definition

no treatment: 25%

AZT: 5-8% risk

AZT and C-section: <2%

Term
How is seropositivity determined in a child?
Definition
2 positive test from different blood samples excluded by repeated by negative viral tests
Term
What immunizations should a child with HIV receive?
Definition

- same as long as child is healthy

- varicella is never given to adults, give to children on a case by case basis

- MMR, Hep A and B given

Term
What is the difference in the course of HIV in children?
Definition
children can go into full blow AIDS more quickly because of underdeveloped immune system
Term
What are some concerns with an adolescent dx of HIV?
Definition

- often dxed when seeking care for STD

- unsafe sex, IV drugs are risk factors

- should be tested for Hep A and Hep B

Term
What are the goals of HIV/AIDS medications?
Definition

- decrease viral load

- maintain/raise CD4

- delay developement/treat HIV symptoms and opportunistic diseases

Term
What is HAART and what does it do?
Definition

- highly active antiretroviral therapy

- inhibits viral replication, does not kill virus

- combo of different types of antiviral

- helps delay onset of symptoms

- HIV can become resistant to one drug

- PT can be taking 30-40 pills a day with multiple and potentially severe side effects

- cost can be over $2000/month

- compliance can be difficult

Term
What are NRTI's and how do they work?
Definition

- neucleoside reverse transcriptase inhibitors, zidovudine (AZT, Retrovir)

- 1st drugs discovered

- bind reverse transcriptase so that the virus cannot replicate

Term
What is a major possible side effect of NRTI's?
Definition
bone marrow depression (pancitopenia) -- suppression of production of RBC, WBC, and platelets
Term
How is bone marrow depression treated?
Definition

erthropenia: erthroprotein (3x/week) or Arrocept (1x/week)

neutropenia: neupogin and neutropenic precautions

thrompocetopenia: platelets given (perferred) or neumega (expensive w/ many side effects)

Term
What are NNRTI's?
Definition
non-nucleoside reverse transcriptase inhibitors, nevirapine (Viramune)
Term
What are some examples of protease inhibitors?
Definition

- saquinavir (Invirase)

- ritonavir (Norvir)

- indinavir (Crixivan)

Term
How does a protease inhibitor work?
Definition

prevent virus from seperate into appropriate length to prevent replication

 

cannot take St. John's wart

Term
What are some examples of Fusion Inhibitors?
Definition
enfuvirtide (Fuzeon)
Term
How does a fusion inhibitor work?
Definition

prevents binding of HIV to cell

 

sub q BID

Term
What are some HIV combination agents?
Definition

- Combivir (lamivvudine and zidovudine)

- Kaletra (ritonavir and lopinavir)

Term
What is the A in an AIDS nutritional assesment?
Definition

A - age, sex, H/W/BMI/idea weight

 

Term
What are some nutritional nursing interventions for a patient with HIV?
Definition

candidia: diflucin, frequent mouth care

anti-emetics

small, frequent meals

cool foods

decreased spicy foods

Peg feedings

gatorade

occasionally TPN

BRAT diet

Term
LOOK UP NURSING INTERVENTIONS FOR HIV
Definition
Term
What is shock?
Definition
a complex clinical syndrom characterized by sustained decreased tissue perfusion which is inadequate to deliver o2 and nutrients to support vital organs and cellular function
Term
What are low blood flow and maldistribution of blood flow types of shock?
Definition

low blood flow: cardiogenic and hypovolemic

 

maldistrubition: nerogenic, anaphylactic, septic

Term
What are pt risk factors for shock?
Definition

- extremeties of age

- malnutrition

- open wounds

- general debilitation

- immunosuppression

Term
What are chronic illnesses that put someone at risk for shock?
Definition

- CHF

- COPD

- Cirrhosis

- Cancer

- CRF

Term
What are septic shock risk factors?
Definition

- trauma

- surgical wounds, drains

- invasive lines, diagnostic procedures

- dental abscess, sinus surgery

- drugs: antibiotics, cyotoxic drugs, immuno-suppressive drugs

Term
What is the pathophysiology of septic shock?
Definition
the presence of sepsis (systemic inflammatory response to infection) with hypotension despite fluid resuscitation and tissue perfusion abnormalities
Term
What are four primary pathophysiologic changes in septic shock?
Definition

- myocardial depression

- massive vasodilation

- maldistribution of intravascular volume

- formation of micro-emboli

Term
What is the compensatory stage of septic shock?
Definition

multiple compensentory mechanism activated to maintain homeostasis

- baroreceptors

- SNS activation (epihenphrine, norepinephrine, renin-angiotension mechanism)

- increased myocardial contractility

- cortisol secretion

- increased CO

-anaerobic metabolism

Term
What is the progressive stage of septic shock?
Definition

- compensatory mechanism fail

- multisystem organ dysfunction syndrome if not correct within the hour

- increased capillary permeability

- anasarca

- increased blood viscosity

- DIC often develops d/t increased clotting factors

- hypoxia

Term
What is the refractory phase of septic shock?
Definition

- shock is profound

- death is inevitable

- no repsonse to treatment

- sever anasarca

- fluids leaks from tissues

- severly oliuric and anuric

- severe tissue hypoxia/necrosis

Term
What are nursing diagnosis for a pt with septic shock?
Definition

- decreased CO

- ineffective tissue perfusion

- deficient intravascular fluid volume

- impaired gas exchange

- risk for injury

- fear

Term
What are diagnostic tests for a pt with suspected septic shock?
Definition

- thorough h and p

- blood c&s (but don't wait for results for broad spectrum antibiotic)

- urinalysis (check for bacteria, hemoturia, increase spec gravity)

- CBC with diff (increased in neutrophils, bands "shift to the left", decreased platlets

- DIC screen

- Chemistries (decreased BUN and Creat - most sens indicator)

- ABG (decrease pH and p02)

- 12 lead EKG

- X-ray

- hemodynamic monitoring

Term
What are collaborative interventions for a pt with septic shock?
Definition

- oxygenation

- fluids

- treat infection

Term
What are nursing interventions for a pt with septic shock?
Definition

- be prepared to intubate

- suctioning/turning/cough/deep breath

- monitor skin temp, color

- moisture

- check for cyanosis: oral mucous membranes

- fluid resuc: fluid challange, run 500 ml NSS

- may give RBC

- colloids: salt poor albumin

- I&O's, foleu

- PCWP b/t 8-12

- maintain medatbolic: sodium bicarb, K& Mg

- monitor blood gases

- treat infection

Term
What is the B in a an ABC aids nutritional assessment?
Definition

B - biochemical (albumin, globulin, prealbumin, Chem 7, CBC, Magnesium)

 

Term
What is the C in an ABC AIDS nutritional assessment?
Definition

C - clinical observations (assess for opportunistic infections, discomfort)

 

Term
What is the D in an ABC AIDS nutritional assessment?
Definition

D - diet (increase protein, increase calorie count, give vitamin supplement, often lactose free diet)

 

Term
What is the E in an ABC AIDS nutritional assessment?
Definition

E - Environmental (asses living arrangement, may not have adequate refrid/stove)

 

Term
What is the F in the ABC AIDS nutritional asessment?
Definition
F - finanacial (many uninsured, no income, huge medical bills)
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